S TAY THUC V BIT DC

PHIN BN 1.0/THNG 9.2010

TI LIU SU TM TNG HP DCH

Gii thiu Information Mc lc

Bin son ebook : L nh Sng

I HC Y KHOA H NI
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THNG TIN

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Khng c chuyn mn , khng phi l nhn vin y t , bn khng c ph p t s dng nhng

thng tin c trong b sch ny chn on v iu tr. T trc ti ny, cc thy thuc IU
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hon ton khc nhau, do vic b nguyn xi tt c mi thng tin trong b sch ny vo thc
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c hay khng mt phn rt ln, khng ch da vo sc lc, s kin tr ca ngi to ra b
sch ny , th nhng ng gp, xy dng, gp , b sung, hiu chnh ca ngi c chnh l
ng lc to ln b sch ny c pht trin. V mt mc tiu tr thnh mt b sch tham
kho y khoa tng hp ph hp vi nhu cu v tnh hnh thc tin trong lnh vc y t ni ring v
trong cuc sng ni chung . Tc gi b sch mong mi bn c nhng li ng gp chn
thnh mang tnh xy dng, nhng ti liu qu m bn mun san s cho cng ng , v mt
tng lai tt p hn. l tt c nim mong mi m khi bt u xy dng b sch ny , ti
vn kin tr theo ui .
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hoc trong tng lai gn. Trong thi i cch mng khoa hc cng ngh tin nhanh nh v bo
nh hin nay, khng ai bit trc c liu nhng kin thc m bn c c c th p dng
vo tng lai hay khng . tr li cu hi ny, ch c chnh bn thn bn , phi lun lun
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Mi l thuyt u ch l mu xm, mt cun sch hay vn cun sch cng ch l l thuyt, ch c
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khng cn phi xp hng ch cu tr.
Mi ng gp lin quan n b sch xin gi v cho tc gi theo a ch trn. Rt mong nhn
c phn hi t cc bn c gi cc phin bn sau c tt hn.

Knh chc bn c, gia quyn v ton th ngi Vit Nam lun c sng trong khe mnh,
cuc sng ngy cng m no hnh phc.
Lng, Ngh An. Thng 8/2010

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THUC VN A
THUC VN B
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THUC VN D
THUC VN E
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THUC VN G
THUC VN H
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THUC VN A

1. ACCUPRIL
PFIZER
c/o ZUELLIG
vin nn 5 mg : v 7 vin, hp 14 v - Bng A.
vin nn 20 mg : v 7 vin, hp 14 v - Bng A.
THNH PHN
Cho 1 vin
Quinapril

5 mg

Quinapril

20 mg

DC LC
Dc l :
Quinapril l mt tin cht, vo c th s nhanh chng c thy phn gc ester thnh
quinaprilat (cn c tn l quinapril diacid, y l cht chuyn ha chnh ca quinapril). Cht ny

 c chng minh qua cc cng trnh nghin cu ngi v ng vt l mt cht c ch

men chuyn angiotensin mnh. Men chuyn angiotensin (ACE) l mt peptidyl dipeptidase. N
xc tc s bin i ca angiotensin I thnh cht gy co tht mch l angiotensin II, cht ny c
lin quan n vic kim sot v vn hnh mch mu thng qua nhiu c ch khc nhau, k c
kch thch v thng thn tit aldosterone. Tc dng u tin ca quinapril trn ngi v trn
ng vt l c ch men chuyn angiotensin, t lm gim p lc mch mu v s bi tit
aldosterone.
S ly i angiotensin II c tc dng phn hi m trn s bi tit renin dn n vic tng hot
tnh ca renin huyt tng. Quinapril c hot tnh chng cao huyt p khi nng renin huyt
tng thp hoc bnh thng.
Cc c ch khc c th gp phn to hot tnh ca cht c ch men chuyn bao gm s gin
mch gy bi bradykinin, gii phng prostaglandin, gim hot ng ca h thn kinh giao cm
v c ch hot tnh ca men chuyn mch lm gin mch mnh.
Dc lc :
Cho bnh nhn b cao huyt p v cn dng 10-40 mg quinapril s lm gim c huyt p t th
ng v ngi vi nh hng ti thiu ln nhp tim. Tc dng h huyt p bt u trong vng 1
gi vi tc dng ti a thng t c 2-4 gi sau khi ung thuc. c c tc dng h
huyt p ti a, c th phi ch n 2 tun iu tr mt s bnh nhn. Khi dng liu khuyn
co, tc dng h huyt p ca thuc ko di trong vng 24 gi v duy tr trong sut thi gian
iu tr di hn m khng b ln thuc.
Phi hp iu tr vi thuc li tiu nhm thiazide v thuc chn bta s lm tng tc dng h
huyt p ca Accupril.
Dng Accupril cho bnh nhn b suy tim sung huyt s lm gim sc khng mch ngoi vi,
gim p lc ng mch trung bnh, gim p lc th tm thu v tm trng, gim p lc trn
mao mch phi v lm tng cung lng tim.
DC NG HC
Sau khi ung, quinapril t nng nh trong huyt tng trong vng 1 gi. Quinapril c thi
gian bn hy thy c l 1 gi. Da trn s tm thy quinapril v cc cht chuyn ha ca n
trong nc tiu, vic nh lng cho thy c khong 61% liu ung quinapril c bi tit vo
nc tiu, trong thnh phn chnh l quinaprilat. Phn cn li ca liu ung vo c bi
tit qua phn.
Thc n khng nh hng n s hp thu ca quinapril. Sau khi c hp thu, quinapril c
thy phn gc ester thnh cht chuyn ha chnh c hot tnh ca n l quinaprilat, y l cht
c tc ng c ch men chuyn, v cc sn phm chuyn ha ph khng c hot tnh khc.
Quinaprilat t nng nh trong huyt tng khong 2 gi sau khi ung mt liu quinapril.
Quinaprilat ch yu c o thi qua thn v c thi gian bn hy tch ly hu hiu l 3 gi.
Khong 97% ca c quinapril v quinaprilat trong mu gn kt vi protein. bnh nhn suy

thn, thi gian bn hy o thi biu kin ca quinaprilat gia tng trong khi s thanh thi
creatinin gim i. C mi tng quan tuyn tnh gia thanh thi quinaprilat trong huyt tng
v thanh thi creatinin.
ngi gi (trn 65 tui) s thanh thi quinaprilat gim i v c lin quan n vic suy chc
nng thn thng hay gp ngi gi (xem phn Liu lng v Cch dng).
Nng quinaprilat gim bnh nhn x gan do ru do qu trnh thy phn ester ca
quinapril b gim. Cc nghin cu chut cng chng t rng quinapril v cc cht chuyn
ha ca n khng i qua hng ro mu no.
CH NH
Cao huyt p : Accupril c ch nh trong iu tr cao huyt p v cn. Accupril c hiu qu
khi c dng ring hay khi c phi hp vi thuc li tiu v thuc chn bta bnh nhn
b cao huyt p.
Suy tim sung huyt : Accupril c hiu qu trong iu tr suy tim sung huyt khi c phi hp
vi thuc li tiu v/hoc mt glycoside tr tim.
CHNG CH NH
Chng ch nh Accupril cho cc bnh nhn b qu mn cm vi thuc ny. Mn cm cho vi
cc thuc c ch men chuyn khc cha c nh gi.
CH PHNG
Ph mch :
Ph mch c ghi nhn bnh nhn c iu tr bng thuc c ch men chuyn, k c
Accupril. Nu c ting th rt thanh qun hay xy ra ph mch mt, li hoc phn thanh
mn ca thanh qun, phi ngng ngay lp tc iu tr bng Accupril v bnh nhn phi c
iu tr bng cc bin php iu tr thch hp cho n lc ph n bin mt. Trong nhng trng
hp ph n ch gii hn mt v mi th thng s t khi m khng cn iu tr ; c th dng
thuc khng histamin lm gim nh cc triu chng. Nu ph thanh qun c th gy t
vong. Khi c ph li, np thanh qun hoc thanh qun c kh nng gy tc ng kh, phi
tin hnh lp tc bin php cp cu : nhanh chng cho tim di da dung dch epinephrine 1 /
1000 (0,3 n 0,5 ml) (xem phn Tc dng ngoi ).
Tt huyt p :
Him khi xy ra triu chng tt huyt p bnh nhn cao huyt p c iu tr bng Accupril,
nu xy ra th c th l hu qu ca liu php c ch men chuyn cc bnh nhn b mt
mui - nc, v d nh nhng bnh nhn c iu tr trc bng thuc li tiu (xem
cc phn Thn trng lc dng, Tng tc thuc v Tc dng ngoi ).
bnh nhn b suy tim sung huyt c kh nng b h huyt p, khi bt u iu tr bng
Accupril nn c theo di cht ch. Nn tng cng theo di trong 2 tun u iu tr v mi
khi tng liu Accupril.
Nu xy ra triu chng gim huyt p, cn t bnh nhn nm nga v, nu cn, truyn tnh

mch dung dch mn ng trng. Nu ch xy ra h huyt p thong qua th khng cn phi

ngng iu tr. Tuy nhin trong tnh hung trn, nn cn nhc gim liu hay phi hp vi bt kz
bin php li tiu no.
Gim bch cu trung tnh / Mt bch cu ht :
Cc thuc c ch men chuyn him khi gy mt bch cu ht v suy ty bnh nhn b cao
huyt p khng c bin chng, nhng thng gp hn nhng bnh nhn b suy thn, c bit
nu h cng b bnh h to keo. Tuy nhin, theo di lm sng trn 2000 bnh nhn c iu
tr bng Accupril th khng c trng hp no b gim bch cu trung tnh ( 1500 bch cu a
nhn/mm3) hay mt bch cu ht (< 2000 bch cu/mm3) c quy l do Accupril gy ra. Cng
nh i vi cc thuc c ch men chuyn khc, vic theo di s lng bch cu nhng bnh
nhn b bnh h to keo phi c xem xt.
THN TRNG LC DNG
Tng qut :
Suy chc nng thn : nhng bnh nhn c mc thanh thi creatinin < 40 ml/pht, thi gian
bn hy ca quinaprilat di ra. Cc bnh nhn ny nn bt u iu tr liu c khuyn co
hng ngy v iu chnh ty theo p ng vi iu tr. Phi theo di cht ch chc nng thn,
mc d cc cng trnh nghin cu ban u trn cc nhm nh bnh nhn khng cho thy rng
quinapril hy hoi thm chc nng thn.
Tng kali huyt v cc thuc li tiu gi kali : Cng nh vi cc thuc c ch men chuyn khc,
bnh nhn c iu tr bng Accupril mt mnh c th b tng kali huyt. nh hng ny c
th gip gim h kali huyt gy bi cc thuc li tiu thiazide. Cha c nghin cu dng
Accupril ng thi vi cc thuc li tiu gi kali. Do c nguy c trn l{ thuyt v kh nng lm
tng kali huyt, nn khi cn phi phi hp iu tr nh vy th phi tht thn trng v phi theo
di st kali huyt ca bnh nhn.
Phu thut / Gy m : Mc d cha c s liu cho thy rng c s tng tc gia Accupril v
cc thuc m h huyt p, cn phi thn trng khi bnh nhn c phu thut ln hoc c
gy m v cc thuc c ch men chuyn c cho thy l c th ngn chn s to ra
angiotensin II th pht sau s gii phng b tr ca renin. iu ny c th dn n tt huyt p
v c th c iu chnh bng cc bin php lm tng th tch.
Sinh ung th, t bin, nh hng n sinh sn :
Quinapril khng gy ung th cho chut nht v chut cng khi cho dng vi liu trn 75 mg n
100 mg/kg/ngy (gp 50 - 60 ln liu ti a hng ngy ca ngi) trong vng 104 tun. C
quinapril v quinaprilat u khng gy t bin trong th nghim vi khun Ames c hoc khng
c s hot ha chuyn ha. Quinapril cng m tnh trong cc cng trnh nghin cu c cht
hc di truyn sau y : t bin im ca t bo loi c v in vitro, s trao i gia cc th
nhim sc ch em trong nui cy t bo loi c v, test nhn nh vi chut nht, khc thng
th nhim sc in vitro vi cc t bo V.79 nui cy v mt cng trnh nghin cu di truyn t

bo in vitro vi ty xng chut cng. Khng c tc dng xu trn sinh ca chut cng cc
mc liu trn 100 mg/kg/ngy (gp 60 ln liu ti a hng ngy ca ngi).
S dng trong thai kz : Khng c nh hng c i vi thai hoc sinh qui thai c quan st
chut cng khi dng liu cao n 300 mg/kg/ngy (gp 180 ln liu ti a hng ngy ca
ngi), mc d c tnh i vi con m l 150 mg/kg/ngy. Trng lng c th ca la con th
gim khi chut cng m c iu tr mun v trong thi gian cho b vi cc liu t 25
mg/kg/ngy hoc nhiu hn. Quinapril khng gy qui thai khi th nghim trn th. Tuy nhin,
ngi ta thy c tnh i vi con m v vi bo thai l t 1 mg/kg/ngy hoc nhiu hn. Cha
c nghin cu th nghim c i chng trn ngi. Khng nn dng Accupril trong khi mang
thai tr khi li ch cho ngi m cao hn nhiu so vi nhng nguy c c th tim tng cho bo
thai.
Lc cho con b : Khng r quinapril hay cc cht chuyn ha ca n c c bi tit qua sa
m hay khng. Do c nhiu thuc c bi tit qua sa m, nn thn trng khi ch nh Accupril
cho b m ang cho con b.
S dng cho tr em : Hin cha xc lp c an ton v hiu qu ca Accupril tr em.
TNG TC THUC
Tetracycline : dng ng thi tetracycline vi Accupril c th lm gim s hp thu ca
tetracycline t 28 - 37% mt s ngi. Vic gim hp thu l do s hin din ca magnesium
carbonate trong thnh phn t dc ca quinapril. Tng tc ny phi c xem x t n khi k
n cng lc Accupril v tetracycline.
Cc thuc khc : Khng c tng tc quan trng v dc ng xy ra khi Accupril c s dng
ng thi vi propranolol, hydrochlorothiazid, digoxin hoc cimetidine. Khng c thay i v
thi gian prothrombine xy ra khi Accupril v warfarin c cho dng cng lc.
Dng ng thi vi thuc li tiu : Cng nh vi cc thuc c ch men chuyn khc, bnh nhn
ang dng thuc li tiu, c bit l mi c iu tr bng thuc li tiu, nu dng phi hp
vi Accupril i khi c ghi nhn b gim huyt p ng k sau liu khi u Accupril. C th
lm gim kh nng b tt huyt p sau khi dng liu Accupril u tin bng cch ngng dng
thuc li tiu hoc tng n mui trc lc bt u iu tr vi quinapril. Nu khng th ngng
dng thuc li tiu th bnh nhn phi c theo di trong vng hai gi sau liu Accupril u
(xem cc phn Ch { phng, Liu lng v Cch dng).
Cc thuc lm tng kali huyt thanh : Nu dng cng lc Accupril v cc thuc li tiu gi kali
(nh spironolactone, triamterene hoc amiloride), thuc b sung kali hay cc mui thay th c
kali, th cn phi thn trng v theo di kali huyt thng xuyn.
TC DNG NGOI
Accupril c nh gi v an ton hn 2000 bnh nhn bao gm 1265 bnh nhn c
iu tr trong 6 thng, 739 bnh nhn c iu tr trong 12 thng v 173 bnh nhn c iu
tr trong 24 thng. Accupril ni chung c dung np tt trong cc th nghim lm sng c i

chng.
Cc tc dng ngoi { thng nh v thong qua. Cc tc dng ph v lm sng thng thy
nht trong cc th nghim c i chng trong iu tr cao huyt p v suy tim sung huyt l
nhc u (0,9%), chng mt (4,7%), vim mi (3%), ho (3,1%), nhim khun ng h hp trn
(2,5%), mt mi (2,5%) v nn, ma (2,3%).
C 3,2% bnh nhn phi ngng iu tr do tc dng ngoi .
Mt s tc dng ngoi xy ra >= 1% bnh nhn c iu tr vi Accupril trong cc th
nghim lm sng c i chng trong iu tr cao huyt p v suy tim sung huyt c lit k
trong Bng 1.
Bng 1

Nhc u
Chng mt
Vim mi
Ho
Nhim trng ng h hp trn
Mt mi
Nn, ma
Kh tiu
Nhim virus
au c
au ngc
au bng
Tiu chy
au lng
Vim xoang
Mt ng
D cm
Lo u, cu gt
Suy nhc
Vim hu
H huyt p

% bnh nhn trong Nghin cu

c i chng*
Accupril
n = 1491
(%)
6,9
4,7
3
3,1
2,5
2,4
2,3
1,9
1,7
1,5
1,5
1,5
1,5
1,3
1,2
1,2
1,2
1,1
1,1
1,1
1

Placebo
n = 394
(%)
12,7
3,3
3,8
1,3
1,8
2
3,3
0,8
2,3
4,1
1,8
1,5
1,3
1,5
1,3
1,3
0,5
1,3
0,8
1,5
0

* bao gm 255 bnh nhn c iu tr suy tim sung huyt.

Mt s tc dng ngoi xy ra trn 0,5-1% bnh nhn c iu tr bng Accupril trong cc th
nghim lm sng c i chng trong iu tr cao huyt p v suy tim sung huyt, bao gm :
H tim mch : gin mch.
H tiu ha : vim d dy, y hi.
H thn kinh : bun ng.
H h hp : vim ph qun, kh th.
Da : nga, pht ban, v m hi.
Cc triu chng khc : ph n, au khp, trm cm, st.
Kt qu th nghim cn lm sng : khng c trng hp no b mt bch cu ht c quy l
do Accupril.
Tng kali huyt : xem phn Thn trng lc dng.
Creatinin v nit ur mu : C 3-4% bnh nhn c iu tr duy nht bng Accupril c ghi
nhn c tng (> 1,25 ln gii hn trn ca gi tr bnh thng). S gia tng s tr li bnh
thng khi ngng iu tr.
LIU LNG v CCH DNG
Ung Accupril khng lin quan n ba n.
Cao huyt p :
Liu php dng mt loi thuc (n liu php) : Liu ban u Accupril c khuyn co bnh
nhn khng dng thuc li tiu l 10 mg mt ln mi ngy. Ty theo p ng lm sng, c th
chnh liu (bng cch tng i liu) cho n liu duy tr ti a l 20-40 mg/ngy ung 1 ln duy
nht hay chia lm 2 ln. Nn duy tr vic kim tra bnh nhn c iu tr vi liu duy nht
trong ngy. Mt s bnh nhn c cho dng Accupril n 80 mg/ngy.
Phi hp vi thuc li tiu : cc bnh nhn c iu tr phi hp vi thuc li tiu th liu
ban u ca Accupril c ch nh l 5 mg xem c tng tc dng h huyt p hay khng.
Sau c th iu chnh (theo cch trn) c c p ng ti u. Hin nay cha c kinh
nghim v liu lng chuyn bit cho bnh nhn c thanh thi creatinin di 15 ml/pht. Bc s
cn phi cn nhc hoc gim liu hoc ko di thi gian gia cc ln dng thuc.
Suy thn : Cc s liu v ng hc cho thy thi gian bn hy o thi ca quinapril tng ln khi
thanh thi creatinin gim. bnh nhn c thanh thi creatinin di 40 ml/pht, liu ban
u phi l 5 mg mi ngy mt ln, sau s iu chnh cho p ng ti u (xem Bng 2).

Bng 2. Phc liu cho bnh nhn b suy thn.

Thanh thi creatinine

Liu ban u

(ml/pht)

(mg/ngy)

< 40

5,0

< 15

* Kinh nghim iu tr cho n nay cha xc nh liu c bit khuyn co cho cc bnh
nhn ny, do bc s nn cn nhc hoc gim liu hoc ko di thi gian gia cc ln dng
thuc.
Ngi gi (trn 65 tui) : Cc thay i v sinh l cng thm tui gi c th nh hng n p
ng ca bnh nhn i vi vic iu tr cao huyt p. Ngoi ra, tc to thnh v o thi
quinaprilat gim i bnh nhn trn 65 tui so vi bnh nhn tr v c lin quan n s suy
chc nng thn thng xy ra ngi gi. Tuy nhin, tui tc khng nh hng n hiu qu
v an ton ca quinapril. Tuy nhin, do chc nng thn c xu hng gim ngi cao tui,
nn liu ban u ca quinapril cho ngi gi c khuyn co l 5 mg mi ngy mt ln, sau
iu chnh cho p ng ti u.
Suy tim sung huyt :
Liu ban u khuyn co cho bnh nhn suy tim sung huyt l liu duy nht 5 mg, sau phi
theo di cht ch pht hin triu chng h huyt p. C th chnh liu n 40 mg mi ngy
chia lm hai ln, phi hp vi thuc li tiu v/hay glycosid tr tim. Tuy nhin, thng th liu
duy tr c hiu qu l t 10 n 20 mg mi ngy chia lm hai ln, km vi cc liu php phi
hp.
QU LIU
Khng c s liu v qu liu ngi. LD50 khi ung ca quinapril trn chut nht v chut cng
l 1440-4280 mg/kg. Nhng biu hin lm sng c th xy ra l gim huyt p nng, thng
phi iu tr bng bin php tng th tch qua ng tnh mch. Hin cha r c th loi
quinapril v cc cht chuyn ha ca n qua ng thm phn phc mc c hay khng.

2. ACT-HIB
AVENTIS PASTEUR
Bt pha tim bp hoc di da : hp 1 l bt ng kh + ng tim cha dung mi 0,5 ml.
THNH PHN
cho 1 n v
Haemophilus influenzae type b polyoside

10 mg

Tris (hydroxymthyl aminomthane)

0,6 mg

Saccharose

42,5 mg

ng dung mi : Sodium chlorure 2 mg, nc

ct pha tim va 0,5 ml
CH NH
D phng cho tr t 2 thng tui tr ln chng li cc nhim trng xm ln do Haemophilus
influenzae b (vim mng no, nhim trng huyt, vim m t bo, vim khp, vim np thanh
qun...).
CHNG CH NH
Mn cm vi mt trong cc thnh phn ca thuc.
CH PHNG
Khng c tim nga trong trng hp st hoc nhim trng cp tnh.
Trng hp dng cng vi vaccin Trimovax, tim 2 vaccin 2 ni cch xa nhau.
LC C THAI
Khng nn dng cho ph n mang thai.
LC NUI CON B
Khng nn dng cho ph n nui con b.
LIU LNG v CCH DNG
ng tim bp hoc di da. Tr em < 2 tui, tim vng i pha trc bn ngoi. Tr em >
2 tui, tim vng c en-ta.
Tr < 6 thng tui : 3 mi tim cch nhau 1 hoc 2 thng. Tim nhc li 1 mi 12 thng sau mi
th 3.
Tr t 6 n 12 thng : 2 mi tim cch nhau 1 hoc 2 thng. Tim nhc li 1 mi 12 thng sau
mi th 2.
Tr em t 1 n 5 tui : 1 mi tim duy nht.

3. ACTAPULGITE
BEAUFOUR IPSEN
Bt pha hn dch ung v ng trc trng : hp 30 gi, hp 60 gi.
THNH PHN
cho 1 gi
Mormoiron attapulgite hot ha (magnesium v aluminium silicate tinh ch t 3 g

nhin)
(Glucose hydrate ha va )

(5,7 g)

DC LC
Thuc c tnh cht hp ph v bng rut.
Actapulgite :
- c kh nng bao ph cao, vo rut s to mt lp mng ng nht, c tc dng che ch.
- c kh nng hp ph c cht v kh c l nhng tc nhn gy kch ng nim mc.
- c tnh cht cm mu ti ch do tc dng hot ha cc yu t V v XII ca tin trnh ng mu.
Actapulgite :
- khng cn quang, v th c th thc hin cc nghin cu X quang khng cn ngng thuc
trc.
- khng lm i mu phn.
DC NG HC
Bng ng rut : thuc khng b hp thu, c thi qua ng tiu ha.
CH NH
- iu tr triu chng cc bnh i trng cp v mn tnh i km vi tng nhu ng rut, nht l
khi c chng bng v tiu chy.
- c ngh dng tht ra trong vim i trc trng xut huyt, nh l mt iu tr ph
tr.
Actapulgite c th dng cho tr em.
CHNG CH NH
Khng c chng ch nh.
THN TRNG LC DNG
- Cn thn trong trng hp phnh i trng v tn thng chc nng vn ng ca i trng.
- Trong trng hp tiu ng, nn tnh n lng ng (2,70 g/gi).
LC C THAI
Thuc c th dng trong thi gian mang thai v khng b hp thu.
TNG TC THUC
C th lm gim hay chm hp thu cc thuc ung cng lc, nn ung cc thuc cch khong
vi Actapulgite.
LIU LNG v CCH DNG
Ngi ln : 2 n 3 gi/ngy (pha trong na ly nc, thng trc ba n).
Tr em : liu lng ty thuc vo trng lng ca tr, trung bnh tr :
di 10 kg : 1 gi/ngy.
trn 10 kg : 2 gi/ngy.

Nn trn bt Actapulgite vi ng trc khi pha vi nc. C th t c mt hn hp

ng nht vi mt mi v thch hp. Thi gian iu tr ty theo bnh.

4. ACTIFED
GLAXOWELLCOME
Actifed vin nn : hp 24 vin.
Actifed syrup : chai 60 ml.
Actifed Compound Linctus : chai 60 ml.
Actifed DM : chai 60 ml.
THNH PHN
Actifed vin :
cho 1 vin
Triprolidine chlorhydrate

2,5 mg

Pseudophdrine chlorhydrate

60 mg

Actifed xir :
cho 5 ml xir
Triprolidine chlorhydrate

1,25 mg

Pseudophdrine chlorhydrate

30 mg

Actifed Compound Linctus :

cho 5 ml xir
Triprolidine chlorhydrate

1,25 mg

Pseudophdrine chlorhydrate

30 mg

Codein phosphate

10 mg

(Natri benzoate)
Actifed DM :

cho 5 ml xir
Triprolidine chlorhydrate

1,25 mg

Pseudophdrine chlorhydrate

30 mg

Dextromethorphan bromhydrate

10 mg

DC LC
- Triprolidine lm gim triu chng nhng bnh c xem l ph thuc hon ton hay mt
phn vo s phng thch t histamine. L hot cht thuc nhm pyrolidine, triprolidine c kh
nng tc dng nh mt cht i khng tng tranh ln th th H1 ca histamine vi tc ng
c ch nh h thn kinh trung ng, c th gy bun ng.
- Pseudo ph drine c tc ng ging giao cm gin tip v trc tip, v l mt cht lm gim
sung huyt hu hiu ng h hp trn. Pseudophdrine yu hn rt nhiu so vi
phdrine v nhng tc dng lm nhp tim nhanh, tng huyt p tm thu cng nh gy kch
thch h thn kinh trung ng.
- Codein v dextromethorphan l nhng dn xut ca morphine c tc dng chng ho. N kim
sot co tht do ho bng cch c ch trung tm ho hnh ty.
CH NH
Actifed v xir Actifed phi hp mt cht i khng th th H1 ca histamine v mt tc nhn
lm gim sung huyt mi ; Actifed Compound Linctus v Actifed DM cn c thm thnh phn
c tc dng chng ho nn thuc c ch nh lm gim hu hiu nhng triu chng ca cc
bnh ng h hp trn nh vim mi d ng v vim mi do vn mch, bnh cm v cm
thng thng.
CHNG CH NH
- Bnh nhn c tin s khng dng np thuc hay bt c thnh phn no ca thuc.
- Bnh nhn cao huyt p nng hay c bnh mch vnh trm trng ; bnh nhn hay ang
dng cc IMAO trong vng 2 tun trc . Dng ng thi pseudophdrine vi loi thuc
ny i khi c th gy tng huyt p.
- Phn ng nng tng xy ra khi dng ng thi codeine v IMAO. Nhng phn ng ny ni
chung xy ra tc th v c th gy ra cn h huyt p, sc v hn m hoc ngc li, tng huyt
p v kch ng.
- Tc nhn khng khun furazolidone c bit c gy mt s c ch lin quan n liu lng
vi IMAO. Mc d khng c bo co v cn tng huyt p do dng ng thi Actifed v
furazolidone, khng nn dng cng mt lc hai thuc ny.
- Actifed Compound Linctus chng ch nh nhng bnh nhn b u t bo a crm.
- Khng c dng Actifed Compound Linctus cho nhng bnh nhn ho km theo hen hoc ho

km theo m qu nhiu.
- Codein, dextromethorphan, cng nh nhng thuc chng ho tc dng ln trung ng thn
kinh khc, khng c dng cho bnh nhn ang b hoc c nguy c b suy h hp.
- Khng c dng Actifed Compound Linctus cho nhng bnh nhn suy gan nng v n c th
thc y nhanh bnh no do gan.
- Trnh dng Actifed Compound Linctus cho nhng bnh nhn suy thn va v nng (t l lc
cu thn thp hn 20 ml/pht).
- Actifed Compound Linctus chng ch nh cho nhng bnh nhn b chn thng s no hoc
tng p lc ni s v cng c ch h hp s cng lm tng ph no.
- Actifed Compound Linctus chng ch nh cho tt c cc dng vim lo t i trng ngoi tr
dng nh nht, v cng nh nhng thuc gim au gy nghin khc, n c th thc y nhanh
co tht hoc gin i trng nhim c.
THN TRNG LC DNG
Actifed c th gy bun ng v lm nh hng nhng xt nghim v thnh gic. Bnh nhn
dng thuc khng nn li xe hay thao tc my khi cha xc nh r cc p ng ca bn thn
i vi thuc.
Mc d khng c cc s liu lm khch quan chng li vic dng ng thi vi ru hay nhng
thuc an thn tc ng ln thn kinh trung ng, nn trnh dng cng lc Actifed vi nhng
tc nhn ny.
Mc d pseudophdrine hu nh khng nh hng ln bnh nhn c huyt p bnh thng,
nn cn thn khi dng Actifed cho bnh nhn ang ung thuc h huyt p, thuc chng trm
cm loi tricyclique v nhng tc nhn ging giao cm khc nh thuc lm gim sung huyt
mi, thuc lm gim ngon ming, v nhng tc nhn kch thch thn kinh ging amphtamine.
Nn quan st tc dng ln huyt p ca nhng bnh nhn ny qua mt liu th u tin trc
khi ch nh ung tip hay khuyn ngng thuc. Ging nh i vi nhng tc nhn ging giao
cm khc, cn thn trng khi dng thuc cho bnh nhn cao huyt p, bnh tim, tiu ng,
cng gip, tng nhn p, ph i tuyn tin lit v hp niu o.
Hin nay cha c nghin cu chuyn su v nh hng ca Actifed ln bnh nhn ri lon chc
nng gan v/hoc thn. Khi khng c chng ch nh, nn cn thn dng thuc thp hn liu
thng thng v da vo p ng ca bnh nhn cho liu tip theo.
Codein hoc nhng thuc gy nghin khc c th lm m nhng du hiu c dng nh
gi chn on hoc tnh trng lm sng ca nhng bnh nhn c tnh trng bnh cp tnh vng
bng.
Tnh gy ung th v gy t bin :
Cha c y thng tin xc nh kh nng c th gy ung th hay t bin ca triprolidine,
pseudophdrine, codein hoc dextromethorphan.
Tnh gy qui thai :

 th v chut, dng ng ton thn triprolidine vi lng ln n 75 ln liu dng hng ngy
cho ngi khng gy tc dng sinh qui thai.
Pseudo ph drine dng ng ton thn vi lng ln n 50 ln nhiu hn liu dng hng
ngy cho ngi chut v 35 ln nhiu hn th vn khng gy tc dng sinh qui thai.
Tc dng ln kh nng sinh sn :
Cha c nghin cu trn sc vt xc nh triprolidine c th lm gim kh nng sinh sn hay
khng. Dng pseudo ph drine ng ton thn vi liu ln n 7 ln hn liu lng hng ngy
ngi cho chut ci v 35 ln hn liu hng ngy ngi cho chut c khng gy gim kh
nng sinh sn cng nh lm thay i hnh th v sc sng ca thai. Khng c thng tin v tc
ng ca Actifed ln kh nng sinh sn ca ngi.
Dng thuc cho ngi gi :
Cha c nghin cu chuyn bit v tc dng ca Actifed ln ngi gi. Kinh nghim cho thy
rng liu dng bnh thng cho ngi ln cng thch hp cho ngi gi mc d c th nn kim
sot chc nng thn v/hoc chc nng gan ; cng phi cn thn khi khng c du hiu suy yu
nghim trng.
Kh nng lm dng thuc :
Dng codein liu cao trong thi gian di c th gy ph thuc thuc dng morphine. Tuy nhin,
iu ny c v nh khng xy ra liu iu ngh dng trong thi gian ngn.
LC C THAI v LC NUI CON B
Mc d pseudo ph drine, triprolidine, codein, dextromethorphan c dng rng ri nhiu
nm m khng gy nh hng bt li r rng no, vn cha c s liu c trng v vic s dng
thuc trong thi gian mang thai. Do cn cn nhc cn thn gia li ch iu tr vi nhng
ngu nhin c th c nh hng ln s pht trin ca thai nhi.
Pseudo ph drine, triprolidine v codein c bi tit mt lng nh qua sa m, nhng tc
dng ny i vi tr b sa m vn khng c bit. c lng c khong 0,5-0,7% ca mt
liu pseudophdrine ung bi ngi m c bi tit qua sa trong vng 24 gi.
Cha c ti liu nghin cu v tnh an ton khi dng dextromethorphan v xir Actifed DM cho
ph n ang mang thai, cng nh cha c s liu v vic cc hot cht v cc cht chuyn ha
ca Actifed DM c tit ra theo sa m hay khng.
Actifed Compound Linctus khng c dng cho ph n c thai trong ba thng cui ca thai kz
v codein c th gy ra nhng triu chng cai thuc tr s sinh.
S dng thuc dng ging opium trong thi gian chuyn d c th gy tr d dy v tng
nguy c nn v vim phi ht phi dch sn ph.
TNG TC THUC
Dng Actifed ng thi vi cc tc nhn ging giao cm, nh cc thuc chng sung huyt, thuc
chng trm cm tricyclique, thuc lm gim ngon ming v cc thuc kch thch thn kinh ging
amph tamine, hay dng Actifed ng thi vi cc IMAO can thip vo qu trnh d ha cc

amine ging giao cm, i khi c th lm tng huyt p (xem Chng ch nh v Thn trng lc
dng).
Do thuc c cha pseudophdrine, Actifed c th lm o ngc mt phn tc ng ca cc
thuc can thip vo hot ng giao cm, bao gm brtylium, bthanidine, gaunthidine,
dbrisoquine, mthyldopa v cc tc nhn c ch a v beta adrnergique (xem Thn trng lc
dng).
Nhng bnh nhn s dng ng thi Actifed Compound Linctus vi cc loi thuc gim au gy
nghin khc, thuc c ch tm thn, thuc chng trm cm cu trc 3 vng, thuc gii lo u,
thuc an thn hoc nhng thuc gy trm cm tc dng ln trung ng thn kinh khc (k c
ru) c th thy tng tc dng an thn v tng tc dng c ch h hp. Codein, cng nh
nhng thuc dng ging opium khc, c th lm chm hp thu mexiletine - mt thuc chng
lon nhp. C th phi dng liu tn cng cao cho thuc chng lon nhp.
Codein, cng ging nh nhng thuc dng opium khc, c th i khng tc dng ca
metoclopramide trn nhu ng d dy-rut. Ru v cc thuc gy ng to tc dng gy trm
cm cng hng i vi h thn kinh trung ng v y l mt kt hp c kh nng gy cht
ngi.
TC DNG NGOI
c ch hoc hng phn h thn kinh trung ng c th xy ra, vi ng g, chong vng v
chng mt l thng xuyn hn c. C mt vi bo co him hoi v ri lon gic ng v o gic.
i khi c th thy ni mn c hoc khng c kch ng, nhp tim nhanh, kh ming, mi, hng,
to bn, bun nn v nn. C vi bo co v chng tiu kh bnh nhn nam dng
pseudoephedrine ; ph i tuyn tin lit c th l yu t quan trng dn ti tc dng ny.
Tc dng ngoi do dextromethorphan gy ra rt him ; thnh thong c th thy bun nn,
nn, chng mt v ri lon tiu ha.
LIU LNG v CCH DNG
Ngi ln v tr em trn 12 tui : 1 vin hoc 10 ml xir, 3 ln mi ngy.
Tr em di 12 tui :
6 - 12 tui

5,0 ml xir 3 ln mi ngy

2 - 5 tui

2,5 ml xir 3 ln mi ngy

6 thng - < 2 tui

1,25 ml xir 3 ln mi ngy

Phi hi kin bc s trc khi nh dng cho tr di 2 tui.

Khng khuyn co dng Actifed Compound Linctus cho tr di 1 tui.
QU LIU
Triu chng : bun ng, ng lm i, chng mt, mt iu ha, cm gic yu t, gim trng lc,

suy h hp, kh da v nim mc, tim nhanh, cao huyt p, st cao, tng hot ng, kch thch,
co git, kh hiu, git rung nhn cu, bun nn v nn ma.
Trong trng hp qu liu trm trng, c th ngng th, suy kit tun hon, ngng tim v t
vong.
iu tr : cn p dng cc bin php cn thit cng c v duy tr h hp v kim sot cc cn
co git. gii c i vi c ch h hp do dextromethorphan hay codein, c th dng
naloxone. Nu c ch nh, cn ra d dy trong vng 3 gi sau khi ung thuc. C th cn t
catheter bng quang. Nu mun, c th tng o thi pseudophdrine bng s bi niu acide
hay thm tch.
BO QUN
Di 25oC, trnh nh sng.

5. ADALAT
BAYER PHARMA
vin nang mm 10 mg : hp 30 vin.
vin n n tc ng ko di (Adalat Retard) 20 mg : hp 30 vin.
vin nn thm thu c tc ng ko di (Adalat LA) 30 mg : hp 30 vin - Bng B.
THNH PHN
cho 1 vin
Nifedipine

10 mg

cho 1 vin Adalat Retard

Nifedipine

20 mg

cho 1 vin Adalat LA

Nifedipine
(10 % nifedipine gi li lp bao ca vin
thuc)

33 mg

DC LC
Nifedipine l thuc i khng calci thuc nhm dihydropyridine, c tc dng c ch mt cch
chn lc, nhng nng rt thp, ion calci i vo trong t bo c tim v c trn ca mch
mu. Do c ch trng lc ng mch theo c ch trn, nifedipine ngn chn s co mch, gim
sc khng ngoi vi v gim huyt p.
Tc dng ny km theo :
- tng ng knh ng mch,
- tng lu lng mu ngoi bin v lu lng mu qua thn, no,
- tng gin ca ng mch.
Nu dng lu di :
- khng lm thay i h thng renin - angiotensin - aldosterol,
- khng gy gi nc - mui.
- khng lm tng tn s tim.
DC NG HC
- Sau khi ung Adalat dng vin nang (Adalat 10 mg), nifedipine c hp thu nhanh qua ng
tiu ha v hin din trong mu sau vi pht. Thi gian bn hy trong huyt tng khong 3
gi v sinh kh dng tuyt i vo khong 50%. Nifedipine gn nh c chuyn ha hon
ton gan thnh cc cht chuyn ha khng c hot tnh. Cc cht chuyn ha ny c o
thi qua nc tiu. 5 n 15% c o thi qua phn. Nifedipine khng b bin i ch c
tm thy dng vt trong nc tiu (di 1%). Trung bnh, dng vin nang c tc dng trong 6
gi.
- dng phng thch k o di (Adalat Retard 20 mg), nifedipine c bo ch di dng vi tinh
th c vn tc ha tan chm. Mc hp thu do chm hn so vi dng vin nang. Nng
ti a trong huyt tng t c sau t 2 n 4 gi sau khi ung. nh hp thu b bt v v s
o thi chm l hu qu ca vic gim vn tc hp thu. Tuy nhin, lng nifedipine c hp
thu cng tng t nh i vi dng vin nang (95%). Cc ghi nhn trn cho php kt lun rng
dng 2 ln vin Adalat Retard cch nhau 10 n 12 gi l liu cho 1 ngy. Cc c tnh dc
ng hc cn li tng t vi dng vin nang. kh dng sinh hc trong khong 70%. Gn kt
vi protein t 90 n 95%.
- i vi dng vin nn thm thu (Adalat LA 30 mg), nng nifedipine trong huyt tng
tng t t v t n tr s ti a sau 6 n 8 gi sau khi ung thuc, v gi mc ny c hi
gim mt cht cho n sau 24 gi. Ngi ta khng thy c hin tng tch ly thuc sau khi
dng thuc lp li. Nifedipine c hp thu trn 90%. kh dng sinh hc t 45 n 68%. S
hp thu ca nifedipine khng thay i nu dng lc i hoc no. C 90 n 95% nifedipine gn
vi protein huyt tng. Cc c tnh dc ng v chuyn ha v o thi tng t nh
dng vin nang. Sau khi c ung vo c th, lp mng bn thm c tnh tr ca vin thuc
khng b bin i trong qu trnh di chuyn qua rut v c o thi qua phn di dng mt

lp mng khng tan.

- Nifedipine khng thm phn c.
CH NH
Adalat 10 mg :
- D phng cn au tht ngc : au tht ngc do c gng, au tht ngc t pht (bao gm au
tht ngc Prinzmetal) : dng ng ung.
- iu tr cn cao huyt p : ngm di li.
- iu tr triu chng hin tng Raynaud nguyn pht hoc th pht :
- iu tr cn : ngm di li ;
- d phng ti pht : dng ng ung.
Adalat Retard 20 mg :
- Cao huyt p.
Adalat LA 30 mg :
- Cao huyt p.
- au tht ngc n nh mn tnh (au tht ngc do gng sc).
CHNG CH NH
Tuyt i :
- Qu mn cm vi nhm dihydropyridine.
- Nhi mu c tim gn y (di 1 thng), au tht ngc khng n nh.
- Hp ng tiu ha nng (i vi vin Adalat LA 30 mg do kch thc ca vin thuc).
Tng i :
- Dantrolene, cyclosporine : xem Tng tc thuc.
- Ph n c thai hoc nui con b : xem Lc c thai v Lc nui con b.
CH PHNG
Cc s liu dch t hc mi nht cho thy rng dng Adalat dng gii phng hot cht tc th,
nht l khi dng liu cao, c th lm tng nguy c trn mch vnh bnh nhn b bnh mch
vnh.
THN TRNG LC DNG
- Cn thn khi dng thuc cho bnh nhn trong tnh trng huyt ng khng n nh (gim
dung lng mu, try, suy gim ng k chc nng tm thu ca tm tht tri, sc tim), bnh
nhn b ri lon chc nng nt xoang hay b ri lon dn truyn nh - tht hay c suy gim ng
k chc nng tm tht.
- Nu c ch nh n c, nifedipine khng c dng iu tr cn au tht ngc pha
cp tnh trong nhi mu c tim.
- Do thuc c chuyn ha gan, s dng thn trng bnh nhn b suy t bo gan.
- i vi dng vin nn thm thu Adalat LA 30 mg : trng hp b to bn nng, nn dng cc
thuc nhun trng gy trn trnh lm trm trng thm tnh trng b to bn.

LC C THAI
Cc nghin cu thc hin trn th vt cho thy nifedipine c th gy qui thai v c c tnh
i vi bo thai. Trn lm sng, cho n nay khng c trng hp no c ghi nhn c gy d
dng hoc c tnh i vi bo thai.
Tuy nhin, vic duy tr iu tr vi nifedipine trong thi kz mang thai th cho n nay cha s
liu c th loi tr tt c nhng nguy c c th xy ra.
Do , khng nn ch nh nifedipine cho ph n c thai. Tuy nhin, nu pht hin c thai khi
ang iu tr bng nifedipine th khng cn thit phi ph thai.
LC NUI CON B
Ngng cho con b trong thi gian iu tr bng nifedipine do thuc c bi tit qua sa m
TNG TC THUC
Nifedipine lm tng tc dng ca cc thuc h huyt p khc v cc thuc gy gin mch khc
(c bit l dn xut nitrate).
Khng nn phi hp :
- Cyclosporine : nguy c phi hp tc dng ngoi kiu gy cc bnh nu rng.
- Dantrolene (tim truyn), do thn trng : ng vt, nhiu trng hp rung tht dn n t
vong c ghi nhn khi phi hp verapamil v dantrolene ng tnh mch. Phi hp thuc
i khng calci v dantrolene do c th gy nguy him. Tuy nhin, mt s bnh nhn dng
phi hp nifedipine v dantrolene m khng thy c bt li g.
Thn trng khi phi hp :
- Thuc chn a-1 (alfuzocine, prazocine) : tng tc dng h huyt p, c th gy h huyt p t
th. Nn tng cng theo di lm sng v lu { n kh nng b h huyt p t th trong vi
gi u sau khi dng thuc chn a-1 (nht l khi mi bt u iu tr bng nifedipine).
- Cimetidine : tng tc dng h huyt p ca nifedipine do cimetidine c ch s d ha ca
nifedipine.
Tng cng theo di lm sng : iu chnh liu nifedipine trong thi gian iu tr bng
cimetidine v sau khi ngng dng thuc ny.
- Phenytoin : tng nng phenytoin trong huyt tng vi cc du hiu qu liu (ch yu l
cc du hiu thn kinh). C ch : ct lin kt ca phenytoin ra khi lin kt vi protein v c ch
s chuyn ha ca cht ny.
Theo di lm sng v gim liu phenytoin ngay khi thy c du hiu qu liu. C th kim tra
nng phenytoin trong huyt tng.
Lu { khi phi hp :
- Thuc chn bta : h huyt p, suy tim bnh nhn b suy tim tim n hoc khng c kim
sot (do tc dng inotrope m tnh in vitro ca nhm dihydropyridine, t hoc nhiu ty theo
tng sn phm, phi hp vi tc dng inotrope m tnh ca thuc chn bta). iu tr bng
thuc chn bta s lm gim cc phn ng giao cm do phn x, xy ra trong cc trng hp

ng lc mu di li qu mc.
TC DNG NGOI
bnh nhn b bnh mch vnh, nifedipine c th gy au tht ngc, thm ch nhi mu c
tim. Cc biu hin ny rt him khi xy ra, nhng nu xy ra cn phi ngng iu tr ngay.
Nu b nhp tim nhanh hoc nh trng ngc lc bt u iu tr trong au tht ngc n nh,
cn phi nh gi li liu lng ca thuc chn bta. Nhp tim nhanh c th xy ra lc u v
gim nu dng lu ngy.
Tc dng ngoi { thng xy ra lc mi dng thuc, a s c lin quan n vic gin mch
ngoi bin, lnh tnh v bin mt khi ngng iu tr. Thng xy ra l : ph chn (l thuc vo
liu), ng mt c km theo nhc u hoc khng, bc ha, nn, au bao t, h nh huyt
p.
Him gp hn : chong vng c th lin quan n vic h huyt p, suy nhc, d ng.
Him khi gp trng hp b gin nu rng, s thuyn gim khi ngng tr liu.
Cng nh cc thuc gy gin mch khc, nifedipine c th gy au tht ngc xy n khong 30
pht sau khi ung thuc, iu ny i hi phi ngng iu tr.
Rt him khi gy tn thng chc nng gan ( mt trong gan, tng transaminase), hi phc khi
ngng iu tr.
Mt vi trng hp to bn c ghi nhn khi dng dng vin nn thm thu.
LIU LNG v CCH DNG
Adalat 10 mg :
Chia cc liu cch nhau t nht 2 gi.
au tht ngc (ng ung) : 3 vin/ngy, chia lm 3 ln ; trong au tht ngc Prinzmetal : 4
vin/ngy chia lm 4 ln trong 1 ln vo lc chun b i ng. Ti a 6 vin/ngy.
Cao huyt p cp tnh (ngm di li) : 1 vin ; nu vn cn cao huyt p, 60 pht sau ngm
thm 1 vin.
iu tr triu chng hin tng Raynaud :
- iu tr cn cp tnh (ngm di li) : 1 vin.
- D phng (ng ung) : 3 vin/ngy, chia lm 3 ln. Ti a 6 vin/ngy.
Adalat Retard 20 mg :
Mi ln 1 vin, 2 ln/ngy, ung thuc khng nhai.
Adalat LA 30 mg :
Dng cho ngi ln : 1 vin/ngy.
QU LIU
Qu liu nh c th gy tng tn s tim.
Nu vic qu liu c pht hin sm : ra rut v theo di phng sn sc c bit. iu tr
triu chng.
Trng hp qu liu nng : tim truyn calci gluconate.

Theo di nhp tim, s dn truyn v lu lng tim. Nu h huyt p nghim trng, tim truyn
noradrenaline nng thng thng, phi hp vi strophantiline IV nu bnh nhn c du
hiu suy tim ; digitalis c tc ng nhanh cng c th c ch nh.

6. ADONA
TANABE SEIYAKU
[FOURNIER GROUP VIETNAM]
dung dch tim 25 mg/5 ml : ng 5 ml, hp 50 ng.
vin nn 30 mg : hp 500 vin.
THNH PHN
cho 1 ng
Carbazochrome sodium sulfonate

25 mg

T dc : sodium bisulfite, D-sorbitol,

propylen glycol.
cho 1 vin
Carbazochrome sodium sulfonate

30 mg

T dc : lactose, tinh bt ng, cellulose

kt tinh, acid silicic long khan, magi
stearat.
M T
Carbazochrome sodium sulfonate c tn ha hc l monosodium 2,3,5,6-tetrahydro-1-methyl6-oxo-5-semicarbazonoindole-2-sulfonate trihydrate. Cng thc phn t : C10H11N4NaO5S.3H20.
Carbazochrome sodium sulfonate l nhng tinh th hoc bt kt tinh mu cam-vng, khng
mi, khng v. Thuc tan t trong nc, tan rt t trong ethanol hu nh khng tan trong ether.
im nng chy : khong 210oC (phn hy).
DC LC
Carbazochrome sodium sulfonate tc ng ln mao mch c ch s tng tnh thm mao mch
lm tng sc bn mao mch, v vy rt ngn thi gian chy mu (tc dng cm mu) m khng
nh hng n s ng mu h thng tiu fibrin.
Tc dng c ch ln tnh thm mao mch :

- Tim bp 5 v 10 mg/kg Carbazochrome sodium sulfonate cho th c ch s tng tnh

thm mao mch gy ra bi kallikrein, theo th t 20% v 30% sau 60 pht.
- Dng ng tnh mch 0,5, 2,5 v 5 mg/kg Carbazochrome sodium sulfonate cho th c
ch tnh tng thm mao mch gy ra bi hyaluronidase theo th t l 28%, 40% v 65%.
Tc dng lm tng sc bn mao mch :
Tim trong phc mc 0,5 mg/kg Carbazochrome sodium sulfonate chut lang lm tng sc
bn mao mch ln cao nht l 41,9 mmHg v tc dng ko di khong 5 gi.
Tim bp 10 mg/kg Carbazochrome sodium sulfonate th c lm tng sc bn mao
mch ca mng nhy ln khong 1.3 ln sau 60 pht.
Tc dng rt ngn thi gian chy mu :
Dng ng tnh mch 2,5 v 5 mg/kg Carbazochrome sodium sulfonate th rt ngn
c thi gian chy mu xung ln lt l 18%, 42% sau 60 pht. Tc dng ko di trn 3 gi.
Tc dng trn tiu cu v h ng mu :
- Dng ng tnh mch 5 mg/kg Carbazochrome sodium sulfonate th cho thy rng khng
tc ng ln s lng tiu cu.
- Tim bp 4 mg/kg Carbazochrome sodium sulfonate th cho thy rng khng nh hng
n thi gian ng mu.
Tc ng trn h h hp tim mch :
- C h hp v huyt p u khng chu nh hng ca Carbazochrome sodium sulfonate dng
ng tnh mch 5 v 10 mg/kg.
- Dung dch Carbazochrome sodium sulfonate khng gy co mch khi truyn dung dch 4% vo
tnh mch tai hoc dung dch 5 x 10-4 M vo mch mc treo rut bit lp th.
DC NG HC
Adona tim :
Khi dng 50 mg Carbazochrome sodium sulfonate ng tnh mch nam gii khe mnh, thi
gian bn hy ca nng trong huyt tng khong 40 pht v 75% liu dng ng o thi
di dng khng i qua nc tiu vi mt tc tng i nhanh.
Adona vin :
- Sau khi ung 150 mg Carbazochrome sodium sulfonate (5 vin) nam gii khe mnh, nng
thuc trong huyt tng t n nh cao nht (25 ng/ml) sau 0,5-1 gi. Thi gian bn hy
ca nng trong huyt tng l khong 1,5 gi.
- Lng Carbazochrome sodium sulfonate bi tit qua nc tiu ph hp vi nng thuc
trong huyt tng v t n nh cao sau khi ung 0,5-1,5 gi v thuc c o thi qua
nc tiu trong vng 24 gi sau khi ung.
DC L LM SNG
Hiu lc lm sng :
Adona tim :

Qua nghin cu lm sng trn tng s 1110 trng hp 50 vin nghin cu cho thy c s
tng sc bn mao mch v ci thin nhng trng hp c xu hng chy mu v chy mu.
Adona vin :
Qua nghin cu lm sng trn 1521 bnh nhn 74 vin nghin cu bao gm 2 nghin cu m
i, nhn thy c s tng sc bn mao mch v ci thin nhng trng hp c xu hng
chy mu v chy mu.
- Qua 1 nghin cu lm sng so snh m i trn 41 bnh nhn tng huyt p v x cng ng
mch c mch mu d v, nhn thy sc bn mch mu gia tng ng k.
- Qua 1 nghin cu so snh m i trn 51 bnh nhn tng huyt p, i tho ng hoc ban
xut huyt vi mch mu d v, nhn thy sc bn mao mch gia tng ng k v ci thin
nhng trng hp chy mu khc nh cc m xut huyt.
Phn ng ph :
T l ca phn ng ph l 1,25% (19 trong 1521 ca) v nhng phn ng ph ch yu l nhng
triu chng trn d dy-rut v da.
NGHIN CU PHI LM SNG
c tnh :
c tnh cp (LD50 mg/kg) :
ng dng
ng vt
ng ung ng tnh mch
Chut nht dng IRC-JCL (c, ci)

> 10.000

> 600

Chut cng dng Wistar-KLB (c, ci)

> 10.000

> 600

Ch sn th (c, ci)

> 5.000

> 600

c tnh mn :
Dng lin tip ng ung vi liu 60, 120, 250 v 500 mg/kg/ngy trong 6 thng chut cng
dng Wistar-KBL, khng thy s khc nhau c { ngha trong nhng nhn xt chung v trong
xt nghim nc tiu gia nhm dng 60 mg/kg/ngy v nhm chng.
Tuy nhin, nhng nhm dng khng di 120 mg/kg/ngy, thy c s tng hng cu li
v nhng nhm dng khng di 250 mg/kg/ngy thy c s gim hematocrit v lng
huyt sc t, xung huyt lch v c s lng ng hemosiderin ti lch (nhng triu chng ny
gim i sau 1 thng th li). Liu an ton ti a l 60 mg/kg.
Tnh gy qui thai :
Tc dng ln bo thai c kim tra trn chut nht dng ICR-JCL v chut cng dng Wistar
bng phng php c hiu do "Chnh sch m bo an ton thuc" ca B Y t v Phc li

cng cng Nht bn qui nh v cho thy khng c tc dng gy qui thai do Carbazochrome
sodium sulfonate.
Hp thu v o thi :
Adona tim :
Khi tim tnh mch 25 mg/kg Carbazochrome sodium sulfonate cho chut nht dng ddY, thuc
c phn b i khp c th tr h thng thn kinh trung ng v nng thuc trong huyt
tng t cc i ngay sau khi dng (nhng trng hp tim bp th t 10 n 30 pht sau khi
tim), v sau gim t t. Trong vng 1 gi th khong 63% liu a vo c o thi
qua nc tiu v trong vng 24 gi khong 91% c o thi qua nc tiu v khong 5% qua
phn.
Adona vin :
Vi liu ung 25 mg/kg Carbazochrome sodium sulfonate chut nht dng ddY, th c khong
20% v 45% liu a vo c hp thu theo th t sau khi dng l 2 gi v 6 gi. Sau khi
dng t 2 gi n 4 gi c nng thuc ti a ti cc c quan. Trong vng 48 gi sau khi dng
khng t hn 90% liu dng c o thi v s lng thuc trong nc tiu gn bng 2 ln
thuc trong phn.
CH NH
- Xu hng chy mu (ban xut huyt...) do gim sc bn mao mch tng tnh thm mao mch.
- Chy mu t da, nim mc v ni mc do gim sc bn mao mch, chy mu y mt, chy
mu thn v bng huyt.
- Chy mu bt thng trong v sau khi phu thut do gim sc bn mao mch.
THN TRNG LC DNG
Thn trng khi s dng cho nhng bnh nhn c tin s qu mn vi sn phm ny.
S dng ngi ln tui : Do ngi ln tui hay c gim chc nng sinh l{, nn cn gim
liu v theo di cht ch.
nh hng n nhng kt qu xt nghim : Test urobilirubin c th tr nn dng tnh do cc
cht chuyn ha ca Carbazochrome sodium sulfonate.
Lu { khi s dng :
Bi v ng Adona (AC-17) tim l ng c vch ct, nn khng cn ct bng da. Thay vo l
ko phn trn ca ng ra khi vng nh du v b gy sau khi lau xung quanh c ng tim
bng bng thm cn.
TC DNG NGOI
Adona tim :
Qu mn : qu mn nh pht ban hoc nhng triu chng ging sc c th gp. Trong nhng
trng hp nh vy nn ngng dng thuc.
Adona vin :
Qu mn : Khi c phn ng qu mn xy ra nh pht ban chng hn th ngng dng thuc.

D dy-rut : Chn n, kh chu d dy.v.v. c th xy ra khng thng xuyn.

LIU LNG v CCH DNG
Adona tim :
Thng ngi ln liu dng hng ngy l 25-100 mg Carbazochrome sodium sulfonate c
dng bng ng tim tnh mch hoc truyn nh git ng tnh mch. Liu dng c th ty
thuc vo tui v nng ca triu chng.
(Liu hng ngy)
Dng liu

Cho ngi ln

Adona (AC-17) tim 25 mg (5 ml)

1-4 ng

Adona (AC-17) tim 50 mg (10 ml)

1-2 ng

Adona vin :
Thng thng, ngi ln liu mi ngy 30 mg n 90 mg Carbazochrome sodium sulfonate
(t 1 n 3 vin), dng ng ung chia liu ra lm 3 ln.
Liu lng c th iu chnh cho ph hp tui v triu chng ca bnh nhn.
BO QUN
Bo qun : di 30oC. Trnh nh sng.

7. ADRENOXYL
SANOFI SYNTHELABO VIETNAM
vin nn 10 mg : v x 16 vin, hp 1 v.
dung dch tim 1,5 mg/3,6 ml : ng 3,6 ml, hp 3 ng.
THNH PHN
cho 1 vin
Carbazochrome dihydrate

10 mg

cho 1 ng
Carbazochrome dihydrate
DC LC
Cm mu.

1,5 mg

- Khng c tc dng trn s ng mu nhng c tc dng cm mu.

- Tc dng ch yu trn thnh mch, c bit l cc mao mch, do lm tng sc bn ca
thnh mch.
- Vi liu iu tr, Adrnoxyl khng c cc tnh cht ging giao cm.
CH NH
c dng nh thuc cm mu chun b phu thut ngoi khoa v iu tr xut huyt do
mao mch.
LIU LNG v CCH DNG
Ngi ln :
- 1 n 3 vin mi ngy, nn ung trc cc ba n 1 gi ;
- hoc 1-3 ng/24 gi, tim bp hay tim di da.
Tr em t 30 thng n 15 tui :
- 1 n 2 vin mi ngy, nn ung trc cc ba n ;
- hoc 1-2 ng/24 gi ch trong mt liu tim bp hay tim di da.
Nh nhi :
- 1/2 n 1 vin/ngy ;
- hoc 1/2 ng/ngy, tim bp hay tim di da.
Phu thut : ngy trc v 1/2 gi trc khi m.
BO QUN
Ni mt, trnh nh sng.

8. ALAXAN
UNITED LABORATORIES
Vin nn : v 20 vin, hp 5 v - v 4 vin, hp 25 v.
THNH PHN
cho 1 vin
Paractamol

325 mg

Ibuprofne

200 mg

DC LC
Alaxan kt hp tc ng gim au v khng vim ca ibuprofne v tnh cht gim au, h
nhit ca parac tamol. Ibuprofne ngn cn s sinh tng hp prostaglandine bng cch c ch
hot ng ca enzyme cyclo-oxygnase, v vy lm gim s vim. Trong khi ibuprofne c tc
ng ngoi bin, paractamol li c tc ng trung ng-ngoi bin, v vy to nn liu php

gim au rt c hiu qu :
- ngay ngun cc cht trung gian dn truyn cm gic au, Alaxan c ch s phng thch
prostaglandine, v vy c ch cm gic au ;
- ti cc th th tip nhn cm gic au, Alaxan ngn cn s nhy cm ca cc th th tip nhn
cm gic au i vi nhng cht trung gian dn truyn cm gic au c phng thch, v vy
ngn cn cm gic au v ct t chu trnh ;
- ti h thng thn kinh trung ng, Alaxan nng ngng chu au chng li cc xung ng ca
cc dy thn kinh th cm au, lm mt tn hiu dn n s co c, v vy ct t hon ton chu
trnh.
Alaxan cung cp tc ng gim au rt tt do cng thc gim au phi hp :
- iu tr mt cch hiu qu triu chng vim khp dng thp cp tnh v mn tnh, vim xng
khp ;
- iu tr hiu qu chng vim khng thuc khp v cc cn au khng c ngun gc ni tng ;
- lm gim hiu qu cc cn au c ngun gc c xng v cc cn au do chn thng.
S kt hp ca ibuprofne v paractamol liu iu tr thp nht th khi s dng s an ton
hn l khi s dng hai vin ring r m vn cho hiu qu gim au cao hn. Ngoi ra, Alaxan
cn lm gim nhng tc dng ph khng mong mun nh tai, chng mt, gim thnh lc, bn
chn, s bo mn hay xut huyt ca nim mc ng tiu ha hoc nhng m khc, bun
ng, nn ma, au u v cc chng tng t thng gp khi s dng cc loi thuc gim au
phi hp khc.
CH NH
Gim au, khng vim trong cc trng hp c khp au do chn thng, thp khp, vim
thn kinh nh au lng, vo c, bong gn, cng c qu mc, gy xng, trt khp, au sau gii
phu...
iu tr cm st, nhc u, au rng, au bng kinh, au nhc c quan vn ng...
CHNG CH NH
Mn cm vi mt trong cc thnh phn ca thuc.
Lot d dy-t trng tin trin.
Suy gan hoc suy thn nng.
Lupus ban ri rc (nguy c b phn ng mng no nh).
THN TRNG LC DNG
Khi bt u iu tr, cn theo di tht k s bi tit nc tiu v chc nng thn bnh nhn b
suy tim, x gan v h thn, bnh nhn ang dng thuc li tiu, bnh nhn b suy thn mn
tnh v c bit ngi gi.
Theo di nhng bnh nhn c tin s lot d dy-t trng, thot v honh hoc xut huyt
tiu ha.
Cn thn khi s dng bnh nhn c bnh tim v tng huyt p.

Ngi iu khin phng tin giao thng v s dng my mc cn lu { v nguy c b chng

mt khi dng thuc.
LC C THAI
Cn thn khi dng trong ba thng u ca thai kz.
Tuyt i khng dng trong qu ba ca thai kz (nguy c nhim c thai : thn v tim phi thai
nhi, vi s ng sm ng ng mch) v vo cui thai kz (do nguy c xut huyt m v c con
do ko di thi gian chy mu).
LC NUI CON B
Cn thn khi dng cho ph n nui con b.
TNG TC THUC
- Dng km ibuprofne vi thuc chng ng mu loi coumarine c th lm tng nguy c xut
huyt.
- Dng km vi aspirine c th h thp nng ca ibuprofne trong mu v lm gim hot
tnh chng vim.
- Dng lu di paractamol c th lm tng tc ng gim prothrombine huyt ca thuc chng
ng mu.
TC DNG NGOI
Ri lon tiu ha : bun nn, i ma, kh tiu, au d dy, au thng v, xut huyt ngm
ngm hoc l r, ri lon vn ng.
Ri lon thn kinh : nhc u, suy nhc, chng mt.
Phn ng mn cm : da (ni mn, nga), h h hp (i khi co tht ph qun ngi d
ng vi aspirine v cc thuc chng vim khng stroide khc), ph.
Ri lon gan (him) : tng tm thi transaminase.
Ri lon thn : tiu t, suy thn.
Ri lon mu : mt bch cu ht, thiu mu tn huyt. Trong mt s rt him trng hp c
th c thiu mu c ba dng, gim bch cu trung tnh v gim bch cu.
Ri lon th gic.
LIU LNG v CCH DNG
Dng cho ngi ln :
- Trng hp cp tnh : 1 n 2 vin, 3 ln/ngy.
- Bnh mn tnh : 1 vin, 3 ln/ngy.

9. ALBOTHYL

BYK GULDEN
c/o TRIDEM PHARMA
thuc trng 90 mg : hp 6 vin v 10 vin trng.
dung dch m c 360 mg/g : chai 25 ml, 100 ml.
THNH PHN
cho 1 vin trng
Policresulen

90 mg

cho 1 g dch m c
Policresulen

360 mg

CH NH
Vin trng :
Ph khoa :
- iu tr ti ch chng vim hoc nhim khun v tn thng t chc ca m o v c t
cung (th d : dch tit do nhim khun, Trichomonas v nm, lo t do m t cung p), cc chng
condylom nhn, v.v...
- Nim mc c t cung li (lc ch c t cung).
Dch m c :
Ph khoa :
- iu tr ti ch chng vim hoc nhim khun v tn thng t chc ca m o v c t
cung (th d : dch tit do nhim khun, Trichomonas v nm, lo t do m t cung p), cc chng
condylom nhn, v.v...
- Nim mc c t cung li (lc ch c t cung).
- Cm mu sau sinh thit hay ct b polyp t cung.
Phu thut v khoa da :
- iu tr ti ch tn thng da nhm lm nhanh s bong vy ca t chc hoi t, lm sch v
kch thch mau lnh (nh bng khu tr, lo t chn v gin tnh mch, lot do nm, qu trnh vim
mn, condylom nhn, v.v...).
- Cm mu vt thng r mu.
Tai Mi Hng :
- iu tr ti ch vim nim mc ming v li, bnh p-t.
- Cm mu sau khi ct amidan hoc chy mu cam.
CHNG CH NH
- Trng hp c thai, c bit giai on mun, trnh bi hay t thuc trong c t cung.

- Ch dng Albothyl khi tuyt i cn thit v phi tnh n mi ri ro c th xy ra cho m v

con. Thc nghim trn ng vt cho thy l thuc khng gy d dng. Cha thy ti liu nghin
cu v ri ro khi dng Albothyl ph n c thai. Cha bit r thuc c tit qua sa m hay
khng.
THN TRNG LC DNG
- Albothyl kch thch qu trnh lnh vt thng. Khng nn lo lng khi t chc hoi t bong ra
khi ni tn thng, d vi lng ln.
- Ngi bnh khng ra vi x phng kch ng hoc giao hp trong thi gian iu tr vi
Albothyl.
- Nh mi thuc khc dng qua ng m o, khng dng Albothyl trong thi gian kinh
nguyt.
- Khng Albothyl tip xc vi mt.
- Khi dnh Albothyl, phi git qun o hoc ra giy dp vi nc trc khi thuc kp kh.
- B ngoi lm m ca vin trng l do cht nn dng lm vin trng, khng nh hng ti
vic s dng, hiu qu hoc tnh dung np.
TC DNG NGOI
- i khi xy ra kch ng ti ch khi bt u dng Albothyl, nhng triu chng ny thng lui
nhanh.
- Khi dng cha nim mc ming, cn nh l acid cao ca Albothyl c th lm tn hi men
rng.
LIU LNG v CCH DNG
Vin trng :
Nu khng c ch nh khc :
- Mi ln t mt vin trng, hai ngy mt ln.
- Nu dng dch m c Albothyl th dng mt vin trng, hai ngy mt ln vo khong
cch gia hai ln dng dch m c Albothyl. d t c th lm m vin trng vi cht
nc, ngi bnh t th nm nga ri a vin trng su vo m o. t vin trng vo
ban m l thc t hn c. Dng thm khn v sinh s trnh thuc dy ra qun o hoc ging
chiu.
Dch m c :
Nu khng c ch nh khc :
Ph khoa :
- ra m o, pha long mt phn dch m c Albothyl vi 5 phn nc.
- bi ln cc ch tn thng b mt hay b su ca t chc, dng Albothyl m c khng
pha long. Bi mt ln hoc hai ln trong tun. Mun bi dch m c Albothyl, dng m vt,
kp thay bng v gc. Trc khi bi thuc, nn dng dch m c Albothyl lau sch c t cung
v ng c t cung ly ht dch nhy. Dng mt ming bng, thm dch m c Albothyl a

vo ng t cung, xoay bng nhiu ln, sau rt ra. Bi thuc bng cch nhng ming gc vo
dch m c ri a gc ti t chc tn thng, p nh trong 1-3 pht.
- Cng vy, dng Albothyl khng pha long cm mu, mt ming gc nhng thuc c
p vo ch chy mu trong 1-2 pht.
Phu thut v khoa da :
- cm mu, vt thng c lau kh v p mt ming gc nhng dch m c Albothyl
trong 1-2 pht ti ni chy mu. Khng phi khi no cng cn thit, nhng nn lau sch ni vt
thng sau khi x l vi dch m c Albothyl.
- cha cc vt bng khu tr, lot do nm v lo t chn v gin tnh mch lm vt thng
mau bong vy t chc hoi t, cng dng dch m c Albothyl theo cch ni trn. Trong cc
trng hp ny, nn tip tc iu tr vi kem Albothyl.
Dng trong nim mc ming v li :
- Sau khi cha nim mc ming v li vi dch m c Albothyl, cn sc ming tht k.
BO QUN
Vin trng : Bo qun nhit di 25oC.
ALBUTEIN 5% - 20% - 25%

10.

ALPHA THERAPEUTIC

c/o DIETHELM
dung dch tim tnh mch 5% : chai 250 mL v 500 mL.
dung dch tim tnh mch 20% : chai 50 mL v 100 mL.
dung dch tim tnh mch 25% : chai 50 mL v 100 mL.
THNH PHN
cho 100 mL Albutein 5%
Albumin ngi

5g

cho 100 mL Albutein 20%

Albumin ngi

20 g

cho 100 mL Albutein 25%

Albumin ngi

25 g

M T
ALBUTEIN (NGI) U.S.P., ALBUTEIN 5%, 20% v 25% l dung dch v trng tim tnh mch n
liu, gm 3 loi cha tng ng 5%, 20% v 25% albumin ngi (trng lng/th tch).
ALBUTEIN c iu ch bng phng php phn on cn lnh t h huyt tng ngi thu
c t mu tnh mch. Sn phm c c nh bng 0,08 mmol sodium caprylate v 0,08
mmol sodium acetyltryptophanate cho mi gram albumin. ALBUTEIN 5% c p sut thm thu
bng th tch ca huyt tng bnh thng c citrat ha, ALBUTEIN 20% c p sut thm
thu bng 4 ln th tch ca huyt tng bnh thng c citrat ha v ALBUTEIN 25% c p
sut thm thu bng 5 ln th tch ca huyt tng bnh thng c citrat ha. ALBUTEIN 5%,
20% v 25% cha 130-160 mEq ion Na+/lt v c pH = 6,9 +/- 0,5. Ch phm khng cha cht
bo qun. ALBUTEIN c x l nhit 60oC trong 10 gi. X l nhit ny tiu dit cc tc
nhn gy vim gan siu vi, nhng cng khng c xc nh hon ton.
DC L LM SNG
Ngi ta cha thy c ca vim gan siu vi no c bit do truyn ALBUTEIN (NGI) U.S.P.,
ALBUTEIN c. Albumin l protein hnh cu, tnh ha tan cao (trng lng phn t 66.500) to
70-80% p sut keo ca huyt tng. V vy, n rt quan trng trong iu ha p sut thm
thu ca huyt tng. ALBUTEIN 5% to p sut thm thu tng ng huyt tng ngi
cng th tch, n lm tng th tch huyt tng tng ng vi th tch dch truyn vo.
ALBUTEIN 20% to p sut thm thu tng ng 4 ln p sut thm thu ca huyt tng
ngi, n lm tng th tch huyt tng tng ng 2,5 ln th tch dch truyn vo trong 15
pht, nu ngi c truyn c cung cp nc y . ALBUTEIN 25% to p sut thm
thu tng ng 5 ln p sut thm thu ca huyt tng ngi, n lm tng th tch huyt
tng tng ng 3,5 ln th tch dch truyn vo trong 15 pht, nu ngi c truyn
c cung cp nc y . Vic tng thm th tch s lm gim c c mu v nht
mu. Mc v thi gian tng th tch ty vo th tch mu ban u. Khi iu tr bnh nhn vi
th tch mu gim, tc dng ca albumin truyn vo tn ti trong nhiu gi. i vi bnh nhn
c th tch mu bnh thng, s pha long mu ko di trong thi gian ngn hn. Albumin
ng thi cng l protein vn chuyn v gn kt vi thuc hoc c cht lu thng trong mu.
Trong vi trng hp, chc nng vn chuyn ny c ch nh. Khi nn dng dung dch
25%.
Albumin c phn b dch ngoi bo v hn 60% nm trong khu vc ngoi mch. Tng s
albumin trong c th ngi 70 kg tng ng 320 g, c chu kz tun hon 15-20 ngy, trung
bnh 15 g mt ngy.
CH NH
ALBUTEIN 5% :
1. iu tr sc gim th tch.
2. Gim albumin mu trm trng. Tuy nhin dung dch albumin ch iu tr triu chng, nn

phi hp vi iu tr nguyn nhn.

3. Ph tr trong lc thn nhn to v phu thut c tun hon ngoi c th.
Trong trng hp i hi dch keo nng cao v t cn dch nn s dng loi 25%.
ALBUTEIN 20% v 25% :
1. iu tr sc gim th tch.
2. Ph tr trong lc thn nhn to cho bnh nhn lc thn di ngy hoc cho bnh nhn b qu
ti tun hon v khng dung np th tch ln dung dch mui trong iu tr sc hoc h huyt
p.
3. Trong cc phu thut tim phi ; tuy nhin, cha xc lp c ch iu tr ti u.
C th c ch nh :
- Hi chng suy h hp cp ngi ln (ARDS).
- Chn thng nng hoc phu thut lm s mt albumin gia tng hoc s tng hp khng y
.
- Thn h cp khng p ng iu tr vi cyclophosphamid hoc steroid. iu tr bng steroid
c th lm tng ph n m c th p ng vi iu tr phi hp albumin v thuc li tiu.
- Suy gan cp hoc c chng, iu tr thay i ty tng bnh nhn.
Tr phi nguyn nhn gy gim albumin huyt c iu chnh, truyn albumin ch lm mt cc
triu chng. Khng c l do gi tr no dng albumin nh cht dinh dng truyn tnh mch.
S dng cho tr em : Albumin (Ngi) U.S.P. 20% v 25% c ch nh phi hp truyn thay
mu trong iu tr tng bilirubin huyt s sinh. S s dng ALBUMIN (NGI) U.S.P, ALBUTEIN
cho tr em cha c nh gi trn lm sng. V vy, bc s nn cn nhc gia nguy c v li
ch ca s dng Albumin (Ngi) cho tr em.
CHNG CH NH
ALBUTEIN chng ch nh bnh nhn thiu mu nng hoc suy tim vi th tch mu ni mch
bnh thng hoc tng.
S s dng ALBUTEIN th chng ch nh bnh nhn c bnh s d ng vi sn phm ny.
CH PHNG
Sau nhng cnh bo cho rng tn ti mt nguy c tiu huyt ti cp v suy thn cp do s s
dng khng ng Nc v trng pha tim nh mt cht dng pha long Albumin (Ngi), nu
s pha long cn thit, dung dch pha long chp nhn c l Clorua Natri 0,9% hoc Dextrose
5% trong Nc.
ALBUMIN (NGI) U.S.P, ALBUTEIN c sn xut t h huyt tng ngi. Da trn s thanh
lc ngi cho huyt tng hiu qu v cc qu trnh sn xut, n mang nguy c v cng xa xi
s truyn bnh v virus, bao gm c nguy c trn l{ thuyt cho s truyn bnh CreutzfeldtJakob (CJD). Mc dng khng c ca truyn bnh virus hoc CJD no pht hin c khi dng
albumin, nguy c cc tc nhn ly nhim khng th hon ton b loi tr. Tt c s ly nhim
m bc s ngh rng c th truyn bi sn phm ny nn c bo cc nh sn xut ti 1-323-

225-9735. Bc s nn cn nhc gia nguy c v li ch ca vic s dng sn phm ny v nn

tho lun iu ny vi bnh nhn.
Dung dch ALBUMIN (NGI) U.S.P, ALBUTEIN khng nn dng nu b c, c cn lng trong l.
Khng nn bt u truyn hn 4 gi sau khi l m np. Vt b phn khng s dng.
THN TRNG LC DNG
ALBUMIN (NGI) U.S.P, ALBUTEIN nn c dng cn thn vi bnh nhn c d tr tim thp.
Truyn nhanh c th gy qu ti dn n ph phi. Bnh nhn nn c theo di st cc du
hiu tng p sut tnh mch.
Huyt p tng nhanh sau khi truyn cn theo di i vi bnh nhn b chn thng hoc hu
phu pht hin v iu tr bnh l mch mu trm trng khng gy chy mu ti p sut
thp hn.
Bnh nhn b mt nc nng i hi cung cp dch truyn thm vo. ALBUTEIN c th dng vi
cc dch truyn dextrose v saline thng thng. Tuy nhin, dung dch protein thy phn hoc
cn khng c phi hp cng mt dy truyn v c th gy kt ta protein.
LC C THAI
Ph n mang thai type C. Nhng nghin cu trn s sinh sn ca th vt cha c thc hin
vi Albumin (Ngi). Ngi ta cng khng bit Albumin (Ngi) c gy tn thng bo thai khi
dng cho ph n mang thai hoc nh hng n kh nng sinh sn. Albumin (Ngi) ch dng
cho ph n mang thai khi tht cn thit.
TC DNG NGOI
Phn ng d ng c th xy ra gy st, n lnh, ni mn, bun nn, i ma, tim p nhanh v
h huyt p. Nu phn ng xy ra, truyn chm hoc ngng truyn c th lm mt cc triu
chng trn. Nu ngng truyn v bnh nhn i hi phi truyn ALBUMIN (NGI) U.S.P,
ALBUTEIN, nn dng sn phm ca l khc.
ALBUTEIN, c bit nu truyn nhanh, c th gy qu ti dn n ph phi.
LIU LNG v CCH DNG
ALBUTEIN dng tim truyn tnh mch. Tng liu ty tng c nhn.
ngi ln liu tim truyn ban u l 500 mL (ALBUTEIN 5%), 100 mL (ALBUTEIN 20%, 25%).
Liu thm vo ty vo ch nh bnh l.
Khi iu tr bnh nhn b sc vi lng mu gim nhiu, ALBUTEIN cn c truyn cng nhanh
cng tt ci thin tnh trng bnh l v phc hi th tch mu, 15-30 pht sau c th lp li
nu liu ban u khng . bnh nhn c th tch mu bnh thng hoc gim nh, tc
truyn l 1-2 mL/pht (ALBUTEIN 5%), 1 mL/pht (ALBUTEIN 20%, 25%).
Nu s pha long ALBUTEIN 20%, 25% cn thit trn lm sng, dung dch pha long thch hp l
Clorua Natri 0,9% v trng hoc Dextrose 5% v trng trong Nc.
S dng tr em : S dng ALBUMIN (NGI) U.S.P, ALBUTEIN tr em cha c nh gi
trn lm sng. Liu lng thay i ty tnh trng bnh l v cn nng. Tiu biu, liu 1/4-1/2

liu ngi ln c th dng, hoc liu c th tnh ton theo 0,6-1 g/kg cn nng (12-20 mL
ALBUTEIN 5%, 3-5 mL ALBUTEIN 20% hay 2,4-4 mL ALBUTEIN 25%). Tc truyn tr em
bng 1/4 tc ngi ln.
ALBUTEIN 20% ALBUTEIN 25% : i vi vng da tn huyt s sinh, liu thch hp gn
bilirubin huyt thanh t do l 1 g/kg cn nng trong sut qu trnh.
Ch phm cn c kim tra bng mt pht hin cn lng v s i mu trc khi em
dng, bt c khi no dung dch v chai cho php.
HNG DN S DNG
S dng vi b tim truyn :
B np nha trn u l, bc l np cao su. Kh trng np cao su khng cn tn ng. Tun
theo k thut v trng v chun b dng c tim v trng nh sau
1. ng kha ca b dy truyn (chy tng ng 15 git/mL ALBUTEIN 5% v 19 git/mL
ALBUTEIN 20% hay 25%).
2. Lt ngc chai chc kim thng vo chnh gia np. Khng chc nghing hoc xoay vn.
3. Lp tc lt ngc chai to t ng mc dch thch hp trong bung nh git (y mt
na).
4. Lp kim tim vo b dy truyn, m kha v ui khng kh khi kim v dy truyn, ri ng
kha.
5. Tim tnh mch v iu chnh git.
6. B ht dng c tim truyn sau khi s dng. B ht thuc tha.
Khi b tim truyn khng c s dng :
B np nha trn u l, bc l np cao su. Kh trng np cao su khng cn tn ng. Tun
theo k thut v trng v chun b dng c tim v trng nh sau
1. Dng k thut v trng, ni kim lc vi ng tim nha v trng s dng mt ln.
2. Chc kim vo chai ALBUMIN (NGI) U.S.P, ALBUTEIN.
3. Rt ALBUTEIN t l vo ng tim.
4. Ly kim lc khi ng tim.
5. Gn kim thch hp vo ng chch.
6. B ht dng c tim truyn sau khi s dng. B ht thuc tha.
BO QUN
ALBUTEIN gi c 3 nm nhit phng khng qu 30oC. Khng c ngn .
Thuc k toa.

11.

ALPHACHYMOTRYPSINE CHOAY

SANOFI SYNTHELABO VIETNAM

vin nn 21 mckatals : v bm 10 vin, hp 2 v.
THNH PHN
cho 1 vin
Chymotrypsine tnh theo mckatals

21

CH NH
Chng ph n khng vim dng men.
iu tr cc trng hp ph n sau chn thng hay sau phu thut.
CHNG CH NH
D ng vi thnh phn ca thuc.
TC DNG NGOI
Trong mt vi trng hp, c th c cc biu hin d ng vi thuc, khi nn trnh hay ngng
s dng.
LIU LNG v CCH DNG
ng ung : 2 vin/ln, 3 hoc 4 ln trong ngy (ung).
Ngm di li : 4 n 6 vin chia u ra trong ngy ( thuc tan t t di li).
BO QUN
Trnh nh sng v m t, gi nhit khng qu 25oC.

12.

ALPHAGAN

ALLERGAN
thuc nh mt 0,2% : l 5 ml, l 10 ml.
THNH PHN
cho 1 ml
Brimonidine tartrate

2 mg

tng ng : Brimonidine base

(1,32 mg)

(Benzalkonium chloride)

(0,05 mg)

(pH)

(6,3 - 6,5)

T dc khng c hot tnh : cn polyvinyl,

natri chloride, natri citrate, acid citric,
nc ct tit khun.
DC LC
C ch tc dng :
Alphagan l cht ch vn ti th th a2-adrenergic. Hai gi sau khi nh mt, thuc t tc dng
h nhn p ti a. Nghin cu bng o quang - huznh quang mnh trn ng vt v trn ngi
cho thy brimonidine tartrate c c ch tc dng kp : va lm gim tit thy dch, va lm
tng thot thy dch cng mc - mng b o.
Nghin cu lm sng :
Yu t nguy c ln nht ngi bnh glaucome l tng nhn p. Nhn p cng tng th cng c
nguy c suy thoi thn kinh th gic, cng d b m. Alphagan lm gim c nhn p, m rt t
nh hng ti cc thng s tim mch v h hp.
Nghin cu lm sng c so snh vi timolol 0,5%, ko di trong mt nm, thy Alphagan lm h
nhn p 4-6 mmHg so vi h 5 mmHg timolol. C 8% bnh nhn b cuc do khng kim sot
c y nhn p, trong s c 30% b cuc trong thng u. Khong 20% phi ngng
thuc do tc dng ngoi .
DC NG HC
Sau khi nh mt lng dung dch 0,2% vo mt t 1-4 gi, thuc s t nng nh trong
huyt tng v gim dn, thi gian bn thi T1/2 khong 3 gi. ngi, brimonidine chuyn
ha mnh, ch yu gan. Thi tr chnh qua nc tiu, di dng hot cht khng b bin i
v cc cht chuyn ha. Khong 87% liu ung ca brimonidine nh du c thi trong vng
120 gi, trong 74% tm thy nc tiu.
CH NH
Alphagan c ch nh lm h nhn p ngi bnh glaucome gc m hoc tng nhn p.
Tc dng lm h nhn p ca thuc ny s gim i mt s bnh nhn sau mt thi gian dng
thuc, do cn theo di cht ch.
CHNG CH NH
Chng ch nh dng Alphagan ngi qu mn cm vi brimonidine tartrate hoc vi cc
thnh phn khc ca thuc.
Khng dng ng thi Alphagan vi cc thuc c ch monoamino-oxidase (IMAO).
CH PHNG v THN TRNG LC DNG
Mc du Alphagan c tc dng rt yu trn huyt p ngi bnh, nhng cng phi thn trng

khi dng ngi sn c bnh tim mch nghim trng.

Cha c nghin cu nh hng ca Alphagan trn ngi suy gan, suy thn, nn cn phi thn
trng khi dng nhng i tng ny.
Cn thn trng khi dng Alphagan ngi bnh trm cm, suy no, suy mch vnh, c hin
tng Raynaud, h huyt p t th, vim tc nghn mch mu.
Trong qu trnh nghin cu, thy c mt tc dng thuc mt vi bnh nhn. Tc dng lm h
nhn p khi dng Alphagan di dng dung dch nh mt trong thng iu tr u tin khng
phi lun lun phn nh s gim nhn p khi dng di hn. Vi ngi bnh m nhn p vn
cha c cn bng tr li khi nh thuc 2 ln mi ngy, th c th nh thm mt git vo bui
chiu. Ngi bnh mun h nhn p bng thuc ny cn c theo di nhn p thng kz.
Cht bo qun trong Alphagan l benzalkonium chloride c th b hp thu qua knh tip xc
mm. Ngi bnh nu t knh tip xc mm cn c hng dn ch t nht 15 pht sau
khi nh Alphagan ri mi t knh tip xc mm.
Li xe v vn hnh my mc :
Cng nh mi thuc ca nhm ny, Alphagan c th gy mt mi v/hoc bun ng mt s
ngi. Vi ngi lao ng ni nguy him, cn phi thn trng do thuc lm gim s tnh to
v tinh thn.
Tc dng gy ung th, gy t bin, nh hng ti sinh sn :
Chut nht ung 2,5 mg/kg/24 gi (tnh theo dng base) trong 21 thng lin, chut cng trng
ung 1,0 mg/kg/24 gi trong 2 nm lin, khng thy gy ung th (liu lng gp 77-118 ln,
tng tng nng ca thuc trong huyt tng ngi sau khi nh mt).
Dng test Ames, th nghim sai lc nhim sc th trn t bo bung trng chut Hamster
Trung quc (CHO), th nghim cht tri trn chut trng nghin cu c in vitro v in vivo khng
thy Alphagan gy bin d hoc c vi t bo.
Tr em : Cha xc nh an ton v hiu lc ca thuc vi tr em.
LC C THAI v LC NUI CON B
Lc c thai :
Nghin cu trn s sinh sn chut cng ci ung 0,66 mg brimonidine base/kg, khng thy
Alphagan nh hng ti sinh sn hoc c vi thai. Liu lng dng trn chut nh vy gp 10
ln nng thuc ny trong huyt tng ngi sau khi nh nhiu ln vo mt.
Cha c nghin cu nh hng ca Alphagan trn ngi mang thai, tuy vy, trn ng vt thy
Alphagan qua c rau thai v mt phn vo ti tun hon thai. Vy ch dng thuc ny
ngi mang thai khi li ch cho m hn hn s ri ro vi thai.
Lc nui con b :
Cha r Alphagan c qua c sa m hay khng, mc du nghin cu trn ng vt thy
brimonidine tartrate bi tit c qua sa ca ng vt mang thai. Ty theo tm quan trng
ca vic dng thuc ny m nn cho tr ngng b hoc m ngng dng thuc.

TNG TC THUC
Mc du cha tin hnh nghin cu v tng tc thuc vi Alphagan, nhng c th c tc dng
hip ng vi cc thuc c ch thn kinh trung ng (ru, barbiturate, thuc phin, thuc an
thn, thuc gy m...). Alphagan khng c tc dng c { ngha trn mch v trn huyt p. Tuy
vy, v l thuc thuc nhm ch vn a-adrenergic, nn cng c th lm gin mch v h huyt
p, v vy cn thn trng khi phi hp Alphagan vi cc thuc chn bta-adrenergic (d dng ti
ch hoc ton thn), thuc tr cao huyt p v/hoc cc glycoside tr tim.
Thuc chng trm cm loi 3 vng c th lm tng tc dng h huyt p ca clonidine (dng
ton thn). Cha r phi hp cc loi thuc chng trm cm ny vi Alphagan c gy tng tc
v tc dng lm h nhn p hay khng? Cng cha r nh thuc Alphagan c nh hng g ti
hm lng catecholamine lu thng hay khng? Tuy nhin, vn cn thn trng vi ngi dng
thuc chng trm cm loi 3 vng, v nhng thuc ny c th nh hng ti chuyn ha v lu
thng ca cc amine ny.
TC DNG NGOI
Tc dng ngoi xut hin khong 10-30% ngi dng thuc. Nhng ri ro d gp tnh theo
th t gim dn l kh ming, xung huyt mt, nng rt v au nhc, au u, m mt, cm
gic c d vt trong mt, mt mi, bun ng, vim kt mc, phn ng d ng mt, nga mt.
Mt s hin tng khc gp 3-9% bnh nhn, theo th t gim dn, nh vt en/vt n mn
gic mc, s nh sng, ban mi mt, au nhc mt, kh mt, chy nc mt, triu chng
h hp mnh, ph kt mc, chng mt, vim mi mt, kch ng mt, triu chng tiu ha, mt
mi, ti nht kt mc, th gic bt thng v au c.
Nhng tc dng ngoi { sau y gp di 3% bnh nhn : cng mi mt, chy mu kt mc, v
gic bt thng, mt ng, xut tit kt mc, trm cm, tng huyt p, chn n, nh trng
ngc, kh mi v ngt.
LIU LNG v CCH DNG
Nh mt git Alphagan vo mt b bnh mi ngy 2 ln. Vi bnh nhn b nhn p cao bui
chiu hoc cn kim tra thm nhn p c th nh thm mt git Alphagan vo bui chiu.
QU LIU
Cha c thng tin v qu liu ngi. Nu ung qu liu do nhm ln hay c th dng bin
php iu tr triu chng, iu tr h tr. Cn m bo s thng kh.
BO QUN
Bo qun nhit <=25oC

13.

ALVESIN 40

BERLIN CHEMIE
c/o CT TNHH DP THNH - SAIGON PHARMA
Dung dch tim truyn : chai 100 ml, 250 ml v 500 ml.
THNH PHN
cho 1000 ml
Isoleucine

2,10 g

Leucine

2,75 g

Lysine

2,00 g

Mthionine

1,75 g

Phnylalanine

3,15 g

Thronine

1,60 g

Tryptophane

0,50 g

Valine

2,25 g

Arginine

4,55 g

Histidine

1,35 g

Alanine

4,00 g

Acide aspartique

2,00 g

Acide glutamique

5,00 g

Glycine

7,00 g

Xylitol

50,00 g

Sodium actate . 3H2O

3,40 g

Potassium chlorure

1,86 g

Magnsium chlorure. 6H2O

0,51 g

Sodium hydroxyde

0,60 g

Na

40,2 mmol

25,0 mmol

Mg

2,5 mmol

Cl

43,6 mmol

Actate

25,0 mmol

Sodium disulfite

0,02 g

(Nng lng cung cp tng cng)

(1551 kj)

(Nit tng cng)

(6,3 g)

( thm thu)

(801,8 mOsm/l)

CH NH
- Nui n qua ng tnh mch d phng v iu tr thiu protine trong cc trng hp b
bng, xut huyt, hu phu.
- Nui n qua ng tnh mch cho tr s sinh v tr sinh non.
- iu chnh cc tnh trng thiu prot ine m nguyn nhn l do tng nhu cu protine hoc
tng tiu th protine hoc do ri lon cung cp protine trong qu trnh tiu ha, hp thu v
bi tit.
- C th dng c ph n c thai v cho con b.
- C th dng c bnh nhn tiu ng type I (v so vi sorbitol, xylitol trong Alvesin khng
lm tng ng huyt).
- C th dng cho bnh nhn suy thn (nhng phi cn nhc ty mc suy thn).
CHNG CH NH
- Suy thn cp.
- Tn thng t bo gan nng, tin trin.
- Chuyn ha acide amine km.
- Ng c ru (methanol).
- Tnh trng tha nc.
- Chn thng s no cp.
- Phi xem xt cn thn khi dng cho cc bnh nhn suy tim, toan chuyn ha, tng kali mu.
Khuyn co :
Khng nn dng Alvesin 40 cho cc bnh nhn bit trc l mn cm vi sulfite v dung dch
ny c cha natri disulfite.

THN TRNG LC DNG

- Khng nn dng trong cc trng hp suy thn tng kali huyt hoc chong m cha c nc
tiu trn lm sng.
- Truyn vi tc qu nhanh tr s sinh c th gy tng kali huyt, ng c ammonium.
- Dng qu liu c th gy d nc, ri lon in gii, ng c acide amine.
TNG TC THUC
- Khng nn pha trn vi cc thuc khc v c th lm tng nguy c nhim khun, bt tng
hp.
- Natri disulfite l mt hp cht rt d sinh phn ng, v vy cn lu { rng thiamine (vitamine
B1) c cho vo cng vi dung dch ny c th b phn hy.
TC DNG NGOI
i khi c th gy mt s ri lon nh nh bun nn, nn, run v gy phn ng kch thch thnh
tnh mch, him gp.
Cn c bit lu { : cc phn ng qu mn nh bun nn, tiu chy, th kh kh, cn hen cp,
ri lon tri gic hoc sc c th xy ra mt s bnh nhn b hen v dch truyn ny c cha
natri disulfite. Cc phn ng qu mn ny rt thay i : c th ch nh, nhng c th nng v
thm ch c kh nng gy t vong. Ngoi ra, hp cht c sinh ra do phn ng ca natri
disulfite vi cc thnh phn khc trong dung dch - c bit l tryptophane - c th lm tng m
trong gan, ng thi tng bilirubine v cc men gan trong huyt tng.
LIU LNG v CCH DNG
Liu lng :
Tr em : 1,5-2,5 g acide amine (tng ng ti a l 60 ml Alvesin/kg cn nng/ngy).
Ngi ln : 0,6-1,0 g acide amine (tng ng ti a l 25 ml Alvesin/kg cn nng/ngy).
Ti a : 1,3-2,0 g acide amine (tng ng ti a l 50 ml Alvesin/kg cn nng/ngy).
Trong cc trng hp c nhu cu tng thm nng lng hoc th tch, bn cnh lng Alvesin
40 c tnh ton, c th truyn b sung hoc xen k cc dung dch in gii, glucose,
ng nghch chuyn, vv.
cc bnh nhn c th n qua ng ming, th tch Alvesin dng s c gim ty theo
lng dch v s calorie cn phi cung cp.
Cch dng :
Truyn tnh mch chm, ti a 40 git/pht.
Khi u 25 git/pht, sau mt thi gian n nh s tng dn tc truyn, ti a 40 git/pht.
BO QUN
Nn nhng ni ti, nhit khng vt qu 25oC.

14.

ALVITYL comprim enrob

SOLVAY
c/o KENI - OCA
vin bao : l 50 vin.
THNH PHN
cho 1 vin
Rtinol

1500 UI

Thiamine chlorhydrate

2,5 mg

Riboflavine (di dng phosphate)

2,5 mg

Calcium pantothnate

2,5 mg

Pyridoxine chlorhydrate

0,75 mg

Biotine

0,025 mg

Acide folique

0,0625 mg

Cyanocobalamine

1,5 mg

Acide ascorbique

37,5 mg

Cholcalcifrol

150 UI

a-tocophrol actate

5 mg

Nicotinamide

12,5 mg

DC LC
Phi hp cc vitamine A, B1, B2, B5, B6, B8, B12, acide folique, C, D3, E, PP.
DC NG HC
Cc vitamine tan trong nc (B1, B2, B5, B6, B8, B12, acide folique, PP, C) c hp thu tt v o
thi qua nc tiu di dng khng thay i hoc chuyn ha.
Vitamine A c d tr gan v c o thi qua nc tiu hoc qua phn.
Vitamine D c thy phn gan v thn v c d tr gan, c v m m.
CH NH

Phng nga v iu chnh mt vi tnh trng thiu ht vitamine do ch dinh dng mt cn

i hoc khng ngi ln, thanh nin v tr em trn 6 tui.
THN TRNG LC DNG
Khng phi hp thuc ny vi cc thuc khc c cha vitamine A.
Dng vin khng thch hp cho tr em di 6 tui, tui ny nn dng Alvityl dng xir.
LC C THAI
Cc nghin cu v tc dng gy qui thai trn ng vt cho thy rng dng vitamine A c th
gy d dng bo thai.
Trn lm sng, mt vi trng hp d dng c m t khi dng di hn liu trn 25.000
UI/24 gi hoc khi dng ngn hn nhng liu cao.
Do cn thiu cc nghin cu dch t hc, khng th c kt lun chnh xc v nguy c ny trn
ngi ; cng nh ph n, khng c bng chng no v vai tr ca vitamine A trong cc
trng hp d tt bm sinh.
Tm li, trnh cung cp vitamine A trn 6.000 UI/ngy (k c trong thc n), ngoi tr khi c
nhng ch nh c th.
TNG TC THUC
liu cao, mt vi vitamine c th gy tng tc (gim tc dng ca phnytoine, barbiturate,
lvodopa).
LIU LNG v CCH DNG
Ngi ln v thanh nin : 1 n 3 vin/ngy.
Tr em t 6 n 15 tui : 1 n 2 vin/ngy.
1 vin Alvityl cha 1.500 UI vitamine A v 150 UI cholcalcifrol.
QU LIU
C th c cc biu hin d vitamine A v D nu dng lu vitamine A v D liu cao, hoc liu
cao duy nht tr cn b.

15.

AMEFERRO

AMERIPHARM
c/o O.P.V. (OVERSEAS)
Vin nn 320 mg : hp 60 vin.
THNH PHN
cho 1 vin

Gluconate st

320 mg

(tng ng vi 36 mg st nguyn t)
T dc : vi tinh th cellulose,
hydroxypropyl methylcellulose,
croscarmellose sodium, crospovidone,
stearic acid, magnesium stearate,
polyethylene glycol, silica, mu nhn to
(titanium dioxide, vng FDC#5, xanh
FDC#1), sodium lauryl sulfate, polysorbate
80.
CH NH
Phng nga v iu tr cc tnh trng thiu mu thiu st do :
- Khu phn n thiu st.
- Nhu cu st tng trong cc trng hp :
c thai
cho con b.
- Gim hp thu st sau phu thut ct d dy.
- Mt mu :
nhim giun mc
bnh l d dy-rut
giai on kinh nguyt
ngi tnh nguyn hin mu
sau phu thut.
CHNG CH NH
Cc tnh trng st.
TC DNG NGOI
Bun nn, nng rt d dy, to bn hay tiu chy. Lu { rng thuc c th gy phn mu en.
LIU LNG v CCH DNG
- Phng nga thiu mu thiu st : ung 1vin/ngy ngay trc ba n.
- iu tr thiu mu thiu st : ung 1 vin/ln, ngay trc ba n, ngy 3 ln.
Thi gian iu tr phi iu chnh tnh trng thiu mu v ngun d tr st, trung bnh 34 thng, c th lu hn nu khng gii quyt c nguyn nhn thiu mu.
QU LIU
C th gy au bng cp, ri lon tiu ha. iu tr bng deferroxamine.

16.

AMEFLU MS

AMERIPHARM
c/o O.P.V. (OVERSEAS)
Sir : chai 118 ml.
THNH PHN
cho 5 ml
Phenylpropanolamine HCl

6,25 mg

Chlorpheniramine maleate

1 mg

Dextromethorphan hydrobromide

5 mg

CH NH
Gim cc triu chng sung huyt mi, ho do au hng nh v kch thch ph qun, s mi,
nght mi, ht hi, nga mi hoc hng, nga mt v chy nc mt do st.
CHNG CH NH
Khng c s dng thuc ny trong cc bnh l :
1-Ho dai dng hoc ho mn tnh do ht thuc, hen ph qun, vim ph qun mn hoc kh ph
thng hoc khi ho km tng tit m qu mc tr phi c s hng dn ca bc s.
2-Bnh l tim mch, cao huyt p, bnh l tuyn gip, tiu ng, kh th do kh ph thng,
vim ph qun mn, hoc tiu kh do ln tin lit tuyn.
3- ang ung thuc an thn tr phi di s hng dn ca bc s, bi v khi ung chung c th
gy nn tnh trng kch ng tr em hoc gy bun ng.
CH PHNG v THN TRNG LC DNG
Gi thuc xa tm tay tr em.
Khng dng qu liu qui nh.
Ngng s dng v hi kin ca bc s trong trng hp :
- Kch ng, l m hoc kh ng
- Triu chng khng ci thin trong 7 ngy hoc km theo st, pht ban hoc nhc u dai dng
hoc nu ho ti xut hin
- Ho dai dng (bi v ho dai dng c th l du hiu ca 1 bnh l nghim trng)
Cn thn s dng thuc khi li xe hay vn hnh my mc.

LC C THAI v LC NUI CON B

Hi kin bc s trc khi s dng.
TNG TC THUC
Khng s dng thuc ny nu ang iu tr ung thuc chng trm cm IMAO. Ch s dng sau
khi ngng thuc nhm IMAO hai tun hoc sau khi hi kin ca bc s .
Cn v thuc an thn c th gia tng bun ng. Trnh dng nhng thc ung c cn trong khi
dng Ameflu MS.
LIU LNG v CCH DNG
Tui

Cn nng

Liu dng cho mi ln ung

T 2-6 tui

Di 22 kg

1 mung c ph

6-<12 tui

22-43 kg

11/2-2 mung c ph

12 tui-ngi ln

43 kg tr ln

3-4 mung c ph

Dng thuc mi 4 gi hoc 6 gi, khng qu 6 ln trong ngy.

HNG DN S DNG
1- Chai thuc c xem l nguyn vn khi cn nim bo v np v 1 ly nha c chia liu lng.
2- Tho b nim, lc chai trc khi dng.
3- M bng cch n mnh np chai xung, ng thi vn ngc chiu kim ng h.
4- Lng xi r bng ly nha c chia liu km theo.
5- Ra sch v lau kh ly nha trc v sau khi dng s dng cho ln k tip, sau ng
cht np chai thuc li.
6- Nu mun s dng phn thuc cn li cho nhng ln sau, gi chai ngn thng t lnh.
QU LIU
Trong trng hp qu liu, hy tm s gip chuyn mn hoc lin h vi Trung tm kim
sot ng c ngay lp tc.
BO QUN
Bo qun thuc nhit phng.

17.

AMEPROXEN

AMERIPHARM
c/o O.P.V. (OVERSEAS)
Vin nn 220 mg : chai 24 vin.
THNH PHN

cho 1 vin
Naproxen sodium

220 mg

CH NH
Khng vim mnh, gim au nhanh iu tr hu hiu cc bnh l :
1. Vim xng khp
2. Vim khp dng thp
3. Vim dnh ct sng
4. au nhc c
5. au lng
6. Nhc u
7. au rng
8. au bng kinh
9. Gim au nhc trong cm lnh
10. H st
11. C th s dng phi hp vi khng sinh tr vim xoang/tai mi hng.
CHNG CH NH
Vim lot d dy ang tin trin.
Nhy cm vi naproxen.
Suy gan nng.
Suy thn nng.
3 thng cui thai kz.
CH PHNG v THN TRNG LC DNG
D ng : khng s dng thuc ny khi b pht ban hoc phn ng d ng nng do s dng bt
kz thuc gim au no. Mc d khng cha thnh phn thuc nhng naproxen sodium c
th gy nn nhng phn ng tng t trn nhng bnh nhn d ng vi cc thuc gim au
khc.
Cn : ni chung nu dng 3 hoc nhiu hn nhng loi thc ung cha cn mi ngy, nn hi
kin bc s v cch s dng v thi im dng naproxen sodium v cc thuc gim au khc.
Khng nn s dng naproxen sodium lu hn 10 ngy gim au hoc hn 3 ngy h st
tr phi c s hng dn ca bc s.
Nn hi kin ca bc s trong trng hp :
- au hoc st vn ko di hoc nng hn
- hoc sng ti v tr au
- Ung thm bt kz loi thuc no khc
- C nhng tc dng ngoi khi dng thuc gim au trc y

- C bt kz triu chng mi mc hoc triu chng khng thng xuyn

- nng, kh chu hoc au d dy trong khi ang dng thuc ny.
Mc d naproxen c ch nh iu tr nhng bnh l ging nh ch nh ca aspirin,
ibuprofen v acetaminophen, nhng khng nn dng naproxen sodium chung vi cc thuc
hoc vi cc sn phm c cha naproxen ngoi tr di s hng dn ca bc s.
- Nu c thai hoc ang cho con b, nn hi kin ca bc s trc khi s dng. c bit khng
c s dng naproxen sodium trong 3 thng cui ca thai kz tr phi c s hng dn
chuyn mn, bi v thuc c th lm thai cht lu hoc gy nhng bin chng trong khi sanh.
- Cn thn trng khi bnh nhn c tin cn lo t d dy t trng.
- Cn thn trng khi s dng cho tr em di 5 tui.
Gi thuc trnh xa tm vi ca tr em.
Trong trng hp qu liu, hy tm s gip chuyn mn hoc lin h vi trung tm kim
sot ng c ngay lp tc.
TC DNG NGOI
Nhc u, bun nn, ng g, au thng v, pht ban da, nga, hen suyn.
LIU LNG v CCH DNG
a. Nhng dng vim mn tnh :
- Vim khp dng thp
- Vim xng khp
- Vim dnh ct sng
Liu tn cng :
800 - 1000 mg naproxen/ngy, chia 2 ln ung
(4 - 5 vin Ameproxen)
Liu duy tr :
400 - 500 mg naproxen/ngy, chia 2 ln ung
(2 vin Ameproxen)
Tr em trn 5 tui : 2,5-5 mg naproxen/kg x 2 ln/ngy. Tng liu < 15 mg/kg/ngy.
b. Cc bnh l{ au nhc thng thng :
- au nhc c, au lng
- Nhc u, au rng
- au bng kinh
- Gim au nhc trong cm lnh
- H st
- C th s dng phi hp vi khng sinh tr vim xoang/tai mi hng
Ngi ln :
2-3 vin/ngy, cch nhau 8-12 gi. C th dng liu u tin 2 vin, nu cn sau 12 gi ung
thm mt vin na.

Nn ung vi liu thp nht m c hiu qu

BO QUN
Bo qun thuc nhit phng, trnh qu nng trn 40oC.

18.

AMIKACIN INJECTION MEIJI

MEIJI SEIKA
c/o NOMURA
Bt pha tim 500 mg : hp 10 l.
THNH PHN
cho 1 l
Amikacine sulfate

500 mg

DC LC
Tc ng :
Amikacin l khng sinh nhm aminoglycoside bn tng hp t kanamycin A. Amikacin c hiu
lc trn hu ht cc enzym lm mt hot tnh ca cc aminoglycoside khc nh kanamycin,
gentamycin v tobramycin.
Vi sinh hc :
Vi khun gram m : In vitro, Amikacin c tc ng khng ph rng cc vi khun gram m, bao
gm cc chng khng vi kanamycin, gentamycin v tobramycin. Cc chng vi khun nhy
cm bao gm : Pseudomonas sp, Escherichia coli, Proteus sp (indole dng tnh, indole m
tnh), Providencia sp, Klebsiella pneumoniae, Enterobacter v Serratia spp, Acinebacter v
Citrobacter freundii.
Vi khun gram dng : In vitro, Amikacin c tc ng khng ph rng cc vi khun
Staphylococcus gram dng, c hoc khng sn sinh enzym penicillinase, bao gm c cc dng
khng methicillin.
CH NH
Nhim khun do vi khun nhy cm gram m v gram dng, k c Pseudomonas sp : Nhim
trng ng h hp, ng tit niu, bng v nhim trng ph khoa, nhim trng mu,
nhim trng xng v khp, v nhim trng da v cu trc da.
CHNG CH NH
Bnh nhn qu mn vi amikacin.
THN TRNG LC DNG
Amikacin c th gy tn thng tin nh. Nn theo di nh kz chc nng gan. Liu nn c
gim bnh nhn suy thn.

TC DNG NGOI
c trn tai, c trn thn.
LIU LNG v CCH DNG
Tim bp :
Ngi ln, tr ln v tr nh vi chc nng thn bnh thng : 15 mg/kg th trng/ngy chia ra
nhiu ln cch qung 8-12 gi. Tng liu hng ngy cho ngi ln khng nn vt qu 1,5 g.
Tim tnh mch :
Liu dng tng t liu tim bp. tim tnh mch, dung dch nn c tim chm trong 2-3
pht. Nu truyn tnh mch, dung dch nn c truyn trong 30-60 pht ngi ln v 1-2
gi tr em.

19.

AMIKLIN AMIKLIN

BRISTOL-MYERS SQUIBB
Bt pha tim 250 mg : hp 10 l bt + 10 ng dung mi 2 ml.
Bt pha tim 500 mg : hp 10 l bt + 10 ng dung mi 4 ml.
Dung dch tim dng trong nhi khoa 50 mg/ml : hp 20 l 1 ml.
THNH PHN
cho 1 l
Amikacine sulfate tnh theo dng base

250 mg

ng dung mi : Nc ct pha tim

2 ml

cho 1 l
Amikacine sulfate tnh theo dng base

500 mg

ng dung mi : Nc ct pha tim

4 ml

cho 1 l
Amikacine sulfate tnh theo dng base
DC LC
Amikacine l khng sinh thuc h aminoside.

50 mg

PH KHNG KHUN
Cc vi khun nhy cm thng xuyn : Staphylococcus nhy cm vi mticilline, Listeria
monocytogenes, Haemophilus influenzae, Branhamella catarrhalis, Campylobacter, Pasteurella,
Escherichia coli, Shigella, Salmonella, Citrobacter freundii, Citrobacter diversus, Proteus
mirabilis, Proteus vulgaris, Morganella morganii, Klebsiella oxytoca, Providencia stuartii,
Yersinia, Nocardia, Enterobacter cloacae, Enterobacter aerogenes, Providencia rettgeri.
Cc vi khun nhy cm khng thng xuyn : Serratia marcescens, Pseudomonas aeruginosa,
Klebsiella pneumoniae.
Cc vi khun khng : Streptococcus, Entrococcus, Pseudomonas cepacia, Xanthomonas
maltophilia, flavobacterium sp, Alcaligenes denitrificans, cc chng vi khun k kh tuyt i,
Chlamydiae, Mycoplasma, Rickettsia, Nocardia, Staphylococcus khng mticilline, Acinetobacter
baumannii.
DC NG HC
Amikacine l khng sinh c s dng bng ng tim.
Phn phi :
- Amikacine khuch tn nhanh sau khi tim.
- bnh nhn c chc nng thn bnh thng, tim bp 7,5 mg/kg (500 mg ngi ln) s cho
nng nh trong huyt thanh l 20 mg/ml sau khi tim 1 gi.
Dng liu 7,5 mg/kg bng cch truyn tnh mch lin tc trong 30 pht s cho nng trong
huyt thanh l 38 mg/ml khi kt thc t truyn.
- ngi tnh nguyn khe mnh, truyn tnh mch lin tc vi liu 15 mg/kg trong 30 pht s
cho nng trong huyt thanh khong 77 mg/ml khi kt thc t truyn v t khong 47
mg/ml v 1 mg/ml tng ng vi 1 gi v 12 gi sau .
- bnh nhn ln tui c thanh thi cratinine trung bnh l 64 ml/pht, truyn tnh mch lin
tc vi liu 15 mg/kg trong 30 pht s cho nng trong huyt thanh l 55 mg/ml khi kt thc
t truyn v t khong 5,4 mg/ml v 1,3 mg/ml tng ng vi 12 gi v 24 gi sau .
- Nhiu nghin cu dng a liu cho thy khng c hin tng tch ly bnh nhn c chc
nng thn bnh thng khi dng liu mt ln mi ngy t 15 n 20 mg/kg.
- Thi gian bn hy trong huyt thanh trung bnh l 2 gi.
- Th tch phn phi biu kin l 24 lt tng ng 28% trng lng c th.
- Sau khi tim, amikacine khuch tn nhanh trong c th :
- khong 10 n 20% nng trong huyt thanh qua mng no bnh thng, v c th tng ln
n 50% khi mng no b vim ;
- amikacine cng c tm thy trong khoang bng, trong dch mng phi, trong dch tit ph
qun vi nng tr liu (10 n 20% nng trong huyt thanh) ;
- thuc khuch tn qua nhau thai mc quan trng. Khong 20% nng amikacine trong
mu m c tm thy trong mu ca bo thai v trong nc i ;

- t l kt dnh vi prot ine di 10%.

Bi tit :
- Amikacine ch yu c o thi qua thn di dng c hot tnh. Trn 90% liu dng c
tm thy trong nc tiu trong 24 gi.
Mt liu 7,5 mg/kg s cho mt nng khong 800 mg/ml trong nc tiu trong 6 gi.
- Bn cnh s o thi qua nc tiu, mt phn rt nh amikacine cng c o thi qua mt.
CH NH
Nhim trng do vi khun Gram m c xc nh l nhy cm, nht l cc nhim trng thn
v ng tit niu.
C th phi hp aminoside vi mt khng sinh khc trong mt s trng hp nhim khun do
vi khun nhy cm da vo cc d liu vi khun hc, c bit trong cc biu hin nhim trng
thn, h tit niu v sinh dc, nhim trng huyt v vim ni tm mc, vim mng no (c th
h tr thm bng liu php ti ch), nhim khun h hp, ngoi da (nhim trng da c tnh do
Staphylocoque mt), nhim khun khp.
CHNG CH NH
- D ng vi khng sinh h aminoglycoside.
- Nhc c.
- Phi hp vi mt khng sinh khc cng thuc h aminoside : xem Tng tc thuc.
CH PHNG v THN TRNG LC DNG
Nhm aminoside c c tnh trn thn v tai, do cn phi thn trng khi s dng :
- theo di chc nng thn v thnh gic v kim tra thng xuyn nng khng sinh trong
huyt thanh.
- trng hp bnh nhn b suy thn, ch dng amikacine khi tht cn thit v cn iu chnh liu
ty theo thanh thi cratinine.
- i vi bnh nhn c ri lon tin nh v c tai, ch nn dng amikacine sau khi cn
nhc li v hi.
- trnh dng thuc lp i lp li v/hoc k o di, c bit ngi ln tui.
- cn thn khi phi hp amikacine vi thuc li tiu mnh.
- nu c can thip phu thut, cn bo cho chuyn vin gy m hi sc bit bnh nhn ang
c iu tr bng thuc ny.
LC C THAI
Tnh v hi ca amikacine trong thai kz cha c xc lp (c th c c tnh i vi c quan c
tai-tin nh ca thai nhi).
LC NUI CON B
Amikacine qua c sa m.
TNG TC THUC
Chng ch nh phi hp :

- Phi hp vi mt khng sinh khc cng thuc h aminoside : c nguy c tng c tnh trn
thn v tai.
Khng nn phi hp :
- Polymyxine (dng tim) : cng thm c tnh trn thn. Ch phi hp khi c s gim st cht
ch v kt qu khng sinh i hi cn phi phi hp hai khng sinh ny.
- c t ca Clostridium botulinum : aminoside c th lm tng tc dng ca c t ca
Clostridium botulinum. Nn s dng mt khng sinh khc.
Thn trng khi phi hp :
- Cfalotine : kh nng c falotine lm tng c tnh trn thn ca aminoside cn ang c
tranh ci. Theo di chc nng thn.
- Thuc gin c loi curare : tc dng curare tng khi khng sinh c s dng bng ng tim
v/hoc ng phc mc ; trc khi, trong khi hoc sau khi s dng thuc c tc dng curare.
Theo di mc ca tc dng curare vo cui giai on gy m.
- Thuc li tiu quai (bum tanide v furos mide) : tng nguy c gy c tnh trn thn v tai
ca aminoside (do thuc li tiu c th gy mt nc dn n suy thn chc nng).
C th phi hp nhng cn theo di tnh trng nc ca c th, chc nng thn v chc nng
c tai-tin nh v nu cn, kim tra nng aminoside trong huyt tng.
Lu { khi phi hp :
- Dng cc aminoside k tip nhau : lu { nguy c c tnh trn tai do tch ly thuc (dng qua
ng ti ch hay ng ton thn).
- Amphot ricine B : c nguy c tng c tnh trn thn.
- Ciclosporine : cratinine huyt tng cao hn so vi ciclosporine dng mt mnh (do hip ng
c tnh trn thn).
TC DNG NGOI
- c tnh trn thn : suy thn th pht sau khi s dng aminoside, trong a s trng hp, c
lin quan n vic dng liu qu cao hoc thi gian iu tr qu di, tn thng thn c t
trc, ri lon huyt ng hoc phi hp vi cc thuc c bit l gy c cho thn.
- c tnh trn tai : tn thng th pht do dng aminoside d xy ra khi dng liu hng ngy
qu cao, thi gian iu tr ko di, c suy thn sn, nht l suy thn chc nng ngi gi, hay
do phi hp vi cc thuc gy c trn tai.
- Phn ng d ng nh (pht ban, ni my ay), s t khi khi ngng iu tr.
LIU LNG v CCH DNG
Khng tim tnh mch trc tip.
C th tim 1 ln/ngy i vi cc trng hp sau :
- bnh nhn di 65 tui.
- bnh nhn c chc nng thn bnh thng.
- khi thi gian iu tr khng qu 10 ngy

- khng b gim bch cu a nhn trung tnh.

- khi loi tr c nhim khun Gram dng.
- i vi nhim khun Gram m (ngoi tr Pseudomonas v Serratia).
Trong trng hp khc, th tim 2 ln/ngy.
Tim bp hoc tim truyn tnh mch trong vng 30 n 60 pht (sau khi ha tan trong dung
dch ng trng NaCl hoc glucose vi nng 500 mg/200 ml) :
- Liu thng thng :
Ngi ln/Tr em/Tr cn b : 15 mg/kg/ngy, chia lm 1 n 3 ln ngi ln v tr em.
- Nhim trng ng tiu khng c bin chng :
Ngi ln/Tr em/Tr cn b : c th dng na liu.
- Nhim trng nng :
Ngi ln : ti a 1,5 g/ngy, v ti a 15 g cho mt t tr liu.
Tim di da : 15 mg/kg/ngy, chia lm 2 hoc 3 ln.
Tim trong ct sng : 0,5 mg/kg, tim mt ln mi 48 gi ; tim lp li 3 hoc 4 ln, sau khi
v khun ha dch no-ty.
Suy thn : 7,5 mg/kg ln tim u tin ; tim lp li sau mi thi gian c tnh nh sau :
T' = 3 T1/2 (T1/2 = 0,3 x cratinine huyt tnh theo mg/l).
TNG K
Trnh pha amikacine trong cng mt chai vi thuc khc, nht l vi khng sinh h btalactamine.
QU LIU
Trong trng hp qu liu hay c phn ng ng c, thm phn mu hoc thm phn phc
mc gip o thi nhanh Amiklin.
BO QUN
- Sau khi pha vi dung mi thch hp, dung dch Amiklin n nh trong 12 gi nhit phng
v trong 10 ngy nhit t lnh.
- Amiklin n nh trong 24 gi khi pha trong cc dung dch NaCl 0,9%, glucose ng trng 5%,
glucose 10%.

20.

AMINOPLASMAL 5% - 10% E

B. BRAUN
Dch truyn 5% : chai 250 ml, 500 ml.
Dch truyn 10% : chai 250 ml, 500 ml.

THNH PHN
Aminoplasmal 5% E :
cho 1000 ml dch truyn
Isoleucine

2,55 g

Leucine

4,45 g

Lysine hydrochloride

3,50 g

ng vi : Lysine

2,80 g

Methionine

1,90 g

Phenylalanine

2,55 g

Threonine

2,05 g

Tryptophane

0,90 g

Valine

2,40 g

Arginine

4,60 g

Histidine

2,60 g

Glycine

3,95 g

Alanine

6,85 g

Proline

4,45 g

Aspartic acid

0,65 g

Asparagine H2O

1,86 g

ng vi : Asparagine

1,64 g

Acetylcysteine

0,34 g

ng vi : Cysteine

0,25 g

Glutamic acid

2,30 g

Ornithine hydrochloride

1,60 g

ng vi : Ornithine

1,25 g

Serine

1,20 g

Tyrosine

0,30 g

Acetyltyrosine

0,43 g

ng vi : Tyrosine

0,35 g

Sodium acetate - 3H2O

3,95 g

ng vi : Potassium acetate

2,45 g

Magnesium acetate - 4H2O

0,56 g

Sodium dihydrophosphate - 2H2O

1,40 g

Sodium hydroxyde

0,20 g

L-Malic acid

1,01 g

Nc ct pha tim va

1000 ml

in gii (mmol/l) :
Sodium

43

Potassium

25

Magnesium

2,6

Acetate

59

Chloride

29

Dihydrophosphate

9,0

L-Malate

7,5

Tng s amino acid

50

Tng s nitrogen (g/l)

Gi tr nng lng :
(kJ/l)

835

(kcal/l)

200

p sut thm thu (mOsm/l)

590

Aminoplasmal 10% E :
cho 1000 ml dch truyn
Isoleucine

5,10 g

Leucine

8,90 g

Lysine hydrochloride

7,00 g

ng vi : Lysine

5,60 g

Methionine

3,80 g

Phenylalanine

5,10 g

Threonine

4,10 g

Tryptophan

1,80 g

Valine

4,80 g

Arginine

9,20 g

Histidine

5,20 g

Glycine

7,90 g

Alanine

13,70 g

Proline

8,90 g

Aspartic acid

1,30 g

Asparagine H2O

3,72 g

ng vi : Asparagine

3,27 g

Acetylcysteine

0,68 g

ng vi : Cysteine

0,50 g

Glutamic acid

4,60 g

Ornithine hydrochloride

3,20 g

ng vi : Ornithine

2,51 g

Serine

2,40 g

Tyrosine

0,30 g

Acetyltyrosine

1,23 g

ng vi : Tyrosine

1,00 g

Sodium acetate - 3H2O

3,95 g

Potassium acetate

2,45 g

Magnesium acetate - 4H2O

0,56 g

Sodium dihydrophosphate - 2H2O

1,40 g

Sodium hydroxyde

0,20 g

L-Malic acid

1,01 g

Nc ct pha tim va

1000 ml

in gii (mmol/l) :
Sodium

43

Potassium

25

Magnesium

2,6

Acetate

59

Chloride

57

Dihydrophosphate

9,0

L-Malate

7,5

Tng s amino acid

100

Tng s nitrogen (g/l)

16

Gi tr nng lng :
(kJ/l)

1675

(kcal/l)

400

p sut thm thu (mOsm/l)

1030

TNH CHT
Trong tnh trng bnh l{, c th bnh nhn khng th hon ton tng hp cc acid amin t 8
acid amin thit yu. Dch truyn cha tt c cc acid amin cn thit do lm gim tiu hao
nng lng do cc phn ng tng hp acid amin.
T l hm lng cc acid amin trong dch truyn cn bng, hp l da trn mc dung np
ca c th. T l ny gip gia tng ng ha : b p nhanh v gim thiu nit m tnh v gi
cn bng acid amin ni mi.
Dch truyn khng cha sulfit do trnh c cc phn ng ph do sulfit, c bit trn c a
bnh nhn hen suyn nng, v khng gy c tnh gan...
Dch truyn khng cha carbohydrate, khng c xylitol do c th trnh cc phn ng ph
ca xylitol nh bun nn, tiu chy, to tinh th oxalat ng thn, no v c th gy t vong.
S vng mt ca sorbitol trong thnh phn cng lm trnh c cc ri lon chuyn ha trn
mt s t bnh nhn c c a khng hp thu sorbitol v thiu men fructose-1 phosphate
aldolase hoc fructose 1-6 diphosphatase.
CH NH
Nui dng bng ng tnh mch.
CHNG CH NH
Ri lon chuyn ha acid amin, toan huyt, qu ti nc, kali huyt cao.

THN TRNG LC DNG

Thng xuyn theo di cn bng nc, ion ca huyt thanh, glucose huyt v p sut thm
thu huyt thanh.
TC DNG NGOI
Khng c tc dng ngoi { no c ghi nhn nu theo ng cc ch dn v Chng ch nh, Liu
lng v Thn trng lc dng.
LIU LNG v CCH DNG
Loi 5% E

Loi 10% E

Liu (ml/kg th trng/ngy)

40

20

Tc truyn (ml/kg th trng/gi)

21.

AMINOSTERIL 5%

FRESENIUS
c/o CT TNHH DP HONG KHANG
Dung dch tim truyn : chai 250 ml, thng 10 chai ; chai 500 ml, thng 10 chai ; chai 1000 ml,
thng 6 chai.
THNH PHN
cho 1000 ml
L-Isoleucine

2,50 g

L-Leucine

3,70 g

L-Lysine acetate

4,654 g

L-Methionine

2,15 g

L-Phenylalanine

2,55 g

L-Threonine

2,20 g

L-Tryptophan

1,00 g

L-Valine

3,10 g

L-Arginine

4,50 g

L-Histidine

1,50 g

Glycine

5,00 g

L-Alanine

7,00 g

L-Proline

5,06 g

L-Serine

3,25 g

Acetyltyrosine

1,038 g

Taurine

0,10 g

L-Ornithine L-Aspartate

2,30 g

Acid acetic

1,837 ml

Amino acid ton phn

50 g/l

Nitrogen ton phn

7,95 g/l

Nng lng cung cp ton phn

200 kcal/l

Nng thm thu

483 mosmol/l

TNH CHT
- Dung dch 5% acide amine dng nui dng ng tnh mch.
- Khng cha cht in gii v carbohydrate.
- Nitrogen ton phn 7,95 g/l, nng 483 mosmol/l.
- Aminosteril 5% l dung dch acid amin u tin dng cho ngi ln c cha taurine, gip bnh
nhn c mt ch nui dng qua ng tnh mch hp l nht.
- Taurine ng vai tr quan trng trong vic chuyn ha acid mt, n nh mng t bo v c
nhng tc dng chng c.
- S thiu ht taurine c th xy ra nhng bnh nhn sau khi phu thut.
- Taurine c vai tr tim n quan trng trong s chng li s mt do nui n bng ng tnh
mch ton phn.

- Aminosteril 5% khng cha acid glutamic, cht ny c nhng tc dng gy c thn kinh v c
th gy tn thng no th pht.
- Aminosteril 5% c th c tim qua ng tnh mch ngoi bin
- Aminosteril 5% l ngun cung cp hp l cc acid amin cn thit v khng cn thit, khng
cha Na bisulfite.
CH NH
Aminosteril 5% c ch nh duy tr hoc ci thin s cn bng Nitrogen nhng bnh
nhn b thiu protein khi khng th hoc khng thch hp vi ng ung. Nhng trng hp
ny bao gm : chn thng nng, phng, nhim trng huyt, iu tr trc hoc sau phu
thut, nhng bnh l v d dy-rut. Aminosteril 5% nn c tim truyn vi mt lng thch
hp, c lp vi cc cht : carbohydrate, cht bo dng huyn dch v cc cht in gii.
Aminosteril 5% cng c th c dng nui dng mt phn bng ng tnh mch.
CHNG CH NH
Chng ch nh Aminosteril nhng bnh nhn b tn thng gan bt hi phc hoc urea mu
tng cao.
THN TRNG LC DNG
Aminosteril 5% nn c dng mt cch cn thn trong iu kin bnh nhn b ri lon chuyn
ha amino acid, b toan chuyn ha, chc nng thn b suy, chc nng gan b suy, suy tim mt
b, tnh trng tha nc, h kali mu v h natri mu. Cn bng nc-in gii phi c theo
di st.
LIU LNG v CCH DNG
Do dung dch Aminosteril 5% c thm thu thp nn c th c dng truyn ng tnh
mch ngoi vi. Th tch dch truyn v tc truyn nn c ch nh ty theo mi c nhn,
ph thuc vo tnh trng lm sng, nhu cu, tui tc v cn nng. Vic iu tr nn c theo
di st. Vic theo di cc vitamine v cc nguyn t vi lng l c bit quan trng nhng
bnh nhn c nui n bng ng tnh mch ton phn di ngy.
Ngi ln (k c ngi cao tui) : ngh chung i vi nhu cu amino acid l :
- Phu thut nh : 1-1,2 g/kg/ngy ;
- Phu thut ln, chn thng nng, nhim trng huyt : 1,2-1,5 g/kg/ngy ;
- D ha nng v d bng, thiu ht protein nghim trng : >= 2 g/kg/ngy.
Tr em :
tr em trn 5 tui c th dng cng liu nh ngi ln. Liu ti a mi ngy cho tt c cc dng
trn l 2 g amino acid/kg/ngy. Tc truyn ti a c ngh l : 0,1 g amino acid/kg/gi.
Thi gian dng ph thuc vo nhu cu ca bnh nhn.
BO QUN
Bo qun di 25oC, trnh nh sng.

Ch dng dung dch trong v chai ng cn nguyn. Khng dng qu hn s dng. xa tm tay
vi ca tr con.

22.

AMINOSTERIL N-HEPA 5%

FRESENIUS
c/o CT TNHH DP HONG KHANG
Dung dch tim truyn : chai 250 ml, thng 10 chai - chai 500 ml, thng 10 chai.
THNH PHN
cho 1000 ml
L-Isoleucine

10,40 g

L-Leucine

13,09 g

L-Lysine monoacetate

9,71g

tng ng :L-Lysine

6,88 g

L-Methionine

1,10 g

Acetylcysteine

0,70 g

tng ng : L-Cysteine

0,52 g

L-Phenylalanine

0,88 g

L-Threonine

4,40 g

L-Tryptophan

0,70 g

L-Valine

10,08 g

L-Arginine

10,72 g

L-Histidine

2,80 g

Aminoacetic acid

5,82 g

L-Alanine

4,64 g

L-Proline

5,73 g

L-Serine

2,24 g

Acid acetic bng

4,42 g

Nitrogen ton phn

12,9 g/l

TNH CHT
- Dung dch acid amin nui dng ng tnh mch thch hp cho bnh nhn b suy gan.
- Dung dch 5%, khng c cht in gii v carbohydrate.
- c c ch b tr s ri lon acid amin trong suy gan.
- L s cung cp thng bng cc acid amin khng ch yu, c 42% chui acid amin phn nhnh
v ch c 2% acid amin thm.
- n nh nng acid amin trong mu.
- Khng lm tng urea mu.
- nh hung tt ln trng thi thn kinh.
- Ci thin cn bng nitrogen.
CH NH
Ngun cung cp acid amin bng ng tnh mch trong cc trng hp bnh nhn b suy gan
nng c hoc khng c bnh l{ no, iu tr hn m gan.
CHNG CH NH
- Ri lon chuyn ha acid amin.
- Cc tnh trng gy ra bi truyn dch qu mc.
- H natri mu, h kali mu.
- Suy thn.
- Suy tim nng.
THN TRNG LC DNG
Hin cha c nhng s liu lin quan n vic dng thuc ph n c thai v tr con.
TC DNG NGOI
Dng bng ng tnh mch, Aminosteril N-Hepa c th lm gia tng s sn xut acid gastric v
lot d dy do stress. V vy, nn kim tra cn nhc rng c nn s dng thuc khng
histamine H2 nh l mt bin php phng nga hay khng.
LIU LNG v CCH DNG
- Truyn tnh mch : 1,7-2,1 ml/kg/gi, v d 40-50 git/pht ngi 70 kg.

- Liu ti a : 1,5 g acid amin/kg/ngy, tng ng 2100 ml/ngy ngi 70 kg.

Lu { : Kim tra thng xuyn cn bng nc-in gii v cn bng acid-base. Cc cht
carbohydrate v in gii phi c a vo vi mt t l cn bng, c th dng b phn hnh
ch Y.
Thi gian iu tr : theo i hi ca vic iu tr.
BO QUN
Bo qun di 25oC, trnh nh nng.
Khng dng qu hn s dng ghi trn nhn.
Khng dng nu dung dch b c hoc chai ng b hng.
thuc xa tm tay vi ca tr con.

23.

AMITASE

DONGKWANG
c/o IC VIET NAM
Vin nn bao phim tan trong rut 10 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Serratio peptidase

10 mg

tng ng :

20.000 n v

DC LC
Enzyme chng vim, gim sng n.
CH NH
Khoa ngoi : Tnh trng vim sau phu thut v chn thng. Ph v sng do vim bnh nhn
tr ni hay ngoi. Kh khc m sau khi gy m.
Khoa TMH : Vim xoang cp hay mn, vim tai gia cp hay mn, vim hng, sau th thut m
xoang.
Khoa nha v phu thut vng ming : Vim ti li rng khn, v p-xe rng.
Khoa ni : iu tr ng thi vi khng sinh trong cc tnh trng nhim trng. Kh khc m
trong cc bnh sau : vim ph qun, hen ph qun v iu tr ng thi vi cc thuc tr lao
trong lao phi.

Ph khoa : Xung huyt v, th thut ct m h, vim v sau khi phu thut.

Khoa niu : Vim bng quang, vim mo tinh hon.
Khoa mt : Xut huyt mt, m c thy tinh th.
THN TRNG LC DNG
Bnh nhn ri lon ng mu, ri lon chc nng gan hay thn nng.
TC DNG NGOI
Nh v him gp : tiu chy, bing n, kh chu d dy, bun nn, nn, ni mn.
LIU LNG v CCH DNG
Thng thng : mi ln ung 1 vin, ngy 3 ln, sau cc ba n. Ung nguyn vin, khng nhai.
Liu c th tng ty theo tnh trng bnh.

24.

AMLOR

PFIZER
c/o ZUELLIG
Vin nang 5 mg : hp 30 vin.
THNH PHN
cho 1 vin nang
Amlodipine besylate, tnh theo
amlodipine

5 mg

DC LC
Amlodipine l cht c ch dng ion calcium (cht c ch knh calcium chm hay cht i khng
ion calcium) v c ch dng ion calcium i qua mng t bo vo c tim v c trn mch mu.
C ch h huyt p ca amlodipine da trn tc dng lm gin trc tip c trn mch mu. C
ch chnh xc lm gim au tht ngc ca amlodipine cha c xc nh hon ton nhng
amlodipine lm gim ton b gnh nng thiu mu cc b bng hai tc ng di y.
- Amlodipine lm gin tiu ng mch ngoi bin v do lm gim tng khng ngoi bin (hu
ti), tc ng trn sc lm vic ca tim. Do nhp tim n nh, tc ng gim ti ny ca tim lm
gim tiu th nng lng ca c tim v gim nhu cu oxy.
- C ch tc ng ca amodipine cng c th lin quan n s gin cc ng mch vnh v tiu
ng mch vnh chnh yu, trn c vng thiu mu ln vng bnh thng. S gin mch ny
lm gia tng cung cp oxygen cho c tim bnh nhn co tht ng mch vnh (hi chng

Prinzmetal v au tht ngc khng n nh) v lm gim nguy c gy co mch vnh do ht

thuc l .
bnh nhn cao huyt p, dng amlodipine mi ngy mt ln lm gim huyt p, c t th
nm nga ln t th ng, ng k trn lm sng trong sut 24 gi. Do khi pht tc ng
chm, amlodipine khng gy h huyt p cp.
bnh nhn b au tht ngc, dng amlodipine mt ln mi ngy lm tng tng thi gian hot
ng, tng thi gian khi pht au tht ngc, v tng thi gian sng T chnh xung 1 mm,
gim c s cn au tht ngc ln s lng nitroglycerin phi dng.
Cc nghin cu in vitro cho thy c khong 97,5% amlodipine trong tun hon gn kt vi
protein huyt tng.
Amlodipine khng c lin quan vi cc tc dng ngoi trn chuyn ha hay thay i lipid trong
huyt tng v s dng thch hp cho nhng bnh nhn hen ph qun, tiu ng, v thng
phong. Cc nghin cu dc ng hc vi cyclosporin chng minh amlodipine khng lm
thay i ng k dc ng hc cyclosporin.
Cc nghin cu huyt ng hc da trn hot ng th lc c kim sot nhng bnh nhn
suy tim NYHA Nhm II-IV cho thy amlodipine khng lm xu i tnh trng lm sng, c
nh gi bng s chu ng tp luyn th lc, phn sut tng mu tht tri v triu chng lm
sng.
Mt nghin cu c kim sot gi dc (PRAISE) c thit k nh gi bnh nhn suy tim
mn tnh NYHA Nhm III-IV dng digoxin, thuc li tiu v thuc c ch men chuyn cho
thy amlodipine khng gy tng nguy c t vong hay phi hp t sut v bnh sut nhng
bnh nhn suy tim.
DC NG HC
Hp thu :
Sau khi ung liu iu tr, amlodipine c hp thu tt vi nng nh trong mu t c
sau 6-12 gi. Sinh kh dng tuyt i c c lng vo khong 64-80%. Th tch phn phi
khong 21 L/kg. S hp thu amlodipine khng b nh hng bi thc n.
Chuyn ha sinh hc/o thi :
Thi gian bn thi cui cng trong huyt tng l khong 35-50 gi v n nh vi liu mt ln
mi ngy. Nng n nh trong huyt tng t c sau 7-8 ngy iu tr lin tc.
Amlodipine c chuyn ha rng ri gan thnh cc cht chuyn ha bt hot v bi tit qua
nc tiu 10% cht ban u v 60% cc cht chuyn ha.
CH NH
Amlodipine c ch nh nh iu tr khi u trong cao huyt p v c th dng nh thuc
duy nht kim sot huyt p cho a s bnh nhn. Bnh nhn khng c kim sot y
vi mt thuc h huyt p c th dng b sung amlodipine, l thuc c dng kt hp vi
thuc li tiu thiazide, thuc c ch a, thuc c ch th th bta-adrenergic, hay thuc c ch

men chuyn.
Amlodipine c ch nh nh iu tr khi u trong thiu mu c tim, do tc nghn mch
vnh c nh (au tht ngc n nh) v/hoc co tht mch/co mch (au tht ngc khng n
nh hoc hi chng Prinzmetal) ca mch vnh. Amlodipine c th s dng khi biu hin lm
sng gi c co tht mch/co mch nhng khng xc nh chc chn. Amlodipine c th dng
ring r, nh mt n liu php, hay kt hp vi cc thuc chng au tht ngc khc nhng
bnh nhn au tht ngc iu tr tht bi vi nitrate v/hoc cc thuc c ch bta d dng
liu .
CHNG CH NH
Amlodipine chng ch nh bnh nhn c qu mn bit vi dihydropyridine hay vi bt c
thnh phn no ca thuc.
CH PHNG v THN TRNG LC DNG
S dng cho bnh nhn suy gan :
Cng nh tt c cc thuc i khng calcium, thi gian bn hy ca amlodipine ko di nhng
bnh nhn suy gan v cha xc nh c liu khuyn co. Do , nn dng thuc cn thn
nhng bnh nhn ny.
S dng cho bnh nhn suy thn :
Amlodipine c chuyn ha rng ri thnh cc cht khng c hot tnh vi 10% c o thi
di dng khng i trong nc tiu. Cc thay i v nng trong huyt tng ca
amlodipine khng lin quan n mc suy thn. Amlodipine c th s dng cho nhng bnh
nhn ny vi liu thng thng. Amlodipine khng th thm phn c.
S dng cho ngi gi :
Thi gian t n nng ti a trong huyt tng ca amlodipine ngi gi cng ging
ngi tr tui. Thanh thi amlodipine c khuynh hng gim do dn n h qu l tng AUC
v thi gian bn thi ngi gi. S gia tng AUC v thi gian bn thi bnh nhn suy tim
sung huyt cng ph hp d bo nhng bnh nhn trong nhm tui nghin cu. Amlodipine
s dng vi liu ging nhau cho ngi gi v ngi tr cng u c dung np tt nh nhau.
Do , liu lng thng thng cng c th dng cho ngi gi.
S dng cho tr em :
Cha xc nh c hiu qu v tnh an ton ca amlodipine tr em.
LC C THAI v LC NUI CON B
Tnh an ton ca amlodipine trong thai kz hay lc nui con b ngi cha c xc nh.
Amlodipine khng th hin c tnh trong nghin cu sinh sn th vt ngoi tc dng lm
chm chuyn d v ko di cuc sanh chut cng vi liu lng cao hn gp 50 ln liu ti a
c khuyn co cho ngi. Do , ch s dng thuc trong thai kz khi khng c thuc thay th
no khc an ton hn v khi bn thn bnh gy nguy c cao hn cho ngi m v thai nhi.
TNG TC THUC

Amlodipine c dng mt cch an ton vi thuc li tiu thiazide, thuc c ch a, thuc c

ch bta, thuc c ch men chuyn, nitrate tc dng ko di, nitroglycerin ngm di li,
thuc khng vim khng steroid, khng sinh v thuc h ng huyt ung.
Cc nghin cu cho thy rng s s dng amlodipine vi digoxin khng lm thay i nng
digoxin trong huyt thanh hay thanh thi digoxin thn ca ngi tnh nguyn khe mnh, v
khi s dng ng thi vi cimetidine khng lm thay i dc ng ca amlodipine.
Cc s liu nghin cu in vitro vi huyt tng ngi chng minh rng amlodipine khng c
tc dng trn s gn kt vi protein ca cc thuc th nghim (digoxin, phenytoin, warfarin hay
indomethacin).
nam gii tnh nguyn khe mnh, s dng ng thi amlodipine khng lm thay i ng k
tc dng ca warfarin trn thi gian prothombin.
TC DNG NGOI
Amlodipine c dung np tt. Trong cc th nghim lm sng c kim sot trn cc bnh
nhn cao huyt p hay au tht ngc, tc dng ngoi { thng gp nht l nhc u, ph n,
mt mi, bun ng, bun nn, au bng, bng mt, nh trng ngc v chng mt. Trong cc
th nghim lm sng ny, khng quan st thy mu bt thng xt nghim no c { ngha lm
sng lin quan n amlodipine.
Tc dng ngoi t gp hn quan st c trong qu trnh thuc lu hnh l thay i thi quen
v sinh, au khp, d cm, kh tiu, kh th, tng sn li, chng to v nam gii, bt lc, tng
s ln i tiu, gim bch cu, mt mi, thay i tnh tnh, kh ming, co tht c, au c, nga
ngy, ni ban, ri lon th gic v him khi c ban a dng.
Vng da v tng men gan t khi c bo co (hu ht u ging nh chng mt). Mt vi
trng hp nng phi nhp vin c bo co l c lin quan n s s dng amlodipine.
Trong nhiu trng hp, mi lin quan ny khng r rng.
Cng nh cc thuc c ch knh calcium khc, cc tc dng ngoi { sau c bo co him khi
xut hin v khng th phn bit vi tin trnh t nhin ca bnh : nhi mu c tim, ri lon
nhp tim (bao gm nhp nhanh tht v rung nh) v au ngc.
LIU LNG v CCH DNG
Liu khi u thng dng cho cao huyt p v au tht ngc l 5 mg amlodipine mi ngy
mt ln v c th tng cho n liu ti a l 10 mg ty theo p ng ca tng bnh nhn.
Khng cn iu chnh liu khi dng thuc ng thi vi thuc li tiu thiazide, thuc c ch
bta, v thuc c ch men chuyn.
QU LIU
ngi, kinh nghim khi dng qu liu do c cn gii hn. Trong mt s trng hp, ra d
dy c th hu ch. Cc s liu hin c gi rng qu liu vi lng ln c th dn n gin
mch ngoi vi qu vi h qu h huyt p ton thn r rt v c kh nng k o di. Tc dng
h huyt p nh hng n tnh trng lm sng do qu liu amlodipine cn bin php h tr

tim mch tch cc bao gm kim tra thng xuyn chc nng tim v h hp, k cao t chi, v
theo di th tch dch tun hon v lng nc tiu. Nu khng c chng ch nh, mt cht co
mch c th gip phc hi trng lc mch mu v huyt p. C th tim tnh mch calcium
gluconate hi phc li tc dng chn knh calcium. Do amlodipine gn kt cht ch vi
protein, thm phn hu nh khng mang li kt qu.

25.

AMOCLAVIC - AMOCLAVIC FORTE

HIKMA
c/o O.P.V. (OVERSEAS)
Amoclavic :
Vin nn 375 mg : chai 20 vin.
Hn dch 156 mg/5 ml : chai 60 ml.
Amoclavic Forte :
Vin nn 625 mg : chai 15 vin.
Hn dch 312 mg/5 ml : chai 60 ml.
THNH PHN
Amoclavic :
cho 1 vin
Amoxicilline (trihydrate)

250 mg

Acid clavulanic (potassium)

125 mg

cho 5 ml
Amoxicilline (trihydrate)

125 mg

Acid clavulanic (potassium)

31,25 mg

Amoclavic Forte :
cho 1 vin

Amoxicilline (trihydrate)

500 mg

Acid clavulanic (potassium)

125 mg

cho 5 ml
Amoxicilline (trihydrate)

250 mg

Acid clavulanic (potassium)

62,5 mg

TNH CHT
Amoclavic l thuc phi hp hai khng sinh dng theo ng ung gm : amoxycillin, mt
khng sinh bn tng hp ph rng v acid clavulanic l mt cht c ch men b-lactamase, ng
thi bo v amoxycillin khi s ph hy v mt hiu lc bi b-lactamase, mt men do rt nhiu
loi vi khun Gram dng v Gram m tit ra. S phi hp ny m rng ph khng khun ca
amoxycillin cho php tc dng vi c nhng nhng dng vi khun sinh b-lactamase. Sau khi
ung Amoclavic, amoxycillin v acid clavuclanic u c hp thu tt trong ng tiu ho.
CH NH
Amoclavic l khng sinh dit khun ph rng bao gm nhiu dng vi khun Gram dng v
Gram m sinh hay khng sinh b-lactamase :
Gram dng : Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes,
Streptococcus pneumoniae, Streptococcus viridans, Streptococcus faecalis, Bacillus anthracis,
Corynebacterium sp., Listeria monocytogenes, Clostridium sp., Peptococcus sp.,
Peptostreptococcus sp.
Gram m : Haemophilus influenzae, Haemophilus ducreyi, Branhamella catarrhalis, Escherichia
coli, Proteus mirabilis, Proteus vulgaris, Klebsiella sp., Salmonella sp., Shigella sp., Bordetella
pertusis, Yersinia enterocolitica, Gardnerella vaginalis, Brucella sp., Neisseria meningitidis,
Neisseria gonorrhoeae, Pasteurella multocida, Campylobacter jejuni, Vibrio cholerae,
Bacteroides sp. k c B. fragilis.
Nh vy, Amoclavic v Amoclavic Forte c ch nh iu tr trong :
- Nhim trng ng h hp trn : vim amian, vim xoang, vim tai gia.
- Nhim trng ng h hp di : vim ph qun cp v mn, vim phi thuz, vim ph qun
phi v p xe phi.
- Nhim trng ng tit niu : vim niu o, vim bng quang, vim i b thn, ph thai
nhim trng, nhim trng vng chu, h cam, lu.
- Nhim trng da v m mm : vim m t bo, vt thng nhim trng, p xe.
- Nhim trng khc : vim xng ty, nhim trng huyt, vim phc mc, nhim trng hu

phu, nhim trng bng.

CHNG CH NH
Qu mn vi nhm penicillin.
CH PHNG
Trc khi dng khng sinh nhm penicillin, cn lu { tin s d ng, phi ngng thuc khi c
du hiu d ng v cn phi iu tr thch hp ngay.
THN TRNG LC DNG
Thn trng khi dng Amoclavic nhng ngi b suy gan nng. Cn phi chnh liu nhng
bnh nhn suy thn trung bnh hay nng.
Amoclavic c thi qua sa m (vi lng nh) do cn phi dng thn trng khi cho con
b. Tnh an ton khi s dng cho ph n c thai cha c cng nhn, tuy nhin cc nghin
cu trn sc vt th nghim th cha thy hin tng sinh qui thai.
TC DNG NGOI
Amoclavic thng c dung np tt. Phn ln cc tc dng ngoi ch thong qua, bao gm :
tiu chy, kh tiu, bun nn, nn, mn da, hng ban, vim gan v vng da mt.
LIU LNG v CCH DNG
Amoclavic nn c s dng cch xa ba n.
Ngi ln v tr ln trn 12 tui :
- Nhim trng nh v trung bnh : mt vin Amoclavic (375 mg) ba ln mi ngy.
- Nhim trng nng : mt vin Amoclavic Forte (625 mg) ba ln mi ngy hay hai vin Amoclavic
(375 mg) ba ln mi ngy.
Tr em :
- Nhim trng nh v trung bnh :
7-12 tui : 10 ml Amoclavic hn dch (156 mg/5 ml) ba ln mi ngy hay 5 ml Amoclavic Forte
hn dch (312 mg/5 ml) ba ln mi ngy.
2-7 tui : 5 ml Amoclavic hn dch (156 mg/5 ml) ba ln mi ngy.
9 thng n 2 tui : 2,5 ml Amoclavic hn dch (156 mg/5 ml) ba ln mi ngy.
- Nhim trng nng : Tng liu gp i.
Trong trng hp suy thn :
- Ngi ln : Khi suy thn nh ( thanh thi creatinine 30 ml/pht) khng cn chnh liu ; khi
suy thn trung bnh ( thanh thi creatinine 10-30 ml/pht) liu 375-750 mg mi 12 gi ; khi
suy thn nng ( thanh thi creatinine < 10 ml/pht) liu dng khng vt qu 375 mg mi 12
gi.
- Tr em : Chnh liu tng t ngi ln.
Cch chun b hn dch Amoclavic : p chai v lc mnh bt phn tn u. Thm vo mt
na th tch nc nh ghi trn nhn v hp, lc mnh. Gi yn chai 5 pht m bo
thuc c trn u hon ton. Thm na th tch cn li, lc u cho n khi c mt hn

dch ng nht. Chai thuc pha c th gi trong t lnh v dng trong 7 ngy.
QU LIU
Him gp qu liu vi Amoclavic. C th ly Amoclavic ra khi mu bng lc mu.

26.

ANAXERYL

A. B A I L L Y - S P E A B
c/o MARKETING SANPROMEX
Thuc m bi ngoi da : tup 38,5 g.
THNH PHN
cho 100 g
Dithranol

350 mg

Ichthyolammonium

850 mg

Acide salicylique

300 mg

Rsorcinol

200 mg

Nha thm P rou

1g

T dc : vaseline, lanoline.
DC LC
Thuc bi ti ch tr bnh vy nn.
CH NH
iu tr bnh vy nn.
H tr iu tr bnh tri tc.
CHNG CH NH
Sang thng r dch.
Qu mn cm vi mt trong cc thnh phn ca thuc.
Khng bi ln nim mc.
CH PHNG v THN TRNG LC DNG
Trnh bi ln mt v ln da u.
TC DNG NGOI

Qu mn vi cc thnh phn ca thuc (lanoline, nha thm P rou...).

LIU LNG v CCH DNG
Bi mi ngy ln cc sang thng cn iu tr :
- ra sang thng vi nc c x phng,
- lau kh bng gc hay vi mng, khng ch xt,
- bi thuc m v thoa nh mt chc thuc thm,
- ra li mt ln na bng nc c x phng.

27.

ANEXATE

HOFFMANN - LA ROCHE
Dung dch tim tnh mch v tim truyn tnh mch 0,5 mg/5 ml : ng 5 ml, hp 1 ng v 6 ng Bng B.
THNH PHN
cho 1 ng
Flumaznil

0,5 mg

DC LC
Thuc i khng ca benzodiazpine.
Flumaznil, imidazobenzodiazpine, l mt thuc i khng ca benzodiaz pine : n ngn chn
mt cch chuyn bit, do c ch cnh tranh, cc tc dng trn h thn kinh trung ng gy bi
cc cht c tc ng trn cng th th ca benzodiazpine.
Cc kt qu thc nghim trn sc vt cho thy rng flumaznil khng lm thay i cc tc dng
gy bi cc cht khng c i lc vi th th ca benzodiazpine (chng hn nh barbiturate,
thanol, mprobamate, cc cht ging GABA v cc cht ch vn trn th th ca adnosine) ;
nhng flumaz nil li ngn chn tc dng gy bi cc cht ch vn khng benzodiazpinique
trn cc th th ca benzodiaz pine, nh cyclopyrrolone (nh zopiclone chng hn) v cc
triazolopyridazine. Flumaz nil tim tnh mch trung ha mt cch nhanh chng (trong 30-50
giy) cc hiu qu gy ng v an thn ca benzodiazpine, v cc hiu qu ny c th xut hin
li t t sau vi gi, ty theo thi gian bn hy ca thuc v tng quan v liu gia thuc
ch vn v thuc i khng dng.
Flumaz nil c dung np tt, ngay c khi dng liu cao. Cc nghin cu v c tnh c thc
hin trn sc vt cho thy rng flumaz nil c c tnh thp v khng gy t bin gne.

Flumaznil c th gy tc ng ch vn ni ti nh nh chng co git chng hn. sc vt c

cho dng benzodiazpine liu cao trong nhiu tun, flumaz nil pht ng xut hin nhng
triu chng cai thuc.
DC NG HC
Kh nng a m thp, flumaznil c t l gn kt vi protine huyt tng khong 50%, trong
albumine chim t l 2/3. Thi gian bn hy o thi trung bnh ca thuc l 50-60 pht. Th
tch phn phi trung bnh khi t n nng n nh (Vss = 0,95 l/kg) th tng t vi ca
benzodiazpine c cu trc tng t ; iu ny cho thy thuc c phn phi tt n cc m.
Flumaz nil c o thi gn nh hon ton (99%) bng ng ngoi thn. Ngi ta tm
thy acide carboxylique di dng t do v di dng lin hp nh l cht chuyn ha chnh
trong nc tiu ngi. Trong cc test v dc l, cht chuyn ha chnh t ra khng c hot
tnh, ng thi l cht ch vn cng nh l cht chuyn ha ca benzodiazpine. S thanh thi
hon ton trong huyt tng ca flumaznil vo khong 1 lt/pht ; v c th ch yu c gn
cho qu trnh thanh thi gan. T l thanh thi yu qua thn cho thy thuc c ti hp thu
tt sau qu trnh lc cu thn. Nu dng ng thi flumaznil v benzodiazpine, midazolam,
flunitrazpam hoc lormtazpam, cc thng s dc ng hc c bn ca flumaznil khng b
bin i.
CH NH
Anexate c ch nh trung ha tc dng an thn ca benzodiazpine trn h thn kinh
trung ng.
Trong khoa gy m :
- Ngng tc dng gy m ton thn trong thi kz dn m v duy tr m bi benzodiazpine
bnh nhn ;
- Ngng tc dng an thn gy bi benzodiazpine trong cc phu thut ngn vi mc ch chn
on hoc iu tr cho bnh nhn nhp vin hoc iu tr ngoi tr ;
- Trung ha cc phn ng ngc ca benzodiazpine.
Trong khoa sn sc c bit :
- Chn on v (hoc) iu tr qu liu benzodiazpine do c hoc do ng c ;
- Chn on ngun gc ca hn m khng gii thch c phn bit l do benzodiaz pine
hay ca mt nguyn nhn khc (dc l hoc thn kinh) ;
- Hy mt cch chuyn bit cc tc dng trn h thn kinh trung ng do qu liu
benzodiazpine (ti lp li s thng kh phi t pht nhm trnh t ni kh qun hoc
ngng dng my gip th).
CHNG CH NH
Flumaznil b chng ch nh bnh nhn bit c d ng hoc khng dung np thuc (hoc
vi cc benzodiazpine).
CH PHNG

- Flumaznil ch i khng vi benzodiazpine, v khng c hiu lc nu hn m gy bi cc

thuc khc. Trong khoa gy m, cng cn lu { rng phi m bo khng cn tc dng lm gin
c trc khi tim Anexate.
- Thi gian tc ng ca thuc thng ngn so vi ca benzodiazpine, cn tip tc theo di
cho n khi d kin l flumaznil mt tc ng do c th xy tr li s ng g.
- bnh nhn c nguy c cao, nn cn nhc gia li ch lm mt tc dng ca benzodiazpine
vi nhc im l lm thc gic nhanh.
- bnh nhn c iu tr lu di bng benzodiazpine, tim nhanh vi liu cao flumaznil
(trn 1 mg) c th gy cc triu chng cai thuc v do cn phi trnh. Trng hp c biu
hin khng mong mun ca hi chng cai thuc, cn tim tnh mch chm benzodiazpine.
- bnh nhn c iu tr di hn bng benzodiazpine hoc qu liu do nhiu loi thuc
(ch yu l cc thuc chng trm cm imipramine phi hp vi cc benzodiazpine), tc dng
i khng ca flumaznil trn tc dng ca benzodiazpine c th lm d dng cho s xut hin
cc ri lon thn kinh (co git) v cc ri lon nhp tim trn tht.
THN TRNG LC DNG
- Chn thn kinh c do tc ng curare phi c trung ha hon ton trc khi dng
flumaznil,
- Liu dng ca Anexate phi c nh gi li cn thn bnh nhn c xem nh b tnh
trng lo u trc phu thut hoc c xc nhn l c tin s b chng lo u kinh nin hay
thong qua. nhng bnh nhn b chng lo u ny (nht l cc bnh nhn b bnh mch vnh),
nn gi li mt mc an thn trong thi kz hu phu hn l lm cho bnh nhn tnh dy hon
ton.
- Cn lu { n cm gic au trong thi kz hu phu. Do sau mt phu thut quan trng,
nn duy tr bnh nhn tnh trng an thn va phi.
- Khi iu tr nhng bnh nhn dng liu cao benzodiazpine trong thi gian di, li ch ca
vic dng flumaznil phi c cn nhc cn thn trc nguy c c th pht ng cc triu
chng cai thuc do benzodiazpine. Mc du liu lng c nh gi mt cch thn trng
m vn xy ra cc triu chng cai thuc, c th phi dng tr li benzodiazpine vi liu thp.
- Hin nay, do kinh nghim iu tr cn thiu, khi s dng Anexate cho tr em di 15 tui phi
lu { n trm trng ca cc nguy c c th xy ra (nht l khi b qu liu) v li ch iu tr
mong mun.
- Khng nn s dng cc cht i khng bnh nhn b ng kinh c iu tr lu di bng
benzodiazpine.
- bnh nhn b chn thng s no nghim trng (v/hoc p lc ni s khng n nh),
Anexate c th lm tng p lc ni s.
Li xe v vn hnh my mc : mc du bnh nhn c lm thc dy v c { thc tr li
sau khi tim tnh mch Anexate, tuy nhin cng cn phi lu { trnh lm nhng vic cn phi

tp trung cao, nh li xe v vn hnh my mc trong vng 24 gi sau khi dng thuc, v tc

dng ca benzodiaz pine trc c th xut hin tr li.
TNG TC THUC
Flumaz nil ngn chn cc tc dng trn h thn kinh trung ng ca benzodiazpine bng cch
cnh tranh cc th th ; flumaz nil cng ngn chn cc tc dng trn th th ca
benzodiazpine do cc cht ch vn khng benzodiaz pinique nh zopiclone v
triazolopyridazine. Flumaz nil khng c ghi nhn c gy tng tc vi cc thuc khc c tc
dng gy trm cm h thn kinh trung ng. Dc ng hc ca cc benzodiazpine khng b
bin i khi c mt flumaznil.
TC DNG NGOI
Khi s dng trong khoa gy m, mt s rt him trng hp gy nn v (hoc) i. i khi gy lo
u, nh trng ngc v s, nht l sau khi tim nhanh Anexate. Thng thng, cc tc dng
ngoi ny khng cn thit phi dng n mt iu tr c bit.
LIU LNG v CCH DNG
Anexate phi c dng ng tnh mch do mt chuyn vin gy m hoc bc s c kinh
nghim thao tc.
Anexate c th c dng bng ng tim truyn bng cch pha long trong glucose 5% hoc
trong dung dch NaCl 0,9%.
Cc bin php hi sc khc c th c tin hnh song song.
n Trong khoa gy m :
- nn dng liu khi u l 0,2 mg, tim tnh mch chm trong vng 15 giy ;
- nu mc thc mong mun ca bnh nhn cha t c trong vng 60 giy, c th tim
tip liu th hai (0,1 mg).
Trong trng hp cn thit, c th thc hin li ng tc ny cch nhau 60 giy, liu tng cng
ti a l 1 mg. Liu thng thng l 0,3-0,6 mg.
n Trong khoa sn sc c bit :
- liu khi u tim tnh mch l 0,3 mg ;
- nu mc thc mong mun ca bnh nhn cha t c trong vng 60 giy, c th tim
tip Anexate cho n khi bnh nhn tnh dy hoc cho n khi t n liu tng cng ti a l 2
mg
Trng hp ng li b ti din li, truyn tnh mch vi liu 0,1-0,4 mg/gi t ra c hiu qu. Tc
tim truyn phi c iu chnh theo tng bnh nhn theo mc hi tnh c ghi nhn.
Nu tnh trng thc ca bnh nhn v chc nng h hp khng cho thy c s ci thin no
ng k sau khi dng lp li cc liu Anexate, phi ngh n nguyn nhn khng phi l do
benzodiazpine.
QU LIU

Ngay c khi dng n liu 100 mg ng tnh mch, vn khng c du hiu qu liu no c
ghi nhn.

28.

ANTIDOL 200 mg - 400 mg

SANOFI SYNTHELABO VIETNAM

Vin bao 200 mg : hp 100 vin, v bm 10 vin, chai 200 vin.
Vin bao 400 mg : hp 100 vin, v bm 10 vin, chai 100 vin.
THNH PHN
cho 1 vin
Ibuprofne

200 mg

cho 1 vin
Ibuprofne

400 mg

DC LC
Ibuprofne l mt khng vim khng corticoide thuc nhm acide propionique trong tp hp
cc dn xut ca acide arylcarboxylique, c tc dng :
- H st,
- Gim au vi liu thp,
- Khng vim vi liu cao (trn 1200 mg/ngy).
DC NG HC
Dc ng hc ca ibuprofne c lin h tuyn tnh vi liu dng.
Hp thu :
- Nng ti a trong huyt thanh t c 90 pht sau khi ung.
- Thc n lm chm s hp thu ca ibuprofne.
Phn b :
- Thi gian bn hy thi tr l 1 n 2 gi.
- 99% gn vi protine huyt tng.
- Trong hot dch, ibuprofne t c nng n nh khong gia gi th 2 v gi th 8 sau
khi ung, nng ti a trong hot dch bng khong 1/3 nng ti a trong huyt tng.
- Sau khi dng 400 mg ibuprofne mi 6 gi ph n ang cho con b, lng ibuprofne tm
thy trong sa di 1 mg/24 gi.

Chuyn ha :
- Ibuprofne khng c tc dng cm ng men.
Thuc c chuyn ha 90% di dng khng hot ng.
Thi tr :
- Ch yu qua nc tiu : trong 24 gi, 10% di dng khng thay i v 90% di dng khng
hot ng ch yu l di dng glucurono kt hp.
CH NH
Liu thp :
- iu tr triu chng cc bnh l{ gy au nh : au u, au rng, au ca h thng c quan
vn ng, thng kinh.
- iu tr triu chng cc bnh l gy st.
Liu cao (trn 1200 mg/ngy) :
- iu tr triu chng trong thi gian di cc trng hp thp khp mn tnh, nht l vim a
khp dng thp, vim dnh khp t sng v cc hi chng tng t nh hi chng FiessingerLeroy-Reiter v thp khp do vy nn ; mt s cc bnh l{ h khp gy au v tn ph.
- iu tr triu chng trong thi gian ngn cc t cp ca cc bnh l quanh khp (au vai cp,
vim gn c...), au tht lng v au r thn kinh nng.
- Chn thng.
- Thng kinh.
CHNG CH NH
Tuyt i :
- D ng trc vi ibuprofne v vi cc cht tng t.
- Lot d dy t trng ang tin trin.
- Suy t bo gan nng.
- Suy thn nng.
- Tr em di 15 tui.
Tng i :
- Khng c kt hp vi cc thuc khng vim khng corticoide khc (bao gm c aspirine).
- Khng nn kt hp vi cc thuc khng ng ng ung, hparine, cc sulfamide h ng
huyt, mui lithium, ticlopidine.
CH PHNG v THN TRNG LC DNG
- Ngi gi : tui tc khng lm thay i dc ng hc ca ibuprofne.
- Nu c tin s lot d dy-t trng, thot v honh hay xut huyt tiu ha : bnh nhn cn
phi c theo di thn trng trong sut qu trnh iu tr.
- Khi khi u iu tr, cn kim sot cn thn th tch nc tiu v chc nng thn nhng
bnh nhn b suy tim, x gan, thn h, bnh nhn ang s dng thuc li tiu, bnh nhn b
suy thn mn v c bit l ngi gi.

- t vng trnh thai : kh nng lm gim hiu qu ca vng trnh thai.

- Khi c ri lon th gic, d l nguyn nhn no, cn phi cho bnh nhn khm mt y .
- Him gp mt vi phn ng mng no lnh tnh do ibuprofne gy ra trn nhng bnh nhn b
lupus ban ri rc.
LC C THAI v LC NUI CON B
Lc c thai :
- Khng c dng ibuprofne trong 3 thng u ca thai kz.
- Trong 3 thng cui ca thai kz, tt c cc cht c ch tng hp prostaglandine c th gy c
trn h tim phi ca thai nhi (tng p lc ng mch phi, gy ng sm ng ng mch), v
trn thn. Do vy, chng ch nh tuyt i dng cc thuc khng vim khng corticoide trong 3
thng cui ca thai kz.
Lc nui con b : do thn trng, khng nn ch nh ibuprofne cho ph n ang cho con b.
TNG TC THUC
Khng c phi hp :
- Cc thuc khng vim khng corticoide khc, bao gm cc salicylate liu cao : nguy c tng
kh nng gy lo t v xut huyt ng tiu ha do tc dng cng lc.
- Khng ng ng ung, h parine tim v ticlopidine : lm tng nguy c xut huyt do c ch
chc nng tiu cu v lm suy yu nim mc d dy-t trng.
- Lithium : tng lithium mu.
- M thotrexate : tng c tnh v huyt hc ca cht ny, c bit khi dng mthotrexate vi
liu trn 15 mg/tun.
- Cc sulfamide h ng huyt : tng hiu qu h ng huyt.
Thn trng khi phi hp :
- Cc thuc li tiu : nguy c gy suy thn cp nhng bnh nhn b mt nc do gim lc
tiu cu.
Nn cn nhc khi phi hp :
- Thuc iu tr cao huyt p (chn bta, c ch men chuyn, li tiu) : gim tc dng cc thuc
ny do c ch prostaglandine dn mch.
- Digoxine : gia tng nghim trng nng digoxine trong mu.
TC DNG NGOI
- Cc biu hin d dy-rut c th xy ra nh : bun nn, nn, au d dy, n khng tiu, xut
huyt tim n hay khng, ri lon nhu ng.
- Qu mn :
- da : rash, pht ban, nga sn, ph ;
- h hp : c kh nng lm xut hin cn hen, c bit trn nhng bnh nhn b d ng vi
aspirine v vi cc thuc khng vim khng corticoide khc.
- Thn kinh : him gp au u, chng mt.

- Mt : vi trng hp him hoi c ri lon th gic.

- C bit, c nhng bo co v nhng tc dng ph trn gan (tng tm thi cc men
transaminase), thn (thiu niu, suy thn) v huyt hc (mt bch cu ht, thiu mu tn
huyt).
LIU LNG v CCH DNG
Liu lng :
Gim au v h st :
Liu khi u t 200 mg n 400 mg ; sau , nu cn c th lp li mi 4 n 6 gi, nhng
khng c vt qu 1200 mg/ngy (6 vin 200 mg hoc 3 vin 400 mg/ngy).
Khoa thp khp :
- iu tr tn cng : 2400 mg/ngy (6 vin 400 mg) ;
- iu tr duy tr : 1200-1600 mg/ngy (6-8 vin 200 mg hoc 3-4 vin 400 mg/ngy).
Thng kinh : 400 mg mi ln (1 vin 400 mg), 3 n 4 ln/ngy nu cn.
Cch dng :
Nut trn vin thuc vi nhiu nc, khng c nhai, v nn ung trong ba n.
BO QUN
Gi ni kh mt, trnh nh sng

29.

APO-AMILZIDE

APOTEX
c/o NHANTAM
vin nn : l 100 vin, 500 vin v 1000 vin.
THNH PHN
cho 1 vin
Hydrochlorothiazide

50 mg

Amiloride
hydrochloride

5 mg

DC LC
Apo-Amilzide (hydrochlorothiazide v amiloride hydrochloride) l mt kt hp thuc li tiu/h
huyt p c tc ng tng bi tit natri-niu mnh ca hydrochlorothiazide cng vi tnh cht

gi kali ca amiloride hydrochloride. Tc ng li tiu v h huyt p nh ca amiloride

hydrochloride hip ng vi hot tnh tng bi tit natri niu, li tiu v h huyt p ca
thiazide trong khi vn gim thiu s mt kali v gim kh nng xut hin s mt cn bng acidbase. Tc dng li tiu ca Apo-Amilzide khi pht trong khong 1 n 2 gi v duy tr khong
24 gi.
Hydrochlorothiazide : Hydrochlorothiazide l mt thuc li tiu v h huyt p. Thuc nh
hng ln c ch ti hp thu cht in gii ng thn. Hydrochloride lm gia tng s o thi
sodium v chloride vi nhng lng gn tng ng nhau v ng thi c th gy mt
bicarbonate nh. Tc dng tng bi tit natri niu thng i km vi s mt kali nht nh.
C ch tc ng h huyt p ca cc thiazide c th lin quan n s o thi v ti hp thu
ca sodium trong c th. Hydrochlorothiazide khng lm gim huyt p ngi bnh thng.
Tc ng li tiu khi pht ca hydrochlorothiazide xut hin trong 2 gi v ln n ti a
trong 4 gi. Tc ng li tiu ko di khong 6 n 12 gi. Hydrochlorothiazide c o thi
nhanh chng qua thn.
Amiloride hydrochloride : Amiloride hydrochloride l mt thuc khng bi tit kali niu vi tc
ng bi tit natri niu v h huyt p nh. Nhng tc ng ny c th hip ng vi tc ng
ca thiazide hay thuc li tiu mui khc. Tc dng chnh ca amiloride hydrochloride l gi kali
trn nhng bnh nhn ang dng thuc li tiu lm mt kali. Tc ng ny khng c lin quan
vi mc tit aldosterone. Amiloride hydrochloride khng phi l mt cht khng
aldosterone. Thuc tc ng trc tip ln phn xa ca ng thn. Amiloride hydrochloride lm
tng thi sodium v gim o thi ion kali v hydrogen. S o thi chloride c th gi nguyn
khng thay i hay tng chm khi tip tc iu tr. Khong 50% liu ung c hp thu.
Amiloride hydrochloride thng bt u tc dng 2 gi sau khi ung. Tc ng ca hot cht
ln s o thi cht in gii t n ti a trong 6 n 10 gi v duy tr trong 24 gi. Nng
cao nht trong huyt tng t c trong 3 n 4 gi v thi gian bn hy thay i t 6 n 9
gi.
Amiloride hydrochloride khng chuyn ha qua gan. Vi liu 20 mg, khong 50% amiloride
hydrochloride c o thi di dng khng i trong nc tiu v 40% c thi qua phn
trong vng 72 gi. Theo cc nghin cu trn lm sng, amiloride hydrochloride c tm thy
c rt t tc ng ln tc lc cu thn hay ti mu thn.
Cc nghin cu sinh kh dng c thc hin trn nhng ngi tnh nguyn. y l mt
trong nhng tiu chun hng u nh gi cht lng thuc. i vi cc thuc ha dc
(generic drug), sinh kh dng l mt iu kin bt buc ca B Y T v chnh ph Canada trong
quy trnh sn xut dc phm, c quy nh ht sc cht ch trc khi cc dc phm ny
c lu hnh khp nc Canada v ton cu. Cc dc phm ca Apotex sn xut ti Canada
u t tiu chun GMP ca T Chc Y T Th Gii. Cc thng s sinh kh dng ca cc thuc
ha dc do Apotex sn xut c so snh vi cc thuc c nhn hiu c a chung cng

loi ca cc hng dc phm hng u trn th gii : Tc v mc hp thu sau khi ung
mt liu 5 mg amiloride v 50 mg hydrochlorothiazide trong Apo-Amilzide 5-50 mg v Moduret
5-50 mg c o lng v so snh. Cc kt qu c th c tm tt nh sau :
Amiloride HCl

Moduret(SD*)

Apo-Amilzide
(SD*)

AUC 0-24 (ng.gi/ml)

62,5 (21,0)

66,8 (18,4)

Cmax (ng/ml)

6,0 (2,2)

6,7 (2,4)

Tmax (gi)

3,8 (0,6)

3,3 (0,8)

t1/2 (gi)

8,2 (2,5)

9,6 (3,8)

AUC 0-24 (ng.gi/ml)

1603 (414)

1654 (426)

Cmax (ng/ml)

235 (73)

242 (60)

Tmax (gi)

2,3 (1,0)

2,4 (0,8)

t1/2 (gi)

9,1 (3,3)

10,0 (5,6)

Hydrochlolothiazide

*SD = lch chun (Standard Deviation)

Kt lun : Sinh kh dng ca Apo-Amilzide v Moduret c nh gi bng cch so snh vn
tc v mc hp thu thuc. Theo nhng s liu ca nghin cu ny, c th kt lun rng ApoAmilzide v Moduret l tng ng v mt sinh hc v do tng ng v hiu qu iu
tr.
CH NH
Cc thuc kt hp vi liu c nh khng c ch nh khi mi bt u tr liu. Bnh nhn nn
c chun trn tng thuc ring l. Nu s kt hp c nh ny thch hp vi liu lng
c xc nh nh trn, s s dng cng thun li hn trong vic kim sot tnh trng bnh.
Nu trong qu trnh iu tr duy tr cn c s iu chnh liu, nn dng tng loi thuc ring
bit.
Apo-Amilzide (hydrochlororthiazide v amiloride hydrochloride) c ch nh dng nh liu
php duy tr trong cc bnh sau :
- bnh nhn x gan c trng v ph n,
- bnh nhn ph do tim hay cao huyt p ng mch b nhc kali huyt hay trn nhng ngi

m s duy tr nng kali bnh thng c xem l rt quan trng v mt lm sng, ngha l,
cc bnh nhn ang dng digitalis, bnh nhn khng hp thu kali d dng qua ch n ung
hay bnh nhn lon nhp tim.
S dng trong trng hp x gan c trng v ph n : Amiloride hydrochloride khi dng
ring c th cho tc dng li tiu tha ng cng vi vic gim mt kali v gim bt nguy c
nhim kim do chuyn ha. Trong nhng trng hp khng, amiloride hydrochloride c th
c s dng vi cc thuc li tiu bi tit kali gip to ra tc dng li tiu tha ng, trong
khi vn duy tr cn bng cht in gii trong huyt thanh. Ging nh tt c cc liu php iu tr
x gan c trng mc ch ch yu l lm gim cn t t v trnh mt cn bng in gii (xem
Thn trng lc dng).
CHNG CH NH
Tng kali huyt : Khng nn dng Apo-Amilzide (hydrochlothiazide v amiloride hydrochloride)
khi nng kali trong huyt thanh cao (xem Ch { phng).
iu tr khng bi tit kali niu hay mui kali : Cc thuc khng bi tit kali niu v s b sung
kali b chng ch nh trn bnh nhn dng Apo-Amilzide (kt hp ny thng i km vi s gia
tng nhanh chng nng kali trong huyt tng).
Suy thn : V niu, suy thn cp, bnh thn nng hay tin trin v bnh thn do tiu ng l
nhng chng ch nh s dng Apo-Amilzide (xem Ch { phng).
Tng nhy cm (qu mn) : Apo-Amilzide chng ch nh trn nhng bnh nhn tng nhy cm
vi bt kz thnh phn no ca thuc hay vi cc thuc dn xut t sulfonamide khc.
CH PHNG
Tng kali huyt : Tng kali huyt, ngha l nng kali trong huyt thanh vt qu 5,5 mEq mi
lt, c nhn thy trn mt vi bnh nhn dng amiloride hydrochloride ring r hay vi
thuc li tiu. c bit tnh trng ny s tr nn trm trng i vi bnh nhn ln tui, bnh
nhn tiu ng v bnh nhn nhp vin do x gan hay ph do tim, c tin s suy thn hay
ang dng thuc li tiu mnh. Do xut hin trng hp t vong trn nhng bnh nhn
ny, nn cn phi theo di cn thn nhng du hiu lm sng, xt nghim v in tm
tm nhng bng chng xut hin chng tng kali mu v nhim acid. Vic theo di nng kali
trong huyt thanh rt quan trng v chng tng kali huyt khng phi bao gi cng i km vi
in tm bt thng.
Cc du hiu v triu chng bo trc ca chng tng kali huyt bao gm d cm, yu c, mt
mi, lit nho cc chi, nhp tim chm, sc v in tm bt thng.
Khi c bt thng, in tm trong trng hp tng kali huyt c tiu biu bng sng T
cao, c nh hay nng ln so vi trc . Cng c th c s h thp sng R v gia tng su
ca sng S, rng hn v c th mt lun sng P, rng v ko di phc hp QRS, ko di khong
PR v rt ngn ST.
Nu xut hin chng tng kali huyt trn nhng bnh nhn dng Apo-Amilzide

(hydrochlorothiazide v amiloride hydrochloride) nn ngng thuc ngay lp tc. Nu nng

kali trong huyt thanh qu 6,5 mEq mi lt, nn thc hin cc bin php ch ng gim bt.
Cc bin php ny bao gm truyn tnh mch dung dch sodium bicarbonate, ung hay truyn
glucose vi mt ch phm insuline tc ng nhanh. Nu cn thit, mt nha trao i cation
nh sodium polystyrene sulfonate c th c cho theo ng ung hay ng tht. Bnh
nhn tng kali mu dai dng c th cn lm thm phn.
Tiu ng : Trong nhng bnh nhn tiu ng chng tng kali huyt thng c bo co
khi s dng amiloride hydrochloride, c bit khi c bnh thn mn tnh hay nit-mu. Mt vi
trng hp t vong xy ra nhm bnh c nu sau cng ny. Do , nu cn thit tr liu
vi amiloride hydrochloride, nn dng cn thn trn bnh nhn tiu ng hay nghi ng c
tiu ng v ch sau khi xc nh u tin tnh trng chc nng thn.
Cn theo di cn thn nng kali huyt thanh trong sut qu trnh tr liu.
Mt bnh nhn tiu ng kh kim sot b tng kali huyt trm trng khi dng amiloride
hydrochloride cht sau hai th nghim dung np glucose truyn tnh mch lp i lp li. Do
, nn ngng dng amiloride ti thiu ba ngy trc khi th nghim dung np glucose.
Trn bnh nhn tiu ng, nhu cu insulin c th gia tng, gim bt hay khng i ty theo
thnh phn hydrochlorothiazide. Chng tiu ng tim n c th biu hin trong qu trnh s
dng thuc li tiu thiazide.
Nhim acid do chuyn ha hay nhim acid do h hp : Liu php khng bi tit kali niu nn
c thc hin ch khi c theo di cn thn trn bnh nhn m chng nhim acid chuyn ha
hay h hp c th xy ra, nh bnh nhn mc bnh tim phi, hay tiu ng. Nu dng ApoAmilzide cho nhng bnh nhn ny, cn phi theo di thng xuyn cn bng acid-base. Nu
s thay i cn bng acid-base lm thay i t l kali trong/ngoi t bo, v s pht trin ca
chng nhim c acid c th i km theo s gia tng nhanh chng nng kali trong huyt
thanh.
Suy thn : bnh nhn c chc nng thn suy gim ngoi nhng trng hp c nu trong
phn "Chng ch nh", v nhng ngi c mc BUN qu 30 mg mi 100 ml, creatinine
huyt thanh qu 1,5 mg mi 100 ml, hay gi tr urea huyt qu 60 mg mi ml khng nn dng
thuc m khng c theo di cn thn v thng xuyn cht in gii, creatinine v BUN trong
huyt thanh. S ng kali i km vi s s dng Apo-Amilzide c gia tng hn khi c suy
thn v c th dn n s tng kali huyt nhanh chng. S k o di qu trnh o thi amiloride
hydrochloride c quan st thy trn bnh nhn suy thn.
THN TRNG LC DNG
Mt cn bng in gii v gia tng BUN : Chng nhc natri huyt v nhc chlorid huyt c
th xut hin trong qu trnh s dng Apo-Amilzide (hydrochlorothiazide v amiloride
hydrochloride). Nhc kali huyt cng c th xut hin mc d vi t l thp hn khi dng
thiazide ring r. Thiu ht chloride thng l nh v c th c iu chnh bng ammonium

chloride (tr khi bnh nhn c bnh gan) v c ngn nga d dng bng cch dng lng
mui thng thng. Gia tng BUN c bo co v thng i km theo mt nc mnh,
c bit khi kt hp s dng cc thuc li tiu trn nhng bnh nng nh nhng bnh nhn x
gan c trng v nhim kim do chuyn ha hay nhng bnh nhn ph do khng. Do ,
theo di cn thn cc cht in gii trong huyt thanh v mc BUN l quan trng khi dng
Apo-Amilzide. Trn bnh nhn suy thn, chng nit huyt c th bc pht hay gia tng bi
hydrochlorothiazide. Do , cn thit phi theo di cn thn nhng bnh nhn ny. Nu chng
nit huyt gia tng hay c thiu niu trong qu trnh tr liu, nn ngng dng Apo-Amilzide.
Tc ng lin quan n li tiu trn bnh nhn x gan : Bnh nhn x gan c trng khng
dung np cc thay i cp trn s cn bng in gii v thng c sn chng nhc kali huyt
nh mt kt qu ca s tng tit aldosterone th pht km theo. Khi s dng thuc li tiu
dng ng ung, nn cn thn theo di nhng bnh nhn ny v nn gy li tiu t t.
Bnh no do gan biu hin bng chng rung ry, l ln v hn m c bo co c i km
vi tr liu bng amiloride hydrochloride.
Trn bnh nhn x gan, ch dng n thun amiloride hydrochloride, chng vng da i km
theo tin trnh bnh tr nn nng hn trong mt vi trng hp, tuy nhin mi lin h vi
thuc ny l khng r rng.
S dng cho tr em : Tnh an ton ca amiloride hydrochloride tr em cha c xc nh :
do , khng nn dng Apo-Amilzide cho tr em.
Cc thn trng khc : Cc thiazide c th lm gim nng PBI trong huyt thanh m khng c
du hiu g ca ri lon tuyn gip.
Hydrochlorothiazide lm gim o thi calcium v tng o thi magnesium.
Cc thay i bnh l trn tuyn cn gip vi chng tng calci huyt v gim phosphate huyt
c nhn thy trn mt vi bnh nhn khi dng thiazide k o di. Khng quan st c cc
bin chng thng gp ca chng tng nng tuyn cn gip nh si thn, hy xng v lo t d
dy. Nn ngng dng thiazide trc khi thc hin cc xt nghim v chc nng tuyn cn gip.
Chng tng acid uric huyt c th xut hin hay bnh thng phong c th bc pht.
Nn quan st bnh nhn thng xuyn v kh nng xy ra ri lon chc nng gan, phn ng
c ng hay lon to mu.
Phn ng nhy cm vi thiazide c th xut hin trn bnh nhn c hay khng c tin s d ng
hay hen ph qun.
Kh nng hot ha hay lm trm trng hn chng lupus ban ton thn c bo co khi
s dng cc thiazide.
LC C THAI v LC NUI CON B
Lc c thai :
Do cc th nghim lm sng cn gii hn, khng nn s dng Apo-Amilzide lc c thai.
Cc nghin cu tnh gy qui thai vi amiloride hydrochloride th v chut nht khng cho

thy c bng chng gy nguy hi n phi. Cc nghin cu sinh sn chut cng khng cho
thy c bng chng lm gim bt kh nng sinh sn. Vi liu gp 5 hay nhiu hn liu ti a
hng ngy dng cho ngi, mt vi c tnh c quan st thy trn chut cng v th trng
thnh v c mt s gim tng trng v t l sng st chut con.
chut cng, c vt ca hot cht i qua hng ro nhau thai.
Cc thiazide i qua hng ro nhau thai v hin din trong mu ct sng. Do , vic s dng
Apo-Amilzide lc c thai hay nghi ng l c thai cn cn nhc gia li ch do thuc v nguy c c
th xy ra cho thai nhi. Cc nguy c ny bao gm chng vng da phi hay vng da tr s sinh,
gim tiu cu v nhng tc dng ngoi khc c th xy ra ngi ln.
Lc nui con b :
ngi, amiloride hydrochloride khng c bit c tit qua sa m hay khng, tuy nhin
chng minh c rng amiloride hydrochloride c tit qua sa chut cng. Cc thiazide c
xut hin trong sa m. Do kh nng c th xy ra tc dng c hi cho tr c nui bng sa
m, nu cn thit phi s dng Apo-Amilzide, bnh nhn nn ngng cho con b.
TNG TC THUC
Hydrochlorothiazide lm tng tc ng ca nhng thuc h huyt p khc. Do , c th cn
phi gim bt liu lng ca cc thuc ny, c bit l cc thuc c ch hch, khi thm ApoAmilzide vo phc iu tr.
Ni chung lithium khng nn dng cho bnh nhn ang dng cc thuc li tiu do nguy c ng
c lithium rt cao.
Cc thuc cha thiazide c th lm tng p ng vi tubocurarine. Tc dng h huyt p ca
thuc c th c gia tng bnh nhn sau khi ct b thn kinh giao cm.
Hydrochlorothiazide c th lm gim p ng ng mch vi norepinephrine nhng khng
ngn nga tnh hu hiu ca tc nhn tng huyt p dng iu tr.
Chng tt huyt p th ng c th xut hin v c th tr nn nng hn do ru, cc
barbiturate hay thuc gy nghin.
TC DNG NGOI
Tuy him khi xy ra, cc tc dng ngoi nng nht do Apo-Amilzide (hydrochlorothiazide v
amiloride hydrochloride) l chng tng kali huyt c biu hin triu chng. Cc thay i chuyn
ha khc xy ra l chng tng kali huyt khng biu hin triu chng v h chlorid huyt.
T l xut hin cc tc dng ngoi { sau c bo co trn bnh nhn c iu tr kt hp
chlorothiazide v amiloride hydrochloride :
Tiu ha (trong 7,1% bnh nhn) : T l >= 3% : bun nn/chn n (3,7%) ; T l 1%-3% : tiu
chy, au bao t, au bng ; T l <= 1% : to bn, xut huyt tiu ha, ri lon tiu ha, thay
i khu v, y bng, nc ct, kht nc, chn n, y hi, ng ming.
H thn kinh trung ng (trong 13,9% bnh nhn) : T l >= 3% : nhc u (7,8%), chng mt
(6,1%), cm thy yu t (4,0%) ; T l <= 1% : d cm/cm gic t di, trng thi sng s, chng

mt, mt ng, lo lng, trm cm, bun ng, l ln tm thn, ri lon th gic.
Da liu (trong 5,2% bnh nhn) : T l >= 3% : ni ban da (3,4%) ; T l t 1-3% : nga ngy ; T
l <= 1% : bng mt.
Tim mch (trong 4,3% bnh nhn) : T l t 1-3% : lon nhp tim ; T l <= 1% : tim nhanh, ng
c digitalis, h huyt p th ng, au tht ngc.
C xng (trong 3,7% bnh nhn) : T l t 1-3% : au chn ; T l <= 1% : co tht c, au khp,
au ngc, au lng.
H hp (trong 2,6% bnh nhn) : T l t 1-3% : kh th ; T l <= 1% : nght mi.
Tit niu-Sinh dc (trong 1,7% bnh nhn) : T l <= 1% : bt lc, tiu m, tiu kh, tiu khng
kim ch.
Ni tit (trong 0,9% bnh nhn) : T l <= 1% : thng phong, mt nc.
Cc tc dng ph khc (trong 2,6% bnh nhn) : T l t 1-3% : mt mi ; T l <= 1% : kh .
Cc tc dng ph khc c bo co vi tng thnh phn ring bit nh sau :
Tim mch : vim mch hoi t (vim mch, vim mch mu da).
Tiu ha : chc nng gan bt thng, vng da (vng da mt trong gan), hot ha lot d dy
c sn, co tht, kch ng d dy, vim ty, kh ming, vim tuyn nc bt.
Ni tit : glucose niu, tng ng huyt, tng acid uric huyt.
Qu mn : Ni my ay, phn v.
H hp : Suy h hp bao gm vim phi.
Gic quan : Nhy cm nh sng, nhn m thong qua, chng trng thy sc vng.
Huyt hc : Mt bch cu ht, thiu mu bt sn, thiu mu huyt tn, gim bch cu, ban xut
huyt, gim tiu cu, gim bch cu trung tnh.
Cc tc dng ph khc : Cm gic khng c ngh ngi, st.
LIU LNG v CCH DNG
Liu ti u nn c xc lp cho tng ngi i vi mi thnh phn.
C th dng liu duy tr thp hn liu cn thit bt u gy li tiu; do , nn thc hin
gim liu khi tnh trng th trng ca bnh nhn c n nh. bnh nhn x gan, vic gim
th trng dn dn c bit cn thit gim bt kh nng xy ra cc phn ng c hi i km
theo liu php li tiu.
X gan c trng v ph n : Liu Apo-Amilzide (hydrochlorothiazide v amiloride
hydrochloride) duy tr thng thng l mt vin mi ngy mt ln. Khng nn dng qu 4 vin
mi ngy, ung theo liu duy nht hay chia lm nhiu ln.
Ph n do tim : Liu Apo-Amilzide duy tr thng thng l 1 hay 2 vin dng mt ln hay chia
lm nhiu ln. Khng nn dng qu 4 vin mi ngy. C th tr liu gin on.
Cao huyt p : Liu duy tr thng thng l 1 hay 2 vin dng mt ln mi ngy hay chia lm
nhiu liu. Khng nn dng qu 4 vin mi ngy.
QU LIU

Khng c s liu v qu liu ngi khi s dng Apo-Amilzide (hydrochlorothiazide v

amiloride hydrochloride) hay vi thnh phn amiloride hydrochloride.
Du hiu v triu chng thng thy nht khi dng qu liu Apo-Amilzide l mt nc v mt
cn bng cht in gii. Nn kim tra cn thn cht in gii trong huyt thanh c bit l nng
kali.
Chng lon nhp tim c th xy ra do nng kali bt thng. Bnh nhn dng digitalis c bit
c kh nng b lon nhp tim.
Khng c thng tin c bit v vic iu tr qu liu v cng khng c cht gii c c hiu i
vi Apo-Amilzide. iu tr qu liu ch l iu tr triu chng v h tr. Nn ngng dng ApoAmilzide v theo di bnh nhn cn thn. Cc bin php ngh bao gm gy nn v/hoc ra
d dy.
Thuc khng c bit c th tch ra bng phng php thm phn hay khng.

30.

APO-DOXY

APOTEX
c/o NHANTAM
Vin nang : l 100 vin, 500 vin v 1000 vin.
Vin nn : l 100 vin, 500 vin v 1000 vin.
THNH PHN
cho 1 vin nang
Doxycycline

100 mg

cho 1 vin nn
Doxycycline

100 mg

DC LC
Apo-Doxy (doxycycline) l mt khng sinh ph rng tc ng ln nhiu vi khun Gram m v
Gram dng. Tc ng khng khun ca doxycyline l c ch s tng hp protein.
DC NG HC
Nghin cu kh dng sinh hc so snh c thc hin trn vin nang Vibramycin v vin nang
Apo-Doxy vi 16 ngi tnh nguyn s dng liu n 100 mg. Kt qu nh sau :

Vibramycin

Apo-Doxy

% sai bit

AUC 0-30 (mg.gi/ml)

34,9 +/- 5,14 37,3 +/- 3,28 + 6,9

Cmax (mg/ml)

1,97 +/- 0,294 2,22 +/- 0,189 + 12,7

Tmax (gi)

2,14 +/- 0,719 2,11 +/- 0,836

Kt lun : Sinh kh dng ca Apo-Doxy v Vibramycin c nh gi bng cch so snh vn

tc v mc hp thu thuc. Theo nhng s liu ca nghin cu ny, c th kt lun rng ApoDoxy v Vibramycin l tng ng nhau v mt sinh hc v do , tng ng vi nhau trn
lm sng.
CH NH
Apo-Doxy (doxycycline) c ch nh trong cc trng hp sau :
Vim phi : Vim phi n hay a thy do cc chng nhy cm ca Pneumococcus,
Streptococcus, Staphylococcus, H. influenzae v Klebsiella pneumoniae.
Cc nhim khun ng h hp khc : Vim hng, vim amian, vim xoang, vim tai gia,
vim ph qun do cc chng nhy cm ca Streptococcus huyt gii bta, Staphylococcus,
Pneumococcus, v H. influenzae.
Nhim khun ng tit niu : vim thn-b thn, vim bng quan, vim niu o, vim niu
o lu do cc chng vi khun nhy cm nhm Klebsiella-Aerobacter, E. coli, Enterococcus,
Staphylococcus, Streptococcus v Neisseria gonorrhoeae.
bnh nhn trng thnh b vim niu o, vim c t cung v vim m o vi kt qu xt
nghim dng tnh cho Chlamydia trachomatis v/hoc Ureaplasma urealyticum, khi kt thc
tr liu vi doxycycline phn tch lm sng v xt nghim khng tm thy vi khun. C th xut
hin ti pht hay ti nhim. Trong nhng trng hp ny, cc s liu gii hn khng cho php
xc nh li ch ca tr liu doxycycline hay cch iu tr khc trn mt s bnh nhn. Cha xc
nh tc dng ca thuc vi bnh mn tnh.
Nhim khun da v m mm : Chc l, mn nht, vim m t bo, p-xe, nhim khun vt
thng, vim quanh mng do cc chng nhy cm Staphylococcus aureus v albus,
Streptococcus, E. coli v nhm Klebsiella-Aerobacter.
Nhim khun ng tiu ha : do cc chng nhy cm ca Shigella, Salmonella v E. coli.
CHNG CH NH
Apo-Doxy chng ch nh trn nhng ngi tng c qu mn vi tetracycline.
CH PHNG
Cng nh cc tetracycline khc, Apo-Doxy (doxycycline) c th to mt phc cht calcium bn
vng trong m c bn cht xng d in vitro doxycycline gn kt vi calcium yu hn so vi cc
tetracycline khc. Mc d cho n nay vn cha quan st c trn nghin cu lm sng

nhng nn xem rng s s dng doxycycline, ging nh cc tetracycline khc trong qu trnh
pht trin rng (ba thng cui ca thai kz, trong lc nui con b, giai on s sinh v thi th
u) c th nhum mu rng. Mc d thng gp hn trong qu trnh s dng ko di, tc dng
ny cng xut hin khi s dng cc thuc tetracycline trong thi gian ngn.
THN TRNG LC DNG
Trn cc nghin cu lm sng cho n nay, khng c s gia tng nng cng nh thi gian
bn hy trong huyt thanh ca doxycycline bnh nhn suy thn. Apo-Doxy (doxycycline) vi
liu thng thng c th dng cho nhng bnh nhn ny. Mc d khng c bng chng v s
gia tng c tnh nhng bnh nhn ny, nn lu tm n kh nng gia tng c tnh trn gan
cng nh cc c quan khc cho n khi c y s liu v s chuyn ha doxycycline trong
cc tnh trng nh trn. Nn thc hin cc xt nghim chc nng gan nh kz bnh nhn dng
liu cao hay ko di. Nu c th nn trnh dng ng thi doxycycline vi cc tc nhn khc
bit c gy c tnh trn gan.
i khi s s dng khng sinh c th a n bi tng cc vi khun nhy cm ; do , cn theo
di bnh nhn cn thn. c bng chng l doxycycline c th c tc dng yu hn trn h
sinh thi ng rut so vi cc tetracycline khc.
Khng nn dng doxycycline cho ph n c thai hay cho con b hoc tr s sinh cho n khi
tnh an ton ca thuc trong nhng trng hp ny c xc nh, tr phi bc s x t thy li
ch cho bnh nhn cn thit hn nguy c c th xy ra cho thai nhi hay cho a b.
Mt vi bnh nhn cao huyt p c th c phn ng quang ng hc vi nh mt tri trong qu
trnh tr liu vi doxycycline. Nu xut hin phn ng ny hay bt kz phn ng d ng no khc,
nn ngng thuc.
Gia tng p lc ni s cng vi phng thp c quan st thy tr em dng cc
tetracycline vi liu tr liu. Mc d cha bit c ch ca hin tng ny, cc du hiu v triu
chng s mt nhanh chng khi ngng thuc m khng li di chng.
Tn thng thc qun bao gm vim v lot thc qun him khi c bo co bnh nhn
dng doxycycline theo ng ung. Nu c tn thng ny, nn ngng dng oxycycline cho
n khi lnh vt thng. Cc thuc khng acid v/hoc cimetidine c th lm gim bt trong
nhng trng hp ny. gim thiu nguy c tn thng thc qun, nn khuyn bnh nhn
dng vin nang hoc vin nn Apo-Doxy vi mt lng nc va trong t th ng hay ngi
thng ngi ln.
TC DNG NGOI
Ging nh nhng khng sinh ph rng khc, cc ri lon tiu ha nh bun nn, nn ma v
tiu chy cng nh vim li, vim ming v vim trc trng c th xut hin khi iu tr vi
Apo-Doxy (doxycycline) nhng him khi cn phi ngng thuc. c nhng bo co rt him
v trng hp vim v lot thc qun khi dng dng vin nang doxycycline (xem Ch {
phng v Liu lng).

Ging nh cc tetracycline khc, c bo co v s gia tng SGOT hay SGPT, thiu mu, gim
bch cu trung tnh, tng bch cu a eosine, gim bch cu hay gia tng BUN, cha bit c
nh hng ca cc tc dng ny.
LIU LNG v CCH DNG
Liu ung khuyn co cho Apo-Doxy (doxycycline) ngi ln cho a s cc nhim trng nhy
cm l mt liu tn cng duy nht 200 mg vo ngy iu tr th nht sau l liu duy tr 100
mg mi ngy mt ln vo cng mt thi im trong ngy.
Phc iu tr cho tr em trn 8 tui cn nng ti a 100 pound l mt liu tn cng duy nht
2 mg/lb th trng vo ngy th nht, sau l liu duy tr 1 mg/lb mi ngy mt ln vo cng
mt thi im trong ngy.
Do s hp thu khng b nh hng bi thc n hay sa, nn dng Apo-Doxy trong hay sau ba
n gim kh nng gy xt d dy. Cc ch phm khng acid v st lm gim hp thu v khng
nn dng ng thi vi thuc ung doxycycline.
Nn dng vin nn v vin nang Apo-Doxy vi nhiu nc t th ng hay ngi thng
gim bt nguy c tn thng thc qun.
Trong cc nhim trng trm trng ngi ln nh p-xe phi hay vim xng ty v nhim
trng ng tiu mn tnh, c th dng mi ngy mt liu n 200 mg sut t iu tr. i vi
nhng nhim trng nng hn tr em, c th dng liu n 2 mg/lb.
Nn tip tc iu tr sau khi cc triu chng v st mt i. Tuy nhin, nn ch { rng cc nng
khng khun hu hiu thng cn hin din 24 n 36 gi sau khi ngng iu tr vi ApoDoxy.
Khi dng trong cc nhim trng Streptococcus, nn iu tr 10 ngy phng nga st thp
khp hay vim thn-tiu cu.
i vi iu tr nhim lu cp, liu khuyn co l 200 mg lc bt u v 100 mg vo bui ti
trc khi ng vo ngy u tin, sau l 100 mg mi ngy hai ln trong 3 ngy.
i vi iu tr nhim trng niu o khng gy bin chng, nhim trng bn trong c t cung
hay m o ngi ln c lin quan n Chlamydia trachomatis v Ureaplasma urealyticum :
liu dng l 100 mg theo ng ung, hai ln mt ngy, ti thiu 10 ngy.
Khng cn phi thay i phc iu tr bnh nhn suy thn.
QU LIU
Ra d dy nu cn.

31.

APO-PIROXICAM

APOTEX
c/o NHANTAM
Vin nang 10 mg : l 100 vin, l 500 vin.
Vin nang 20 mg : l 100 vin, l 500 vin.
THNH PHN
cho 1 vin
Piroxicam 10 mg
cho 1 vin
Piroxicam 20 mg
DC LC
Apo-Piroxicam (piroxicam) l mt thuc khng vim khng steroid c tnh gim au v h st.
C ch tc ng ca thuc vn cha c bit r rng. Piroxicam c ch tc ng ca men tng
hp prostaglandin. Sinh tng hp prostaglandin gim c th gii thch phn no tc dng khng
vim ca thuc. Piroxicam khng tc ng bng cch kch thch tuyn yn-thng thn.
Trong vim khp dng thp, hiu qu ca piroxicam 20 mg mi ngy cng tng t nh 4,2 g
acetylsalicylic acid mi ngy.
DC NG HC
Piroxicam c hp thu tt theo ng ung. Mc v tc hp thu khng b nh hng
bi thc n hay cc thuc khng acid. Khi dng thuc hng ngy, nng trong huyt tng gia
tng trong vng 5 n 7 ngy t n trng thi n nh. Nng n nh ny khng tng
ln khi tip tc dng thuc u n hng ngy.
Mt nghin cu sinh kh dng dng liu n (20 mg) c thc hin bi Richardson v cng s
kho st s khc bit lin quan n tui tc v gii tnh trn dc ng hc ca piroxicam,
ngi ta thy rng ph n ln tui (62-75 tui) thanh thi piroxicam thp hn 33% so vi ph
n tr tui (20-31 tui), v c thi gian bn hy tng ng l 61,7 v 44,9 gi. Khng c khc
bit ng k v tc thanh thi gia nam gii tr tui v ln tui. Nng n nh trong
huyt tng c lng c l 5,7, 5,4 v 5,7 mg/ml ph n tr tui, nam gii tr tui v
nam gii ln tui so vi 9,3 mg/ml ph n ln tui. Kt qu ny mu thun vi nghin cu
ca Hobbs v cng s v Woolf v cng s - hai tc gi ny kt lun rng tui tc khng c
hoc nh hng khng ng k ln s thanh thi v nng trng thi n nh ca
piroxicam.
Piroxicam c chuyn ha rng ri v di 5% liu dng hng ngy o thi di dng khng
thay i trong phn v nc tiu. ng chuyn ha ch yu l hydroxyl ha vng pyridyl, sau
l s lin hp vi acid glucuronic v o thi qua nc tiu. Khong 5% liu dng c o

thi v chuyn ha di dng saccharin.

Quan st trong 4 ngy hai mi ngi n ng khe mnh dng 20 mg piroxicam mi ngy
dng liu n hoc chia lm nhiu ln cho thy gim ng k lng mu mt trung bnh trong
phn so vi 10 ngi n ng khe mnh dng 3,9 g acetylsalicylic acid mi ngy.
Nghin cu sinh kh dng c thc hin trn ngi tnh nguyn khe mnh. Tc v mc
hp thu sau mt liu n 20 mg ca Feldene 10 mg v Apo-Piroxicam 10 mg ; v ca Feldene
20 mg v Apo-Piroxicam 20 mg c xc nh v so snh. Kt qu c th c tm tt nh
sau :
Feldene 10
mg

Apo-Piroxicam 10
mg

% sai bit

ACU 0-119 (mg.gi/ml)

112,96

113,66

+0,6

Cmax (mg/ml)

2,13

2,08

-2,2

Tmax (gi)

1,8

2,7

+45,8

t1/2 (gi)

50,8

55,1

+ 8,5

Feldene 20
mg

Apo-Piroxicam 20
mg

% sai bit

ACU 0-119 (mg.gi/ml)

119,42

113,84

-4,7

Cmax (mg/ml)

2,17

2,13

-6,0

Tmax (gi)

2,6

2,4

-8,1

t1/2 (gi)

52,3

52,1

-0,4

Kt lun : Sinh kh dng ca Apo-Piroxicam v Feldene c nh gi bng cch so snh vn

tc v mc hp thu thuc. Theo nhng s liu ca nghin cu ny, c th kt lun rng ApoPiroxicam v Feldene l tng ng v mt sinh hc v do , tng ng vi nhau trn lm
sng.
CH NH
Apo-Piroxicam (piroxicam) c ch nh iu tr triu chng vim khp dng thp, vim xng
khp (bnh khp thoi ha) v vim dnh t sng.
CHNG CH NH
Apo-Piroxicam chng ch nh trn tt c cc bnh nhn c tin s va mi hay ti pht lot d
dy t trng hay vim tin trin trn ng tiu ha.

Piroxicam chng ch nh trn nhng bnh nhn nghi ng hay c qu mn bit vi thuc.
Khng nn s dng piroxicam cho nhng bnh nhn b cn hen cp, ni my ay, vim mi hay
cc biu hin d ng khc b kch ng bi acetylsalicylic acid hay cc thuc khng vim khng
steroid khc. c phn ng dng phn v gy t vong nhng bnh nhn ny.
CH PHNG
Lot d dy, t trng thng v xut huyt tiu ha, i khi trm trng v thnh thong gy t
vong c bo co trong qu trnh iu tr vi cc khng vim khng steroid trong c
piroxicam.
Nn dng Apo-Piroxicam (piroxicam) cng vi s theo di cn thn nhng bnh nhn c
khuynh hng b kch ng ng tiu ha, c bit l nhng ngi c tin s lot d dy t
trng, c ti tha hay cc bnh vim khc ca ng tiu ha. Trong nhng trng hp nh
vy, bc s phi cn nhc gia li ch tr liu v cc nguy c c th xy ra.
Bnh nhn dng cc thuc khng vim khng steroid trong c piroxicam nn c hng
dn phi n khm bc s ngay trong trng hp c triu chng hay du hiu no c th ngh
n lot d dy hay xut huyt tiu ha. Cc phn ng ny c th xut hin m khng c triu
chng bo trc ti bt kz thi im no trong qu trnh tr liu.
Bnh nhn gi, yu t v suy kit c v nh c nguy c b nhiu tc dng ngoi do thuc
khng vim khng steroid hn. i vi nhng bnh nhn ny, nn bt u iu tr vi liu 10
mg/ngy v gia tng cho n 20 mg/ngy nu cn thit. Nn c bit cn thn theo di nhng
bnh nhn ny v kh nng xy ra tc dng ngoi .
Trong cc th nghim lm sng c i chng, t l lot d dy t trng vi liu ti a c
khuyn co 20 mg piroxicam l 1,8%. Liu cao hn i km vi t l lot v kch ng tiu ha. Do
, khng nn dng liu cao hn 20 mg.
THN TRNG LC DNG
Do ngi gi c nguy c b nhiu tc dng ph do thuc khng vim khng steroid v bnh
nhn ln tui, yu t v suy kit km chu ng tc dng ph trn ng tiu ha hn, nn
xem xt dng liu khi u thp hn thng thng v ch gia tng liu nu cc triu chng
khng cn kim sot c. Nn theo di nhng bnh nhn ny cn thn.
H tiu ha : Nu nghi ng hay xc nh lot d dy t trng, hoc c xut huyt hay thng
ng tiu ha, nn ngng thuc, p dng nhng tr liu thch hp v theo di bnh nhn cn
thn.
Khng c bng chng xc nh rng s dng ng thi cht i khng th th histamine H2
v/hoc thuc khng acid s ngn nga tc dng ngoi { trn ng tiu ha hay cho php tip
tc dng piroxicam nu cc phn ng ny xut hin.
Chc nng thn : Ging nh nhng thuc khng vim khng steroid khc, s dng piroxicam
lu ngy trn th vt lm hoi t nh thn v cc bnh l bt thng khc trn thn. ngi,
c nhng bo co vim thn m k cp tnh vi chng tiu ra mu, tiu protein v i khi c

hi chng thn h.
Dng th nh ca c tnh trn thn c quan st thy bnh nhn c bnh l{ trc
thn lm gim ti mu thn hay gim th tch mu, khi cc prostaglandin thn ng vai tr h
tr trong vic duy tr ti mu. nhng bnh nhn ny, thuc khng vim khng steroid c th
gy gim to thnh prostaglandin ph thuc liu lng v c th gia tng chng suy thn mt
b. Bnh nhn c nhiu nguy c xy ra phn ng ny l nhng ngi b suy thn, suy tim, suy
gan, ang dng thuc li tiu, v ngi gi. Thng thng, vic ngng thuc khng vim khng
steroid s phc hi c tnh trng ban u.
Piroxicam v cc cht chuyn ha ca n c o thi ch yu qua thn (di 5% liu hng
ngy c o thi di dng khng i) do nn cn thn khi s dng thuc bnh nhn
suy thn. Trong nhng trng hp ny, nn dng liu Apo-Piroxicam thp hn v theo di bnh
nhn tht cn thn. Hn na, cc thay i c th hi phc trn chc nng thn, vim thn k,
vim cu thn, hoi t nh thn v hi chng thn h cng c bo co vi piroxicam.
Nn nh kz kim tra chc nng thn khi iu tr lu ngy.
Chc nng gan : Vi piroxicam, cng nh cc thuc khng vim khng steroid khc, c th xy
ra s gia tng khng r rng ca mt hay nhiu test chc nng gan t l n 15% bnh nhn.
Cc bt thng ny c th tin trin, c th k o di khng thay i hay ch thong qua trong
qu trnh tip tc dng thuc. Xt nghim SGPT (ALT) c l l ch th nhy nht ca hot ng
chc nng gan. Gia tng ng k (gp 3 ln gii hn trn bnh thng) ca SGOT v SGPT (AST)
xut hin vi t l di 1% bnh nhn trong cc th nghim lm sng c kim chng. Mt bnh
nhn c triu chng v/hoc du hiu suy gan hay c kt qu xt nghim chc nng gan bt
thng nn c khm cn thn tm bng chng ca phn ng gan nng khi iu tr vi
piroxicam. Phn ng gan trm trng bao gm vng da v nhng trng hp vim gan gy t
vong c bo co xut hin vi piroxicam. Mc d nhng phn ng ny rt him nhng
nu cc kt qu xt nghim chc nng gan vn dng tnh hoc xu hn, nu pht trin nhng
du hiu v triu chng lm sng ca bnh gan, hay nu c biu hin ton thn (nh tng bch
cu i toan, ni ban...) nn ngng piroxicam (xem thm Tc dng ngoi ).
Trong qu trnh dng thuc ko di, nn lm xt nghim chc nng gan nh kz. Nu cn phi
dng thuc khi suy gan, cn theo di tht cht ch.
Cn bng nc v cht in gii : Gi nc v ph c quan st 2% bnh nhn c
iu tr vi piroxicam. Do , cng nh nhiu thuc khng vim khng steroid khc, nn lu {
n kh nng gy suy tim xung huyt trn bnh nhn ln tui hay ngi c suy yu chc nng
tim. Nn dng Apo-Piroxicam cn thn bnh nhn suy tim, cao huyt p hay nhng tnh trng
dn n kh nng nc, do s s dng thuc c th lm nng hn.
Nn theo di nh kz cht in gii trong huyt thanh khi iu tr di ngy, c bit bnh
nhn c nguy c.
Huyt hc : Cc thuc c ch sinh tng hp prostaglandin nh hng n chc nng tiu cu

mt vi mc ; do , bnh nhn c th b tc ng bt li do tc ng ny nn c theo

di cn thn khi iu tr vi Apo-Piroxicam.
Mc d vi liu khuyn co 20 mg/ngy piroxicam khng lm tng lng mu trong phn do
kch ng d dy-rut, khong 4% bnh nhn c iu tr vi piroxicam ring r hay dng phi
hp vi acetylsalicylic acid, quan st c gim hemoglobin v hematocrit. Do , nn nh
kz kim tra cc gi tr ny nu c du hiu hay triu chng thiu mu.
Him khi c lon to mu lin quan n s s dng thuc khng vim khng steroid nhng
cng c th i km vi cc h qu trm trng khc.
Nhim khun : Cng ging nh cc khng vim khng steroid khc, piroxicam c th che khut
cc du hiu ca nhim khun.
Nhn khoa : Nhn m hay gim th lc c bo co xut hin khi dng piroxicam v cc
thuc khng vim khng steroid khc. Nu xut hin cc triu chng ny, nn ngng thuc v
khm mt ; nn khm mt nh kz trn cc bnh nhn dng thuc lu ngy.
Phn ng qu mn : S kt hp cc du hiu v/hoc triu chng trn da v d ng gi { n
bnh huyt thanh i khi xy ra khi dng piroxicam. Cc triu chng ny bao gm : au khp,
nga ngy, st, mt mi v ni ban bao gm phn ng bng nc-mn nc v vim da trc
vy.
S dng trn tr em : Apo-Piroxicam khng nn s dng cho tr em di 16 tui do cha xc
nh c liu lng v ch nh trong trng hp ny.
LC C THAI v LC NUI CON B
Ging nh cc thuc c ch tng hp v gii phng prostaglandin, piroxicam lm tng t l
kh v ko di qu trnh sanh th vt c thai khi dng cui thai kz. c tnh trn ng tiu
ha gia tng ph n c thai ba thng cui khi so snh vi ph n khng c thai v c thai ba
thng u.
Khng nn dng Apo-Piroxicam cho b m nui con b theo cc nghin cu trn th vt v v
tnh an ton ca thuc trn ngi cha c xc nh.
TNG TC THUC
- Acetyl salicylic acid v cc khng vim khng steroid khc : Nng piroxicam trong huyt
tng gim khong 80% gi tr bnh thng khi dng piroxicam kt hp vi acetylsalicylic acid
(3900 mg/ngy), nhng dng ng thi khng acid khng c nh hng ln nng piroxicam
trong huyt tng.
Khng nn s dng piroxicamvi acid acetylsalicylic hay cc khng vim khng steroid khc do
khng c s liu chng minh tc dng ng vn v c kh nng gia tng tc dng ngoi .
- Thuc chng ng : Piroxicam gn kt cht ch vi protein, v do c th thay th ch ca
cc thuc gn kt vi protein khc. Mc d khng xy ra tc dng ny trong nghin cu in vitro
vi thuc chng ng loi coumarine, tng tc vi thuc chng ng loi coumarine vi
piroxicam c bo co trong qu trnh a thuc lu hnh trn th trng. Do , bc s

nn theo di bnh nhn tht cn thn v nhu cu thay i liu lng khi dng piroxicam vi
thuc chng ng loi coumarine hay cc thuc c gn kt cao vi protein khc.
- Lithium : Cc tc nhn khng vim khng steroid trong c piroxicam c bo co lm gia
tng nng n nh lithium trong huyt tng. Nn kim sot nng lithium trong huyt
tng khi khi u dng, iu chnh liu v ngng dng piroxicam.
TC DNG NGOI
Tc dng ngoi { thng gp nht vi khng vim khng steroid l trn ng tiu ha, trong
lo t d dy t trng, c hay khng c xut huyt l trm trng nht. i khi c t vong, c
bit l ngi gi.
T l tc dng ngoi vi piroxicam da trn th nghim lm sng bao gm khong 2300 bnh
nhn, trong c khong 400 ngi c iu tr hn 1 nm v 170 ngi c iu tr
hn 2 nm. Khong 30% tng d bnh nhn dng 20 mg piroxicam mi ngy b tc dng
ngoi . Cc triu chng trn ng tiu ha l tc dng ngoi ni bt nht xut hin trn
khong 20% bnh nhn m trong hu ht cc trng hp khng lm nh hng n t tr
liu. Trong s nhng bnh nhn b tc dng ngoi { trn ng tiu ha, khong 5% ngng
dng thuc vi t l lot d dy t trng ni chung vo khong 1%.
Ngoi cc triu chng trn ng tiu ha, ph n, chng mt, nhc u, thay i trn cc
thng s huyt hc v ni ban c bo co xut hin trn mt t l nh bnh nhn. Soi y
mt v khm mt bng n khe khng cho thy c bng chng thay i trn mt 205 bnh
nhn c tr liu t 3 n 24 thng.
Tiu ha (17,4%) : au thng v (6,4%), bun nn (4,1%), to bn (2,4%), bng kh chu (2,2%),
trng bng (2,1%), tiu chy (1,8%), au bng (1,5%), kh tiu (1,3%), chn n (1,2%) ; lo t d
dy (khong 1%) ; vim ming, bun nn, nn ra mu, phn c mu en, xut huyt tiu ha v
thng (xem Ch { phng), kh ming, vim ty, mi tc dng ngoi xut hin vi t l di
1% s bnh nhn c iu tr.
D ng (< 1%) : phn v, co tht ph qun, ni my ay/ph mch, vim mch, bnh huyt
thanh (xem Thn trng lc dng), mi tc dng ngoi xut hin vi t l di 1% s bnh nhn
c iu tr.
H thn kinh trung ng (5%) : nhc u (1,8%), kh (1,0%) ; chng mt, bun ng/an thn,
chong vng, trm cm, o gic, mt ng, lo lng, d cm, thay i tnh tnh, gic m bt
thng, l ln tm thn, mi tc dng ngoi xut hin vi t l di 1% s bnh nhn c
iu tr.
Da (2,0%) : ni ban da (2,0%), nga ngy, ban , bm tm, trc vy da, vim da trc vy, ban
a dng, hoi t nhim c da, phn ng mn nc-bng nc trn da, bong mng, hi
chng Stevens-Johnson, phn ng da d ng nh sng, mi tc dng ngoi xut hin vi t l
di 1% s bnh nhn c iu tr.
Tim mch/h hp (1%) : ph n (xem Thn trng lc dng), cc tc dng ngoi sau xut hin

vi t l di 1% s bnh nhn c iu tr : cao huyt p, nh trng ngc, kh th, suy tim

sung huyt nng hn (xem Thn trng lc dng), tng au tht ngc.
Gic quan (1%) : tai (khong 1%); nhn m, kch ng/sng mt, mi tc dng ngoi xut hin
vi t l di 1% s bnh nhn c iu tr.
Huyt hc (15%) : gim hemoglobin (4,6%) v hematocrit (4,2%) (xem Thn trng lc dng),
gim tiu cu (2,4%), tng bch cu i toan (1,8%), tng bch cu (1,7%), tng bch cu a base
(1,7%), gim bch cu (1,4%) ; ni ban m xut huyt, bm mu, suy ty bao gm thiu mu
bt sn, chy mu cam, mi tc dng ngoi xut hin vi t l di 1% s bnh nhn c
iu tr.
Thn (1%) : ph n (1,6%) (xem Thn trng lc dng) ; kh tiu, tiu mu, tiu protein, vim
thn m k, suy thn, hoi t nh thn, tng kali huyt, vim cu thn, hi chng thn h (xem
Thn trng lc dng), mi tc dng ngoi xut hin vi t l di 1% s bnh nhn c iu
tr.
Gan (< 1%) : vng da, vim gan, bt thng chc nng gan (xem Thn trng lc dng), mi tc
dng ngoi xut hin vi t l di 1% s bnh nhn c iu tr.
Chuyn ha <( 1%) : h ng huyt, tng ng huyt, tng/gim cn, mi tc dng ngoi
xut hin vi t l di 1% s bnh nhn c iu tr.
Cc tc dng ngoi { khc (< 1%) : m hi, au (qun), st, hi chng dng cm (xem Thn
trng lc dng), suy yu mi tc dng ngoi xut hin vi t l di 1% s bnh nhn c
iu tr.
Thm vo , mt s t bo co cn nu ra tnh trng chm lnh vt thng, vim tnh mch
huyt khi, bnh pemphigus, rng tc, au v, gim hay mt tnh dc, bt lc, tiu thng
xuyn, gim tiu, a kinh, mt tr nh, lo lng, rung ry, ic, kht nc, n lnh, tng cm gic
thm n, ngi nm khng yn, tim nhanh, bng mt, i mu rng, vim li, au ngc, v tc
nhn khng nhn dng tnh (ANA) ; cha xc nh c mi lin h nhn qu cho cc phn
ng ph him nu trn.
LIU LNG v CCH DNG
Trong vim khp dng thp v vim dnh t sng, nn bt u tr liu vi Apo-Piroxicam
(piroxicam) vi liu n duy nht 20 mg mi ngy. Nu mun, c th dng 10 mg hai ln mi
ngy. Hu ht cc bnh nhn duy tr vi liu 20 mg. Mt s tng i t c th duy tr vi 10 mg
mi ngy.
Trong vim xng khp, liu Apo-Piroxicam (piroxicam) bt u l 20 mg mi ngy mt ln.
Nu mun c th chia lm 10 mg hai ln mi ngy. Liu duy tr thng thng l 10-20 mg mi
ngy.
Do nguy c gia tng c tnh trn ngi gi, yu t v suy kit hay bnh nhn suy thn, nn
dng liu khi u 10 mg/ngy. Liu c th gia tng n 20 mg/ngy nu cn thit (xem Ch
phng v Thn trng lc dng). Phi theo di cn thn nhng bnh nhn nh trn.

Khng nn dng Apo-Piroxicam (piroxicam) vi liu cao hn 20 mg do nguy c gia tng tc dng
ngoi { trn ng tiu ha.
QU LIU
Mt vi trng hp qu liu (n 1800 mg) c bo co v c hi phc hon ton. Cc
triu chng v du hiu bao gm bun nn, au bng, lot nh d dy t trng nhiu ni,
xut huyt tiu ha.
Khng bit c cht gii c c hiu cho piroxicam. Nn p dng cc bin php iu tr triu
chng v h tr. Dng than hot tnh c th lm gim hp thu ca thuc, do lm gim lng
thuc qu liu.

32.

APO-RANITIDINE

APOTEX
c/o NHANTAM
Vin nn bao phim 150 mg : l 12 vin, l 56 vin, l 100 vin v l 500 vin.
Vin nang 300 mg : l 100 vin, l 500 vin.
THNH PHN
cho 1 vin nn
Ranitidine hydrochloride

150 mg

cho 1 vin nang

Ranitidine hydrochloride

300 mg

DC LC
Ranitidine l mt cht i khng th th histamin H2 c tnh chn lc cao v l mt thuc c
ch tit acid dch v mnh. Do , ranitidine c ch c s tit dch v ca t bo nn v tit acid
do histamin, pentagastrin v cc cht gy tit khc. Trn c s khi lng, ranitidine mnh hn
cimetidine trong khong t 4 n 9 ln. S c ch tit acid d dy quan st c qua vic
dng ranitidine theo ng tnh mch, cho vo t trng v theo ng ung. Tc ng c ch
ny ph thuc vo liu lng vi p ng ti a t c vi liu ung 150 mg.
S tit pepsin cng b c ch tuy nhin s tit ca nim dch d dy khng b nh hng.
Ranitidine khng lm thay i s tit bicarbonate hay men ty p ng vi secrectin v
pancreozymin.

DC NG HC
Ranitidine c hp thu nhanh chng sau khi ung, nng ti a trong huyt tng t c
trong vng 2 n 3 gi. Nng trong huyt tng khng b nh hng ng k khi c thc n
d dy ti thi im ung hay khi c s hin din ca cc thuc khng acid.
Kh dng sinh hc ca ranitidine dng theo ng ung vo khong 50%. S gn kt protein
vi ranitidine ngi vo trong khong 10 n 19%. Thi gian bn hy o thi vo khong 3
gi. ng o thi ch yu l nc tiu (t l o thi trong nc tiu ca ranitidine dng t
do v chuyn ha trong 24 gi sau khi ung mt liu 100 mg l vo khong 33%).
C mt mi tng quan tuyn tnh gia liu lng (ln ti 150 mg) v tc dng c ch tit acid
d dy. Nng ranitidine trong huyt tng l 93,6 ng/ml (trong khong 48-125) c tc ng
c ch s tit acid d dy c kch thch vo khong 50%. IC50 ca ranitidine vo khong 100
ng/ml. Khi ung 150 mg ranitidine, nng huyt tng vt qu IC50 (100 ng/ml) k o di hn
8 gi v sau 12 gi, nng huyt tng vn cn cao cho tc dng c ch s tit acid d
dy. bnh nhn lot t trng, ung 150 mg ranitidine mi 12 gi lm gim ng k hot tnh
ion hydrogen trung bnh trong 24 gi n 69% v lng acid d dy tit ra vo ban m n
90%. Nng hu hiu trong mu ca ranitidine duy tr qua 24 gi vi mt liu n duy nht
300 mg hay 150 mg hai ln mi ngy.
Mc khc, tnh theo acid trong 24 gi v lng acid tit ra vo ban m, 150 mg ranitidine
dng hai ln mi ngy u vit hn 200 mg cimetidine ba ln mi ngy v 400 mg vo bui ti
(vi p < 0,001 v 0,05 tng ng).
ngi tnh nguyn s dng ranitidine, khng c bo co v tc dng ngoi { ng k trn
ng tiu ha hay h thn kinh trung ng; hn na, nhp tim, huyt p, in tm v in
no khng b nh hng nhiu khi dng ranitidine.
ngi tnh nguyn khe mnh v bnh nhn, ranitidine khng nh hng nng trong
huyt tng ca cc ni tit t sau : cortisol, testosterone, oestrogen, GH, FSH, LH, TSH,
aldosterone hay gastrin - mc d cng nh cimetidine, ranitidine lm gim lng vasopressin
tit ra. iu tr vi liu 150 mg ranitidine hai ln mi ngy n 6 tun khng lm nh hng
trc h i-tuyn yn-tinh hon, bung trng hay thng thn.
Vi liu tim tnh mch 50 mg ranitidine khng c tc dng trn nng prolactin. Ch vi liu
tim tnh mch 300 mg mi thy c s tng tit prolactin, tng t nh tc dng sinh ra do liu
200 mg cimetidine tim tnh mch.
So snh kh dng sinh hc : Cc nghin cu kh dng sinh hc c thc hin ngi tnh
nguyn nam gii bnh thng. Mc v vn tc hp thu sau mt liu n ung 150 mg Zantac
v 150 mg Apo-Ranitidine c o lng v so snh. Tm lc kt qu nh sau :
Zantac 150 mg Apo- Ranitidine 150 mg

% sai bit

ACU 0-12 (ng.gi/ml)

2041

2186

+7,1

AUC 0-inf. (ng.gi/ml)

2107

2243

+6,5

Cmax (ng/ml)

466

478

+2,6

Tmax (gi)

2,8

2,8

0,0

t1/2 (gi)

2,6

2,5

-3,8

Kt lun : Sinh kh dng ca Apo-Ranitidine v Zantac c nh gi bng cch so snh vn

tc v mc hp thu thuc. Theo nhng s liu ca nghin cu ny, c th kt lun rng ApoRanitidine v Zantac l tng ng v mt sinh hc v do , tng ng vi nhau trn lm
sng
Nng ti a trong huyt tng quan st c trong t 1 n 4 gi.
CH NH
Apo-Ranitidine (ranitidine) c ch nh trong :
- iu tr ngn hn lot t trng tin trin.
- iu tr duy tr bnh nhn lo t t trng sau khi lnh vt lot cp.
- iu tr tnh trng tng tit qu bnh l{ (nh hi chng Zollinger-Ellison v bnh tng bo
h thng.
- iu tr ngn hn lot d dy lnh tnh tin trin.
- iu tr bnh hi lu thc qun d dy.
CHNG CH NH
Ranitidine chng ch nh bnh nhn bit c qu mn vi thuc.
CH PHNG
Lot d dy : iu tr vi mt cht i khng histamine c th che khut cc triu chng i km
vi carcinome d dy v do c th lm tr hon chn on bnh. Do , khi nghi l lo t d
dy, kh nng c tnh phi c loi b trc khi bt u iu tr vi Apo-Ranitidine.
THN TRNG LC DNG
S dng cho bnh nhn suy thn : Ranitidine c o thi qua thn v khi suy thn nng, nng
ranitidine trong huyt tng c gia tng v k o di. Do , khi c suy thn nng, bc s
nn gim mt na liu.
S dng cho tr em : Kinh nghim s dng ranitidine tr em rt gii hn v vn cha kho st
y trn lm sng. Tuy nhin, thuc cng c s dng tt tr em trong tui 8-18
vi liu ti a n 150 mg hai ln mi ngy m khng gy tc dng ngoi .
Tng tc vi cc thuc khc : Mc d ranitidine c bo co l gn kt yu vi cytochrome
P450 in vitro, vi liu khuyn co thuc khng c ch tc ng ca oxygenase gn kt

cytochrome P450 gan. Trong y vn c nhng bo co tri ngc nhau v cc tng tc c

th xy ra vi ranitidine v mt vi loi thuc khc, { ngha lm sng ca cc bo co ny khng
nhiu. Trong s nhng thuc c nghin cu c warfarin, diazepam, metoprolol v nifedipine.
LC C THAI v LC NUI CON B
Cha xc nh c tnh an ton ca Apo-Ranitidine (ranitidine) trong iu tr cc bnh cn
phi gim s tit acid d dy trong thai kz. Cc nghin cu v tnh sinh sn thc hin chut
cng v th khng cho thy bng chng g v gim kh nng sinh sn cng nh nguy hi n
thai nhi do ranitidine. Nu cn thit phi dng ranitidine, phi cn nhc li ch ca thuc vi cc
nguy c c th xy ra cho bnh nhn v thai nhi.
Ranitidine tit qua sa nhng { ngha lm sng vn cha c kho st y .
TC DNG NGOI
Nhc u, ni ban, chng mt, to bn, tiu chy v bun nn c bo co xut hin
mt s rt t bnh nhn c iu tr vi thuc nhng cng xy ra nhng ngi dng gi
dc. Mt vi bnh nhn sau khi b tc dng ph li dng th tr li ranitidine b ti pht ni
ban da, nhc u hay chng mt.
c bo co v mt vi trng hp gia tng transaminase huyt thanh v g-glutamine
transpeptidase nhng tr v tnh trng bnh thng trong c hai trng hp tip tc tr liu
hay ngng thc. Trong nghin cu c i chng gi dc bao gm gn 2500 bnh nhn,
khng c khc bit gia t l gia tng SGOT v SGPT nhm bnh nhn c iu tr vi
ranitidine v nhm bnh nhn dng gi dc. Cc trng hp vim gan him khi xy ra cng
c bo co, nhng cn bnh ny cng thong qua v khng xc nh c mi lin h nhn
qu vi s s dng thuc.
Phn ng dng phn v (phn v, ni m ay, ph mch thn kinh, co tht ph qun) him khi
xut hin khi dng ranitidine theo ng ung v ng tim. i khi cc phn ng ny cng
xut hin sau mt liu n duy nht.
Gim s lng bch cu v tiu cu xut hin trn mt vi bnh nhn. Cc xt nghim huyt
hc v trn thn khng cho thy bt thng no lin quan vi thuc.
Khng c nh hng lm sng ng k no v chc nng ni tit hay tuyn sinh dc c bo
co.
LIU LNG v CCH DNG
Ngi ln :
Lot t trng, lot d dy lnh tnh : mt liu 300 mg hay hai vin 150 mg mi ngy mt ln vo
lc i ng.
Trong hu ht cc trng hp, vt lot lnh trong vng 4 tun. Trn mt s t bnh nhn c vt
lo t cha lnh hon ton c th p ng vi mt t iu tr k tip.
iu tr duy tr : Bnh nhn p ng vi iu tr ngn hn ny, c bit l nhng ngi c tin
s lot ti pht, c th ko di tr liu duy tr vi liu thp hn l 150 mg lc i ng.

Tnh trng tng tit bnh l{ (nh hi chng Zollinger-Ellison) : 150 mg hai ln mi ngy. mt
vi bnh nhn c th cn phi dng liu 150 mg nhiu ln hn trong ngy. Nn iu chnh liu
lng theo tnh trng ca tng bnh nhn v tip tc tr liu khi c ch nh lm sng. Liu 6
g/ngy c s dng bnh nhn nng.
Bnh hi lu thc qun-d dy : 150 mg hai ln mi ngy vo bui sng v trc khi ngh ngi
hoc theo s hng dn ca bc s.
Tr em :
Kinh nghim vi ranitidine tr em cm gii hn v vn cha c kho st y trn cc
nghin cu lm sng (xem Thn trng lc dng).
QU LIU
Khng c tai bin c bit no xy ra khi dng qu liu ranitidine. Nn p dng tr liu triu
chng v h tr thch hp. Nu cn thit, c th loi thuc ra khi huyt tng bng phng
php lc mu.

33.

APRANAX

HOFFMANN - LA ROCHE
Vin bao 275 mg : hp 10 vin.
Vin bao 550 mg : hp 16 vin.
Ta dc 550 mg : hp 15 vin.
THNH PHN
cho 1 vin
Naproxne sodique

275 mg

cho 1 vin
Naproxne sodique

550 mg

cho 1 ta dc
Naproxne sodique

DC LC

550 mg

Apranax c c tnh gim au, khng vim v h st mnh. Naproxne sodique l dn xut
khng stroide ca acide propionique, c ch sinh tng hp ca prostaglandine. Hot cht
chnh di dng mui Na c hp thu nhanh v hon ton, v tc dng gim au xy ra
nhanh, sau khi ung thuc khong 15 n 30 pht.
DC NG HC
Hp thu :
Sau khi ung, thuc c hp thu nhanh v hon ton. Naproxne sodique t nng ng
k trong huyt tng sau 20 pht, v t nng ti a sau khi ung thuc khong 1-2 gi.
Thc n khng gy nh hng n tin trnh hp thu ca thuc.
Phn phi :
Lng hot cht gn vi protine huyt tng l 99%.
Chuyn ha/o thi :
Thi gian bn hy trong huyt tng khong 13 gi. Khong 95% liu dng c o thi trong
nc tiu di dng naproxne khng i, cht chuyn ha 6-desmthylnaproxne khng c
hot tnh hoc dng lin hp ca naproxne.
CH NH
Gim cc cn au t nh n trung bnh k c au sau khi sinh, au sau khi t vng trnh thai,
au hu phu, au do phu thut chnh hnh, au bng kinh nguyn pht, gim (nga) cn au
na u. Apranax cng c ch nh trong vic iu tr nhng du hiu t nh n trung bnh,
cp hay mn ca nhng chng vim c xng, vim m mm v goutte cp.
CHNG CH NH
Mn cm vi naproxne hay naproxne sodique.
V kh nng gy phn ng cho, khng nn dng Apranax nhng bnh nhn vn s dng
aspirine hay thuc khng vim khng stroide khc m dn n hi chng suyn, vim mi hay
ni m ay.
CH PHNG v THN TRNG LC DNG
- Do cha c nhng nghin cu y v hiu qu v an ton nn Apranax c khuyn
khng nn s dng tr em di 2 tui.
- Apranax khng c s dng bnh nhn ang b lot d dy, t trng tin trin. nhng
bnh nhn c tin s bnh ng tiu ha nn theo di cht ch khi dng Apranax.
- Nhng phn ng ph trn ng tiu ha c th xy ra bt c lc no vi bnh nhn iu tr
bng thuc khng vim khng st roide. Nguy c xut hin nhng phn ng ph ny dng nh
khng ty thuc vo thi gian iu tr.
- Cho ti nay, nhng cng trnh nghin cu u khng xc nh c thi im pht trin nguy
c lo t d dy t trng v xut huyt, tuy nhin nhng bnh nhn cao tui v suy yu, kh
nng dung np s lot v chy mu ng tiu ha k m hn nhng ngi khc. Phn ln
nhng phn ng ph ng tiu ha gy cht ngi, c lin quan n vic s dng thuc

khng vim khng stroide nhng bnh nhn cao tui v suy yu ny.
- Apranax lm gim kt tp tiu cu v ko di thi gian chy mu. Nn lu { n tc ng ny
khi thi gian chy mu c xc nh. Khi dng cc loi thuc ny, cn phi theo di cc kt
qu xt nghim v chc nng gan.
Vin Apranax 275 mg cha khong 25 mg (khong 1 mEq) sodium.
Vin Apranax 550 mg cha khong 50 mg (khong 2 mEq) sodium.
iu ny cn lu { i vi nhng bnh nhn ang phi hn ch s dng mui sodium.
Bnh nhn suy thn :
- V naproxne v cht chuyn ha ca n b thi tr ch yu (95%) bng ng thn qua lc
tiu cu thn. Do phi ht sc thn trng khi s dng Apranax cho nhng bnh nhn suy
thn, i vi nhng bnh nhn ny phi kim tra cratinine huyt thanh v/hay thanh thi
cratinine.
- Apranax khng c dng lu di nhng bnh nhn c thanh thi cratinine nh hn 20
ml/pht.
- nhng trng hp c bit nh : bnh nhn b mt nhiu nc ngoi bo, x gan, bnh
nhn ang king mui sodium, suy gan sung huyt v bnh nhn mc bnh thn trc , cn
phi nh gi chc nng thn trc v trong khi iu tr bng Apranax. i vi bnh nhn cao
tui, chc nng thn vn suy yu cng cn phi thn trng ging nh cc trng hp trn.
i vi tt c bnh nhn ny, vic gim liu Apranax iu tr hng ngy cn c xem x t
trnh s tch t thi qu cht chuyn ha ca Apranax trong c th.
Bnh nhn suy gan :
bnh nhn bnh gan mn do ru v c th cn nhng dng khc ca bnh x gan na,
nng tng qut ca naproxne trong huyt tng gim, nhng nng naproxne khng
gn kt li tng. iu khm ph ny khin liu lng chnh xc ca naproxne cha c bit
r, nhng tt nht ch nn s dng Apranax liu thp nht c hiu qu.
Bnh nhn cao tui :
Nhng cng trnh nghin cu chng t rng mc d nng tng qut ca naproxne trong
huyt tng khng thay i nhng nng ca naproxne khng gn kt trong huyt tng
tng bnh nhn cao tui. iu khm ph ny khin liu lng chnh xc ca naproxne cha
c bit r, nhng tt nht ch nn s dng Apranax liu thp nht c hiu qu.
LC C THAI
Do cc th nghim trn sc vt cho thy thuc c tc dng gy qui thai, khng nn dng
Apranax trong qu 1 v qu 2 ca thai kz, ch tr khi tuyt i cn thit. Chng ch nh Apranax
qu 3 ca thai kz do c th gy c ch s co bp t cung v gy ng sm ng ng mch.
LC NUI CON B
Ph n cho con b khng nn dng Apranax. Naproxne c bi tit yu qua sa m (nng
: khong 1% nng trong huyt tng).

TNG TC THUC
Do Apranax c mc gn kt cao vi protine huyt tng, nn nh gi li liu v theo di
cht ch cc bnh nhn c iu tr ng thi vi hydantoine.
Mc du cho n nay cha c quan st thy trn lm sng c tng tc thuc gia Apranax
v thuc chng ng mu hoc cc sulfonylurea, cng cn phi thn trng do xy ra tng
tc vi cc thuc cng nhm.
Dng ng thi vi probncide s lm tng nng naproxne trong huyt tng v k o di
thi gian bn hy sinh hc.
Cc tng tc thuc ca Apranax cng nh ca cc thuc khng vim khng st roide khc cng
c m t : gim tc dng li tiu ca furosmide, gim thanh thi lithium thn, gim tc
dng h huyt p ca propranolol v cc thuc chn bta khc, gim bi tit mthotrexate qua
thn.
Apranax c th giao thoa vi mt vi nh lng 17-ctostroide v 5-hydroxyindoactique
trong nc tiu, nn ngng tm thi Apranax 48 gi trc khi lm xt nghim chc nng thn.
Apranax gy c ch c hi phc s kt tp tiu cu v ko di thi gian chy mu. Tc dng ny
phi c lu { n khi xc nh thi gian chy mu.
TC DNG NGOI
- Cc tc dng ph thng thng nht : ri lon tiu ha, au thng v, nhc u, bun nn,
ph ngoi vi nh, tai, chng mt.
- Nhng phi ng ph him khi xy ra nhng c ghi nhn : rng tc, phn ng sc phn v
vi naproxne v nhng cht c cng cng thc vi naproxne sodique, ph mch, thiu mu
khng ti to, thiu mu tan huyt, vim mng no v khun, lon chc nng nhn thc, vim
phi tng bch cu a osine, hoi t biu b, ban a dng, vim gan, xut huyt d dy-t
trng v/hay thng d dy-t trng, gim bch cu ht, gim thnh lc, tiu ra mu, mt kh
nng tp trung, mt ng, vng da, bnh thn, lot d dy-t trng, lo t ng tiu ha, vim da
do nhy cm vi nh sng, ni ban, hi chng Stevens-Johson, gim lng tiu cu, vim bao t
c lot, vim mch, ri lon th lc, bun nn.
Mc d cha c mt nghin cu no v s gi mui Na c ghi nhn, nhng vi bnh nhn c
tin s bnh tim c th c nguy c cao khi dng Apranax.
LIU LNG v CCH DNG
n Liu thng thng :
Ngi ln :
n Bnh vim thp khp v thoi ha : liu tn cng v trong cc cn cp tnh : 1100 mg/ngy.
Liu duy tr 550-1100 mg/ngy ty theo cng au.
n Bnh thp ngoi khp, au sau phu thut v sau chn thng : thng thng dng liu hng
ngy 1100 mg t ra c hiu qu. Liu lng ny phi c nh gi li tng trng hp,
nhng khng vt qu 1375 mg/ngy. Liu hng ngy c th dng mt ln duy nht hoc chia

lm 2 ln cch nhau 12 gi.

n au bng kinh : liu khuyn co khi u l 550 mg, sau l 275 mg mi 6-8 gi trong 3-4
ngy.
n Bnh goutte : liu khi u l 825 mg, sau l 275 mg mi 8 gi cho n khi cn au cp
gim.
n phng nhc na u : liu khuyn co l 550 mg, 2 ln/ngy. Nu dng thuc trong vng
4-6 tun m bnh khng thuyn gim, nn ngng s dng thuc.
n Trng hp au sau khi sinh : liu duy nht l 550 mg.
n Trng hp vim c xng, m mm t nh n trung bnh, cp hay mn : liu khuyn co
khi u cho ngi ln l 275 mg, 2 ln/ngy (sng v ti) hay 275 mg bui sng v 550 mg
bui ti. Trong thi gian iu tr lu di, liu lng tng hay gim ty thuc vo p ng lm
sng ca bnh nhn.
Ghi ch :Khng nn b vin Apranax 550 mg.

34.

APROVEL

SANOFI SYNTHELABO VIETNAM

vin nn 75 mg : v 14 vin, hp 2 v.
vin nn 150 mg : v 14 vin, hp 2 v.
vin nn 300 mg : v 14 vin, hp 2 v.
THNH PHN
cho 1 vin
Irbesartan

75 mg

cho 1 vin
Irbesartan

150 mg

cho 1 vin
Irbesartan

300 mg

C CH TC DNG
Irbesartan l cht c ch th th angiotensin II (loi AT1) mnh. Angiotensin II l thnh phn

quan trng ca h renin-angiotensin v tham d vo c ch sinh l bnh ca cao huyt p cng

nh chuyn dch natri. Irbesartan tc ng khng cn phi qua s chuyn ha.
Irbesartan c ch kh nng co mch v tit aldosterone ca angiotensin II bng cch cnh tranh
chn lc trn th th AT1 c trn v v thng thn. N khng c tc ng ch vn vi th
th AT1 v c i lc mnh th th AT1 8500 ln hn so vi th th AT2 (th th khng lin
quan n s n nh h tim mch). Irbesartan khng c ch cc men ca h renin-angiotensin
(nh renin, men chuyn) hay nh hng n cc th th hormon khc, cc knh ion c tham
d vo vic iu ha huyt p v hng nh natri. Irbesartan c ch th th AT1 s ct t vng
phn x ca h renin-angiotensin lm tng renin huyt thanh v angiotensin II. Aldosterone
huyt thanh gim sau khi dng Irbesartan, tuy nhin kali huyt tng khng thay i ng k
(tng < 0,1 mEq/L) vi liu khuyn co.
Irbesartan khng nh hng n triglycerides, cholesterol hay glucose. N cng khng nh
hng n acid uric huyt thanh hay s bi tit acid uric trong nc tiu.
DC LC
Tc dng h p ca Irbesartan r rng sau liu u tin v gi vng sau 1-2 tun, tc dng ti
a sau 4-6 tun. Trong cc nghin cu di hn, hiu qu Irbesartan duy tr hn 1 nm.
Liu ngy 1 ln ti 900 mg c tc dng h p ph thuc vo liu. Liu 150-300 mg ngy 1 ln
lm h huyt p tm thu v tm trng t th nm v ngi sau 24 gi l 8-13 / 5-8 mmHg, cao
hn gi dc. Tc dng sau 24 gi vi huyt p tm trng v tm thu l 60-70%. Tc dng ti
u trn kim sot huyt p sau 24 gi t c khi ch dng liu ngy 1 ln.
Huyt p gim tng ng nhau c t th ng v nm. H p t th t xy ra nhng cng
nh c ch men chuyn, n c th xy ra trn bnh nhn gim th tch mu hay gim natri.
Tc dng h p ca Irbesartan cng lc vi li tiu thiazide. bnh nhn khng kim sot c
huyt p vi Irbesartan n c, phi hp vi hydrochlorothiazide liu thp 12,5 mg lm gim
huyt p tm thu / tm trng thm 7-10 / 3-6 mmHg.
Hiu qu ca Irbesartan khng b nh hng bi tui v gii. Cng nh sau khi ngng
Irbesartan, huyt p tr v bnh thng. Khng ghi nhn hin tng tng vt huyt p sau khi
ngng thuc.
DC NG HC
Irbesartan c hot tnh sau khi ung v khng cn qua s chuyn ha. Sau khi ung, Irbesartan
c hp thu nhanh v hon ton. Kh dng sinh hc bng ng ung l 60-80%. Thc n
khng nh hng n kh dng sinh hc. Nng nh t c 1,5-2 gi sau khi ung thuc.
T l gn vi protein huyt tng khong 96% v t gn kt vi cc thnh phn t bo ca mu.
Th tch phn phi l 53-93 lt.
Sau khi ung hay tim tnh mch, Irbesartan nh du 14C, 80-85% hot tnh phng x trong
huyt tng l do Irbesartan. Irbesartan c chuyn ha ti gan bng hin tng glucuronide
ha v oxy ha. Cht chuyn ha chnh lu thng trong mu l Irbesartan glucuronide (khong

6%). Irbesartan b oxy ha ch yu bi men cytochrome P450 CYP2C9, ng men CYP3A4 t c

tc dng.
Irbesartan v cc cht chuyn ha c thi qua mt v thn. Khong 20% lng ng v phng
x 14C Irbesartan sau khi chch hay ung c pht hin nc tiu, phn cn li trong phn.
Di 2% Irbesartan c thi trong nc tiu di dng khng i.
Thi gian bn hy thi tr cui cng l 11-15 gi. Tc thanh thi sau khi chch l 157-176
mL/pht, trong 3,0-3,5 mL/pht do thn.Irbesartan c dc ng hc t l theo liu. Nng
huyt tng n nh sau 3 ngy, vi liu dng ngy 1 ln.
Khi dng lp li, t l tch t huyt thanh < 20%.
- Trn bnh nhn cao huyt p nam v n : Nng huyt thanh n hi cao hn nam (1144%), tuy nhin sau khi dng nhiu ln, s khng cn khc bit gia nam v n. Hiu qu lm
sng cng khng khc bit gia 2 gii.
- Trn ngi ln tui (65-80 tui), huyt p, chc nng gan thn bnh thng : Nng AUC v
nng nh Cmax ca Irbesartan ln hn ngi tr tui (18-40 tui) 20-50%. Thi gian bn
hy thi tr tng ng nhau. Tc dng lm sng khng khc nhau c { ngha theo tui.
- Ngi da trng v da en huyt p bnh thng : Nng AUC v thi gian bn hy ngi
da en cao hn da trng 20-25%. Nng ti Cmax tng ng nhau.
- bnh nhn suy thn v chy thn nhn to : Dc ng hc khng thay i. Irbesartan
khng b lc bi thn nhn to.
- bnh nhn suy gan do x gan nh v trung bnh : Dc ng hc khng thay i.
CH NH
iu tr cao huyt p nguyn pht (dng n liu php hay phi hp vi cc thuc khc).
CHNG CH NH
Tng nhy cm vi bt c thnh phn no ca thuc.
CH PHNG
- Bnh nhn gim th tch mu-h p :
Aprovel him khi gy tt huyt p. Cng nh cc thuc c ch men chuyn, tt huyt p triu
chng c th xy ra bnh nhn gim th tch mu hay gim natri do iu tr bng thuc li
tiu, hay ang theo ch n king mui hay ang chy thn nhn to. Cn iu chnh tnh
trng gim th tch mu hay gim natri trc khi iu tr Irbesartan hay phi h liu iu tr.
- T vong v bnh tt thai nhi/s sinh :
Mc d khng c kinh nghim no v vic dng Aprovel trn ph n mang thai, vic dng c
ch men chuyn bnh nhn mang thai qu 2 v qu 3 ca thai kz c th gy tn hi v t
vong cho thai nhi. Do vy, nh bt c thuc no c tc ng trc tip ln h renin-angiotensinaldosterone, Aprovel khng c dng khi mang thai. Nu pht hin th thai trong khi iu
tr, Aprovel phi c ngng dng ngay tc th.
THN TRNG LC DNG

- Tng qut :
Trn mt s bnh nhn nhy cm, c th c thay i chc nng thn do hu qu ca vic c
ch h renin-angiotensin-aldosterone. Trn nhng bnh nhn c chc nng thn ph thuc vo
hot ng ca h renin-angiotensin-aldosterone (nh bnh nhn cao huyt p c hp ng
mch thn 1 bn hay 2 bn, bnh nhn suy tim xung huyt nng), iu tr vi cc loi thuc nh
hng n h renin-angiotensin-aldosterone s gy ra thiu niu v/hay tng nit mu vi suy
thn cp v/hay t vong.
Kh nng c hiu qu tng t cng khng c loi tr khi dng cht c ch th th
angiotensin II.
- Tng tc thuc :
Da trn kt qu in-vitro, khng c tng tc xy ra khi dng chung vi cc thuc chuyn ha
da vo cc men cytochrome P450 nh CYP1A1, CYP1A2, CYP2A6, CYP2B6, CYP2D6, CYP2E1
hay CYP3A4. Irbesartan c chuyn ha ch yu do CYP2C9. Tuy nhin, trong cc nghin cu
tng tc thuc trn lm sng, khng ghi nhn c tng tc dc lc hc no ng k khi
dng chung vi warfarin (l thuc chuyn ha bi CYP2C9).
Irbesartan cng khng nh hng n dc ng hc ca digoxin hay simvastan. Dc ng
hc ca Irbesartan cng khng nh hng khi dng chung vi nifedipine hay
hydrochlorothiazide.
Theo kinh nghim, dng cc thuc nh hng n h renin-angiotensin-aldosterone chung vi
cc thuc li tiu tit kim kali, thuc b sung kali hay cc mui c cha kali c th lm tng kali
huyt thanh.
- Kh nng gy ung th, t bin gen, v sinh hay c cho thai :
Khng c bng chng v kh nng gy ung th khi dng Irbesartan chut cng vi liu ti
500/1000 mg/kg/ngy (chut c v ci) v liu 1000 mg/kg/ngy cho chut nht trong 2 nm.
So vi liu ngi dng hng ngy 300 mg, liu chut cng cao gp 4-25 ln v chut nht
cao gp 4-6 ln. Irbesartan khng gy t bin gen trong cc th nghim in-vitro (th nghim
Ames trn vi trng, th nghim sa cha DNA t bo gan chut, th nghim t bin gen V79
t bo ng vt c v). Irbesartan cng m tnh trong cc th nghim lm chuyn i nhim
sc th (th nghim t bo lympho ngi in-vitro, nghin cu vi nhn chut).
Kh nng sinh sn v th thai cng khng b nh hng trn cc th nghim chut c v ci
vi liu ung kh cao (650 mg/kg/ngy). Khng c s thay i trn lng hong th, s u
thai hay s lng thai cn sng. Irbesartan khng nh hng n s sng, pht trin v sinh
sn ca cc th h sau.
Vi liu 50 mg/kg/ngy v cao hn, mt vi tc ng thong qua nh tng lng b thn, niu
qun nc, ph di da c quan st thy chut. Nhng tc ng ny bin mt sau khi
sinh. th, liu 30 mg/kg/ngy c s tng t l t vong m, tng sy thai v thai teo nh.
Khng thy hu qu sinh ung th trn chut v th.

- C thai:
Khi mang thai, phi ngng dng Aprovel.
- Cho con b :
Thuc qua c sa loi chut. Khng r thuc c qua c sa ngi khng. Ty vo s cn
thit ca Aprovel i vi m v nguy c cho thai quyt nh xem nn ngng cho con b hay
ngng thuc.
- Dng thuc ngi gi :
Trong s bnh nhn ln tui c nghin cu, khng thy c s khc bit no v hiu qu v
s an ton gia nhm bnh nhn ln tui (>= 65 tui) v nhm bnh nhn tr.
- Dng tr em :
S an ton v hiu qu trn bnh nhn tr em cha c xc nh.
- Hu qu trn vic li xe v vn hnh my mc :
Da trn c ch, Irbesartan kh c kh nng gy nh hng n 2 hot ng trn. Cn lu { l
khi iu tr cao huyt p, bnh nhn c th thy hi chong vng hay mt mi.
TC DNG NGOI
Cc tc dng khng mong mun ca Aprovel nh v thong qua, khng lin quan n liu,
khng lin quan n tui, gii v chng tc.
Trong cc nghin cu so snh vi gi dc gm 1965 bnh nhn iu tr vi Irbesartan t 1-3
thng, t l ngng thuc do tc dng ph trn lm sng hay trn xt nghim l 3,3% i vi
Irbesartan v 4,5% i vi gi dc (p = 0,029).
T l tc dng ph khng chc v c th c lin quan n iu tr l 1% cho c bnh nhn dng
Irbesartan v gi dc.
T l tc dng ph so snh vi gi dc :
Tc dng ph

T l
Irbesartan (n =
1965)

Gi dc (n =
641)

2,4

2,0

0,9

1,4

Tng qut
Mt
Tim mch
Ph
Tiu ha

Nn, bun nn

1,1

0,3

Chong vng

3,8

3,6

Nhc u

6,1

7,8

Thn kinh

Cc tc dng ph khc chim t l t 0,5% n < 1% tng t hay t hn so vi gi dc, bao

gm : au ngc, ho, tiu chy, kh tiu, nng, chong vng khi i t th, ri lon kh nng
tnh dc, chm nhp tim.
- Theo di sau khi thuc c a ra th trng : cng ging nh cc thuc c ch th th
angiotensin II khc, c vi trng hp c phn ng qu mn (ni m ay, ph mao mch)
c bo co.
- Bt thng v xt nghim : Trong cc nghin cu, khng ghi nhn c thay i cc ch tiu xt
nghim. Cng khng cn phi theo di xt nghim c bit g khi dng Aprovel.
LIU LNG v CCH DNG
Liu khi u v liu duy tr c ngh thng l 150 mg mt ln mi ngy, cng vi thc n
hay khng. Liu c iu chnh theo p ng h p.
i vi bnh nhn khng kim sot c huyt p, liu c th tng n 300 mg/ngy. Nu
huyt p vn cha c kim sot vi Aprovel, c th phi hp vi thuc li tiu
(hydrochlorothiazide 12,5 mg/ngy) hay mt thuc h p khc (c ch bta, c ch knh calci).
- Gim th tch mu : i vi bnh nhn gim th tch mu hay gim natri nng (nh khi iu tr
bng thuc li tiu hay khi chy thn nhn to), phi iu chnh cc ri lon ny trc khi dng
Aprovel hay khi u bng liu thp hn. Nu huyt p khng kim sot c, s tng dn liu.
- Ngi gi v suy gan, suy thn : Khng cn phi chnh liu i vi bnh nhn gi, suy chc
nng gan v suy chc nng thn.
QU LIU
Kinh nghim cho thy dng vi liu ti 900 mg/ngy trong 8 tun ngi ln cng khng gy
c tnh no. Cha c thng tin no v cch iu tr qu liu Aprovel. Bnh nhn qu liu cn
c theo di k, iu tr nng v iu tr triu chng. Cc bin php c ngh bao gm
c dng thuc gy nn i hay ra d dy. Irbesartan khng b lc qua thn nhn to.
BO QUN
Hn dng: 24 thng
Gi ni kh ro, nhit di 30oC.

35.

ARCALION 200 mg

LES LABORATOIRES SERVIER

Vin bao 200 mg : hp 30 vin.
THNH PHN
cho 1 vin
Sulbutiamine

200 mg

DC LC
Arcalion l mt phn t c bit, kt qu ca qu trnh bin i cu trc ca nhn thiamine :
thnh lp cu ni disulfure, gn thm mt nhnh ester a lipide, m vng thiazole. Cc bin i
ny a n :
- kh nng ha tan trong lipide lm cho thuc c hp thu nhanh qua ng tiu ha v cho
ph p qua c hng ro mu-no ;
- tnh hng thn kinh chuyn bit trn h thng li, sng Ammon v th hnh trng, cng
nh trn cc t bo Purkinje v tiu cu ca lp ht v tiu no, c xc nhn bng phng
php nhum m huznh quang, trong khi thiamine cng iu kin th khng bt huznh quang
no c ;
- cc tnh cht dc l :
trn ng vt :
- dng Arcalion cho php ci thin rt r s phi hp vn ng v chng li s mt mi c,
ch yu trong cc kho st c s dng thuc an thn kinh lm suy gim h vn ng ;
- v no, Arcalion ci thin s chu ng ca v no i vi vic gim oxy m lp i lp li
nhiu ln. Mt khc, Arcalion cng lm tng trng thi tnh to ng vt ;
- ghi nhn thuc c hiu lc tt trn s hnh thnh vn ng v ghi nh trong cc kho st v
rn luyn ng vt ;
trn ngi : Arcalion c nghin cu trn lm sng so snh vi placebo hoc sn phm
tham kho bng cch s dng cc kho st v dng thang nh gi tm thn. Cc kho st ny
cho thy Arcalion c hiu lc ch ng trn tm thn vi tc ng u th trn s c ch tm
thn v c ch th lc.
DC NG HC
ng vt cng nh ngi, sulbutiamine c hp thu nhanh chng, v t c nng
ti a trong mu sau khi ung thuc t mt n hai gi. Nng trong mu sau gim theo
hm s m.

Thuc c phn tn nhanh trong c th. Sau thuc c o thi vi thi gian bn hy
trong khong nm gi, o thi ti a qua thn t hai n ba gi sau khi ung thuc.
CH NH
iu tr mt vi tnh trng c ch th lc hoc tm thn vi suy gim hot ng v trng thi
suy nhc :
- Suy nhc th lc, tm l, tnh dc.
- Suy nhc sau nhim khun, trong hi chng i trng kch thch.
- Suy nhc sinh vin vo ma thi.
Trng hp bnh nhn c xc nhn l b trm cm, vic s dng thuc ny khng th
thay cho mt tr liu chuyn bit bng thuc chng trm cm.
CHNG CH NH
C tin s qu mn cm vi thuc.
TC DNG NGOI
i khi thuc c th gy kch ng ngm ngi ln tui.
Mt vi trng hp c th gy d ng da.
LIU LNG v CCH DNG
1 n 3 vin, ung mt ln hoc chia lm nhiu ln trong ngy.
ngi ln, liu trung bnh l 2 vin, ung mt ln vo ba n sng.
QU LIU
Trng hp ung mt lng ln Arcalion, c th b kch ng km theo sng khoi v rung u
chi. Cc ri lon ny ch tm thi v qua nhanh khng li di chng.

36.

ARDUAN

GEDEON RICHTER
bt pha tim : hp 25 l bt ng kh + 25 ng dung mi - Bng A.
THNH PHN
cho 1 l
Pipecuronium bromure dng ng
4 mg
kh
ng dung mi : dung dch NaCl 0,9% 2 ml

DC LC
Arduan l mt thuc phong b thn kinh-c khng kh cc, tc dng trn tm vn ng ca c
vn. L thuc gin c c thi gian tc dng trung bnh. Nu thuc c dng sau khi t ng
thng kh qun nh succinylcholine, sau khi kt thc s phong b do kh cc, tc dng ca n
xut hin sau 2-3 pht. Nu dng mt mnh t ng thng, tc dng ca n pht trin t 4-5
pht. Thi gian tc dng lm sng ph thuc vo liu dng v s nhy cm ca tng c th.
CH NH
Thuc c dng gy gin c trong gy m, trong cc loi phu thut khc nhau khi cn s gin
c lu hn 20-30 pht.
CHNG CH NH
Nhc c nng.
THN TRNG LC DNG
V c tc dng ln c h hp, ch c th c dng Arduan cc phng gy m c bit c
trang b y .
Ch dng dung dch va pha xong.
TNG TC THUC
- S phong b trc , gy ra bi s kh cc ca succinylcholin, c th lm tng mnh tc
dng ca pipecuronium bromure.
- Cc thuc gy m ng h hp (halothane, methoxyflurane, diethylether) v thiobarbiturate
c th lm tng hay ko di tc dng ca pipecuronium bromure.
- Trong s cc khng sinh c nghin cu liu thng thng khi phu thut (gentamicine,
clindamycin, ampicillin v tetracyclin) khng thy c nh hng n tc dng ca Arduan, c
th bng test co cng c. V khng c test ny, nn khng loi tr kh nng gy tng tc ging nh vi cc thuc gin c khng kh cc khc - trong vi trng hp, tc dng c th ko
di thi kz hu phu.
Vy khi dng ng thi Arduan v khng sinh (nht l nhm aminoglycoside), nn cn thn v
cn theo di k bnh nhn.
TC DNG NGOI
Khng thy tc dng ngoi trn h tun hon do Arduan gy ra, nhng c vi trng hp gp
nhp tim chm bnh nhn dng ng thi halothane hoc fentanyl, hoc trong giai on dn
m. Khng gii phng histamin. Cho n nay vn cha thy cc tc dng ngoi khc.
LIU LNG v CCH DNG
Vi ngi ln trong cc phu thut c thi gian trung bnh hoc k o di, tim tnh mch :
t ng thng kh qun v s gin c phu thut 0,06-0,08 mg/kg th trng l liu thng
thng ; vi cc bnh nhn c t ng thng vi succinylcholine, th liu dng l 0,04-0,06
mg/kg th trng.
Nu suy thn, khng dng liu vt qu 0,04 mg/kg th trng. Nu cn tim lp li, th dng

liu bng 1/4-1/3 liu khi u. Liu cao hn c th gy ko di tc dng ca thuc.

Phc hi tc dng :
Trong trng hp phong b 80-85% (c o bng my kch thch thn kinh ngoi bin), hoc
khi phong b tng phn (c xc nh trn c s cc triu chng lm sng), th tc dng c
th c phc hi bng 1-3 mg neostigmine hoc 10-30 mg galantamine kt hp vi atropine.
S phc hi hon ton tc dng gin c c kim tra bng my kch thch thn kinh ngoi bin
hay quan st cc triu chng lm sng.

37.

AREDIA

NOVARTIS
Bt pha tim 30 mg : l bt 30 mg + ng dung mi 10 ml .
THNH PHN
cho 1 l
Acide pamidronique dng mui
sodium

30 mg

DC LC
Pamidronate disodium, hot cht ca Aredia, c kh nng c ch s tiu hy t bo xng do
hy ct bo. Cht ny gn mnh vo cc tinh th hydroxyapatite v c ch s hnh thnh v ha
tan ca cc tinh th ny trong ng nghim. Trong c th, s c ch hot ng tiu hy t bo
xng ca hy ct bo t nht mt phn l do s lin kt ca thuc vi cc cht khong ti
xng.
Pamidronate ngn chn s xm nhp ca tin hy ct bo ti xng v ngn cn cc cht ny
bin i thnh cc hy ct bo thc th vi chc nng lm tiu xng. Tuy vy s gn ca
biphosphonate vo xng c xem l phng thc chnh thuc c tc dng trc tip ti
ch chng tiu xng theo ghi nhn c t cc nghin cu trong ng nghim v trong c th.
Cc thc nghim chng minh tc dng c ch s tiu hy xng do bnh khi u ca
pamidronate c dng khi tin hnh cy ghp t bo u.
Cc thay i v sinh ha phn nh tc dng ca Aredia trong vic c ch qu trnh lm tng
calci huyt do bnh l khi u, c ghi nhn qua s gim canxi v phosphate huyt thanh v
tip theo l s gim bi tit canxi, phosphate v hydroxyproline trong nc tiu.
Vic tng canxi huyt c th dn ti s gim lng dch ngoi t bo v lm gim lc tiu

cu thn (glomerular filtration rate : GFR). Nh tc dng kim ch nng canxi huyt, Aredia
lm ci thin GFR v lm gim creatinine trong huyt thanh hu ht bnh nhn. Trong cc
nghin cu lm sng bnh nhn c di cn tiu hy xng hay a u ty, Aredia c tc dng
ngn nga hay lm chm cc bin chng xy ra (tng canxi huyt, gy xng, iu tr tia x,
phu thut xng, chn p ty sng) v c tc dng lm gim au xng. Khi c dng cng
cc thuc chng ung th, Aredia c ghi nhn lm chm qu trnh pht trin di cn xng.
Hn na, iu tr vi Aredia c th cho thy tc dng n nh hay hnh nh x trn X quang
nhng ca khng vi c t tr liu v hc mn tr liu.
Bnh Paget xng, c c trng bng nhng tng tiu xng v tng s to xng vi
nhng thay i v cht lng trong qu trnh ti to xng, c p ng tt vi Aredia. S
thuyn gim v lm sng v sinh ha c th hin qua chp nhp nhy xng, gim
hydroxyproline niu v gim phosphatase kim trong huyt thanh ; v qua cc du hiu ci
thin v lm sng.
Nhng d kin v an ton tin lm sng :
Tc dng c ca pamidronate c biu hin trc tip (c t bo) vi cc c quan c cp
mu ti nhiu, c bit l thn sau khi chp tnh mch. Ch phm khng gy t bin v dng
nh khng c nguy c sinh ung th.
DC NG HC
Cc c tnh chung :
Pamidronate c i lc mnh i vi cc t chc c vi ha, v s o thi ton b
pamidronate khi c th khng thy c trong thi gian tin hnh th nghim. Cc t chc
vi ha do vy c coi l ni thuc c o thi.
Hp thu :
Pamidronate disodium c dng qua ng truyn tnh mch. Hp thu hon ton c xc
nh sau khi tim truyn.
Phn b :
Nng pamidronate trong huyt tng tng nhanh sau khi bt u truyn v gim nhanh khi
ngng truyn. Thi gian bn hy ca thuc trong huyt tng vo khong 0,8 gi. Nng n
nh do vy t c vi thi gian truyn di hn 2-3 gi. Nng nh ca pamidronate trong
huyt tng vo khong 10 nmol/ml t c sau khi truyn tnh mch 60 mg trong 1 gi.
ng vt cng nh ngi, t l pamidronate c gi li ging nhau sau mi liu dng. Do
vy s tch t pamidronate ti xng l khng hn ch, v ch ph thuc vo tng s liu thuc
c tng cng sau .
T l pamidronate tun hon gn vi protein huyt tng kh thp (khong 54%) ; v tng ln
khi nng canxi tng ln bt thng.
o thi :
Pamidronate dng nh khng b o thi qua chuyn ha sinh hc. Sau khi truyn tnh mch,

khong 20-25% liu dng c pht hin trong nc tiu di dng khng i trong vng 72
gi. Trong thi gian th nghim phn thuc cn li tn ti trong c th. T l liu dng c
gi li trong c th khng ph thuc vo c liu dng (trong khong 15-180 mg) ln tc
truyn (trong mc 1,25-60 mg/gi). S o thi pamidronate qua nc tiu c ghi nhn qua
hai pha, vi thi gian bn hy vo khong 1,6 v 27 gi. H s thanh thi huyt tng ton b
vo khong 180 ml/pht v h s thanh thi ca thn vo khong 54 ml/pht, v c xu hng
tng quan vi h s thanh thi creatinine.
Mt s c im ty theo bnh nhn :
H s thanh thi gan v thanh thi chuyn ha ca pamidronate l khng ng k. Suy chc
nng gan do vy khng nh hng ng k ti dc lc hc ca Aredia. Aredia nh c vai
tr th yu trong vic tng tc thuc mc chuyn ha cng nh gn kt vi protein (xem
phn trn).
Gi tr AUC trung bnh trong huyt tng thng cao hn hai ln ngi b suy nng (thanh
thi creatinine < 30ml/pht). Tc bi tit qua nc tiu gim cng vi vic gim thanh thi
creatinine, mc d tng lng o thi qua ng tit niu khng b nh hng nhiu bi chc
nng thn. Do vy kh nng gi pamidronate trong c th ngi suy thn v khng suy thn
l ging nhau, v vic chnh liu nhng bnh nhn ny l khng cn thit khi dng cc liu
c ngh.
CH NH
Thuc dng iu tr cc tnh trng bnh l c km theo s tng hot ng tiu hy xng ca
hy ct bo :
- Di cn xng c tiu hy xng chim u th v bnh a u ty.
- Tng canxi huyt do bnh khi u.
- Bnh Paget xng.
CHNG CH NH
Qu mn vi Aredia hay vi cc bisphosphonate.
CH PHNG v THN TRNG LC DNG
Ch { phng :
Aredia khng c tim liu lng ln (tim bolus), m bao gi cng phi pha long v truyn
tnh mch chm.
Aredia khng c dng cng cc ch phm bisphosphonate khc v tc dng phi hp ca
chng cha c nghin cu.
Thn trng lc dng :
Cc cht in gii trong huyt thanh, canxi huyt v phosphate huyt cn c theo di t lc
bt u iu tr vi Aredia. Nhng bnh nhn phu thut tuyn gip c th d biu hin gim
canxi huyt do thiu nng tuyn cn gip.
Bnh nhn dng thuc Aredia thng xuyn trong mt thi gian di, c bit ngi c bnh

thn t trc hay d xut hin suy thn (nh bnh nhn a u ty v/hoc tng canxi huyt)
phi c nh gi nh kz cc xt nghim tiu chun v cc ch s lm sng v chc nng thn
v hin tng gim chc nng thn (bao gm c suy thn) c ghi nhn trong iu tr di
ngy vi Aredia cho bnh nhn a u ty. Tuy nhin do cn c s hin din ca bnh chnh
v/hoc cc bin chng nn mi lin h nhn qu vi vic dng Aredia cha c chng minh.
ngi c bnh tim, c bit bnh nhn ln tui, vic truyn thm nhiu mui c th gy
suy tim (suy tht tri hay suy tim xung huyt). St (cc triu chng gi cm) cng c th gp
phn to ra bin chng ny.
Ngi mc bnh Paget xung c nguy c v s thiu ht canxi hoc vitamin D, cn dng b
sung canxi bng ng ung v vitamin D hn ch ti a nguy c gim canxi huyt.
nh hng i vi kh nng li xe v vn hnh my mc :
Bnh nhn cn c bit trong mt s t trng hp c th gp ng g v/hoc chng mt sau
khi tim truyn Aredia. Trong nhng trng hp ny h khng nn li xe, iu hnh nhng my
mc c th gy nguy him, hay tham gia vo nhng hot ng khc c an ton thp do km
tnh to.
LC C THAI v LC NUI CON B
Vi nhng th nghim trn ng vt, pamidronate c ghi nhn khng gy nguy c sinh qui
thai v khng nh hng n kh nng sinh dc hay sinh sn. chut, thi gian sinh di v
gim t l sng ca chut con c th l do s gim lng canxi trong huyt thanh. chut
mang thai, pamidronate cho thy qua c nhau thai v tch ly trong xng ca thai ging
nh thy c chut m.
Hin cha c kinh nghim lm sng v vic dng Aredia ph n c thai. V vy khng nn
dng thuc trong thi kz mang thai tr trng hp c tng canxi huyt e da tnh mng.
Nghin cu trn chut ci cho thy pamidronate qua c sa chut m. Do vy ngi m
c iu tr vi Aredia khng nn cho con b.
TNG TC THUC
Aredia c dng cng lc vi cc thuc chng ung th thng thng m khng c biu
hin tng tc.
Aredia c dng kt hp vi calcitonin cho bnh nhn tng canxi huyt nng, to ra tc
dng hip lc lm gim nhanh hn lng canxi trong huyt thanh.
TC DNG NGOI
Cc tc dng khng mong mun vi Aredia thng nh v thong qua. Nhng phn ng
thng gp nht l gim canxi huyt khng biu hin triu chng v st (nhit c th tng
khong 1-2oC), thng trong vng 48 gi sau khi truyn. St thng t ht v khng cn iu
tr. Gim canxi huyt c triu chng thng him. Qui c v t l xut hin : thng gp >
10%, t gp 1-10%, him gp 0,001-1%, c bit < 0,001%.
Nhng du hiu ton thn :

Thng gp : st v cc triu chng gi cm i khi km kh chu, rt run, mt mi, nng bng.

Nhng phn ng ti ch :
t gp : phn ng ti ch tim : au, , sng, cng, vim tnh mch, vim tnh mch huyt
khi.
H c xng :
t gp : au xng thong qua, au khp, au c, au mi ton thn.
Him gp: co cng c.
ng d dy - rut :
t gp : bun nn, nn.
Him gp : chn n, au bng, a chy, to bn, ri lon tiu ha.
Trng hp c bit : vim d dy.
H thn kinh trung ng :
t gp : au u.
Him gp : gim canxi huyt triu chng (d cm, tetany), kch ng, l ln, chng mt, mt ng,
ng g, chng ng lm.
Trng hp c bit : co git, o th.
Mu :
t gp : gim lymph bo.
Him gp : thiu mu, gim bch cu.
Trng hp c bit : gim tiu cu.
H tim mch :
Him gp : h huyt p, tng huyt p.
Trng hp c bit : suy tht tri (kh th, ph phi), suy tim xung huyt (ph) do dch.
H tit niu :
Trng hp c bit : huyt niu, suy thn cp, lm tng bnh thn c t trc.
Da :
Him gp : ni ban, nga.
Gic quan :
Trng hp c bit: vim kt mc, vim mng mch nho (vim mng mt, vim mng mt-th
mi), vim cng mc, vim thng cng mc, chng thy sc vng.
Biu hin khc :
C bit : s ti hot ca herpes simplex v zona tai.
Nhng bin i v sinh ha :
Thng gp : gim canxi huyt, gim phosphate huyt.
t gp : gim magne huyt.
Him gp : tng kali huyt, gim kali huyt, tng natri huyt.
Trng hp c bit : xt nghim chc nng gan bt thng, tng creatinine v ur huyt thanh.

Rt nhiu trong nhng tc dng khng mong mun ny l c th do cn bnh m bnh nhn
mc phi.
LIU LNG v CCH DNG
Aredia khng bao gi c tim bolus. Dch thuc trong ng tim hoc bt thuc tinh ch trong
l phi c pha long trong dch truyn khng c canxi (v d nh dung dch NaCl 0,9% hay
glucose 5%) v truyn vi tc chm.
Tc truyn khng vt qu 60 mg/gi (1 mg/pht), v nng Aredia trong dch truyn
khng vt qu 90 mg/250 ml. Liu dng 90 mg cn c dng theo ng truyn trong 2 gi
vi 250 ml dung dch. Tuy nhin bnh nhn a u ty hay bnh nhn tng canxi huyt do bnh
khi u khng nn dng qu liu 90 mg trong 500 ml truyn hn 4 gi.
Nhm hn ch ti a nhng phn ng ti ch, cn t ng canun vo tnh mch tng i rng.
Dng Aredia ngi ln v ngi c tui.
Di cn xng c tiu hy xng chim u th v bnh a u ty :
Liu dng Aredia trong iu tr di cn tiu hy xng v bnh a u tu{y l 90 mg mi 4 tun liu
n.
nhng bnh nhn di cn xng iu tr bng ha cht 3 tun mt ln, c th dng liu Aredia
90 mg mi 3 tun.
Tng canxi huyt do bnh khi u : bnh nhn cn c b in gii bng dch mui ng trng
trc hoc trong khi iu tr.
Tng s liu dng Aredia cho mt t iu tr ty thuc vo lng canxi huyt thanh. Cc
hng dn di y c rt ra t cc ti liu lm sng vi lng canxi cha c iu chnh.
Tuy vy mc liu dng c ngh di y cng c th p dng i vi trng hp cc gi
tr canxi iu chnh v protein hay albumine huyt thanh bnh nhn c b nc.
Tng s liu
dng

Lng canxi ban u

(mmol/L)

(mg%)

(mg)

ln ti 3,0

ln ti
12,0

15-30

3,0-3,5

12,0-14,0 30-60

3,5-4,0

14,0-16,0 60-90

4,0

90

Tng liu Aredia c th c dng mt ln hay truyn nhiu ln trong vng 2-4 ngy lin tip.
Liu dng ti a cho mt t iu tr l 90 mg i vi t u cng nh cho cc t sau. Lng
canxi huyt thanh gim xung ng k thng trong vng 24-48 gi sau khi dng thuc ; v cn
bng thng t c trong vng 3-7 ngy. Nu lng canxi trung bnh khng t c trong
thi gian trn, c th tng thm liu thuc. Thi gian p ng c th thay i trn tng bnh
nhn, v cn iu tr nhc li khi tng canxi ti hin. Mt s kinh nghim lm sng cho thy c
th t hiu qu k m hn nu tng nhiu s ln iu tr.
Bnh Paget xng :
Tng liu Aredia c ngh cho mt t iu tr l 180-210 mg. Thuc c th c chia lm
6 liu 30 mg mt ln/tun (tng liu 180 mg) ; hoc chia lm 3 liu 60 mg dng cch tun. Nu
dng thuc hm lng 60 mg, c th bt u iu tr vi liu 30 mg (tng liu 210 mg).
Phc iu tr ny, khng tnh ti liu ban u, c th c nhc li sau 6 thng cho ti khi lui
bnh, v khi bnh ti pht.
Bnh nhn suy thn :
Cc nghin cu v dc ng hc cho thy vic iu chnh liu l khng cn thit cho bnh
nhn suy thn bt c mc no. Tuy vy, khng nn vt qu tc truyn l 20 mg/gi
bnh nhn suy thn.
Tr em :
Hin cha c kinh nghim lm sng trong vic s dng Aredia cho tr em.
Hng dn s dng :
Pamidronate s kt hp vi cc cation ha tr hai v khng c cho vo cc dung dch truyn
tnh mch c cha canxi.
Bt thuc tinh ch trong l trc ht c ha tan trong nc v trng, v d 15 mg trong 5 ml
; v 30 mg, 60 mg, 90 mg trong 10 ml. Nc v khun pha ch dung dch tim c cung cp
cng l thuc. Mi trng pH ca dch ha tan mc 6,0-7,4. Dch thuc ha tan cn c
pha long hn vi dung dch truyn khng c canxi (NaCl 0,9% hay glucose 5%) trc khi s
dng. iu quan trng l bt thuc phi c ha tan ht trc khi ht dch ha tan pha
long hn.
Dch thuc trong ng tim cn c pha long vi dung dch khng cha calci (NaCl 0,9% hoc
glucose 5%) trc khi s dng.
QU LIU
Nhng bnh nhn c iu tr vi liu cao hn mc ngh trn cn c theo di cn
thn. Trng hp c du hiu lm sng gim canxi mu dn n d cm, tetany v h huyt p,
s phc hi c th t c khi truyn dch calci gluconate.
BO QUN
Trnh khng thuc mi trng nng. Aredia c ha tan trong nc v khun nhit
o 8oC n nh ti 24 gi. Dch thuc ha tan pha long vi mt trong cc dch truyn c

 ngh trn nhit trong phng cn c dng trong vng 24 gi tnh t khi bt u ha
tan thuc. Loi b phn dch thuc khng dng.
Bo qun ng tim trong t lnh vi nhit 2-8o C. Khng nn lu tr dch thuc pha trc
khi truyn. Dch thuc pha cn c s dng ngay.

38.

ARGININE VEYRON

VEYRON FROMENT
c/o MARKETING SANPROMEX
Dung dch ung : ng 5 ml, hp 20 ng ; chai 125 ml, 250 ml.
THNH PHN
cho 1 ng
Arginine chlorhydrate 1 g
ng vi : L (+) arginine 0,827 g
(Saccharose)

(0,8 g)

cho 1 mung caf

Arginine chlorhydrate 0,918 g
ng vi : L (+) arginine 0,759 g
(Saccharose)

(0,75 g)

DC LC
Thuc c tc ng hng gan.
H amoniac trong mu.
Trong trng hp s to ur b suy gim do di truyn, dng arginine s lm tng s gii c v
o thi amoniac di dng citrulline hoc acide argino-succinique.
CH NH
c s dng trong cc ri lon chc nng gan.

iu tr h tr cc ri lon kh tiu.
Tng amoniac huyt bm sinh hoc do suy gim chu trnh ur.
THN TRNG LC DNG
Trong trng hp bnh tiu ng hay n ch t ng, lu { n lng ng trong thuc
(0,8 g mi ng v 0,75 g mi mung caf).
Trong trng hp tiu chy hay cho con b, nn ngng s dng thuc.
TC DNG NGOI
C th gy tiu chy khi dng liu cao.
LIU LNG v CCH DNG
Cc ri lon gan, kh tiu :
- Ngi ln : 3 n 6 g/ngy, tng ng mi ln ung 1 n 2 ng thuc hoc 1 n 2 mung
caf , trc 3 ba n chnh (hoc 1 mung canh vo bui tra v bui ti) ;
- Tr em : mi ln 1 ng thuc hoc 1 mung caf , 2 n 3 ln/ngy.
Tng amoniac huyt bm sinh : 250 n 500 mg/kg/ngy, tng ng :
- nh nhi : 1 n 5 ng thuc hoc 1 n 5 mung caf/ngy, pha long vi nc hoc trong
bnh sa ;
- tr em : 5 n 10 ng thuc hoc 5 n 10 mung caf/ngy.
Ung thuc vi mt t nc.

39.

ARTHRODONT

VEYRON FROMENT
c/o MARKETING SANPROMEX
Kem bi nu rng : tup 5 g, 40 g, 80 g.
THNH PHN
cho 100 g
Enoxolone
T dc : calcium carbonate, glycerol,
sodium laurylsulfate, sodium alginate,
carrhagenates, sodium silicate ngm nc,
tinh du bc h, tinh du hi,
levomenthol, saccharine, eugenol, mi
thm du, nc tinh khit. Cht bo qun

1g

: formaldehyde.
DC LC
Cc bnh nu rng.
Enoxolone : khng vim khng steroid.
CH NH
Chng sung huyt v gim au trong cc bnh nu v tn thng do dng rng gi.
CHNG CH NH
- Qu mn vi mt trong cc thnh phn ca thuc.
- Nh nhi v tr em di 3 tui (do trong thnh phn c menthol c th gy cc nh hng trn
thn kinh nh co git khi dng liu cao).
LIU LNG v CCH DNG
Thoa thuc ln nu v chi rng trong vi pht sau mi ba n, sau sc ming li vi nc.

40.

ASCORTONYL

GERDA
c/o KENI - OCA
Dung dch ung : ng 5 ml, hp 24 ng.
THNH PHN
cho 1 ng
Acide ascorbique

450 mg

Aspartate magnesium v potassium

400 mg

(Saccharose)

(2 g)

Lng magnesium : 14,5 mg/ng ; potassium :

46,9 mg/ng.

DC LC
Chng suy nhc (A : b my tiu ha v chuyn ha).
CH NH
iu tr h tr trong suy nhc chc nng.
CHNG CH NH

- Qu mn cm vi mt trong cc thnh phn ca thuc.

- Si thn khi dng liu cao vitamine C, trn 1 g.
THN TRNG LC DNG
Do c vitamine C, thuc c th gy kh ng, do khng nn ung thuc sau 4 gi chiu.
Trong trng hp bnh nhn ang p dng ch n king t cht ng hay bnh nhn b
tiu ng, cn lu { n lng saccharose trong khu phn n hng ngy.
Lu { n s hin din ca magnesium v potassium trong dung dch thuc.
LC C THAI v LC NUI CON B
Lc c thai :
Khng c nghin cu v c tnh gy qui thai trn th vt. Trn lm sng, khng c tc dng
gy d dng hay c phi no c ghi nhn cho n nay. Tuy nhin, hin cha s liu dch
t hc loi hn nguy c.
Do , nn thn trng khng dng thuc trong thi gian mang thai.
Lc nui con b :
Do thiu d kin v s vn chuyn ca thuc qua sa m, nn trnh dng thuc ny trong thi
gian cho con b m.
TC DNG NGOI
Dng liu cao vitamine C (trn 1 g) c th gy si thn mt s ngi v c th lm tng s tn
huyt nhng ngi b thiu men G6PD trong cc dng tn huyt mn tnh.
LIU LNG v CCH DNG
Ngi ln :
Mi ngy ung 2 ng, gm 1 ng bui sng v 1 ng bui tra.
Do trong thnh phn c vitamine C, trnh ung thuc sau 4 gi chiu. Thi gian iu tr c
gii hn trong 4 tun.

41.

ASPGIC

SANOFI SYNTHELABO VIETNAM

Bt pha dung dch ung 100 mg : hp 20 gi.
Bt pha dung dch ung 250 mg : hp 20 gi.
Bt pha dung dch ung 500 mg : hp 20 gi.
Bt pha dung dch ung 1000 mg : hp 20 gi.
bt pha tim bp, tnh mch v tim truyn tnh mch 0,5 g : hp 6 l bt + 6 ng dung mi 5
ml.

bt pha tim bp, tnh mch v tim truyn tnh mch 1 g : hp 6 l bt + 6 ng dung mi 5 ml.
THNH PHN
cho 1 gi
Actylsalicylate de lysine

180 mg

tng ng : Acide
actylsalicylique

100 mg

cho 1 gi
Actylsalicylate de lysine

450 mg

tng ng : Acide
actylsalicylique

250 mg

cho 1 gi
Actylsalicylate de lysine

900 mg

tng ng : Acide
actylsalicylique

500 mg

cho 1 gi
Actylsalicylate de lysine

1800 mg

tng ng : Acide
actylsalicylique

1000 mg

cho 1 n v tim
Actylsalicylate de lysine

900 mg

tng ng : Acide
actylsalicylique

500 mg

ng dung mi : Nc ct pha
tim

5 ml

cho 1 n v tim

Actylsalicylate de lysine

1,8 g

tng ng : Acide
actylsalicylique

1g

ng dung mi : Nc ct pha
tim

5 ml

DC LC
- Gim au ngoi bin.
- H st.
- Khng vim liu cao.
- Chng kt tp tiu cu.
DC NG HC
Sau khi ung, actylsalicylate de lysine tch thnh acide actylsalicylique v lysine. Acide
ac tylsalicylique c hp thu nhanh chng v thy phn trong huyt tng thnh acide
salicylique. Mt phn ln cht ny gn vi protine huyt tng. Thuc t nng ti a
trong mu sau 2 n 4 gi. S o thi ca thuc qua nc tiu tng theo pH nc tiu. Thi
gian bn hy ca acide salicylique t 3 n 9 gi v tng theo liu dng.
Nng acide salicylique trong mu tng nhanh sau khi tim tnh mch (220 mg/l, 15 pht sau
khi tim 1 g aspirine) v tim bp (110 mg/l, 15 pht sau khi tim 1 g aspirine). Sau 6 gi, nng
trong mu vn cn l 120 mg/l.
CH NH
au cp t nh n nng v/hoc tnh trng st.
Bnh thp khp.
CHNG CH NH
- D ng bit vi dn xut salicylate v cc cht cng nhm, nht l cc khng vim khng
stroide.
- Lot d dy - t trng tin trin.
- Bnh chy mu do th tng hoc mc phi.
- Nguy c xut huyt.
CH PHNG
Aspirine c tc ng chng kt tp tiu cu, ngay c vi liu rt thp, tc ng ny ko di vi
ngy, nn bo trc cho bnh nhn bit v nguy c chy mu c th gp trong khi phu thut,
k c tiu phu thut (v d : nh rng).
Cc dng c hm lng trn 500 mg khng thch hp cho tr em (trng lng di 35 kg).
THN TRNG LC DNG

Thn trng khi s dng trong nhng trng hp c tin s b lot d dy t trng hoc xut
huyt tiu ha, suy thn, hen ph qun (trng hp b d ng vi thuc khng vim khng
stroide hay aspirine, c th gy ra cn hen ph qun), rong huyt / bng huyt, bnh do virus
tr em di 12 tui (c th gy hi chng Reye).
Khng nn dng trong bnh thng phong.
Khi dng liu cao trong cc bnh thp khp, cn theo di cc du hiu nh tai, gim thnh lc
hay chng mt : nu xy ra cc triu chng ny, phi lp tc gim liu.
LC C THAI
ng vt : aspirine c ghi nhn c tc dng gy qui thai.
ngi n : da trn rt nhiu kho st, ngi ta thy rng khng c mt tc dng gy qui
thai no c ghi nhn nu dng thuc trong 3 thng u ca thai kz. 3 thng cui ca thai
kz, acide ac tylsalicylique cng nh tt c cc thuc c ch tng hp prostaglandine khc, c
th gy c tnh trn thn v tim phi ca thai nhi (tng p lc phi vi s ng sm ng ng
mch) v nu dng thuc cui thai kz s c nguy c k o di thi gian mu chy m v tr.
Do , mt iu tr ngn hn bng acide actylsalicylique vi liu < 150 mg/ngy trong 5 thng
u ca thai kz dng nh khng c nh hng g c. Ngc li, chng ch nh tuyt i thuc
k t thng th 6 ca thai kz.
LC NUI CON B
Aspirine hin din trong sa m, do khng nn cho con b khi ang dng aspirine.
TNG TC THUC
Chng ch nh phi hp :
- Mthotrexate liu >= 15 mg/tun : tng c tnh trn mu ca mthotrexate (do thuc
khng vim lm gim thanh thi ca mthotrexate thn, ngoi ra nhm salicylate cn ct lin
kt ca mthotrexate vi protine huyt tng).
- Salicylate liu cao (>= 3 g/ngy ngi ln) vi cc thuc ung chng ng mu : tng nguy
c xut huyt do c ch chc nng ca tiu cu, tn cng ln nim mc d dy-t trng v ct
lin kt ca thuc ung chng ng mu vi protine huyt tng.
Khng nn phi hp :
- Hparine dng tim : tng nguy c xut huyt do dn xut salicylate gy c ch chc nng tiu
cu v tn cng ln nim mc d dy-t trng.
Thay bng mt thuc gim au h st khc (nh parac tamol).
- Cc thuc khng vim khng stroide vi salicylate liu cao : tng nguy c gy lo t v xut
huyt ng tiu ha do hip ng tc dng.
- Cc thuc chng ng mu vi salicylate liu thp : tng nguy c xut huyt do dn xut
salicylate gy c ch chc nng ca tiu cu v tn cng ln nim mc d dy-t trng.
Cn c bit kim tra thi gian mu chy.
- Ticlopidine : tng nguy c xut huyt do hip ng tc dng chng kt tp tiu cu cng vi

tc dng tn cng ln nim mc d dy-t trng ca dn xut salicylate. Nu bt buc phi phi
hp thuc, nn tng cng theo di lm sng v sinh hc, c bit l thi gian mu chy.
- Cc thuc thi acide urique niu nh benzbromarone, prob n cide : gim tc dng thi acide
urique do cnh tranh s o thi acide urique ng thn.
Thn trng khi phi hp :
- Thuc tr tiu ng (insuline, chlorpropamide) : tng tc dng h ng huyt vi acide
actylsalicyque liu cao (acide actylsalicylique c tc dng h ng huyt v ct sulfamide ra
khi lin kt vi protine huyt tng).
Bo cho bnh nhn bit iu ny v tng cng t theo di ng huyt.
- Glucocorticoide ng ton thn : gim nng salicylate trong mu trong thi gian iu tr
bng corticoide vi nguy c qu liu salicylate sau ngng phi hp do corticoide lm tng o
thi salicylate.
iu chnh liu salicylate trong thi gian phi hp v sau khi ngng phi hp vi
glucocorticoide.
- Interf ron a : nguy c gy c ch tc dng ca thuc ny. Nn thay bng mt thuc gim au
h st khc khng thuc nhm salicylate.
- Mthotrexate liu thp, di 15 mg/tun : tng c tnh trn mu ca mthotrexate (do
thuc khng vim lm gim thanh thi ca mthotrexate thn, ngoi ra nhm salicylate cn
ct lin kt ca mthotrexate vi protine huyt tng).
Kim tra huyt hng tun trong cc tun l u iu tr phi hp.
Tng cng theo di trng hp chc nng thn ca bnh nhn b h hi, d nh, cng nh
tng cng theo di ngi gi.
- Pentoxifylline : tng nguy c xut huyt.
Tng cng theo di lm sng v kim tra thng hn thi gian mu chy.
- Salicylate liu cao vi thuc li tiu : gy suy thn cp bnh nhn b mt nc do gim
thanh lc tiu cu tip theo sau s gim tng hp prostaglandine thn.
B nc cho bnh nhn v theo di chc nng thn trong thi gian u phi hp.
Lu { khi phi hp :
- Dng c t trong t cung : nguy c (cn ang tranh lun) gim hiu lc trnh thai.
- Thuc lm tan huyt khi : tng nguy c xut huyt.
- Thuc bng nim mc d dy-rut (mui, oxyde v hydroxyde ca Mg, Al v Ca) : tng bi tit
salicylate thn do kim ha nc tiu.
TC DNG NGOI
- tai, gim thnh lc, nhc u, thng l du hiu ca s qu liu.
- Lot d dy.
- Xut huyt tiu ha r rng (nn ra mu, i cu ra mu...) hoc tim n a n tnh trng
thiu mu do thiu st.

- Hi chng xut huyt (chy mu cam, chy mu li, ban xut huyt), vi s gia tng thi gian
mu chy. Tc ng ny cn k o di n 4 hoc 8 ngy sau khi ngng dng aspirine. C th gy
nguy c xut huyt trong phu thut.
- Tai bin do mn cm (ph Quincke, ni my ay, hen suyn, tai bin phn v).
- au bng.
LIU LNG v CCH DNG
Dng ung :
Tr em : 25-50 mg/kg/ngy aspirine chia lm nhiu ln trong ngy. Khng cho > 80 mg/kg/ngy
i vi tr em di 30 thng tui v > 100 mg/kg/ngy i vi tr t 30 thng tui n 15 tui.
Ngi ln : 500-1000 mg mi ln, ti a 3 g/ngy.
Ngi ln tui : 500-1000 mg mi ln, ti a 2 g/ngy.
Bnh thp khp :
Ngi ln : 4-6 g/ngy, chia lm 3 n 4 ln.
Tr em : 50-100 mg/kg/ngy, chia lm 4 n 6 ln.
Dng tim :
Tim bp su hoc tim tnh mch, c th tim tnh mch trc tip hoc pha trong dung mi
tng hp tim truyn (dung dch NaCl, glucose hoc sorbitol). Khng nn pha Aspgic vi
mt loi thuc tim khc trong cng mt ng tim. Cc ln dng thuc cch nhau t nht 4 gi.
Dng cho ngi ln :
au cp nng :
Ngi ln : 0,5-1 g mi ln, 2-3 ln nu thy cn thit, ti a 4 g aspirine/ngy.
Ngi ln tui : 0,5-1 g mi ln, ti a 2 g aspirine/ngy.
Bnh thp khp : ti a 6 g/ngy.
QU LIU
Khng c l l khi thy c du hiu ng c aspirine nht l ngi ln tui v tr nh do
thng c tnh cht trm trng v c th dn n t vong.
Du hiu lm sng :
- Ng c va phi : tai, gim thnh lc, nhc u, chng mt, nn : y l nhng du hiu
cho thy qu liu, cn phi gim liu.
- Ng c nng : st, th gp, tch ctone, nhim kim ng h hp, nhim acide chuyn ha,
hn m, try tim mch, suy h hp, h ng huyt nhiu.
iu tr :
- Chuyn lp tc n bnh vin chuyn khoa.
- Ra d dy loi cht nut vo bao t.
- Kim tra cn bng acide-kim ; tng bi niu ; c th lm thm phn lc mu hoc thm phn
phc mc nu cn thit.
- iu tr triu chng.

42.

ASPIRINE PH8

3M SANT
c/o KENI - OCA
Vin bao tan trong rut 500 mg : hp 50 vin.
THNH PHN
cho 1 vin
Acide
actylsalicylique

500 mg

DC LC
- Gim au ngoi bin.
- H st.
- Khng vim liu cao.
- Chng kt tp tiu cu.
DC NG HC
Vi dng bo ch c bit vin bao tan trong rut, hot cht l acide ac tylsalicylique c gii
phng v hp thu vo c th ti on th hai ca t trng. Acide ac tylsalicylique c thy
phn trong huyt tng thnh cht chuyn ha c hot tnh l acide salicylique. Cht ny phn
ln lin kt vi protine huyt tng. Nng ti a trong mu t c sau 6 n 7 gi. o
thi qua nc tiu tng theo pH nc tiu. Thi gian bn hy ca acide salicylique l t 3 n 9
gi v tng theo liu s dng.
CH NH
- iu tr triu chng cc chng au v/hoc st.
- Bnh thp khp.
CHNG CH NH
- D ng bit vi dn xut salicylate v cc cht cng nhm, nht l cc khng vim khng
stroide.
- Lot d dy-t trng tin trin.
- Bnh chy mu do th tng hoc mc phi.
- Nguy c xut huyt.
- Ph n c thai (3 thng cui) : xem Lc c thai v cho con b.
- Mthotrexate vi liu >= 15 mg/tun : xem Tng tc thuc.

- Cc thuc ung chng ng mu khi dn xut salicylate c dng liu cao trong cc bnh
thp khp : xem Tng tc thuc.
CH PHNG v THN TRNG LC DNG
Khng nn ch nh vin 500 mg cho tr em, la tui ny nn dng nhng dng c hm lng
thp hn.
Khng nn ch nh aspirine trong bnh thng phong (goutte).
Aspirine phi c s dng thn trng trong nhng trng hp :
- c tin s lot d dy t trng v xut huyt tiu ha ;
- suy thn ;
- suyn : mt vi bnh nhn c th xut hin cn suyn c lin quan n d ng aspirine hoc
thuc khng vim khng stroide ; chng ch nh trong nhng trng hp ny ;
- bng huyt v/hoc rong kinh v dng aspirine c nguy c lm tng lng huyt v ko di chu
kz kinh nguyt.
Do aspirine c tc dng chng kt tp tiu cu, ngay c khi dng liu thp v duy tr trong
nhiu ngy, cn thng bo cho bnh nhn bit v nguy c xut huyt c th xay ra khi cn phi
phu thut, ngay c khi lm nhng tiu phu (nh nh rng).
liu cao c ch nh trong bnh thp khp, cn theo di cc du hiu tai, gim thnh lc
v chng mt. Nu xy ra cc du hiu ny, cn gim liu ngay.
LC C THAI
ng vt : aspirine c ghi nhn c tc dng gy qui thai.
ngi n : da trn rt nhiu kho st, ngi ta thy rng khng c mt tc dng gy qui
thai no c ghi nhn nu dng thuc trong 3 thng u ca thai kz. 3 thng cui ca thai
kz, acide ac tylsalicylique cng nh tt c cc thuc c ch tng hp prostaglandine khc, c
th gy c tnh trn thn v tim phi ca thai nhi (tng p lc phi vi s ng sm ng ng
mch) v nu dng thuc cui thai kz s c nguy c k o di thi gian mu chy m v tr.
Do , mt iu tr ngn hn bng acide actylsalicylique trong 6 thng u ca thai kz dng
nh khng c nh hng g c. Ngc li, chng ch nh tuyt i thuc ny trong 3 thng cui
ca thai kz.
LC NUI CON B
Chng ch nh s dng nhiu ln : do nng ca salicylate cao trong sa c th gy nhim
c cho tr s sinh (toan huyt, hi chng xut huyt).
TNG TC THUC
Chng ch nh phi hp :
- Mthotrexate liu >= 15 mg/tun : tng c tnh trn mu ca mthotrexate (do thuc
khng vim lm gim thanh thi ca mthotrexate thn, ngoi ra nhm salicylate cn ct lin
kt ca mthotrexate vi protine huyt tng).
- Salicylate liu cao vi cc thuc ung chng ng mu : tng nguy c xut huyt do c ch

chc nng ca tiu cu, tn cng ln nim mc d dy-t trng v ct lin kt ca thuc ung
chng ng mu vi protine huyt tng.
Khng nn phi hp :
- Hparine dng tim : tng nguy c xut huyt do dn xut salicylate gy c ch chc nng tiu
cu v tn cng ln nim mc d dy-t trng.
Thay bng mt thuc gim au h st khc (ch yu l paractamol).
- Salicylate liu cao vi cc thuc khng vim khng st roide khc : tng nguy c gy lo t t
trng v xut huyt ng tiu ha do hip ng tc dng.
- Salicylate liu thp vi cc thuc ung chng ng mu : tng nguy c xut huyt do dn xut
salicylate gy c ch chc nng ca tiu cu v tn cng ln nim mc d dy-t trng.
Cn c bit kim tra thi gian mu chy.
- Ticlopidine : tng nguy c xut huyt do hip ng tc dng chng kt tp tiu cu cng vi
tc dng tn cng ln nim mc d dy-t trng ca dn xut salicylate. Nu bt buc phi phi
hp thuc, nn tng cng theo di lm sng v sinh hc, c bit l thi gian mu chy.
- Cc thuc thi acide urique niu nh benzbromarone, prob n cide : gim tc dng thi acide
urique do cnh tranh s o thi acide urique ng thn.
Thn trng khi phi hp :
- Thuc tr tiu ng (insuline, chlorpropamide) : tng tc dng h ng huyt vi acide
actylsalicyque liu cao (acide actylsalicylique c tc dng h ng huyt v ct sulfamide ra
khi lin kt vi protine huyt tng).
Bo cho bnh nhn bit iu ny v tng cng t theo di ng huyt.
- Glucocorticoide ng ton thn : gim nng salicylate trong mu trong thi gian iu tr
bng corticoide vi nguy c qu liu salicylate sau ngng phi hp do corticoide lm tng o
thi salicylate.
iu chnh liu salicylate trong thi gian phi hp v sau khi ngng phi hp vi
glucocorticoide.
- Interf ron a : nguy c gy c ch tc dng ca thuc ny. Nn thay bng mt thuc gim au
h st khc khng thuc nhm salicylate.
- Mthotrexate liu thp, di 15 mg/tun : tng c tnh trn mu ca mthotrexate (do
thuc khng vim lm gim thanh thi ca mthotrexate thn, ngoi ra nhm salicylate cn
ct lin kt ca mthotrexate vi protine huyt tng).
Kim tra huyt hng tun trong cc tun l u iu tr phi hp.
Tng cng theo di trng hp chc nng thn ca bnh nhn b h hi, d nh, cng nh
tng cng theo di ngi gi.
- Pentoxifylline : tng nguy c xut huyt.
Tng cng theo di lm sng v kim tra thng hn thi gian mu chy.
- Salicylate liu cao vi thuc li tiu : gy suy thn cp bnh nhn b mt nc do gim

thanh lc tiu cu tip theo sau s gim tng hp prostaglandine thn.

B nc cho bnh nhn v theo di chc nng thn trong thi gian u phi hp.
Lu { khi phi hp :
- Dng c t trong t cung : nguy c (cn ang tranh lun) gim hiu lc trnh thai.
- Thuc lm tan huyt khi : tng nguy c xut huyt.
- Thuc bng nim mc d dy-rut (mui, oxyde v hydroxyde ca Mg, Al v Ca) : tng bi tit
salicylate thn do kim ha nc tiu.
TC DNG NGOI
- tai, cm gic gim thnh lc, nhc u, thng l du hiu ca s qu liu.
- Lot d dy.
- Xut huyt tiu ha r rng (i mu, i cu ra mu...) hoc tim n a n tnh trng thiu
mu do thiu st.
- Hi chng xut huyt (chy mu cam, chy mu li, ban xut huyt), vi s gia tng thi gian
mu chy. Tc ng ny cn k o di n 4 hoc 8 ngy sau khi ngng dng aspirine. C th gy
nguy c xut huyt trong phu thut.
- Tai bin do mn cm (ph Quincke, ni my ay, hen suyn, tai bin phn v).
- au bng.
LIU LNG v CCH DNG
Dng cho ngi ln.
Vin thuc c ung khng nhai vi nhiu nc.
Trong cc ch nh gim au/h st :
- Ngi ln :
- liu ti a hng ngy l 3 g.
- vi mc ch iu tr : ung mi ln 1 vin 500 mg, nu cn lp li sau mi 4 gi, khng qu 6
vin/ngy.
- Ngi gi :
- liu ti a hng ngy l 2 g.
- vi mc ch iu tr : ung mi ln 1 vin 500 mg, nu cn lp li sau mi 4 gi, khng qu 4
vin/ngy.
Trong bnh thp khp :
- liu hng ngy t 4 n 6 vin chia ra lm 3 n 4 ln.
- vi mc ch iu tr : ung mi ln 2 vin 500 mg, lp li sau mi 6 gi.
QU LIU
Vic ng c l rt ng ngi i vi ngi ln tui v nht l tr nh (do iu tr qu liu
hoc ngu nhin), i khi trm trng c th gy t vong.
Du hiu lm sng :
- Ng c va phi : tai, cm gic gim thnh lc, nhc u, chng mt, nn : y l nhng

du hiu cho thy qu liu, cn phi gim liu.

- Ng c nng : st, th gp, tch ctone, nhim kim ng h hp, nhim acide chuyn ha,
hn m, try tim mch, suy h hp, h ng huyt trm trng.
iu tr :
- Chuyn ngay lp tc n bnh vin chuyn khoa.
- Ra d dy loi cht nut vo bao t.
- Kim tra cn bng kim-toan.
- Tng bi niu ; c th lm thm phn lc mu hoc thm phn phc mc nu cn thit.
- iu tr triu chng.

43.

ATARAX

UCB PHARMA
vin bao d b 25 mg : hp 30 vin - Bng B.
vin bao d b 100 mg : hp 30 vin - Bng B.
xir : chai 200 ml - Bng B.
dung dch tim bp, tnh mch 100 mg/2 ml : ng 2 ml, hp 6 ng - Bng B.
THNH PHN
cho 1 vin
Hydroxyzine
dichlorhydrate

25 mg

(Lactose)
cho 1 vin
Hydroxyzine
dichlorhydrate

100 mg

(Lactose)
cho 1 mung caf
Hydroxyzine

10 mg

dichlorhydrate
(Menthol)
(Ethanol 95deg)
(Saccharose)
cho 1 ng thuc
Hydroxyzine
dichlorhydrate

100 mg

DC LC
Hydroxyzine l mt dn xut ca piprazine khng thuc nhm ha hc vi cc phnothiazine.
Cc th nghim v kho st lm sng khc nhau cho thy rng : hydroxyzine khng c tc
dng gy c ch v no, m ch c ch mt vi vng di v no. iu ny lm cho thuc c tc
ng lm du cng xc cm v lo u, v nh th gip cho vic kim sot cm xc v mt vi
phn ng thn kinh thc vt.
DC NG HC
Dng ung :
- Sau khi c hp thu nhanh qua ng tiu ha, hydroxyzine c chuyn ha hon ton.
- Nng ti a trong huyt tng t c sau 2 gi n 2 gi 30 pht.
- Thuc c tc ng sau khi ung t 15 n 30 pht.
- Thi gian tc ng t 6 n 8 gi.
Dng tim :
- Thi gian tc ng t 6 n 8 gi.
CH NH
- Y khoa tng qut : cc biu hin nh ca chng lo u.
- Khoa thn kinh-tm thn : lo u nh.
- Khoa gy m : tin m trong gy m tng qut (dng ung), c bit trong mt vi thm d
chc nng hoc thm d quang tuyn gy au (dng tim).
- iu tr triu chng cc biu hin d ng khc nhau : vim mi vn mch (theo ma hoc
khng theo ma), vim kt mc, ni m ay.
CHNG CH NH
- Qu mn cm vi hydroxyzine.
- Lin quan n tc ng khng cholinergique : nguy c b glaucome kh p gc v nguy c b b
tiu c lin quan n cc ri lon niu o-tuyn tin lit.
CH PHNG

Khuyn bnh nhn khng nn ung ru trong thi gian iu tr.

Atarax gy bun ng. Nn lu { ngi li xe v vn hnh my mc v iu ny.
THN TRNG LC DNG
Dng tim :
Trng hp tim tnh mch, cn pha long 1 ng thuc trong 10 ml huyt thanh sinh l. Khi
tim, nn rt ra 1 ml mu v tim tr li cng vi thuc tht chm, ch dng ng tnh mch,
trnh huyt gii. Khng bao gi dng ng ng mch.
Phn thuc cha trong ng thuc Atarax khng tng hp vi thiopental sodique, cng nh vi
cc dung dch tim c pH trn 7.
LC C THAI
ng vt, kinh nghim cho thy thuc c kh nng gy qui thai.
Khng k toa Atarax trong 3 thng u ca thai kz, mc du cho n nay cha c ghi nhn no
v kh nng gy qui thai ngi.
TNG TC THUC
- Tng tc dng ca cc thuc gy c ch h thn kinh trung ng (thuc ng, thuc v cm).
- Tc dng loi atropine c th tng ln nu c phi hp vi cc thuc khng cholinergique khc
(thuc khng histamine, thuc an thn kinh, thuc chng trm cm nhm imipramine...).
TC DNG NGOI
Thng ch thong qua : kch ng, to bn.
Gy bun ng.
Tc dng khng cholinergique c th gy kh ming, b tiu, ri lon iu tit, l ln ngi
gi.
Cc tc dng gy c ch h hp khng c ghi nhn.
LIU LNG v CCH DNG
n Dng vin : Thay i ty theo ch nh.
p Y khoa tng qut : 50-100 mg/24 gi.
p Khoa thn kinh-tm thn : 100-300 mg/24 gi.
p Khoa gy m : 100-200 mg/24 gi.
p Khoa da liu : 50-100 mg/24 gi.
p Nhi khoa (tr t 30 thng n 15 tui) : 1 mg/kg/ngy.
Dng 100 mg khng thch hp cho tr em.
Cc liu khuyn co trn y c th c tng hay gim ty theo yu cu.
n Dng xir :
Ngi ln : liu trung bnh t 1 n 4 mung canh/ngy (30-120 mg/ngy).
Tr em : liu trung bnh l 1 mg/kg/ngy.
n Dng tim :
Ngi ln : 1-3 ng thuc/ngy.

Nn tim bp.
Tim tnh mch nghim ngt sau khi pha trong 10 ml huyt thanh sinh l.
Tr em : 1 mg/kg/ngy.
Ch c tim bp.
QU LIU
Khi c qu liu, tng trm du l biu hin thng gp nht, tuy nhin, cng phi ngh n kh
nng b ng c vi nhiu loi thuc khc.
Gy nn khi pht hin b qu liu, c th tin hnh ra rut.
Trong nhng trng hp nng, c th s dng cc bin php hi sc kinh in. Khng c
dng pinphrine. Khng c thuc gii c c hiu.

44.

ATUSSIN

UNITED LABORATORIES
Sir : chai 30 ml.
Sir : chai 60 ml.
THNH PHN
cho 5 ml (1 mung c ph)
Dextromethorphane
bromhydrate

5 mg

Chlorphniramine malate

1,33 mg

Phnylpropanolamine
chlorhydrate

8,3 mg

Sodium citrate

133 mg

Ammonium chlorure

50 mg

Glycryl guaiacolate

50 mg

DC LC
Thuc tr ho phi hp vi 3 cht long m.

Xir Atussin l mt thuc khng gy nghin lm long m, tr ho v lm gin ph qun. Thuc

iu tr long m theo 3 hng : ho khan - ho d ng - ho c m.
Atussin lm gia tng ng k dch tit trong ng h hp, t lm lng mt cch c hiu qu
cht m quo dnh v cc cht tit khc ca ph qun khin chng d b tng xut. S gia tng
lng dch t nhy hn khng nhng lm cho d tng xut m cn c tc dng lm du nhng
hnh lang h hp ang b kch ng.
Xir Atussin cho tc dng tr ho tng ng vi cod ine, nhng khng gy nghin. N kim
sot c tn s v mc trm trng ca cn ho, ng thi phc hi kh nng t lm sch
ca hai l phi.
Xir Atussin cn gip kim ch cn ho hiu qu hn. Tc dng lm gin ph qun, chng sung
huyt rt cn thit cho vic gim ho. Xir Atussin cng l loi khng histamine rt c ch vi ho
do d ng. Xir c v d chu rt thch hp cho tr s sinh v tr em.
CH NH
Dng kim sot cc cn ho do cm lnh, cm, lao, vim ph qun, hen ph qun, ho g, si,
vim phi, vim ph qun phi, vim hng, vim thanh qun, vim kh qun, vim kh ph qun,
mng phi b kch ng, ht thuc qu , ht phi cc cht kch ng, ho c ngun gc tm sinh.
CH PHNG
Thuc c th lm bun ng, mt nhanh nhn. Cc bnh nhn dng thuc ny khng nn li xe
hoc cc phng tin vn chuyn khc m nu thiu tp trung c th b tai nn.
Atussin c th lm tng tc dng an thn ca cc cht gy c ch h thn kinh trung ng bao
gm : ru, barbiturate, thuc ng, thuc gim au gy nghin, thuc an thn. Tc dng ca
cc cht khng choline nh atropine v thuc chng trm cm ba vng c th tng ln.
THN TRNG LC DNG
Cn thn trng khi s dng thuc ging giao cm cho cc bnh nhn tim mch, cao huyt p,
tiu ng v cng gip.
LC C THAI
Atussin c bnh nhn mang thai s dng m khng thy xut hin cc biu hin c hi.
Trong lc c nhng bo co ngh kh nng gy d thai do vic s dng cc loi thuc
chng d ng khc. Quan h nhn qu b bc b mt cch rng ri.
TC DNG NGOI
Tc dng lm du, thay i t l m cho n ng li b c th xy ra nhng s gim bt sau vi
ngy. Cc tc dng ph khc bao gm mt s ri lon ng tiu ha v thn kinh trung ng.
LIU LNG v CCH DNG
n Cho mi 6-8 gi :
Tr s sinh : 1,25 - 2,5 ml (1/4 - 1/2 mung c ph) ;
Tr t 2 n 6 tui : 5 ml (1 mung c ph) ;
Tr t 7 n 12 tui : 10 ml (2 mung c ph) ;

Ngi ln : 15 ml (3 mung c ph hay 1 mung canh).

Hay theo s ch dn ca bc s.
QU LIU
tr s sinh v tr em : hi chng qu liu c th l co git hoc st cao.
ngi ln : hi chng kch thch nh l bun ng, kch ng, nhp tim nhanh, run ry, git c
v co git vi cc cn ng kinh.

45.

AUGMENTIN inj

SMITHKLINE BEECHAM
bt pha tim tnh mch v tim truyn tnh mch dng cho ngi ln (1 g, 200 mg) : hp 1 l
bt hoc 10 l.
bt pha tim tnh mch v tim truyn tnh mch dng cho Tr em/Nh nhi (500 mg, 50 mg) :
hp 10 l bt.
THNH PHN
L 1 g/200 mg :
cho 1 l
Amoxicilline sodium 1 g
Clavulanate
potassium

200 mg

(Na)

(62,9 mg)

(K)

(39,2 mg)

L 500 mg/50 mg :
cho 1 l
Amoxicilline sodium 500 mg
Clavulanate
potassium

50 mg

(Na)

(31,5 mg)

(K)

(9,8 mg)

CH NH
iu tr ngn hn cc nhim khun ng h hp trn v di (bao gm c Tai-Mi-Hng),
ng niu dc, da v m mm, xng v khp v cc nhim khun khc nh sy thai nhim
khun, nhim khun sn khoa, nhim khun bng, nhim khun huyt, vim phc mc, nhim
khun sau phu thut.
Augmentin tim tnh mch cng c ch nh d phng nhim khun cc phu thut ln
nh phu thut trn ng tiu ha, phu thut vng chu, phu thut u v c, phu thut
tim, phu thut thn, thay khp v phu thut ng mt. Augmentin c tnh dit khun i
vi nhiu loi vi khun k c cc dng tit b-lactamase khng vi ampicillin v amoxycillin
(tham kho thng tin k toa y v cc vi khun nhy cm).
CHNG CH NH
Qu mn vi penicillin ; c tin s vng da/suy gan khi dng Augmentin hay penicillin.
CH PHNG v THN TRNG LC DNG
Cn thn khi s dng cho bnh nhn c bng chng suy gan do c kh nng vng da mt. Cc
phn ng qu mn trm trng v i khi c th dn n t vong (dng phn v) c bo
co xy ra trn bnh nhn dng cc khng sinh penicillin. c xut hin ban (a dng) i
km vi st ni hch (tng bch cu n nhn nhim khun) nhng bnh nhn dng
amoxycillin. Nn trnh s dng Augmentin nu nghi ng c tng bch cu n nhn nhim
khun. Nn iu chnh liu cho bnh nhn suy thn. Khi cn thit dng liu cao theo ng
tim, phi lu { n thnh phn sodium ca thuc bnh nhn ang tun theo ch n ung
gii hn sodium.
LC C THAI v LC NUI CON B
Cng nh i vi tt c cc thuc, nn trnh dng trong thai kz tr phi c kin ca bc s cho
l cn thit. C th dng Augmentin trong thi kz nui con b.
TNG TC THUC
Khng nn s dng ng thi vi probenecid. S dng Augmentin ng thi c th lm gia
tng v k o di nng amoxycillin trong mu nhng khng c tc dng ny i vi acid
clavulanic.
Nn thn trng khi s dng Augmentin bnh nhn ang iu tr vi thuc chng ng mu,
v cng ging nh cc khng sinh ph rng khc, Augmentin c th lm gim hiu lc ca cc
thuc trnh thai ung, do nn cnh bo cho bnh nhn bit iu ny.
TC DNG NGOI
Tc dng ngoi { thng t gp v hu ht c tnh cht nh v thong qua. Tiu chy, kh tiu,

bun nn, nn ma, vim kt trng khi s dng khng sinh v bnh nm Candida c bo
co. ghi nhn c hin tng gia tng va phi AST v/hoc ALT. Vim gan v vng da
mt c bo co d him gp nhng c th trm trng v ko di khong vi thng. Cc
phn ng trn gan thng c bo co gp nam gii v ngi ln tui v c th xy ra khi
liu trnh iu tr ko di. Cc du hiu v triu chng thng xy ra trong hay mt thi gian
ngn sau khi iu tr nhng trong mt vi trng hp c th khng biu hin r rng cho n
vi tun sau khi ngng iu tr. Cc phn ng ny thng l c hi phc. Cc phn ng trn gan
c th trm trng v rt him khi gy t vong.
M ay v ban i khi xy ra. Him khi c bo co v chng ban a dng, hi chng
Stevens-Johnson, hoi t da nhim c, vim da bng nc trc vy v mn m ngoi da ton
thn cp tnh (AGEP). Nu xy ra mt trong nhng ri lon k trn th khng nn tip tc iu
tr. Gim bch cu thong qua, gim tiu cu v thiu mu huyt tn. Cng nh cc khng sinh
nhm b-lactam khc, c bo co v chng ph mch (ph Quincke), hi chng phn v (qu
mn) dng bnh huyt thanh v vim mch qu mn. Him khi c vim thn k. Gim bch cu
c hi phc (bao gm gim bch cu trung tnh hay mt bch cu ht), gim tiu cu c hi
phc v thiu mu huyt tn c bo co. Chng tng hot ng, chng mt, nhc u v
co git c hi phc c bo co him khi xut hin. Co git c th xy ra bnh nhn suy
thn hay nhng ngi ang s dng liu cao.
LIU LNG v CCH DNG
Ch s dng tim tnh mch trc tip hoc truyn tnh mch ngt qung (thuc khng thch hp
cho tim bp). Tham kho thng tin k toa y v cc chi tit nh cch pha thuc, n
nh v phng php s dng. Khong cch gia cc liu ty thuc vo mc nhim khun v
nm trong cc gii hn sau :
Ngi ln v tr em trn 12 tui : 1,2 g, mi su n tm gi ;
Tr em 3 thng n 12 tui : 30 mg/kg, mi su n tm gi ;
Tr em t 0 n 3 thng : 30 mg/kg, mi mi hai gi tr sinh non v tr sinh thng trong
giai on chu sinh, tng n mi tm gi sau ;
Gim liu bnh nhn suy thn (xem thng tin k toa y ).
i vi bnh nhn suy gan : k liu cn thn v kim tra chc nng gan nh kz. iu tr khng
nn k o di qu 14 ngy m khng nh gi li.
QU LIU
Cc trng hp qu liu Augmentin thng l khng biu hin triu chng. C th thy r s
ri lon cn bng nc v cht in gii. Cc ri lon ny c th c iu tr theo triu chng.
Augmentin c th c loi b ra khi tun hon bng cch lc mu. Trong qu trnh dng liu
cao Augmentin, nn duy tr tha ng lng nc thu nhn vo v lng nc tiu thi ra
gim thiu kh nng to thnh tinh th niu amoxicyllin.

46.

AUGMENTIN oral

SMITHKLINE BEECHAM
Vin bao 1000 mg : hp 14 vin.
Vin bao 500 mg : hp 12 vin.
Vin bao 375 mg : hp 10 vin.
Bt ung dng gi 250 mg cho tr em : hp 12 gi.
Bt ung dng gi 500 mg cho tr em : hp 12 gi.
THNH PHN
cho 1 vin bao
Amoxicilline
trihydrate

875 mg

Clavulanate
potassium

125 mg

cho 1 vin bao

Amoxicilline
trihydrate

500 mg

Clavulanate
potassium

125 mg

cho 1 vin bao

Amoxicilline
trihydrate

250 mg

Clavulanate
potassium

125 mg

cho 1 gi 250 mg

Amoxicilline
trihydrate

250 mg

Clavulanate
potassium

62,5 mg

cho 1 gi 500 mg
Amoxicilline
trihydrate

500 mg

Clavulanate
potassium

125 mg

CH NH
iu tr ngn hn cc nhim khun ng h hp trn v di (bao gm c Tai-Mi-Hng),
ng niu dc, da v m mm, xng v khp v cc nhim khun khc nh sy thai nhim
khun, nhim khun sn khoa, nhim khun bng.
Augmentin c tnh dit khun i vi nhiu loi vi khun k c cc dng tit b-lactamase
khng vi ampicillin v amoxycillin (tham kho thng tin k toa y v cc vi khun nhy
cm).
CHNG CH NH
Qu mn vi penicillin ; c tin s vng da/suy gan khi dng Augmentin hay penicillin.
CH PHNG v THN TRNG LC DNG
Cn thn khi s dng cho bnh nhn c bng chng suy gan do c kh nng vng da mt. Cc
phn ng qu mn trm trng v i khi c th dn n t vong (dng phn v) c bo
co xy ra trn bnh nhn dng cc khng sinh penicillin. c xut hin ban (a dng) i
km vi st ni hch (tng bch cu n nhn nhim khun) nhng bnh nhn dng
amoxycillin. Nn trnh s dng Augmentin nu nghi ng c tng bch cu n nhn nhim
khun. Nn iu chnh liu cho bnh nhn suy thn. Augmentin dng hn dch cha 12,5 mg
aspartam trong mi liu 5 ml v do nn thn trng trong trng hp phenylketon niu.
Dng thn trng bnh nhn ang iu tr vi thuc chng ng mu. Augmentin c th lm
gim hiu lc ca thuc trnh thai loi ung v do nn cnh bo bnh nhn trc v iu
ny.
LC C THAI v LC NUI CON B
Cng nh i vi tt c cc thuc, nn trnh dng trong thai kz tr phi c kin ca bc s cho
l cn thit. C th dng Augmentin trong thi kz nui con b.
TNG TC THUC

Khng nn s dng ng thi vi probenecid. S dng Augmentin ng thi c th lm gia

tng v k o di nng amoxycillin trong mu nhng khng c tc dng ny i vi acid
clavulanic.
Nn thn trng khi s dng Augmentin bnh nhn ang iu tr vi thuc chng ng mu,
v cng ging nh cc khng sinh ph rng khc, Augmentin c th lm gim hiu lc ca cc
thuc trnh thai ung, do nn cnh bo cho bnh nhn bit iu ny.
TC DNG NGOI
Tc dng ngoi { thng t gp v hu ht c tnh cht nh v thong qua. Tiu chy, kh tiu,
bun nn, nn ma, vim kt trng khi s dng khng sinh v bnh nm Candida c bo
co. ghi nhn c hin tng gia tng va phi AST v/hoc ALT. Vim gan v vng da
mt c bo co d him gp nhng c th trm trng v ko di khong vi thng. Cc
phn ng trn gan thng c bo co gp nam gii v ngi ln tui v c th xy ra khi
liu trnh iu tr ko di. Cc du hiu v triu chng thng xy ra trong hay mt thi gian
ngn sau khi iu tr nhng trong mt vi trng hp c th khng biu hin r rng cho n
vi tun sau khi ngng iu tr. Cc phn ng ny thng l c hi phc. Cc phn ng trn gan
c th trm trng v rt him khi gy t vong.
M ay v ban i khi xy ra. Him khi c bo co v chng ban a dng, hi chng
Stevens-Johnson, hoi t da nhim c, vim da bng nc trc vy v mn m ngoi da ton
thn cp tnh (AGEP). Nu xy ra mt trong nhng ri lon k trn th khng nn tip tc iu
tr. Gim bch cu thong qua, gim tiu cu v thiu mu huyt tn. Cng nh cc khng sinh
nhm b-lactam khc, c bo co v chng ph mch (ph Quincke), hi chng phn v (qu
mn) dng bnh huyt thanh v vim mch qu mn. Him khi c vim thn k. Gim bch cu
c hi phc (bao gm gim bch cu trung tnh hay mt bch cu ht), gim tiu cu c hi
phc v thiu mu huyt tn c bo co. Chng tng hot ng, chng mt, nhc u v
co git c hi phc c bo co him gp. Co git c th xy ra bnh nhn suy thn hay
nhng ngi ang s dng liu cao.
LIU LNG v CCH DNG
Ngi ln v tr em trn 12 tui :
- Nhim trng nh n trung bnh : mt vin 375 mg x 3 ln/ngy ;
- Nhim trng nng : mt vin 1 g x 2 ln/ngy hoc mt vin (hay gi) 625 mg x 3 ln/ngy
hoc hai vin 375 mg x 3 ln/ngy ;
Tr em di 12 tui : ty theo mc nhim trng, 25-50 mg/kg/ngy chia lm cc liu dng
mi tm gi, ch dng dng xir. Augmentin 1 g khng dng cho tr di 12 tui.
Gim liu cho nhng bnh nhn suy thn (xem thng tin k toa y ).
i vi Augmentin 1 g : khng cn chnh liu tr c GFR > 30 ml/pht.
Khng dng Augmentin vin 1 g ngi suy thn trung bnh.
i vi bnh nhn suy gan : k liu cn trng v theo di chc nng gan u n.

 gim thiu kh nng khng dung np ng tiu ha v to iu kin gip Augmentin

c hp thu tt nht, hy dng thuc vo u ba n. Khng iu tr qu 14 ngy m khng
nh gi li.
QU LIU
Cc trng hp qu liu Augmentin thng khng biu hin triu chng. C th thy r s ri
lon cn bng nc v cht in gii. Cc ri lon ny c th c iu tr theo triu chng.
Augmentin c th c loi b ra khi tun hon bng cch lc mu. Trong qu trnh dng liu
cao Augmentin, nn duy tr tha ng lng nc thu nhn vo v lng nc tiu thi ra
gim thiu kh nng to thnh tinh th niu amoxicyllin.

47.

AVELOX

BAYER PHARMA
Vin bao phim 400 mg : hp 5 vin.
THNH PHN
cho 1 vin
Moxifloxacin hydrochloride

436,8 mg

Tng ng : Moxifloxacin

400 mg

DC LC
Moxifloxacin l thuc khng sinh thuc nhm fluoroquinolone hot ph rng v c tc dng
dit khun. Tc dng dit khun do cn tr men topoisomerase II v IV. Topoisomerase l
nhng men ch yu kim sot v nh khu (topology) ca DNA v gip s ti to, sa cha v
sao chp DNA.
Vi sinh hc :
In vitro, moxifloxacin c tc dng chng li a s cc vi khun gram dng v gram m.
Moxifloxacin c tc dng dit khun nh c ch men topoisomerase II (DNA gyrase) v
topoisomerase IV rt cn thit cho vic ti to, sao chp, sa cha v ti kt hp DNA ca vi
khun. Nh c na C8-methoxy gp phn gia tng tc dng dit khun v gim s chn lc cc
t bin gy khng thuc ca vi khun gram dng so vi na C8-H.
C ch tc dng ca quinolones, bao gm c moxifloxacin, khc vi c ch tc dng ca

macrolides, b-lactam, aminoglycosides hoc tetracyclines ; do , cc vi khun khng vi cc

thuc ny c th vn nhy cm vi moxifloxacin v cc quinolones khc. Khng c khng
cho gia moxifloxacin v nhng khng sinh thuc cc nhm khc.
Ngi ta thy c khng cho gia moxifloxacin v cc fluoroquinolones khc chng li vi
khun gram m. Tuy nhin, vi khun gram dng khng vi cc fluoroquinolones khc c th
vn nhy cm vi moxifloxacin.
Moxifloxacin c hot tnh ln a s cc dng vi khun sau trong c in vitro v nhim khun trn
lm sng c cp trong phn Ch nh :
Vi khun gram dng hiu kh : Staphylococcus aureus (ch nhng chng nhy cm methicillin),
Streptococcus pneumoniae (ch nhng chng nhy cm penicillin).
Vi khun gram m hiu kh : Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella
pneumoniae, Moraxella catarrhalis.
Nhng vi sinh vt khng in hnh : Chlamydia pneumoniae, Mycoplasma pneumoniae.
Mt s d liu in vitro khc cng c thc hin, tuy nhin { ngha lm sng cha r.
Theo nhng nghin cu in vitro ny, moxifloxacin cho thy vi nng c ch ti thiu (MIC) 2
mg/ml hoc thp hn c tc dng chng li a s (>= 90%) cc dng vi khun sau, tuy nhin,
an ton v tnh hiu qu ca moxifloxacin trong iu tr nhng trng hp nhim khun trn
lm sng do nhng vi khun ny cha c xc nh trong nhng nghin cu lm sng c kim
chng tt v y :
Vi khun gram dng hiu kh : Streptococcus pneumoniae (chng khng penicillin),
Streptococcus pyogenes.
Vi khun gram m hiu kh : Citrobacter freundii, Enterobacter cloacae, Escherichia coli,
Klebsiella oxytoca, Legionella pneumophila, Proteus mirabilis.
Vi khun k kh : Fusobacterium species, Peptostreptococcus species, Prevotella species.
Th nghim nhy cm :
K thut pha long : Dng cc phng php nh lng xc nh nng c ch ti thiu c
tc dng dit khun (MIC). Nng c ch ti thiu ny gip c lng nhy cm ca vi
khun i vi cc hot cht khng khun. Nn xc nh MIC bng cch dng cc xt nghim tiu
chun. Cc xt nghim ny da vo phng php pha long1 (thch hoc nc canh cy) hoc
tnh tng ng vi nng cy tiu chun v nng bt thuc moxifloxacin tiu chun.
Cc gi tr MIC s c nh gi theo cc tiu chun sau :
i vi th nghim chng Enterobacteriaceae v Staphylococcus :
MIC (mg/ml)

nh gi

<= 2,0

Nhy cm (S)

4,0

Trung gian (I)

>= 8,0

khng (R)

i vi th nghim chng Haemophilus influenzae v Haemophilus parainfluenzaea.

MIC (mg/ml)

nh gi

<= 1,0

Nhy cm (S)

Tiu chun nh gi ny ch p dng vi th nghim nhy cm vi pha long nc canh cy vi

Haemophilus influenzae v Haemophilus parainfluenzae bng mi trng th nghim
Haemophilus1.
Hin ti cha c d liu no ni v nhng dng khng, iu ny loi b bt c kt qu nh
gi no khc vi "Nhy cm". Nhng dng c kt qu MIC nghi ng "khng nhy cm" nn gi
n phng xt nghim tham kho thc hin thm cc th nghim khc.
i vi th nghim Streptococcus pneumoniaeb :

MIC (mg/ml)

nh gi

<= 1,0

Nhy cm (S)

2,0

Trung gian (I)

>= 4,0

khng (R)

Tiu chun nh gi ny ch p dng cho th nghim nhy cm vi pha long nc canh cy

Mueller-Hinton c iu chnh cation vi mu nga ly gii 2-5%.
Mt kt qu "Nhy cm" chng t tc nhn gy bnh c th b c ch nu hp cht khng sinh
trong mu t n nng trong mu n nng cho php. Kt qu "Trung gian" cho thy
kt qu cha c r rt, v nu vi khun khng nhy cm mt cch r rng, v i vi cc
thuc c xem l nhy cm trn lm sng, nn lp li th nghim. S phn loi ny cng ng
thuc vn c th c s dng trong lm sng nu v tr c th c nng phn b thuc cao
hoc trng hp c th s dng thuc liu cao. Phn loi ny cng li mt vng m (buffer
zone) nhm loi tr nhng yu t sai st v k thut nh nht c th dn n s khc bit ng
k khi nh gi. Kt qu " khng" khi tc nhn gy bnh khng b c ch bi hp cht khng
sinh trong mu t n nng cho php, lc ny nn chn la thuc khc iu tr.
Cc xt nghim th nghim nhy cm tiu chun cn dng vi khun chng phng xt
nghim kim chng kha cnh k thut ca phng xt nghim. Bt moxifloxacin tiu chun
s c gi tr MIC nh sau :

Vi khun

MIC (mg/ml)

Enterococcus faecalis

ATCC 29212

0,06-0,5

Escherichia coli

ATCC 25922

0,008-0,06

Haemophylus influenzae

ATCC 49247c

0,008-0,03

Staphylococcus aureus

ATCC 29213

0,015-0,06

Streptococcus pneumonia

ATCC 49619d

0,06-0,25

Gii hn chng nh tnh ny ch p dng cho H. influenzae ATCC 49247 c th bng xt

nghim vi pha long nc canh cy vi mi trng th nghim Haemophilus (HTM)1d Gii hn
chng nh tnh ny ch p dng cho S. pneumonia ATCC 49619 c th bng xt nghim vi
pha long nc canh cy vi mi trng canh cy Mueller-Hinton c iu chnh cation vi 2-5%
mu nga ly gii.
Phng php khuch tn : Cc phng php nh lng i hi o ng knh vng cng gip
c lng m phng nhy cm ca vi khun i vi hp cht khng sinh. Mt xt nghim
tiu chun nh vy cn s dng nng cy tiu chun. Xt nghim ny dng que nhng c
tm 5mg moxifloxacin th nghim nhy cm ca vi khun i vi moxifloxacin.
Nhng bo co t phng xt nghim cung cp kt qu ca th nghim nhy cm a khng
sinh n tiu chun vi a moxifloxacin 5 mg nn nh gi theo cc tiu chun sau y :
Tiu chun nh gi ng knh vng sau y nn s dng i vi th nghim chng
Enterobacteriaceae v Staphylococcus :
ng knh vng (mm)

nh gi

>= 19

Nhy cm (S)

16-18

Trung gian (I)

<= 15

khng (R)

i vi th nghim chng Haemophilus influenzae v Haemophilus parainfluenzaee.

ng knh vng (mm)

nh gi

>= 18

Nhy cm (S)

Tiu chun ng knh vng ny ch p dng cho th nghim vi Haemophilus influenzae v

Haemophilus parainfluenzae bng mi trng th nghim Haemophilus (HTM)2.
Hin ti cha c d liu no ni v nhng dng khng, iu ny loi b bt c kt qu nh
gi no khc vi "Nhy cm". Nhng dng c kt qu ng knh vng nghi ng "khng nhy
cm" nn gi n phng xt nghim tham kho thc hin thm cc th nghim khc.
i vi th nghim Streptococcus pneumoniaef :
ng knh vng (mm)

nh gi

>= 18

Nhy cm (S)

15-17

Trung gian (I)

<= 14

khng (R)

Tiu chun nh gi ny ch p dng cho th nghim khuch tn a bng thch MuellerHinton c b sung mu cu 5% trong CO2.
Cc nh gi nh nu trn nn dnh cho nhng kt qu dng k thut pha long. nh gi
ny c lin quan n s tng ng v ng knh c c trong th nghim a khng sinh vi
MIC ca moxifloxacin.
Nh trong k thut pha long tiu chun, k thut khuch tn cn dng vi khun chng trong
phng th nghim kim chng phng din k thut ca phng xt nghim. i vi k thut
khuch tn, a moxifloxacin 5 mg s c ng knh vng trong nhng dng vi khun c kim
chng nh tnh phng xt nghim nh sau :
Vi khun

ng knh vng (mm)

Escherichia coli

ATCC 25922

28-35

Haemophylus influenzae

ATCC 49247g

31-39

Staphylococcus aureus

ATCC 25923

28-35

Streptococcus pneumonia

ATCC 49619h

25-31

Gii hn chng nh tnh ny ch p dng cho th nghim H. influenzae ATCC 49247 bng mi
trng th nghim Haemophilus (HTM)2
h
Gii hn chng nh tnh ny ch p dng cho nhng th nghim vi S. pneumonia ATCC
49619 c thc hin bng phng php khuch tn a vi mi trng thch Mueller-Hinton
c b sung 5% mu cu loi b fibrin.

DC NG HC
S hp thu :
Vin moxifloxacin c hp thu tt v nhanh chng ng tiu ha. Kh dng sinh hc tuyt
i khong 90% v khng b nh hng bi thc n v cc sn phm sa.
Phn b :
Vi liu 400 mg ung mi ngy mt ln, nng thuc ti a trong huyt tng giai on n
nh khong 3,2 mg/l, c c sau khi ung thuc t 0,5 n 4 gi. Nng y trung bnh l
0,6 mg/l. Nng thuc trong huyt tng tng t l vi liu lng ln n liu cao nht th
nghiml 800 mg. Giai on n nh c c trong vng 3 ngy vi liu 400 mg ung mi ngy
mt ln.
T l gn kt vi protein trong mu trung bnh khong 50% v khng ph thuc nng .
Moxifloxacin phn b rng khp c th, vi nng trong m thng vt qu nng trong
mu (xem bng di).
Nng moxifloxacin ti a (nh trung bnh) mu v m o c sau khi ung liu 400
mg

1
2

Nng

Huyt tng

3,1

mg/l

Nc bt

3,6

mg/l

0,75-1,3

Dch nt phng

1,61

Nim mc ph qun

5,4

i thc bo ph nang

56,7 mg/kg 18,6-70,0

Dch lt lp biu m

20,7 mg/l

Xoang hm

7,5

mg/kg 2,0

Xoang bm

8,2

mg/kg 2,1

Polyp mi

9,1

mg/kg 2,6

Dch m k

1,02 mg/l

T l m c th/ huyt tng

1,71
mg/kg 1,7-2,1

10 gi sau khi ung, do biu mu tha tht

Nng khng gii hn

5-7

0,8-1,42,3

T 3-36 gi sau ung

Chuyn ha : Moxifloxacin c chuyn ha bng cch kt hp. H thng cytochrome P450
khng lin quan n chuyn ha moxifloxacin. dng kt hp vi sulfat (M1) chim khong 38%
liu, c bi tit ch yu trong phn. Khong 14% liu ung hoc tim tnh mch bin i
thnh dng kt hp glucuronide (M2), c bi tit hon ton trong nc tiu.
Bi tit : Thi gian bn hy thuc trong huyt tng khong 12 gi. Khong 45% liu
moxifloxacin ung hoc tim tnh mch c bi tit di dng khng i (khong 20% trong
nc tiu v khong 25% trong phn).
CH NH
iu tr bnh nhim khun ngi ln (>= 18 tui) do nhng dng vi khun nhy cm :
Vim xoang cp do vi khun gy bi Streptococcus pneumoniae, Haemophilus influenzae hoc
Moraxella catarrhalis.
t cp ca vim ph qun mn do vi khun gy bi Streptococcus pneumoniae, Haemophilus
influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Staphylococcus aureus hoc
Moraxella catarrhalis.
Vim phi mc phi trong cng ng (vi mc t nh n trung bnh) gy bi Streptococcus
pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae hoc
Moraxella catarrhalis.
CHNG CH NH
Mn cm vi bt c thnh phn no trong vin thuc hay vi cc quinolones khc.
Chng ch nh dng vin Avelox tr em, thiu nin ang tng trng v ph n c thai.
Quinolones cng phn b tt qua sa cc ph n ang cho con b. Nhng bng chng tin
lm sng cho thy mt lng nh moxifloxacin c th c tit qua sa m. Cha c d kin
v s dng thuc ph n ang cho con b. Do , chng ch nh s dng moxifloxacin ph
n c thai v cho con b.
CH PHNG v THN TRNG LC DNG
ng kinh c th xy ra khi iu tr bng quinolones. Moxifloxacin nn c s dng mt cch
thn trng trn nhng bnh nhn c hay ang nghi ng c nhng bnh l h thn kinh trung
ng c th lm khi pht ng kinh hay h thp ngng ng kinh.
V khng c d kin v dc ng hc trong nhng trng hp suy gan nng, nn s dng
moxifloxacin mt cch thn trng trong nhm bnh nhn ny.
Moxifloxacin, cng nh vi loi quinolones khc v macrolides, c th lm ko di khong QTc.
Mc d mc ko di QTc nh (1,2%), moxifloxacin nn c s dng thn trng trn nhng
bnh nhn c hi chng QTc di bm sinh hay mc phi hoc trn nhng bnh nhn ang dng
nhng thuc c kh nng k o di khong QTc (th d nh nhng thuc chng lon nhp nhm Ia
v III).
Vim gn v t gn c th xy ra khi iu tr bng quinolones, c bit trn bnh nhn gi v

nhng ngi ang iu tr vi corticosteroids. Khi c nhng du hiu u tin ca au hay

vim, bnh nhn phi c ngng thuc v bt ng chi b nh hng. Cha thy bo co v
t gn trong nhng nghin cu lm sng vi moxifloxacin.
Vim i trng c gi mc c bo co khi s dng nhng khng sinh ph rng ; do ,
iu quan trng l phi ngh ti chn on ny nhng bnh nhn b tiu chy trm trng khi
dng khng sinh. Trong tnh hung ny, nn tin hnh cc bin php iu tr ph hp. Khng
ghi nhn trng hp no b vim i trng c gi mc trong nhng chng trnh nghin cu
lm sng.
TNG TC THUC
- Thc phm v cc sn phm sa : S hp thu moxifloxacin khng b thay i khi s dng
chung vi thc n. Do , c th dng moxifloxacin khng ph thuc vo ba n.
- Ranitidine : S dng ng thi vi ranitidine khng lm thay i ng k kh nng hp thu ca
moxifloxacin. Cc thng s v hp thu (Cmax, tmax, AUC) rt ging nhau, iu ny cho thy pH d
dy khng nh hng ln s hp thu moxifloxacin ng tiu ha.
- Thuc khng acid, cht khong v a sinh t : S dng chung moxifloxacin vi thuc khng
acid, cht khong v a sinh t c th lm gim hp thu thuc do s hnh thnh nhng phc
hp chelate ha vi nhng cation a ha tr c trong nhng ch phm ny. iu ny c th lm
cho nng trong huyt tng thp hn ng k so vi mong mun. Do , thuc khng acid,
cc thuc chng retrovirus v nhng ch phm khc cha magnesium, nhm v nhng cht
khong khc nh st nn c s dng t nht 4 gi trc hoc 2 gi sau khi ung
moxifloxacin.
- Warfarin : Khng ghi nhn c tng tc thuc khi iu tr ng thi vi warfarin trn thi gian
prothrombin v cc thng s v ng mu khc.
- Digoxin : Dc ng hc ca digoxin khng b nh hng ng k bi moxifloxacin (v ngc
li).
- Theophylline : Moxifloxacin khng nh hng ln dc ng hc ca theophylline giai on
n nh (v ngc li), cho thy moxifloxacin khng nh hng phn nhm 1A2 ca cc men
cytochrome P450 ; nng theophylline khng tng giai on n nh khi iu tr phi hp
moxifloxacin (Cmax 10,5 so vi 10,1 mg/l, khng c v c theophylline). Do , khng cn chnh
liu theophylline.
- Probenecid : Trong mt nghin cu lm sng kho st tc dng ca probenecid ln s bi tit
qua thn cho thy khng c nh hng ng k trn thanh thi ton c th v qua thn ca
moxifloxacin. Do , khng cn chnh liu khi s dng ng thi hai thuc.
- Thuc tiu ng : Khng c tng tc thuc quan trng v lm sng gia glibenclamide v
moxifloxacin.
- Nhy cm vi nh sng : Gy c vi nh sng c bo co vi nhng quinolones khc.
Tuy nhin, mt nghin cu trn ngi tnh nguyn kt lun moxifloxacin khng c tim nng

gy c vi nh sng.
TC DNG NGOI
Trong nhng th nghim lm sng vi moxifloxacin, a s cc tc dng ph mc nh n
trung bnh. T l ngng thuc moxifloxacin do tc dng ph l 3,8%. Tc dng ph thng gp
nht (ty theo mc c th, c kh nng hay khng th nh gi c) da trn nhng th
nghim lm sng vi moxifloxacin c lit k di y :
Tn sut >= 1% < 10% :
Ton thn : au bng, nhc u.
- H tiu ha : bun nn, tiu chy, nn, kh tiu, bt thng trn cc xt nghim chc nng
gan.
- Gic quan : ri lon v gic.
- H thn kinh : chng mt.
Tn sut >= 0,1% < 1% :
- Ton thn : suy nhc, nhim nm Candida, au, au lng, mt mi, bt thng v xt
nghim, au ngc, phn ng d ng, au chn.
- H tim mch : tim nhanh, ph ngoi bin, cao huyt p, hi hp.
- H tiu ha : kh ming, bun nn v nn, y hi, to bn, nhim nm Candida ming,
bing n, vim ming, ri lon d dy rut, vim li, tng g-GT.
- H mu v bch huyt : gim bch cu, gim prothrombin, tng bch cu i toan, tng tiu
cu, gim tiu cu, thiu mu.
- Chuyn ha v dinh dng : tng amylase.
- H c xng : au khp, au c.
- H thn kinh : mt ng, chng mt, bt rt, bun ng, lo u, run, d cm, ln ln, trm cm.
- Da v phn ph : ni ban, nga, m hi, m ay.
- Ng quan : qung g.
- H niu sinh dc : nhim nm Candida m o, vim m o.
Tn sut >= 0,01% < 0,1% :
- Ton thn : au vng chu, ph mt.
- H tim mch : h huyt p, gin mch.
- H tiu ha : vim d dy, i mu li, kh nut, vng da, tiu chy (gy bi Clostridium
difficile).
- H mu v bch huyt : gim thromboplastin, tng prothrombin.
- Chuyn ha v dinh dng : tng ng huyt, tng lipid mu, tng uric mu.
- H c xng : vim khp, ri lon v gn.
- H thn kinh : o gic, ri lon nhn cch, tng trng lc, mt iu hp, kch ng, ic ngn
t, mt ngn ng, bt n v cm xc, ri lon gic ng, ri lon pht m, bt thng v t duy,
gim cm gic, gic m bt thng, co git.

- H h hp : hen ph qun, kh th.

- Da v phn ph : ni ban (dt sn, ban xut huyt, mn m).
- Ng quan : tai, bt thng v th gic, mt v gic, lon khu.
- H niu sinh dc : bt thng chc nng thn.
Nhng thay i xt nghim thng gp nht khng lin quan vi vic s dng thuc v khng
c xem nh l tc dng ph ca moxifloxacin, gm : tng v gim hematocrit, tng bch cu,
tng v gim hng cu, gim ng huyt, gim hemoglobulin, tng alkaline phosphatase, tng
SGOT/AST, tng SGPT/ALT, tng bilirubin, tng urea, tng creatinin, tng BUN.
Hin cha kt lun c nhng bt thng ny gy ra do thuc hoc do nhng bnh l gc
ang c iu tr.
LIU LNG v CCH DNG
Trong tt c cc ch nh, liu c khuyn co i vi moxifloxacin l 1 vin (400 mg) ung mi
ngy mt ln.
Nn ung trn vin thuc vi mt ly nc. C th ung thuc khng ph thuc vo ba n.
Thi gian iu tr :
Nn xc nh thi gian iu tr ty theo mc nng nh ca bnh hay p ng lm sng.
Khuyn co chung sau y dnh cho iu tr nhim khun ng h hp trn v di :
t cp ca vim ph qun mn : 5 ngy.
Vim phi mc phi trong cng ng : 10 ngy.
Vim xoang cp : 7 ngy.
Vin Avelox 400 mg c nghin cu trong nhng th nghim lm sng k o di n 14 ngy
iu tr.
Ngi gi : Khng cn chnh liu.
Tr em : Khng s dng moxifloxacin tr em v thiu nin trong giai on tng trng.
Suy gan : Khng cn phi chnh liu bnh nhn suy gan nh. Khng c d kin v dc ng
hc trn bnh nhn suy gan nng.
Suy thn : Khng cn phi chnh liu bnh nhn suy thn bt kz mc no (gm c thanh
thi creatinine <= 30 ml/pht/1,73 m2). Khng c d kin v dc ng hc trn bnh nhn
ang iu tr lc mu ngoi c th.
S khc bit theo chng tc : Khng cn chnh liu trong cc nhm chng tc.
QU LIU
Ch c mt s gii hn nhng d kin v qu liu. Liu duy nht di 800 mg v nhng liu lin
tc 600 mg trn 10 ngy c s dng trn ngi khe mnh m khng c tc dng ph
ng k no. Trong trng hp qu liu, nn tin hnh cc bin php iu tr nng thch
hp ty theo tnh trng lm sng ca bnh nhn.
BO QUN
Bo qun ni kh ro, nhit di 30oC.

48.

AVELOX

BAYER PHARMA
Vim bao phim 400 mg : hp 5 Vim.
THNH PHN
cho 1 Vim
Moxifloxacin hydrochloride

436,8 mg

Tng ng : Moxifloxacin

400 mg

DC LC
Moxifloxacin l thuc khng sinh thuc nhm fluoroquinolone hot ph rng v c tc dng
dit khun. Tc dng dit khun do cn tr men topoisomerase II v IV. Topoisomerase l
nhng men ch yu kim st v nh khu (topology) ca DNA v gip s ti to, sa cha v
sao chp DNA.
Vi sinh hc :
In vitro, moxifloxacin c tc dng chng li a s cc vi khun gram dng v gram m.
Moxifloxacin c tc dng dit khun nh c ch men topoisomerase II (DNA gyrase) v
topoisomerase IV rt cn thit cho vic ti to, sao chp, sa cha v ti kt hp DNA ca vi
khun. Nh c na C8-methoxy gp phn gia tng tc dng dit khun v gim s chn lc cc
t bin gy khng thuc ca vi khun gram dng so vi na C8-H.
C ch tc dng ca quinolones, bao gm c moxifloxacin, khc vi c ch tc dng ca
macrolides, b-lactam, aminoglycosides hoc tetracyclines ; do , cc vi khun khng vi cc
thuc ny c th vn nhy cm vi moxifloxacin v cc quinolones khc. Khng c khng
cho gia moxifloxacin v nhng khng sinh thuc cc nhm khc.
Ngi ta thy c khng cho gia moxifloxacin v cc fluoroquinolones khc chng li vi
khun gram m. Tuy nhin, vi khun gram dng khng vi cc fluoroquinolones khc c th
vn nhy cm vi moxifloxacin.
Moxifloxacin c hot tnh ln a s cc dng vi khun sau trong c in vitro v nhim khun trn
lm sng c cp trong phn Ch nh :
Vi khun gram dng hiu kh : Staphylococcus aureus (ch nhng chng nhy cm methicillin),
Streptococcus pneumoniae (ch nhng chng nhy cm penicillin).
Vi khun gram m hiu kh : Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella

pneumoniae, Moraxella catarrhalis.

Nhng vi sinh vt Khng in hnh : Chlamydia pneumoniae, Mycoplasma pneumoniae.
Mt s d liu in vitro khc cng c thc hin, tuy nhin { ngha lm sng cha r.
Theo nhng nghin cu in vitro ny, moxifloxacin cho thy vi nng c ch ti thiu (MIC) 2
mg/ml hoc thp hn c tc dng chng li a s (>= 90%) cc dng vi khun sau, tuy nhin,
an ton v tnh hiu qu ca moxifloxacin trong iu tr nhng trng hp nhim khun trn
lm sng do nhng vi khun ny cha c xc nh trong nhng nghin cu lm sng c kim
chng tt v y :
Vi khun gram dng hiu kh : Streptococcus pneumoniae (chng khng penicillin),
Streptococcus pyogenes.
Vi khun gram m hiu kh : Citrobacter freundii, Enterobacter cloacae, Escherichia coli,
Klebsiella oxytoca, Legionella pneumophila, Proteus mirabilis.
Vi khun k kh : Fusobacterium species, Peptostreptococcus species, Prevotella species.
Th nghim nhy cm :
K thut pha lng : Dng cc phng php nh lng xc nh nng c ch ti thiu c
tc dng dit khun (MIC). Nng c ch ti thiu ny gip c lng nhy cm ca vi
khun i vi cc hot cht khng khun. Nn xc nh MIC bng cch dng cc xt nghim tiu
chun. Cc xt nghim ny da vo phng php pha lng1 (thch hoc nc canh cy) hoc
tnh tng ng vi nng cy tiu chun v nng bt thuc moxifloxacin tiu chun.
Cc gi tr MIC s c nh gi theo cc tiu chun sau :
i vi th nghim chng Enterobacteriaceae v Staphylococcus :
MIC (mg/ml)

nh gi

<= 2,0

Nhy cm (S)

4,0

Trung gian (I)

>= 8,0

khng (R)

i vi th nghim chng Haemophilus influenzae v Haemophilus parainfluenzaea.

MIC (mg/ml)

nh gi

<= 1,0

Nhy cm (S)

Tiu chun nh gi ny ch p dng vi th nghim nhy cm vi pha lng nc canh cy vi

Haemophilus influenzae v Haemophilus parainfluenzae bng mi trng th nghim
Haemophilus1.

Hin ti cha c d liu no ni v nhng dng khng, iu ny loi b bt c kt qu nh

gi no khc vi "Nhy cm". Nhng dng c kt qu MIC nghi ng "Khng nhy cm" nn gi
n phng xt nghim tham kho thc hin thm cc th nghim khc.
i vi th nghim Streptococcus pneumoniaeb :
MIC (mg/ml)

nh gi

<= 1,0

Nhy cm (S)

2,0

Trung gian (I)

>= 4,0

khng (R)

Tiu chun nh gi ny ch p dng cho th nghim nhy cm vi pha lng nc canh cy

Mueller-Hinton c iu chnh cation vi mu nga ly gii 2-5%.
Mt kt qu "Nhy cm" chng t tc nhn gy bnh c th b c ch nu hp cht khng sinh
trong mu t n nng trong mu n nng cho php. Kt qu "Trung gian" cho thy
kt qu cha c r rt, v nu vi khun Khng nhy cm mt cch r rng, v i vi cc
thuc c xem l nhy cm trn lm sng, nn lp li th nghim. S phn loi ny cng ng
thuc vn c th c s dng trong lm sng nu v tr c th c nng phn b thuc cao
hoc trng hp c th s dng thuc liu cao. Phn loi ny cng li mt vng m (buffer
zone) nhm loi tr nhng yu t sai st v k thut nh nht c th dn n s khc bit ng
k khi nh gi. Kt qu " khng" khi tc nhn gy bnh Khng b c ch bi hp cht khng
sinh trong mu t n nng cho ph p, lc ny nn chn la thuc khc iu tr.
Cc xt nghim th nghim nhy cm tiu chun cn dng vi khun chng phng xt
nghim kim chng kha cnh k thut ca phng xt nghim. Bt moxifloxacin tiu chun s
c gi tr MIC nh sau :
Vi khun

MIC (mg/ml)

Enterococcus faecalis

ATCC 29212

0,06-0,5

Escherichia coli

ATCC 25922

0,008-0,06

Haemophylus influenzae

ATCC 49247c

0,008-0,03

Staphylococcus aureus

ATCC 29213

0,015-0,06

Streptococcus pneumonia

ATCC 49619d

0,06-0,25

Gii hn chng nh tnh ny ch p dng cho H. influenzae ATCC 49247 c th bng xt

nghim vi pha lng nc canh cy vi mi trng th nghim Haemophilus (HTM)1d Gii hn
chng nh tnh ny ch p dng cho S. pneumonia ATCC 49619 c th bng xt nghim vi
pha lng nc canh cy vi mi trng canh cy Mueller-Hinton c iu chnh cation vi 2-5%
mu nga ly gii.
Phng php khuch tn : Cc phng php nh lng i hi o ng knh vng cng gip
c lng m phng nhy cm ca vi khun i vi hp cht khng sinh. Mt xt nghim
tiu chun nh vy cn s dng nng cy tiu chun. Xt nghim ny dng que nhng c
tm 5mg moxifloxacin th nghim nhy cm ca vi khun i vi moxifloxacin.
Nhng bo co t phng xt nghim cung cp kt qu ca th nghim nhy cm a khng
sinh n tiu chun vi a moxifloxacin 5 mg nn nh gi theo cc tiu chun sau y :
Tiu chun nh gi ng knh vng sau y nn s dng i vi th nghim chng
Enterobacteriaceae v Staphylococcus :
ng knh vng (mm)

nh gi

>= 19

Nhy cm (S)

16-18

Trung gian (I)

<= 15

khng (R)

i vi th nghim chng Haemophilus influenzae v Haemophilus parainfluenzaee.

ng knh vng (mm)

nh gi

>= 18

Nhy cm (S)

Tiu chun ng knh vng ny ch p dng cho th nghim vi Haemophilus influenzae v

Haemophilus parainfluenzae bng mi trng th nghim Haemophilus (HTM)2.
Hin ti cha c d liu no ni v nhng dng khng, iu ny loi b bt c kt qu nh
gi no khc vi "Nhy cm". Nhng dng c kt qu ng knh vng nghi ng "Khng nhy
cm" nn gi n phng xt nghim tham kho thc hin thm cc th nghim khc.
i vi th nghim Streptococcus pneumoniaef :
ng knh vng (mm)

nh gi

>= 18

Nhy cm (S)

15-17

Trung gian (I)

<= 14

khng (R)

Tiu chun nh gi ny ch p dng cho th nghim khuch tn a bng thch MuellerHinton c b sung mu cu 5% trong CO2.
Cc nh gi nh nu trn nn dnh cho nhng kt qu dng k thut pha lng. nh gi
ny c lin quan n s tng ng v ng knh c c trong th nghim a khng sinh vi
MIC ca moxifloxacin.
Nh trong k thut pha lng tiu chun, k thut khuch tn cn dng vi khun chng trong
phng th nghim kim chng phng din k thut ca phng xt nghim. i vi k thut
khuch tn, a moxifloxacin 5 mg s c ng knh vng trong nhng dng vi khun c kim
chng nh tnh phng xt nghim nh sau :
Vi khun

ng knh vng (mm)

Escherichia coli

ATCC 25922

28-35

Haemophylus influenzae

ATCC 49247g

31-39

Staphylococcus aureus

ATCC 25923

28-35

Streptococcus pneumonia

ATCC 49619h

25-31

Gii hn chng nh tnh ny ch p dng cho th nghim H. influenzae ATCC 49247 bng mi
trng th nghim Haemophilus (HTM)2
h
Gii hn chng nh tnh ny ch p dng cho nhng th nghim vi S. pneumonia ATCC
49619 c thc hin bng phng php khuch tn a vi mi trng thch Mueller-Hinton
c b sung 5% mu cu loi b fibrin.
DC NG HC
S hp thu :
Vim moxifloxacin c hp thu tt v nhanh chng ng tiu ha. Kh dng sinh hc tuyt
i khong 90% v Khng b nh hng bi thc n v cc sn phm sa.
Phn b :
Vi liu 400 mg ung mi ngy mt ln, nng thuc ti a trong huyt tng giai on n
nh khong 3,2 mg/l, c c sau khi ung thuc t 0,5 n 4 gi. Nng y trung bnh l
0,6 mg/l. Nng thuc trong huyt tng tng t l vi liu lng ln n liu cao nht th
nghiml 800 mg. Giai on n nh c c trong vng 3 ngy vi liu 400 mg ung mi ngy
mt ln.
T l gn kt vi protein trong mu trung bnh khong 50% v Khng ph thuc nng .
Moxifloxacin phn b rng khp c th, vi nng trong m thng vt q nng trong

mu (xem bng di).

Nng moxifloxacin ti a (nh trung bnh) mu v m o c sau khi ung liu 400 mg

Nng

Huyt tng

3,1

mg/l

Nc bt

3,6

mg/l

0,75-1,3

Dch nt phng

1,61

Nim mc ph qun

5,4

i thc bo ph nang

56,7 mg/kg 18,6-70,0

Dch lt lp biu m

20,7 mg/l

Xoang hm

7,5

mg/kg 2,0

Xoang bm

8,2

mg/kg 2,1

Polyp mi

9,1

mg/kg 2,6

Dch m k

1,02 mg/l

T l m c th/ huyt tng

1,71
mg/kg 1,7-2,1

5-7

0,8-1,42,3

10 gi sau khi ung, do biu mu tha tht

Nng Khng gii hn
3
T 3-36 gi sau ung
Chuyn ha : Moxifloxacin c chuyn ha bng cch kt hp. H thng cytochrome P450
Khng lin quan n chuyn ha moxifloxacin. dng kt hp vi sulfat (M1) chim khong 38%
liu, c bi tit ch yu trong phn. Khong 14% liu ung hoc tim tnh mch bin i
thnh dng kt hp glucuronide (M2), c bi tit hon ton trong nc tiu.
Bi tit : Thi gian bn hy thuc trong huyt tng khong 12 gi. Khong 45% liu
moxifloxacin ung hoc tim tnh mch c bi tit di dng Khng i (khong 20% trong
nc tiu v khong 25% trong phn).
CH NH
iu tr bnh nhim khun ngi ln (>= 18 tui) do nhng dng vi khun nhy cm :
Vim xoang cp do vi khun gy bi Streptococcus pneumoniae, Haemophilus influenzae hoc
Moraxella catarrhalis.
t cp ca Vim ph qun mn do vi khun gy bi Streptococcus pneumoniae, Haemophilus
2

influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Staphylococcus aureus hoc

Moraxella catarrhalis.
Vim phi mc phi trong cng ng (vi mc t nh n trung bnh) gy bi Streptococcus
pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae hoc
Moraxella catarrhalis.
CHNG CH NH
Mn cm vi bt c thnh phn no trong Vim thuc hay vi cc quinolones khc.
Chng ch nh dng Vim Avelox tr em, thiu nin ang tng trng v ph n c thai.
Quinolones cng phn b tt qua sa cc ph n ang cho con b. Nhng bng chng tin
lm sng cho thy mt lng nh moxifloxacin c th c tit qua sa m. Cha c d kin
v s dng thuc ph n ang cho con b. Do , chng ch nh s dng moxifloxacin ph
n c thai v cho con b.
CH PHNG v THN TRNG LC DNG
ng kinh c th xy ra khi iu tr bng quinolones. Moxifloxacin nn c s dng mt cch
thn trng trn nhng bnh nhn c hay ang nghi ng c nhng bnh l h thn kinh trung
ng c th lm khi pht ng kinh hay h thp ngng ng kinh.
V Khng c d kin v dc ng hc trong nhng trng hp suy gan nng, nn s dng
moxifloxacin mt cch thn trng trong nhm bnh nhn ny.
Moxifloxacin, cng nh vi loi quinolones khc v macrolides, c th lm k o di khong QTc.
Mc d mc ko di QTc nh (1,2%), moxifloxacin nn c s dng thn trng trn nhng
bnh nhn c hi chng QTc di bm sinh hay mc phi hoc trn nhng bnh nhn ang dng
nhng thuc c kh nng k o di khong QTc (th d nh nhng thuc chng lon nhp nhm Ia
v III).
Vim gn v t gn c th xy ra khi iu tr bng quinolones, c bit trn bnh nhn gi v
nhng ngi ang iu tr vi corticosteroids. Khi c nhng du hiu u tin ca au hay
vim, bnh nhn phi c ngng thuc v bt ng chi b nh hng. Cha thy bo co v
t gn trong nhng nghin cu lm sng vi moxifloxacin.
Vim i trng c gi mc c bo co khi s dng nhng khng sinh ph rng ; do , iu
quan trng l phi ngh ti chn n ny nhng bnh nhn b tiu chy trm trng khi dng
khng sinh. Trong tnh hung ny, nn tin hnh cc bin php iu tr ph hp. Khng ghi
nhn trng hp no b Vim i trng c gi mc trong nhng chng trnh nghin cu lm
sng.
TNG TC THUC
- Thc phm v cc sn phm sa : S hp thu moxifloxacin Khng b thay i khi s dng
chung vi thc n. Do , c th dng moxifloxacin Khng ph thuc vo ba n.
- Ranitidine : S dng ng thi vi ranitidine Khng lm thay i ng k kh nng hp thu
ca moxifloxacin. Cc thng s v hp thu (Cmax, tmax, AUC) rt ging nhau, iu ny cho thy pH

d dy Khng nh hng ln s hp thu moxifloxacin ng tiu ha.

- Thuc khng acid, cht khng v a sinh t : S dng chung moxifloxacin vi thuc khng acid,
cht khng v a sinh t c th lm gim hp thu thuc do s hnh thnh nhng phc hp
chelate ha vi nhng cation a ha tr c trong nhng ch phm ny. iu ny c th lm cho
nng trong huyt tng thp hn ng k so vi mong mun. Do , thuc khng acid, cc
thuc chng retrovirus v nhng ch phm khc cha magnesium, nhm v nhng cht khng
khc nh st nn c s dng t nht 4 gi trc hoc 2 gi sau khi ung moxifloxacin.
- Warfarin : Khng ghi nhn c tng tc thuc khi iu tr ng thi vi warfarin trn thi gian
prothrombin v cc thng s v ng mu khc.
- Digoxin : Dc ng hc ca digoxin Khng b nh hng ng k bi moxifloxacin (v ngc
li).
- Theophylline : Moxifloxacin Khng nh hng ln dc ng hc ca theophylline giai on
n nh (v ngc li), cho thy moxifloxacin Khng nh hng phn nhm 1A2 ca cc men
cytochrome P450 ; nng theophylline Khng tng giai on n nh khi iu tr phi hp
moxifloxacin (Cmax 10,5 so vi 10,1 mg/l, Khng c v c theophylline). Do , Khng cn chnh
liu theophylline.
- Probenecid : Trong mt nghin cu lm sng kho st tc dng ca probenecid ln s bi tit
qua thn cho thy Khng c nh hng ng k trn thanh thi ton c th v qua thn ca
moxifloxacin. Do , Khng cn chnh liu khi s dng ng thi hai thuc.
- Thuc tiu ng : Khng c tng tc thuc quan trng v lm sng gia glibenclamide v
moxifloxacin.
- Nhy cm vi nh sng : Gy c vi nh sng c bo co vi nhng quinolones khc.
Tuy nhin, mt nghin cu trn ngi tnh nguyn kt lun moxifloxacin Khng c tim nng
gy c vi nh sng.
TC DNG NGOI
Trong nhng th nghim lm sng vi moxifloxacin, a s cc tc dng ph mc nh n
trung bnh. T l ngng thuc moxifloxacin do tc dng ph l 3,8%. Tc dng ph thng gp
nht (ty theo mc c th, c kh nng hay Khng th nh gi c) da trn nhng th
nghim lm sng vi moxifloxacin c lit k di y :
Tn sut >= 1% < 10% :
Ton thn : au bng, nhc u.
- H tiu ha : bun nn, tiu chy, nn, kh tiu, bt thng trn cc xt nghim chc nng gan.
- Gic quan : ri lon v gic.
- H thn kinh : chng mt.
Tn sut >= 0,1% < 1% :
- Ton thn : suy nhc, nhim nm Candida, au, au lng, mt mi, bt thng v xt
nghim, au ngc, phn ng d ng, au chn.

- H tim mch : tim nhanh, ph ngoi bin, cao huyt p, hi hp.

- H tiu ha : kh ming, bun nn v nn, y hi, to bn, nhim nm Candida ming, bing
n, Vim ming, ri lon d dy rut, Vim li, tng g-GT.
- H mu v bch huyt : gim bch cu, gim prothrombin, tng bch cu i toan, tng tiu
cu, gim tiu cu, thiu mu.
- Chuyn ha v dinh dng : tng amylase.
- H c xng : au khp, au c.
- H thn kinh : mt ng, chng mt, bt rt, bun ng, lo u, run, d cm, ln ln, trm cm.
- Da v phn ph : ni ban, nga, m hi, m ay.
- Ng quan : qng g.
- H niu sinh dc : nhim nm Candida m o, Vim m o.
Tn sut >= 0,01% < 0,1% :
- Ton thn : au vng chu, ph mt.
- H tim mch : h huyt p, gin mch.
- H tiu ha : Vim d dy, i mu li, kh nut, vng da, tiu chy (gy bi Clostridium
difficile).
- H mu v bch huyt : gim thromboplastin, tng prothrombin.
- Chuyn ha v dinh dng : tng ng huyt, tng lipid mu, tng uric mu.
- H c xng : Vim khp, ri lon v gn.
- H thn kinh : o gic, ri lon nhn cch, tng trng lc, mt iu hp, kch ng, ic ngn
t, mt ngn ng, bt n v cm xc, ri lon gic ng, ri lon pht m, bt thng v t duy,
gim cm gic, gic m bt thng, co git.
- H h hp : hen ph qun, kh th.
- Da v phn ph : ni ban (dt sn, ban xut huyt, mn m).
- Ng quan : tai, bt thng v th gic, mt v gic, lon khu.
- H niu sinh dc : bt thng chc nng thn.
Nhng thay i xt nghim thng gp nht Khng lin quan vi vic s dng thuc v Khng
c xem nh l tc dng ph ca moxifloxacin, gm : tng v gim hematocrit, tng bch cu,
tng v gim hng cu, gim ng huyt, gim hemoglobulin, tng alkaline phosphatase, tng
SGOT/AST, tng SGPT/ALT, tng bilirubin, tng urea, tng creatinin, tng BUN.
Hin cha kt lun c nhng bt thng ny gy ra do thuc hoc do nhng bnh l gc
ang c iu tr.
LIU LNG v CCH DNG
Trong tt c cc ch nh, liu c khuyn co i vi moxifloxacin l 1 Vim (400 mg) ung
mi ngy mt ln.
Nn ung trn Vim thuc vi mt ly nc. C th ung thuc Khng ph thuc vo ba n.
Thi gian iu tr :

Nn xc nh thi gian iu tr ty theo mc nng nh ca bnh hay p ng lm sng.

Khuyn co chung sau y dnh cho iu tr nhim khun ng h hp trn v di :
t cp ca Vim ph qun mn : 5 ngy.
Vim phi mc phi trong cng ng : 10 ngy.
Vim xoang cp : 7 ngy.
Vim Avelox 400 mg c nghin cu trong nhng th nghim lm sng ko di n 14
ngy iu tr.
Ngi gi : Khng cn chnh liu.
Tr em : Khng s dng moxifloxacin tr em v thiu nin trong giai on tng trng.
Suy gan : Khng cn phi chnh liu bnh nhn suy gan nh. Khng c d kin v dc ng
hc trn bnh nhn suy gan nng.
Suy thn : Khng cn phi chnh liu bnh nhn suy thn bt kz mc no (gm c thanh
thi creatinine <= 30 ml/pht/1,73 m2). Khng c d kin v dc ng hc trn bnh nhn
ang iu tr lc mu ngoi c th.
S khc bit theo chng tc : Khng cn chnh liu trong cc nhm chng tc.

49.

AXEPIM

BRISTOL-MYERS SQUIBB
Bt pha tim 1 g : hp 1 l.
THNH PHN
cho 1 l
Cefepime dichlorhydrate monohydrate, tnh theo cefepime 1 g
T dc : L-Arginine va pH 4,7 sau khi pha.
DC LC
Cefepime l mt khng sinh thuc h btalactamin, nhm cephalosporin th h th t.
Hot tnh khng khun :
- Cc loi thng nhy cm (CMI <= 4 mg/l) :
Trn 90% cc chng ca loi nhy cm vi khng sinh (S).
Escherichia coli, Salmonella, Shigella, Proteus mirabilis, Proteus vulgaris, Morganella morganii ;
Providencia, Citrobacter diversus, Citrobacter freundii*, Klebsiella oxytoca, Serratia
enterobacter ; streptocoques, Streptococcus pneumoniae nhy vi penicillin ; Haemophilus
influenzae, Neisseria, Branhamella catarrhalis ; Peptostreptococcus, Clostridium perfringens ;

staphylocoques nhy vi mticilline.

- Cc loi nhy cm trung bnh :
Khng sinh c tc ng trung bnh in vitro. C th thy cc kt qu lm sng tt khi nng
khng sinh ti ni b nhim trng cao hn nng c ch ti thiu CMI (xem phn Dc ng
hc).
Pseudomonas aeruginosa.
- Cc loi khng (CMI > 32 mg/l) :
t nht 50% cc chng ca loi khng vi khng sinh (R).
Entrocoques, Listeria, staphylocoques khng mticilline ; Pseudomonas cepacia, Xanthomonas
maltophilia ; Clostridium difficile, vi khun k kh Gram (-).
- Cc loi nhy cm khng n nh :
T l cc chng nhy cm vi khng sinh khng n nh. Do cn lm khng sinh kt
lun tnh nhy cm ca vi khun i vi khng sinh.
Klebsiella pneumoniae ; Streptococcus pneumoniae gim nhy cm hoc khng vi penicillin
; Acinetobacter baumannii.
Ghi ch : mt vi loi vi khun khng c lit k trong ph khng khun trn do khng c ch
nh lm sng.
Php, nm 1995 c 30-40% pneumocoques gim nhy cm vi penicillin (CMI > 0,12 mg/lt).
Vic gim nhy cm ny c th nh hng n tt c cc bta-lactamin nhng mc khc
nhau v cn phi c lu { khi iu tr vim mng no do tm quan trng ca bnh v trong
iu tr vim tai gia cp do trong trng hp ny tn sut cc chng gim nhy cm c th
vt qu 50%.
DC NG HC
Dc ng hc ca cefepime theo tuyn tnh khi liu dng trong khong 250 mg-2 g (ng
tnh mch), v 500 mg-2 g (tim bp), v khng dao ng trong thi gian iu tr.
Hp thu :
Sau khi tim bp, thuc c hp thu nhanh v hon ton.
Phn phi :
Cc nng trung bnh trong huyt tng ca cefepime c quan st n ng sau khi
truyn tnh mch trong 30 pht liu duy nht 250 mg, 500 mg, 1 g v 2 g hoc sau khi tim bp
liu duy nht 250 mg, 500 mg, 1 g, 2 g c tm tt trong bng sau :
Nng trung
bnh trong huyt
tng ca
cfpime

(mg/ml)
Liu cfpime

0,5 gi 1 gi 2 gi 4 gi 8 gi 12 gi

250 mg IV

20,1

10,9 5,9

500 mg IV

38,2

21,6 11,6 5

1 g IV

78,7

2,6

0,5

0,1

1,4

0,2

44,5 24,3 10,5 2,4

0,6

2 g IV

163,1 85,8 44,8 19,2 3,9

1,1

500 mg IM

8,2

12,5 12

6,9

1,9

0,7

1 g IM

14,8

25,9 26,3 16

4,5

1,4

2 g IM

36,1

49,9 51,3 31,5 8,7

2,3

Cc nng ca cefepime trong m v cc dch sinh l{ c m t trong bng sau :

Nng
trung
bnh ca
cefepime
trong m
v cc
dch sinh
l
Nng
trung bnh : Nng trung bnh
M hoc Liu/ng Ly mu : khong cch
- m (mg/g) trong huyt tng
dch
s dng
trung bnh (gi)
- dch sinh-l (mg/ml)
(mg/ml)
Nc tiu 500 mg IV 0-4*

292

4,9**

1 g IV

0-4*

926

10,5**

2 g IV

0-4*

3120

20,1**

Mt

2 g IV

11,2

9,2

Dch phc
2 g IV
mc

4,4

18,3

24,8

Dch m
2 g IV
k

1,5

81,4

72,5

Nim mc
2 g IV
ph qun

4,8

24,1

40,4

Rut tha 2 g IV

5,7

5,2

17,8

Ti mt

9,6

8,1

8,5

2 g IV

* nc tiu c ly trong khong 0-4 gi sau khi tim.

** huyt tng c ly sau khi tim 4 gi.
S phn phi n m ca cefepime khng bin i khi liu dng trong khong 250 mg-2 g. Th
tch phn phi trung bnh tnh trng cn bng l 18 lt. Thi gian bn hy ca cefepime trung
bnh l 2 gi. Khng ghi nhn c hin tng tch ly thuc khi dng liu 2 g IV mi 8 gi trong
vng 9 ngy. T l gn kt vi protein huyt tng di 19% v khng ph thuc vo nng
trong huyt thanh ca cefepime.
Chuyn ha :
Cefepime t b chuyn ha. Thuc c chuyn ha thnh M-methylpyrrolidine N-oxyd; cht
ny c bi tit qua nc tiu, tng ng vi 7% liu dng.
o thi :
Thanh thi ton phn trung bnh l 120 ml/pht. Thanh thi trung bnh thn ca cefepime l
110 ml/pht, thuc c o thi ch yu qua thn, ch yu do qu trnh lc cu thn. 85%
liu dng c tm thy di dng khng i trong nc tiu. Sau khi dng liu 500 mg ng
tnh mch, nng cefepime khng cn pht hin c trong huyt tng sau 12 gi v khng
cn pht hin c trong nc tiu sau 16 gi.
Nng trung bnh trong nc tiu, trong khong 12-16 gi sau khi tim, l 17,8 mg/ml. Sau
khi dng 1 hoc 2 g ng tnh mch, cc nng trung bnh trong nc tiu tng ng l
26,5 v 28,8 mg/ml trong khong 12-24 gi.
Khng th pht hin c cc nng trong huyt tng sau 24 gi.
Ngi ln tui :
S phn phi ca cefepime ngi ln tui (> 65 tui) c nghin cu. ngi c chc
nng thn bnh thng th khng cn phi chnh liu.
Ngi b suy gan :

ng hc ca cefepime khng b thay i ngi b suy gan c cho dng liu duy nht 1 g.
Do khng cn thit phi chnh liu.
Ngi b suy thn :
Cc nghin cu c thc hin nhng ngi c cc mc suy thn khc nhau cho thy thi
gian bn hy ca thuc k o di ng k. C mt mi lin quan tuyn tnh gia s thanh thi c
nhn vi s thanh thi cratinine nhng ngi gim chc nng thn (xem phn Liu lng v
Cch dng). Thi gian bn hy trung bnh nhng bnh nhn c thm phn (lc mu hay
thm phn phc mc lu ng lin tc) l 13-17 gi.
CH NH
Cc ch nh iu tr ca thuc da trn hot tnh khng khun v cc tnh cht dc ng ca
cefepime, bao gm cc nhim khun ngi ln do vi khun nhy cm vi cefepime, c bit
l nhim khun huyt v du khun huyt, cc nhim trng ng h hp di mc phi ti
cng ng v vim phi nng, cc nhim trng ng tiu phc tp v khng phc tp, cc t
st nhng bnh nhn b gim bch cu a nhn trung tnh v nhim trng ng mt.
CHNG CH NH
D ng vi khng sinh nhm cephalosporin hay vi L-Arginine.
CH PHNG v THN TRNG LC DNG
Nu xy ra cc biu hin d ng phi ngng ngay vic iu tr.
Phi hi thm bnh s trc khi k toa cephalosporin. C t 5 n 10% trng hp xy ra d
ng cho gia nhm penicillin v nhm cephalosporin :
- phi tht thn trng khi dng cephalosporin cho bnh nhn b nhy cm vi penicillin ; cn
theo di y khoa cht ch ngay trong ln s dng u tin ;
- tuyt i khng ch nh cephalosporin cho bnh nhn c tin s d ng vi cephalosporin
kiu phn ng tc th. Trong trng hp c nghi ng, thy thuc cn phi tc trc bn cnh
bnh nhn trong ln dng thuc u tin x l tai bin phn v nu c.
Nu bnh nhn b tiu chy th c th l triu chng, tuy nhin him khi xy ra, ca vim i
trng c gi mc, cn phi c chn on bng soi i trng. Tai bin ny him xy ra vi
cephalosporin, tuy nhin nu xy ra th phi ngng ngay thuc v cho dng liu php khng
sinh chuyn bit thch hp (vancomycin). Trong trng hp ny, tuyt i trnh dng nhng
thuc lm ng phn.
LC C THAI v LC NUI CON B
Lc c thai :
S dung np ca cefepime cha c nghin cu trn ph n c thai.
Trong cc nghin cu thc nghim trn ng vt, ghi nhn rng khi cho dng liu hng ngy
cao gp 8-10 ln liu dng cho ngi vn khng gy tc dng c hi trc tip hoc gin tip cho
s sinh sn, s pht trin ca phi hay ca bo thai, thi gian mang thai, s pht trin ca thai
nhi trong v sau khi sinh.

Ch s dng cefepime trong thi gian mang thai khi m li ch iu tr cao hn nhng nguy c
c th xy ra.
Lc nui con b :
Cefepime c bi tit mt lng rt nh qua sa m. Do cn phi thn trng khi s dng
thuc cho ph n cho con b.
TNG TC THUC
Cc xt nghim cn lm sng :
Test Coombs cho kt qu dng tnh khng r c tn huyt hay khng c m t nhng
bnh nhn c iu tr bng cefepime hai ln mi ngy.
Phn ng dng tnh gi c th xy ra khi lm xt nghim tm ng niu, nn dng phng
php nh lng s dng glucose-oxydase.
TC DNG NGOI
Thng gp nht : tiu chy, pht ban.
Him gp hn :
- d ng : nga, m ay, st ;
- ng tiu ha : bun nn, nn ;
- ti ch : vim tnh mch v vim tnh mch huyt khi sau khi tim tnh mch ; au v vim ti
im tim ;
- thn kinh cm gic : nhc u, d cm.
Rt him gp : phn v, h huyt p, gin mch, au bng, vim i trng, vim i trng c gi
mc, lot ming, ph, au khp, l ln, cm gic chng mt, co git, thay i v gic, tai,
vim m o.
Cc bt thng sinh l, mc trung bnh v thong qua, c ghi nhn : tng cao bch cu
a osine, tng transaminase (ASAT-ALAT), tng thi gian prothrombine v thi gian cphaline
c kch hot v gim phosphore huyt. Mt vi trng hp rt him gim bch cu ht cng
c ghi nhn.
LIU LNG v CCH DNG
Liu lng :
Ngi ln :
Liu thng dng qua ng tnh mch hay ng tim bp c khuyn co trong n liu
php nh sau :
Loi nhim trng

Liu n v

Nhim trng ng h hp cng ng

1 g IV hay IM 2 ln/ngy

Vim thn-b thn khng c bin chng

S ln/ngy

Nhim trng nng :

2 g IV

2 ln/ngy

Nhim khun huyt/Du khun huyt

Vim phi
Nhim trng ng tiu c bin chng
Nhim trng mt
Bnh nhn b gim bch cu a nhn trung
2 g IV
tnh

2 n 3 ln/ngy

Nhim trng nng do Pseudomonas

3 ln/ngy

2 g IV

* Cch dng : 2 g x 3 ln/ngy ch c dng duy nht trong n tr liu.

Bnh nhn b suy thn :
Cefepime c o thi qua thn hon ton, do qu trnh lc vi cu thn. Do , nhng
bnh nhn b suy thn (lc vi cu thn < 30 ml/pht), cn phi chnh liu cho ph hp vi mc
lc thn. Cn cn c trn mc lc cu thn quyt nh liu duy tr.
Phc chnh liu theo mc suy thn c m t trong bng sau :
Liu thng
thng

Thanh thi
creatinin
(ml/pht)
30-50

11-29

< 10

1 g x 2 ln/ngy 1 g x 1 ln/ngy

500 mg x 1
ln/ngy

250 mg x 1
ln/ngy

2 g x 2 ln/ngy 2 g x 1 ln/ngy

1 g x 1 ln/ngy

500 mg x 1
ln/ngy

2 g x 3 ln/ngy 1 g x 3 ln/ngy

1 g x 2 ln/ngy

1 g x 1 ln/ngy

Nu ch xc nh c creatinin huyt (P-creat) theo mg/l, c th dng biu thc Cockcroft

c lng mc thanh thi creatinin :
Clcr (ml/pht) =
(Trng lng (kg) x (140 - tui)) / (7,2 x P-creat tnh theo mg/l)
Biu thc ny c p dng cho nam gii, i vi n phi ly kt qu trn nhn cho 0,85.

 nhng bnh nhn c lc mu, khong 68% lng cefepime c trong c th c o thi
sau 3 gi lm thm phn. Sau mi ln lm thm phn, phi dng thm mt liu tng ng
vi liu c khuyn co.
nhng bnh nhn c lm thm phn phc mc lu ng lin tc, cefepime c th c
dng mt cch bnh thng liu khuyn co mi 48 gi.
Cch dng :
Axpim 1 g c th c dng bng ng tnh mch hoc tim bp su.
ng tnh mch :
Cfpim c th c pha trong nc ct pha tim hay trong cc dung mi pha tim tng hp
khc (xem phn Tng hp pha di).
Th tch cn phi pha trc khi s dng :
L

Th tch dung mi cn thm vo Th tch xp x sau khi pha

Nng xp x

1 g IM 3 ml

4,4 ml

240 mg/ml

1 g IV 10 ml

11,4 ml

90 mg/ml

1 g IV 50-100 ml

50-100 ml

20-10 mg/ml

Cc dung dch sau khi pha mc ch tim tnh mch c th c dng trc tip bng cch
tim tnh mch chm (3-5 pht) hoc tim vo b ng ca dch truyn hoc tim trc tip vo
dch truyn.
ng tim bp :
Pha Ax pim 1 g trong nc ct pha tim hoc trong dung dch lidocain chlorhydrate 0,5% hoc
1%.
Tng hp :
Cefepime c th pha vi cc dung mi v dung dch sau : chlorur natri 0,9% (c hoc khng c
phi hp vi glucose 5%), glucose 5% hoc 10%, dung dch Ringer (c hoc khng c phi hp
vi glucose 5%), sodium lactate M/6.
Cefepime c th c s dng ng thi vi cc khng sinh khc vi iu kin l khng c
pha chung trong cng ng tim, trong cng mt dch truyn hay tim cng mt v tr.
Nh vi cc cephalosporin khc, dung dch sau khi pha c th c mu vng h phch, iu ny
khng c ngha l thuc mt hot tnh.
QU LIU
Nng ca cefepime trong huyt tng c th c gim bng cch lc mu hay thm phn
phc mc.
TNG K

Do khng c cc nghin cu chuyn bit, khng c trn chung vi cc thuc khc trong cng
ng tim hay dch truyn.
BO QUN
Bo qun nhit di 30oC v trnh nh sng.
Sau khi pha : dung dch c bo qun trong vng 18 gi nhit phng v trong vng 7
ngy nhit t 2 n 8oC (trong t lnh).

50.

AXID

ELI LILLY
Vin nang 150 mg : hp 28 vin.
THNH PHN
cho 1 vin
nang
Nizatidine

150 mg

M T
Nizatidine USP l cht i khng vi histamine ti receptor H2. Cng thc ha hc l N-[2-[[[2[(dimethylamino)methyl]-4-thiazolyl]methyl]thio]ethyl]-N'-methyl-2-nitro-1,1-ethenediamine.
Cng thc phn t ca nizatidine l C12H21N5O2S2 ; phn t lng l 331,45. L tinh th rn,
mu trng ng n vng, tan trong nc. Nizatidine c v ng, mi gn ging sulfid. Mi vin
nang dng ung cha 150 mg (0,45 mmol) hoc 300 mg (0,91 mmol) nizatidine.
DC L LM SNG
Nizatidine i khng c cnh tranh thun nghch vi histamine receptor H2, nht l ti cc
receptor H2 t bo thnh ca d dy.
Tc dng c ch s bi tit
1. Tc dng trn s tit acid
Nizatidine c ch s tit acid ca d dy, r rt nht vo ban m, tc dng ny ko di trong
12 gi. Nizatidine cng c ch r s tit acid d dy b kch thch bi thc n, c ph, betazole
v pentagastrin (Bng 1).
Bng 1 Hiu qu ca ung nizatidine trn s tit acid d dy
Thi gian sau khi ung (gi)

% lng

acid d
dy b c
ch so vi
liu
nizatidine
ung (mg)
20-25
57

75

100
73

150

300
90
99
67
97

Ban m
sau 10 gi
Bentazole
-393
100
Pentagastrin - 6 25
64
Trong ba
-441
64
98
n
Cafein
-373
85
96
2. Tc dng ln cc s bi tit khc ca h tiu ha
Pepsin : Liu ung nizatidine t 75 n 300 mg khng nh hng n tc dng ca pepsin trong
dch tit ca d dy. Lng pepsin ton phn tit ra cng gim tng ng vi gim th tch dch
tit ca d dy.
Yu t ni ti : Ung nizatidine liu 75-300 mg lm tng tit yu t ni ti c kch thch bi
betazole.
Gastrin trong huyt thanh : Nizatidine khng c tc ng trn nng c bn gastrin trong
huyt thanh. Khng c s tit gastrin tr li, khi thc n tiu ha trong 12 gi sau khi dng
nizatidine.
3. Cc tc dng dc l khc
a. Hormone : Nizatidine khng c nh hng n nng trong huyt thanh ca nhng cht
sau : gonadotropin, prolactin, hormone tng trng, hormone chng bi niu, cortisol,
triiodothyronine, thyroxin, testosterone, 5a-dihydrotestosterone, estradiol hoc
androstenedione.
b. Nizatidine khng c tc dng i khng androgen.
4. Dc ng hc
Sinh kh dng tuyt i ca nizatidine khi ung l > 70%. Nng ti a trong huyt tng
(700-1.800 mg/L khi ung liu 150 mg nizatidine v 1.400-3.600 mg/L khi ung liu 300mg) t
c sau khi ung t 1/2 gi n 3 gi. Nng 1.000 mg/L tng ng vi 3 mmol/L ; liu
300 mg tng ng vi 905 mmol. Nng trong huyt tng 12 gi sau khi ung thp hn
10 mg/L. Thi gian bn thi t 1 n 2 gi, thanh thi trong huyt tng t 40 ti 60 L/gi
v th tch phn phi t 0,8 ti 1,5 L/kg. V thi gian bn thi ngn v thanh thi nhanh, nn
khng c tch ly thuc ngi bnh c chc nng thn bnh thng khi dng liu 300 mg mt
ln duy nht mi ngy vo bui ti hoc 150 mg mi ln, dng 2 ln trong 24 gi. Liu dng
nizatidine nn t l theo liu khuyn co.

Sinh kh dng ca nizatidine khi ung khng b nh hng khi dng chung vi propantheline.
Cc cht khng acid bao gm hydroxide nhm, magnesi hydroxide v simethicone lm gim s
hp thu nizatidine khong 10%. Khi dng chung vi thc n, din tch di ng cong (AUC)
v nng ti a tng ln khong 10%.
ngi, di 7% liu ung nizatidine c chuyn ha thnh N2-monodesmethyl-nizatidine,
cng l mt cht i khng vi histamine receptor H2 v l cht chuyn ha chnh c thi
tr theo nc tiu. Cc cht chuyn ha khc l N2-oxide (di 5% liu ung nizatidine), v Soxide (di 6% liu ung nizatidine).
Hn 90% liu nizatidine ung vo c thi tr theo nc tiu trong vng 12 gi. Khong 60%
c thi tr di dng cht m nguyn vn. thanh thi thn khong 500 mL/pht cho thy
thuc c thi tr tch cc qua ng thn. Di 6% liu dng nizatidine thi theo ng tiu
ha.
Suy thn mc trung bnh n nng s ko di thi gian bn thi ca thuc v lm gim
thanh thi nizatidine. nhng ngi b thn cm chc nng, thi gian bn thi t 3,5 gi n
11 gi, v thanh thi huyt tng t 7 n 14 L/gi. Trn lm sng, trnh tch ly thuc
ngi bnh suy thn nng, nn gim s lng v/hoc s ln dng nizatidine thch hp vi
trm trng ca bnh l chc nng thn (xin c phn Liu lng v Cch dng).
Khong 35% nizatidine kt hp vi protein huyt tng, ch yu l vi a1-acid glycoprotein. In
vitro, warfarin, diazepam, acetaminophen, propantheline, phenobarbital v propranolol khng
c nh hng ti s gn kt nizatidine vo protein huyt tng.
Cc Th Nghim Lm Sng
1. Lot t trng tin trin :
Trong cc nghin cu m i c dng placebo kim chng nhiu trung tm ti Hoa Kz, ni soi
chn on thy so vi placebo th vt lo t t trng c cha lnh nhanh hn sau khi dng
nizatidine 300 mg mi ngy mt ln duy nht lc i ng ti hoc 150 mg mi ln, dng 2 ln/24
gi (Bng 2). Cc liu thp hn, nh 100 mg dng mi ngy mt ln, s cho hiu qu thp hn.
Bng 2 Cha lnh cc vt lot bng nizatidine
Nizatidine
300 mg
dng ngy
1 ln lc
i ng
S bnh
Cha
nhn
lnh/C
th nh
gi c
Nghin
cu 1

Nizatidine
150 mg
mi ln,
dng ngy
2 ln
S bnh Cha lnh/C
nhn
th nh gi
c

Placebo

S bnh
nhn

Cha lnh/C
th nh gi
c

tun 2

276

tun 4
Nghin
cu 2
tun 2 108
tun 4

24/103
(23%)*
65/97
(67%)*

106

93/265
(35%)*
198/259
(76%)*

279

27/101
(27%)*
66/97
(68%)*

101

Nghin
cu 3
tun 2 92

55/260 (21%)
95/243 (39%)

9/93 (10%)
24/84 (29%)

22/90
98
13/92 (14%)
(24%)**
tun 4
52/85
29/88 (33%)
(61%)*
tun 8
68/83
39/79 (49%)
(82%)*
* P < 0,01 so vi placebo
** P < 0,05 so vi placebo
Ti Chu u, trong cc nghin cu m i c kim chng, so snh nhiu trung tm, thy t l
lnh vt lot sau khi ung nizatidine (N=388) l 81% trong vng 4 tun l v 92% trong vng 8
tun l.
2. iu tr duy tr cc lo t t trng lnh :
Gim liu nizatidine chng t c hiu qu nh mt phng php iu tr duy tr sau khi cc
lot t trng tin trin lnh. Ti Hoa Kz, trong cc th nghim m i c placebo kim chng
nhiu trung tm, thy khi ung 150 mg nizatidine vo mi bui ti c lm gim r rng mc
ti pht vt lot t trng nhng ngi bnh iu tr trong sut mt nm (Bng 3).
Bng 3 T l phn trm cc vt lot t trng ti pht sau 3 - 6 v 12 thng trong cc th
nghim m i thc hin Hoa Kz
Thng

Nizatidine 150 mg mt ln lc i ng
Placebo
ti

13% (28/208)*

40% (82/204)

24% (45/188) *

57% (106/187)

12

34% (57/166) *

64% (112/175)

* P < 0,001 so vi placebo

3. Lot d dy lnh tnh tin trin :
Ti Chu u, trong cc nghin cu m i c so snh kim chng ti nhiu trung tm, ngi
bnh c chn ngu nhin v ung 150 mg nizatidine mi ln, dng 2 ln trong 24 gi, hoc
300 mg nizatidine vo mi bui ti, thy kt qu nh sau (Bng 4) :
Bng 4 Hiu qu cha lnh vt lot d dy lnh tnh
Nizatidine 150 mg, ngy 2 ln

Nizatidine 300 mg vo mi bui ti

(S bnh nhn = 80)

(S bnh nhn = 89)

66%

65%

90%

87%

Tun

T l cha lnh vt lot c hai nhm sau khi ung nizatidine khng khc nhau v mt thng
k. C 68 -76% bnh nhn ht triu chng sau 4 tun iu tr trong cc nghin cu m i c
kim chng nhiu trung tm tin hnh ti Hoa Kz v Canada. Ni soi chn on cc vt lot
d dy lnh tnh lnh ng k (p < 0,05) ngi bnh dng nizatidine (300 mg mi ti ; hoc
150 mg mi ln, ngy 2 ln) nhanh hn nhiu so vi ngi dng placebo. S ngi bnh c
iu tr vi placebo phi ngng li do khng c hiu qu nhiu hn l nhm iu tr bng
nizatidine (p <= 0,01).
4. Bnh tro ngc d dy-thc qun (GERD) :
Trong cc th nghim lm sng m i c placebo kim chng, thy nizatidine c hiu qu hn
placebo trong bnh vim thc qun c chn on qua ni soi v trong iu tr vim thc
qun c lo t v vim xc nim mc (Bng 5). Ngoi ra, nizatidine lm bt chng nng nhiu
hn. Ngi bnh dng nizatidine t phi dng cc cht chng acid hn l ngi bnh iu tr vi
placebo.
Bng 5 p ng lnh bnh vim thc qun c lot v vim xc nim mc do nizatidine
Nizatidine
150 mg
mi ln, 2
ln/24
gi
S bnh
Lnh vt
nhn
lot/C th
nh gi
c
Nghin

Nizatidine
300 mg
mi ln, 2
ln/24
gi
S bnh
Lnh vt
nhn
lot/C th
nh gi
c

Placebo*

S bnh
nhn

Lnh vt
lot/C th
nh gi
c

cu 1
tun 6 82
14 (17%)**
88
12 (14%)
88
7 (8%)
tun 3 80
28 (35%)**
82
28 (34%)**
77
16 (21%)
Nghin
cu 2
tun 6 91
21 (23%)***
75
10 (13%)
tun
82
29 (35%)**
59
12 (20%)
12
Nghin
cu 3
tun 6
33
9 (27%)
28
5 (18%)
tun
33
12 (36%)
28
6 (21%)
12
* Tt c cc so snh i vi placebo u l nghin cu mt chiu
** P < 0,05 so vi placebo
*** P = 0,056 so vi placebo
CH NH
Nizatidine dng trong thi gian 8 tun cha vt lot t trng tin trin. Hu ht vt lo t u
lnh trong vng 4 tun.
Nizatidine dng iu tr duy tr vi liu thp 150 mg hng ngy lc i ng ti ngi bnh c
vt lot t trng tin trin lnh. Vic dng nizatidine lin tc hn 1 nm, kt qu hin nay
cha bit r.
Nizatidine c dng cha bnh lot d dy lnh tnh tin trin thi gian l 8 tun. Trc khi
dng thuc, nn cn thn loi tr kh nng bnh lot d dy c tnh.
Nizatidine cn c dng trong 12 tun cha bnh vim thc qun c chn on qua ni
soi, bao gm c vim thc qun do lo t v xc, c km triu chng hi nng do tro ngc
d dy-thc qun. Chng hi nng c ci thin sau mt ngy iu tr.
CHNG CH NH
Cm dng nizatidine ngi bnh qu mn cm vi thuc. V c nhy cm cho gia cc hp
cht thuc nhm i khng vi histamine receptor H2, k c nizatidine, v vy khng dng cho
ngi bnh c tin s mn cm vi cc cht khc cng i khng vi histamine receptor H2.
CH PHNG v THN TRNG LC DNG
Tng qut
- p ng tt v triu chng do dng nizatidine khng loi tr c bnh l d dy c tnh.
- Nizatidine c thi tr ch yu qua thn, do cn phi gim liu i vi ngi b suy thn
t mc trung bnh n nng (xin c phn Liu lng v Cch dng).
- Cha nghin cu c dc ng hc nhng ngi b hi chng gan thn. Mt phn
nizatidine chuyn ha gan. ngi bnh c chc nng thn bnh thng, v c ri lon chc

nng gan khng bin chng, th s thi tr nizatidine tng t nh nhng ngi bnh
thng.
Cc th nghim ti phng xt nghim :
Th nghim urobilinogen c th dng tnh gi vi Multistix trong khi iu tr bng nizatidine.
Tng tc thuc :
Khng c tng tc gia nizatidine vi theophylline, chlordiazepoxide, lorazepam, lidocaine,
phenytoin, warfarin, aminophylline, diazepam v metoprolol. Nizatidine khng c ch h thng
enzym chuyn ha thuc gn vi cytochrome P-450, cho nn cc tng tc thuc qua trung
gian c ch enzym chuyn ha gan khng th xy ra. ngi bnh dng aspirin liu cao
(3.900 mg) hng ngy, khi dng chung vi nizatidine 150 mg hai ln/ngy, thy nng
salicylate trong huyt thanh tng cao.
Tnh gy ung th, t bin gen, s v sinh :
Mt nghin cu v tnh gy ung th chut cng trong 2 nm, ung nizatidine liu cao 500
mg/kg/ngy (gp 80 ln liu iu tr khuyn dng hng ngy cho ngi), chng t khng c
du hiu gy ung th. C thy mt t bo ging t bo rut a crm (ECL) tng ln nim
mc tit acid d dy, s gia tng bt thng ny t l thun liu dng. Nghin cu trn chut
nht trng trong 2 nm. khng thy c du hiu gy ung th chut nht c, mc du cc
hch tng sn gan gia tng nhiu hn nhm dng placebo. Chut nht ci dng liu
nizatidine rt cao (2.000 mg/kg/24 gi, gp 330 ln liu dng cho ngi) cho thy gia tng c {
ngha thng k v tng sn dng nt gan v ung th t bo gan, m khng thy gia tng
nhm dng liu khc. T l ung th gan nhm sc vt dng nizatidine liu cao c hn ch
th nghim c kim sot thc hin loi chut nht trng. nhm chut nht ci dng liu
cao hn liu dung np ti a, thy c gim th trng (30%) khi so snh vi cc chut chng, v
c tn thng nh gan (tng transaminase). Trng thi bnh l trn ch gp nhng ng vt
c dng liu qu cao, ngang vi liu gy c cho gan v khng c du hiu gy ung th
chut cng, chut nht c v ci (dng n 360 mg/kg/ngy), gp 60 ln liu dnh cho ngi),
v khng c chng t bin gen ; v vy, coi nh nizatidine khng c kh nng gy ung th.
Nizatidine khng gy t bin gen cc chng th nghim qua nhng nghin cu thc hin
nh gi kh nng gy c cho gen, bao gm cc th nghim t bin vi khun, xo trn tng
hp DNA, trao i nhim sc th ch em, kho st u bch huyt chut lang, th nghim lm
sai lch cu trc nhim sc th v cc th nghim vi nhn.
Trong mt nghin cu qua hai th h chut cng v kh nng sinh sn trc v sau khi sinh, vi
liu 650 mg/kg/24 gi khng gp cc bin chng trn tnh sinh sn ca chut i cha m hay
i con ca chng.
Tc dng khi mang thai - Sinh qui thai
Nhng nghin cu trn chut cng ang mang thai, dng n liu gn gp 300 ln liu cho
ngi v trn th H Lan dng liu gp 55 ln cho ngi, chng t khng c nh hng gy

v sinh hoc sinh qui thai, nhng mt th nghim khc vi liu tng ng gp 300 ln
liu cho ngi, thy th b sy thai, s bo thai sng st gim, v trng lng bo thai gim.
Nu tim tnh mch cho th trng Tn Ty Lan ang mang thai, vi liu nizatidine 20 mg/kg lm
cho tim to hn, hp cung ng mch ch, v ph n di da mt bo thai, v vi liu 50
mg/kg gy bin dng tm tht, chng bng, gai ui ct sng, no nc v tim to ln mt
bo thai khc. Tuy nhin, khng c cc nghin cu c kim chng v y ngi ang mang
thai. Cha bit nizatidine c gy c cho thai nhi khi dng cho ngi mang thai, hoc c nh
hng n kh nng sinh sn hay khng. Nizatidine ch nn dng lc c thai, mt khi cn
nhc li ch mang n cho ngi m hn tai bin c th xy ra cho thai nhi.
Thi kz cho con b :
Trn ngi cho con b, thy 0,1% liu dng nizatidine c bi tit theo sa m, t l thun vi
nng thuc trong huyt tng. chut cng con c nui bng sa ca chut m dng
nizatidine c s gim tng trng, do quyt nh ngng cho con b hay l ngng thuc,
th cn phi cn nhc n tm quan trng ca vic dng nizatidine i vi ngi m.
Dng cho tr em :
Tnh an ton v hiu qu trn tr em cha c xc nh.
Vi ngi cao tui :
T l lnh lot ngi cao tui tng t nh nhm ngi tr. T l cc bin chng v
nhng bt thng v xt nghim tng t nh cc nhm tui khc. Yu t tui tc c th
khng quan trng trong ch nh dng nizatidine. Ngi cao tui c th b gim chc nng thn
(xin c phn Liu lng v Cch dng).
TC DNG NGOI
Cc th nghim lm sng c kim chng ca nizatidine trn 6.000 ngi bnh dng nizatidine
ti nhiu ni, trong nhng khong thi gian khc nhau. Cc th nghim c placebo kim chng
ti Hoa Kz v Canada, trn 2.600 ngi bnh dng nizatidine v trn 1.700 ngi dng placebo.
Trong s nhng phn ng c hi ca cc th nghim c placebo kim chng ny, bnh thiu
mu (0,2% so vi 0%) v ni m ay (0,5% so vi 0,1%) thng xy ra ng k cc nhm dng
nizatidine.
T l xy ra nhng tai bin trong cc th nghim c placebo kim chng Hoa Kz v Canada :
Bng 6 lit k cc phn ng c hi thng xy ra vi tn sut 1% hoc ln hn nhng ngi
bnh dng nizatidine. Nhng s liu ny coi nh l c s d liu c tnh vai tr ca thuc
v ca nhng yu t khng lin quan thuc, nh hng n t l xy ra cc phn ng c hi.
Bng 6 Tn sut xy ra cc phn ng c hi cn phi c iu tr theo th nghim lm sng
c placebo kim chng thc hin ti Hoa Kz v Canada
H thng c quan/ Phn ng c hi*

T l % ngi bnh ghi

nhn c phn ng c hi

Ton thn
Nhc u
au bng
au nhc
Suy nhc
au lng
au ngc
Nhim khun
St
X tr ngoi khoa
Chn thng do tai nn
H tiu ho
Tiu chy
Bun nn
y hi
Nn ma
n khng tiu
To bn
Kh ming
Bun nn v nn ma
Ch|n n
Ri lon tiu ho
Ri lon rng
H c xng
Chng au c
Thn kinh
Chng mt
Mt ng
D mng
Ng m m{ng
Lo lng
Cng thng
H hp
Vim mi
Vim hng
Vim xoang
Ho nhiu
Da v cc phn ph ca da
Ban
Nga

Nizatidine (N= 2.694)

Placebo (N=1.729)

16,6
7,5
4,2
3,1
2,4
2,3
1,7
1,6
1,4
1,2

15,6
12,5
3,8
2,9
2,6
2,1
1,1
2,3
1,5
0,9

7,2
5,4
4,9
3,6
3,6
2,5
1,4
1,2
1,2
1,1
1,0

6,9
7,4
5,4
5,6
4,4
3,8
1,3
1,9
1,6
1,2
0,8

1,7

1,5

4,6
2,7
1,9
1,9
1,6
1,1

3,8
3,4
1,9
1,6
1,4
0,8

9,8
3,3
2,4
2,0

9,6
3,1
2,1
2,0

1,9
1,7

2,1
1,3

Nhng gi|c quan c bit

Gim th lc

1,0

0,9

* Bao gm cc phn ng c hi xy ra vi t l ti thiu l 1% ngi bnh c cha bng

nizatidine
Nhng phn ng khc t xy ra cng c ghi nhn ; khng th xc nh c phi do nizatidine
gy ra hay khng.
Gan : Tn thng t bo gan, da vo kt qu th nghim tng cc enzym gan *SGOT (AST),
SGPT (ALT)], hoc phosphatase kim, xy ra vi ngi bnh v c l c kh nng lin quan n
nizatidine. Trong vi trng hp, enzym SGOT, SGPT tng cao r rt (> 500 IU/L), v mt
trng hp, SGPT tng qu 2.000 IU/L. D t l bnh nhn c enzym gan tng v tng gp 3 ln
gii hn trn ca mc bnh thng, th cng khng c s khc nhau r rt v bt thng ca
enzym gan so vi nhm dng placebo. Tt c nhng bt thng ny tr li bnh thng sau khi
ngng dng nizatidine. T khi a nizatidine ra th trng, c ghi nhn chng vim gan v vng
da. Trong mt s trng hp, chng mt hoc tn thng t bo gan km mt cng vi
chng vng da cng phc hi tt sau khi ngng nizatidine.
H tim mch : Trong cc th nghim v dc l lm sng, c thy nhng t ngn nhp nhanh
tht khng triu chng hai ngi dng nizatidine, v ba ngi khng dng nizatidine.
H thn kinh trung ng : Cng gp chng l ln tm thn thong qua (him xy ra).
H ni tit : Trong cc nghin cu dc l lm sng v cc th nghim lm sng c kim chng,
thy nizatidine khng c tc dng khng androgen. Bt lc v gim ham mun tnh dc cng
gp vi tn sut tng t nh ngi bnh ung placebo. Him c trng hp v to n
ng.
H huyt hc : Chng thiu mu thng gp ngi dng nizatidine hn ngi dng
placebo. Chng gim tiu cu gy t vong c gp mt ngi bnh dng nizatidine phi hp
vi mt cht i khng histamine H2 khc ; ngi bnh ny cng tng b gim tiu cu khi
dng nhng thuc khc. Cng gp mt s him trng hp ban xut huyt gim tiu cu sau
khi dng nizatidine.
Da : Chng m hi v ni m ay thng gp ngi dng nizatidine hn l nhm dng
placebo. da v vim da bong vy cng c ghi nhn.
Qu mn cm : Cng nh cc thuc i khng khc receptor H2, mt s him trng hp b
phn ng phn v sau khi dng nizatidine. Cc phn ng qu mn him xy ra (nh co tht ph
qun, ph thanh qun, da, tng bch cu a eosin) cng c ghi nhn.
Cc phn ng ph khc : C gp tng acid uric/mu khng do bnh gt hoc bnh si thn.
Chng tng bch cu a eosin, st v bun nn c lin quan n nizatidine cng c ghi nhn.
LIU LNG v CCH DNG

Lot t trng tin trin : Liu khuyn dng cho ngi ln l 300 mg, ung mt ln vo bui ti,
hoc 150 mg mi ln, ung hai ln trong 24 gi.
Phng nga (liu duy tr phng nga ti pht) : Liu khuyn dng cho ngi ln l ung 150 mg
mt ln duy nht trong 24 gi, ung vo bui ti.
Lot d dy lnh tnh tin trin : Liu khuyn dng cho ngi ln l ung 300 mg, dng mt ln
trc khi i ng ti, hoc chia lm hai ln trong 24 gi, mi ln 150 mg. Trc khi khi u tr
liu, nn cn thn loi tr kh nng lo t d dy c tnh.
Bnh tro ngc d dy-thc qun : Liu ung cho ngi ln tr cc vim xc nim mc,
lot d dy km theo cm gic hi nng l mi ln 150 mg, dng 2 ln trong 24 gi, hoc c
th dng n 300 mg mi ln, 2 ln trong 24 gi.
iu chnh liu vi ngi b suy thn mc trung bnh hay nng
Liu dng ca ngi suy thn nn gim nh sau :
Lot t trng v lot d dy lnh tnh tin trin hoc bnh tro ngc d dy-thc qun
thanh thi creatinine
Liu dng
20-50 mL/pht
150 mg mi ngy
< 20 mL/pht
150 mg cch ngy
Ngi bnh b tro ngc d dy-thc qun cn chn liu cao hn
thanh thi creatinine
20-50 mL/pht
< 20 mL/pht
Liu duy tr

Liu dng
mi ln 150 mg, dng hai ln trong 24 gi
150 mg/24 gi

thanh thi creatinine

Liu dng
20-50 mL/pht
150 mg cch ngy
20 mL/pht
150 mg cch mi 3 ngy
Da trn cc d liu dc ng hc i vi ngi bnh suy thn, nn gim liu cho mt s
ngi bnh cao tui c thanh thi creatinine di 50 mL/pht. Hiu qu lm sng khi gim
liu cho ngi suy thn cha c nh gi. i vi ngi bnh kh nut c vin nang, c th
m vin nang nizatidine v trn ngay cc thnh phn trong vin thuc vo cht lng ung.
Ch phm lng ny c ghi bng sau km cch bo qun thch hp.
Bng 7 S n nh ca nizatidine trong ch phm ung pha sn t lnh v nhit
phng
Dung mi (120mL)
Gatorade
Nc to p

iu kin bo qun
T lnh
Nhit phng
T lnh

S gi n nh (gi)
48
48
48

Nhit phng
T lnh
Nhit phng
T lnh
Nhit phng

Nc nho p
Cran-Grape
Nc

48
48
8
48
48

QU LIU
Him gp dng qu liu nizatidine. Sau y l cch x tr khi dng qu liu :
Cc du hiu v triu chng : t c kinh nghim lm sng v qu liu nizatidine ngi. Loi vt
dng liu cao nizatidine c biu hin kiu cholinergic, nh chy nc mt, tit nc bt, nn,
co ng t v tiu chy. Dng liu ung duy nht 800 mg/kg ch v 1.200 mg/kg kh khng
gy t vong. Liu gy cht 50% khi tim tnh mch chut cng l 301 mg/kg v chut nht
trng l 232 mg/kg.
X tr : Khi x tr vic dng qu liu, cn xt kh nng qu liu nhiu loi thuc, s tng tc
gia cc thuc, v dc ng hc bt thng ca thuc i vi ngi bnh.
Nu qu liu xy ra, nn dng than hot, gy nn hoc ra rut cng vi theo di trn lm
sng, v iu tr h tr. Kh nng thm phn lc mu loi nizatidine ra khi c th cha
c xc minh r rng ; tuy nhin, do th tch phn phi ln, nn khng hy vng loi tr
nizatidine ra khi c th bng phng php ny.
BO QUN
Bo qun nhit phng, 59oF n 86oF (15oC n 30oC).

THUC VN B

51.

BABYGAZ

AMERIPHARM
c/o O.P.V. (OVERSEAS)

Dung dch ung : chai 30 ml + ng m git.

THNH PHN
cho 0,3 ml
Simethicone
T dc : citric acid, hydroxypropyl methylcellulose, maltitol, hng v thin
nhin, nc tinh ch, Red 22, Red 288, sodium benzoate, sodium citrate, gm
xanthan. Khng cha hng liu nhn to. Khng cha ng ha hc. Khng
cha cn.
TNH CHT
Tc ng nh nhng lm v cc bng kh trong vng vi pht.
Tc ng an ton v simethicone khng hp thu vo mu.
CH NH
Lm gim cc triu chng au do y hi.
THN TRNG LC DNG
- Khng nn dng qu 12 liu mi ngy tr phi c ch nh ca bc s.
- Gi thuc trnh xa tr em.
LIU LNG v CCH DNG
Lc k trc khi dng.
Liu dng cho mi ln ung :
Tui

Cn nng

Liu dng cho mi ln ung

1 thng - 2 tui

Di 12 kg

0,3 ml

Trn 2 tui

Trn 12 kg

0,6 ml

20 mg

Cc liu c th lp li khi cn, nn dng sau ba n v bui ti trc khi i ng hoc theo ch
dn ca bc s. Khng nn dng qu 12 liu mi ngy.
C th ha thuc vi nc, sa bt tr em hoc vi cc dung dch thch hp khc.
Hng dn s dng :
- Ht thuc vo ng m git, ti mc ch nh.
- a ng m git vo bn trong m em b ri th ra t t m khng cn pha vi nc.
- Sau ra sch ng m git, lau kh cho vo chai, vn cht np. Gi chai thuc ngn
thng trong t lnh.
BO QUN
Bo qun nhit phng 15-30oC.

52.

BACTROBAN

SMITHKLINE BEECHAM
Thuc m bi ngoi da 2 % : ng 5 g v 15 g.
THNH PHN
cho 100 g
Mupirocine 2 g

DC LC
Bactroban l mt thuc khng khun ti ch, c hot tnh trn hu ht cc vi khun gy nhim
khun da nh Staphylococcus aureus, bao gm nhng chng khng vi methicilline, nhng
loi Staphylococcus v Streptococcus khc. N cng c hot tnh chng li cc vi khun gy
bnh Gram m nh Escherichia coli v Haemophilus influenzae.
DC NG HC
ngi, Bactroban thm qua da cn nguyn vn nhng t l hp thu ton thn l rt thp.
Bactroban hp thu vo c th c chuyn ha nhanh chng thnh cht chuyn ha khng
c hot tnh l acid monic v c bi tit nhanh chng qua thn.
CH NH
Cc nhim khun da do vi khun nh : chc, vim nang lng, nht.
CHNG CH NH
Qu mn vi Bactroban hoc cc loi thuc m cha polyethylene glycol v bt kz thnh phn
no ca thuc.
THN TRNG LC DNG
Dng Bactroban ny khng thch hp s dng cho mt v bn trong mi. Khi dng bi trn
mt, nn thn trng trnh vy vo mt. Polyethylene glycol c th c hp thu qua cc vt
thng h v da b tn thng v c bi tit qua thn.
Cng ging nh cc dng thuc m khc c cht nn l polyethylene glycol, Bactroban nn
c s dng thn trng bnh nhn c biu hin suy thn va hay nng.
LC C THAI
Nhng nghin cu trn ng vt cho thy mupirocine khng gy ra qui thai. Tuy nhin cha c
bng chng y v tnh an ton cho php s dng Bactroban trong thai kz. Khng c d liu
nh gi y v s s dng thuc lc nui con b ngi v th vt.
TC DNG NGOI

Cc th nghim lm sng cho thy c vi tc dng ngoi nh khu tr ti ni thoa thuc nh

cm gic nng, chm chch v nga. Cc phn ng nhy cm trn da c bo co him gp.
Phn ng mn cm ton thn c ghi nhn vi Bactroban m.
LIU LNG v CCH DNG
i vi ngi ln v tr em : Nn thoa Bactroban vng da b tn thng ti a 3 ln mi
ngy, dng ti a trong 10 ngy. Vng thng tn c th bng kn nu mun.
Cha c kinh nghim v vic s dng Bactroban di ngy ngi.
BO QUN
Bo qun nhit di 25oC.
Lng thuc cn li vo cui liu trnh iu tr nn c hy b.

53.

BASDENE

DOMS-RECORDATI
c/o MARKETING SANPROMEX
Vin nn 0,025 g : hp 50 vin.
THNH PHN
cho 1 vin
Benzylthio-uracile

0,025 g

(Amidon la m, lactose, bt talc, starate de magnsium, rythrosine)

cho 1 hp
Benzylthio-uracile

1,25 g

(Amidon la m, lactose, bt talc, starate de magnsium, rythrosine)

DC LC
Thuc khng gip tng hp, c hot tnh qua ng tiu ha. Basdne iu ha s tit ca
tuyn gip. Thuc ngn tr s tng hp hormone tuyn gip ch yu bng cch c ch hu c
ha Iode. Thuc gy tng tit TSH.
DC NG HC
Hp thu nhanh, thuc qua khi ng tiu ha trong khong 2 gi. o thi nhanh, ch yu

qua thn : 12 n 24 gi. Benzylthio-uracile cng nh cc cht khng gip tng hp khc, i qua
nhau thai v vo sa m.
CH NH
Cng gip, bnh Basedow, chun b ct tuyn gip, kt hp vi tr liu bng Iode phng x.
CHNG CH NH
Ung th tuyn gip ph thuc TSH.
Bnh v mu trm trng.
THN TRNG LC DNG
Khng nn dng Basdne khi khng c xc nhn v mt sinh hc ca bnh cng gip. Theo di
cng thc mu trc khi iu tr v u n mi tun (nguy c mt bch cu ht, t l : 0,7%)
trong 6 tun u iu tr. Khi dng thuc, nu b st, au hng, hoc b nhim trng khc, phi
lp tc lm cng thc mu.
LC C THAI v LC NUI CON B
Tuyn gip ca thai nhi ch bt u pht trin vo tun l th 11 ca thai kz, c th tin hnh
iu tr khng c vn g cho n thng th ba. T thng th ba tr i, do c ghi nhn tnh
trng suy gip tr s sinh c m s dng thuc vi liu cao trong thi gian c thai, do
khng nn dng thuc v nguy c suy gip bo thai. Tuy nhin, theo mt s tc gi, c th
dng thuc liu thp v hn na tnh trng cng gip thng thng c th chu ng c
trong thi gian c thai.
TNG TC THUC
Tng tc dng ca cc cht khng gip tng hp khi dng chung vi cc Sulfamide h ng
huyt, cc Hydantoine, Iode, Iodure.
TC DNG NGOI
Mi s gia tng th tch tuyn gip, trc tin phi ngh ti suy gip do dng thuc qu liu.
Gim bch cu, mt bch cu ht hay suy ty t ngt, phi ngng thuc.
D ng (ngoi da, st, pht ban, au khp, au c, nhc mi).
LIU LNG v CCH DNG
Bt u bng liu tn cng trong khong 1 thng, sau theo di lm sng, gim liu dn
t c liu duy tr trong 3 hay 4 thng v tip tc liu ny trong 18 thng.
Vic iu chnh liu iu tr rt quan trng v :
- nu dng khng liu lng, cc du hiu cng gip s xut hin tr li hoc trm trng
hn ln ;
- nu dng qu liu : suy tuyn gip, biu hin qua tng TSH, tng th tch tuyn gip.
Liu tn cng : 150 n 200 mg (6 n 8 vin)/ngy, trong vi tun.
Liu duy tr (khi c ci thin v lm sng v cc th nghim chc nng cho kt qu bnh thng
tr li) : 100 mg/ngy (4 vin/ngy), trong nhiu thng.

Dng thuc 3 n 4 ln chia u trong ngy, nn ung vo cc ba n.

Thi gian n nh : 5 nm.

54.

BASEN

TAKEDA
c/o MEGA PRODUCTS
Vin nn 0,2 mg : v 10 vin, hp 10 v - Bng B.
Vin nn 0,3 mg : v 10 vin, hp 10 v - Bng B.
THNH PHN
cho 1 vin
Voglibose 0,2 mg
cho 1 vin
Voglibose 0,3 mg
TNH CHT
Voglibose l cht c ch a-glucosidase c c lp t Streptocomyces hygroscopicus thuc
phn loi limoneus.
Vi liu iu tr, voglibose khng xm nhp vo mu m ch c ch chn lc a-glucosidase l
men tc ng giai on cui ca qu trnh tiu ha v hp thu carbohydrate, do c ch s
tng vt nng glucose trong mu sau khi n. Voglibose l cht c ch cnh tranh trn cc
men thy phn cc disaccharide thnh monosaccharide nh maltase, isomaltase v sucrase ti
nim mc rut non chut mnh hn so vi arcabose. Tuy nhin, n c tc ng c ch cnh
tranh yu hn trn a-amylase c ngun gc t ty.
Trong lm sng, voglibose lm tr hon s hp thu sucrose on u v on gia ca rut
non, cho ph p sucrose i n phn cui ca rut non v c dn dn thy phn v hp thu ti
y, do c ch s tng vt nng glucose trong mu sau khi n.
Cc nghin cu lm sng cho thy rng khi bnh nhn tiu ng khng ph thuc insulin c
ng huyt khng c kim sot tt vi sulfonylurea c iu tr b sung thm vi
voglibose th ng huyt lc i v sau khi n gim i m khng cn tng liu sulfonylurea.
Khi bnh nhn tiu ng khng ph thuc insulin v tiu ng ph thuc insulin c ng
huyt khng c kim sot tt vi iu tr insulin c kt hp dng thm voglibose vi liu

0,6 mg mi ngy, ng huyt sau khi n gim i ng k. Voglibose cng c th ngn nga s
s dng qu insulin, lm gim t l h ng huyt.
bnh nhn s dng voglibose k o di hn 1 nm, c s ci thin trn ng huyt lc i v
sau khi n v trn nng HbA1C.
CH NH
Tiu ng khng ph thuc insulin (NIDDM, type 2).
Tiu ng ph thuc insulin (IDDM, type 1).
Dng phi hp vi insulin trong trng hp s s dng n c insulin khng c ch c
ng huyt sau khi n.
CHNG CH NH
- Nhim cetone nng, tnh trng hn m hay tin hn m do tiu ng.
- Nhim trng nng, trc hoc sau phu thut, hoc chn thng nng.
- C tin s mn cm vi bt c thnh phn no ca thuc.
- i vi tiu ng type 1, khng dng Basen iu tr n c.
THN TRNG LC DNG
Tnh trng h ng huyt c th xy ra trong trng hp s dng chung vi cc thuc tr tiu
ng khc. Do , khi phi hp nn khi u vi Basen liu thp. V tc dng lm chm s
tiu ha v hp thu ng i (disaccharide) nn khi triu chng h ng huyt xy ra, cn
cho bnh nhn s dng glucose thay v sucrose. Ngoi ra, cn gii thch cho bnh nhn r cc
triu chng h ng huyt v bin php x l.
Nguyn tc chung :
- Ch dng cho bnh nhn c chn on xc nh.
- i vi bnh nhn tiu ng type 2 c iu tr bng tit ch n ung v vn ng, Basen
ch nn dng khi ng huyt o c 2 gi sau khi n >=200 mg/l.
- Trong thi gian iu tr vi Basen, cn theo di cn thn din bin cng nh quyt nh tip
tc iu tr.
- Sau 2 n 3 thng iu tr, nu khng kim sot c ng huyt 2 gi sau khi n <= 200
mg/l, cn thay i bin php iu tr thch hp hn.
- Nu kim sot c ng huyt 2 gi sau khi n mc <=160 mg/l v s kim sot ny c
th tip tc duy tr tt vi bin php tit thc, vn ng hoc vi mt loi thuc h ng
huyt dng ung hoc insulin, c th ngng s dng Basen v tip tc theo di sau .
Thn trng khi ch nh trong cc trng hp sau :
- C tin s phu thut m bng hoc tc rut.
- Bnh l{ ng rut mn tnh c km theo ri lon tiu ha hoc hp thu.
- Bnh nhn c triu chng tng nng do s sinh hi trong rut (chng hn nh thot v nng,
hp v lot rut gi).
- Ri lon chc nng gan, thn trm trng.

- Bnh nhn ln tui (xem thm phn S dng cho ngi ln tui).
S dng cho tr em :
Khng dng cho tr em v cha chng minh c tnh an ton trn tr em.
S dng cho ngi ln tui :
Do s suy gim chc nng ngi ln tui, cn thn trng khi u iu tr vi Basen liu
thp nh 0,1 mg mi ln. Cn theo di cn thn ng huyt v din tin cc triu chng v
tiu ha.
LC C THAI
Khng s dng cho ph n c thai hoc nghi ng c thai v cha chng minh c tnh an ton
cho bnh nhn.
LC NUI CON B
Thuc gy ra tc dng c ch tng cn sc vt s sinh trong thc nghim, c th do tc dng
c ch s tit sa v ngn hp thu carbohydrate th m. Do , khng nn dng cho ph n
ang nui con b.
TNG TC THUC
C th xy ra triu chng h ng huyt trong trng hp dng ng thi vi insulin.
C th xy ra triu chng h ng huyt khi dng phi hp vi cc dn cht sulfonylamide,
sulfonylurea hoc biguanide, hoc vi insulin, do cn iu tr khi u vi liu thp.
Cng nh cc loi thuc tiu ng khc, cn lu { khi s dng Basen chung vi cc thuc c
th lm tng hay gim tc dng h ng huyt nh cc thuc c ch bta, cc dn xut
salicylate, cc cht c ch monoamine oxidase.
TC DNG NGOI
Tiu ha : Trng bng, y hi t xy ra. Him gp triu chng ging tc rut do s sinh hi
trong rut. Nu cc triu chng ny xy ra, cn c bin php x l thch hp k c vic ngng
dng thuc. C th gp tiu chy, phn lng, si bng, au bng, to bn, chn n, bun nn
hay nn ma.
Qu mn : Him khi gp ni mn v nga. Ngng thuc khi xut hin cc triu chng ny.
Gan : C th c tng GOT, GPT, LDH, g-GTP hay alkaline-P.
Tm thn kinh : Nhc u him khi xy ra.
Phn ng khc : Tng kali huyt, tng amylase huyt thanh, gim HDL cholesterol nhng t gp.
LIU LNG v CCH DNG
Liu thng thng cho ngi ln : mi ln ung 1 vin 0,2 mg, 3 ln mi ngy ngay trc mi
ba n. Nu cha t tc dng mong mun, c th tng liu bng cch chuyn qua vin 0,3 mg,
mi ln ung 1 vin, 3 ln mi ngy.
BO QUN
Thuc c bo qun nhit phng (di 30oC).
Nn s dng cng sm cng tt sau khi m, d ang cn trong hn s dng.

55.

BCILAN

DB PHARMA
c/o GALIEN
Vin nn d b 250 mg : hp 40 vin.
Dung dch tim 250 mg/5 ml : ng 5 ml, hp 5 ng.
THNH PHN
cho 1 vin
Pyridoxine chlorhydrate 250 mg
ho 1 ng thuc tim 5
ml
Pyridoxine chlorhydrate 250 mg
DC LC
Vitamine B6.
DC NG HC
Pyridoxine c hp thu rut non v c phosphoryl ha thnh cc dn xut c hot tnh :
pyridoxine-phosphate, k l pyridoxal phosphate. Pyridoxine ch yu c tch tr gan,
sau c o thi qua nc tiu ch yu di dng cc cht chuyn ha.
Pyridoxine qua c nhau thai v sa m.
CH NH
- Dng vin : iu tr thiu vitamine B6.
- Dng tim : iu tr thiu vitamine B6, khi khng dng c dng ung.
CHNG CH NH
- Qu mn vi thnh phn ca thuc.
- L vodopa (xem Tng tc thuc).
CH PHNG v THN TRNG LC DNG
Trong thnh phn ca dung dch tim c cha sulfites, cht ny c th gy ra hoc lm nng
thm cc phn ng dng chong phn v.
LC C THAI v LC NUI CON B
Lc c thai :
Khng c nghin cu v tc ng gy qui thai ca pyridoxine trn ng vt. Trn lm sng, cho

n nay cha c trng hp no c ghi nht b d tt hay c phi do dng thuc, tuy nhin
khng th loi hn mi nguy c. Do thn trng, khng nn dng thuc ny trong thi gian mang
thai.
Lc nui con b :
Vitamine B6 qua c sa m, do trnh dng thuc trong thi gian cho con b.
TNG TC THUC
Chng ch nh phi hp :
- Lvodopa : c ch hot tnh ca lvodopa khi dng cht ny m khng km theo cht c ch
men dopadcarboxylase ngoi bin. Trnh dng phi hp vi pyridoxine m khng km theo
cht c ch dopadcarboxylase.
TC DNG NGOI
Mt s biu hin thn kinh, him gp v s khi khi ngng thuc, c th xy ra sau khi dng liu
cao hay ko di vitamine B6.
LIU LNG v CCH DNG
Dng cho ngi ln.
Dng vin :
1-4 vin/ngy, ung vi mt t nc.
Dng tim :
1-2 ng/ngy, tim IM hay IV.
BO QUN
Dng tim : Bo qun trnh nh sng.
Dng vin nn : Bo qun nhit di 25oC.

56.

BENADRYL

PFIZER
c/o ZUELLIG
Sir : chai 60 ml, thng 24 chai.
THNH PHN
cho 5 ml
Diphenhydramine
HCl

12,5 mg

Ammonium chlorure 125 mg

Sodium citrate

50 mg

DC LC
Diphenhydramine l thuc khng histamine, c tc dng c ch muscarinic v an thn. Ngoi
hiu lc trn cc triu chng d ng thng thng, thuc cng c s dng iu tr chng
ho do kch thch. Ngoi ra, diphenhydramine cn c tc dng lm gim bun nn, nn, chng
mt do say tu xe.
DC NG HC
Thuc c hp thu tt qua ng tiu ha. Thi im bt u tc dng sau khi ung thuc l
15 n 30 pht, v nng nh t c sau 2-4 gi. Khong thi gian tc dng t 4-6 gi.
Tc dng an thn cao nht t c trong khong 1-3 gi. Diphenhydramine c gn kt cao
vi protein. Thuc c phn phi rng trong m v dch c th. Thuc qua c nhau thai v
c bi tit qua sa m.
Diphenhydramine c chuyn ha gan, to thnh diphenylmethoxyacetic acid, sau
chuyn thnh dng lin hp, ngoi ra cn to thm mt s dng chuyn ha khc. Thi gian
bn hy trong huyt tng l 2-8 gi. Hu ht phn thuc cha chuyn ha v cc sn phm
chuyn ha c bi tit qua thn trong vng 24-48 gi khi dng mt liu.
CH NH
iu tr dt cn ho, chng ph n ht hi do nhng kch thch nh hng v ph qun trong
nhng trng hp d ng, cm lnh, vim ph qun hoc ht phi nhng cht kch thch ; Vim
mi d ng ; Nga, ni m ay ; Mt ng ; Say tu xe ; Chng mt.
CHNG CH NH
D ng vi cc thnh phn ca thuc.
THN TRNG LC DNG
Cn thn v thuc c cha 5% cn.
Ngi ang li xe hay iu khin my mc cn thn trng khi s dng do thuc c th gy ngy
ngt.
Trnh ung ru khi dng thuc.
Thn trng khi ch nh cho tr em di 2 tui.
TNG TC THUC
Thn trng khi phi hp vi cc thuc tc dng ln h thn kinh trung ng nh dn xut
phenothiazine, benzodiazepine, IMAO, thuc chng trm cm 3 vng.
LIU LNG v CCH DNG
Ngi ln : 25-50 mg (2-4 mung c ph), ung mi 4-6 gi.

Tr em : 1,25 mg/kg, ung mi 4-6 gi. Khng qu 300 mg / ngy. C th nh sau :

Tr di 10 kg cn nng : 1/2-1 mung c ph, ung mi 4-6 gi.
Tr trn 10 kg cn nng : 1-2 mung c ph, ung mi 4-6 gi.

57.

BENALAPRIL 5

BERLIN CHEMIE
c/o CT TNHH DP THNH - SAIGON PHARMA
Vin nn 5 mg : v 10 vin, hp 3 v.
THNH PHN
cho 1 vin
Enalapril
maleate

5 mg

CH NH
- Tng huyt p.
- Suy tim - dng ng thi vi cc thuc li tiu, v dng thm nhng thuc lm tng cung
lng tim (digitalis), c bit l trong nhng trng hp suy tim nng.
CHNG CH NH
Qu mn cm vi enalapril, ph cc m (chng ph thn kinh mch, ging nh khi iu tr bng
mt s thuc khc cng trong nhm c ch men chuyn). Hp ng mch thn (2 bn hoc 1
bn trn ngi c 1 thn duy nht). Sau ghi ghp thn, hp cc van tim hoc c nhng tc
nghn s lu thng mu tm tht tri ca tim (v d : bnh ph i c tim). Tng aldosteron
nguyn pht hoc ri lon cc chc nng gan, khi mang thai, thi kz cho con b, tr em.
Dextran sulfate tuyt i khng c dng cng lc khi ang thay mu bnh nhn ang s
dng cc thuc c ch men chuyn, bi v nhng phn ng qu mn cm c th xy ra e da
tnh mng.
Nhng phn ng phn v (nhng phn ng qu mn cm trong mt giai on ca chong) c
th xy ra nu Benalapril 5 c s dng cng lc trong khi iu tr lc thn nhn to bng
nhng mng lc loi polyacrylnitril ethyl sulfonate lung chy cao.
V vy s kt hp ny tuyt i nn trnh, hoc l s dng nhng thuc khc (khng thuc
nhm thuc c ch men chuyn) iu tr tng huyt p hoc suy tim, hoc l s dng nhng

loi mng lc khc cho vic lc thn nhn to.

TNG TC THUC
Nhng tc dng v tc dng ph ca thuc c th nh hng v b nh hng bi nhng thuc
khc. Mt s tng tc thuc c bit gia enalapril v nhng thuc khc nh nhng thuc
tng v h huyt p, thuc gim au v bnh khp, thuc gy m, thuc trm cm, thuc ung
th v nhng thuc tr bnh tiu ng. Khng nn ung ru khi ang s dng thuc.
TC DNG NGOI
Benalapril 5 ni chung khng c tc dng ph.
Thnh thong, c bit l trong thi gian u iu tr vi Benalapril 5, hoc cc bnh nhn b
mt mui v nc (v d : trc iu tr bng cc loi thuc li tiu), suy tim, tng huyt p
trm trng (hoc tng huyt p do bnh thn), huyt p gim qu nhiu (huyt p thp, h
huyt p t th) vi cc triu chng nh chng mt, yu v ri lon th lc c th xy ra.
i khi xy ra ho v kh da, cc phn ng da d ng nh ni ban v nga.
Trong s t cc trng hp c bit, ph m thanh qun, vim hng v/hoc li v chn tay
(ph thn kinh mch) c th xut hin.
LIU LNG v CCH DNG
Liu thuc Benalapril 5 cho mi bnh nhn c chia ra da theo huyt p v vic k toa c th
theo s hng dn sau :
Tng huyt p :
Liu thuc ban u thng dng l 5 mg vo bui sng. Nu nh liu thuc khng a
huyt p v c mc bnh thng th c th tng liu ln thnh 10 mg (2 vin Benalapril 5).
Khng nn tng liu cho n khi s dng thuc c 3 tun.
Suy tim :
Benalapril 5 c th c s dng nh l 1 loi thuc dng thm vo cho vic iu tr cng vi
thuc li tiu v cc thuc lm tng cung lng tim. Liu bt u l 2,5 mg vo bui sng (na
vin Benalapril 5). Vic tng liu c th thc hin mt cch t t ty thuc vo p ng ca
tng bnh nhn i vi vic iu tr. Liu duy tr thng l 5-10 mg/ngy (1-2 vin Benalapril 5).
Liu ti a khng nn vt qu 20 mg/ngy (4 vin Benalapril 5).
Khi chc nng thn b gim khng nhiu ( thanh thi creatinine 30-60 ml/pht hay nng
creatinine trong huyt thanh cao hn 1,2 mg/dl v thp hn 1,8 mg/dl) v vi nhng bnh nhn
ln tui (trn 65 tui) :
Liu bt u l 2,5 mg vo bui sng (na vin Benalapril 5), liu duy tr thng l 5-10
mg/ngy (1-2 vin Benalapril 5). Liu ti a khng nn vt qu 20 mg/ngy (4 vin Benalapril
5).
Khi ri lon chc nng thn trm trng ( thanh thi creatinine di 30 ml/pht v lc thn
nhn to) :

Liu bt u l 2,5 mg vo bui sng (na vin Benalapril 5), liu duy tr thng l 5 mg/ngy (1
vin Benalapril 5). Liu ti a khng nn vt qu 10 mg/ngy (2 vin Benalapril 5).

58.

BERLAMIN MODULAR

BERLIN CHEMIE
Bt pha dung dch ung : gi 360 g.
THNH PHN
cho 100 g bt
Nng lng

450 kcal (1907

KJ)

Protein

17,0 g

Carbohydrates

61,2 g

Glucose

1,7 g

Lactose

0,02 g

Maltose

9,2 g

Dextrines

50,3 g

Cht bo

15,2 g

Acid bo bo ha

3,1 g

Acid bo thit yu (tnh theo acid

linoleic)

8,8 g

Khong cht

2,3 g

Sodium

350 mg

Potassium

630 mg

Calcium

219 mg

Phosphorus

148 mg

Magnesium

59 mg

Chloride

428 mg

Iron

3,3 mg

Zinc

2,9 mg

Copper

0,5 mg

Iodine

45 mg

Chromium

9,9 mg

Fluoride

0,32 mg

Manganese

0,81 mg

Molybdenum

32 mg

Vitamin A

0,2 mg (677 IU)

Vitamin D

2,2 mg (881 IU)

Vitamin E

2,7 mg (3 IU)

Vitamin K1

13,5 mg

Vitamin B1

0,2 mg

Vitamin B2

0,45 mg

Vitamin B6

0,41 mg

Vitamin B12

0,9 mg

Vitamin C

18 mg

Niacin

4,1 mg

Pantothenic acid

2,3 mg

Folic acid

0,05 mg

Biotin

27 mg

thm thu

300 mOsm/l

CH NH
- Dinh dng hon ton qua ng thng cho cc trng hp : hn m, a chn thng, phng
nng, chn n do tm l{, ung th, HIV...
- Dinh dng b sung cho tr ang tng trng, ph n ang mang thai, ngi gi, bnh nhn
giai on phc hi.
CHNG CH NH
D ng vi cc thnh phn ca Berlamin.
LIU LNG v CCH DNG
- Dung dch pha chun : 225 g Berlamin ha tan trong 850 ml nc c 1000 ml dung dch
Berlamin cung cp 1000 kcal.
- Liu dng : theo ng ch nh ca Bc s, thng thng vi phng php nh git lin tc qua
ng thng nn bt u vi liu thp, sau tng dn theo nhu cu :
Ngy

ml dd Berlamin/gi

ml dd Berlamin/20 gi

25

500

50

1.000

75

1.500

100

2.000

59.

BERLTHYROX (L-THYROXINE)

c/o CT TNHH DP THNH - SAIGON PHARMA

Vin nn 100 mg : hp 50 vin v 100 vin - Bng B.
THNH PHN

cho 1 vin
Lvothyroxine
sodium

100 mg

(Lactose)

DC LC
Thuc c hot cht chnh l thyroxine dng ng phn L. y l mt dng ng phn t
nhin, ng thi c hot tnh cao hn dng ng phn DL l dng hay thng c s dng.
Dng lvothyroxine s cho cc tc ng :
- tng tiu th oxy m.
- tng chuyn ha c bn.
- tng nhp tim.
DC NG HC
L vothyroxine c hp thu nhanh qua ng tiu ha v vo mu ton b, mt phn ln lin
kt vi protine huyt tng. Phn on khng lin kt l phn on thc s gy tc ng iu
tr. Lvothyroxine c thi gian bn hy sinh hc khong 7 gi.
L vothyroxine khng qua c nhau thai.
CH NH
- Dng iu tr thay th trong cc trng hp thiu hormone gip trng cc bnh nhn suy
tuyn gip (suy gip tin pht hoc th pht, sau phu thut ct b bu, hoc trong cc
trng hp iu tr bng iode ng v phng x).
- Ngn nga s ph i tr li ca tuyn gip sau phu thut ct b bu gip (ngn nga bu
gip ti pht) mc d thy chc nng tuyn gip l bnh thng.
- iu tr bnh Goitre nh trong cc trng hp chc nng tuyn gip bnh thng.
- iu tr h tr trong cc iu tr cng gip vi cc thuc khng gip tng hp sau khi tnh
trng chuyn ha c iu chnh v mc bnh thng.
- Trong cc trng hp bu gip c tnh, nht l sau phu thut, dng L-thyroxine ngn
chn bu ti pht v iu tr thay th trong cc trng hp thiu hormone tuyn gip.
CHNG CH NH
Tuyt i :
- Cng gip khng c iu tr bng thuc khng gip tng hp.
- Sau nhi mu c tim, au tht ngc hay nhi mu c tim bnh nhn ln tui c bu gip,
trong nhng trng hp vim c tim v nhng ri lon chc nng v thng thn cha c
iu tr.

Tng i :
- Suy mch vnh.
- Lon nhp tim.
CH PHNG
- Khng ch nh trong chng bo ph khng do thiu nng tuyn gip. Liu thp khng c tc
dng v liu qu cao th nguy him, nht l khi kt hp vi cc cht loi amphtamine (gy chn
n).
- Hot tnh ca lvothyroxine (L-T4) cng nh cc du hiu khng dung np thuc c th c v
ch xut hin sau mt giai on t 15 ngy n 1 thng.
THN TRNG LC DNG
- Trong trng hp c tin s bnh tim mch, phi cho o in tm .
- Theo di cht ch trong trng hp ri lon mch vnh hoc lon nhp tim.
- Cn thn khi dng trong trng hp cao huyt p, suy v thng thn, tnh trng chn n km
suy dinh dng, lao.
- bnh nhn tiu ng, do hormone tuyn gip c th gy tng ng huyt, nn cn iu
chnh liu thuc h ng huyt.
- bnh nhn ln tui, vic kim tra tim mch l rt cn thit.
LC C THAI v LC NUI CON B
Thi kz c thai v cho con b phi cung cp mt lng lvothyroxine thch hp v nn c
iu tr lin tc. Tuy nhin, trong sut thai kz, lvothyroxine khng nn cho km theo vi cc
thuc khng gip (nhng thuc dng iu tr cng gip) v nu dng chung th phi tng
liu thuc khng gip ln. Khc vi lvothyroxine, cc thuc khng gip i qua c hng ro
nhau thai v c th gy suy gip bo thai.
TNG TC THUC
Lin quan n hormone tuyn gip :
Thn trng khi phi hp :
- Thuc ung chng ng mu : tng tc dng chng ng mu v nguy c xut huyt (do lm
tng s chuyn ha ca cc yu t ca phc hp prothrombine). Nn kim tra thng hn
nng prothrombine v theo di ch s INR. iu chnh liu ca thuc ung chng ng mu
khi bt u iu tr thiu nng tuyn gip hoc khi c qu liu hormone tuyn gip.
- Colestyramine : gim tc ng ca hormone tuyn gip (do gim s hp thu qua rut). Dng
cc thuc ny cch xa nhau, ti thiu 2 gi nu c th.
- Cc thuc gy cm ng men : ph nytoine, rifampicine v carbamaz pine : nguy c gy thiu
nng tuyn gip lm sng khi c phi hp do lm tng s chuyn ha ca T3 v T4. Theo di
nng ca T3 v T4 trong huyt thanh v nu cn, iu chnh liu ca hormone tuyn gip
trong thi gian iu tr phi hp vi thuc gy cm ng men v sau khi ngng iu tr bng
thuc ny.

Lin quan n thyroxine :

Thn trng khi phi hp :
- Mui st (ng ung) : gim hp thu thyroxine v gy h thyroxine huyt. Dng cc thuc
ny cch xa nhau, ti thiu 2 gi nu c th.
TC DNG NGOI
- Lm nng thm bnh l tim c sn.
- Du hiu cng gip : nh trng ngc, lon nhp tim, run tay, hi hp, mt ng, v m hi,
st cn, tiu chy ; khi xut hin cc du hiu ny phi ngng iu tr vi ngy ri bt u li vi
liu thp hn.
- C kh nng tng calci niu tr cn b v tr em.
LIU LNG v CCH DNG
Thiu nng tuyn gip :
- Ngi ln : liu khi u 25-100 mg lvothyroxine sodium/ngy, liu duy tr 125-250 mg
lvothyroxine sodium/ngy.
- Tr em : liu khi u 12,5-50 mg lvothyroxine sodium/ngy, liu duy tr thay i theo cn
nng, 100-150 mg lvothyroxine sodium/m2 b mt da/ngy.
D phng ti pht bnh Goitre : 75-200 mg lvothyroxine sodium/ngy.
H tr trong iu tr cng vi cc ch phm tuyn gip khc : 50-100 mg lvothyroxine
sodium/ngy.
iu tr sau phu thut tuyn gip do bu c tnh : 150-300 mg lvothyroxine sodium/ngy.
Ghi ch :
- i vi ph n c thai, khng iu chnh liu trong thi gian mang thai.
- Thiu nng tuyn gip trong a s trng hp l mt bnh l{ vnh vin, do vic iu tr mt
s trng hp cn phi c duy tr sut i.
QU LIU
Nu c du hiu ng c cp tnh, cn gim ng k liu ang s dng, thm ch ngng iu tr
trong vi ngy, v sau dng li vi liu thp.
X l : thuc an thn, thuc chn bta.

60.

BETAGAN

ALLERGAN
Thuc nh mt 0,5 % : l 5 ml.
THNH PHN

cho 100 ml
Levobunolol
chlorhydrate

0,5 g

DC LC
Levobunolol l tc nhn c ch th th bta khng chc lc trn tim. Tc ng mnh nh nhau
trn c 2 th th bta 1 v bta 2. Levobunolol c tc ng c ch th th bta mnh gp 60
ln so vi ng phn dextro. ng phn l vo, levobunolol, c dng t c hiu lc c
ch bta cao nht m khng lm gia tng nh hng trc tip n suy gim c tim. Levobunolol
khng c tc ng gy t ti ch ng k (n nh mng), khng c tc ng ging thn kinh
giao cm ni ti.
Betagan (levobunolol chlorhydrate 0,5%) c hiu qu tng t Timolol trong h nhn p. Khi
nh Betagan vo mt s lm h nhn p n mc bnh thng cho d bnh c km hay khng
km glaucome. p lc ni nhn cao l nhn t nguy him chnh trong sinh bnh hc ca vic
mt th trng do glaucome. p lc ni nhn cng cao cng c nhiu kh nng lm tn thng
dy thn kinh mt v lm mt th trng.
C ch chnh xc v tc ng ca levobunolol trong vic h nhn p cha c bit. Tc ng
h nhn p ca Betagan c t hoc khng c nh hng ln kch thc ng t, ngc li vi
tc ng lm co ng t do cc tc nhn tit choline gy ra. Chng m mt v qung g thng
hay xy ra ng thi khi dng nhng tc nhn co ng t s khng xut hin khi dng Betagan.
Bnh nhn b c thy tinh th khng c kh nng nhn xung quanh th thy tinh c do s co
ng t.
DC NG HC
Tc ng khi u ca 1 git Betagan c th c nhn thy trong vng 1 gi sau khi nh mt,
hiu lc ti a c thy trong vng 2 - 6 gi. Tc ng h nhn p ng k c th c duy tr
n 24 gi sau khi nh 1 liu duy nht.
Trong cc nghin cu lm sng c kim sot c thi gian k o di trn 1 nm, levobunolol
0,5% c hiu qu h nhn p trn 88% bnh nhn c nh thuc 2 ln/ngy. Levobunolol lm
h nhn p khong t 5,93 - 9,01 mm Hg sau mi ln dng. Khng thy c tc ng r rng trn
kch thc ng t, s to nc mt hay mn cm ca gic mc. cc nng th nghim ca
levobunolol v timolol dng ng ti ch, c hai u lm gim nhp tim v h huyt p.
CH NH
Betagan c dng kim sot nhn p trong bnh glaucome gc m mn tnh v bnh tng
nhn p.
CHNG CH NH
Chng ch nh bnh nhn b nghn tc phi mn tnh trm trng, co tht ph qun, hen ph

qun v suy tim sung huyt khng kim sot c.

Chng ch nh i vi nhng bnh nhn nhy cm vi bt kz thnh phn no ca thuc.
CH PHNG
Nh cc thuc dng ng ti ch trong nhn khoa khc, Betagan c kh nng c hp thu
trn ton c th.
THN TRNG LC DNG
Nn thn trng nhng bnh nhn b chng ch nh vi cht c ch th th bta dng ng
ton thn bao gm nhp tim chm tht thng, chn tim nng hn 1. Nn kim sot cht
ch trng hp suy tim sung huyt trc khi bt u tr liu vi Betagan. Nn theo di bnh
nhn c tin s bnh tim, nhp mch.
Nn dng thn trng Betagan cc bnh nhn mn cm vi cc thuc c ch th th bta
khc.
Thn trng khi dng cho bnh nhn suy yu chc nng phi.
Tnh an ton v hiu qu ca Betagan trn tr em cha c chng minh.
LC C THAI v LC NUI CON B
Khng c cc th nghim c theo di cht ch v thch hp trn thai ph. Ch dng Betagan
cho thai ph trong trng hp li ch ca vic iu tr ln hn nguy c trn thai nhi.
Betagan cha c bit c bi tit qua sa m hay khng. Cc tc nhn c ch th th bta c
tc ng ton thn v timolol maleate c tc ng cc b c bi tit qua sa m. Do cc
thuc c tc ng tng t c bi tit qua sa m, nn thn trng khi dng Betagan ph
n cho con b.
TNG TC THUC
Betagan c th lm tng tc ng ca cc thuc h p tc dng ton thn. Hiu lc ny gm h
huyt p, bao gm h huyt p th ng, tim p chm, chng mt, v/hoc ngt xu. Ngc
li, cc tc nhn c ch th th bta c tc ng ton thn c th c kh nng gy h nhn p
ca Betagan.
TC DNG NGOI
i khi c vim kt mc m, gim nhp tim v h huyt p khi dng Betagan. t khi gp ni m
ay do dng Betagan. Cc tc dng ngoi { sau c ghi nhn l him gp v cha c xc
nh c mi lin h khi dng Betagan : thay i nhp tim, nhc u, chng mt, nng mt, au
nhc v nga ngy.
LIU LNG v CCH DNG
Nh 1 git vo mt bnh 2 ln/ngy.

61.

BETNOVATE CREAM

GLAXOWELLCOME
Kem bi da : ng 5 g, 15 g, 100 g.
THNH PHN
Kem bi da Betnovate :
cho 100 g kem
Betamethasone valerate

0,1 g

Kem bi da Betnovate-N :
cho 100 g kem
Betamethasone valerate

0,1 g

Neomycin sulphate , tng ng vi neomycin

0,35 g
base
(3500 n v trong 1 gram)
Kem bi da Betnovate-C
cho 100 g kem
Betamethasone
valerate

0,1 g

Clioquinol

3g

TNH CHT
Betamethasone valerate l mt corticoid tc dng ti ch mnh ; thuc c hiu qu p ng
nhanh trong cc dng vim da m thng thng c p ng tt vi cch iu tr bng corticoid
bi da, v thng c hiu qu trong bnh da k m p ng hn nh vy nn.
Neomycin sulphate l mt loi khng sinh dit khun ph rng tc dng trn phn ln cc vi
khun thng gp trong cc nhim trng da.
Clioquinol l hot cht va c tc dng khng khun va c tc dng khng nm.
CH NH
Kem bi da Betnovate :
Betnovate c ch nh iu tr :
Chm, k c chm d ng, chm tr em, v chm hnh a ; sn nga ni cc ; vy nn (ngoi
tr vy nn dng mng lan rng) ; cc bnh da do thn kinh, k c liken n ; liken phng ; vim

da tit b nhn ; cc phn ng d ng da do tip xc : Lupus ban hnh da.

Betnovate cream cn c th s dng iu tr ph tr cho liu php iu tr bng corticoid
ng ton thn trong bnh da ton thn.
Kem bi da Betnovate-N :
Betnovate-N c ch nh iu tr cc bnh da sau y khi c hin din hoc nghi ng c
nhim khun th pht : chm, k c chm d ng, chm tr em, v chm hnh a ; sn nga
ni cc ; vy nn (ngoi tr vy nn dng mng lan rng) ; cc bnh da do thn kinh, k c liken
n ; liken phng ; vim da tit b nhn ; hm vng hu mn v sinh dc ; cc phn ng da d
ng do tip xc ; Lupus ban hnh da ; vt cn trng t bi nhim ; vim tai ngoi (xem
Chng ch nh).
Kem bi da Betnovate-C :
Betnovate-C c ch nh cc bnh da sau y khi c hin din hoc nghi ng c nhim th
pht vi khun hoc vi nm : Chm k c chm d ng, chm tr em, v chm hnh da ; sn
nga ni cc ; vy nn (ngoi tr vy nn dng mng lan rng) ; cc bnh da do thn kinh, k c
liken n, liken phng ; vim da tit b nhn ; hm vng hu mn v sinh dc ; cc phn ng d
ng da do tip xc ; phn ng do cn trng t ; vim tai ngoi (xem phn Chng ch nh).
CHNG CH NH
Qu mn i vi thuc.
Mn trng c , mn trng c thng, v vim da quanh ming. Nhim virt da nguyn pht
(v d : herpes simplex, thy u).
Cc dng Betnovate dng ngoi da khng c ch nh iu tr cc sang thng da nhim
trng nguyn pht gy ra bi vi nm (v d nh : nhim nm candida, cc dng tinea) hoc
nhim vi khun (v d nh bnh chc) ; bnh da tr em di mt tui, k c vim da thng
v hm do t lt.
Cc dng ch phm cha neomycin (Betnovate-N) khng c s dng iu tr vim tai
ngoi khi mng nh b thng, v s c nguy c nhim c tai.
THN TRNG LC DNG
Nn trnh iu tr lin tc di ngy vi cc dng Betnovate nu c th trnh c, nht l i
vi tr em, v c th xy ra tnh trng c ch thng thn, ngay c khi khng bng kn vng da
c bi thuc.
Vng mt d b teo da hn cc vng da khc trn c th khi iu tr ko di bng cc corticoid
tc dng ti ch mnh. Cn ghi nh iu ny khi iu tr cc bnh da nh vy nn, lupus ban
hnh da v chm nng. Khi bi thuc ln vng da quanh mt, cn phi thn trng khng
thuc ri vo mt, v c th gy glcm.
Cc corticoid tc dng ti ch c th c nguy c gy hi khi c dng iu tr vy nn v mt s
nguyn nhn, bao gm ti pht ny ngc, kh nng ln thuc, nguy c gy vy nn dng mn
m ton thn, v kh nng gy c ti ch hoc ton thn do chc nng hng ro bo v ca da

 b h hi. Khi dng corticoid bi da iu tr vy nn, cn phi theo di cn thn tnh trng
bnh nhn.
Khng nn iu tr thuc lin tc qu 7 ngy m khng c du hiu ci thin lm sng, bi v s
lan rng tim n ca nhim trng c th xy ra do tc dng che du nhim trng ca corticoid.
Nu tnh trng nhim khun k o di, nn iu tr khng sinh ng ton thn. Khi c du hiu
nhim trng lan rng, cn thit phi ngng s dng corticoid ngoi da v cn phi iu tr
khng sinh ng ton thn. Khi bng kn vng da c bi thuc, da tr nn m v m s to
iu kin cho nhim khun pht trin, v vy cn phi ra sch vng da trc khi bi thuc v
t bng sch ln trn.
Bi thuc Betnovate-N trn din tch da rng ln ngi ln tui hoc bnh nhn suy thn
c th c nguy c nhim c tai.
Cc sn phm c cha cht khng khun hoc khng sinh (Betnovate-C hoc Betnovate-N)
khng nn pha long.
LC C THAI
Cc corticoid tc dng ti ch khi c s dng trn cc ng vt c thai c th gy ra cc d
dng trong qu trnh pht trin thai. S lin quan gia kt qu thc nghim trn ng vt ny
v thc t trn ngi cha c xc lp ; tuy nhin, khng c s dng cc corticoid bi da
trong thai kz mt cch rng ri, c ngha l vi mt lng ln hoc trong thi gian di.
TC DNG NGOI
iu tr ko di vi liu cao corticoid tc dng mnh c th gy teo da ti ch nh cc vt nt
da, mng da, dn cc mch mu b mt, c bit l khi iu tr c bng kn, hoc trn vng np
gp da.
Cng nh cc corticoid tc dng ti ch khc, khi c s dng vi mt lng ln ko di hoc
c iu tr trn mt din tch da rng ln, thuc c th c hp th ton thn vi mt
lng gy nn cc biu hin ca tnh trng cng v thng thn. Tc dng ny d xy ra
hn tr nh nhi v tr em, v trong cch iu tr thuc c bng kn. tr nh nhi, t lt c th
c tc dng nh khi bng kn vng da c bi thuc.
Trong vi trng hp t gp, iu tr (hoc ngng iu tr) bnh vy nn bng corticoid c
cho l khi pht dng mn m ca bnh.
Nu c du hiu qu mn, nn ngng dng thuc ngay.
Nn la chn loi corticoid nh nht kim sot c bnh.
Cc dng kem bi da Betnovate, Betnovate-N, Betnovate-C khng cha parabens hoc lanolin.
LIU LNG v CCH DNG
Bi mt lng nh thuc ln vng da bnh hai ln hoc ba ln mi ngy cho n khi c ci thin
bnh. Sau , c th tip tc ci thin bnh bng cch bi thuc ch mt ln mi ngy, hoc
thm ch t ln hn.
Dng kem bi da c bit thch hp cho cc b mt da m t hoc rn nc.

i vi cc sang thng kh iu tr hn, chng hn nh mng da dy b vy nn ci ch v

u gi, hiu qu ca thuc c th c tng cng, nu xt thy cn thit, bng cch bng kn
vng da c bi thuc bng mng film polythene. Thng ch cn bng qua m l mang
li p ng mong mun trn nhng sang thng nh vy ; sau , bi thuc u n m khng
cn phi bng kn, thng thng bnh vn c th tip tc c ci thin.
Lu { : Betnovate-C c th li vt trn da, tc v vi, v vy cn ph bng ming gc khi
bn qun o.
QU LIU
Tnh trng qu liu cp tnh rt t khi xy ra, tuy nhin, trong trng hp qu liu mn tnh hoc
s dng sai, cc biu hin cng v thng thn c th xy ra v trong trng hp ny cn
phi ngng ngay thuc corticoid bi da.

62.

BETOPTIC S 0,25%

ALCON
huyn dch nh mt 0,25% : l 5 ml - Bng B.
THNH PHN
cho 1 ml
Betaxolol hydrochloride

2,8 mg

ng vi : Betaxolol

2,5 mg

Cht bo qun : benzalkonium chloride

0,01%.
T dc : mannitol, poly (styrene-divinyl
benzene) sulfonic acid, carbomer 934P,
edetate disodium, hydrochloride acid hay
sodium hydroxide ( iu chnh pH) v
nc tinh khit.
DC L LM SNG
Betaxolol HCl cht phong ta th th (bta-1-adrenergic) chn lc tim, khng c hot tnh n
nh mng ng k (v cm ti ch) v bn thn khng c tc dng hng giao cm. Nhn p

cao l mt yu t nguy c chnh trong vic mt th trng do glaucome. Nhn p tng cng cao,
kh nng tn thng th thn kinh v mt th trng cng ln.
Betaxolol c tc dng lm gim nhn p cao cng nh nhn p bnh thng v c ch tc dng
lm h nhn p dng nh do gim sn xut thy dch. iu ny c chng minh bng
nhn p k{ v phng php o long fluorescein trong thy dch. Ni chung betaxolol bt
u c tc dng trong vng 30 pht v hiu qu ti a thng c pht hin 2 gi sau khi
dng thuc ti ch. Dng liu duy nht lm gim nhn p trong 12 gi. Trong nhng nghin cu
m i c i chng, mc v thi gian tc dng h nhn p ca huyn dch nh mt
Betoptic S 0,25% v ca dung dch nh mt Betoptic 0,5% tng ng nhau v mt lm sng.
Huyn dch Betoptic S d chu hn ng k so vi dung dch Betoptic. Dung dch betaxolol nh
mt nng 1% (mt git nh mt) khng c tc dng no ng k ln chc nng phi theo
kt qu o FEV1, FVC, t s FEV1/FVC. Khng thy c bng chng no v tc dng chn btaadrenergic trn h tim mch ca thuc betaxolol. D liu thu c t nhng th nghim lm
sng c i chng nhng bnh nhn b glaucome gc m mn tnh v nhn p cao cho thy
rng so vi iu tr bng timolol, mt cht chn bta khng chn lc, th iu tr betaxolol c li
hn v lu di i vi th trng. Hn na, trong khi iu tr bng betaxolol, khng thy c tc
dng xu no i vi vic cp mu cho thn kinh th gic. ng hn l betaxolol duy tr hay ci
thin dng mu/ti mu cho mt.
AN TON TIN LM SNG
Thuc nh mt Betoptic S c hot cht chnh l betaxolol hydrochloride, cht phong ta th th
bta-adrenergic chn lc tim c ha tan trong mt ch phm huyn dch resin v trng.
Hot tnh gin mch ngoi vi ca betaxolol c chng minh trong mt nghin cu in vivo
ch, trong khi nhng tc dng gin mch v c ch knh calcium ca betaxolol c ch ra
trong mt s nghin cu in vivo bng cch s dng cc mch mu mt v ngoi mt trong cc
m hnh nghin cu chut, chut lang, th, ch, ln v b.
Tc dng bo v thn kinh ca betaxolol cng c chng minh trong cc th nghim in vivo
cng nh in vitro vng mc th, mi trng nui v no chut v nui vng mc g con.
Kh nng sinh ung th, t bin gen, suy gim kh nng sinh sn : Betaxolol HCl cho thy khng
c tc dng gy ung th.
CH NH
Huyn dch Betoptic S t ra c hiu qu trong vic h thp nhn p v c th s dng cho
nhng bnh nhn b glaucome gc m mn tnh v nhn p cao. Thuc ny c th c s
dng mt mnh hay kt hp vi cc thuc h nhn p khc.
CHNG CH NH
Qu mn vi bt kz thnh phn no ca thuc. Huyn dch Betoptic S 0,25% chng ch nh
dng cho nhng bnh nhn b nhp chm xoang, nhiu hn bloc nh tht mt, sc tim hay
nhng bnh nhn c suy tim r.

CH PHNG
Nn thn trng khi s dng thuc nhng bnh nhn c bnh s suy tim hay bloc tim. Nn
ngng iu tr bng huyn dch Betoptic S 0,25% ngay khi c du hiu u tin ca suy tim.
THN TRNG LC DNG
Tng qut :
i tho ng : cc thuc c ch th th bta-adrenergic c th che lp cc du hiu v triu
chng h ng huyt cp tnh.
Nhim c gip (thyrotoxicosis) : cc thuc chn bta-adrenergic c th che lp mt s du
hiu lm sng (v d nhp tim nhanh) ca chng cng gip.
Yu c : c ch bta-adrenergic c bo co c tc dng lm yu c ging nh mt s
triu chng ca bnh nhc c.
Phu thut ln : nn ch { ngng thuc chn bta-adrenergic t t trc khi gy m.
i vi phi : nn thn trng trong iu tr nhng bnh nhn glaucome c hn ch nhiu v
chc nng h hp.
Thng tin cho bnh nhn :
Khng chm u ng thuc nh mt vo bt kz vt g c th lm nhim bn thuc. Khng s
dng thuc khi c mang knh st trng (contact lenses).
S dng trong nhi khoa :
Cha xc nh c tnh an ton v hiu qu ca thuc i vi tr em.
LC C THAI
Cha c nhng nghin cu y v c i chng tt ph n mang thai. Ch nn dng
Betoptic S trong thi kz thai nghn nu xt thy c li nhiu hn so vi cc nguy c c th i
vi thai.
LC NUI CON B
Do khng bit liu betaxolol HCl c c bi tit qua sa ngi hay khng, nn thn trng khi
s dng huyn dch nh mt Betoptic S 0,25% cho ph n ang cho con b.
TNG TC THUC
Nn theo di nhng bnh nhn va dng chn bta-adrenergic ng ung va nh huyn
dch nh mt Betoptic S 0,25% pht hin tc dng b sung c th c ca hai thuc ln nhn
p hay cc tc dng ln ton thn ca hin tng chn bta. Nn theo di st bnh nhn khi
dng thuc chn bta cho nhng bnh nhn ang dng thuc hy catecholamine nh
reserpine bi v c kh nng c tc dng b sung ca hai thuc v gy h huyt p v/hay chm
nhp tim.
Mt : nhng bnh b glaucome gc ng, mc tiu iu tr tc thi l m li gc bng cch
gy co ng t vi thuc co ng t. Betaxolol t hay hay khng c tc dng ln ng t. Khi
huyn dch nh mt Betoptic S c s dng lm h nhn p trong glaucome gc ng, nn
dng phi hp vi mt thuc lm co ng t ch khng nn s dng mt mnh.

TC DNG NGOI
Mt : Trong cc th nghim lm sng, hin tng thng xy ra nht khi dng huyn dch nh
mt Betoptic S 0,25% l kh chu tm thi mt. Sau y l mt s tnh trng khc c bo
co mt s nh bnh nhn : nhn m, vim gic mc dng chm, cm gic xn mt, chy
nc mt, nga, kh mt, mt, vim, xut tit, au mt, gim th lc v cng mi mt.
Ton thn : Cc phn ng ton thn sau khi dng huyn dch nh mt Betoptic S 0,25% hay
dung dch nh mt Betoptic 0,5% him khi c bo co.
LIU LNG v CCH DNG
Lc k trc khi s dng.
Liu ngh l nh mt hay hai git huyn dch nh mt Betoptic S 0,25% vo mt b bnh hai
ln mi ngy. mt s bnh nhn, phi cn vi tun p ng h nhn p mi n nh. Cng
nh bt kz loi thuc mi no, ngi ta khuyn theo di bnh nhn cn thn. Nu iu tr nh
trn m nhn p bnh nhn vn khng c khng ch mt cch y , c th iu tr phi
hp vi pilocarpine v cc thuc co ng t khc v/hay dng epinephrine v/hay thuc c ch
carbonic anhydrase,
QU LIU
Cha c thng tin no v hin tng qu liu thuc ngi. Khi nh ti ch qu liu lng
thuc huyn dch nh mt Betoptic S 0,25% c th ra bng dng nc m.
BO QUN
Gi thuc nhit phng. thuc trnh xa tm tay tr em. B khng s dng na sau khi
m l thuc mt thng.

63.

BVITINE

BVITINEDB PHARMA
c/o GALIEN
vin nn 250 mg : hp 20 vin.
dung dch tim 100 mg/2 ml : ng 2 ml, hp 5 ng.
THNH PHN
cho 1 vin

Thiamine chlorhydrate

250 mg

cho 1 ng thuc tim 2 ml

Thiamine chlorhydrate

100 mg

DC LC
Vitamine B1
DC NG HC
Thiamine c hp thu rut non v c khuch tn vo tt c cc m. N khng b tch t
ngay c khi dng liu rt cao. Thuc c o thi qua nc tiu di dng cc cht chuyn
ha.Thiamine qua c sa m.
CH NH
Dng ung :
- iu tr thiu vitamine B1 : bnh Bribri.
- Bnh no do nghin ru, dng chuyn tip vi dng tim.
Dng tim :
- iu tr thiu vitamine B1 khi khng th dng c dng ung.
CHNG CH NH
Khng dung np vitamine B1.
CH PHNG v THN TRNG LC DNG
Dng tim : thiamine c th gy phn ng dng sc phn v. Bc s nn d tr cc bin php hi
sc - cp cu thch hp.
LC C THAI v LC NUI CON B
Lc c thai :
Khng c nghin cu v tc dng gy qui thai ca thuc trn ng vt. Trn lm sng, cho n
nay khng c trng hp no gy d dng hay c cho thai c bo co. Tuy nhin khng th
loi hn mi nguy c c th xy ra khi dng thuc ny trong thi gian mang thai. Do nn
thn trng khng dng thuc ny trong thi gian mang thai.

Lc nui con b :
Thiamine qua c sa m, tuy nhin cn thiu d liu v nh hng trn nh nhi, khng nn
dng thuc trong thi gian cho con b.
TC DNG NGOI
Dng tim :
- H huyt p thong qua.
- Ngoi l : sc phn v.
LIU LNG v CCH DNG
Dng cho ngi ln.
Dng ung :1-2 vin/ngy, ung thuc khng nhai vi mt t nc.
Dng tim :Tim bp hoc tim tnh mch.1-2 ng 100 mg/ngy. Trong mt vi trng hp, c
th cn dng n liu cao hn bng ng tim tnh mch (ti a 1000 mg/ngy). Nu liu
vt qu 2 ng/ngy, cn phi chia u ra trong 24 gi.Trng hp dng ng tnh mch,
phi tim chm trn 10 pht (xem Ch { phng v Thn trng lc dng).
BO QUN
Vin nn : Bo qun trnh m.

64.

BIOCALYPTOL

LAPHAL
c/o HYPHENS
Sir : chai 60 ml.
THNH PHN
cho 1 mung caf
Pholcodine

6,55 mg

Cinole

9,17 mg

Gaiacol

0,99 mg

(Alcool)

(24,6 mg)

(Saccharose)

(4,2 g)

cho 1 mung canh

Pholcodine

19,65 mg

Cinole

27,51 mg

Gaiacol

2,97 mg

(Alcool)

(73,8 mg)

(Saccharose)

(12,6 g)

DC LC
Thuc ho c opium.
- Pholcodine : dn xut ca morphine, chng ho c tc ng trn thn kinh trung ng, t gy
suy h hp hn so vi codine.
- Cin ole (hay eucalyptol) : st trng ng h hp.
- Gaiacol : long m.
DC NG HC
Pholcodine c hp thu hon ton sau khi ung thuc.
Pholcodine c o thi ch yu qua ng tiu v c khong 30 n 50% liu s dng c
tm thy di dng khng i.
Cin ole c hp thu nim mc d dy-rut. Cin ole c o thi ch yu qua ng tiu
v ng h hp.
CH NH
Thuc ho, c ch nh trong cc chng ho khan, ho do kch ng.
CHNG CH NH
Tuyt i :
- Suy h hp.
- Ho suyn.
- C tin s d ng vi mt trong cc thnh phn ca thuc.
- Ph n c thai : xem Lc c thai v Lc nui con b.

Tng i :
- Acool : xem Tng tc thuc.
CH PHNG v THN TRNG LC DNG
Ch { phng :
- Bit dc ny c cha cinol (dn xut ca terpne), khi dng liu cao c th gy cc tai bin
trn thn kinh kiu gy co git nh nhi v tr em.
- Trng hp ho c m cn phi t nhin v l yu t c bn bo v phi-ph qun.
- Khng hp l khi phi hp thuc long m hoc thuc tan m vi thuc ho.
- Trc khi k toa thuc chng ho, cn tm nguyn nhn gy ho c iu tr c hiu.
- Nu ho vn dai dng sau khi iu tr vi mt loi thuc ho liu thng thng, khng nn
tng liu m cn khm li tnh trng lm sng ca bnh nhn.
- Nn tn trng liu lng v thi gian iu tr khuyn co.
Thn trng lc dng :
Khng nn ung ru v cc thuc c cha alcool (xem Tng tc thuc) trong thi gian iu
tr.
Nu bnh nhn c tin s b ng kinh, cn lu { s hin din ca cinole trong thnh phn ca
thuc.
Li xe v s dng my mc : cn lu { cc i tng ny v kh nng c th b bun ng sau
khi ung thuc.
LC C THAI v LC NUI CON B
Lc c thai :
Khng c s liu v kh nng gy qui thai ca thuc trn ng vt.
Trn lm sng, cho n nay khng ghi nhn c trng hp no b d dng hoc c tnh trn
bo thai do dng thuc. Tuy nhin, cc nghin cu trn ph n c thai cha c kt lun
tht chnh xc.
Trong 3 thng cui thai kz, nu sn ph dng pholcodine di hn c th gy hi chng cai
nghin cho tr s sinh sau ny.
Vo cui thai kz, dng liu lng cao d t iu tr ngn cng c th gy c ch h hp tr
s sinh.
Do , v l{ do thn trng, khng nn ch nh thuc c cha pholcodine cho ph n mang thai.
Lc nui con b :
Pholcodine c bi tit qua sa m ; vi codine, mt vi trng hp b gim trng lc v
ngng th c m t nh nhi sau khi b m m ngi m li ung codine qu liu iu
tr. Do suy lun t codine, chng ch nh pholcodine cho ph n nui con b.
TNG TC THUC
Khng nn phi hp :
- Alcool : lm tng tc dng an thn ca thuc ho c tc ng trn thn kinh trung ng.

Trnh ung ru v cc thuc c cha alcool trong thi gian iu tr.

Lu { khi phi hp :
- Cc thuc gy c ch h thn kinh trung ng khc (thuc gim au v tr ho dn xut
morphine, mt vi thuc chng trm cm, thuc khng histamine H1 gy bun ng, nhm
barbiturate, benzodiazpine, clonidine v cc thuc cng h, thuc ng, thuc an thn kinh,
thuc gii lo u khng thuc nhm benzodiaz pine) : tng tc ng gy c ch h thn kinh
trung ng.
TC DNG NGOI
Lin quan n pholcodine :
C th gy to bn, bun ng.
Him gp : chng mt, nn, ma, co tht ph qun, phn ng d ng da.
Lin quan n cinole :
C th gy kch ng hoc l ln ngi gi trong trng hp khng chp hnh liu lng
khuyn co, c th gy co git tr em.
LIU LNG v CCH DNG
iu tr triu chng phi ngn hn (vi ngy) v dng trong nhng thi im xy ra cn ho.
Trng hp khng dng mt thuc no khc c cha pholcodine hoc tt c cc thuc ho khc
c tc ng ln thn kinh trung ng, liu hng ngy ca pholcodine khng c vt qu 90
mg ngi ln v 1 mg/kg tr em.
- Tr em t 30 thng n 6 tui : 0,5 mg pholcodine/kg/24 gi, tng ng vi na mung caf
xir/6 kg th trng/ngy.
- Tr em t 6 n 15 tui : 1 mg pholcodine/kg/24 gi, tng ng vi 1 mung caf xir/6 kg
th trng/ngy.
- Ngi ln : 90 mg pholcodine/24 gi, tng ng 4 mung canh/ngy.
Nn chia liu thnh 4 hoc 6 ln/ngy, cch nhau ti thiu 4 gi.
- Ngi gi hoc suy gan : khi u nn ung na liu ngi ln, sau c th tng liu ty
theo mc dung np v nhu cu.
QU LIU
Lin quan n pholcodine :
Du hiu sau khi dng liu rt cao : hn m, suy h hp, co git.
iu tr triu chng :
- gy i,
- trng hp b suy h hp : dng naloxone, tr h hp,
- trng hp b co git : dng benzodiazpine.
Lin quan n cinole :
Cc du hiu ng c gm nng rt thng v, nn, i, chong vng, yu c, nhp tim nhanh v
cm gic ngt th.

65.

BIODERMINE

BIODERMINEBIOCODEX
c/o TEDIS
kem dng ngoi da (tng du/nc) : ng 24 g.
THNH PHN
cho 1 ng
T bo sinh hc c c dng ht

0,75 g

DC LC
Biodermine c cha trong thnh phn nhiu loi vitamine B, ch yu l vitamine B2
(riboflavine), vitamine B6 (pyridoxine), vitamine H (biotine), v vitamine B5 (acide
pantothnique) m cc kho st ng vt cho thy, nu thiu cc vitamine ny, s d xut
hin cc biu hin bnh l da.Biodermine, vi thnh phn cng thc ca n, cho php chng
li c 3 yu t gy mn trng c thanh nin :
- iu chnh s bi tit b nhn do b sung cc vitamine nhm B ;
- c tc ng tiu sng do c acide salicylique ;
- c tc ng km khun do c pH acide.
CH NH
c s dng sn sc da nhn c bit trong mn trng c, vim da do kch thch, mn .
CHNG CH NH
Tin s mn cm vi mt trong cc thnh phn (t dc).
LIU LNG v CCH DNG

Thoa kem u n vo bui sng v bui ti, sau khi v sinh da sch s, massage cho n khi
thuc c hp thu hon ton. Biodermine cng c s dng lm mt n dng da.

66.

BIOFIDIN

WAKAMOTO
c/o O.P.V. (OVERSEAS)
Vin nang 20 mg : hp 10 vin.
THNH PHN
cho 1 vin
27,9 mg (tng s vi khun sng trong khong t 1,2 x 107 n 9 x 109) vi khun
sinh acid lactic khng vi khng sinh v ha tr liu gm Bifidobacterium infantis,
Lactobacillus acidophilus, Streptococcus faecalis.
TNH CHT
Hiu ng dc l ca vi khun sinh acid lactic :
Bifidobacterium infantis chim trn 90% vi khun ca h vi sinh ng rut nh nhi nui bng
sa m. Ngoi acid lactic, n cn c kh nng sn xut mnh m acid acetic, c ch s tng
trng v ngn cn s xm nhp ca cc vi khun gy bnh, do vy n ng vai tr quan trng
trong vic duy tr sc khe ca tr. Khi Bifidobacterium infantis chim u th trong ng rut,
n c ch s tng sinh ca cc khun gy bnh v gip cho c th khng vi nhim khun
ng rut.
Lactobacillus acidophilus c th sng c trong mi trng acid pH 3, c kh nng sn xut
mnh m acid lactic, tc ng tt trn ri lon ng rut v c dng lm ch phm ch lc
cha vi khun sinh acid lactic u - M.
Streptococcus faecalis l khun Gram dng va c sc sng ln kh nng tng sinh mnh m,
c dng rng ri lm khun sinh acid lactic iu tr ri lon ng rut.
DC LC
Ngay c trong ng rut b mt cn bng h vi sinh do dng khng sinh hay ha tr liu, vi
khun sinh acid lactic trong Biofidin vn tng sinh v chng li s pht trin ca cc vi khun gy
bnh, to mt hiu ng tt trn ri lon ng rut nh gip bnh thng ha h vi sinh
ng rut.
Khi dng chung vi khng sinh hay ha tr liu, vi khun sinh acid lactic trong Biofidin khng h

b hy dit m li cn thc y s hi phc h vi sinh ban u ca ng rut.

Cc vi khun sinh acid lactic trong Biofidin c chuyn tnh khng khng sinh cho vi khun
khc hay khng? Kho st trn mi trng nui cy vi khun sinh acid lactic trong Biofidin vi
Escherichia coli - khun Gram m thng tr trong ng rut v Staphylococcus aureus khun Gram dng gy bnh cho thy khng c hin tng chuyn giao tnh khng.
CH NH
Ci thin cc triu chng khc nhau do bt thng trong h vi sinh ng rut trong khi dng
khng sinh v ha tr liu nh : cc dn xut ca penicillin, cephalosporin, aminoglycoside,
macrolid, tetracyclin v acid nalidixic.
CHNG CH NH
Biofidin khng c chng ch nh.
TC DNG NGOI
Cho n nay khng ghi nhn tc dng ph no.
LIU LNG v CCH DNG
Liu thng dng :
Ngi ln v tr em t 12 tui : ung 1 vin Biofidin, ba ln mi ngy.
Tr em :
- di 4 tui : ung 1 vin Biofidin, mt ln mi ngy.
- t 4-12 tui : ung 1 vin Biofidin, hai ln mi ngy.
Liu lng c iu chnh ty theo tui v cc triu chng ca bnh nhn.
BO QUN
Bo qun nhit phng, trnh ni m t.

67.

BIOFLOR 250

BIOCODEX
c/o TEDIS
bt ng kh pha dung dch ung : hp 10 gi v 50 gi.
THNH PHN
cho 1 gi
Saccharomyces
boulardii

282,5 mg

DC LC
Thuc chng tiu chy c ngun gc sinh hc.
Saccharomyces boulardii c kh nng khng vi dch v v dch rut, cng nh vi cc thuc
khng sinh, khng khun v sulfamide.
Thuc trng thi t bo men nm sng.
Cc nghin cu dc l hc trn th vt cho thy :
- Trong iu kin in vitro v in vivo, thuc c tc dng c ch cc vi khun v candida.
- Thuc c tc ng kch thch s min dch khi c nhim trng.
Thuc c kh nng tng hp cc vitamine nhm B : vitamine B1, vitamine B2, acide
pantothnique, vitamine B6, acide nicotinique. Cc vitamine ny khng b ph hy trong c th
ng vt.
ngi v ng vt, thuc lm tng ng k s sn xut disaccharidase thnh rut.
CH NH
- iu tr ti pht do Clostridium difficile.
- Ngn nga v iu tr vim i trng, tiu chy do dng khng sinh.
- iu tr tiu chy cp do nhim trng ngi ln v tr em.
- D phng tiu chy do nui dng bng ng ng.
- iu tr hi chng i trng kch thch.
TNG TC THUC
Do c bn cht l mt nm, Saccharomyces boulardii khng c dng chung vi cc thuc
khng sinh khng nm ng ung v ton thn.
TC DNG NGOI
Cc kho st lm sng v cc s liu dc cnh gic cho thy rng dng Bioflor khng c mt
tc dng ngoi no. Mt s t trng hp c ghi nhn c ri lon thng v hoc b trng
bng. Tuy nhin khng nh hng n vic tip tc dng thuc.
LIU LNG v CCH DNG
C th dng thuc vo bt kz lc no, tuy nhin thuc c th hp thu tt nht, nn ung
thuc xa ba n. Thuc cng c th c s dng cng lc vi cc khng sinh. Khng nn pha
thuc trong nc nng (> 50oC), nc lnh hoc thc ung c cha alcool.
Khi dng, pha thuc trong nc hoc nc c ng hoc trong cc dung dch thc n.
Ngi ln : 2 gi/ngy.
Tr em v tr cn b : 1 gi/ngy.
Liu lng c th c tng ln theo { kin ca bc s, v khng c mt chng ch nh no.

68.

BIOLACTYL

DB PHARMA
c/o GALIEN
thuc bt : hp 14 gi.
THNH PHN
cho 1 gi 1 g
C t nht 1 t n v men sng, bao gm Lactobacillus acidophilus,
lactobacillus casei (chng rheum nosus)
T dc malto-dextrine.

DC LC
Cung cp cho c th cc men lactic cn sng c chn lc, khng b khng sinh c hot ph
rng lm mt tc dng, m bo n nh v cn bng li h vi khun ng rut, ng thi cn
cung cp nhiu vitamine nhm B.
CH NH
Vim rut v vim rut kt, d phng v iu tr cc ri lon gy ra do dng khng sinh, ng
c rut, tiu chy.
LIU LNG v CCH DNG
Tr em v ngi ln : 1-2 gi/ngy, nn ung vo lc i hay trc ba n.
Nh nhi : 1/2-1 gi/ngy, pha trong sa, thc n lng hay nc ng.
BO QUN
Trnh nng.

69.

BIOTONE

LAPHAL
c/o HYPHENS
Dung dch ung : ng 10 ml, hp 20 ng.
THNH PHN

cho 1 ng
Cn thuc ti 20% ht Kola

3,42 g

Acide phosphorique m c

285 mg

Inositocalcium

296 mg

Manganse glycrophosphate

28,5 mg

(Saccharose)

(0,843 g)

(Alcool 95deg)

(0,72 g)

Cung cp cafine : 4,8 mg/ng thuc.

cn : 15,3% (th tch/th tch), tng
ng 1,2 g thanol/ng thuc.
DC LC
Chng suy nhc.
CH NH
iu tr h tr trong suy nhc chc nng.
CHNG CH NH
Tuyt i : Qu mn cm vi mt trong cc thnh phn ca thuc.
Tng i : noxacine : xem Tng tc thuc.
CH PHNG v THN TRNG LC DNG
Trng hp p dng ch n king c ng hoc bnh nhn tiu ng, cn lu { trong
mi ng thuc c cha 0,843 g saccharose.
Lu { : cn ca thuc l 15,3% (th tch/th tch), tng ng 1,2 g thanol/ng thuc.
Cn lu { cc vn ng vin th thao rng thuc c cha hot cht (cafine) c th cho kt qu
dng tnh x t nghim s dng cht kch thch.
Li xe v s dng my mc : cn lu { cc i tng ny do thuc c cha acool, c th gy
nguy him khi li xe hoc ang s dng my mc.
LC C THAI
Khng c s liu v kh nng gy qui thai ca thuc trn ng vt.
Trn lm sng, cho n nay khng ghi nhn c trng hp no b d dng hoc c tnh trn
bo thai do dng thuc. Tuy nhin, cc nghin cu trn ph n c thai cha c kt lun
tht chnh xc.
Do , v l{ do thn trng, khng nn ch nh thuc ny cho ph n mang thai.

LC NUI CON B
Do khng c s liu v s bi tit ca thuc qua sa m, nn trnh s dng thuc ny trong
thi gian nui con b.
TNG TC THUC
Lin quan n alcool :
Lu { khi phi hp :
- Disulfirame, cfamandole, cfoprazone, latamoxef (khng sinh nhm cphalosporine),
chloramphnicol (khng sinh nhm phnicol), chlorpropamide, glibenclamide, glipizide,
tolbutamide (sulfamide h ng huyt), grisofulvine (khng nm), nitro-5-imidazole
(mtronidazole, ornidazole, secnidazole, tinidazole), ktoconazole, procarbazine (thuc km t
bo) : cc thuc ny c th gy phn ng antabuse vi alcool (nng, bng, bun nn, nhp
tim nhanh).
- Cc thuc gy trm cm h thn kinh trung ng.
Lin quan n cafine :
Khng nn phi hp :
- noxacine : tng ng k hm lng caf ine trong c th c th gy kch ng hoc o gic
(do lm gim s d ha ca cafine gan).
Lu { khi phi hp :
- Ciprofloxacine, norfloxacine : tng ng k hm lng caf ine trong c th (do lm gim s d
ha ca cafine gan).
LIU LNG v CCH DNG
Dng cho ngi ln (> 15 tui) :
2 n 3 ng thuc/ngy.
Khi dng, pha long ng thuc trong mt t nc, ung thuc trong cc ba n.
Thi gian iu tr gii hn trong vng 4 tun l.

70.

BLEPHAMIDE

ALLERGAN
Hn dch tra mt : l 5 ml - Bng B.
Hn dch tra mt : l 15 ml - Bng B.
THNH PHN

cho 1 ml
Sulfactamide sodium

100 mg

Prednisolone actate

2 mg

Phnylphrine

1,2 mg

DC LC
Sulfactamide sodium nng 10% l tc nhn km khun mnh (c tc dng trn ph khng
khun rng, bao gm cu khun). Prednisolone (dng hn dch vi ht khng kch ng) c cng
dng trn cc biu hin vim v d ng ca bnh vim m mt. Phnylphrine trong Blephamide
lm co mch nhanh chng nhng mch b mu trong mt v m mt.
CH NH
Vim m mt khng mng m v vim kt mc- m (gy ra do cht tit nhn, d ng, cu khun),
vim kt mc khng mng m (do d ng v do vi khun).
CHNG CH NH
Herps cp tnh (vim gic mc dng ui gai), nhim trng mng m cha c iu tr, u
ma, thy u v hu ht cc bnh nhim virus khc ca gic mc v kt mc, lao mt v nm
mt.
THN TRNG LC DNG
1. nhng bnh c lin quan n vi khun, s nhim khun c th b che lp, c tng ln
hay c hot ha bi corticoide.
2. Dng rng ri c th gy tng nhn p trn cc bnh nhn nhy cm. Nn kim tra nhn p
thng xuyn cc bnh nhn ny.
3. cc bnh gy mng gic mc, dng corticoide ng cc b c th lm thng gic mc.
4. Dng thn trng nhng bnh nhn c bit hoc nghi ng mn cm vi sulfamide. Ngng
thuc nu mn cm hoc xy ra cc phn ng khng mong mun khc.
5. Nn dng thn trng bnh nhn b glaucome gc hp.

6. C nhng bo co v hin tng c thy tinh th bao sau (posterior subcapsular lenticular
opacities) xy ra sau khi dng thuc vi liu cao hoc iu tr ko di vi cc corticoide dng ti
ch trong nhn khoa.
LIU LNG v CCH DNG
Nh 1 git vo mt, 2-4 ln/ngy ty theo mc bnh. Thng thng trong giai on u hay
cp tnh ca vim m mt, Blephamide mang li kt qu nhanh v hu hiu nht khi nh trc
tip vo mt, vi s tri rng trn m mt (phng php I). Tuy nhin trong trng hp ch
dng m mt, c th nh Blephamide trc tip vo v tr thng tn (phng php II).
Phng php I : trong mt v trn m mt
1. Ra tay sch, nghing l thuc nh 1 git vo mt.
2. Nhm mt v lm tn rng thuc vo trn v di m mt.
3. Khng c lau mt, thuc s kh hon ton sau 4-5 pht li mt mng trong sut m
mt trong nhiu gi. Ngi khc khng nhn thy cng nh s khng cn tr th gic.
4. Nn ra sch thuc khi m mt, 1-2 ln trong ngy. Tuy nhin phi dng thuc li sau mi
khi ra.
Phng php II : trn m mt
1. Ra tay sch, nhm mt, nghing l thuc nh 1 git vo m mt, tt nht l nh vo gc mt
pha mi.
2. Phn tn rng thuc vo trn v di m mt.
3. Khng c lau mt, thuc s kh hon ton sau 4-5 pht li mt mng khng nhn thy
m mt trong nhiu gi.
4. Nn ra sch thuc khi m mt, 1-2 ln trong ngy. Tuy nhin phi dng thuc li sau mi
khi ra.

71.

BONEFOS

SCHERING AG
c/o ZUELLIG
vin nang 400 mg : hp 100 vin.
dung dch m c dng pha tim truyn tnh mch 60 mg/ml : ng 5 ml, hp 5 ng.

THNH PHN
cho 1 vin
Disodium clodronate tetrahydrate

500 mg

tng ng : Disodium clodronate khan

400 mg

cho 1 ng 5 ml
Disodium clodronate khan

300 mg

DC LC
Clodronate v mt ha hc thuc nhm bisphosphonate, c tc dng ha hc trn m xng.
Clodronate c ch s tiu hy xng.Clodronate, mt cht bisphosphonate khng hot tnh ca
phosphatase ni sinh, c mt tc dng chn lc trn xng. C ch tc dng ca thuc cha
c hiu ht nhng thuc c th can thip vo s tiu hy xng bng mt tc dng trc tip
trn hot tnh ca hy ct bo cng nh c ch s ha tan ca cc tinh th hydroxyapatite.
DC NG HC
Sau khi tim, khong 20-40% thuc ng li b xng, sau c thi tr theo tc chu
chuyn ca xng. Thi gian bn hy trong huyt tng l 2 gi. 60-80% clodronate c bi
tit di dng khng thay i trong nc tiu 48 gi sau khi tim mt liu tnh mch, v
khong 5% bi tit trong phn.
CH NH

Bonefos c ch nh iu tr chng tng hy xng do bnh c tnh v iu tr tng canxi mu

do bnh c tnh.
CHNG CH NH
Chng ch nh dng Bonefos bnh nhn bit c qu mn cm vi hot cht ca thuc.
THN TRNG LC DNG
Clodronate c bi tit qua thn dng khng b chuyn ha. Kinh nghim dng thuc khi c
ri lon chc nng thn cha cho ph p hng dn iu tr c th. Bnh nhn cn c theo di
cn thn. Cho n nay, cha c kinh nghim dng thuc trong khi chy thn nhn to.Tng
canxi mu c th gy ra hoc lm ri lon chc nng thn nng thm. Bonefos c th gy tn
thng ng thn gn. iu quan trng l phi bo m chc nng thn chu ng tnh
trng tng khi lng dch v bi tit thuc qua thn.
LC C THAI v LC NUI CON B
Nn trnh dng Bonefos trong khi c thai hoc cho con b. Mt s t nghin cu trn ng vt
khng cho thy bng chng gy qui thai, nhng tip xc vi thuc thp. Khng c thng tin v
s bi tit trong sa m. Bonefos cha c dng cho ngi trong khi c thai.
TNG TC THUC
Mt s cht trong thc n c th lm gim s hp thu Bonefos. V vy, khng nn ung vin
nang Bonefos cng mt lc vi thc n (th d nh sa) v thuc c cha canxi, st, mangan,
magn. Nn ung thuc cch 2 gi trc hoc sau ba n.
TC DNG NGOI
Khi ung thuc c th xy ra kch ng ng tiu ha, nhng thng nh v ch xy ra 10% s
bnh nhn.Trn vi bnh nhn thy c protein niu thong qua ngay sau khi tim truyn tnh
mch.Nng hormon cn gip, creatinin, acid lactic, dehydrogenase v alkaline phosphatase
trong huyt thanh tng tm thi cng c bo co.
LIU LNG v CCH DNG
Dng ung :
Tng hy xng km tng canxi mu : 6-8 vin nang/ngy.Tng hy xng nhng khng tng
canxi mu : 4 vin nang/ngy.Liu dng hng ngy c th chia thnh 2-3 ln (xem nhng lu {
trong phn Tng tc thuc).

Dng tim truyn tnh mch :

Tng canxi mu : 300 mg (1 ng 5 ml) mi ngy, pha trong 500 ml dung dch natri clorua 0,9%
goc glucose 5% v truyn nh git tnh mch trong t nht l 2 gi. Bnh nhn cn c b
nc trc v trong thi gian iu tr. iu tr lin tc cho n khi t c canxi mu bnh
thng, thng thng l sau 2-5 ngy. Khng nn iu tr ko di qu 7 ngy. Truyn tnh mch
liu duy nht : 1500 mg (5 ng 5 ml) pha trong 500 ml dung dch NaCl 0,9% v truyn IV trong 4
gi. Sau chuyn sang iu tr duy tr bng Bonefos dng ung vi liu 1600-3200 mg/ngy
duy tr nng canxi huyt thanh bnh thng.Cn theo di chc nng thn trong khi iu tr.
Nu thy c du hiu ri lon chc nng th nn gim liu. Khng nn dng Bonefos cho tr em
tr khi b tng canxi mu c tnh e da n tnh mng.
QU LIU
Khng nhn c bo co no v ng c nng do clodronate.Nguy c tc dng ngoi trn
thn tng sau truyn clodronate qu nhanh (xem Liu lng v Cch dng).
BO QUN
Bo qun nhit phng (15oC - 25oC).Dung dch pha phi c dng trong vng 24 gi.

72.

BRADOSOL

NOVARTIS
vin ngm 0,5 mg : hp 20 vin.
THNH PHN
cho 1 vin
Benzalkonium chloride

0,5 mg

DC LC
Thuc st trng.Vin ngm Bradosol c dng iu tr cc nhim trng ming v vng c
hng.Vin ngm Bradosol sau khi tan khng gy kch ng v v hi cho m ngi, c hiu lc
chng li nhim trng nng rt thp.Vin ngm Bradosol khng cha ng v c b

sung cc t dc cho mi v thm nh to cm gic d chu. T dc s dng cng c c tnh

lm du m vim.
CH NH
iu tr chng au hng v khn ging (vim thanh qun). Trong v sinh rng ming, Bradosol
c th c dng thay th hon ton cho cc loi thuc st trng sc ming v sc hng lm
gim s ly lan nhim trng.
TC DNG NGOI
Mt vi trng hp rt him c ghi nhn c hin tng qu mn ti vng hng v lm cho
ng tc nut b kh khn.
LIU LNG v CCH DNG
Ngm mi ln 1 vin mi 2 hay 3 gi.Cch dng : vin ngm phi c cho tan t t trong
nc bt. m bo cho Bradosol lu trong nc bt, khng c nhai v phi gi vin
ngm trong ming cng lu cng tt. Trong giai on u iu tr au hng, khong cch gia
cc ln ngm nn ngn hn (tng s ln ngm) cho n khi mc nhim trng v au hng
c kim sot v thuyn gim. Nn tip tc ngm thuc mi 2 n 3 gi trong 1 hay 2 ngy
sau khi ht au hng. Vic ngm vin Bradosol mi 2 n 3 gi cn l bin php thun tin
so vi vic sc ming trong d phng v sinh rng ming lm gim s ly lan nhim trng.
ly vin thuc ra khi v, ch cn nhn tch vin thuc qua lp v kim loi.

73.

BRISTOPEN injectable oral

BRISTOL - MYERS SQUIBB VIETNAM

Bt pha tim bp v tnh mch 1 g : hp 1 l bt + ng dung mi 5 ml.
Vin nang 500 mg : hp 12 vin.
THNH PHN
cho 1 hp
Oxacilline mui Na, tnh theo oxacilline

1g

Na

52 mg hay 2,2
mmol

ng dung mi : Nc ct pha tim

5 ml

cho 1 vin
Oxacilline mui Na tnh theo oxacilline

500 mg

(Na)

26 mg hay (1,1
mmol)

(Lactose)

(+)

DC LC
Bristopen l khng sinh dit khun h bta-lactamine, nhm pnicilline M bn tng hp
khng vi pnicillinase.
PH KHNG KHUN
Cc vi khun nhy cm thng xuyn : Staphylocoque nhy cm vi mticilline, Streptocoque.
Cc vi khun nhy cm khng thng xuyn : Streptococcus pneumoniae.
Cc vi khun khng : Staphylocoque khng mticilline.
DC NG HC
Hp thu :
- Oxacilline c th c dng bng ng ung hoc tim.
- Kh dng sinh hc khi dng ng ung l 41% do oxacilline chu s chuyn ha gan.
Phn phi :
- Tim bp vi liu 500 mg cho ph p t nng ti a trong huyt thanh l 11 mg/ml, sau 30
pht.

- Tim tnh mch chm vi liu tng t s cho nng ti a trong huyt thanh l 43 mg/ml,
sau 5 pht.
- Ung 500 mg Bristopen cho ph p t nng ti a trong huyt thanh l 4 mg/ml, sau 1 gi.
- T l kt dnh vi protine khong 90%.
- Thi gian bn hy khong 30 pht i vi ng tim, 60 pht i vi ng ung.
- Oxacilline khuch tn nhanh n a s cc m trong c th nht l nc i v mu ca bo
thai.Chuyn dng sinh hc : khong 45% oxacilline c chuyn ha c nhiu kh nng l
gan.
Bi tit :
oxacilline c o thi ch yu qua nc tiu.
CH NH
Nhim trng do t cu khun v lin cu khun nhy cm vi khng sinh, ch yu trong cc biu
hin nhim trng ng h hp, tai mi hng, thn, niu sinh dc, ngoi da, xng, nhim
trng mu v vim ni tm mc, mng no (mc d thuc qua mng no yu).c s dng d
phng ngn hn trong mt s phu thut c nguy c cao b nhim t cu khun (phu thut
chnh hnh hay tim mch).Trong trng hp nhim trng huyt v vim ni tm mc do t cu
khun, Bristopen ung c dng chuyn tip sau khi iu tr bng Bristopen chch.
CHNG CH NH
D ng vi nhm pnicilline.
CH PHNG
- Ngng tr liu nu xut hin cc biu hin d ng.
- Phn ng qu mn (phn v) rt him nhng nng, c khi gy t vong cc bnh nhn c
iu tr bng p nicilline M. Do phi hi bnh s trc khi dng thuc. Nu c tin s d ng
vi cc khng sinh ny, dt khot khng c ch nh dng oxacilline.
THN TRNG LC DNG
- Lu { nguy c xy ra d ng cho vi cc khng sinh trong h cphalosporine.- Thn trng khi
dng cho tr s sinh, do c nguy c tng bilirubine huyt do cnh tranh gn trn cc protine
huyt thanh (vng da nhn no).

LC C THAI
Thn trng khi s dng oxacilline cho ph n c thai, mc du cc nghin cu c thc hin
trn rt nhiu loi ng vt khng cho thy thuc c tc dng gy qui thai hoc c c tnh
trn thai nhi.
LC NUI CON B
Oxacilline c bi tit qua sa m do khng nn con b trong thi gian iu tr.
TNG TC THUC
V nguyn tc chung, khng nn pha oxacilline vi cc thuc khc do c th xy ra tng k.
TC DNG NGOI
- Biu hin d ng : st, ni m ay, tng bch cu i toan, ph Quincke, him khi gp sc phn
v.
- Ri lon tiu ha : bun nn, i ma, tiu chy.
- Ri lon gan : him gp tng va phi transaminase, hn hu c vim gan vng da.
- Ri lon thn : c th gy vim thn k cp tnh c ngun gc d ng min dch.
- Ri lon mu, hi phc khi ngng thuc : thiu mu, gim tiu cu, gim bch cu.
- Dng pnicilline vi liu rt cao c bit bnh nhn suy thn c th gy bnh no (ri lon
thc, c ng bt thng, cn co git).
LIU LNG v CCH DNG
Dng tim :
Ngi ln/Tr em/Tr cn b : 50 n 100 mg/kg/ngy, tim bp hoc tnh mch.Tr s sinh :
25 n 100 mg/kg/ngy, tim tnh mch.Suy thn nng (thanh thi cr atinine di 30 ml/pht)
: Trong trng hp nhim trng nng, cn phi dng liu cao qua ng tim, phi iu chnh
liu ty theo mc thanh thi cratinine.
Dng ung :
35 n 50 mg/kg/ngy tc l trung bnh :Ngi ln : mi ln 2 vin 500 mg, 2 ln/ngy.Tr
em/Nh nhi : 35 n 50 mg/kg/ngy.Tr em : 2 mung lng sirop 250 mg, ngy 2 ln.Nh nhi :

1/2 mung lng sirop 250 mg cho mi 5 kg cn nng, ngy 2 ln.Suy thn nng : c th dng
oxacilline ung vi liu thng thng.
Cch dng :
ng tim : tim bp su, c th truyn tnh mch chm.Oxacilline tng hp vi cc dung
dch thng c s dng tim truyn : mui ng trng, glucose ng trng, vv.ng
ung : ung thuc vi mt t nc, khong na gi trc ba n.
BO QUN
Sau khi pha, oxacilline dng tim n nh nhit phng trong vng 4 gi, trong dung dch
ng hay mui ng trng, dng sirop n nh 15 ngy trong t lnh (+2oC n 8oC)

74.

BROMOCRIPTIN Richter

GEDEON RICHTER
vin nn 2,5 mg : hp 30 vin - Bng B.
THNH PHN
cho 1 vin
Bromocriptin mesylate

2,5 mg

DC LC
Bromocriptin hot ng nh l ch vn th dopamine vng di i v tuyn yn gim s
tng tit prolactin, ti khi ng chu kz kinh nguyt bnh thng v iu ha ri lon cc chc
nng sinh sn km theo prolactin huyt cao, phng nga v chn ng vic tit sa. cc bnh
nhn to u chi, bromocriptin lm gim nng qu cao ca hormon tng trng qua nh
hng thun li n cc triu chng lm sng v s dung np glucose. Nh vo hot tnh kch
thch tit dopamin, bromocriptin lm tng gii phng dopamine ni sinh t t bo thn kinh
tin synap cn hot ng v vn en, ng thi cng kch thch chn lc n cc th th hu

synap. Kt qu l : thuc c hiu qu trong iu tr bnh Parkinson. Bromocriptin c th c

dng mt mnh cho nhng bnh nhn di 60 tui va c chn on mc bnh Parkinson
giai on u, trnh phn ng ph c kh nng xut hin v sau (hin tng "On-Off") ca
cc liu php thay th. Tuy nhin nhng bnh nhn ny, cc phn ng ph ca bromocriptin
c kh nng cao hn (bun nn, l ln v gim huyt p). Bromocriptin c th c kt hp vi
cc thuc khng Parkinson khc (v d : levodopa v cht c ch decarboxylase).Bromocriptin
nn c chia liu nh iu tr cho mi bnh nhn vi liu c hiu lc ti thiu ty theo s
p ng iu tr. Nn tng liu mt cch dn dn (phc "chm v thp") trnh phn ng
ph "hin tng ngng thuc t ngt" v lon vn ng.S kt hp iu tr vi levodopa
thng cho ph p ng thi gim liu levodopa v cht c ch decarboxylase.
CH NH
Khoa ni tit :
Cc ri lon chu kz kinh v v sinh ph thuc prolactin (km theo prolactin huyt bnh thng
hoc cao), v kinh (c hay khng c tit a sa), thiu kinh, suy pha hong th v tng prolactin
huyt do thuc (thuc hng tm thn v cao huyt p).V sinh khng ph thuc prolactin :Hi
chng a u nang bung trng, iu tr ph tr vi cc thuc khng estrogen (v d clomifen)
trong bnh khng rng trng.U prolactin :iu tr bo tn trong trng hp u tuyn nh v u
tuyn ln tit prolactin ca tuyn yn lm ngng s pht trin hay gim kch thc ca u
tuyn trc khi phu thut d ct b, lm gim nng prolactin hu phu nu vn cn
cao.Bnh to u chi :Dng mt mnh hoc ph tr vi chiu x hoc phu thut, dng
Bromocriptin mt mnh lm gim nng huyt tng ca hormone tng trng.Phng nga
tit sa sinh l :Sau khi sinh hoc sy thai, bng cch ngn chn s tit sa bromocriptin c ch
xung huyt, cng v v phng chng vim v thi kz c.Bnh v lnh tnh :Bromocriptin
lm gim cn au ngc c lin quan ti hi chng tin kinh hoc cc bin i ca v di dng
hch hoc dng nang.
Khoa thn kinh :Trong tt c cc giai on ca bnh Parkinson hu vim no v t pht, dng
mt mnh hoc kt hp vi cc thuc khng Parkinson khc.
CHNG CH NH
Khng c chng ch nh tuyt i trong khoa ni tit.Dng cho ph n mang thai : xem phn
Thn trng lc dng.
Trong khoa thn kinh :

ng kinh v cn v ng kinh gia nh, ma git Huntington, ri lon tim mch nng, cc dng
bnh tm thn ni sinh, cao huyt p kh tr, nhim c huyt thai kz, tng mn cm vi cc
loi alcaloid nm ca g khc.
CH PHNG v THN TRNG LC DNG
Kh nng sinh sn c th c phc hi qua iu tr vi bromocriptin. Nhng ph n tui
sinh khng mun c thai nn dng phng php nga thai ng tin cy (khng hormon).
nhng bnh nhn mun c thai, phi chm dt dng bromocriptin khi xc nh c thai.Sut
sy thai khng thy tng ln sau khi ngng bromocriptin. Dng trong 8 tun u ca thai kz
n khng gy ra hu qu g. Nu mang thai xy ra khi c u tuyn yn th ngng iu tr vi
bromocriptin, phi thng xuyn gim st cht ch sut thai kz v kim tra thng xuyn th
trng ngi bnh. nhng bnh nhn c s lan rng ca u prolactin, phi s dng li
bromocriptin. Nhng bnh nhn c iu tr bnh au v, cc u nh v/hoc u nang v phi
loi tr trng hp c tnh.Khi bromocriptin c dng c ch tit sa kz c, c bit l
trong tun iu tr u tin nn kim tra huyt p. Trong trng hp cao huyt p, nhc u
trm trng thng xuyn i km hoc khng i km ri lon th gic, phi ngng iu tr v
bnh nhn phi c kim tra.Cc bnh nhn mc bnh to u chi c tin s xut huyt tiu
ha, tt hn nn dng phng php iu tr khc. Nu cc bnh nhn ny bt buc phi iu
tr bng bromocriptin th khuyn h nn thng bo ngay cc phn ng v tiu ha nu c.Phi
thn trng c bit khi dng liu cao cho cc bnh nhn c tin s ri lon tm thn hoc b ri
lon tim mch nng. Nu iu tr cho cc ph n c cc bnh khng lin quan vi chng
prolactin huyt cao, th phi dng bromocriptin vi liu hiu qu ti thiu trnh kh nng
lm gim prolactin huyt thanh xung di nng bnh thng, dn n suy chc nng
hong th. Khi dng cho cc bnh nhn Parkinson, phi kim tra thng xuyn cc chc nng
gan-thn v chc nng to huyt. Nhng bnh nhn dng liu cao c th b ri lon tm thn v
sa st tr tu nh.Trong s cc bnh nhn Parkinson iu tr ko di (2-10 nm) vi liu cao
bromocriptin (30-140 mg), i khi thy xy ra trn dch mng phi. Mc d quan h nhn qu
gia vic iu tr bromocriptin vi nhng triu chng mng phi cha c xc nh, nhng
bnh nhn b ri lon mng phi phi c khm ton din v chm dt dng bromocriptin.
Nhng ngi m cho con b khng nn iu tr vi bromocriptin. V cha c y kinh
nghim, thuc khng nn k toa cho tr em di 15 tui.Khi b dng qu liu cp tnh c th
dng metoclopramide (nh cerucal) gii c, tt nht l ng tim.V ri lon th gic c
th xy ra, phi c bit cn thn khi li xe hoc iu khin my mc. dung np bromocriptin
c th gim do ru.
TNG TC THUC

Cn thn khi dng vi cc thuc sau :

- Erythromycin (nng huyt thanh bromocriptin c th tng).
- Cht i khng dopamine, nh butyrophenon v phenotiazine (tc dng ca bromocriptin c
th gim).
Khng dng ng thi vi dn xut alcaloid nm ca g khc.
TC DNG NGOI
Trong mt vi ngy iu tr u tin, mt s bnh nhn c th bun nn, nn, chng mt hoc
mt mi, tuy nhin cc phn ng ph ny khng nng n ni phi chm dt iu tr. Bun nn
v/hoc chong vng ban u c th c c ch bng vic dng thuc chng nn thch hp
(nh dimenhydrinate, thiethylperazine hoc metoclopramide) khong 1 gi trc khi dng
bromocriptin.Trong mt s t trng hp, bromocriptin c th gy gim huyt p th ng, nn
kim tra huyt p bnh nhn t th ng.Khi iu tr liu cao c th xy ra o gic, l ln, ri
lon th gic, mt iu ha vn ng, kh ming, to bn, vp b. Tt c nhng phn ng ph
ny u ph thuc vo liu lng v thng c th kim sot c bng cch gim liu.Chng
xanh tm u chi do tri lnh, thnh thong c th xy ra khi iu tr lu di, c bit nhng
bnh nhn trc c biu hin bnh Raynaud.
LIU LNG v CCH DNG
Bromocriptin-Richter nn c dng vi thc n.
Khoa ni tit :
Ri lon chu kz kinh v v sinh n :Ung 2,5-3,75 mg (1/2 vin x 2-3 ln)/ngy. Nu cn thit
liu dng c th tng ln 1 vin x 2-3 ln/ngy. iu tr lin tc cho n khi chu kz kinh tr li
bnh thng hoc cho n khi phc hi s rng trng. Nu cn, s iu tr c th c tip tc
trong nhiu chu kz kinh trnh ti pht.U prolactin :Ung 2,5-3,75 mg (1/2 vin x 2-3
ln)/ngy, tng dn n vi vin/ngy ty yu cu gi nng prolactin mt cch thch
hp.Bnh to u chi :Dng liu khi u 2,5-3,75 mg (1/2 vin x 2-3 ln)/ngy, tng dn ln 4-8
vin (10-20 mg)/ngy ty theo p ng lm sng v phn ng ph.c ch s tit sa :Dng 5
mg (1 vin x 2 ln)/ngy trong ba n sng v ti, trong 14 ngy. trnh tit sa ban u, vic
iu tr nn bt u khng sm hn 4 gi sau khi sinh hoc sy thai. S tit sa mc nh
thnh thong xy ra 2-3 ngy sau khi ngng thuc. iu ny s chm dt khi iu tr li vi liu
nh trn trong tun tip theo.Cng v kz c :Liu n 2,5 mg (1 vin) ; nu cn thit, c th
lp li sau 6-12 gi, khi khng gim tit sa.Vim v kz c khi pht :Liu tng t nh dng

cho c ch sa, nn dng thm khng sinh.Bnh v lnh tnh :2,5-3,75 mg (1/2 vin x 2-3
ln)/ngy, tng dn n 2-3 vin/ngy.
Khoa thn kinh :
Bnh Parkinson :iu tr nn bt u vi liu thp 1,25 mg (1/2 vin), tt nht l vo bui ti,
trong tun u.(Trong trng hp iu tr kt hp, liu dng phi c bt u ng thi vi
s xut hin ca phn ng ph ca liu php levodopa nh lon vn ng, hin tng "ngng
thuc t ngt").Vic tng liu phi c thc hin t t vi liu gia lng 1,25 mg/ngy mi
tun. Liu hng ngy c chia lm hai hoc ba liu n. S p ng iu tr c th t trong 68 tun.Liu thng thng i vi iu tr mt mnh hoc kt hp l 10-40 mg/ngy
bromocriptin. mt vi bnh nhn c th cn liu cao hn, iu ny nn cn nhc ty theo
tng c nhn. iu quan trng l phi duy tr p ng iu tr ti u cng lu cng tt vi liu
hiu qu ti thiu. Nu phn ng ph xy ra trong giai on phn liu th liu hng ngy phi
gim v duy tr liu ny ti thiu l mt tun. Nu ht phn ng ph th c th tng liu tr li.
V l do an ton liu ti a hng ngy khng vt qu 100 mg.
BO QUN
Thuc c bo qun nhit phng, trnh nh sng.

THUC VN C

75.

CaC 1000 SANDOZ

NOVARTIS
vin nn si bt : ng 10 vin.
THNH PHN
cho 1 vin
Acid ascorbic

1g

Calcium lactate gluconate

1g

ng vi : Ca nguyn t

130 mg

CH NH
- Tng nhu cu canxi v vitamin C, v d : ph n c thai v cho con b, trong giai on tng
trng nhanh (thiu nin, tui dy th), tui gi, khi b nhim trng, trong thi kz dng bnh.
- iu tr tnh trng thiu canxi v vitamin C.
- Ph tr trong iu tr cm cm
.CHNG CH NH
Nhy cm vi bt c thnh phn no ca thuc, tng canxi huyt (do cng ph gip, qu liu
vitamin D, u phn hy canxi nh u tng bo, u di cn xng), tng canxi niu cao, suy thn
nng.
THN TRNG LC DNG
- bnh nhn tng canxi huyt nh (> 300 mg = 7,5 mmol/24 gi) km vi suy thn nh hoc
va, cn phi theo di chc nng thn. Nu cn thit th phi gim liu hoc ngng thuc. Cc
bnh nhn c nguy c b si thn th cn phi ung nhiu nc.- Cn trnh dng vitamin D liu
cao khi ang dng CaC 1000 Sandoz, tr trng hp tht cn thit.- V mui citrate c th lm
tng hp thu aluminium, nn cn thn trng khi dng CaC 1000 Sandoz bnh nhn suy thn
nng, c bit l cc bnh nhn c dng cc ch phm cha aluminium (do thuc c cha acid
citric).- Ca C 1000 Sandoz c cha ng (2 g/vin) nn khi dng cho bnh nhn tiu
ng. Thuc c 0,27 g natri, do cn ngi king mui.
LC C THAI v LC NUI CON B
Cc nghin cu v dch t hc vi canxi ung cho thy khng c nguy c gy qui thai bo
thai.Mc d canxi b sung c th tit qua sa m, nhng nng rt thp khng nh hng g
n tr khi sinh ra.
TNG TC THUC
C th hnh thnh cc phc hp khng hp thu khi dng CaC 1000 Sandoz vi estramustine,
etidronate v c th cc bisphosphonate khc, phenytoin, quinolone, tetracycline ung, hoc

cc ch phm cha fluoride. Cn ung cc thuc ny t nht l 3 gi cch thi im ung CaC
1000 Sandoz.Dng chung vi vitamin D v cc dn xut s tng hp thu canxi, mt s thc n c
th lm gim hp thu canxi : rau i hong, spinach, cm, thc n lm t ng cc.Khi dng canxi
chung vi vitamin D hoc dn xut liu cao, canxi c th lm gim p ng ca verapamil v c
th l c cc cht c ch canxi khc. bnh nhn ang s dng digitalis, nu dng nhiu canxi
c th lm tng nguy c ri lon nhp tim.Thuc li tiu nhm thiazide c th lm gim bi tit
canxi niu, do cn { nguy c tng canxi huyt khi dng chung CaC 1000 Sandoz vi thuc
li tiu nhm thiazide.Khi dng liu cao acid ascorbic c th nh hng n cc xt nghim tm
gluco niu.
TC DNG NGOI
Him gp : ri lon tiu ha nh (y bng, tiu chy). nhng ngi c bnh si tit niu
trc , dng CaC 1000 Sandoz lu di c th dn n vic d b si tit niu.
LIU LNG v CCH DNG
Ngi ln v tr em > 7 tui : 1 vin si bt mi ngy.Tr em 3-7 tui : 1/2 vin si bt mi
ngy.
QU LIU
Cha gp trng hp no. C th s c triu chng ri lon tiu ha, nhng khng gy tng
canxi huyt, tr trng hp c dng km vitamin D hoc dn xut vi liu cao.

76.

CALCIBRONAT

NOVARTIS
Vin nn si bt 2 g : tube 20 vin, hp 60 vin.
Dung dch tim tnh mch 0,124 g/ml : ng 5 ml, hp 10 ng ; ng 10 ml, hp 5 ng.
THNH PHN
cho 1 vin
Calcium bromo-galactogluconate

2g

T dc : macrogol 4000, saccharose (2,86

g/vin), acid citric khan, sodium bicarbonat.
Hm lng canxi : 150,7 mg hay 3,77
mmol/vin
Hm lng brom : 300 mg hay 3,77 mmol/vin
Hm lng natri : 241 mg hay 10 mmol/vin

cho 1 ng 5 ml
Calcium bromo-galactogluconate

0,62 g

T dc : nc ct pha tim.
Hm lng canxi : 46,5 mg (1,16 mmol)/ng 5 ml
Hm lng brom : 93 mg (1,16 mmol)/ng 5 ml
cho 1 ng 10 ml
Calcium bromo-galactogluconate

1,24 g

T dc : nc ct pha tim.
Hm lng canxi : 93 mg (2,32 mmol)/ng 10 ml
Hm lng brom : 186 mg (2,32 mmol)/ng 10 ml

DC LC
Thuc ng v du thn kinh (N : h thn kinh trung ng).Phi hp tc ng du thn kinh ca
brom v tc ng ngoi bin ca canxi trn tnh d b kch thch ca thn kinh c
.DC NG HC
Canxi c hp thu qua d dy-rut khong 30%.Bromid c hp thu nhanh qua rut v t
nng nh sau khi ung thuc t 30 n 45 pht. Phn ln c o thi qua thn.Thi gian
bn hy trong huyt tng khong 12 ngy do d dn n tch ly thuc, cn lu { iu ny

khi iu tr ko di (xem Liu lng v Cch dng). Bromid c chng minh l qua c
hng ro nhau thai v sa m.
CH NH
Dng ung :iu tr b tr cc ri lon nh v gic ng, cng thng thn kinh, hay cu gt.Dng
tim :iu tr b tr cc tnh trng kch ng, vt v, bn chn, cn tetani.
CHNG CH NH
Tuyt i :
- Mn trng c tui dy th.
- Tr em di 30 thng tui.
- Ngi gi dinh dng km v/hay mt nc.
- Tng canxi mu, canxi niu, si canxi, vi ha m (nhim canxi thn).
- Bnh cu thn mn tnh.
Dng vin :
Do c saccharose trong thnh phn t dc, chng ch nh trng hp bnh nhn khng dung
np fructose, b hi chng km hp thu glucose v galactose hay suy gim men sucraseisomaltase.
Dng tim :
Bnh nhn ang c iu tr vi digitalis (xem phn Tng tc thuc).
Tng i :
- Ph n c thai v cho con b (xem phn Lc c thai v Lc nui con b).
CH PHNG v THN TRNG LC DNG
Ch { phng :
- Ngng thuc nu xy ra cc biu hin d ng da v/hay cc ri lon thn kinh-tm thn (xem
phn Tc dng ngoi ).
- Tim nhanh c th gy bun nn, nn v cc ri lon vn mch (xem phn Liu lng v Cch
dng).

- Nn tm hiu nguyn nhn gy kch ng, bn chn v ty trng hp, c th c nhng tr liu
chuyn bit.
Thn trng lc dng :
- Khng ung ru trong thi gian iu tr.
- Ngi gi d nhy cm vi nhng tc ng trn thn kinh-tm thn, nht l trong trng hp
b suy thn, ngay c mc va phi.
- Trng hp bnh nhn ang p dng ch n king mui, nn lu { n hm lng natri c
trong vin thuc (xem Thnh phn)
.- Trng hp bnh nhn b tiu ng hoc ang p dng ch n king ng, nn tnh
ton hm lng saccharose c trong vin thuc vo khu phn n hng ngy (xem Thnh phn).
- C th cn kim tra canxi niu. Gim liu hoc ngng thuc nu canxi niu vt qu 7,5
mmol/kg/24 gi.
- Nu dng chung vi nhng thuc c cha chlorid, Calcibronat c th cho kt qu xt nghim
tng Cl trong mu gi to.
Li xe v vn hnh my :
Khng nn li xe v vn hnh my do thuc c th gy bun ng.
LC C THAI v LC NUI CON B
Lc c thai :
ngi :Trong 3 thng u thai kz : khng thy c nguy c.Trong 3 thng gia v cui, nu
ngi m dng thuc c bromid, ghi nhn thy tr s sinh nhng trng hp b gim trng
lc, ng li b, pht ban da (i khi xy ra chm).Do thn trng, khng nn k toa cc thuc c
bromid cho ph n c thai.
Lc nui con b :
Do bromid qua c sa m v c kh nng gy gim trng lc, ng li b, sang thng da
cho nh nhi, khng nn dng thuc trong thi gian cho con b.
TNG TC THUC
Dng ung :

Chng ch nh phi hp :Digitalis : c nguy c gy lon nhp nng, thm ch c th gy t

vong.Lu { khi phi hp :Thuc li tiu nhm thiazides : c nguy c gy tng canxi huyt do
gim o thi canxi qua ng tiu.Cc phi hp khc :Ru v cc thuc c th gy bun ng
: tng cng tc ng.
Dng tim :
Thn trng khi phi hp :c bit khi c phi hp vi vitamin D :Khng sinh nhm cyclines : lm
gim s hp thu ca cyclines qua ng tiu ha. Dng mui canxi v cyclines cch xa nhau
(trn 2 gi nu c th).Digitalis : c nguy c gy lon nhp. Theo di lm sng, nu cn c th
kim tra in tm v canxi mu.Diphosphonates : c nguy c lm gim s hp thu ca cc
diphosphonates qua ng tiu ha. Dng cc thuc cch xa nhau (trn 2 gi nu c th).Cht
st (dng mui) : lm gim s hp thu ca cc mui st qua ng tiu ha. Dng mui st
cch ca ba n v khng cng lc vi mui canxi.Cc phi hp khc :Ru v cc thuc c th
gy bun ng : tng cng tc ng.
TC DNG NGOI
- Him khi gy d ng da ca bromide, quan st sau iu tr di hn.
- Ri lon thn kinh-tm thn : ng li b ban ngy, ln ln, bn chn kh chu, o gic. Cc tc
dng ph ny thng c ghi nhn ngi gi hay khi dng liu cao.
- Ri lon tiu ha : chn n, to bn.
- Bun nn, nn v cc ri lon vn mch c ghi nhn khi tim thuc nhanh (xem phn Liu
lng v Cch dng).
LIU LNG v CCH DNG
Liu lng :
Dng ung :
Ngi ln : 1-2 vin/ngy.
Tr em trn 30 kg : 1 vin/ngy.
trnh nguy c tch ly thuc (xem Dc ng hc) :
- khng nn dng qu liu 10 mg/kg/ngy, tng ng vi 2 vin i vi ngi ln, 1 vin i
vi tr em trn 30 kg.

- khng nn iu tr qu 3 tun.Trng hp dng tr li, nn cch khong 3-4 tun gia hai t
iu tr.
QU LIU
iu tr qu liu bao gm :Cho ung 1 g mui NaCl mi gi, cho n khi nng bromid trong
mu tr v gi tr bnh thng, nu cn, truyn dung dch NaCl ng trng.Bi niu bng
furosemide v mannitol
.BO QUN
Vin si bt : bo qun trnh m.

77.

CALCINOL RB / CALCINOL-1000

RAPTAKOS BRETT
Vin nn : chai 100 vin.
Bt si bt pha dung dch ung : gi 6,7 g, hp 10 gi.
THNH PHN
cho 1 vin
Calcium carbonate

375 mg

Calcium phosphate

75 mg

Calcium fluorure

0,5 mg

Magnsium hydroxyde

50 mg

Cholecalciferol (vitamine D3)

250 UI

(mi vin cung cp 180 mg nguyn t calci)

cho 1 gi
Calcium carbonate

2,5 g

tng ng : nguyn t calci

1000 mg

Cholecalciferol ht (vitamine D3)

400 UI

DC LC
Cc mui calci ng vai tr quan trng trong s iu ha tnh thm ca mng t bo i vi
sodium v potassium, tnh ton vn ca nim mc, tnh gn dnh ca t bo. Nng calci tng
lm gim tnh thm v ngc li. Calcium carbonate l dng c hm lng calci cao nht (40%)
nhng c tc dng ph l gy to bn.
Vin n n : Phosphate ng vai tr quan trng trong vic iu chnh nng calci trong cc m.
Nng phosphate trong huyt tng gim thp s lm gia tng lng calci trong mu v c
ch s tch t calci vo xng. Sinh t D3 kch thch trc tip ng ln gn ti thu phosphate.
Thuc m bo c t l Ca : P l 1,8 : 1,0 l t l cn thit cho s pht trin xng.
Tc dng nhun trng ca phosphate v magnesium hydroxyde gip khc phc tc dng ph
gy to bn ca cc mui calci. Bng c ch cnh tranh, magnesium cn c s dng ngn
cn qu trnh calci to phc hp hoc to cc mui khng tan vi phytate trong thc n khin
khng th hp thu c.
Fluore bng con ng tip xc trc tip cng nh qua ng mu lm cho men rng bn
vng cng nh lm gim t l su rng. Fluore cn c vai tr quan trng trong s pht trin
xng.
DC NG HC
Hp thu :
Calci c hp thu phn trn ca rut non. ngi ln khe mnh, lng hp thu c
chim khong 1/3 lng n vo. Sinh t D lm gia tng s hp thu calci v phosphate t rut
ng thi huy ng calci vo trong xng. Phytate v oxalate c th to phc hp hay to mui
khng tan vi calci lm cho calci khng hp thu c. Sinh t D kch thch s hp thu phosphate
t rut v iu ny dn n tc dng ca sinh t D trn s chuyn vn calci.
Magnesium hydroxyde l dng mc d khng tan nhng vn c th c khong 5-10%
magnesium c hp thu, do mt liu lng nht nh trong mu c th nguy him cho
ngi b suy thn.
Phn b :
H xng cha 90% lng calci trong c th. Cc mnh cu trc ca xng khng ch cu to
bi calci m cn bi nhiu loi mui v c khc bao gm sodium, potassium, magnesium,
carbonate v fluore. Trong huyt tng, 40% lng calci di dng kt hp vi protine, 10%

phn tn v to phc hp vi anion nh citrate v phosphate, s cn li phn tn di dng ion

calci. Phosphate hin din trong huyt tng, dch ni bo, collagen v m xng.
Bi tit :
Calci c bi tit qua h tiu ha nh qua nc bt, mt v dch ty thi qua phn. Calci
cng c bi tit ng k qua sa m v m hi. Calci c thi tr qua nc tiu v c mi
lin quan vi vic bi tit sodium. Calci c ti thu ti ng ln gn di nh hng ca PTH
v ti ng ln xa di nh hng ca sinh t D. Phosphate v magnesium c bi tit ch
yu qua nc tiu.
CH NH
Tnh trng thiu calci (nh ci xng, long xng, suy dinh dng) v trng hp gia tng nhu
cu calci (nh tr em ang ln, m mang thai, m cho con b).
CHNG CH NH
D ng vi cc thnh phn ca thuc. Trnh dng ko di trn bnh nhn suy thn (vin nn) ;
tng calci huyt ; cng ph gip trng ; tng calci niu ; si niu ; hi chng Zollinger-Ellison ;
tr liu song song vi digoxine (cn theo di cn thn lng calci mu).
THN TRNG LC DNG
Vin nn c cha magnesium l cht cn trnh dng cho trng hp suy thn cp v tng ur
huyt.
TNG TC THUC
Tng calci mu nguy him khi dng ch phm c calci km vi verapamil, thuc li tiu loi
thiazide, digitalis. Dng chung lm gim tc dng ca salicylate v tng tc dng quinidine.
TC DNG NGOI
Ri lon tiu ha him gp. liu cao c th c triu chng ca tnh trng tng calci huyt v
tng calci niu bao gm bing n, bun nn, i ma, to bn, au bng, kh ming, kht nc
v a niu.
LIU LNG v CCH DNG
Vin nn :
Ngi ln : mi ln 2 vin, ngy 2-3 ln, nn ung 1-2 gi sau ba n.
Tr em : na liu ngi ln.
C th nhai, ngm hay nut nguyn vin.
Gi :
Mi ngy 1 gi. Cho 200 ml nc chn vo ly. Va trt t t gi thuc vo va khuy u. Ung
ngay.

78.

CALCIUM CORBIRE VITAMINS

SANOFI SYNTHELABO VIETNAM

Dung dch ung : ng ung 10 ml, hp 24 ng v hp 4 ng.
Vin nn si bt : ng 10 vin.
THNH PHN
cho 1 ng
Calcium glucoheptonate

1,1 g

Acide ascorbique (vitamine C)

0,1 g

Nicotinamide (vitamine PP)

0,050 g

Acide phosphoreux

0,04 g

cho 1 vin
Calcium glucoheptogluconate

1g

Acide ascorbique (vitamine C)

1g

Colcalcifrol (vitamine D3)

0,05 mg (2000 UI)

Nicotinamide (vitamine PP)

0,1 g

DC LC
Chng mt nhc : cung cp vitamine v calci.
CH NH
Dng iu tr triu chng suy nhc chc nng.
CHNG CH NH
Tng calci mu, bnh si calci.
Mn cm vi vitamine D.
THN TRNG LC DNG
Lin quan n vitamine D : lu { ngun cung cp vitamine D c th c t cc ngun khc.
TNG TC THUC
Thn trng khi phi hp :
- Cc cycline : lm gim hp thu cc cycline ng tiu ha, do nn ung 2 loi thuc cch

nhau trn 2 gi.

- Digitalis : nguy c gy ri lon nhp. Theo di lm sng v nu cn, kim tra in tm v
nng calci huyt.
- Diphosphonate : nguy c lm gim hp thu diphosphonate ng tiu ha. Do nn ung
hai loi thuc cch nhau trn 2 gi.
Nn cn nhc khi phi hp :
- Thuc li tiu nhm thiazide : nguy c lm tng calci huyt do lm gim thi tr calci ti thn.
LIU LNG v CCH DNG
Dung dch ung :
- Ngi ln : 1-2 ng/ngy chia lm 2 ln (sng v tra).
- Tr em : 1 ng/ngy vo bui sng.
Vin nn si bt :
- Ngi ln v thiu nin : 1-2 vin/ngy. thuc tan hon ton trong ly nc. Trnh dng
thuc sau 17 gi.

79.

CALCIUM-SANDOZ FORTE

NOVARTIS
vin nn si bt : ng 20 vin.
THNH PHN
cho 1 vin
Calcium gluconolactate

2,94 g

Calcium carbonate

0,30 g

tng ng : Ca : 12,5 mmol hoc

500 mg

(Sodium : 12,5 mmol hoc)

(275 mg)

(Sucrose)

(868 mg)

DC LC
Calcium-Sandoz forte cha cc mui canxi c th ion ha v d tan. Thuc cha hm lng
canxi cao do c s dng nh mt liu php b sung canxi mnh dng ung, iu tr cc

tnh trng thiu canxi cp tnh hoc mn tnh cng nh cc ri lon chuyn ha xng mi
tui.
DC NG HC
Khong 30% canxi dng ion c hp thu ti ng tiu ha. Xng v rng cha 99% lng
canxi ca c th. Trong tng lng canxi huyt thanh c 50% dng ion, 5% dng phc hp
anion v 45% gn kt vi protein huyt tng. Khong 20% canxi thi qua ng tiu v 80%
qua phn, lng thi qua phn ny bao gm lng canxi khng c hp thu v lng canxi
c tit qua ng mt v dch ty.
CH NH
- Long xng do nhiu ngun gc khc nhau (mn kinh, ln tui, iu tr bng corticoide, ct
d dy, hoc bt ng lu).
- Phng nga tnh trng gim s khong ha xng giai on tin v hu mn kinh.
- Thiu canxi trong thi kz thai nghn, cho con b v tr trong giai on tng trng.
- iu tr cng thm trong ci xng v nhuyn xng.
- c ngh iu tr tnh trng c gi l "tng a co git" (bnh ttanie mn tnh).
- Tnh trng d ng (iu tr h tr).
CHNG CH NH
- Qu mn cm vi mt trong cc thnh phn ca thuc.
- Tng canxi huyt, tng canxi niu, si canxi, vi ha m, suy thn nng.
THN TRNG LC DNG
- Trng hp canxi niu tng nh (trn 300 mg hoc 7,5 mmol/24 gi), suy thn va hoc nh
hoc tin s si canxi, nn tng cng theo di s o thi canxi qua ng tiu v nu cn, c
th gim liu hoc tm thi ngng thuc.
- Mt khc, nhng bnh nhn c kh nng b si canxi niu nn ung nhiu nc. Ngoi tr
trong nhng ch nh tht c th, trnh dng vitamine D liu cao trong khi ang iu tr bng
canxi.
- { n lng ng c trong thuc khi s dng cho bnh nhn tiu ng.
LC C THAI v LC NUI CON B
Cc nghin cu c kim sot ph n khng cho thy c nguy c g trn bo thai khi dng
thuc trong 3 thng u ca thai kz ; khng c du hiu g cho thy dng thuc c kh nng gy
nguy him trong cc thng tip theo ca thai kz v kh nng gy nh hng xu n bo thai
hu nh l khng c.
Lc c thai v lc nui con b nn dng ng theo liu lng khuyn co.
Mc d canxi b sung c tit qua sa, nhng vi nng khng gy bt kz mt tc dng no
tr s sinh.
TNG TC THUC
Khng dng canxi trong vng 3 gi trc hoc sau khi ung ttracycline, fluor, estramustine,

biphosphonate, phenytoin, quinolone (do c th to hp cht khng hp thu c). Dng ng

thi vi vitamine D s lm tng hp thu canxi.
Khi s dng canxi liu cao phi hp vi vitamin D c th gy gim p ng vi thuc c ch
canxi. Mt s loi thc n lm gim hp thu canxi. Li tiu nhm thiazide lm gim bi tit canxi
niu, c nguy c gy tng canxi huyt.
bnh nhn ang c iu tr bng digitalis, dng canxi liu cao c th lm tng nguy c lon
nhp tim.
TC DNG NGOI
Trong mt vi trng hp rt him, c th gy ri lon tiu ha (to bn, y bng, hoc tiu
chy).
LIU LNG v CCH DNG
Pha vin nn si bt trong mt ly nc.
Liu thng dng l khong 500-1000 mg/ngy b sung cung cp khong 70% nhu cu
khuyn co mi ngy. Trong nhng trng hp nng, c th dng n 2000 mg trong nhng
tun l u iu tr.
QU LIU
Cho n nay cha c trng hp qu liu cp tnh no c ghi nhn. Qu liu canxi c th gy
ri lon tiu ha, nhng khng dn n tng canxi huyt tr khi ng thi c dng qu liu
vitamin D.

80.

CALCIUM-SANDOZ injectable

NOVARTIS
dung dch tim bp, tnh mch hoc truyn tnh mch : ng 5 ml, hp 10 ng.
dung dch tim bp, tnh mch hoc truyn tnh mch : ng 10 ml, hp 10 ng.
THNH PHN
cho 1 ng 5 ml
Calcium glubionate

0,687 g

tng ng : Ca : 1,12 mmol/5 ml hoc

45 mg

cho 1 ng 10 ml

Calcium glubionate

1,374 g

tng ng : Ca : 2,24 mmol/10 ml hoc

90 mg

DC LC
Dng canxi ng tim cho ph p iu chnh nhanh tnh trng h canxi huyt v cc triu chng
lm sng bao gm : d cm, co tht thanh qun, vp b, tng kch thch thn kinh c dn n co
git.
Trong cc tnh trng thiu canxi mn tnh do ri lon hp thu rut, dng liu php canxi
ng tim s n nh li cc thng s v canxi v duy tr chng tnh trng cn bng.
Tng nng canxi s lm gim tnh thm thnh mao mch, do lm gim qu trnh xut tit,
vim v d ng.
Nh c dung np tt m, calcium glubionate khng ch c tim bng ng tnh mch,
m cn c th c tim bp su (tuy nhin khng nn tim bp tr em).
DC NG HC
Xng v rng cha 99% lng canxi ca c th. Trong tng lng canxi huyt thanh c 50%
dng ion, 5% dng phc hp anion v 45% gn kt vi protein huyt tng. Khong 20%
canxi thi qua ng tiu v 80% qua phn, lng thi qua phn ny bao gm lng canxi
khng c hp thu v lng canxi c tit qua ng mt v dch ty.
CH NH
- Co cng c do h canxi huyt (bnh ttanie) v cc ri lon thn kinh c lin quan.
- Tnh trng thiu canxi mn tnh, ci xng, nhuyn xng v long xng nhng bnh nhn
m vic s dng canxi dng ung khng t hiu qu tt.
- iu tr h tr trong cc trng hp xut tit da (v d : m ay cp, chm cp).
- Ng c kim loi ch (iu tr au bng do ng c ch), ng c fluoride.
- H tr iu tr chng tng kali huyt nng.
CHNG CH NH
- Qu mn cm vi cht thuc.
- Tng canxi huyt v tng canxi niu nng.
- Suy thn nng, galactose huyt.
- Tuyt i khng ch nh canxi dng tim cho bnh nhn ang c iu tr bng digitale hoc
adrnaline.
THN TRNG LC DNG
- Khi dng liu php canxi liu cao cn phi kim tra cht ch canxi huyt v canxi niu, nht l
tr em v bnh nhn ang s dng vitamin D. Ngng iu tr ngay khi canxi huyt vt qu
2,625 mmol/l (105 n 110 mg/l) v khi canxi niu vt qu 0,125 mmol/kg (5 mg/kg) trong 24

gi.
- Nn theo di in tm khi truyn canxi ng tnh mch iu tr tng kali huyt nng.
- Ngi ta pht hin rng trong dung dch tim canxi (k c Calcium-Sandoz) c cha mt
lng nh aluminium (ti a 10 mg/l). Do , trnh dng lu di canxi ng tim cho tr s
sinh, tr nh nhi v bnh nhn b suy thn nng, do dng lu di c th gy tch t aluminium
h xng, cc ri lon h thn kinh, mu v xng.
LC C THAI v LC NUI CON B
Cc nghin cu dch t hc vi canxi ung cho thy khng c s gia tng kh nng gy qui thai,
ngi ta cho rng cng khng c mt tc dng ph no xy ra khi s dng ng tim, ngoi
tr khi tim tnh mch qu nhanh hoc liu cao s dn n tng canxi huyt.
TNG TC THUC
Canxi lm tng tc dng ca digitalis v adrenalin trn tim. Canxi cn c th lm gim bt tc
dng ca vrapamil v ca cc thuc c ch canxi khc.
Li tiu thiazide lm gim bi tit canxi niu. Nguy c tng canxi huyt cn c ch khi s
dng chung Calcium-Sandoz vi thiazide.
TC DNG NGOI
Nn, ma, bc ha, v m hi, h huyt p, lon nhp v try mch, c th xy ra khi tim tnh
mch qu nhanh.
Khi tim tnh mch chch hoc tim bp nng, d ng ti vng tim c th dn n trc vy
hoc hoi t da. Him khi xy ra tnh trng canxi ha m mm ti ch.
LIU LNG v CCH DNG
Liu lng :
Liu thng thng :
Ngi ln : 10 ml, 1 n 3 ln/ngy, tnh mch hoc tim bp su trong trng hp c bit.
Tr em : 5-10 ml, 1 ln/ngy, tim tnh mch.
Trng hp h canxi huyt nng ngi ln hoc tr em, dng canxi bng ng truyn tnh
mch, iu chnh liu theo canxi huyt v canxi niu.
Trng hp h canxi huyt nng tr cn b hoc tr nh nhi, liu thng thng l 40-80 mg
canxi nguyn t/kg/24 gi (khong 4-9 ml) bng cch truyn tnh mch, trong ti a 3 ngy.
Vic iu tr sau c chuyn sang dng ung.
Nu ng qui nh, canxi dng tim c th kt hp vi vitamin D.
Cch dng :
Tim tnh mch chm (3 pht cho 10 ml) ; theo di nhp tim. ngi ln, c th tim bp su
mng trong mt s trng hp c bit. Khng tim bp cho tr em. Tuyt i trnh tim di
da Calcium-Sandoz.
QU LIU
Cc triu chng bao gm cc triu chng ca tng canxi huyt : chn n, nn, ma, to bn,

au bng, yu c, a niu, kht, ng gt ; trng hp nng : hn m, lon nhp, ngng tim.

Vic iu tr nhm vo iu chnh tng canxi huyt : c th dng sodium phosphate dng ung,
hoc truyn tnh mch trong trng hp nng.

81.

CALCREM

RAPTAKOS BRETT
Kem bi ngoi da : tup 15 g.
THNH PHN
cho 100 g
Clotrimazole

1g

DC LC
Clotrimazole l mt dn cht tng hp ca imidazole v c cu trc ha hc gn ging vi
miconazole. Thuc c tnh khng nm ph rng c bo ch di dng bi ngoi da, c kh
nng c ch s pht trin ca hu ht cc loi vi nm gy bnh ngi loi dermatophytes,
nm men v Malassezia furfur. Clotrimazolecho hot tnh km vi nm v dit vi nm in vitro
chng li cc chng phn lp ca Trichophyton rubrum, T. mentagrophytes, Epidermophyton
floccosum, Mycrosporum canis v Candida species, k c Candida albicans. Khng c tnh trng
khng bc n hay a vi clotrimazole pht trin khi ang iu tr C. albicans v T.
mentagrophytes. Calcrem cng c tc dng chng li mt s vi khun Gram dng c bit l
Staphylococcus v chng li Trichomonas.
Ging nh cc imidazole khc, thuc tc ng ln tnh thm thu ca vch t bo vi nm bng
cch can thip ln cc lipide ca mng. liu iu tr, thuc c ch s tng hp ergostrol ca
vch t bo, nhng nng cao hn, thuc cn c thm mt c ch khc na gy hy hoi
mng m khng c lin quan g n s tng hp st rol, n nay cha r c ch . C tc gi
nu clotrimazole c tc dng c ch tng hp acide nhn, lm ri lon chuyn ha lipide,
polysaccharide gy tn thng mng t bo v lm tng tnh thm cc mng phospholipide ca
lysosome ca t bo vi nm.
Clotrimazole khng gy qui thai cho chut cng, chut nht hay th. Liu cao ng ung c
du hiu c cho thai chut cng. Khng c bo co no v kh nng gy ung th ca thuc.
DC NG HC
Thuc c phn b da di dng khng chuyn ha nng gim dn t ngoi vo trong.

Nng ti a ti lp sng ha v thuc hin din ko di ti cc nang lng.

Sau khi bi ti ch da lnh hay da b tn thng, 0,1-0,5% thuc c hp thu nhng khng tm
thy trong huyt thanh (ngha l nng thuc di 1 ng/ml).
Nghin cu dng thuc bng ng ung (l ng t dng trong thc t iu tr) v ng bi
m o cho thy thuc c chuyn ha nhanh ti gan trc khi c nh hng ton thn. 50%
lng clotrimazole v chuyn ha cht ca thuc trong huyt thanh gn vi albumine huyt
tng. Hm lng c hai t nh cao nht trong vng 2-6 gi sau mt liu ung. Nng ny
gim dn trong khi tip tc dng thuc. Clotrimazole liu ung thp 7 mg/kg/ngy kch thch
kh nng oxy ha ca gan lm gia tng s chuyn ha ca chnh n. Thuc c bi tit ch yu
qua ng mt v ng tiu vi ch 1% dng hot ng. Cha r c bi tit qua sa m hay
c chuyn vn qua nhau thai hay khng. Sau mt liu ung, 10% c thi qua nc tiu sau
24 gi, 25% trong 6 ngy.
CH NH
iu tr ti ch tinea pedis (nm da chn, nm k), tinea cruris (nm bn), tinea corporis (nm
da thn, lc ng tin) do T. rubrum, T. mentagrophytes, E. floccosum v M. canis ; bnh
Candida do C. albicans v tinea versicolor (lang ben) do M. furfur. Thuc cng c tc dng trong
mt s trng hp nhim trng da khng do vi nm nh erythrasma do Corynebacterium
minutissimum.
CHNG CH NH
Tng cm i vi clotrimazole hay imidazole bi ti ch.
THN TRNG LC DNG
Ch dng bi ngoi da. Trnh thuc chm mt. Nu c kch ng hay nhy cm, ngng iu tr
v thay bng liu php khc.
Ph n c thai : Trong nghin cu lm sng, dng clotrimazole dng dng bi m o cho
ph n c thai ba thng gia v ba thng cui thai kz khng thy c tc dng ph. Tuy nhin,
cha c nghin cu y v hon chnh trn ph n c thai ba thng u do ch dng nu
c ch nh r rng v trnh bi din rng.
Ph n cho con b : Ngi ta khng r thuc ny c bi tit qua sa m hay khng. Cn thn
trng khi dng i vi m ang cho con b.
TNG TC THUC
Tc dng i khng gia cc imidazole (k c clotrimazole) v cc khng sinh polyne in vitro
c bo co. C l do imidazole c ch s tng hp ergosterol trong khi cc khng sinh
polyne li c tc dng chng nm bng cch gn vi cc strol ca mng t bo. S tc ng
ca clotrimazole ln cc enzyme ti th gan khng l vn i vi dng thuc bi.
TC DNG NGOI
Thnh thong xy ra ni mn ; cm gic chm chch ; ni mn nc ; trc da ; ph ; nga ;
m ay ; cm gic rt phng ; kch ng da tng qut, nht l khi da c tn thng h. Nu cc

triu chng trn nh, khng r rng th khng cn phi ngng thuc.
LIU LNG v CCH DNG
Sau khi ra sch vng da bnh, bi mt lp mng thuc, ch xt nh nhng ti vng da bnh v
rng ra vng xung quanh. Hai ln mi ngy, sng v ti, lin tc trong mt thng hoc ti thiu
hai tun sau khi sch cc triu chng nga ti pht. Trnh lm try xt da trc khi bi
thuc. Cn gi vng da bnh sch v kh, kt hp vi v sinh c nhn v mi trng.
Triu chng lm sng thng c ci thin, gim nga trong vng tun u tin.
D triu chng c th ch mi bt cng trnh ngng gia chng m nn tip tc dng thuc
cho n ht liu trnh.
Nu khng thy ci thin triu chng sau 4 tun cn xem li chn on hay i thuc khc.
ngng s dng nu bnh tr nn t hn, hay nu c kch ng.
Vi tn thng c nhiu vy, cht tit, m, dch bn nn lm sch trc khi bi thuc v trnh
bng hay p kn.

82.

CALMOL 325 / CALMOL 500

SANOFI SYNTHELABO VIETNAM

Vin nn 325 mg : v 10 vin, hp 10 v.
Vin nn 500 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Paracetamol

325 mg

cho 1 vin
Paracetamol

500 mg

DC LC
Gim au, h st.
CH NH
iu tr triu chng cc bnh gy au v/hoc gy st.

CHNG CH NH
Qu mn vi paracetamol.
Suy chc nng t bo gan.
LC C THAI v LC NUI CON B
Khng c bng chng cho thy thuc gy qui thai trn ph n mang thai. Thuc c th dng
c trong thi kz cho con b.
TC DNG NGOI
Vi trng hp d ng biu hin bi cc pht ban ngoi da vi hng ban hoc m ay.
Him khi gy gim tiu cu.
LIU LNG v CCH DNG
Ngi ln :
- Calmol 500 : 1-2 vin, ung 3-4 ln/ngy, khng qu 8 vin trong 24 gi.
- Calmol 325 : 2 vin mi 4 gi.
Tr em :
- Di 1 tui : 10 mg/kg cn nng, mi 4 gi.
- T 1-5 tui : Calmol 325 : 1/2-1 vin, 4-6 ln/ngy.
- T 6-12 tui : Calmol 325 : 1 vin, 4-6 ln/ngy.
Trng hp suy thn nng, h s thanh thi creatinin di 10 ml/pht, khong cch gia 2 ln
dng phi ti thiu l 8 gi.
QU LIU
Triu chng : Bun nn, nn, chn n, xanh xao, au bng, thng xut hin trong 24 gi u.
Dng liu qu cao (trn 10 g ngi ln hoc 150 mg/kg cn nng tr con, ung mt ln duy
nht) c th gy phn hy t bo gan a n hoi t hon ton v khng hi phc.
X tr cp cu : Chuyn ngay n bnh vin. Ra d dy loi tr thuc ung. Dng than
hot tnh ung. Dng cht gii c c hiu N-acetylcystein, ty theo lng paracetamol dng.
BO QUN
Gi ni kh mt.

83.

CALYPSOL

GEDEON RICHTER
dung dch tim 500 mg/10 ml : l 10 ml, hp 5 l.
THNH PHN

cho 1 l tim 10 ml
Ketamine chlorhydrate, tnh theo ketamine

500 mg

DC LC
Thuc m to ra s gy mt cm gic phn ly, c c trng bi s gi nguyn th v mt tr
nh, c tim tnh mch. Thuc cng gy tng trng lc c, mt bnh nhn thng vn m
trong khi gy m.
CH NH
Thuc c th dng cho cc phu thut c thi gian ngn v trong cc can thip chn on gy
au hay c dng thit b. Thuc cng c th dng dn m trc khi dng cc thuc gy m
khc. Ketamine gip tng cng hiu qu ca cc thuc gy m yu (v d : N2O).
CHNG CH NH
- Qu mn vi hot cht.
- Chng kinh git, cao huyt p.
- Nhng ngi bnh c tin s co git, tng p lc ni nhn, tng p lc ni s.
CH PHNG v THN TRNG LC DNG
- C th xy ra try h hp khi dng qu liu. Trong trng hp ny nn dng thng kh h tr.
Tr h hp c hc c a chung hn dng thuc hi sc, v tc dng ca thuc hi sc
khng . Ch phm ny ch c dng bi nhng nh gy m chuyn nghip v ti nhng c
s y t c trang b tt.
- Calypsol nn c tim tnh mch chm, trong thi khong 60 giy hoc lu hn.
- Barbiturate c tng k ha hc vi ketamine, v vy khng nn dng chung trong mt ng
tim.
TNG TC THUC
Ketamine lm tng tc dng c ch ca barbiturate v opioid. Thi gian gy m tng trong
trng hp tin m bng diazepam, hydroxyzine v quinalbarbitone. Thuc lm tng mnh tc
dng ca tubocurarine v ergometrine, nhng khng lm thay i tc dng ca pancuronium
v succinylcholine. Trong khi iu tr tuyn gip trng, th Calypsol c th lm tng huyt p v
nhp tim. Barbiturate c tng k ha hc vi ketamine, v vy khng nn dng chung trong
mt ng tim.
TC DNG NGOI
Tng huyt p, nhp tim nhanh, tng p lc ni s, try h hp, nhn i, rung git nhn cu,
bun nn, nn, chy nc mt, tit nc bt, tng trng lc c, v o gic, kch ng tm
thn vn ng, c th xy ra khi hi phc, thng c th c phng nga bng droperidol
(tim bp 0,1 mg/kg th trng).

LIU LNG v CCH DNG

Liu lng c xc nh ty theo tng c th.
Liu tim tnh mch :
- Ngi ln : liu tim tnh mch khi u thay i t 1,0-4,5 mg/kg th trng.
- Tr em : 0,5-4,5 mg/kg th trng.
Liu trung bnh gy m trong thi khong 5-10 pht l 2,0 mg/kg th trng.
Liu tim bp :
- Ngi ln : liu tim bp khi u thay i t 6,5-13,0 mg/kg th trng.
Mt liu 10 mg/kg gy m c trong thi khong 12-25 pht.
- Tr em : 2,0-5,0 mg/kg th trng.
Gy m c th c duy tr bng na liu khi u.
BO QUN
Bo qun nhit 15-30oC, trnh nh sng.

84.

CARBOPHOS

UPSA
vin nn nhai d b : ng 20 vin, hp 2 ng.
THNH PHN
cho 1 vin
Than tho mc

400 mg

Ca carbonate

200 mg

Ca phosphate trung tnh

100 mg

tng ng : Ca

118 mg

(Saccharose)

(500 mg)

DC LC
Cht hp th rut (A : h tiu ha v chuyn ha).
CH NH
- iu tr triu chng cc biu hin ri lon chc nng rut, nht l khi c km theo chng

bng v tiu chy.

TNG TC THUC
Do than tho mc c c tnh hp ph nn c th lm gim s hp thu ca cc thuc khc, do
nn dng Carbophos cch xa cc thuc khc (trn 2 gi nu c).
TC DNG NGOI
Dng thuc ny liu cao c th lm cho phn c mu en.
C lin quan n canxi : dng thuc ko di v liu cao c th gy tng canxi huyt, si thn v
suy thn.
LIU LNG v CCH DNG
Dng cho ngi ln.
1-2 vin, nhai v ung vi mt t nc, sau ba n hay khi c cn au.

85.

CARDIMAX-20

USV
c/o CT TNHH DP MINH HIN
Vin nn bao phim 20 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Trimetazidine dihydrochloride

20 mg

T dc: lactose, polyvinyl pyrrolidone,

magnesium stearate, croscarmellose
sodium, colloidal silicon dioxide,
pharmacoat 606, titanium dioxide,
polyethylene glycol 400, isopropyl alcohol,
lake of brilliant blue FCF, methylene
chloride, talc.
M T
Trimetazidine dihydrochloride l 1-(2,3,4-trimethoxybenzyl) piperazine dihydrochloride.
DC LC

Trimetazidine l thuc tr chng au tht v chng thiu mu cc b duy nht thuc nhm cc
hp cht mi c tc dng chng thiu mu cc b m khng gy ra bt kz thay i huyt ng
no, v ci thin tnh trng thiu mu cc b c tim. Thuc c tc dng tr chng au tht
thng qua tc ng trc tip bo v t bo trn c tim, do trnh c cc tc dng ngoi
nh thiu nng tm tht tri, gin mch ngoi bin qu mc v cc bt li khc khi dng cc
thuc tr chng au tht.
DC L LM SNG
Trimetazidine gi n nh nng lng ca t bo trong tnh trng gim oxy huyt ton thn
hoc thiu mu cc b. Thuc ngn chn cc biu hin in sinh l ca thiu mu cc b. Thuc
lm gim s gia tng on ST trong in tm ca ch b nhi mu c tim th nghim.
Vi s hin din ca trimetazidine, s nhim toan trong t bo gy bi thiu mu cc b gim
ng k v nhanh chng tr li gn nh bnh thng.
Nghin cu in th nng lng t bo chut ln sau khi tim vasopressin v chut nht
trong trng thi gim oxy m trm trng cho thy rng trimetazidine c tc dng : Ngn nga
s st gim nng lng cung cp ATP trong t bo c tim ; ngn nga s st gim d tr ATP v
AMP vng trong t bo no ; duy tr hot ng chc nng ca cc enzym ty lp th, ni sn xut
nng lng t bo trong t bo gan.
Trimetazidine lm gim c tnh ca cc gc t do c oxy ha trong tnh trng thiu mu cc
b t bo. Do thuc c tc dng bo v t bo chng li s gim oxy m.
Nhng c tnh ny t l vi mc gim oxy m t bo v khng ph thuc vo s hot ha
giao cm.
Cc th nghim m i c kim sot trong chng au tht chng minh rng trimetazidine
lm gia tng s dung np thc hnh bt u t ngy th 15 ca tr liu, vi mt s gia tng
ng k tng nng lc lm vic th nghim dung np thc hnh ; lm gim ng k tn s v
cng cc t au tht ; v lm gim ng k s s dng trinitrate.
DC NG HC
Thuc c hp thu nhanh, vi nh trong huyt tng t c khong 2 gi sau khi ung
thuc. Sinh kh dng tuyt i hn 85%. Nng ti a trong huyt tng khong 85 ng/ml
sau khi dng liu duy nht 40 mg trimetazidine. Th tch phn phi biu kin l 4,8 l/kg ; gn kt
vi protein huyt tng thp, khong 21%.
Trimetazidine c thi tr ch yu qua nc tiu ; thi gian bn hy trung bnh l 5,5 gi.
CH NH
Trimetazidine c ch nh trong iu tr bnh tim do thiu mu cc b (cn au tht ngc, di
chng nhi mu). iu tr di hn cn au tht ngc.
CHNG CH NH
Qu mn vi trimetazidine.
LC C THAI v LC NUI CON B

Lc c thai :
Nn trnh dng Cardimax-20 c bit l trong 3 thng u ca thai kz tr khi tht cn thit ; tuy
nhin, khng c nghin cu no trn sc vt cho thy thuc c tc dng gy qui thai hay c
tnh vi phi.
Lc nui con b :
Khng c s liu v s bi tit trimetazidine qua sa m. Tuy nhin, nn ngng cho con b nu
cn thit phi dng trimetazidine.
TNG TC THUC
Cho n nay khng c tng tc thuc no c ghi nhn. C th khng tng tc no c
ghi nhn vi cc thuc chn beta, thuc c ch calci, nitrate, heparin, thuc h lipid huyt hoc
digitalis.
TC DNG NGOI
Thng thy nht l kh chu d dy, bun nn, nhc u v chng mt. Tuy nhin cc tc dng
ngoi { thng nh v khng c hiu.
LIU LNG v CCH DNG
3 vin/ngy (24 gi), nn chia lm 3 ln trong cc ba n.
Khng cn chnh liu bnh nhn suy chc nng gan v thn.

86.

CARDURAN

PFIZER
c/o ZUELLIG
vin nn 1 mg hp 10, 28 v 100 vin.
vin nn 2 mg hp 10, 28 v 100 vin.
vin nn 4 mg hp 10, 28 v 100 vin - Bng B.
THNH PHN
cho 1 vin
Doxazosin mesylate, tnh theo doxazosin

1 mg

cho 1 vin
Doxazosin mesylate, tnh theo doxazosin

2 mg

cho 1 vin
Doxazosin mesylate, tnh theo doxazosin

4 mg

T dc : mui natri glycolate,

microcrystalline cellulose, lactose,
magnesium stearate v mui natri lauryl
sulfate.
DC LC
Doxazosin c tc dng gin mch thng qua hot ng c ch chn lc v cnh tranh v tr sau
khp a 1-adrenoceptor.
Doxazosin lm gim huyt p mt cch ng k do gim khng lc mch mu ton thn. Tc
dng ny c cho l do c ch chn lc trn a 1-adrenoceptor nm ti mch mu. Liu dng
mt ln duy nht trong ngy lm gim ng k huyt p sut ngy v sau 24 gi. Huyt p gim
t t v t hiu qu ti a sau 2-6 gi ung thuc. Bnh nhn cao huyt p, iu tr bng
doxazosin c huyt p tng t nh nhau c hai t th nm v ng. Khng ging nh cc
thuc c ch chn lc a adrenoceptor khc, iu tr lu di bng doxazosin khng gy hin
tng ln thuc. Cng t thy hin tng tng hot tnh renin v nhp nhanh khi tr liu lu di.
Doxazosin c tc dng tt trn lipid mu lm tng ng k t l HDL/tng cholesterol, gim
triglycerides v tng cholesterol. Thuc c tc dng thun li hn so vi li tiu v c ch bta
v nhng thuc c th nh hng khng tt n cc thng s ni trn. Do c s lin quan
gia cao huyt p v lipid mu vi bnh l mch vnh, tc dng tr liu thch hp ca doxazosin
trn c hai huyt p v lipid mu lm gim nguy c bnh l mch vnh.
Tr liu bng doxazosin lm gim ph i tht tri, c ch s kt dnh tiu cu v thc y tc
dng hot ha plasminogen m. Thm vo doxazosin ci thin tnh nhy cm vi insulin
bnh nhn km nhy cm.
Trong mt nghin cu lm sng c kim sot trn bnh nhn cao huyt p, iu tr bng
doxazosin c lin quan vi vic ci thin tnh trng ri lon cng dng. Ngoi ra nhng bnh
nhn ung doxazosin cho bit t b ri lon cng dng so vi nhng bnh nhn ung cc loi
thuc h p khc.
Vic dng doxazosin cho nhng bnh nhn b bu lnh tin lit tuyn ci thin ng k chc
nng ng tiu v nhng triu chng khc. Tc dng trn bu lnh tin lit tuyn c cho
l do c ch chn lc a-adrenoceptor nm trn m stroma c tin lit tuyn, bao v c bng
quang.
Doxazosin cho thy c tc dng c ch phn nhm 1A ca a1-adrenoceptor, chim hn 70% cc
phn nhm trong tin lit tuyn. iu ny chng t tc dng ca doxazosin trn nhng bnh

nhn bu lnh tin lit tuyn.

Doxazosin cng cho thy hiu qu v an ton khi iu tr lu di bu lnh tin lit tuyn (trn
48 thng).
Doxazosin cho thy khng c tc dng ph trn chuyn ha v thch hp khi s dng trn bnh
nhn tiu ng, hen ph qun, ri lon chc nng tht tri, bnh gt v bnh nhn cao tui.
Mt nghin cu in vitro cho thy c tnh chng oxy ha ca dng chuyn ha 6' v 7' hydroxy
ca doxazosin nng 5 mmol.
DC NG HC
Hp thu :
Sau khi ung liu iu tr, doxazosin c hp thu tt t nng nh vo khong hai gi sau
.
Chuyn ha/Thi tr :
Thi tr lm hai giai on vi thi gian bn thi l 22 gi, iu ny l c s cho vic s dng liu
duy nht trong ngy. t hn 5% doxazosin bi tit di dng khng i.
Nghin cu dc ng hc trn bnh nhn cao tui v bnh nhn suy thn khng thy thay i
ng k so vi bnh nhn tr c chc nng thn bnh thng. D liu trn bnh nhn suy gan
v tc ng ca nhng thuc nh hng trn chuyn ha gan (nh cimetidine) cn rt gii hn.
Nh i vi tt c cc loi thuc chuyn ha hon ton qua gan, vic dng doxazosin trn bnh
nhn c chc nng gan thay i phi cn thn (xem phn Thn trng lc dng).
CH NH
Cao huyt p :
Doxazosin c ch nh trong iu tr cao huyt p v c th dng nh loi thuc kim sot
cao huyt p u tin phn ln bnh nhn. Doxazosin c th dng phi hp vi cc loi thuc
h p khc nh li tiu thiazide, chn bta, c ch canxi hoc c ch men chuyn nhng
bnh nhn khng kim sot c vi mt loi thuc h p n thun.
Bu lnh tin lit tuyn :
Doxazosin c ch nh iu tr tc nghn ng tiu v cc triu chng km theo ca bu
lnh tin lit tuyn. Doxazosin c th dng trn bnh nhn b bu lnh tin lit tuyn c hay
khng km theo cao huyt p. iu tr bng doxazosin c hiu qu tt nhng bnh nhn b
bu lnh tin lit tuyn km theo cao huyt p v khng lm thay i ng k v mt lm
sng huyt p ca bnh nhn b bu lnh tin lit tuyn c huyt p bnh thng.
CHNG CH NH
Doxazosin chng ch nh nhng bnh nhn qu mn vi quinazoline.
CH PHNG v THN TRNG LC DNG
Trng hp suy gan :
Nh i vi bt kz cc loi thuc no chuyn ha hon ton qua gan, vic s dng doxazosin
cn phi cn trng bnh nhn suy gan (xem phn Dc ng hc).

nh hng trn kh nng li xe v vn hnh my :

Kh nng li xe hoc vn hnh my c th b nh hng, c bit vo lc bt u iu tr.
LC C THAI v LC NUI CON B
Mc d khng thy tc ng gy qui thai trong cc th nghim sc vt nhng kh nng sng
st ca phi thai gim khi s dng liu cc kz cao. Liu ny xp x 300 ln liu khuyn co ti a
ngi. Vn cha c nhng nghin cu y c kim sot trn ph n c thai hoc cho con
b, tnh an ton ca vic s dng doxazosin trong thi kz mang thai hoc cho con b vn cha
r. Theo , trong thi kz mang thai hoc cho con b ch dng doxazosin khi bc s cho rng li
ch iu tr vt qu nguy c c th c.
TNG TC THUC
Phn ln doxazosin trong huyt tng di dng gn kt vi protein (98%). D liu in vitro trn
huyt tng ngi cho thy doxazosin khng nh hng trong vic gn kt protein ca digoxin,
warfarin, phenytoin, hoc indomethacin. Ung doxazosin khng c bt kz mt tng tc thuc
ngoi no trn lm sng vi cc thuc li tiu h thiazide, frusemide, chn bta, cc thuc
khng vim khng steroid, khng sinh, cc thuc h ng huyt dng ung, cc thuc tng
acid uric niu hoc thuc chng ng.
TC DNG NGOI
Cao huyt p :
Trong cc nghin cu lm sng c kim sot, phn ng thng thng nht khi dng doxazosin
l h huyt p t th (him khi ngt) hoc khng chuyn bit, gm c chng mt, nhc u,
mt mi, kh chu, chng mt t th, chong vng, ph, suy nhc, ng g, bun nn v vim
mi.
Khi thuc lu hnh, c thm mt s tc dng ngoi { di y c bo co : mt s trng
hp him nh kh chu ng tiu ha : au bng, tiu chy, i ma, kch ng v run. Mt s
trng hp cc kz him gp nh tiu khng t ch c l do tc dng dc lc ca doxazosin.
Mt s ca him gp b cng au dng vt v bt lc c bo co lin quan n vic
dng thuc c ch a-1 k c doxazosin. Mt s trng hp khc b pht ban ngoi da, nga
ngy, gim tiu cu, cht xut huyt, gim bch cu, tiu mu, mt, vng da, bt thng men
gan, chy mu mi v nhn m cng c bo co.
Nhng tc dng ngai { thm vo di y c bo co khi thuc c lu hnh dng
iu tr bnh nhn cao huyt p, ni chung khng th phn bit vi nhng triu chng c th
xy ra khi khng dng doxazosin : nhp nhanh, hi hp, au ngc, cn au tht ngc, nhi mu
c tim, tai bin mch mu no, lon nhp tim v nhn m.
Bu lnh tin lit tuyn :
Kinh nghim trn nhng cuc th nghim lm sng c kim sot bnh nhn bu lnh tin
lit tuyn cho thy cc tc dng ngoi { tng t nh bnh nhn iu tr cao huyt p.
LIU LNG v CCH DNG

Doxazosin c th ung vo bui sng hoc chiu.

Cao huyt p :
Liu doxazosin c th thay i t 1-16 mg mi ngy. Tr liu nn bt u vi liu 1 mg, mi ngy
mt ln trong 1-2 tun. C th tng ln 2 mg liu duy nht mi ngy trong 1-2 tun k tip. Nu
cn thit liu hng ngy c th tng t t mi 1-2 tun ln 4 mg, 8 mg, v 16 mg da trn p
ng ca bnh nhn t c hiu qu gim p mong mun. Liu thng thng l 2-4 mg
mi ngy mt ln.
Bu lnh tin lit tuyn :
Liu bt u l 1 mg mi ngy mt ln. Ty thuc vo lng nc tiu v triu chng ca bu
lnh tin lit tuyn mi bnh nhn liu lng c th tng ln 2 mg sau 4 mg v c th tng
n liu ti a c khuyn co l 8 mg. Vic chnh liu trong khong 1-2 tun. Liu thng
thng l 2-4 mg mt ln duy nht trong ngy.
Trn bnh nhn suy thn :
Dc ng hc ca doxazosin khng thay i trn bnh nhn suy thn v cng khng c bng
chng cho thy doxazosin lm nng thm tnh trng bnh l thn nn c th dng liu thng
thng nhng bnh nhn ny.
i vi tr em :
Khng c kinh nghim s dng doxazosin trn tr em.
QU LIU
Tnh trng qu liu c th a dn tt huyt p, nn t bnh nhn nm nga u thp. Nhng
phng php h tr khc nn c thc hin nu thy thch hp cho tng trng hp c th.
Doxazosin gn kt vi protein cao nn khng ch nh chy thn nhn to.

87.

CATAFLAM

NOVARTIS
vin bao ng 25 mg : hp 100 vin, 500 vin.
THNH PHN
cho 1 vin
Diclofnac potassium

25 mg

DC LC
Cataflam l mt thuc khng vim khng st roide c c tnh gim au, khng vim v h st

mnh.
Cataflam c tc ng khi pht nhanh chng lm cho thuc c bit thch hp trong vic iu
tr cc chng au v vim cp tnh.
Tc dng c ch sinh tng hp prostaglandine c kt lun qua cc th nghim, c xem
nh l c ch tc dng c bn ca thuc. Prostaglandine gi vai tr rt ln trong gy vim, au
v st.
In vitro, diclofnac khng lm gim sinh tng hp protoglycane trong sn cc nng tng
ng vi nng c ghi nhn ngi.
Cataflam c chng minh c tc ng gim au mnh trong nhng cn au t trung bnh cho
n trm trng. Khi c vim, v d nh vim do chn thng hay do can thip phu thut,
thuc nhanh chng lm gim chng au t nhin v au do vn ng, v gim ph n do vim
v ph n vt thng.
Cc nghin cu lm sng cng cho thy vi au bng kinh tin pht, hot cht c kh nng lm
gim au v gim mc xut huyt.
Trong cn migrain, Cataflam chng minh lm gim nhc u v ci thin cc triu chng
bun nn, nn i km.
DC NG HC
Hp thu :
Diclof nac potassium c hp thu nhanh chng v hon ton sau khi ung. S hp thu bt
u ngay sau khi ung v lng hp thu tng t nh lng thuc c hp thu t cng mt
liu di dng vin nn diclofnac sodium khng tan trong d dy. Nng ti a trung bnh
trong huyt tng l 3,8 mmol/l t c sau 20-60 pht sau khi ung mt vin thuc 50 mg.
Ung thuc khi n khng gy nh hng n lng diclof nac c hp thu, mc d tc dng
khi u v tc hp thu c th ko di mt t.
Lng thuc c hp thu c lin quan tuyn tnh vi liu s dng.
Do khong mt na diclofnac b chuyn ha trong ln qua gan u tin, do din tch di
ng cong nng khi dng dng ung hoc ng trc trng ch bng khong mt na so
vi ng tim vi liu tng t.
Dc ng ca thuc khng thay i sau khi dng nhiu liu lin tip. Thuc khng b tch t
nu c dng ng khong cch liu c khuyn co.
Phn phi :
Lng diclofnac lin kt vi protine huyt tng l 99,7%, ch yu vi albumine (99,4%). Th
tch phn phi trong khong 0,12-0,17 l/kg. Diclof nac i vo trong hot dch, ni c nng
ti a o c t 2 n 4 gi sau khi t c nng ti a trong huyt tng. Thi gian bn
hy o thi t hot dch l 3-6 gi. Hai gi sau khi t n nng ti a trong huyt tng,
nng hot cht trong hot dch cao hn nng trong huyt tng, v nng ny
c duy tr cao hn so vi trong huyt tng cho n 12 gi.

Chuyn ha sinh hc :
Chuyn ha sinh hc ca diclofnac mt phn do s lin hp ca bn thn phn t nhng phn
ln bi s hydroxyl ha v mthoxyl ha mt gc hoc nhiu gc, to nn mt vi cht chuyn
ha phenol (3'-hydroxy-, 4'-hydroxy-, 5-hydroxy-, 4',5-dihydroxy-, v 3'-hydroxy-4'-mthoxydiclofnac), hu ht nhng cht chuyn ha ny c chuyn thnh dng lin hp
glucuronique. Hai trong s nhng cht chuyn ha ny c hot tnh sinh hc, nhng vi mc
yu hn nhiu so vi diclofnac.
o thi :
Ton b thanh thi ton thn ca diclofenac t huyt tng l 263 +/- 56 ml/pht (gi tr trung
bnh +/- SD). Thi gian bn hy cui cng trong huyt tng l 1-2 gi. Bn trong s cc cht
chuyn ha, trong c hai cht chuyn ha c hot tnh, cng c thi gian bn hy ngn trong
huyt tng t 1-3 gi. Mt cht chuyn ha l 3'-hydroxy-4'-mthoxy-diclofnac, c thi gian
bn hy trong huyt tng di hn. Tuy nhin, cht chuyn ha ny hu nh khng c tc
dng.
Khong 60% liu dng c o thi qua nc tiu di dng lin hp glucuronique ca hot
cht v ca cht chuyn ha (hu ht nhng cht ny cng c chuyn sang dng lin hp
glucuronique). Di 1% c o thi di dng khng i. Phn cn li c o thi i
dng cht chuyn ha theo mt qua phn.
Tnh trng bnh nhn :
Khng ghi nhn c s khc bit theo tui tc trong s hp thu, chuyn ha hay o thi thuc.
bnh nhn suy thn, khi dng liu duy nht theo phc iu tr thng thng, khng ghi
nhn c s tch t hot cht thuc di dng khng i c th can thip n dc ng ca
thuc. Vi thanh thi cr atinine di 10 ml/pht, nng trong huyt tng trng thi
bn vng tnh c ca cht chuyn ha hydroxyl cao hn khong 4 ln so vi ngi thng.
Tuy nhin, cc cht chuyn ha c o thi hon ton qua mt.
bnh nhn vim gan mn tnh hay x gan khng mt b, dc ng v chuyn ha ca
diclof nac cng ging nh bnh nhn khng c bnh gan.
D liu tin lm sng :
Diclofnac khng nh hng ln kh nng sinh sn ca sc vt th nghim v c s pht trin
trc, trong v sau khi sanh ra ca la con sau ny. Khng ghi nhn c tc dng gy qui thai
chut nht, chut ln v th. Khng thy c tc dng gy bin d trn nhiu th nghim in vivo
v in vitro khc nhau, v khng ghi nhn kh nng gy ung th trong nhng nghin cu di hn
chut ln v chut nht.
CH NH
iu tr ngn hn trong nhng trng hp vim au cp tnh nh trong cc chuyn khoa tai
mi hng, rng hm mt, sn ph khoa ... v cn au bng kinh, sau chn thng hoc phu
thut, cn migrain, au trong hi chng ct sng, thp ngoi khp.

CHNG CH NH
- Lot d dy t trng.
- Qu mn bit vi hot cht hay t dc ca thuc.
- Nh cc khng vim khng st roide khc, Cataflam khng c ch nh cho bnh nhn c
cn hen, ni m ay hay vim xoang cp do tc dng ca acide actylsalicyclique hay nhng
thuc khc c hot tnh c ch tng hp prostaglandine.
CH PHNG
Xut huyt tiu ha hay lot/thng d dy rut c th xy ra bt c lc no trong qu trnh tr
liu, c th c hoc khng c triu chng bo trc hay tin s bnh. Nhn chung, nhng chng
ny gy hu qu nghim trng cho ngi gi. Trong mt s rt t trng hp c xut huyt d
dy hay lot bnh nhn dng Cataflam, nn ngng thuc.
Nh cc khng vim khng st roide khc, nhng phn ng d ng, bao gm phn v/ging
phn v, cng c th xy ra trong nhng trng hp rt him m khng c xy ra khi dng
thuc trc .
Nh cc khng vim khng st roide khc, s dng Cataflam c th che i nhng du hiu v
triu chng nhim trng do tnh cht dc l ca n.
THN TRNG LC DNG
Theo di y khoa cht ch bnh nhn c triu chng cho thy c ri lon tiu ha, hay mt
bnh s gi n lot t trng hay d dy, bnh nhn b vim lot kt trng hay bnh Crohn, v
bnh nhn b suy gan.
Nh cc khng vim khng st roide khc, cc tr s ca mt hay nhiu enzyme gan c th gia
tng. Trong qu trnh iu tr ko di vi Cataflam, vic theo di chc nng gan c p dng
nh mt bin php phng. Nu kt qu th nghim chc nng gan bt thng ko di hay
xu i, nu c pht trin nhng du hiu hay triu chng lm sng ng vi bnh gan, hay nu
nhng biu hin khc xut hin (nh tng bch cu a osine, ni ban...) nn ngng Cataflam.
Chng vim gan c th xut hin m khng c triu chng bo trc.
Nn cn trng khi dng Cataflam bnh nhn c ri lon chuyn ha porphyrine gan, v
Cataflam c th gy bc pht cn.
Do tm quan trng ca prostaglandine trong s duy tr s ti mu thn, nn c bit cn
trng khi dng cho bnh nhn suy tim hay suy thn, ngi gi, bnh nhn ang iu tr vi
thuc li tiu v bnh nhn thiu ng k th tch dch ngoi bo do bt kz nguyn do g, v d
nh trc v sau i phu. Theo di chc nng thn c khuyn co p dng nh mt bin
php phng khi dng Cataflam trong nhng trng hp nh trn. S ngng thuc thng
dn theo sau tnh trng nh trc khi tr liu.
Vic iu tr vi Cataflam trong nhng ch nh nu trn thng cho thy ch cn dng trong
mt vi ngy. Nhng nu s dng ngc vi nhng li khuyn v cch dng thuc, c ngha l
iu tr di hn, nn o cng thc mu nh khi iu tr di hn vi nhng khng vim khng

st roide khc. Nh nhng khng vim khng stroide khc, Cataflam c th c ch tm thi s
kt tp tiu cu. Bnh nhn c ri lon ng mu nn c theo di cn thn. Trn c s y hc
c bn, nn cn thn khi dng cho ngi gi. c bit khuyn co rng nn dng liu hu hiu
thp nht cho ngi ln tui hay ngi nh cn.
Bnh nhn b chng mt hay nhng ri lon trn thn kinh trung ng nh ri lon th gic khi
dng thuc khng nn li xe hay s dng my mc.
LC C THAI v LC NUI CON B
Ph n mang thai ch c dng Cataflam khi c l{ do chnh ng v ch dng vi liu hu hiu
thp nht nh i vi nhng thuc c ch tng hp prostaglandine khc, c bit khi dng
thuc trong ba thng cui ca thai kz (do kh nng gy t cung v/hoc ng sm ng ng
mch).
Vi liu ung 50 mg mi 8 gi, hot cht c bi tit qua sa m, nhng vi lng rt nh v
khng ghi nhn c tc dng ngoi no ln tr s sinh.
TNG TC THUC
(Bao gm cc tng tc thuc quan st c khi dng cc hm lng khc v ca diclofnac
sodium)
- Lithium, digoxine : Cataflam c th lm tng nng trong huyt tng ca lithium hay
digoxine.
- Thuc li tiu : nh cc khng vim khng st roide khc, Cataflam c th c ch tc ng ca
thuc li tiu. iu tr ng thi vi thuc li tiu gi kali c th lm tng nng kali trong
huyt thanh, do nn theo di khi dng chung hai loi thuc ny.
- Cc khng vim khng stroide khc : dng phi hp cc khng vim khng stroide c th
lm tng kh nng xy ra tc dng ngoi .
- Thuc chng ng mu : mc d nhng thm d lm sng khng cho thy rng Cataflam tc
ng ln tnh cht chng ng, cng c nhng bo co ring bit v s gia tng nguy c xut
huyt bnh nhn dng ng thi Cataflam v thuc chng ng mu. Do , nn theo di
cn thn nhng bnh nhn ny.
- Thuc h ng huyt : cc nghin cu lm sng cho thy Cataflam c th c dng chung
vi thuc h ng huyt m khng nh hng n tc dng trn lm sng. Tuy nhin, c
nhng trng hp ring bit c bo co v tc ng tng ng huyt ln h ng huyt
i hi phi thay i liu lng ca thuc h ng huyt trong qu trnh iu tr vi Cataflam.
- Mthotrexate : cn cn thn nu thuc khng vim khng st roide c dng di 24 gi
trc khi hoc sau khi iu tr vi mthotrexate, do nng trong mu ca mthotrexate c
th tng v do tng c tnh.
- Cyclosporine : tc ng ca thuc khng vim khng stroide ln prostaglandine thn c th
lm tng c tnh ca cyclosporine trn thn.
- Khng sinh nhm quinolone : c nhng bo co ring l v chng co git c th l do s

dng ng thi quinolone v thuc khng vim khng stroide.

TC DNG NGOI
Bao gm cc tc dng ngoi xy ra khi dng cc hm lng khc ca Cataflam v diclofenac
sodium trong iu tr ngn hn hay di hn.
(Tn sut c lng : thng xuyn > 10% ; i khi > 1-10% ; him > 0,001-1% ; trng hp
ring bit < 0,001%).
- ng tiu ha : i khi : au thng v, cc ri lon tiu ha khc nh bun nn, nn ma,
tiu chy, co tht rut, kh tiu, trng bng, chn n ; him : xut huyt tiu ha (nn ra mu,
phn en, tiu chy c mu), lot d dy hay rut c hay khng c xut huyt hay thng ;
trng hp ring bit : vim nim mc ming, vim li, sang thng thc qun, hp rut
dng biu , bnh phn i trng nh vim kt trng xut huyt khng c hiu v vim kt
trng c lo t tng nng hn hay bnh Crohn, to bn, vim ty.
- H thn kinh trung ng : i khi : nhc u, chng mt, chong vng ; him : bun ng ;
trng hp ring bit : ri lon cm gic, bao gm d cm, ri lon tr nh, mt nh hng,
mt ng, kch thch, co git, trm cm, bn chn, ng c c mng, run ry, phn ng lon tm
thn, vim mng no v khun.
- Gic quan : trng hp ring bit : ri lon th gic (nhn m, song th), gim thnh gic, tai,
ri lon v gic.
- Da : i khi : ni ban hay pht ban da ; him : ni m ay ; trng hp ring bit : ni ban c
mn nc, ecz ma, ban a dng, hi chng Stevens- Johnson, hi chng Lyell (chng bong
biu b nhim c cp), chng da (vim da trc vy), rng tc, phn ng nhy cm nh sng,
ban xut huyt, bao gm ban xut huyt d ng.
- Thn : him : ph n ; trng hp ring bit : suy thn cp, bt thng tit niu nh tiu ra
mu v protine niu, vim k thn, hi chng thn h, hoi t nh thn.
- Gan : i khi : tng aminotransferase huyt thanh ; him : vim gan c hay khng c vng da ;
trng hp ring bit : vim gan kch pht.
- Mu : trng hp ring bit : gim tiu cu, gim bch cu, thiu mu tn huyt, thiu mu
bt sn, mt bch cu ht.
- Qu mn : him : phn ng qu mn nh hen suyn, phn ng phn v hay ging phn v
ton thn bao gm h huyt p ; trng hp ring bit : vim mch, vim phi.
- H tim mch : trng hp ring bit : nh trng ngc, au ngc, cao huyt p, suy tim sung
huyt.
LIU LNG v CCH DNG
Dng cho ngi ln : liu khi u khuyn co dng mi ngy l 100-150 mg. Trong nhng
trng hp nh hn cng nh cho tr em trn 14 tui, thng ch dng 75-100 mg/ngy l .
Nn chia liu mi ngy thnh 2-3 ln dng.
nau bng kinh nguyn pht : liu hng ngy nn iu chnh theo tng ngi v thng t 50-

150 mg. Nn dng liu khi u l 50-100 mg v nu cn c th tng trong mt vi trng hp

ln n 200 mg/ngy. Nn bt u iu tr ngay khi c xut hin triu chng u tin v ty
thuc vo cc triu chng, tip tc thm vi ngy na.
Nn nut vin thuc vi nc, tt nht l trc ba n.
nTrong cn migrain : khi u iu tr liu 50 mg khi c tin triu u tin. Trong trng hp
sau 2 gi vn khng c du hiu gim au, c th ung thm 1 liu 50 mg. Nu cn thit c th
dng 50 mg mi 4-6 gi. Tng liu khng qu 200 mg/24 gi.
QU LIU
iu tr : vic iu tr ng c do thuc khng vim khng st roide c bit bao gm cc bin
php h tr v iu tr triu chng. Khng c nhng chi tit in hnh lm sng no ca qu liu
diclofnac.
Nn p dng cc bin php iu tr sau y trong trng hp qu liu : iu tr h tr v iu
tr triu chng c ch nh cho nhng bin chng nh h huyt p, suy thn, co git, kch ng
tiu ha v suy h hp.
Cc bin php c hiu nh gy li tiu, thm phn hay truyn mu hu nh khng hu hiu
trong vic loi b cc khng vim khng stroide v mc gn kt cao vi protine v do s
chuyn ha rng ri ca thuc.

88.

CATALIN

TAKEDA
c/o MEGA PRODUCTS
thuc nh mt : hp ng 1 vin nn + l dung mi 15 ml.
THNH PHN
cho 1 vin
Pirenoxine

0,75 mg

cho 1 ml dung mi ha tan ng trng

Acide borique

12,0 mg

Potassium chlorure

1,6 mg

Methylparaben

0,2 mg

Propylparaben

0,1 mg

Thiomersal

0,001 mg

DC LC
Theo l thuyt Quinoid (Ogino), c thy tinh th xy ra khi cc protine ha tan trong thy
tinh th bin cht v tr thnh khng ha tan gy bi cc quinoid to thnh do s trc trc ca
qu trnh chuyn ha cc acide amine vng (tryptophane, thyroxine...). Pirenoxine c tc dng
dc l{ nh sau :
- n nh chc nng mng thy tinh th bng cch ngn chn s oxyde ha gc -SH, duy tr tnh
thm thu ca v bc (capsule) v chc nng trao i cation.
- Ngn chn s bin i protine ha tan trong thy tinh th thnh protine khng ha tan.
- Ngn chn s thnh lp cht kynurenine pht huznh quang do tc dng i khng hin tng
oxyde ha tryptophane ca thy tinh th di nh hng ca tia t ngoi.
- c ch peroxyde ha lipide ngn khng cho kt hp vi protine ca thy tinh th nh tnh
kh oxy mnh.
- c ch tc dng ca aldose reductase trong qu trnh bin i glucose thnh sorbitol trong
thy tinh th.
- Tng tranh vi coenzyme NADPH trong chu trnh bin i glucose sang sorbitol.
CH NH
Phng nga v iu tr trong giai on sm cc trng hp :
- c thy tinh th ngi ln tui.
- c thy tinh th do bin chng tiu ng.
- Sau phu thut c thy tinh th.
THN TRNG LC DNG
Ch dng nh mt, khng c tim vo xung quanh hoc trong mt.
Bo qun dung dch nh mt sau khi pha ch mt v ti.
Trnh tip xc phn u ca l thuc vi mt khi nh mt.
TC DNG NGOI
Catalin khng c v rt t khi gy tc dng ph.
C th c vim gic mc nng lan ta, vim b mi, sung huyt kt mc, xt hay nga. Nu mt
trong nhng triu chng trn xy ra, cn ngng thuc ngay lp tc.
LIU LNG v CCH DNG

Pha vin thuc vo chai dung mi, lc cho tan u.

Nh mi ln 1 n 2 git, 5 n 6 ln mi ngy.
BO QUN
Thuc sau khi pha c mu vng trong v c s dng trong vng 30 ngy. Bo qun ni mt
v trnh nh sng mt tri trc tip.

89.

CAVINTON

GEDEON RICHTER
vin nn 5 mg : v 25 vin, hp 2 v.
dung dch tim 10 mg/2 ml : ng 2 ml, hp 10 ng.
THNH PHN
cho 1 vin
Vinpocetine

5 mg

cho 1 ng
Vinpocetine

10 mg

DC LC
Cavinton ci thin chuyn ha no, lm tng tiu th oxygen ca no, lm tng sc chu ng
s thiu oxygen ca t bo no. Mt mt, do c ch s kt t tiu cu v lm gim s tng sc
khng ca mch, Cavinton ci thin c chn lc vi tun hon ; mt khc, do lm tng hm lng
ATP v cAMP, cng nh lm tng s vn chuyn oxygen bi hng cu, nn Cavinton to ra
nhng iu kin nng lng thun li.
CH NH
ng ung : lm gim nhng du hiu tm thn v thn kinh ca cc ri lon mch no
khc nhau (sau khi ngp mu no, sau cc tnh trng chn thng hoc x cng) : ri lon tr
nh, mt ngn ng, mt dng ng tc, lon vn ng, chong vng, nhc u v iu tr
nhng triu chng mao mch sinh dng ca hi chng sau mn kinh. Bnh no do tng huyt
p, suy mch no gin on, ri lon co tht mch no v vim ni mc ng mch no.
Ci thin tun hon bn trong chn thng no cc b v trong va x ng mch no tin
trin.

Trong khoa mt, thuc c th dng iu tr ri lon va x ng mch tin pht, ri lon
mao mch ca vng mc v mch mc cng nh iu tr thoi ha im vng v glaucome
th pht do huyt khi nghn mch tng phn hay hon ton.
Trong khoa tai, thuc dng iu tr suy thnh gic do nguyn nhn mch lin quan n tui
gi hoc do nhim c (do dng thuc), v chong vng c ngun gc m o.
Dng ng tim : iu tr cc bnh thn kinh trong cc ri lon mch do thiu mu no cc b
c , cp tnh, nu gii quyt c ngun xut huyt v c bit dng di dng truyn dch
gin on chm.
CHNG CH NH
- Ph n ang mang thai.
- Cm dng ng tim trong thiu mu c tim cc b nng v lon nhp nng.
CH PHNG v THN TRNG LC DNG
Do c thnh phn sorbitol trong thuc tim, ngi bnh b tiu ng phi kim tra thng
xuyn lng ng trong mu trong khi iu tr.
TNG TC THUC
Thuc tim tng k vi heparin, do khng nn truyn dch ny cho ngi bnh ang dng
heparin.
TC DNG NGOI
Cc tc dng khng mong mun rt him.
Tim mch : h huyt p tm thi, him khi nhp tim nhanh hoc ngoi tm thu.
Thn kinh : ri lon gic ng, chong vng, nhc u v yu mt c th xy ra, mc du chng
c th l nhng du hiu ca bnh c bn.
Tiu ha : nng, au bng, bun nn.
Ngoi da : nhng phn ng d ng ngoi da.
LIU LNG v CCH DNG
15-30 mg/24 gi (1-2 vin nn mi ln, ung 3 ln/24 gi) ; liu duy tr :15 mg/ 24 gi (mi ln
ung 1 vin, dng 3 ln trong 24 gi), dng trong thi gian di.
Khi truyn dch gin on, liu khi u l 20 mg/24 gi (pha 2 ng trong 500-1000 ml dch
truyn). Sau , liu thng thng l 30 mg/24 gi (pha 3 ng trong 500-1000 ml dch truyn).
Nu tnh trng ca ngi bnh i hi v nu ch phm ny c dung np tt, liu di dng
truyn dch c th c tng mt cch cn thn t n 1 mg/kg th trng/24 gi cho n
ngy iu tr th 10.
Lu { : Ch phm ny khng bao gi c dng tim bp hoc tim ngay vo tnh mch m
khng pha long.
BO QUN
Bo qun nhit phng, trnh nh sng.

90.

CECLOR

ELI LILLY
vin nang 250 mg : hp 12 vin.
bt pha hn dch ung 125 mg/5 mL : l 60 mL.
bt pha hn dch ung 250 mg/5 mL : l 60 mL.
bt pha hn dch ung 125 mg/ti : hp 12 ti.
THNH PHN
cho 1 vin nang
Cefaclor

250 mg

cho 5 mL
Cefaclor

125 mg

cho 5 mL
Cefaclor

250 mg

cho 1 ti
Cefaclor

125 mg

DC LC
Cefaclor l khng sinh bn tng hp, thuc nhm cephalosporin, dng ng ung. Tn ha
hc ca Ceclor l 3-chloro-7-D-(2-phenylglycinamido)-3-cephem-4-carboxylic acid
monohydrate.
Ph khng khun : Cc th nghim in vitro cho thy rng cephalosporin c tc dng dit khun
do c ch qu trnh tng hp thnh t bo. Trong khi cc th nghim in vitro chng minh
c tnh nhy cm ca phn ln cc chng vi khun sau y vi cefaclor, th hiu qu lm sng

i vi cc chng khng c cp trong phn Ch nh li cha c bit.

Vi khun hiu kh, gram dng
Staphylococci, bao gm chng to men penicillinase, coagulase dng tnh, coagulase m tnh
(khi c th nghim in vitro), c biu hin khng cho gia cefaclor v methicillin.
Streptococcus pneumoniae
Streptococcus pyogenes
Vi khun hiu kh, gram m
Citrobacter diversus
Escherichia coli
Hemophilus influenzae, bao gm cc chng to men b-lactamase, khng ampicillin.
Klebsiella spp.
Moraxella (Branhamella) catarrhalis
Neisseria gonorrhoeae
Proteus mirabilis
Vi khun k kh
Bacteroides spp. (ngoi tr Bacteroides fragilis).
Peptococcus niger
Peptostreptococcus spp.
Propionibacteria acnes
Ch : Staphylococci khng methicillin v phn ln cc chng enterococci [Enterococcus
faecalis (trc y gi l Streptococcus faecalis) v Enterococcus faecium (trc y gi l
Streptococcus faecium)+ khng vi cefaclor v cc loi cephalosporin khc. Cefaclor khng
tc ng trn phn ln cc chng Enterobacter spp, Serratia spp, Morganella morganii, Proteus
vulgaris v Providencia rettgeri. Cefaclor khng tc ng trn Pseudomonas spp hoc
Acinetobacter spp.
Khng sinh
Phng php khuch tn : Cc phng php nh lng i hi phi o ng knh vng v
khun, cho ph p c lng chnh xc nht tnh nhy cm ca vi khun vi cc khng sinh.
Phng php chun mc ny s dng a tm 30 mg cefaclor nh gi tnh nhy cm ca vi
khun. Bin lun kt qu da vo kt qu c ng knh vng v khun v nng c ch ti
thiu (MIC) ca cefaclor.
c kt qu khng sinh , dng a tm 30 mg cefaclor, nn bin lun da theo nhng tiu
chun sau y :
ng knh vng v khun (mm)

c kt qu

>= 18

(S) Nhy cm

15 - 17

(I) Trung gian

<= 14

(R) khng

Khi th nghim* vi H. influenzae

ng knh vng v khun (mm)

c kt qu

>= 20

(S) Nhy cm

17 - 19

(I) Trung gian

<= 16

(R) khng

* Th nghim ny s dng mi trng Haemophilus test medium (HTM).

Mc d ph khng khun ca cefaclor, v tnh cht tng t nh ph ca cephalothin v cc
cephalosporin th h th 1 khc, nhng tc ng ca cefaclor trn H. influenzae mnh hn
nhiu so vi cc cephalosporin th h th 1. V vy c th dng a tm 30 mg cefaclor xc
nh tnh nhy cm ca H. influenzae theo phng php c y Ban Quc Gia v cc Chun
mc Phng Th Nghim Lm Sng Hoa Kz (NCCLS) m t.
Kt qu "nhy cm" c ngha l vi khun gy bnh c th b c ch vi nng khng sinh t
c trong mu. Kt qu "trung gian" gi rng vi khun nhy cm khi dng liu cao hoc khi
ni b nhim khun l cc m v dch c nng khng sinh cao. Kt qu " khng" cho thy
nng khng sinh t c khng th c ch c vi khun v nn chn cch iu tr khc.
Cc phng php tiu chun i hi phi s dng cc chng vi khun chng trong phng th
nghim. a tm 30 mg cefaclor phi to ra ng knh vng v khun nh sau :
Vi khun

ng knh vng v khun (mm)

E. coli ATCC 25922

23 - 27

S. aureus ATCC 25923

27 - 31

H. influenzae ATCC 49766*

25 - 31

* Th nghim ny s dng mi trng Haemophilus test medium (HTM).

Phng php pha long : Phng php pha long chun mc (pha long trong plate, pha long
trong thch) hoc phng php tng ng, dng bt cefaclor. Tr s MIC c c nn bin
lun theo tiu chun sau :
MIC (mg/mL)

c kt qu

<= 8

Nhy cm

16

Trung gian

>= 32

Khng

Ging nh k thut khuch tn chun mc, k thut pha long i hi phi s dng cc chng
vi khun chng trong phng th nghim. Bt cefaclor chun mc phi cho kt qu MIC vi cc
tr s sau :
Vi khun

MIC (mg/mL)

S. aureus ATCC 29213

1-4

E. coli ATCC 25922

1-4

E. faecalis ATCC 29212

> 32

H. influenzae ATCC 49766*

1-4

*Th nghim pha long trong plate s dng mi trng Haemophilus Test Medium (HTM).
DC NG HC
Cefaclor c hp thu rt tt khi ung tnh trng i. Tng s thuc c hp thu ging nhau
d bnh nhn dng lc i hay lc no, tuy nhin khi dng chung vi thc n nng nh ch
t c 50%-70% so vi nng nh t c khi bnh nhn nhn i v t c chm hn
khong 45-60 pht. Khi ung tnh trng i, sau khi dng liu 250 mg, 500 mg, 1 g, nng
nh trung bnh trong huyt thanh tng ng l 7, 13, v 23 mg/L, t c sau 30-60 pht.
Khong 60-85% lng thuc c thi tr di dng khng i trong nc tiu trong vng 8
gi, mt phn ln thuc c thi tr trong 2 gi u. Trong khong 8 gi ny, nng nh
trong nc tiu tng ng sau khi ung 250 mg, 500 mg, 1 g t c l 600, 900, v 1.900
mg/L. Thi gian bn hy trung bnh trong huyt thanh ngi bnh thng khong 1 gi (t 0,6
n 0,9). bnh nhn c chc nng thn suy gim, thi gian bn hy thng k o di hn mt
cht. ngi suy gim hon ton chc nng thn, thi gian bn hy trong huyt thanh ca
dng thuc ban u l 2,3 n 2,8 gi. ng thi tr thuc bnh nhn suy thn nng cha
c xc nh. Lc mu lm gim thi gian bn hy ca thuc khong 25-30%.
CH NH
Cefaclor c ch nh cho cc nhim khun do cc vi khun nhy cm sau y:
- Vim tai gia do S. pneumoniae, H. influenzae, Staphylococci, S. pyogenes, (Streptococcus
beta tn huyt nhm A) v M. catarrhalis.
- Nhim khun ng h hp di, k c vim phi, gy ra do S. pneumoniae, H. influenzae, S.

pyogenes (Streptococcus beta tn huyt nhm A) v M. catarrhalis.

- Nhim khun ng h hp trn, k c vim hng v vim amian gy ra do S. pyogenes
(Streptococcus beta tn huyt nhm A) v M. catarrhalis.
Lu { : Penicillin l thuc thng c chn iu tr v phng nga nhim khun do
Streptococcus, gm c iu tr d phng thp khp. Hi Tim Hoa Kz ngh s dng
amoxillin nh l mt thuc chun mc d phng vim ni tm mc nhim khun trong cc
th thut nha khoa, cc th thut ti ming v ng h hp trn, penicillin V c th c chp
nhn l thuc thay th phng nga nhim khun huyt do Streptococcus ng tai mi
hng ; tuy nhin hin nay cha c cc s liu chc chn v hiu qu ca cefaclor trong phng
nga thp khp hoc vim ni tm mc nhim khun.
- Nhim khun tit niu bao gm vim b thn v vim bng quang do E. coli, P. mirabilis,
Klebsiella spp, v t cu coagulase m tnh.
Lu { : Cefaclor c hiu qu trong nhim khun tit niu k c cp tnh ln mn tnh.
- Nhim khun da v cu trc da do S. aureus v S. pyogenes (Streptococcus beta tn huyt
nhm A)
- Vim xoang
- Vim niu o do lu cu
Nn nui cy v lm khng sinh xc nh tnh nhy cm ca vi khun gy bnh vi
cefaclor.
CHNG CH NH
Khng dng thuc cho bnh nhn c tin s mn cm vi khng sinh thuc nhm
cephalosporin.
CH PHNG
Trc khi p dng phng php iu tr vi cefaclor, cn hi k xem trc y bnh nhn c
tin s phn ng qu mn vi cefaclor, cephalosporin, penicillin hoc cc thuc khc khng.
Nu phi dng cefaclor cho cc bnh nhn nhy cm vi penicillin, nn cn thn v ghi nhn
c phn ng d ng cho bao gm phn ng chong phn v gia cc khng sinh nhm blactam.
Nu c phn ng d ng vi cefaclor, nn ngng thuc. Khi cn thit, phi iu tr bnh nhn
vi cc loi thuc thch hp : cc amin co mch, khng histamin hoc corticosteroid.
Cc khng sinh bao gm cefaclor nn c dng cn thn cho cc bnh nhn c mt dng d
ng no , c bit l d ng vi thuc.
Vim kt trng gi mc c bo co xy ra vi hu ht cc khng sinh ph rng (bao gm
cc macrolide, cc penicillin bn tng hp, v cc cephalosporin). V vy vic cn nhc chn
on bnh nhn b tiu chy khi dng khng sinh rt quan trng.
Chng vim kt trng ny c th t nh n nng e da tnh mng ca bnh nhn. Th nh
thng ch cn ngng thuc. Th trung bnh n nng cn n cc bin php iu tr thch hp.

THN TRNG LC DNG

Tng qut : S dng cefaclor di ngy c th lm pht trin qu mc cc chng khng nhy
cm. Cn theo di bnh nhn cn thn. Nu b bi nhim, cn c cc bin php iu tr thch
hp.
c bo co cho thy phn ng Coombs trc tip dng tnh c th xy ra trong qu trnh
iu tr vi cc khng sinh cephalosporin. Cn bit rng kt qu dng tnh c th l do thuc,
th d trong cc nghin cu v huyt hc hay trong cc test th phn ng cho khi cn truyn
mu c s dng antiglobulin cc v tr th yu, hoc p dng th nghim Coombs trn tr s
sinh c m dng cc khng sinh cephalosporin trc khi sinh.
Cn thn khi dng cefaclor cho bnh nhn c chc nng thn suy gim nng. V thi gian bn
hy ca cefaclor bnh nhn v niu l 2,3-2,8 gi, nn thng khng iu chnh liu i vi
bnh nhn suy thn nng hay trung bnh. V cha c nhiu kinh nghim lm sng trong vic s
dng cefaclor cho nhng trng hp ny, nn cn theo di trn lm sng v kt qu xt nghim
tht cn thn.
Nn thn trng khi k toa khng sinh, bao gm cephalosporin cho bnh nhn c bnh ng
tiu ha, c bit l bnh vim kt trng.
S dng cho tr em : Tnh an ton v hiu qu ca cefaclor tr em di 1 thng tui cha
c bit.
Tc ng ca thuc trn cc xt nghim cn lm sng : Bnh nhn dng cefaclor c th c
dng tnh gi i vi xt nghim glucose nc tiu khi th vi dung dch Benedict v Fehling,
vin Clinitest, nhng s khng c dng tnh gi khi dng Testape (Glucose Enzymatic Test
Strip, USP, Lilly).
C mt vi bo co cho thy tc dng khng ng tng khi dng ng thi cefaclor v cht
khng ng ng ung (xem phn Tc dng ngoi ).
Cng nh cc khng sinh nhm b-lactam khc, probenecid c ch s bi tit cefaclor qua
ng thn.
Tnh gy ung th, t bin, nh hng kh nng sinh sn : Cha c cc nghin cu xc nh
tnh gy ung th v t bin. Cc nghin cu v kh nng sinh sn cho thy khng c bng
chng du hiu tn hi kh nng sinh sn.
LC C THAI
Cc nghin cu v sinh sn thc hin chut nht v chut cng vi liu gp 12 ln liu dng
cho ngi v chn sng vi liu gp 3 ln liu ti a cho ngi khng thy c du hiu tn
thng kh nng sinh sn hay nguy hi cho bo thai do cefaclor. Tuy nhin cc cng trnh
nghin cu kim sot cht ch trn ph n c thai cn cha y . V cc nghin cu trn sc
vt khng phi lun lun tin on c p ng ca ngi, ch nn dng thuc ny trn ph
n c thai nu tht cn thit.
Chuyn d v sinh n : nh hng ca cefaclor i vi chuyn d v sinh n cha c bit.

LC NUI CON B
Mt lng nh cefaclor c tm thy trong sa m sau khi dng thuc vi liu 500 mg. Nng
trung bnh trong sa l 0.18, 0.21, 0.16 mg/L tng ng vi cc thi im 2, 3, 4 v 5 gi.
Sau 1 gi nng trong sa rt t, ch dng vt. nh hng trn tr b m cha c bit.
Cn thn khi dng cefaclor cc b m ang cho con b.
TC DNG NGOI
Sau y l nhng tc dng ph c lin quan n vic s dng cefaclor.
Cc phn ng qu mn c bo co xut hin trong khong 1,5% bnh nhn, di dng ni
ban dng si (1/100 trng hp). Nga, m ay, phn ng Coombs dng tnh xy ra vi t l
thp hn cha n 1/200 trng hp cho mi loi. Cc trng hp xut hin phn ng ging
bnh huyt thanh c bo co trong mt vi trng hp s dng cefaclor. Cc c trng
ca phn ng ny gm hng ban a dng, ni ban v cc biu hin khc trn da i km vi vim
khp/ au khp, c st hoc khng st. Cc phn ng ny khc vi bnh huyt thanh c in
ch him khi km theo ni hch bch huyt v protein niu, khng c phc hp min dch
trong mu, v khng li di chng. i khi c th c tng triu chng ring l, nhng
khng phi l biu hin ca phn ng ging bnh huyt thanh. Trong khi cc cuc nghin cu k
cng thm na ang c tin hnh, phn ng ging bnh huyt thanh hnh nh l do phn
ng qu mn, v thng xy ra hn trong v sau khi iu tr cefaclor ln 2 (hoc nhng ln sau
na). Nhng phn ng ny c bo co thng thy tr em hn l ngi ln, vi t l t
1/200 (0,5%) trong mt th nghim tp trung n 2/8346 (0,024%) trong ton b cc th
nghim lm sng (t l tr em trong cc th nghim lm sng l 0,055%) n 1/38000
(0,003%) trong cc bo co ngu nhin. Cc du hiu v triu chng thng xy ra mt vi ngy
sau khi bt u iu tr v gim dn trong vi ngy sau khi ngng thuc. Cng c trng hp
bnh nhn phi nhp vin v nhng phn ng ny nhng thi gian nm vin thng ngn
(trung bnh t 2 n 3 ngy, theo bo co ca cc nghin cu theo di sau khi a thuc ra th
trng). nhng bnh nhn cn phi nhp vin, cc triu chng c th t nh n nng, phn
ln cc triu chng nng xy ra tr em. Thuc khng histamine v glucocorticoid gip gii
quyt cc du hiu v triu chng. Khng c bo co v cc di chng trm trng.
Cc phn ng qu mn nng hn, bao gm hi chng Stevens-Johnson, hoi t biu b nhim
c v phn ng phn v, him khi xy ra. Triu chng ging chong phn v c th biu hin
bng cc phn ng ring l bao gm ph mch, mt mi, ph (ph mt v chi), kh th, d cm,
ngt, hoc gin mch. Phn ng phn v c th xy ra ph bin hn cc bnh nhn c tin s
d ng penicillin. Cc phn ng qu mn c th k o di trong vi thng nhng rt him.
Triu chng tiu ha xy ra trong khong 2,5% bnh nhn, thng l tiu chy (1/70 trng
hp). Chng vim kt trng gi mc c th xut hin c trong v sau qu trnh iu tr bng
thuc khng sinh. Bun nn v nn t khi xy ra. Cng ging nh mt s penicillin v
cephalosporin khc, vim gan nh v vng da mt cng c bo co xy ra rt t.

Cc tc dng khc cho l lin quan n tr liu bng khng sinh bao gm chng tng bch cu
a eosine (1/50 bnh nhn), nga b phn sinh dc, vim m o (< 1/100 bnh nhn), him
khi c gim tiu cu v vim thn k c hi phc.
Cc tc dng khc khng chc c lin quan n thuc, bao gm :
H thn kinh trung ng : Tng ng th hi phc, lo lng, cng thng, mt ng, l ln, tng
trng lc c, chng mt, o gic, ng g, c c bo co nhng rt t.
Nhng bt thng tm thi v cc xt nghim lm sng cng c bo co mc du nguyn
nhn cha c xc nh r rng, chng cng c nu ra nh nhng thng tin bc s tham
kho :
Gan : tng nh AST (SGOT), ALT (SGPT) hoc phosphatase kim (1/40).
C quan to mu : Ging nh cc khng sinh h b-lactam khc, tng t bo lympho huyt, gim
bch cu tm thi, v him hn thiu mu do tn huyt, thiu mu bt sn, mt bch cu ht,
gim bch cu trung tnh c th hi phc c { ngha trn lm sng.
Cng c nhng bo co v s gia tng thi gian prothrombin c hoc khng c xut huyt lm
sng bnh nhn dng ng thi cefaclor v coumadin.
Thn : tng nh BUN hay creatinine huyt thanh (t hn 1/500) hoc kt qu nc tiu bt
thng (t hn 1/200).
Mt s cephalosporin c th gy bc pht cn ng kinh, c bit nhng bnh nhn suy thn
khi khng c gim liu. Nu xut hin cn ng kinh do dng thuc, nn ngng thuc. C
th iu tr chng co git nu trn lm sng thy cn thit.
LIU LNG v CCH DNG
Cefaclor c s dng bng ng ung.
Ngi ln : Liu thng thng l 250 mg mi 8 gi. i vi vim phi v vim ph qun, dng
250 mg, 3 ln mi ngy. i vi vim xoang, dng 250 mg, 3 ln mi ngy trong 10 ngy. i vi
nhim khun trm trng hn (nh vim phi) hoc nhim khun do cc vi khun khc t nhy
cm hn, c th tng liu gp i. Liu 4g/ngy c dng mt cch an ton cho ngi bnh
thng trong vng 28 ngy, tuy nhin liu tng cng hng ngy khng nn vt qu lng ny.
iu tr vim niu o cp do lu cu nam v n, dng mt liu duy nht 3 g, phi hp vi
1 g probenecid.
Tr em : Liu thng thng l 20 mg/kg/ngy, chia ra mi 8 gi. i vi vim ph qun v vim
phi, dng liu 20 mg/kg/ngy, chia lm 3 ln. i vi cc nhim khun trm trng hn, vim
tai gia, v nhim khun do vi khun t nhy cm nn dng liu 40 mg/kg/ngy chia lm nhiu
ln ung. Liu ti a l 1 g/ngy.
Cch dng cefaclor dng dung dch treo :
Liu 20 mg/kg/ngy :

Ghi ch : mung caf

(mcf)
Trng lng tr

Loi 125 mg/5 mL

9 kg

1/2 mcf, 3 ln/ngy

18 kg

1 mcf, 3 ln/ngy

Loi 250 mg/5 mL

1/2 mcf, 3 ln/ngy

Liu 40 mg/kg/ngy :
Trng lng tr

Loi 125 mg/5 mL

Loi 250 mg/5 mL

9 kg

1 mcf, 3 ln/ngy

1/2 mcf, 3 ln/ngy

18 kg

1 mcf, 3 ln/ngy

iu tr vim tai gia v vim hng, tng liu hng ngy c th chia lm 2 ln, cch 12 gi/ln
theo cch dng sau :
Vim hng : 20
mg/kg/ngy
Trng lng tr

Loi 187 mg/5 mL

9 kg

1/2 mcf, 2 ln/ngy

18 kg

1 mcf, 2 ln/ngy

Loi 375 mg/5 mL

1/2 mcf, 2 ln/ngy

Vim tai gia : 40

mg/kg/ngy
9 kg
18 kg

1 mcf, 2 ln/ngy

1/2 mcf, 2 ln/ngy

1 mcf, 2 ln/ngy

Cefaclor c th dng cho bnh nhn suy thn, trong trng hp ny thng khng cn iu
chnh liu (xin xem phn Thn trng lc dng).
Trong iu tr nhim khun do Streptococcus beta tn huyt, nn dng Cefaclor t nht 10 ngy.
QU LIU

Du hiu v triu chng : Cc triu chng ng c khi dng cefaclor c th gm : bun nn,
nn, au thng v, tiu chy. Mc au thng v v tiu chy ph thuc vo liu lng.
Nu c thm cc triu chng khc, c th l do phn ng th pht ca mt bnh tim n, ca
phn ng d ng hay tc ng ca chng ng c khc km theo.
iu tr : iu tr qu liu, cn cn nhc n kh nng qu liu ca nhiu loi thuc, tng
tc gia cc loi thuc, dc ng hc bt thng ca bnh nhn. Ngoi tr trng hp ung
liu gp 5 ln liu bnh thng, khng cn thit phi p dng bin php ra d dy.
Bo v ng h hp ca bnh nhn, h tr thng kh v truyn dch. Theo di cn thn v duy
tr cc du hiu sinh tn ca bnh nhn, kh mu, cht in gii trong huyt thanh v.v. C th
lm gim s hp thu thuc ng tiu ha bng than hot tnh. Trong nhiu trng hp,
bin php ny c hiu qu hn gy nn hoc ra d dy. Cn nhc xem nn dng than hot tnh
thay cho ra d dy hay phi kt hp c hai. Dng nhiu liu lin tip than hot tnh c th lm
gia tng s o thi thuc c hp thu. Cn bo v ng h hp ca ngi bnh khi p
dng phng php ra d dy hay dng than hot tnh. Cc bin php khc nh dng thuc li
tiu mnh, thm phn phc mc, lc mu, thm tch mu bng than hot, cha c xc nh
l c hiu qu trong iu tr qu liu cefaclor.
BO QUN
Bo qun thuc nhit phng, 59o-86oF (15o-30oC).
Nn ct thuc dng dung dch treo pha trong t lnh. Vn np cht v lc k trc khi
dng. C th ct gi thuc trong 14 ngy m hiu lc gim khng ng k. Sau 14 ngy, b
phn thuc cn tha i.

91.

CECLOR CD

ELI LILLY
vin nn phng thch chm 375 mg : hp 10 vin.
THNH PHN
cho 1 vin
Cefaclor monohydrate, tng ng Cefaclor

375 mg

DC LC
In vitro, tnh cht dit khun ca Ceclor CD l do bi cefaclor. Cc th nghim in vitro cho thy
cephalosporin c tc dng dit khun do c ch qu trnh tng hp thnh t bo. Cefaclor

khng b nh hng bi enzym b-lactamase, do cefaclor dit c nhng vi khun tit

enzym b-lactamase khng vi penicillin v mt s cephalosporin. Ceclor CD chng minh hiu
qu dit khun c trn lm sng v in vitro i vi cc vi khun sau :
Vi khun gram dng :
Staphylococcus aureus (bao gm nhng chng tit b-lactamase)
Staphylococcus epidermidis (bao gm nhng chng tit b-lactamase)
Staphylococcus saprophyticus
Streptococcus pneumoniae
Streptococcus pyogenes (lin cu nhm A).
Ghi ch : Cefaclor khng nhy cm vi chng t cu khng Methicillin.
Vi khun gram m :
Haemophilus parainfluenzae
Haemophilus influenzae (bao gm nhng chng tit b-lactamase)
Moraxella (Branhamella) catarrhalis (bao gm nhng chng tit b-lactamase)
Escherichia coli
Klebsiella pneumoniae
Proteus mirabilis
Mc du hiu qu trn lm sng cha c xc nh, nhng in vitro, cefaclor nhy cm vi cc
vi khun sau:
Vi khun gram m :
Citrobacter diversus
Neisseria gonorrhoeae
Vi khun k kh :
Propionibacterium acnes
Cc chng Bacteroides (ngoi tr Bacteroides fragilis)
Peptococci
Peptostreptococci
Ghi ch : Pseudomonas sp, Acinetobacter calcoaceticus, hu ht cc chng enterococci,
Enterobacter sp, Proteus indol dng tnh v Serratia sp khng vi cefaclor.
Th nghim khng sinh :
Phng php khuch tn : Cc phng php nh lng yu cu phi o ng knh vng v
khun c tnh nhy cm ca khng sinh. y l phng php c y Ban Quc Gia v
Chun Mc Xt Nghim Lm Sng (NCCLS) ca Hoa kz chp thun. Phng php ny ngh
dng a khng sinh cefaclor nh gi nhy cm ca vi khun. Bin lun kt qu da vo
ng knh vng v khun v nng c ch ti thiu (MIC) ca cefaclor. Kt qu khng sinh
vi mt a khng sinh chun duy nht cha 30 mg cefaclor s c bin lun theo nhng
tiu chun sau :

ng knh vng v khun (mm)

Bin lun kt qu

>= 18

(S) Nhy cm

15 - 17

(I) Trung gian

<= 14

(R) khng

Khi th nghim vi H. influenzae*

ng knh vng v khun (mm)

Bin lun kt qu

>=20

(S) Nhy cm

17 - 19

(I) Trung gian

<= 16

(R) khng

* Th nghim ny s dng mi trng cy Haemophilus test medium (HTM).

Kt qu "nhy cm" ngha l vi khun gy bnh c th b c ch vi nng khng sinh t
c trong mu. Kt qu "trung gian" ngha l vi khun nhy cm khi dng khng sinh liu cao
hoc khi cc vng b nhim khun nh cc t chc, dch c th (v d : nc tiu) t c
nng khng sinh cao. Kt qu " khng" cho thy nng khng sinh t c khng th
c ch c vi khun v nn chn khng sinh khc.
Cc phng php chun mc yu cu phi s dng cc vi khun chng phng xt nghim. Vi
a tm 30 mg cefaclor phi to c ng knh cc vng v khun nh sau :
Vi khun

ng knh vng v khun (mm)

E. coli ATCC 25922

23 - 27

S. aureus ATCC 25923

27 - 31

H. influenzae ATCC 49766*

25 - 31

* Th nghim ny s dng mi trng cy Haemophilus test medium (HTM).

Ngoi M. catarrhalis v H. influenzae, cc vi khun khc c th th nghim vi a tm
cephalothin 30 mg hoc bng phng php pha long. Dng Ceclor CD mang li hiu qu p
ng tha ng v lm sng cng nh v vi khun hc trong hu ht cc trng hp nhim M.
catarrhalis, khng cn da vo kt qu o ng knh vng v khun, do vy, t khi dng
cefaclor th nghim nhy cm trn vi khun ny. Nn th nghim H. influenzae vi a

tm cefaclor trn mi trng Mueller-Hinton chocolate v bin lun kt qu theo cc tiu

chun nu trn. Haemophilus influenzae cng c th th nghim trn mi trng
Haemophilus test medium (HTM) v s dng cc tiu chun do NCCLS ngh bin lun kt
qu nh sau :
ng knh vng v khun (mm)

Bin lun kt qu

>= 24

(S) Nhy cm

19 - 23

(I) Trung gian

<= 18

(R) khng

Phng php pha long : Cc phng php pha long trong thch v canh thang nh NCCLS
ngh, c th dng xc nh nng c ch ti thiu ca cefaclor. Kt qu th nghim ny
c bin lun theo cc tiu chun sau :
Nng c ch ti thiu (mg/mL)

Bin lun kt qu

<= 8

(S) Nhy cm

16

(I) Trung gian

>= 32

(R) khng

Ging nh cc phng php khuch tn chun, phng php pha long cng yu cu phi dng
cc chng vi khun chng phng xt nghim. Dng bt cefaclor chun s cho kt qu nng
c ch ti thiu nh sau :
Chng vi khun

Nng c ch ti thiu (mg/ml)

E. coli ATCC 25922

1-4

S. aureus ATCC 29213

1-4

E. faecalis ATCC 29212

> 32

H. influenzae ATCC 49766*

1-4

* Cc th nghim pha long canh thang dng mi trng cy Haemophilus test medium (HTM).
DC NG HC
Ceclor CD c hp thu tt qua ng tiu ha sau khi ung. Mc du Ceclor CD c th ung

lc no hoc lc i, tuy nhin ung lc no thuc s c hp thu tt hn. Ung thuc sau khi
n mt gi, sinh kh dng ca Ceclor CD trn 90% so vi cefaclor. Nu ung lc i th con s
ny l 77%. So vi Cefaclor (ung lc i), nng nh trung bnh trong huyt thanh ca
Ceclor CD (o c lc no ln lc i) u thp hn v t n chm hn t 40 n 90 pht. Cc
thuc c ch H2 dng chung khng lm hn ch s hp thu ca Ceclor CD. Cc thuc khng acid
cha hydroxide nhm hoc hydroxide magnesium c ung mt gi sau khi dng Ceclor CD,
khng nh hng n tc nhng lm gim 17% mc hp thu ca Ceclor CD.
Sau khi dng liu 375 mg, 500 mg v 750 mg, nng nh trung bnh trong huyt thanh ln
lt l 4, 8 v 11 mg/ml t c sau 2,5 n 3 gi. Khng ghi nhn c s tch ly thuc khi
dng liu hai ln mi ngy.
Thi gian bn hy trung bnh trong huyt thanh ngi bnh thng khong mt gi (t 0,6 0,9 gi) v khng ph thuc vo liu dng. ngi cao tui (trn 65 tui) c creatinine mu
bnh thng, th nng nh ca thuc trong huyt thanh c th cao hn v din tch di
ng cong (AUC) c th b nh hng do gim nh chc nng thn v khng c { ngha trn
lm sng. V vy, khng cn thit phi iu chnh liu dng ngi cao tui c chc nng thn
bnh thng. Khng c bng chng no v s chuyn ha cefaclor ngi.
CH NH
Ceclor CD c ch nh trong nhim khun do cc vi khun nhy cm sau :
- Vim ph qun cp v t cp ca vim ph qun mn do S. pneumonia. H. influenzae (bao
gm nhng chng tit b-lactamase), H. parainfluenzae, M. catarrhalis (bao gm nhng chng
tit b-lactamase) v S. aureus.
- Vim hng v vim amian do S. pyogenes (lin cu nhm A). (Penicillin l thuc thng c
chn iu tr v phng nga nhim khun do lin cu, k c iu tr d phng thp khp.
Ni chung, Ceclor CD iu tr c hiu qu cc trng hp nhim lin cu vng hu hng; tuy
nhin, hin nay cha c cc s liu ng k v hiu qu ca Ceclor CD trong phng nga thp
khp).
- Vim phi do S. pneumoniae, H. influenzae (bao gm nhng chng tit b-lactamase) v M.
catarrhalis (bao gm nhng chng tit b-lactamase).
- Nhim khun ng tit niu di khng bin chng bao gm vim bng quang v vi khun
niu khng triu chng do E. coli, K. pneumoniae, P. mirabilis v S. saprophyticus.
- Nhim khun da v cu trc da do S. pyogenes (lin cu nhm A), S. aureus (bao gm nhng
chng tit b-lactamase) v S. epidermidis (bao gm nhng chng tit b-lactamase).
Nn nui cy v lm khng sinh xc nh vi khun gy bnh v nhy cm vi cefaclor.
C th bt u iu tr ngay trong khi ch i cc kt qu ny, nhng mt khi c kt qu
khng sinh , th phi thay i cho ph hp.
CHNG CH NH
Ceclor CD khng dng cho ngi bnh c tin s mn cm vi cefaclor v cc khng sinh nhm

cephalosporin khc.
CH PHNG
Trc khi p dng phng php iu tr vi Ceclor CD, cn hi xem trc y ngi bnh c
tin s phn ng qu mn vi cefaclor, cephalosporin, penicillin hoc cc thuc khc hay
khng. Thn trng s dng khng sinh ngi bnh mn cm vi penicillin v ni chung, l
bt c ngi bnh no c biu hin d ng, nht l d ng vi thuc. Nu c phn ng vi
Ceclor CD th nn ngng thuc ngay. Trng hp phn ng nghim trng c th cn phi dng
n adrenaline v cc bin php hi sc cp cu khc.
Vim rut kt mng gi gp hu ht cc trng hp dng khng sinh ph rng (gm cc
nhm macrolide, penicillin bn tng hp v cephalosporin) ; v vy vic cn nhc chn on
bnh nhn b tiu chy trong khi dng khng sinh rt quan trng. Vim rut kt mng gi c th
mc t nh n nng. Trng hp nh ch cn ngng thuc, trng hp nng phi cn
n nhng bin php iu tr thch hp.
THN TRNG LC DNG
S dng Ceclor CD di ngy c th lm pht trin qu mc cc chng vi khun khng nhy cm.
Cn theo di ngi bnh cn thn, nu b bi nhim, phi c cc bin php iu tr thch hp.
Tnh gy ung th, t bin v v sinh : Cha c cc nghin cu trn loi vt xc nh kh
nng gy ung th v t bin ca Ceclor CD. Cc nghin cu v kh nng sinh sn cho thy
khng c bng chng gy v sinh.
S dng cho tr em : Cha xc nh c tnh hiu qu v an ton trn tr em.
LC C THAI
Cc nghin cu v kh nng sinh sn thc hin chut nht, chut cng vi liu gp 12 ln v
loi chn sng vi liu gp 3 ln liu dng ti a cho ngi khng thy c bng chng gy v
sinh hoc gy nguy hi cho bo thai do cefaclor. Tuy nhin cha c y cc nghin cu c
kim sot cht ch trn ph n c thai. V cc nghin cu trn loi vt khng phi bao gi cng
c th suy on c p ng ca ngi, nn ch dng thuc ny trn ph n c thai khi tht
cn thit.
Chuyn d v sinh : Cha nghin cu vic dng Ceclor CD trong thi kz chuyn d sinh. Ch
nn dng thuc khi tht cn thit.
LC NUI CON B
Cha c nghin cu v vic dng Ceclor CD trn i tng ny. Mt lng nh cefaclor c
tm thy trong sa m sau khi dng mt liu 500 mg. Nng trung bnh trong sa l 0.18,
0.21, 0.16 mg/ml tng ng vi cc thi im sau 2, 3, 4 v 5 gi. Sau 1 gi nng trong sa
ch dng vt. nh hng ca thuc trn tr b m cha c bit. Cn thn khi dng Ceclor
CD cho cc b m cho con b.
TNG TC THUC
Mc hp thu Ceclor CD gim nu ung cc loi thuc khng acid c cha hydroxide nhm

hoc hydroxide magnesium trong vng 1 gi sau khi ung Ceclor CD. Cc thuc khng H2 khng
lm thay i tc v mc hp thu thuc. Cng nh cc khng sinh thuc nhm b-lactam
khc, probenecid c ch s thi tr Cefaclor qua thn (c l c vi Ceclor CD). Cc th nghim
lm sng cho thy khng c tng tc i vi cc thuc khc.
Cc sai lch i vi kt qu xt nghim : Ngi bnh dng Ceclor CD c th c kt qu dng
tnh gi i vi xt nghim ng niu khi th vi cc dung dch Benedict, Fehling hoc vi vin
Clinitest, nhng khng nh hng khi dng phng php Tes-Tape (Glucose Enzymatic Test
Strip, USP. Lilly).
TC DNG NGOI
a s cc phn ng ph ca Ceclor CD trong cc th nghim lm sng u nh v ch thong
qua. Ngng thuc do cc phn ng ph xy ra 1.7% s ngi bnh. Sau y l cc phn ng
ph c ghi nhn khi dng Ceclor CD trong cc th nghim lm sng. T l xy ra cc phn
ng thng di 1%.
H tiu ha : tiu chy (3,4%), bun nn (2,5%), nn v kh tiu.
Phn ng qu mn : Khong 1,7% ngi bnh c phn ng ni ban, ni m ay v nga. C gp
mt trng hp (0,03%) phn ng ging-bnh-huyt-thanh trong s 3.272 ngi bnh dng
Ceclor CD trong cc th nghim lm sng c kim sot.
Nhiu trng hp phn ng ging-bnh-huyt-thanh tng c ghi nhn ngi bnh
dng cefaclor gm cc triu chng nh : hng ban a dng, ni mn v cc biu hin ngoi da
khc km theo vim khp/au khp, khng hoc c st v khc vi bnh huyt thanh kinh in
ch t khi gp bnh l hch bch huyt v protein niu, khng c phc hp min dch lu
hnh v cc phn ng ny khng li di chng. i khi c cc triu chng n thun xy ra
nhng khng phi l phn ng ging-bnh-huyt-thanh. Trong cc nghin cu tip tc thm
sau , cc phn ng ging-bnh-huyt-thanh xut hin cn l do qu mn cm v thng d
xy ra trong hoc sau khi dng liu trnh cefaclor ln th hai (hoc k tip). Cc phn ng ny
thng xy ra tr em hn l ngi ln v bin thin t 1 trn 200 ngi bnh (0,5%) trong
mt nghin cu khu tr ; 2 trn 8346 ngi bnh (0,024%) trong cc th nghim lm sng rng
ri (vi t l xy ra tr em l 0,055%) v 1 trn 38000 ngi bnh (0,003%) theo cc bo co
ngu nhin. Cc du hiu v triu chng lm sng thng xy ra vi ngy sau khi bt u iu
tr v gim dn trong vng vi ngy sau khi ngng thuc ; cc phn ng ny him khi cn phi
nhp vin, thng ch ko di trong mt thi gian ngn (thi gian nm vin trung bnh 2-3 ngy,
da trn nhng kt qu kho st sau khi a thuc vo th trng). i vi nhng trng hp
cn vo vin, cc triu chng thng thy t nh n nng v thng nng hn i vi tr em.
Cc thuc khng histamine v corticoid t ra c hiu qu trong x tr cc du hiu v triu
chng ny. Khng c di chng trm trng no c ghi nhn.
H to mu v bch huyt : tng bch cu a eosin.
H tit niu sinh dc : Nhim candida m o (2,5%) v vim m o (1,7%).

Sau dy l cc phn ng ph gp ngi bnh dng Ceclor CD ; cha r c phi do thuc gy ra

hay khng :
H thn kinh trung ng : nhc u, chng mt v ng g.
Gan : Tng thong qua SGOT, SGPT v phosphatase kim.
Thn : Tng thong qua BUN hoc creatinine.
Cc xt nghim : Gim tiu cu thong qua, gim bch cu, tng bch cu limph, gim bch
cu a nhn trung tnh v kt qu phn tch nc tiu bt thng.
Ngoi cc phn ng ph gp ngi bnh dng Ceclor CD c lit k trn, di y l cc
phn ng ph v nhng thay i xt nghim ghi nhn c ngi bnh dng cefaclor :
Hng ban a dng, st, phn ng phn v (thng d xy ra ngi bnh c tin s d ng
penicillin), hi chng Stevens-Johnson, th nghim Coombs trc tip dng tnh v nga b
phn sinh dc. Cc triu chng vim rut kt mng gi c th xut hin trong hoc sau khi iu
tr bng khng sinh. Cc phn ng dng phn v c th biu hin qua cc triu chng ring l
gm ph mch, suy nhc, ph ( mt v chi), kh th, d gic, ngt hoc dn mch.
Him khi cc triu chng qu mn ko di trong vi thng.
Cc phn ng sau y rt t khi gp ngi bnh dng cefaclor :
Hoi t biu b nhim c, vim thn k c hi phc, ri lon chc nng gan bao gm mt,
thi gian prothrombin ko di ngi bnh dng cefaclor cng vi warfarin, hng phn c hi
phc, cng thng, mt ng, l ln, tng trng lc c, thiu mu bt sn, tng bch cu ht v
thiu mu huyt tn.
Ngoi ra cn gp cc phn ng nh nhng ngi dng khng sinh nhm b-lactam bao gm :
Vim rut kt, ri lon chc nng thn v bnh l thn do nhim c.
Mt vi khng sinh nhm b-lactam c th gy kch hot cc cn ng kinh, nht l ngi b
suy thn khng c gim liu mc. Nu cn ng kinh xut hin lin quan n vic dng
thuc, nn ngng thuc ngay. C th dng thuc chng ng kinh khi cn thit.
LIU LNG v CCH DNG
Ceclor CD c th ung lc i hoc lc no. Tuy nhin ung lc no thuc c hp thu tt hn
(xem Dc ng hc). Vin thuc khng c ct, nghin nt hoc nhai.
Liu khuyn dng trong vim hng, vim amian, nhim khun da v cc cu trc da l 375 mg,
dng 2 ln trong 24 gi. Vi nhim khun ng tit niu di, liu khuyn dng l 375 mg,
dng 2 ln trong 24 gi hoc 500 mg, dng mi ngy 1 ln. Liu khuyn dng trong vim ph
qun l 375 mg hoc 500 mg, dng 2 ln trong 24 gi. Vi bnh vim phi, liu khuyn dng l
750 mg, dng 2 ln trong 24 gi.
Trong nhim khun do S. pyogenes (lin cu nhm A), liu trnh Ceclor CD nn ko di t nht l
10 ngy.
Ceclor CD nn c bo qun nhit phng t 15oC n 30oC (59oF n 86oF).
QU LIU

Du hiu v triu chng : Cc triu chng ng c khi dng qu liu Ceclor CD c th gm bun
nn, nn, au vng thng v v tiu chy. Mc au vng thng v v tiu chy ph thuc
vo lng thuc dng. Nu c thm cc triu chng khc, c th l do phn ng th pht
ca mt bnh tim n, phn ng d ng hay tc ng ca chng ng c khc i km.
iu tr : iu tr qu liu, cn cn nhc n kh nng qu liu ca nhiu loi thuc, tng
tc gia cc loi thuc, dc ng hc bt thng ca ngi bnh.
Bo m ng th thng, h hp h tr v truyn dch. Theo di cn thn v duy tr mc
cho php cc du hiu sinh tn, cc cht kh trong mu, cc cht in gii... C th lm gim s
hp thu thuc qua ng tiu ha bng cch dng than hot. Trong nhiu trng hp, bin
php ny c hiu qu hn l ra rut hoc gy nn. Nn cn nhc vic dng than hot thay cho
vic ra d dy hoc kt hp c hai phng php. Dng nhiu liu than hot lin tip c th
lm gia tng s thi tr cc thuc c hp thu. Cn bo v ng th ca ngi bnh khi
p dng bin php ra d dy hoc dng than hot.
Dng thuc li niu mnh, thm phn mng bng, thm phn tch mu hoc truyn mu t ra
khng c hiu qu trong x tr qu liu cefaclor.

92.

CEDAX

SCHERING-PLOUGH
Vin nang 200 mg : v 2 vin, hp 3 v.
Vin nang 400 mg : v 2 vin, hp 3 v.
Hn dch 36 mg/ml : chai 30 ml.
THNH PHN
cho 1 vin
Ceftibuten dihydrate

200 mg

cho 1 vin
Ceftibuten dihydrate

400 mg

cho 1 ml hn dch
Ceftibuten dihydrate

36 mg

TNH CHT
Dc l hc :
Ging nh hu ht cc khng sinh b-lactam, tc ng dit khun ca ceftibuten l kt qu ca
s c ch tng hp thnh t bo vi khun. Do c tnh ca cu trc ha hc, ceftibuten bn
vng vi cc b-lactamase. Nhiu vi khun sinh b-lactamase khng vi pnicilline hay cc
cphalosporine c th b c ch bi ceftibuten.
Ceftibuten-trans hnh thnh do s isomere ha ceftibuten (dng cis) ch c 1/4 - 1/8 hot tnh
ca ceftibuten.
Vi khun hc :
Ceftibuten c tnh bn vng cao vi cc pnicillinase v cphalosporinase qua trung gian
plasmide. Tuy nhin cht ny khng bn vng vi mt vi cphalosporinase qua trung gian
nhim sc th cc vi khun nh Citrobacter, Enterobacter v Bacteroides. Cng nh nhng blactam khc, ceftibuten khng nn s dng cho cc dng khng vi b-lactam bng c ch
tng qut nh qua tnh thm thu hay cc protine gn kt pnicilline (PBP) v d nh dng S.
pneumoniae khng p nicilline. Ceftibuten u tin gn kt vi PBP-3 ca E. coli l kt qu ca
s hnh thnh cc th si 1/4 - 1/2 nng c ch ti thiu (MIC) v phn gii nng gp
2 ln MIC. Nng dit khun ti thiu (MBC) cho dng E. coli nhy cm v khng
p nicillinase cng gn bng MIC.
Ceftibuten c chng minh in vitro v trn lm sng c tc dng trn hu ht cc dng vi
khun sau :
Gram dng : Streptococcus pyogenes, Streptococcus pneumoniae (tr cc dng khng
pnicilline).
Gram m : Haemophilus influenzae (c hai dng b-lactamase dng tnh v m tnh) ;
Hemophilus para-influenzae (b-lactamase dng tnh v m tnh) ; Moraxella (Branhamella)
catarrhalis (hu ht l b-lactamase dng tnh) ; Escherichia coli ; Klebsiella sp. (bao gm K.
pneumoniae v K. oxytoca) ; Proteus indol dng tnh (bao gm P. vulgaris) cng nh cc loi
Proteus khc, nh Providencia ; P. mirabilis ; Enterobacter sp (bao gm E. cloacae v E.
aerogenes), Salmonella sp ; Shigella sp.
Ceftibuten chng minh in vitro c hot tnh chng li hu ht cc dng vi khun sau ; tuy
nhin, vn cha xc nh c tnh hu hiu trn lm sng :
Gram dng : Streptococcus nhm C v nhm G.
Gram m : Brucella, Neiserria, Aeromonas hydrophilia, Yersinia enterocotilica, Providencia

rettgeri, Providencia stuartii v cc dng Citrobacter, Morganella v Serratia khng a tit

cphalosporinase qua trung gian nhim sc th.
Ceftibuten khng c hot tnh trn Staphylococcus, Enterococcus, Acinetobacter, Listeria,
Flavobacteria v Pseudomonas spp. Thuc cho thy c tc dng rt t trn hu ht cc vi khun
k kh, bao gm hu ht cc dng Bacteroides. Ceftibuten-trans khng c hot tnh trn vi
khun in vitro v in vivo vi cc dng ny.
Th nghim tnh nhy cm :
Phng php khuch tn : Cc phng php nh lng yu cu phi o ng knh vng v
khun c tnh nhy cm ca khng sinh. Ceftibuten c th nghim bng phng
php a nh gi tnh nhy cm c m t bi Bauer AW v cng s ; Am J Clinical
Pathology 1966 ; 45 ; 493, y Ban Quc Gia v Chun Mc Xt Nghim Lm Sng, tiu chun
c chp thun : thng t 1990 v ng k{ lin bang 1974 ; 39 (30 thng 5) 19182 - 19184. Kt
qu nhy cm l bin gii s tng ng gia ng knh vng v khun thu c t a x t
nghim vi MIC ca ceftibuten.
Kt qu xt nghim dng a khng sinh chun duy nht cha 30 mg ceftibuten s c bin
lun theo tiu chun sau : ng knh >= 21 mm l nhy cm (S) ; 18-20 mm l nhy cm trung
gian (MS), <= 17 mm l khng (R). Kt qu "Nhy cm" ngha l vi khun gy bnh c th b
c ch vi nng khng sinh thng thng t c trong mu. Kt qu "Trung gian" ngha l
vi khun nhy cm khi dng khng sinh liu cao hoc khi cc vng b nhim khun nh cc m
v dch c th (nh nc tiu) t c nng khng sinh cao. Kt qu " khng" cho thy
nng khng sinh t c khng th c ch c vi khun v nn chn khng sinh khc. Cc
phng php chun mc yu cu phi s dng cc vi khun chng phng xt nghim. Vi a
tm 30 mg ceftibuten phi to c vng v khun vi ng knh 29-35 mm i vi E. coli
ATCC 25922.
Nn s dng a 30 mg ceftibuten cho tt c cc xt nghim in vitro cc mu phn lp. a thy
tinh (c falotine) th nghim tnh nhy cm ca cphalosporine khng thch hp v ph khc
vi ceftibuten.
Phng php pha long : phng php c dng th nghim tnh nhy cm ca Cedax l
phng php pha long ca y Ban Quc Gia v Chun Mc Xt Nghim Lm Sng. Tiu chun
c chp thun : Cc phng php th nghim tnh nhy cm bng phng php pha long
cho vi khun hiu kh. Thch Mueller-Hinton hay nc canh cy Mueller-Hinton iu chnh ion
l mi trng c khuyn co cho cc vi khun gy bnh c c lp bng cch thng thng
v pht trin nhanh v Haemophilus sp. Mu v cc thnh phn ca mu c th c thm vo
trong th nghim mt s Streptococcus nht nh.
Vi khun c th c xem l nhy cm vi ceftibuten nu gi tr MIC cho ceftibuten l <= 8
mg/ml, v khng nu MIC >= 32 mg/ml. Vi khun c MIC 16 mg/ml l nhy cm trung gian.
Ging nh cc phng php khuch tn tiu chun, cc phng php pha long cng yu cu

s dng vi khun chng phng xt nghim. Bt ceftibuten tiu chun phi cho gi tr MIC
trong khong 0,125-0,5 mg/ml cho E. coli ATCC 25922 v >= 32 mg/ml cho S. aureus ATCC
29213.
CH NH
iu tr cc loi nhim khun do cc chng nhy cm :
Nhim khun ng h hp trn, bao gm cc nhim khun c hiu sau : vim hng, vim
amian v st tinh hng nhit ngi ln v/hoc tr em ; vim xoang cp ngi ln, vim
tai gia tr em.
Nhim khun ng h hp di ngi ln, bao gm vim ph qun, t cp ca vim ph
qun mn v vim phi cp bnh nhn c th iu tr bng ng ung, ngha l nhng
ngi nhim khun tin pht mc phi trong cng ng.
Nhim khun ng niu tr em v ngi ln, c hai trng hp c v khng c bin chng.
Vim rut v vim d dy rut tr em do Salmonella, Shigella hay E. coli. Khng chng minh
c hot tnh ca Cedax vi cc loi Campylobacter hay Yersinia.
CHNG CH NH
Bnh nhn c d ng vi cphalosporine hay vi bt kz thnh phn no ca Cedax.
THN TRNG LC DNG
Cn tht cn thn khi s dng cc khng sinh cphalosporine cho bnh nhn c nghi ng hay
bit chc l c d ng vi pnicilline. Khong 5% bnh nhn c tin s d ng vi pnicilline c
phn ng cho vi cphalosporine. Phn ng qu mn cp trm trng (phn v) cng c
bo co trn nhng bnh nhn dng pnicilline v cphalosporine v phn ng qu mn cho
vi phn v cng xut hin. Nu xut hin phn ng phn v vi Cedax, ngng thuc v
dng cc liu php thch hp. Phn v nng cn cp cu thch hp nh dng adrenaline, truyn
dch, kim sot thng kh v cho th oxygen, khng histamine, corticoide, cc amine tng huyt
p v theo di cn thn.
Trong qu trnh iu tr vi cc khng sinh ph rng nh Cedax, s thay i h sinh thi ng
rut c th dn n tiu chy do dng khng sinh, bao gm vim i trng c gi mc do c t
ca Clostridium difficile. Bnh nhn c th b tiu chy trung bnh n nng hoc i khi b t
vong, c hay khng c mt nc, trong hay sau qu trnh iu tr vi khng sinh. Xem xt chn
on ny rt quan trng nhng bnh nhn c ghi nhn l c tiu chy ko di trong khi s
dng khng sinh ph rng nh Cedax.
C th cn phi iu chnh liu lng Cedax bnh nhn suy thn nng cng nh nhng bnh
nhn ang lm thm phn.
Cedax c thm phn mt cch d dng. Bnh nhn thm phn nn c theo di cn thn
v nn dng Cedax ngay khi phm phn.
Nn k toa Cedax cn thn ngi c tin s bnh tiu ha c bin chng, c bit l vim i
trng mn.

S dng cho tr em :
Cha xc nh c tnh an ton v hu hiu ca Cedax tr em nh hn 6 thng.
LC C THAI v LC NUI CON B
Khng c nghin cu y v c kim sot ph n c thai v trong lc sinh n. Do cc
nghin cu sinh sn trn th vt khng phi bao gi cng c th suy on cho ngi, nn cn
nhc gia li ch v nguy c c th xy ra do s s dng Cedax trong nhng trng hp lm
sng trn i vi c b m v thai nhi.
Khng tm thy Cedax trong sa m.
TNG TC THUC
Cc nghin cu tng tc thuc c thc hin nghin cu tng tc ca Cedax v cc
yu t sau : liu cao thuc khng acide aluminium-magnsium hydroxyde, ranitidine v liu duy
nht tim tnh mch th ophylline. Khng c tng tc ng k no xy ra.
Khng bit c tc dng ca Cedax trn nng trong huyt tng cng nh dc ng hc
ca thophylline ung. Cho n nay khng c tng tc c { ngha no c bo co.
Tng tc thuc/Thc n : Dng ng thi vi thc n khng lm nh hng n hiu lc ca
vin nang Cedax. Tuy nhin, tc v mc hp thu ca Cedax di dng hn dch c th b
nh hng khi dng chung vi thc n.
Tng tc thuc/Kt qu xt nghim : Khng c tng tc ha hc hay xt nghim no c
ghi nhn vi Cedax. Kt qu dng tnh gi trong xt nghim Coombs trc tip c bo co
trong qu trnh s dng cc cphalosporine khc. Tuy nhin, cc kt qu xt nghim dng t
bo hng cu ca ngi khe mnh xt nghim xem Cedax c gy cc phn ng vi test
Coombs in vitro khng cho phn ng dng tnh, ngay c vi nng cao n 40 mg/ml.
TC DNG NGOI
Trong cc th nghim lm sng ca khong 300 bnh nhn, ni chung Cedax an ton v c
dung np tt vi a s cc tc dng ngoi { quan st c c tnh cht trung bnh v thong
qua v t l xut hin l him cho n rt him.
Tc dng ngoi { thng c bo co nhiu nht l trn ng tiu ha, bao gm bun nn
(<= 3%) v tiu chy (3%) v nhc u (2%).
Tc dng ngoi { c bo co him xut hin bao gm kh tiu, vim d dy, nn ma, au
bng v chng mt. Rt him khi Clostridium difficile i km vi tiu chy t trung bnh n
nng ; khng cn phi nhp vin. Co git cng c bo co rt him nhng khng nht thit l
do tr liu. Tc dng ny c bo co 1 bnh nhn ln tui mc bnh phi tt nghn mn
tnh ang iu tr vi nhiu thuc trong c th ophylline, b co git tng cn 5 ngy sau
khi bt u iu tr vi Cedax.
Hu ht cc tc dng ngoi { p ng vi iu tr triu chng hay gim i sau khi ngng
dng Cedax.
Cc bt thng xt nghim trn lm sng, bao gm gim hemoglobin, gim bch cu, tng bch

cu a eosine, tng tiu cu c bo co xut hin rt him. Cng c bo co rt him l s

gia tng thong qua ca AST (SGOT), ALT (SGPT) v LDH. Him khi cc tc dng ngoi ny
c xem nh l do tr liu vi Cedax.
LIU LNG v CCH DNG
Liu lng :
Cng ging nh nhng khng sinh dng theo ng ung khc, thi gian iu tr ni chung l 510 ngy. i vi nhng nhim khun do Streptococcus pyogenes, nn dng Cedax ti thiu l
10 ngy.
Ngi ln : Liu khuyn co Cedax l 400 mg mi ngy. C th dng vin nang Cedax khng ph
thuc vo ba n. i vi iu tr nhng ch nh sau, c th dng 400 mg mt ln mi ngy :
Vim xoang cp do vi khun, vim ph qun cp, cn bc pht cp ca vim ph qun mn v
nhim khun ng tiu c hay khng c bin chng.
i vi vic iu tr vim phi mc phi trong cng ng bnh nhn c th dng thuc theo
ng ung, liu khuyn co l 200 mg mi 12 gi.
Bnh nhn ngi ln b suy thn : Tr trng hp h s thanh thi cratinine < 50 ml/pht,
dc ng hc ca Cedax khng b nh hng nhiu cn phi iu chnh liu. Nu thanh
thi cratinine trong khong 49 n 30 ml/pht, nn gim liu hng ngy xung cn 200 mg.
Vi thanh thi cratinine trong khong 29 n 5 ml/pht, liu hng ngy nn dng l 100 mg.
Nu la chn phng php k o di thi gian s dng, c th dng liu 400 mg Cedax trong 48
gi (mi 2 ngy) cho bnh nhn c thanh thi cratinine trong khong 39-40 ml/pht, v 96 gi
(mi 4 ngy) cho bnh nhn c thanh thi cratinine t 5-29 ml/pht
bnh nhn lm thm phn 2 hay 3 ln mi tun, c th dng mt liu 400 mg Cedax duy nht
sau mi ln lm thm phn.
Tr em : Liu khuyn co l 9 mg/kg/ngy (ti a 400 mg mi ngy) di dng hn dch ung.
C th dng mt ln mi ngy trong iu tr cc ch nh sau : Vim hng, c hay khng c vim
amian, vim tai gia cp c chy m v nhim trng ng tiu c hay khng c bin chng.
i vi vim rut cp do vi khun tr em, tng liu mi ngy c th chia lm hai ln vi 4,5
mg/kg mi 12 gi.
Tr em cn nng > 45 kg hay > 10 tui c th dng liu khuyn co dnh cho ngi ln. C th
dng hn dch Cedax 1 hay 2 gi trc hay sau ba n.
Pha ch hn dch ung :
- Chai 60 ml, 15 g bt pha thuc cha 2,16 g ceftibuten : Khi pha ch theo hng dn cho 60
ml hn dch ung c nng ceftibuten 36 mg/ml (180 mg/5 ml).
Lc mnh chai lm ti bt bn trong, sau pha ch hn dch nh hng dn.
Cho dc s : Thm mt lng nc tng cng l 50 ml chia lm hai ln. Lc mnh chai sau mi
ln thm nc lm t v phn tn hon ton bt thnh hn dch.
Ngi dng thuc : y nc vo tch cho n vch 50 ml. Cho khong mt na lng

nc ny vo chai v lc mnh hn hp bt c m u. Sau thm phn nc cn li

vo chai v lc mnh hn hp mt ln na.
- Chai 30 ml, 7,5 g bt pha thuc cha 1,08 g ceftibuten : Khi pha ch theo hng dn cho 30
ml hn dch ung c nng ceftibuten 36 mg/ml (180 mg/5 ml).
Lc mnh chai lm ti bt bn trong, sau pha ch hn dch nh hng dn.
Cho dc s : Thm mt lng nc tng cng l 25 ml chia lm hai ln. Lc mnh chai sau mi
ln thm nc lm t v phn tn hon ton bt thnh hn dch.
Ngi dng thuc : y nc vo tch cho n vch 25 ml. Cho khong mt na lng
nc ny vo chai v lc mnh hn hp bt c m u. Sau thm phn nc cn li
vo chai v lc mnh hn hp mt ln na. Lc chai k trc khi ong thuc.
QU LIU
Khng quan st c biu hin ng c no khi nhm ln dng Cedax qu liu. C th ch nh
ra d dy, tuy nhin khng c cht gii c no i vi thuc ny. C th loi nhng lng
ng k ra khi mu bng phng php lc mu. Cha xc nh c tnh hu hiu ca vic
loi b thuc ra khi c th bng thm phn phc mc.
ngi tnh nguyn trng thnh khe mnh dng cc liu n cho n 2 g Cedax, khng
quan st thy c tc dng ph trm trng no v cc kt qu xt nghim vn trong gii hn bnh
thng.
BO QUN
Bo qun nhit t 2-25 oC (nhit phng). Sau khi pha hn dch 36 mg/ml c th tn tr
trong 14 ngy trong t lnh nhit 2-8 oC.

93.

CEFAZOLIN MEIJI

MEIJI SEIKA
c/o NOMURA
Bt pha tim 1 g : hp 10 l.
THNH PHN
cho 1 l
Cefazoline

DC LC

1g

Tc ng :
Cefazolin Meiji l khng sinh nhm cepahlosporin bn tng hp, dng ng tim truyn.
Vi sinh hc :
In vitro, Cefazolin Meiji c tc ng khng cc vi khun sau : Staphylococcus aureus (c hoc
khng sn sinh enzym penicillinase), Streptococcus tiu huyt bta nhm A v cc dng
Streptococci khc: Streptococcus pneumoniae, Escherichia coli, Proteus mirabilis, Klebsiella sp,
Enterobacter aerogenes, Haemophilus influenzae.
CH NH
Nhim khun do vi khun nhy cm : Nhim trng ng h hp, ng tit niu-sinh dc, da
v m mm, ng mt, xng v khp, nhim trng mu v vim ni tm mc.
CHNG CH NH
Bnh nhn c tin s qu mn vi khng sinh nhm cephalosporin.
THN TRNG LC DNG
Trc khi dng cefazolin, nn thn trng hi tin s qu mn vi cephalosporin v penicillin.
Cc thuc thuc nhm cephalosporin nn c dng thn trng bnh nhn mn cm vi
penicillin.
Cc phn ng qu mn trm trng cn cp cu bng epinephrine v cc thuc cp cu khc.
C mt s bng chng lm sng v cn lm sng cho thy c d ng cho gia cephalosporin v
penicillin. C bo co cc trng hp phn ng nng bnh nhn, bao gm phn v khi dng
mt trong hai thuc.
Do , bt kz bnh nhn no c triu chng d ng, c bit vi thuc, nn s dng khng sinh
thn trng.
Lc c thai : S an ton ca Cefazolin Meiji s dng trong thai kz cha c nghin cu.
Trong nhi khoa : S an ton ca Cefazolin Meiji s dng cho s sinh v tr sinh non cha
c nghin cu.
TC DNG NGOI
Cc phn ng sau c bo co :
Qu mn : st do thuc, ni mn, nga m h v tng bch cu i toan.
Huyt hc : gim bch cu trung tnh, gim bch cu, gim tiu cu, th nghim Coombs trc
tip v gin tip dng tnh.
Gan thn : tng thong qua SGOT, SGPT, BUN v phosphate kim m khng thy du hiu lm
sng suy gan v suy thn.
Tiu ha : bun nn, chn n, nn, tiu chy, nm candida ming.
Mt s tc dng ngoi { khc : au ti ni tim bp, i khi chai cng. Vim tnh mch ti ni
tim cng c ghi nhn. Cc phn ng khc bao gm nga hu mn v sinh dc, nhim
candida sinh dc, vim m o.
LIU LNG v CCH DNG

Ngi ln : 1-4 g mi ngy chia ra nhiu ln cch nhau mi 6-12 gi.

Tr em : 25-50 mg/kg th trng/ngy chia ra nhiu ln cch nhau mi 6-8 gi.
Cefazolin Meiji c th dng ng tim bp hay tim tnh mch sau khi pha. pha Cefazolin
Meiji, c th dng dung mi l nc ct pha tim hay sodium chloride 0,9%. Lng dung mi c
th l 2,5 ml cho l 1 g.

94.

CELESTAMINE

SCHERING-PLOUGH
Vin nn : v 20 vin, hp 1 v - Bng B.
THNH PHN
cho 1 vin
Btamthasone

0,25 mg

Dexchlorphniramine malate

2 mg

DC LC
Vin nn Celestamine phi hp hai tc ng khng vim v khng d ng ca corticoide l
btamthasone, mt dn xut ca prednisolone v tc ng khng histamine ca
dexchlorphniramine malate.
Phi hp btamthasone v dexchlorphniramine malate cho php gim liu corticoide m
vn thu c hiu qu tng t khi ch dng ring corticoide vi liu cao hn.
CH NH
Vin n n Celestamine c ch nh trong nhng trng hp phc tp ca d ng ng h
hp, d ng da v mt, cng nh nhng bnh vim mt cn ch nh h tr bng corticoide ton
thn.
Cc trng hp tiu biu bao gm d ng phn hoa hay bi trm trng, hen ph qun nng,
vim mi d ng kinh nin, vim da d ng (eczma), vim da tip xc, cc tng tc thuc v
bnh huyt thanh.
Cc chng vim mt bao gm vim kt mc d ng, vim gic mc, vim th mi khng c u ht,
vim mng mt - th mi, vim mng mch, vim mng mch - vng mc v vim mng mch
nho.
Vin nn Celestamine kim sot s tit dch r v vim ca cc chng bnh mt, do gip

bo tn s phi hp hot ng ng nht ca mt trong khi vn cho ph p iu tr nhim trng

c hiu hay nhng nguyn do khc bng phng php iu tr thch hp.
CHNG CH NH
Chng ch nh vin nn Celestamine cho bnh nhn b nhim nm ton thn, tr s sinh v tr
thiu thng, bnh nhn ang dng thuc IMAO v trn nhng ngi c qu mn vi bt c
thnh phn no ca thuc hay vi nhng thuc c cu trc tng t.
CH PHNG v THN TRNG LC DNG
Btamthasone :
- Nn iu chnh liu khi din tin bnh c gim bt hay gia tng, theo p ng ring bit
ca tng bnh nhn vi phng php iu tr hay khi bnh nhn c thm cc stress v cm xc
hay v th cht nh nhim trng nng, phu thut hay chn thng. C th cn theo di n 1
nm sau khi ngng qu trnh iu tr bng corticoide liu cao hay dng ko di.
- Nn dng liu thp nht c th c kim tra tnh trng bnh. Trc khi ngng thuc nn
gim liu t t.
- Tc ng ca corticoide c gia tng bnh nhn nhc gip hay bnh nhn x gan.
- Nn cn thn khi dng corticoide cho bnh nhn herpes simplex mt v c kh nng gy thng
gic mc.
- Cc chng lon tr c th xut hin khi tr liu bng corticoide. Cc chng khng cn bng v
xc cm hay khuynh hng lon tm thn c sn c th b nng hn do s dng corticoide.
- Nn cn thn khi dng corticoide trong nhng trng hp sau : vim lot kt trng khng c
hiu, nu c kh nng tin ti thng, abcs, hay nhng nhim trng sinh m khc ; vim ti
tha ; va mi ni rut ; lot d dy hot ng hay tim n ; suy thn ; cao huyt p ; long
xng ; v nhc c nng. Do cc bin chng t qu trnh tr liu vi corticoide ph thuc vo
liu lng v thi gian tr liu, nn cn nhc gia li ch tr liu v nguy c c hi trn tng bnh
nhn.
- Corticoide c th che lp mt vi du hiu ca nhim trng v bi nhim c th xut hin
trong qu trnh iu tr. Khi dng corticoide, s gim khng v mt kh nng khu tr nhim
trng c th xy ra.
- S dng corticoide ko di c th dn n c thy tinh th di bao sau (c bit tr em),
glaucome c th nh hng n dy thn kinh th gic, v c th thc y nhim trng th pht
mt do nm hoc do virus.
- Liu trung bnh v liu cao corticoide lm tng huyt p, gi mui-nc, v s o thi kali.
Cc tc ng ny hu nh t xy ra vi nhng dn xut tng hp tr khi c dng vi liu cao.
Nn cn nhc ch n ung hn ch mui v cung cp thm kali. Tt c corticoide u lm gia
tng s o thi calcium.
- Trong qu trnh iu tr vi corticoide, bnh nhn khng nn chng nga u ma. Khng nn
p dng cc bin php min dch cho bnh nhn ang dng corticoide, c bit khi dng vi

liu cao do c th xy ra bin chng thn kinh v thiu p ng khng th.

- Nn gii hn vic iu tr bng corticoide trn bnh nhn b lao tin trin cc trng hp lao
cp hay lao lan trn, trong nhng bnh ny corticoide nn c dng kt hp vi bin php
khng lao thch hp.
- Nu corticoide c ch nh trn bnh nhn mc lao tim n, nn theo di cht ch do c th
xut hin s ti kch hot cn bnh. Trong qu trnh tr liu corticoide ko di, bnh nhn nn
p dng phng php ha d phng.
- iu tr vi corticoide c th lm thay i tnh di ng v s lng ca tinh trng.
Dexchlorphniramine malate :
- Nn dng cn thn vin nn Celestamine cho bnh nhn mc chng glaucome gc hp, lot
d dy hp, tt nghn mn v t trng, ph i tuyn tin lit hay tt nghn c bng quang, bnh
tim mch bao gm cao huyt p, cho nhng ngi b gia tng p lc ni nhn hay cng gip.
Tc ng ln kh nng li xe hay thao tc my mc : Bnh nhn nn c lu { khi thc hin
nhng hot ng cn cnh gic thn kinh nh li xe hay iu hnh cc thit b, my mc...
S dng thuc cho tr em : Cha xc nh c tnh an ton v hiu lc ca Celestamine tr
di 2 tui. Nn theo di cht ch s tng trng v pht trin ca tr em do corticoide c th
lm nh hng n tc pht trin v c ch s sn xut corticoide ni sinh nhng bnh
nhn ny.
Bnh nhn, c bit l tr em, ang dng corticoide vi liu lm suy yu min dch nn c
cnh co trnh tip xc vi ngun ly bnh si hay thy u, v nu b tip xc, nn tham kho
kin ca bc s.
S dng thuc cho ngi gi : Cc thuc khng histamine thng thng c th gy chng mt,
an thn v h huyt p cc bnh nhn trn 60 tui.
LC C THAI v LC NUI CON B
S dng Celestamine cho ph n mang thai, b m cho con b hay ph n tui c con i hi
phi cn nhc gia li ch iu tr v kh nng gy nguy him cho b m v thai nhi hay tr s
sinh. Nhng tr c m dng nhiu liu corticoide lc c thai nn c theo di cn thn v cc
du hiu suy thng thn.
TNG TC THUC
Btamthasone :
- Dng ng thi vi phnobarbital, phenytoine, rifampine hay phdrine c th lm tng
chuyn ha corticoide, v do gim tc dng iu tr.
- Bnh nhn dng c hai thuc corticoide v estrogne nn c theo di v tc ng qu mc
ca corticoide.
- Dng ng thi corticoide vi cc thuc li tiu lm mt kali c th dn n chng h kali
huyt. Dng ng thi corticoide vi cc glycoside tim c th lm tng kh nng gy lon nhp
hay ng c digitalis i km vi h kali huyt. Corticoide c th thc y kh nng mt kali gy

ra do amphotricine B. Trn mi bnh nhn dng bt c cc kt hp thuc no c k trn,

nn kim tra k cng cht in gii trong huyt thanh, c bit l nng kali.
- Dng ng thi corticoide vi nhng thuc chng ng thuc loi coumarine c th lm tng
hay gim tc dng chng ng, c th cn phi iu chnh liu.
- Tc dng do kt hp thuc khng vim khng st roide hay ru vi cc glucocorticoide c th
lm tng t l hay mc trm trng ca lot d dy-rut.
- Corticoide c th lm gim nng salicylate trong mu. Nn cn thn khi phi hp acide
actylsalicylique vi corticoide trong trng hp gim prothrombine huyt.
- C th cn phi iu chnh liu ca thuc tiu ng khi dng corticoide cho ngi mc bnh
tiu ng.
- iu tr ng thi vi glucocorticoide c th c ch p ng vi somatotropine.
Dexchlorphniramine malate :
- Thuc c ch monoamine oxidase (IMAO) k o di v lm tng tc dng ca cc thuc khng
histamine ; c th gy chng h huyt p trm trng.
Dng ng thi dexchlorphniramine malate vi ru, thuc chng trm cm loi tricyclique,
barbiturate hay nhng thuc c ch h thn kinh trung ng c th lm tng tc dng an thn
ca dexchlorph niramine. Tc ng ca thuc chng ng ung c th b c ch bi cc khng
histamine.
Tng tc thuc vi cc xt nghim cn lm sng :
- Corticoide c th nh hng n xt nghim nitroblue tetrazolium tm s nhim khun v cho
kt qu m tnh gi to.
TC DNG NGOI
Bc s nn cnh gic n kh nng xy ra cc tc dng ngoi do s dng corticoide v khng
histamine, c bit loi tc dng gy an thn.
Btamthasone : cc tc dng ngoi do thnh phn ny ca thuc, cng ging nh nhng tc
dng ngoi { khc c bo co t cc corticoide khc, c lin quan n liu lng v thi gian
iu tr. Tuy nhin, lng corticoide trong vin thuc thp lm gim bt i t l xy ra tc
dng ph.
Cc tc dng ngoi { c bo co bao gm :
- Ri lon nc v cht in gii : gi natri, mt kali, kim mu gim kali ; gi nc ; suy tim
sung huyt trn nhng bnh nhn nhy cm ; cao huyt p.
- H c xng : nhc c, bnh c do corticoide, gim khi c ; gia tng triu chng nhc c
trong bnh nhc c nng ; long xng ; gy ln ct sng ; hoi t v khun u xng i v
xng cnh tay ; gy bnh l{ cc xng di ; t dy chng.
- H tiu ha : lot d dy c th gy thng v xut huyt sau ; vim ty, trng bng ; vim
lot thc qun.
- Da : lm chm lnh vt thng, teo da, da mng manh ; c m xut huyt v mng bm mu

; ni ban trn mt ; tng m hi ; sai lch cc test th da ; cc phn ng nh vim da d

ng, m ay, ph mch thn kinh.
- Thn kinh : co git ; tng p lc ni s cng vi ph gai th (u no gi) thng sau khi iu tr
di hn ; chng mt ; nhc u.
- Ni tit : kinh nguyt bt thng ; hi chng ging Cushing ; tr em chm pht trin hay gim
pht trin ca phi bn trong t cung ; s khng p ng th pht thng thn v tuyn yn,
c bit trong nhng giai on stress nh chn thng, phu thut hay bnh tt ; gim dung
np carbonhydrate, lm l ra cc triu chng ca bnh tiu ng tim n, tng nhu cu
insuline hay cc tc nhn h ng huyt trn bnh nhn tiu ng.
- Mt : c thy tinh th di bao ; tng p lc ni nhn, glaucome ; li mt.
- Chuyn ha : cn bng nit m tnh do d ha protine.
- Tm thn : sng khoi, cm gic l lng ; trm cm nng cho n cc biu hin tm thn thc
s ; thay i nhn cch ; d b kch thch ; mt ng.
- Cc tc dng ngoi khc : phn ng ging phn v hay qu mn v h huyt p hay phn ng
ging nh b sc.
Dexchlorphniramine malate :
Cc phn ng ngoi do thnh phn ny ca thuc cng ging nh nhng tc dng ngoi
c bo co vi nhng thuc khng histamine thng thng (c tc dng an thn), v him
khi gy c tnh. Cm gic bun ng nh n trung bnh l tc dng ph thng thy nht. Cc
tc dng ph ca cc thuc khng histamine c tnh an thn thay i khc nhau v mc v t
l. Cc tc dng ph bao gm nhng thay i v tim mch, v huyt hc (gim ton th huyt
cu, gim tiu cu, thiu mu huyt gii), v thn kinh (l ln, o gic, run ry), tiu ha, b tiu,
tc dng ngoi trn h hp v thay i tnh tnh. Tc dng ngoi { thng thng nht bao
gm an thn, bun ng, chng mt, ri lon iu ha, au thng v, ni ban, kh ming v lm
c cht tit ph qun.
LIU LNG v CCH DNG
Liu dng nn c iu chnh ty theo bnh c iu tr, mc trm trng v p ng ca
bnh nhn. Khi c ci thin, nn gim dn liu cho n mc duy tr ti thiu v nn ngng
thuc ngay khi c th. Khi cc triu chng d ng h hp c kim sot y , nn ngng
t t dng phi hp v xem xt thay th bng mt khng histamine duy nht.
Ngi ln v tr em trn 12 tui : Liu khi u c khuyn co l 1 n 2 vin, 4 ln mi
ngy, sau khi n v trc lc i ng. Khng c vt qu 8 vin mi ngy.
i vi tr nh hn nn iu chnh liu ty theo mc trm trng ca bnh v p ng ca
bnh nhn hn l theo tui tc hay th trng.
Tr t 6 n 12 tui : liu khuyn co l 1/2 vin, 3 ln mi ngy. Nu cn thit tng thm liu,
tt hn nn dng lc i ng. Khng c vt qu 4 vin mi ngy.
QU LIU

Celestamine l mt thuc kt hp v do , phi cn nhc c tnh c th c ca mi thnh

phn. c tnh t mt liu duy nht Celestamine ch yu l do dexchlorphniramine. Liu gy
cht c c lng ca thuc khng histamine dexchlorphniramine malate l 2,5-50
mg/kg.
Triu chng: Cc phn ng qu liu xy ra vi cc khng histamine thng thng (tc dng an
thn) c th thay i t tc dng c ch h thn kinh trung ng (an thn, ngng th, gim
cnh gic thn kinh, try tim mch), n kch thch (mt ng, o gic, run ry, co git), thm ch
gy t vong.
Cc du hiu v triu chng khc bao gm chng mt, tai, mt iu ha, nhn i v h huyt
p. tr em, s kch thch vt tri hn, nh l cc du hiu v triu chng ging atropine
(kh ming, gin ng t, bng mt, st v triu chng trn ng tiu ha). C th xut
hin chng o gic, mt phi hp v co git loi ng kinh cn ln. ngi ln, mt chu kz
bao gm chng trm cm vi chng bun ng v hn m, v sau l pha kch ng dn n
co git i sau l trm cm c th xy ra.
Mt liu duy nht vt qu gii hn ca b tam thasone thng khng to ra cc triu chng
cp tnh. Ngoi tr khi dng thuc vi liu qu cao, vic qu liu glucocorticoide vi ngy hu
nh khng gy kt qu nguy hi tr khi iu ny xy ra vi bnh nhn c nguy c c bit do
ang c bnh hay ang dng ng thi thuc khc c kh nng tng tc gy tc dng ngoi
vi btamthasone.
iu tr : Qu liu cp : lp tc gy nn (cho bnh nhn cn tnh) hay ra d dy. Cha thy
c hiu qu ch li ca thm phn phc mc trong nhng trng hp qu liu.
iu tr qu liu bao gm iu tr triu chng v iu tr h tr. Khng nn dng cht kch thch.
C th dng thuc tng huyt p iu tr chng h huyt p. Cc cn co git c x l tt
nht vi cc thuc lm gim hot ng c tc dng ngn hn nh thiopental. Duy tr cung cp
nc y v kim sot cht in gii trong huyt thanh v trong nc tiu, c bit ch
cn thn n s cn bng natri v kali. iu tr mt cn bng in gii nu cn thit.
BO QUN
Bo qun trong khong nhit t 2 n 30oC.

95.

CELESTODERM-V

SCHERING-PLOUGH
Kem bi ngoi da : ng 15 g.
THNH PHN

cho 1 g
Btamthasone valrate tnh theo btamthasone

1,0 mg

Nomycine sulfate tnh theo nomycine

3,5 mg

DC LC
B tam thasone val rate c c tnh khng vim, chng nga v co mch.
Hot cht corticoide l b tam thasone c vi phn tn trong thuc kem bo m s tip xc
hu hiu vi da v cho tc ng khi pht nhanh chng.
Nomycine biu hin tc ng khng khun ti ch khng li nhiu vi khun gram dng v
gram m bao gm Staphylococcus, cc chng Proteus v Pseudomonas. Thuc khng c tc
dng chng nm. Nomycine him khi gy pht trin cc chng vi khun khng. Khi dng
ngoi, hot cht tng i khng c v khng gy kch ng.
CH NH
Kem Celestoderm-V c ch nh lm gim nhng biu hin vim ca cc bnh da p ng vi
corticoide khi c bin chng nhim trng th pht do cc vi khun nhy cm vi nomycine hay
khi nghi ng c kh nng nhim trng do cc vi khun trn.
Cc chng bnh c ch nh bao gm : vy nn, vim da tip xc (dermatitis venenata), vim
thn kinh da (liken simplex mn tnh), eczma (bao gm ecz ma hnh ng tin, eczma tr
em, eczma d ng), vim da tit b, vim da do nh nng, vim da ng, nga vng hu
mn-sinh dc v nga do lo ha.
CHNG CH NH
Kem Celestoderm-V b chng ch nh cho nhng bnh nhn c tin s c phn ng qu mn
vi bt c thnh phn no ca thuc.
CH PHNG
Bt kz tc dng ngoi { c bo co khi dng corticoide ng ton thn, bao gm suy
thng thn, cng c th xy ra vi cc corticoide dng ti ch, c bit tr em v tr s sinh.
S hp thu ton thn ca corticoide hay nomycine dng ngoi s gia tng nu iu tr trn mt
din tch c th rng hay bng kn vt thng. Nn trnh s dng nomycine trn vt thng
h hay vng da b tn thng. Nn p dng cc bin php phng thch hp trong nhng
trng hp ny hay trong nhng trng hp dng thuc di ngy, c bit i vi tr em v
tr s sinh.
i khi vic s dng ti ch ko di cc khng sinh c th a n s pht trin ca nhng
chng khng nhy cm trong c nm. Nu xy ra iu ny hay nu c phn ng nhy cm
hay bi nhim, nn ngng iu tr Celestoderm-V v p dng bin php iu tr thch hp.
Kem Celestoderm-V khng dng trong nhn khoa.

S dng cho tr em : tr em c th biu hin nhy cm ln hn vi nhng suy gim trc h i

- tuyn yn - tuyn thng thn do corticoide ti ch v vi nhng tc dng ca corticoide
ngoi sinh hn so vi bnh nhn trng thnh v c s hp thu mnh hn do t l vng b
mt da rng ln hn so vi trng lng c th.
S suy gim trc h i - tuyn yn - tuyn thng thn, hi chng Cushing, s chm tng
trng, chm tng cn, v tng p lc ni s c bo co xut hin tr em dng
corticoide ti ch. Cc biu hin ca s suy thng thn trn tr em bao gm nng cortisol
thp trong huyt tng v khng p ng vi kch thch ACTH. Cc biu hin ca tng p lc ni
s bao gm thp phng, nhc u v ph gai th hai bn.
LC C THAI v LC NUI CON B
Do tnh an ton ca corticoide dng ti ch s dng cho ph n c thai cha c xc nh,
thuc thuc nhm ny ch nn dng lc c thai nu li ch tr liu cao hn nguy c c th gy ra
cho thai nhi. Cc thuc thuc nhm ny khng nn dng qu vi mt liu lng ln hay vi
thi gian ko di cho ph n mang thai.
Hin khng bit c l lng corticosteroid dng ti ch c hp thu vo mu c th
tm thy trong sa m hay khng. Cc corticosteroid dng ton thn c bi tit qua sa m
vi mt lng rt nh khng c kh nng gy nh hng bt li cho tr. Tuy nhin, khi quyt
nh tip tc iu tr hay ngng thuc nn lu { n tm quan trng ca thuc vi b m.
TC DNG NGOI
Cc phn ng ngoi ti ch c bo co xut hin vi s s dng corticoide ti ch, c bit
khi dng di lp bng bt, bao gm : rt bng, nga, kch ng, kh da, vim nang, rm lng,
ni ban dng trng c, nhc sc t, vim da quanh ming, vim da d ng do tip xc, lt da,
nhim trng th pht, teo da, ni vn da v bnh ht k.
c tnh trn tai, trn thn v cc phn ng nhy cm c bo co xut hin lin quan n
vic s dng nomycine ti ch.
LIU LNG v CCH DNG
Bi mt lp mng kem Celestoderm-V vo vng da b nhim, hai hay ba ln mi ngy. Nn xc
nh khong cch dng liu thch hp ty theo mc trm trng ca bnh. Cc trng hp
nh c th p ng vi liu mt ln mi ngy ; cc trng hp nng hn c th cn bi thuc
nhiu ln hn trong ngy.
QU LIU
Triu chng : s dng corticoide ti ch qu mc hay ko di c th n n hot ng chc
nng tuyn yn-thng thn, a n kt qu thiu nng thng thn th pht, v cho cc
biu hin tng tit tuyn thng thn, bao gm bnh Cushing.
N omycine c hp thu mnh sau khi dng ti ch, do c th l mt tc nhn gy c thn
mnh. C th xut hin chng suy thn cp.
iu tr : bin php iu tr triu chng thch hp c ch nh trong trng hp qu liu

Celestoderm. Cc triu chng tng tit tuyn thng thn thng l c hi phc. iu tr mt
cn bng in gii nu cn thit. Trong trng hp ng c mn, nn ngng thuc t t.
Chng suy thn c th c iu tr bng lc mu. Khi ngng iu tr vi nomycine v p dng
nhng bin php c hiu iu tr ng c thn, c th phc hi c cc tn thng thn.
BO QUN
Bo qun trnh nng.

96.

CELESTONE

SCHERING-PLOUGH
Vin nn 0,5 mg : hp 100 vin - Bng B.
THNH PHN
cho 1 vin
Btamthasone

0,5 mg

TNH CHT
Btamthasone l mt dn xut tng hp ca prednisolone.
DC LC
Btamthasone l mt corticoide thng thn c tnh khng vim. Btamthasone c kh nng
khng vim mnh, chng vim khp v khng d ng, c dng iu tr nhng ri lon c p
ng vi corticoide.
L mt glucocorticoide, btamthasone gy hiu qu chuyn ha su rng v khc nhau, ng
thi lm gim kh nng khng ca c th i vi nhng tc nhn kch thch. Btamthasone
c hot tnh glucocorticoide cao v hot tnh minralocorticoide thp.
CH NH
c s dng trong bnh ni tit, c - xng, ri lon cht to keo, da, d ng, mt, h hp,
mu, ung th v nhng bnh khc c p ng vi iu tr corticoide.
Ri lon ni tit t : thiu nng v thng thn s cp hoc th cp (dng kt hp vi
minralocorticoide, nu c th c) ; tng sn tuyn thng thn bm sinh ; vim tuyn gip
khng mng m v tng calci huyt c lin quan n ung th.
Ri lon v c - xng : c dng nh mt iu tr b sung trong thi gian ngn (gip cho
bnh nhn khc phc qua giai on cp tnh v lan trn) trong chng thp khp do bnh vy
nn ; vim khp dng thp (trong mt s trng hp c th dng liu duy tr thp) ; vim dnh

khp sng ; vim bao hot dch cp v bn cp ; vim gn mng hot dch cp tnh khng c
hiu ; bnh thng phong ; bnh thp cp tnh v vim mng hot dch.
Bnh ca cht to keo : trong thi kz lan trn hoc trong iu tr duy tr mt s trng hp
lupus ban ton thn, vim c tim cp tnh do thp khp, x cng b v vim da-c.
Khoa da : bnh Pemphigus ; vim da mn nc dng herpes ; hng ban a dng nghim trng
(hi chng Stevens-Johnson) ; vim da trc vy ; u si dng nm ; bnh vy nn nng ; eczma
d ng (vim da mn tnh) v ni m ay.
Cc trng hp d ng : c dng trong nhng trng hp b d ng nng hoc tht bi sau
cc iu tr thng thng, nh l nhng trng hp vim mi d ng theo ma hoc dai dng,
polyp mi, hen ph qun (bao gm suyn), vim da tip xc, vim da d ng (vim da thn
kinh), cc phn ng thuc v huyt thanh.
Mt : nhng tin trnh vim v d ng cp v mn, trm trng lin quan n mt v cc cu trc
ca mt nh vim kt mc d ng, vim gic mc, lot mp gic mc d ng, herps zona mt,
vim mng mt, vim mng mt th mi, vim hc vng mc, vim phn trc, vim mng mch
nho v vim mch mc trc lan ta ra sau, vim dy thn kinh mt, vim mt giao cm ; vim
vng mc trung tm ; vim thn kinh sau nhn cu.
H hp : bnh sarcoidose c triu chng ; hi chng Loeffler khng kim sot c bng cc
phng php khc ; ng c berylium ; phi hp vi ha tr liu trong iu tr bnh lao phi cp
v lan ta ; trn kh mng phi ; x ha phi.
Mu : gim tiu cu t pht v th pht ngi ln ; thiu mu tn huyt t min dch ; gim
nguyn hng cu v thiu mu do gim sn do di truyn ; phn ng vi ng tim truyn.
Ung th : iu tr tm thi ung th mu v u bch huyt bo ngi ln v ung th mu cp
tnh tr em.
Trng thi ph : li tiu hoc lm gim protine niu khng gy tng ur huyt trong hi chng
thn h nguyn pht hoc do lupus ban ; ph mch.
Cc ch nh khc : lao mng no c tc nghn hoc nguy c tc nghn di mng nhn, sau khi
iu tr bng ha liu php khng lao tng ng ; vim i trng lot ; lit Bell's.
CHNG CH NH
Nhng bnh nhn nhim nm ton thn, phn ng nhy cm vi btamthasone hoc vi cc
corticoide khc hoc vi bt c thnh phn no ca Celestone.
THN TRNG LC DNG
iu chnh liu ty theo mc gim hoc tng bnh, p ng ca tng c a, trong nhng
trng hp b nhim khun nghim trng, b thng hoc tri qua phu thut. Cn phi gim
st n 1 nm trong trng hp ngng liu php corticoide di hn hay liu cao.
Corticoide c th che khut mt vi du hiu ca s nhim trng. Khi s dng corticoide, kh
nng khng ca c th gim v khng c kh nng khu tr nhim trng.
S dng lu di corticoide c th gy c thy tinh th di bao (c bit tr em), bnh tng

nhn p c th gy nguy hi n thn kinh mt v c th lm tng cc nhim trng nm hoc

virus th pht mt.
liu trung bnh v liu cao, corticoide c th lm tng huyt p v tng gi mui nc, v
tng bi tit kali. Nhng tc ng ny hu nh t xy ra i vi cc dn xut tng hp ngoi tr
dng liu cao. Nn p dng ch n hn ch mui v giu kali. Tt c corticoide u lm
tng bi tit calci.
Khng c chng nga u ma trong qu trnh iu tr bng corticoide. Cng khng nn
dng cc liu php gy gim min dch trong liu php corticoide, c bit liu cao, v c kh
nng gy cc ri lon thn kinh v lm mt tnh p ng ca khng th. Tuy nhin, nhng
bnh nhn ang c iu tr bng corticoide nh mt liu php thay th (chng hn trong
bnh Addison) vn c th dng liu php min dch.
Bnh nhn dng nhng liu corticoide gy gim p ng min dch cn lu { trnh tip xc vi
ngun ly bnh thy u v si ; nu phi tip xc vi nhng mi trng ny, cn c kin ca
Bc s. iu ny c bit quan trng tr em.
iu tr bng corticoide trong bnh lao th hot ng, nn gii hn th lao cp v lan ta
trong corticoide c dng phi hp vi mt ch khng lao thch hp.
nhng bnh nhn dng corticoide iu tr lao tim tng hoc phn ng vi lao t, cn phi
quan st k v c th xy ra phn ng. Trong sut qu trnh iu tr di hn bng corticoide,
bnh nhn nn c dng ha d phng. Nu dng rifampine d phng, th ch { n tc
dng ca n lm tng chuyn ha thanh thi corticoide gan, c th cn iu chnh liu
corticoide.
Trong tr liu, nn dng liu corticoide thp nht c th ; khi c th gim liu, nn gim t t.
Nu gim nhanh liu coriticoide, c th gy suy thng thn th pht do thuc v nguy c ny
c th gim thiu bng cch ngng thuc t t. Suy thng thn c th ko di nhiu thng sau
khi ngng tr liu ; do , nu c stress trong thi gian ny, nn dng li liu php corticoide.
Nu bnh nhn dng liu php corticoide trc , liu c th c tng ln. Nn dng
ng thi mui v/hoc liu php minralocorticoide bi v s tit minralocorticoide c th b
suy gim.
Hiu qu corticoide c th c tng ln nhng bnh nhn thiu nng tuyn gip hoc b x
gan.
S dng thn trng corticoide nhng bnh nhn b herpes simplex v c th gy thng gic
mc.
Cc ri lon tm thn c th xy ra trong liu php corticoide, ng thi c th lm nng thm
cc bt n tm l{ v khuynh hng b bnh tm thn.
Corticoide nn c s dng thn trng trong vim lo t i trng khng c hiu, nu c nguy
c b thng, p-xe hoc nhim trng mng m, vim ti tha, va qua phu thut ni rut ;
lot d dy th hin hoc tim tng ; suy thn ; cao huyt p ; long xng v nhc c

nng.
Do bin chng ca liu php glucocorticoide ty thuc vo liu lng v thi gian iu tr, cho
nn vic quyt nh iu tr c th c li hoc hi khc nhau tng bnh nhn.
V vic s dng corticoide c th gy ri lon mc tng trng v c ch s sn xut
corticoide ni sinh tr em. Do cn thn trng nhng bnh nhn iu tr di hn.
Corticoide c th lm thay i tnh di ng v s lng tinh trng mt vi bnh nhn.
LC C THAI v LC NUI CON B
Do cha c cng trnh nghin cu, vic s dng Celestone trong thi kz c thai v thi kz nui
con b nn c cn nhc gia li ch tr liu v nhng nguy c khi s dng thuc ngi m,
bo thai hoc a b . a b c m dng nhiu liu corticoide phi c quan st cn thn v
nhng du hiu suy thng thn.
TNG TC THUC
S dng ng thi vi phnobarbital, phnytoine, rifampicine hoc phdrine c th lm tng
chuyn ha corticoide, lm gim tc dng iu tr.
Bnh nhn dng ng thi corticoide v estrogne nn c theo di v kh nng tng hiu
qu ca corticoide.
S dng ng thi corticoide v thuc li tiu gim kali c th gy h kali huyt. S dng ng
thi corticoide vi cc glucoside tr tim c th lm tng kh nng gy lon nhp hoc c tnh
ca digitalis c lin quan n vic h kali huyt. Corticoide c th lm tng vic h kali huyt
gy bi amphotricine B. Trong tt c cc bnh nhn dng phi hp cc loi thuc trn, cn
phi theo di cht ch nng cc cht in gii trong huyt thanh, c bit l nng kali.
Dng ng thi corticoide vi thuc chng ng mu loi coumarine c th lm tng hay gim
hiu qu chng ng. Trng hp ny cn phi iu chnh liu lng.
Phi hp ca thuc khng vim khng stroide hoc ru vi glucocorticoide c th gy tng
lot d dy rut.
Corticoide c th lm gim nng salicylate trong mu.
Trong bnh gim prothrombine trong mu, nn thn trng khi phi hp acide actyl salicylique
vi corticoide.
C th cn iu chnh liu lng thuc chng i tho ng khi c phi hp vi corticoide.
Dng ng thi liu php glucocorticoide c th c ch hiu qu ca somatotropine.
Cc tng tc trong cc x t nghim phng th nghim : corticoide c th nh hng trn th
nghim nitro-blue t trazolium i vi nhim khun v to ra kt qu m tnh gi to.
TC DNG NGOI
Nhng tc dng bt li ca Celestone cng ging nh i vi cc loi corticoide khc, c lin
quan n liu lng v thi gian iu tr. Thng thng nhng tc dng ny l c th hi phc
hoc gim bt bng cch gim liu ; ni chung, tt hn nn ngng thuc trong nhng trng
hp ny.

Ri lon nc v in gii : gi mui v nc, suy tim sung huyt, mt kali, cao huyt p, kim
huyt gim kali.
Trn h c xng : suy yu c, bnh l{ c do corticoide, gim khi lng c, lm nng thm
triu chng nhc c, long xng, gy ln ct sng, hoi t v trng u xng i v u
xng cnh tay, gy xng di bnh l{, t dy chng.
Trn ng tiu ha : lot d dy vi thng hoc xut huyt, vim ty, trng bng, vim lot
thc qun.
Bnh v da : lm chm s lnh vt thng, ln da non, da mng gin ; c m xut huyt v
mng bm mu ; hng ban mt ; tng tit m hi ; thay i cc kt qu xt nghim da ; d ng
nh vim da d ng, ni m ay ; ph mch thn kinh.
Thn kinh : co git ; tng p lc ni s vi ph gai th (gy bu gi no) thng sau khi iu
tr ; chng mt ; nhc u.
Ni tit : ri lon kinh nguyt ; hi chng ging Cushing ; lm gim tng trng ca phi trong
t cung hoc s pht trin ca a b ; mt p ng tuyn yn v thng thn th pht, c
bit trong thi gian b stress, v d nh chn thng, gii phu hoc b bnh ; lm gim dung
np carbohydrate ; cc biu hin ca bnh i tho ng tim n, gy tng nhu cu v
insuline hoc cc tc nhn h ng huyt trong iu tr bnh i tho ng.
Mt : gy c thy tinh th di bao, tng nhn p, glaucome, chng li mt.
Chuyn ha : Cn bng nitrogne m tnh do d ha protine.
Tm thn : gy sng khoi, cm gic lng lng ; cc biu hin suy gim tm l trm trng ; thay
i nhn cch ; mt ng.
Cc tc dng khc : sc phn v hoc phn ng tng mn cm.
LIU LNG v CCH DNG
Liu dng thay i ty theo tng loi bnh, mc nng nh v p ng ca bnh nhn.
Liu khi u ca btamthasone c th thay i t 0,25 n 8 mg/ngy, ty theo chng bnh
ang iu tr. Trong nhng trng hp nh, thng ch dng liu khi u thp l , ngoi tr
mt s bnh nhn phi dng liu cao.
Liu khi u nn c duy tr hoc iu chnh n khi t c hiu qu mong mun.
Nu sau mt thi gian m vn cha t c hiu qu lm sng tha ng, phi ngng
Celestone v chuyn sang iu tr khc.
tr em, liu ung khi u thng thay i t 17,5 n 200 mg (0,0017-0,25 mg)/kg cn
nng/ngy hoc 0,5 n 7,5 mg/m2 c th/ngy. Liu dng cho tr em phi c kim sot cht
ch theo nhng iu kin cn nhc nh ngi ln hn l bm st vo t l tui tc hoc cn
nng.
Khi nhn c p ng thch hp th cn xc nh liu duy tr bng cch gim liu dn dn
t c liu ti thiu c hiu lc lm sng.
Trong qu trnh iu tr bnh mn tnh, nu bnh t thuyn gim, nn ngng iu tr.

Liu Celestone c th c tng ln trong trng hp bnh nhn phi tip xc vi cc stress
khc khng lin quan n bnh ang c iu tr. Trong trng hp sau khi iu tr lu di,
nu mun ngng thuc phi gim liu t t.
Liu khuyn co cho cc chng bnh nh sau :
Vim thp khp v cc thng tn khp khc : liu khi u hng ngy t 1 n 2,5 mg, n
khi nhn c p ng tt, thng sau 3 hoc 4 ngy, hoc 7 ngy. Mc d ni chung khng
cn s dng liu cao nhng c th dng to ra p ng mong mun ban u. Nu sau 7
ngy m khng c p ng, nn chn on li. Khi c s p ng tha ng, nn gim liu
xung 0,25 mg mi 2 hoc 3 ngy n khi t liu duy tr thch hp, thng t 0,5 n 1,5
mg/ngy. Trong bnh thng phong cp tnh, vic iu tr phi c tip tc trong vi ngy mc
d cc triu chng thuyn gim. iu tr bng corticoide nhng bnh nhn b vim khp
dng thp khng ngn nga vic phi hp vi cc phng php iu tr h tr khc c ch
nh.
Thp khp cp tnh : liu khi u hng ngy t 6 n 8 mg. Khi kim sot c y
chng bnh, liu tng cng hng ngy gim xung 0,25 n 0,5 mg/ngy n khi t liu duy tr
tha ng v tip tc vi liu ny trong 4 n 8 tun l hoc lu hn na. Khi ngng tr liu, nn
dng li thuc nu xut hin li s ti kch hot li cn bnh.
Vim mng hot dch : liu khi u t 1 n 2,5 mg/ngy, nn chia ra nhiu ln. Thng sau 2
n 3 ngy s nhn c p ng lm sng, gim liu t t trong vi ngy tip theo v sau
ngng thuc. Thng ch cn mt t iu tr ngn ; nu c ti pht, tin hnh t iu tr th
hai.
Tnh trng hen suyn : 3,5 n 4,5 mg/ngy, trong 1 hoc 2 ngy gim cn ; sau gim liu
xung 0,25 n 0,5 mg/cch ngy n khi t liu duy tr hoc l ngng iu tr.
Suyn mn tnh kh tr : bt u liu 3,5 mg (hoc hn)/ngy n khi c p ng hoc dng
sut trong 7 ngy ; sau gim 0,25 n 0,5 mg/ngy n khi t c liu duy tr.
Kh ph thng hoc x ha phi : thng bt u t 2 n 3,5 mg/ngy (chia nhiu ln) trong
vi ngy cho n khi c p ng ; sau gim 0,5 mg trong mi 2 hoc 3 ngy n khi t liu
duy tr, thng l 1 n 2,5 mg.
Bnh d ng bi hay phn hoa kh tr : nn nh hng iu tr gim triu chng bnh trong
giai on cao im. Ngy th nht : dng liu 1,5 n 2,5 mg/ngy, chia lm nhiu ln ; sau
gim dn 0,5 mg mi ngy n khi triu chng pht li. Liu c iu chnh v sau duy tr
liu ny trong sut t bnh (thng khng qu 10 n 14 ngy) v sau ngng thuc. Ch
dng Celestone h tr cc tr liu khng d ng thch hp khc khi c yu cu.
Trong bnh lupus ban h thng : nhn chung, liu khi u t 1 n 1,5 mg x 3 ln/ngy
trong vi ngy l thch hp ; mc d i khi c th cn liu cao hn t c p ng tha
ng. Sau gim liu t t n liu duy tr va (thng t 1,5 n 3 mg/ngy).
Bnh da : liu khi u t 2,5 n 4 mg/ngy, n khi t hiu qu mong mun. Sau gim

0,25 n 0,5 mg mi 2 hoc 3 ngy cho n khi t n liu duy tr.

Trong cc ri lon ngn hn v t hn ch : thng c th ngng thuc m khng gy ti pht
sau khi kim sot c cn bnh trong vng vi ngy. Liu lng rt thay i trong cc iu tr
di hn.
Trong nhng ri lon trn, thy thuc nn tham kho thm ti liu iu tr.
Vim mt (hu phng) : liu khi u t 2,5 n 4,5 mg/ngy, chia lm nhiu ln, n khi t s
kim sot mong mun, hoc iu tr trong vng 7 ngy. Sau gim 0,5 mg mi ngy n liu
duy tr iu tr cc ri lon mn tnh. Thng thng nhng bnh cp tnh hay t hn ch,
ngi ta ngng thuc sau mt khong thi gian thch hp.
Hi chng sinh dc-thng thn : liu dng thay i ty theo c a v c iu chnh duy
tr nng 17-ktostroide niu nm trong gii hn bnh thng, v thng c hiu qu liu
1 n 1,5 mg/ngy, chia nhiu ln.
Liu mt ln trong ngy : to thun li cho bnh nhn ng thi vn m bo nguyn tc ci
thin liu, liu duy tr hng ngy c th c dng mt ln vo mi sng sm.
iu tr cch ngy : khng c p dng cho liu php corticoide v btamthasone c thi gian
bn hy di (t 36 n 54 gi), vi tc dng c ch trc h i-tuyn yn-thng thn. Nu
iu tr trong thi gian di, nn xem xt dng ch liu xen k btamthasone vi mt tc
ng adrnocorticoide tc thi (nh prednisone, prednisolone hoc mthylprednisolone).
QU LIU
Triu chng : Qu liu cp tnh glucocorticoide (bao gm btamthasone) khng dn n tnh
trng nguy kch. Ngoi tr liu cc cao, mt vi ngy dng glucocorticoide qu liu hu nh
khng gy ra cc hu qu nguy hi tr nhng trng hp thuc v chng ch nh c hiu, nh
bnh nhn i tho ng, glaucome hoc vim lot d dy, hoc nhng bnh nhn ang
c iu tr bng digitaline, chng ng mu loi coumarine hoc thuc li tiu mt kali.
iu tr : trng hp b qu liu cp tnh, nn iu tr tc khc bng cch gy nn hoc tht ra
d dy. Mc khc, nn c cc iu tr thch hp i vi cc bin chng do tc dng chuyn ha
ca corticoide, hoc do tc dng gy c ca bnh gc hoc nhng bnh cng mc ng thi,
hoc nhng hu qu do tng tc thuc.

97.

CELLCEPT

HOFFMANN - LA ROCHE
vin nang 250 mg : hp 300 vin - Bng A.

vin nn 500 mg : hp 150 vin - Bng A.

THNH PHN
cho 1 vin
Mycophnolate moftil

250 mg

cho 1 vin
Mycophnolate moftil

500 mg

DC LC
Mycophnolate moftil c tn ha hc l ester 2-morpholinothylique de l'acide
mycophnolique (MPA). MPA l mt cht c ch chn lc men ionosine monophosphate
d hydrog nase (IMPDH), do n c ch s tng hp nhn nuclotide ca guanosine m
khng cn thm nhp vo ADN. Do s tng hp nhn purine rt cn thit cho to thnh cc t
bo lymph B v T, trong khi cc loi t bo khc th c th tn dng c ch ti s dng nhn
purine, MPA c hiu lc km t bo trn cc t bo lymph ng k hn hn so vi trn cc t
bo khc.
Kh nng gy ung th, t bin, nh hng trn thai kz :
Trong nhng nghin cu trn chut cng v chut nht, mycophnolate moftil khng gy
bu.
Mycoph nolate mof til khng gy t bin trn cc ng vt th nghim.
Mycophnolate moftil khng nh hng n kh nng sinh sn trn chut cng c. Trong
mt nghin cu v kh nng th thai v sinh sn ca chut cng ci, quan st thy c d dng
(nht l mt v u) la chut con u (F1) trong khi chut m khng c du hiu ng
c. cc chut ci m c cho dng thuc (P1) cng nh cc chut con, c hoc ci, ca
th h th nht (P2), khng thy c hu qu g trn kh nng sinh sn.
DC NG HC
Hp thu :
Sau khi ung thuc, mycoph nolate mof til c hp thu nhanh v phn ln qua ng tiu
ha, sau c chuyn ha thnh MPA l cht chuyn ha c hot tnh. Dng bng ng
ung, mycoph nolate mof til khng c pht hin trong huyt tng.
nh hng ca thc n : Cmax gim cn 77%.
Dng vin nang v vin nn cho nng Cmax khc nhau, nhng c AUC (din tch di ng
cong) tng ng nhau.
sinh kh dng trung bnh ca mycoph nolate mof til dng ng ung, tnh theo AUC ca

AMP, chim 94% so vi sinh kh dng ca mycoph nolate mof til khi dng ng tnh mch.
Phn phi :
Do nh hng ca chu kz gan-rut, thng quan st thy c mt nh th nh ca AMP sau khi
ung thuc t 6 n 12 gi. Din tch di ng cong (AUC) ca MPA gim khong 40% khi
mycoph nolate mof til c dng ng thi vi cholestyramine (mi ln 4 g, ngy 3 ln), iu
ny cho thy nh hng quan trng ca chu kz gan-rut.
nhng nng ng k v lm sng, c 97% MPA gn kt vi albumine huyt tng.
nhng nng MPAG c quan st bnh nhn ghp thn c n nh, c 82% MPAG
gn kt vi albumine huyt tng. nhng nng MPAG cao hn, chng hn nhng nng
c 1quan st bnh nhn c mnh ghp chm hot ng hay bnh nhn b suy thn
nng, t l gn kt in vitro ch c 62%.
Chuyn ha :
MPA ch yu c chuyn ha nh men glucuronyl transfrase thnh glucuronide phnolique
MPA (MPAG), cht ny khng c hot tnh dc l.
o thi :
Kh xc nh c thi gian bn hy (T1/2) ca MPA do b nh hng ca chu kz gan-rut. Thi
gian bn hy biu kin vo khong 16 n 18 gi. Khong 93% liu dng c o thi qua
thn, phn ln di dng MPAG, v khong 5,5% c o thi qua phn.
Dc ng trong mt s trng hp c bit :
Trong mt nghin cu c thc hin vi liu duy nht (6 ngi mi nhm), AUC ca MPA
bnh nhn b suy thn nng mn tnh (tc lc di 25 ml/pht/1,73 m2) cao hn khong 2875% so vi AUC ngi khe mnh hay bnh nhn b suy thn nh hn. Vic tng trung bnh
ca AUC ca MPA bnh nhn suy thn nng c th so snh vi khi tng liu mycophnolate
mof til n 2-3 g/ngy. nhng bnh nhn c mnh ghp chm hot ng, AUC0-12 trung bnh
ca MPA c th so snh vi nhng bnh nhn c gh p c quan c tin trin bnh thng.
Suy gan khng nh hng n dc ng ca thuc. Cha c nghin cu dc ng bnh
nhn cao tui.
CH NH
CellCept c ch nh d phng cc phn ng thi ghp nhng bnh nhn c ghp
thn d thn. CellCept phi c dng ng thi vi cysclosporine v corticoide.
CHNG CH NH
Mt s trng hp d ng vi CellCept c quan st. Do chng ch nh CellCept cho
bnh nhn qu nhy cm vi mycophnolate moftil hay vi acide mycophnolique. Tnh dung
np v hiu qu ca thuc khi dng cho tr em cha c xc lp.
THN TRNG LC DNG
Cng nh i vi tt c cc bnh nhn c dng thuc c ch min dch v thng dng di
dng phi hp, nhng bnh nhn dng CellCept c nguy c b u lymph bo v cc loi bu c

tnh khc, nht l da. Nguy c ny dng nh c lin quan nhiu n liu dng v thi gian
iu tr hn l do vic s dng mt loi thuc c k toa.
Vic c ch qu mc h thng min dch cng c th lm c th d mc cc bnh nhim trng.
nhng bnh nhn dng CellCept hay cc thuc c ch min dch khc, thy c tng cc bnh
tng sinh t bo lymph hay u lymph bo 0,6-1% bnh nhn trong mt nghin cu c kim
sot v vic d phng phn ng thi ghp (0-0,3% nhm chng).
Trong 3 cng trnh nghin cu c kim sot v vic d phng phn ng thi ghp, mt s
trng hp t vong (t l tng t nhau l < 1%) do b cc bnh nhim trng c ghi nhn
nhng bnh nhn c dng thuc c ch min dch, nhm dng CellCept v c nhm
chng. Di 1,5% bnh nhn dng CellCept d phng phn ng thi ghp b gim bch cu
trung tnh nng (ANC < 500/ml).
Cn theo di s lng bch cu trung tnh bnh nhn dng CellCept.
Trng hp gim bch cu trung tnh (AUC < 1,3x103/ml), phi ngng hoc gim liu CellCept,
ngoi ra cn lm cc test chn on v iu tr cho bnh nhn nu cn.
Mt vi trng hp him ghi nhn c xut huyt v thng d dy-rut bnh nhn c iu
tr bng CellCept. Do vic dng CellCept c lin quan n vic tng nhng tc dng ngoi trn
ng tiu ha nh lo t d dy-rut, xut huyt, thng... phi thn trng khi dng cho nhng
bnh nhn ang c nhng bnh ng tiu ha. nhng bnh nhn b suy thn nng mn
tnh (tc lc di 25 ml/pht/1,73 m2), dng CellCept liu duy nht, thy AUC ca MPA v
MPAG trong huyt tng tng cao so vi bnh nhn b suy thn t hn hay ngi khe mnh.
Nhng bnh nhn ny khng c dng liu hng ngy trn 1 g x 2 ln, v phi c bit theo
di.
nhng bnh nhn c mnh ghp chm hot ng, AUC0-12 trung bnh ca MPA c th so snh
vi nhng bnh nhn c gh p c quan c tin trin bnh thng, trong khi AUC0-12 ca
MPAG li cao gp 2-3 ln. Khng cn phi chnh liu nhng bnh nhn ny, nhng phi tng
cng theo di.
Khng nn dng CellCept cng lc vi azathioprine. Do cholestyramine lm gim ng k AUC
ca MPA, nn c bit thn trng khi dng ng thi CellCept vi cc thuc gy cn tr chu kz
gan-rut, do c th lm gim hiu lc ca CellCept.
Test sinh hc :
Nn kim tra cng thc mu mi tun mt ln trong thng iu tr u, sau 2 tun mt ln
trong 2 thng k v mi thng mt ln trong nhng thng tip theo trong nm iu tr u.
LC C THAI v LC NUI CON B
Dng thuc c th gy nguy c cho bo thai, tuy nhin c th cn nhc vi li ch iu tr mang
n cho ngi m. Nn dng bin php trnh thai hu hiu trong thi thi gian dng CellCept.
Cc nghin cu trn chut cng cho thy rng mycoph nolate mof til c bi tit qua sa
m. Hin cha c s liu v s bi tit qua sa m ngi. Tuy nhin do c nhiu loi thuc

c bi tit qua sa m v do nhng nguy c v tc dng ngoi ca mycophnolate moftil

c th xy ra cho tr b m, nn quyt nh hoc ngng cho con b hoc ngng dng thuc.
Trong trng hp ny, li ch iu tr cho ngi m phi c u tin.
TNG TC THUC
Khng dng ng thi CellCept v azathioprine.
Aciclovir : nu dng 2 thuc ny ng thi, AUC ca c hai thuc ny tng ng k : MPAG tng
8,6% v aciclovir tng 17,4%. Nng trong huyt tng ca MPAG v aciclovir tng trng
hp bnh nhn b suy thn do hai cht ny cnh tranh trn s bi tit ng thn v do dn
n vic tng nng ca c hai cht ny.
Thuc khng acide (magnesium hydroxyde v aluminium hydroxyde) : s hp thu ca
mycophnolate moftil gim khi dng ng thi vi cc thuc khng acide.
Cholestyramine : AUC ca MPA gim 40%.
Cyclosporine A : dc ng ca cyclosporine A khng b bin i bi mycophnolate moftil.
Ganciclovir : khng thy c tng tc thuc gia mycophnolate moftil v ganciclovir dng
ng tnh mch.
Thuc trnh thai dng ung : khng thy c tng tc thuc gia mycophnolate moftil v
dng phi hp northistrone (1 mg) v thinylestradiol (35 mg). Nghin cu ny c thc
hin vi liu duy nht, c th gip kt lun rng khng xy ra tng tc thuc quan trng. Tuy
nhin khi CellCept c dng di hn, khng th loi tr c th nh hng n dc ng ca
cc thuc trnh thai cng nh hiu lc ca chng.
Trimthoprime/sulfamthoxazole : khng thy c nh hng trn sinh kh dng ca MPA.
Cc tng tc khc : dng ng thi probncide v mycophnolate moftil thy c du hiu
tng gp 3 ln AUC ca MPA. Mt s thuc khc c bi tit qua ng thn cng c th xy ra
tng tc vi MPAG nh tng nng MPAG trong huyt tng hay ca cc thuc c bi
tit qua ng thn.
TC DNG NGOI
Kh c th xc nh u l tc dng ngoi ca mt thuc c ch min dch do c th l
nhng triu chng ca mt bnh l tim n nht l do c nhiu thuc c s dng ng thi.
Cc tc dng ngoi { thng gp c lin quan n vic dng CellCept l tiu chy, gim bch
cu, nhim trng mu v nn ma. Ngoi ra, mt s nhim trng c th xy ra vi tn sut cao.
Di y l mt s tc dng ngoi { c ghi nhn trong cc kho st lm sng c kim sot
nhng bnh nhn c iu tr bng CellCept vi tun sut >= 10% v t 3 n 10% :
Tng qut :
- >= 10% : nhim trng mu (19,7%), nhim trng (20,9%), st (23,3%), suy nhc (16,1%), nhc
u (21,1%), au ngcc,4%), au bng (27,6%), au lng (12,1%), au khng xc nh c v
tr (33,0%).
- t 3 n 10% : nang, xut huyt, thot v, cng bng, au m h, hi chng cm, ph mt.

Mu v h bch huyt :
- >= 10% : gim bch cu (34,5%), gim tiu cu (10,1%), thiu mu (25,8%), thiu mu nhc
sc (11,5%).
- t 3 n 10% : tng bch cu, tng hng cu.
H tit niu :
- >= 10% : nhim trng ng tiu (37,2%), hoi t ng thn (10,0%), huyt niu (14,0%).
- t 3 n 10% : albumine niu, thn nc, tiu kh, i dt, ri lon ng tiu.
Tim mch :
- >= 10% : cao huyt p (32,4%).
- t 3 n 10% : huyt khi, h huyt p (k c h HA t th), rung nh, nhp tim nhanh, nh
trng ngc, gin mch.
Chuyn ha :
- >= 10% : tng ng huyt (12,4%), gim phosphate huyt (15,8%), ph n, ngay c ngoi
bin (12,2%).
- t 3 n 10% : tng mt s thng s sinh hc : g-GT, SGPT, SGOT, LDH, phosphatase kim,
calcium, cholesterol, lipide, acide urique v creatinine ; gim nng potassium, calcium,
glucose v proteine trong mu, nhim toan, mt nc, tng th tch mu, tng cn.
Tiu ha :
- >= 10% : nn (23,6%), ma (13,6%), kh tiu (17,6%), tiu chy (36,1%), to bn (17,6%),
nhim Candida ming (12,1%).
- t 3 n 10% : xut huyt d dy-rut, nhim trng, chn n, sng nu, vim nu, vim thc
qun, vim d dy, vim rut, y hi, tc rut, ri lon trc trng, cc gi tr bt thng ca
chc nng gan.
H hp :
- >= 10% : nhim trng (23,0%), kh th (17,3%), ho (15,6%).
- t 3 n 10% : vim phi, ph phi, vim ph qun, vim hu, vim xoang, vim mi.
Thn kinh :
- >= 10% : mt ng (11,8%), run ry (11,5%).
- t 3 n 10% : chng mt, d cm, tng trng lc, lo u.
Da v phn ph :
- >= 10% : nhim trng Herpes simplex (20,0%).
- t 3 n 10% : zona, lo t da, ung th da, bm mu, mn trng c, ngoi ban, rm lng, ra m
hi nhiu.
Ni tit :
- t 3 n 10% : tiu ng, ri lon chc nng tuyn gip.
C, xng :
- t 3 n 10% : au khp, au c, vp b bp chn, nhc c.

C quan cm gic :
- t 3 n 10% : vim kt mc, gim th lc.
Trong cc nghin cu lm sng c kim sot trong d phng thi ghp, liu hng ngy ca
mycoph nolate mof til 2 g/ngy c dung np tt hn so vi liu 3 g/ngy. i chiu vi
nhm bnh nhn dng azathioprine hay gi dc thy nhm bnh nhn dng CellCept c tn
sut b tiu chy, nn ma, nhim trng mu v nhim trng tiu cao hn. Ngoi ra, gim bch
cu cng thng xy ra hn nhm dng CellCept so vi nhm chng, v thng xy ra
nhm dng liu 3 g/ngy hn.
Trong cc nghin cu d phng thi ghp, cc nhim trng xm ln do cytomegalovirus cng
thng c quan st nhng bnh nhn dng liu 3 g/ngy so vi nhm dng liu 2 g/ngy
v nhm dng cc thuc i chng.
Khi d phng phn ng thi ghp bng CellCept hay mt thuc i chng v c phi hp vi
thuc c ch min dch khc, nguy c nhim trng dn n t vong xy ra ng u c hai
nhm vi t l < 1%.
Gim bch cu trung tnh nng (ANC 500/ml) xy ra < 1,5% bnh nhn dng CellCept d
phng thi ghp. Trong cc nghin cu c kim sot v d phng thi ghp, tai bin xy ra cc
bnh l c tnh thp v tng t vi nhng tai bin c lit k trong y vn i vi nhng bnh
nhn c ghp thn d thn. Tai bin gy tng sinh t bo lymph v u lymph bo hi cao
nhm bnh nhn dng CellCept (khong 1%) so vi nhm chng (0-0,3%).
LIU LNG v CCH DNG
D phng thi ghp :
Liu tt nht sau khi cn nhc gia li v hi l 2 g (2x4 vin nang hoc 2x2 vin nn).
nhng bnh nhn ghp thn, liu hng ngy c khuyn co l 2 g. Nu cn phi tng cng
c ch min dch, c th tng liu CellCept n 3 g/ngy (2x6 vin nang hoc 2x3 vin nn).
Liu u tin ca CellCept phi c dng trong vng 72 gi sau phu thut ghp.
CellCept phi c dng ng thi vi cysclosporine v corticoide.
Hng dn liu trong nhng trng hp c bit :
nhng bnh nhn b suy thn nng mn tnh (tc lc di 25 ml/pht/1,73 m2), nn trnh
dng liu cao hn 1 g CellCept, 2 ln/ngy sau giai on dng thuc ngay sau phu thut ghp.
bnh nhn c mnh ghp chm hot ng, nn chnh liu cho thch hp.
Trng hp gim bch cu trung tnh (AUC < 1,3x103/ml), phi ngng hoc gim liu CellCept,
ngoi ra cn lm cc test chn on v iu tr cho bnh nhn nu cn.
QU LIU
Cho n nay, khng c trng hp no c bo co v qu liu mycophnolate moftil
ngi.
MPA v MPAG khng thm phn c. Tuy nhin, trng hp nng MPAG trong mu tng

cao (> 100 mg/ml), dng bin php thm phn c th loi mt lng nh MPAG. Dng cc tc
nhn gi acide mt nh cholestyramine c th lm tng s o thi ca thuc v ca MPA.

98.

CEPODEM

RANBAXY
Vin nn 100 mg : v 6 vin, hp 5 v.
Vin nn 200 mg : v 6 vin, hp 5 v.
Hn dch ung 50 mg/5 ml : chai 60 ml.
Hn dch ung 100 mg/5 ml : chai 60 ml.
THNH PHN
cho 1 vin
Cefpodoxime proxetil, tng ng Cefpodoxime

100 mg

cho 1 vin
Cefpodoxime proxetil, tng ng Cefpodoxime

200 mg

cho 5 ml hn dch
Cefpodoxime proxetil, tng ng Cefpodoxime

50 mg

cho 5 ml hn dch
Cefpodoxime proxetil, tng ng Cefpodoxime

100 mg

M T
Cefpodoxime proxetil l khng sinh cephalosporin th h 3 ph khng khun rng dng ng
ung. y l tin dc ca cefpodoxime. Cefpodoxime proxetil c cu trc ha hc l RS-1(isopropoxycarbonyloxy) ethyl(+)-6R,7R-7-(2-(2-amino-4-thiazolyl)-2-((Z)-methoxyimino)
acetamido)-3-methoxymethyl-8-oxo-5thia-1-azabicyclo (4.2.0) oct-2-ene-2 carboxylate. Cng
thc phn t ca Cefpodoxime proxetil l C21H27N5O9S2 v khi lng phn t l 557,61.
DC LC

C ch tc ng :
Tc dng khng khun ca Cefpodoxime thng qua s c ch tng hp thnh t bo vi khun
nh s acyl ha cc enzymes transpeptidase gn kt mng ; iu ny ngn nga s lin kt
cho ca cc chui peptidoglycan cn thit cho mnh v bn ca thnh t bo vi khun.
Ph khng khun :
Cefpodoxime proxetil c tc dng chng li cc vi khun Gram dng v Gram m. Thuc n
nh i vi b-lactamases. Ph khng khun bao gm Staphylococcus aureus ngoi tr
Staphylococci khng methicillin, Streptoccocus pyogenes, Streptococcus pneumoniae,
Streptococcus agalactiae v Streptococcus spp. khc (Nhm C, F, G). Cc vi khun Gram m
nhy cm vi cefpodoxime bao gm cc chng sinh b-lactamase v khng sinh b-lactamase ca
H. influenzae, H. para- influenzae, Moraxella catarrhalis, Neisseria meningitidis, Neisseria
gonorrhoea, E. coli, Klebsiella pneumoniae, Proteus vulgaris, Providencia rettgeri v Citrobacter
diversus. Cefpodoxime cng hiu qu i vi Peptostreptococcus spp.
Th nghim nhy cm :
Kt qu th nghim bng cch s dng mt a khuch tn 10 mg c gii thch nh sau :
ng knh (mm)

nh gi

>= 21

Nhy cm (S)

18-20

Nhy cm trung bnh (I)

<= 17

khng (R)

DC NG HC
Sau khi ung, cefpodoxime proxetil c hp thu v thy phn nhanh thnh cefpodoxime.
Trong cc t bo biu m rut nhm ester c gii phng do ch c cefpodoxime i vo
mu. Sau khi dng liu 100 mg, nng nh trung bnh trong huyt tng l 1,4 mg/ml t
c trong khong 2 gi. Khi c ung cng vi thc n, mc hp thu v nng nh
trung bnh trong huyt tng tng ln ; din tch di ng cong AUC tng 33% cc con vt
nui. Thuc c gn kt vi protein huyt tng khong 29%. Nng cefpodoxime trong cc
m thay i ty cc liu khc nhau ca cefpodoxime proxetil theo bng di y :
Nng ca Cepodem ti cc m :
Liu lng

Nng mg/g

100 mg

Amian

0,24

200 mg

Phi

0,63

200 mg

Nt bng da

1,6

In vivo c s chuyn ha nh ca cefpodoxime. Khang 33% liu dng c thi tr di dng

khng i qua nc tiu. Thi gian bn hy trong huyt tng khong 2,8 gi.
CH NH
Cepodem c ch nh iu tr cc nhim khun sau y :
- Nhim khun h hp trn bao gm vim tai gia cp, vim xoang, vim amian v vim hng.
- Vim phi cp tnh mc phi trong cng ng.
- Nhim lu cu cp cha c bin chng.
- Nhim khun ng tiu cha c bin chng.
- Nhim khun da v cu trc da.
CHNG CH NH
Cepodem c chng ch nh cc bnh nhn c tin s nhy cm vi cefpodoxime proxetil.
CH PHNG v THN TRNG LC DNG
Ch { phng :
Cn phi ngh n vim i trng mng gi cc bnh nhn b tiu chy sau khi ung
cefpodoxime proxetil.
Thn trng lc dng :
Cn thn trng c bit cc bnh nhn c p ng phn v i vi penicillin. Khng nn
ch nh Cepodem cho cc bnh nhn c tin s nhy cm vi cephalosporin hoc cc b-lactam
khc. Phn ng d ng d xy ra cc bnh nhn c tin s d ng.
AN TON TIN LM SNG
Tnh gy ung th, t bin gen :
Cc th nghim lu di v tnh gy ung th trn vt th nghim cha c tin hnh. Cc th
nghim v tnh gy t bin ca Cefpodoxime gm c th nghim Ames, th nghim sai lc
nhim sc th, th nghim gy t bin gene v th nghim vi nhn in vivo u m tnh.
LC C THAI v LC NUI CON B
Cc nghin cu tin hnh nhiu loi vt th nghim khng cho thy bt kz biu hin gy
qui thai hoc gy c cho thai ; tuy nhin, c th ch nh cefpodoxime cho ph n c thai ch
khi thc s cn thit. Do phn ng nng n tr b m, cn thn trng quyt nh nn ngng
b hay ngng thuc.
TNG TC THUC
Nng trong huyt tng gim khong 30% khi Cefpodoxime proxetil c ch nh cng vi
thuc khng acid hoc c ch H2. Khi ch nh Cepodem ng thi vi hp cht c bit l gy
c thn, nn theo di st chc nng thn. Nng cefpodoxime trong huyt tng gia tng

khi ch nh Cepodem vi probenecid.

Thay i cc gi tr xt nghim : Cephalosporins lm cho th nghim Coomb trc tip dng
tnh.
TC DNG NGOI
Tc dng ph c ghi nhn trong cc th nghim lm sng thng nh v thong qua, bao
gm : i tiu chy, bun nn, nn i, au bng, vim i trng v au u. Him khi xy ra phn
ng qu mn, ni ban, chng nga, chng mt, chng tng tiu cu, chng gim tiu cu, gim
bch cu hoc tng bch cu a eosin.
LIU LNG v CCH DNG
Ngi ln :
Nhim khun h hp trn, k c vim amian v vim hng : 100 mg mi 12 gi trong 10 ngy.
Vim phi cp tnh mc phi trong cng ng : 200 mg mi 12 gi trong 14 ngy.
Nhim lu cu cp cha c bin chng : liu duy nht 200 mg.
Nhim khun ng tiu cha c bin chng : 100 mg mi 12 gi trong 7 ngy.
Nhim khun da v cu trc da : 400 mg mi 12 gi trong 7 - 14 ngy.
Tr em :
Vim tai gia cp tnh : 10 mg/kg/ngy (ti a 400 mg/ngy chia lm 2 ln) trong 10 ngy.
Vim hng v vim amian : 10 mg/kg/ngy (ti a 200 mg/ngy chia lm 2 ln) trong 10 ngy.
Cepodem nn c ch nh cng vi thc n. cc bnh nhn suy thn ( thanh thi
creatinine di 30 ml/pht), khong cch gia liu nn c tng n 24 gi.
Khng cn phi iu chnh liu cc bnh nhn x gan.
QU LIU
Qu liu i vi cefpodoxime proxetil cha c bo co. Triu chng do dng thuc qu liu
c th gm c bun nn, nn, au thng v v i tiu chy. Trong trng hp c phn ng
nhim c nng n do dng qu liu, thm phn mu hay thm phn phc mc c th gip loi
b cefpodoxime ra khi c th, c bit khi chc nng thn b suy gim.
BO QUN
Bo qun di 25oC, trnh nh sng v trnh m.

99.

CEPOREX

GLAXOWELLCOME
vin nang 250 mg : hp 100 vin.
vin nang 500 mg : hp 100 vin.
thuc tim 1 g : hp 1 ng thuc.
THNH PHN
cho 1 vin nang 250 mg
Cfalexine

250 mg

cho 1 vin nang 500 mg

Cfalexine

500 mg

cho 1 ng thuc
Cfalexine

1g

DC LC
Cfalexine l mt khng sinh dit khun c hot tnh ln nhiu loi vi khun gram dng v
gram m.
Cfalexine bn vng vi tc ng ca pnicillinase ca Staphylococcus, v do , khng li cc
chng Staphylococcus aureus khng nhy cm vi pnicilline (hay ampicilline) do c kh nng
sn xut enzyme p nicillinase. C falexine cng c hot tnh ln a s cc E. coli khng
ampicilline.
DC NG HC
Cfalexine hu nh c hp thu hon ton, ngay c khi c s hin din ca thc n, v khng
b nh hng bi cc bnh ng tiu ha, sau khi ct mt phn d dy, chng thiu acide
chlorhydrique, vng da hay bnh c ti tha ( t trng hay hng trng). Thuc c o thi
vi nng cao qua nc tiu.
Thi gian bn hy thng khong 1 gi, nhng lu hn tr s sinh (xem Liu lng).
Ceporex c mc an ton cao.
CH NH
- Nhim khun ng h hp : vim ph qun cp v mn v gin ph qun c bi nhim.
- Nhim khun tai mi hng : vim tai gia, vim xng chm, vim xoang, vim amygdale v
vim hng.
- Nhim trng ng tiu : vim b thn cp v mn, vim bng quang v vim tuyn tin lit.

D phng nhim khun ng niu ti pht.

- Nhim khun sn v ph khoa.
- Nhim khun da, m mm v xng.
- Bnh lu v giang mai (khi dng pnicilline khng ph hp)
- Trong nha khoa : thay th tm thi iu tr phng nga vi pnicilline cho bnh nhn mc
bnh tim phi iu tr bnh rng.
CHNG CH NH
Mn cm vi cphalosporine.
THN TRNG LC DNG
Ceporex thng c dung np tt bnh nhn d ng p nicilline, tuy nhin cng c mt s
rt t phn ng cho xy ra. Ging nh nhng khng sinh c o thi ch yu qua thn, khi
chc nng thn suy yu, nn gim bt liu lng Ceporex cho thch hp (xem Liu lng).
bnh nhn dng Ceporex, c th gy phn ng dng tnh gi to trong xt nghim glucose
niu vi dung dch Benedict hay dung dch Fehling hoc c dng tnh gi to vi cc vin nn
"Clinitest" nhng khng c tc dng ny vi cc xt nghim da trn c s enzyme.
Ceporex c th nh hng ln xt nghim cratinine bng picrate kim, cho mt kt qu cao
gi, tuy nhin mc tng cao hu nh khng quan trng trn lm sng.
LC C THAI
Cc nghin cu trong phng th nghim v kinh nghim trong lm sng khng cho thy bng
chng v tc ng gy qui thai, tuy nhin nn thn trng khi dng trong nhng thng u ca
thai kz nh i vi mi loi thuc khc.
TC DNG NGOI
Mt s t bnh nhn dng Ceporex c th b ri lon tiu ha nh bun nn, nn ma v tiu
chy. Nh vi nhng khng sinh ph rng khc, Ceporex c th gy tng trng vi khun cng
sinh (i khi c th xut hin Candida albicans di dng vim m o).
Mt s rt t bnh nhn c xy ra gim bch cu trung tnh c hi phc.
t khi c ni ban do thuc, m ay v dt sn.
LIU LNG v CCH DNG
a s trng hp nhim trng ngi ln p ng vi liu ung 1-2 g/ngy chia lm nhiu ln.
i vi hu ht cc nhim trng, ch liu lng n gin nh sau c th tha ng :
Ngi ln v tr em trn 12 tui : 500 mg x 3 ln mi ngy.
Tr em 5-12 tui : 250 mg x 3 ln mi ngy.
Tr em 1-5 tui : 125 mg x 3 ln mi ngy.
Di 1 tui : 125 mg x 2 ln mi ngy.
ph hp hon cnh, c bit vi bnh nhn i li thng xuyn, lng dng hng ngy c
th chia lm 2 liu bng nhau, ngha l 1 g x 2 ln mi ngy cho ngi ln mc bnh nhim
trng ng niu.

n Cng nn xem x t cn nhc cc thng tin sau :

Ngi ln :
p Nhim trng nng hay khu tr su, c bit trong nhng trng hp vi khun km nhy cm :
nn tng liu n 1 g x 3 ln mi ngy, hay 1,5 g x 4 ln mi ngy.
p D phng nhim trng ng tiu ti pht : liu khuyn co nn dng l 125 mg mi ti v c
th dng lin tc trong vi thng.
Tr em : nn tnh ton liu lng da trn trng lng c th, c bit cc tr nh. Cc
khuyn co v liu lng sau cho tr em da trn liu lng bnh thng 25-60 mg/kg/ngy.
i vi cc nhim trng mn, nhim trng trm trng hay khu tr su, liu lng ny nn tng
n 100 mg/kg/ngy (dng ti a 4 ngy).
Tr nh hn hoc 3 thng tui : 62,5-125 mg x 2 ln mi ngy.
Tr 4 thng-2 nm : 62,5-125 mg x 4 ln mi ngy hay 125-500 mg x 2 ln mi ngy.
Tr 3-6 tui : 125-250 mg x 4 ln mi ngy hay 250-500 mg x 2 ln mi ngy.
Tr em 7-12 tui : 250-500 mg x 4 ln mi ngy hay 500-1 g x 2 ln mi ngy.
Ch : i vi hu ht cc nhim trng cp, nn tip tc iu tr t nht hai ngy sau khi cc du
hiu tr li bnh thng v triu chng gim bt, nhng trong cc nhim trng ng niu v
giang mai phc tp, ti pht hay mn tnh nn iu tr 2 tun (dng 500 mg x 4 ln mi ngy).
i vi bnh lu, thng dng liu duy nht 3 g vi 1 g prob n cide cho n ng v 2 g vi 0,5
g probncide cho ph n. Dng kt hp vi probncide s lm ko di thi gian o thi ca
c falexine v lm tng nng trong huyt thanh n 50-100%. Cho n nay, Ceporex cha
cho thy c c tnh ln thn, tuy nhin nh i vi nhng khng sinh o thi ch yu do
thn, c th xut hin s tch t khng cn thit khi chc nng thn gim di mt na mc
bnh thng. Do , liu lng ti a c khuyn co (ngha l 6 g/ngy cho ngi ln v 4
g/ngy cho tr em) nn gim cho ph hp nhng bnh nhn ny.
ngi gi, nn xem xt cn nhc kh nng suy thn.
Ngi ln ang iu tr thm phn tng t nn dng thm 500 mg sau mi t thm phn,
ngha l liu tng cng ti a 1 g vo ngy . i vi tr em, nn dng liu b sung l 8 mg/kg.
QU LIU
Nng trong huyt thanh ca cfalexine c th gim mt phn ln do thm phn phc mc
hay thm phn mu.
BO QUN
Nn bo qun trnh nh sng cho vin nang.
Xir pha xong c th gi tnh nng ca thuc trong vng 10 ngy nu bo qun ni lnh, thch
hp nht l gi trong t lnh. Thuc c th pha long vi nc (khng phi dng xir BP) sau
nn dng trong vng 7 ngy.

100.

CEREBROLYSIN

EBEWE - ARZNEIMITTEL
dung dch tim : hp 10 ng tim 1 ml, hp 5 ng tim 5 ml v hp 5 ng tim 10 ml.
dung dch tim : l 20 ml, 30 ml v 50 ml.
THNH PHN
cho 1 ml
Tinh cht peptide t no ln

215,2 mg

ng vi :
Acide amine

85%

Peptide c trng lng phn t thp

15%

DC LC
c im :
Cerebrolysin l hp cht cha cc peptide v acide amine, c sn xut t protine tinh khit
no ln bng cng ngh sinh hc, da trn phng php dng enzyme ct on chun ha c
kim sot. Khong 15% trng lng kh ca thuc l cc peptide c trng lng phn t thp
khng qu 10 KD v 85% cn li l acide amine.
Dung dch dng tim hoc truyn, khng cha protine, lipide hoc cc hp cht c tnh
khng nguyn.
1 ml Cerebrolysin cha 215,2 mg tinh cht peptide t no ln.
Dc lc :
Cerebrolysin l mt thuc thuc nhm dinh dng thn kinh, bao gm cc acide amine v
peptide c hot tnh sinh hc cao, tc ng ln no theo nhiu c ch khc nhau v c th c
gii thch c ng nh sau :
- Tng cng v ci thin chuyn ha ca cc t bo thn kinh, do ngn chn c hin
tng nhim acid lactic trong thiu oxy no hoc thiu mu no.
- iu chnh s dn truyn synap thn kinh, t ci thin c hnh vi v kh nng hc tp.
- C hiu qu dinh dng thn kinh ging nh NGF (nerve growth factor - v th ring kha
cnh c bit ny Cerebrolysin cn c gi l nerve growth factor like). Hiu qu ny bao gm
: tng bit ha t bo thn kinh, m bo chc nng thn kinh v bo v t bo no trnh khi
tn thng do thiu mu v nhim c gy ra.

C ch tc dng, tnh nng, hiu qu ca Cerebrolysin c chng minh qua mt lot cc th

nghim trong phng th nghim, trn ng vt v trn cc th nghim lm sng tiu biu l
nhng th nghim nh sau :
Nui cy t bo thn kinh trong mi trng Cerebrolysin chng minh c rng
Cerebrolysin c c tnh ging NGF ch m bo cho t bo thn kinh sng bi v trc
vic nui cy t bo thn kinh ch thc hin trong mi trng c NGF. Sau c tnh trn ca
Cerebrolysin cng c chng minh qua th nghim tch ri vng Fimbria-fornix no chut,
gy ra hin tng cht t bo hi hi m do thiu NGF. Trn th nghim ny, vic thm
Cerebrolysin vo lm ngn nga s thoi ha v teo t bo thn kinh cholinergique b h hi,
tng s t bo sng st t 30-50%. Cc th nghim trn chng t c tnh duy tr s sng
t bo thn kinh ca Cerebrolysin.
iu c bit quan trng l NGF t nhin khng th ng dng iu tr v trng lng phn t
qu ln, khng vt qua hng ro mu no c nn khng th tim truyn ngoi bin. Cn
Cerebrolysin do trng lng phn t nh nn c th tim truyn ngoi bin m vn cho tc
dng ging nh tim thng vo no tht do d dng vt qua hng ro mu no.
Rt nhiu th nghim khc nhau trn ng vt m phng bnh tt ca ngi c nghin
cu trong c bit quan trng l th nghim m phng thiu oxy t bo thn kinh (m
phng t qu thiu mu) vi vic a vo mi trng nui cy t bo thn kinh cht cyanure
to ra hin tng thiu oxy t bo thn kinh dn n cht t bo. a Cerebrolysin trc
hay sau khi x l cht c vo mi trng trn c tc dng cu sng t bo thn kinh (hn 60%)
do tc dng bo v t bo thn kinh ca Cerebrolysin. In vivo cc kho st sau khi gy nghn
ng mch cnh hai bn cho thy iu tr bng Cerebrolysin lm gim 50% t l t vong do
ngn nga s ph n do ng c trong thn no v phn nn ca no trc.
Cc gc t do l sn phm cui cng ca cc tn thng thiu mu cc b hay tn thng do
ng c. Chng lm hi cc t bo thn kinh v dn n s cht hoi ca t bo. Tc dng iu
bin chuyn ha quan trng nht ca Cerebrolysin l gim gc t do, tng hiu qu s dng oxy
trong t bo thn kinh, chnh v th c tc dng bo v t bo thn kinh.
Nghin cu mc su hn, ngi ta nhn thy rng Cerebrolysin bin i dn truyn qua
synapse thn kinh trn vng CA1, m no chut ti hi hi m. Phn tch chi tit chng
minh rng s c ch l c ch tin synapse v c th gim bt vi liu thp 8cyclopentylthophylline l mt cht c ch c hiu ca th th A1 ca adnosine. Do khng
tm thy bt kz mt lng adnosine no trong Cerebrolysin, tc dng trn th th adnosine
A1 l gin tip, c l l do s phng thch cht ch vn ni sinh.
Bn cnh chng minh c rng Cerebrolysin tc ng trn hng ro mu no mc
tng vn chuyn tch cc glucose qua hng ro mu no do tng tng hp ARN thng tin, c
hiu cho tng hp mt cht mang l GLUT1 glucotransporter.
Th nghim lm sng :

Ba th nghim lm sng quan trng minh ha cho tc dng ca Cerebrolysin v cc ch nh ca

n nh sau :
- Th nghim lm sng ca gio s Ruther (1984) trn bnh nhn Alzheimer vi phng php
m i v placebo c kim sot chng minh tc dng ca Cerebrolysin khi tim tnh mch 30
ml Cerebrolysin vi 70 ml dung dch mui sinh l 5 ngy mi tun, trong 4 tun l ci thin
tnh trng lm sng, triu chng ca 61,7% bnh nhn (nh gi da trn tiu chun CGI :
Clinical Global Impression, tiu chun SCAG : Sandoz clinical Assesment of Geriatric ca Hoa Kz).
- Th nghim trn t qu nghn mch ca gio s Koppi (1996) a ra khi nim iu tr b
sung ("add-on therapy") bng Cerebrolysin bn cnh iu tr cn bn "Standard therapy" hay
iu tr thng qui. Quan trng nht l Cerebrolysin nhm vo cc t bo vng xung quanh tn
thng trong t qu gi l vng "tranh ti tranh sng". Cc t bo ny mc d cha cht
nhng gim chuyn ha n mc ti thiu v vy gn nh mt chc nng. Mc tiu ca vic
iu tr t qu l khng cho cc t bo ny cht v bnh thng ha hot ng ca n. V
vy, nhiu tc gi cn gi vng ny l "vng iu tr". Cerebrolysin vi cc tnh nng dinh dng
thn kinh ca n c th cu vn cc t bo vng ny v vy c coi l mt thuc quan trng
bn cnh iu tr cn bn phc hi chc nng thn kinh.
- i vi cc chn thng s no, th nghim quan trng nht l th nghim ca gio s Duma
(1990). Cerebrolysin tc dng rt r trn bnh nhn chn thng s no da trn cc ch tiu
gim thi gian dng my th, gim thi gian nm vin v quan trng v khch quan nht l ch
tiu tng p lc bm mu ln no. iu c ngha l hp cht ny c th lm gim hin tng
ph no sau chn thng. Ngoi ra, Cerebrolysin cn c tc dng bo v cc t bo thn kinh
sau chn thng s no.
c tnh :
Cerebrolysin dung np tt, c tnh an ton cao. ngi, vi liu iu tr thuc khng gy ra bt
kz triu chng nhim c no. Nhng s liu v c tnh nh sau :
c tnh cp : Sau mt liu Cerebrolysin tim tnh mch duy nht, cc gi tr LD50 quan st
c (vi thi gian th nghim l 14 ngy) nh sau : chut cng : chut c l 68 ml/kg th
trng, chut ci l 74 ml/kg th trng ; ch l 52,2 ml/kg th trng c hai phi tnh.
c tnh mn (nhiu liu sau 6 thng) : chut c cho dng vi liu ln n 12,5 ml/kg th
trng mi ngy, tim trong vng 26 tun ch thy c bin i nh v cng thc mu ; ch, liu
cao nht l 9 ml/kg th trng hng ngy trong vng 28 ngy (khong ln hn 5 ln liu iu tr
ngi) v 4,5 ml/kg th trng hng ngy trong vng 26 tun (khong ln hn ln liu iu tr
ngi) khng thy c phn ng no chng t ng vt khng dung np Cerebrolysin.
Ngi ta cng chng minh rng sn phm phn gii ca protine no ln l Cerebrolysin qua
hn 30 nm c s dng khng cho thy c s ly nhim no do ngun gc t ng vt m t
thuc c tinh ch. iu ny c bit c { ngha trong giai on hin nay khi ang c bnh
b in c th nh hng cho con ngi. Nm 1994, B Y T Lin Bang c khng nh tnh

an ton v hi ca Cerebrolysin trong c cp n bnh b in v s an ton chung i

vi cc sn phm c ngun gc t ng vt.
c tnh trn chc nng sinh sn : Khi tim Cerebrolysin vo ng vt (th, chut) ang c thai
liu rt cao vn khng thy c bin i g trong thai kz. Khng thy c c tnh vi bo thai
hoc gy qui thai hoc nh hng ti s pht trin ca thai nhi ; khng thy c nh hng g
n th h sau (F1 v F2). Khng thy thuc lm v sinh hoc nh hng n kh nng sinh sn
trn th vt th nghim.
t bin gen, nhy cm v kh nng gy ung th : Cerebrolysin khng cho thy c kh nng gy
t bin gen, tc ng gy nhy cm cng nh gy ung th in vitro cng nh in vivo.
DC NG HC
Cc peptide ca Cerebrolysin vt qua hng ro mu no. 8 gi sau khi tim tnh mch, hot
tnh dinh dng thn kinh c th c pht hin trong huyt thanh ngi chng t thuc c
hiu qu ko di ngay c khi dng mt liu tim tnh mch duy nht.
CH NH
Sa st tr tu :
- Bnh Alzheimer ;
- Bnh sa st tr tu do mch no.
t qu : dng trong pha cp v phc hi chc nng ca t qu nghn mch v chy mu.
Cerebrolysin l mt thuc hu hiu dng trong iu tr b sung ("add-on therapy") bn cnh
iu tr thng qui, vi mc tiu ngn nga vng m no b h hi mt phn xung quanh ni
t qu khi tin dn n tnh trng hoi t v lm bnh thng ha tr li chuyn ha t bo
thn kinh b nh hng do tnh trng bnh.
Chn thng s no : dng trong pha cp v thi kz phc hi chc nng, c bit sau chn
ng, ng dp no hoc phu thut thn kinh.
CHNG CH NH
- Qu mn cm vi nhng thnh phn ca thuc.
- Tnh trng ng kinh hoc ng kinh cn ln, hoc ngi ng kinh do tn xut ng kinh
tng ln.
- Suy thn nng.
TNG TC THUC
Dng Cerebrolysin cng vi cc thuc chng trm cm hoc IMAO c th gy tng tch ly
thuc. Trong trng hp dng cc thuc ny ng thi, nn gim liu.
Khng pha truyn Cerebrolysin cng cc dung dch cha acide amine.
LC C THAI v LC NUI CON B
Mc d cc s liu trn ng vt khng cho thy bng chng v tnh gy qui thai, cha c kinh
nghim lm sng ph n c thai. Do , tr phi li ch tr liu cao hn bt kz nguy c no c
th xy ra, khng nn dng Cerebrolysin lc c thai cng nh trong thi gian cho con b.

TC DNG NGOI
Ni chung Cerebrolysin dung np tt. Nu tim qu nhanh c th gy ra cm gic nng. Trong
mt s him cc trng hp, phn ng nhy cm c th c biu hin qua chng n lnh,
nhc u hay tng nh thn nhit. Cho n nay khng c trng hp no c triu chng khng
mong mun ko di hoc e da n tnh mng ngi bnh.
LIU LNG v CCH DNG
Liu dng mi ngy cho ngi ln :
Bnh sa st tr tu :
- Bnh Alzheimer : 5-10 ml.
- Sa st tr tu do bnh mch no : 5-10 ml.
t qu :
- t qu trong cn cp : 30 ml.
- Phc hi chc nng sau t qu : 10 ml.
Chn thng no :
- Chn thng s no trong cp cu : 30 ml.
- Phc hi chc nng sau chn thng no : 10 ml.
Sau phu thut thn kinh : 10 ml.
Liu cho tr em : 0,1-0,2 ml/kg th trng/24 gi.
Thi gian iu tr : 4 tun cho mt liu trnh (28 ngy), c th nhc li 6 thng sau khi ngng
thuc v ph thuc vo p ng lm sng ca ngi bnh. di ca thi gian iu tr v liu
lng ty thuc vo tui ca ngi bnh v mc nng nh ca bnh. Trong trng hp
nng, khng nn ngng thuc t ngt m nn tip tc iu tr bng cch tim thuc mi ngy
mt ln v 2 ngy mt ln, trong thi gian 4 tun.
Khi cn tim truyn, pha Cerebrolysin trong 100 ml dung dch mui hoc ng ng trng
truyn trong vng 20-60 pht.
Ch : Khng pha thuc vi dung dch acide amine. Khng dng km theo cc thuc IMAO.
BO QUN
Bo qun ni an ton, xa tm tay tr em.
thuc ni kh ro, nhit di 25o C, trnh nh sng.
CETAPHIL SKIN CLEANSER
GALDERMA
Lotion dng ngoi da : chai 125 ml, 250 ml, 500 ml.
M T
Cetaphil Skin Cleanser cha cetyl alcohol, stearyl alcohol, sodium lauryl sulfate, propylene
glycol, methyl hydroxybenzoate, propyl hydroxybenzoate, propyl hydroxybenzoate v nc tinh
khit.
Do c im bo ch, Cetaphil Skin Cleanser l dng nc ra khng phi x phng, c cha

glycerin, cetyl alcohol v propylene glycol, nhng khng cha du hay cht bo. N khng lm
mt lp mng lipid bo v cho da c m v dng rt tt cho ngi c da nhy cm hay da d
b kch ng.
Cetaphil Skin Cleanser c pH tng ng vi pH bnh thng ca da, vo khong 6,5, nh
cho php ra sch da mt cch m du v trit m khng cn phi dng phi hp vi x
phng.
Cetaphil Skin Cleanser khng gy mn trng c v cng khng gy kch ng khi s dng, khng
lm kh da, khng c tnh kim ; c pH bng vi pH bnh thng ca da v khng cha hng
liu.
CH NH
Dng cho da b mn trng c, chm th tng, eczema, rm sy, hm da, nga, da kh, da nhy
cm, vy c, da, vy nn, bng nng, vim da d ng, chm tip xc, da b lo ha, nm da,
da b kch ng khi s dng benzoyl peroxide, tretinoine, adapalene...
THN TRNG LC DNG
Ch dng ngoi da.
LIU LNG v CCH DNG
Dng cho da mt, tay, ton thn, ngy 2-4 ln.
Vi nc : Xoa ln da ri ra li vi nc.
Dng kh : Bi ln da, xoa nh bng tay, xong lau li bng giy hoc vi mm.

101.

CTORNAN 10 g

JACQUES LOGEAIS
c/o HYPHENS
Bt pha ung v dng ng thc qun 10 g : hp 50 gi.
THNH PHN
cho 1 gi
L-ornithine oxoglurate monohydrate

10 g

tng ng : Azote

1,30 g

DC LC
L-ornithine oxoglurate monohydrate l mt dn xut ca acide amine, c cha 13,08% azote.

Mt gi 10 g cung cp 1,30 g azote. Cc kho st c thc hin trn chut cng bnh thng
v thiu dinh dng cho thy rng thuc c kh nng cung cp azote v ci thin tin trnh ln
so v kch thch s bi tit hormone (insuline, hormone tng trng).
Cc kim tra lm sng cho thy rng c s ci thin ng k trn biu azote.
DC NG HC
Sau khi ung C tornan 10 g, hm lng ornithine oxolate khng thay i ; ngc li, hm lng
ca acide glutamique, proline v c bit l ca ornithine c tng ln.
CH NH
B sung vo dinh dng (thin nhin hoc nhn to) i vi ngi thiu dinh dng hoc trong
tnh trng tng d ha.
TC DNG NGOI
Tiu chy.
LIU LNG v CCH DNG
- ng thc qun : 2 gi/ngy, pha vi cc cht b sung dinh dng khc, a vo c th
bng ng thng thc qun.
- ng ung : 2 gi/ngy chia lm 2 ln, ha tan trong 1 ly nc.

102.

CETRIZET

SUN PHARMA
Vin nn 10 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Cetirizin dihydrochlorid
T dc: Lactose BP, tinh bt BP, polyrinyl
pyrrolidon K30 BP, cellulose vi tinh th BP,
talcum BP, magnesi stearat BP, silicon
dioxid keo NF, tinh bt natri glycolat NF,
eudragit E100 IH, titan dioxid BP,
polyethylen glycol 6000 BP, natri lauryl
sulfat BP.

10 mg

DC LC
Cetrizet l mt khng histamin hiu nghim t gy bun ng nhng liu hot ng dc l, c
thm tc dng chng d ng. N l cht khng H1 chn lc vi nhng tc dng c th b qua ln
cc c quan cm th khc, do hon ton khng c tc dng khng Cholinergic v Serotonin.
Cetrizet c ch thi kz u histamin - gin tip ca phn ng d ng, gim s thm nhp ca
nhng t bo vim v gii phng nhng cht trung gian km theo p ng d ng mun.
DC NG HC
Mc cao im trong mu vo khong 0,3 mg/ml t c vo khong t 30 n 60 pht sau
khi ung mt liu 10 mg Cetirizin. Thi gian bn hy huyt tng xp x 11 gi hp th nht
qun mi i tng. Tc thanh thi thn l 30 ml/pht v thi gian bn hy xp x 9 gi.
Cetirizin lin kt mnh vi Protein huyt tng.
CH NH
Cetirizin Dihydroclorid c ch nh cho iu tr vim mi kinh nin, vim mi d ng theo ma
(Hay fever) v m ay t pht mn tnh v nhng bnh ngoi da lin quan n histamin nh
nga....
CHNG CH NH
Chng ch nh Cetirizin Dihydroclorid i vi bnh nhn c tin s mn cm vi bt kz dn
xut no ca thuc.
Chng ch nh Cetirizin Dihydroclorid i vi ph n ang trong thi kz cho con b v cht ny
bi tit vo sa.
THN TRNG LC DNG
Nhng th nghim ngi tnh nguyn khe mnh mc 20 v 25 mg/ngy khng thy tc
dng ln s nhanh nhn cng nh thi gian phn ng. Tuy nhin, bnh nhn khng nn s
dng qu liu ngh nu ang li xe hoc ang vn hnh my.
LC C THAI
Khng c tc dng ngoi no khi nghin cu trn ng vt. Khng s dng hoc s dng t
Cetirizin Dihydroclorid trong thi kz thai ngh n. Cng nh vi cc thuc khc, trnh s dng
Cetirizine khi mang thai.
TC DNG NGOI
Trong nhng th nghim chc nng tm thn vn ng khch quan t l an thn Cetirizin
Dihydroclorid l tng t nh i vi placebo. C quan st thy mt s tc dng ph nh v
tm thi nh nhc u, chng mt, bun ng, kch ng, kh ming v kh chu d dy rut.
Nu cn thit, liu s dng l 5 mg vo bui ti.
LIU LNG v CCH DNG
Dng ung.
Ngi ln v tr em trn 12 tui : 1 vin 10 mg/ngy.
Cha c s liu y t hiu qu ngh s dng Cetirizin Dihydroclorid cho tr di 12 tui.

QU LIU
Ng g c th l triu chng qu liu khi ung 50 mg Cetirizin Dihydroclorid trong mt liu n.
Trong trng hp qu liu lng ln, nn ra d dy v p dng cc bin php tr gip thng
thng. n nay cha c thuc gii c c tr.
BO QUN
Bo qun ni kh ro, trnh nh sng (thch hp t 15oC n 30oC).

103.

Children's TYLENOL

MC NEIL
c/o JANSSEN-CILAG
c/o MEGA PRODUCTS
Hn dch ung 80 mg/2,5 ml : chai 60 ml, np cu to c bit tr em khng t m c.
THNH PHN
cho 1/2 mung c ph (2,5 ml)
Acetaminophen (paracetamol)

80 mg

TNH CHT
Hn dch Children's Tylenol c cc hng v khc nhau, c bo ch c bit khc hn vi cc
loi thuc xir thng thng. Hn dch Children's Tylenol c v ngt, thm gip tr d ung.
Cng nh cc sn phm Tylenol khc, Children's Tylenol khng cha aspirin hay cn.
DC LC
H st nh tc dng c ch tng hp prostaglandin trung tm iu nhit vng i th. Tc
ng trung ng gim au c ch cha c bit r.
DC NG HC
Hp thu : Acetaminophen (paracetamol) khi dng ng ung c hp thu nhanh chng v d
dng.
Phn phi : Acetaminophen c phn phi nhanh n tt c cc m. Mc kt hp protein
huyt tng liu iu tr l 10%.
Chuyn ha : Acetaminophen c chuyn ha hon ton gan, theo 3 ng : lin hp vi
glucuronic, lin hp vi sulfate v con ng men oxy ha, chc nng hn hp ph thuc
cytochrome P450. ngi ln, phn ln acetaminophen chuyn ha bng cch lin hp vi
glucuronic ; tr s sinh, tr nh nhi ch yu l ng lin hp vi sulfate.

Thi tr : Acetaminophen c thi tr qua nc tiu. ngi ln, 60% liu dng c thi
tr di dng lin hp glucuronic, 30% di dng lin hp sulfate, 4% di dng lin hp
cysteine v mercapturic v di 4% di dng khng i. tr em t l tng t, nhng thuc
c chuyn ha di dng lin hp sulfate nhiu hn, dng lin hp glucuronic t hn.
CH NH
Nhanh chng h st, gim au nhc thng thng v gim kh chu trong cc trng hp cm
lnh, cm, mc rng, au rng, au u, au tai, au sau khi tim chng, vim hng...
CHNG CH NH
Tr nhy cm vi acetaminophen.
TNG TC THUC
Ung acetaminophen c th lm sai lch kt qu nh lng acid uric trong mu bng phng
php acid phosphotungstic ; v nh lng ng mu bng glucose-oxydase-peroxydase.
TC DNG NGOI
Kch ng d dy nh, c th xy ra nhng rt him.
LIU LNG v CCH DNG
Mi ln ung
Cn nng (kg)

Tui
S mung c ph*

S ml

Di 5

Di 4 thng

Hi kin bc s

Hi kin bc s

5-8

4 thng - 11 thng

1/2

2,5 ml

9 - 10

12-23 thng

3/4

3,75 ml

11 - 16

2-3 tui

5 ml

17 - 21

4-5 tui

11/2

7,5 ml

22 - 26

6-8 tui

10 ml

27 - 31

9-10 tui

21/2

12,5 ml

32 - 42

11 tui

15 ml

* Mi mung c ph tng ng 5 ml. hiu qu nhanh v an ton cho b, dng ly nha

Tylenol chia liu chnh xc : 1 TSP = 1 mung (5ml), 11/2 TSP = 11/2 mung (7,5ml)...
Cc ln ung cch nhau t nht 4 gi, khng qu 5 ln mi ngy.
Lc k chai thuc trc khi dng.

QU LIU
Liu ti thiu gy c tr em l 150 mg/kg.
Triu chng : bun nn, nn, bing n, xanh ti.
X tr : ra d dy hoc gy nn bng xir ipeca, dng cht gii c N-acetylcysteine.
BO QUN
ngoi tm vi ca tr em.
Bo qun nhit phng.

104.

CHOPHYTOL ROSA oral

ROSA-PHYTOPHARMA
c/o TEDIS
vin bao : hp 180 vin.
THNH PHN
cho 1 vin
Cynara scolymus, cao kh

0,20 g

DC LC
Liu php thc vt c tc dng li mt, tng thi nc thn.
CH NH
iu tr triu chng cc ri lon kh tiu : trng bng, y hi, chm tiu, hi, bun nn.
c ch nh lm d dng cc chc nng o thi thn v gan.
THN TRNG LC DNG
Khng dng trong trng hp b nghn ng mt v suy t bo gan.
Trng hp b tiu chy hay au bng, nn gin on vic dng thuc.
TC DNG NGOI
Dng liu cao c th gy tiu chy.
LIU LNG v CCH DNG
Dng cho ngi ln.
Ung vi mt t nc, mi ln 1 n 2 vin trc 3 ba n chnh hay khi c cc ri lon tiu
ha.

105.

CIDERMEX

XNLD RHNE POULENC RORER

[AVENTIS PHARMA]
thuc m : ng 10 g.
THNH PHN
cho 100 g
Triamcinolone actonide

100 mg

Nomycine sulfate tnh theo dng base

350 000 UI

DC LC
Liu php phi hp corticoide v khng sinh iu tr ngoi da.
- Khng vim do tc ng ca triamcinolone actonide, thuc nhm corticoide c tc ng kh
mnh.
- Khng khun do tc ng ca nomycine l mt khng sinh dit khun thuc h aminoside.
Cidermex c corticoide l thnh phn hot cht chnh.
Thnh phn khng sinh c phi hp trong cng thc iu tr cc nhim trng phi hp
nhng khng c ch nh d phng.
Phi hp ny ch c u th so vi liu php corticoide n thun trong nhng ngy iu tr u
v ch khi c nhim trng, nht l nhim trng do t cu khun.
Tuy nhin, nu c nhim trng nhiu, cn phi dng n khng sinh ng ton thn.
DC NG HC
Mc thuc qua da v tc dng ton thn ph thuc vo din tch bi thuc, mc thay i
ca da, thi gian iu tr. Tc dng ny ng ngi khi iu tr di ngy.
CH NH
- Cc bnh ngoi da cn iu tr bng liu php corticoide ti ch, c bi nhim v iu tr trong
8 ngy u, ch yu trong : eczma do tng d ng, vim da do tip xc c nhim trng, eczma
ng xu c nhim trng.
- c ngh trong chng nga khng r nguyn nhn vng hu mn-sinh dc, vim b thn
kinh c nhim trng, vim da b nhn c nhim trng, vim da xung quanh cc vt lot c
nhim trng, thi hn iu tr khng qu 8 ngy.
CHNG CH NH
- Mn cm vi mt trong cc thnh phn ca thuc, c bit l vi nomycine.

- Tn thng nhim trng nguyn pht da do ngun gc vi khun, virus, nm v k sinh trng.
Dng phi hp ny c th lm cho tnh trng nng thm. Ngoi ra cn lm thay i cc triu
chng do s kh chn on v iu tr sau ny.
- Trong khoa da liu :
- bnh ngoi da nguyn pht do vi khun, virus v nm, nh : chc l do eczma, bnh da do
nhim trng ;
- khng dng cho cc tn thng lo t chn, cho vt thng khng trng lc, mng m hot
t, mn trng c ;
- bnh da c bi nhim nhng c chng ch nh bi bt.
- Khng bi ln m mt (nguy c tng nhn p).
- Tr em di 2 tui, v nguy c n omycine qua da, v gy c cho tai.
- Vt thng v khi ang cho con b, v tr c th hp thu thuc.
CH PHNG
S hin din ca corticoide khng lm mt cc biu hin d ng da hoc nim mc i vi
nomycine nu c, nhng c th lm cho du hiu lm sng nh i.
Trng hp xy ra nhy cm da hoc nim mc i vi nomycine dng ngoi th s c
nh hng sau ny nu dng mt khng sinh cng h bng ng tng qut.
Nu bi thuc ln mt b mt rng hoc bng kn, triamcinolone v/hoc nomycine c th i
vo mu, gy tc dng ton thn ging nh dng corticoide hoc khng sinh ng tng qut.
Tc dng ny c bit ng lo tr cn b v tr nh.
THN TRNG LC DNG
- Khng bi thuc m Cidermex vo mt v cc tn thng c r dch v xp np do c th gy
bt vt thng to thun li cho nhim trng xy ra.
- Thi gian iu tr thng khng nn qu 8 ngy v :
- khng thy c li khi dng qu thi hn ny ;
- bi thuc lu ngy mt hoc trn cc tn thng din rng c th gy cc tc dng ngoi
nh khi iu tr bng corticoide ng tng qut.
- do trong thnh phn c nomycine, c kh nng gy chn la chng khng.
- Khng nn bi thuc trn b mt rng, nht l tr cn b (xem Tc dng ngoi ).
- tr cn b : khng nn bi thuc cc np da hoc di lp t khng thm nc.
LC C THAI v LC NUI CON B
Lc c thai :
Do s hin din ca nomycine, mt aminoside, c c tnh trn tai, v c kh nng hp thu
ton thn, do khuyn khng nn s dng ph n c thai.
Lc nui con b :
Thiu nhng bng chng v vic thuc qua sa m, nn trnh bi trn ngc khi ang nui con
b, v tr c th hp thu thuc.

TC DNG NGOI
Do triamcinolone :
Thng him gp nu iu tr ngn hn : c th gy da rp, pht ban dng mn trng c hoc
mn m, chng rm lng, mt sc t, vim da quanh ming, gy ra hoc lm nng thm mn
trng c (xem Ch { phng v Thn trng lc dng).
Do nomycine :
- C th gy eczma d ng do tip xc.
- C th gy d ng cho vi cc khng sinh khc thuc h aminoside.
- C th gy tc dng ton thn (xem Ch { phng v Thn trng lc dng), nht l khi bi
thuc trn din rng, vt thng c chy mu v iu tr cho tr cn b, iu tr di ngy.
LIU LNG v CCH DNG
Gii hn iu tr trong vng mt tun.
- thng thng : bi thuc 1 hoc 2 ln/ngy ; gii hn din tch iu tr, xoa nh.
- trnh bi lp thuc qu dy.

106.

CILOXAN

ALCON
dung dch nh mt 0,3% : l 5 ml.
thuc m tra mt 0,3% : tube 3,5 g.
THNH PHN
cho 5 ml
Ciprofloxacin HCl

3,5 mg

ng vi : Ciprofloxacin base

3 mg

Cht bo qun : Benzakonium chloride

0,006%.
T dc : Sodium acetate, Acetic acid,
Mannitol 4,6%, Edetate disodium 0,05%,
Hydrochloric Acid v/hoc Sodium
hydroxide ( iu chnh pH) v nc tinh

khit.
pH xp x 4,5 v thm thu xp x
300 mOsm.

cho 1 g thuc m
Ciprofloxacin HCl

3,33 mg

ng vi : Ciprofloxacin base

3 mg

T dc : du khong cht v m petrolatum

trng.
DC L LM SNG
Thuc nh mt v thuc m Ciloxan (Ciprofloxacin HCl) l thuc khng khun tng hp, tit
trng, a liu dng trong nhn khoa.
Hp thu ton thn : Mt nghin cu v hp thu ton thn c thc hin, trong dung
dch nh mt Ciloxan c nh mi hai gi khi ang thc trong vng hai ngy, v thm nm
ngy tip sau nh mi bn gi khi ang thc. Nng trong huyt tng ti a ca
ciprofloxacin c ghi nhn l di 5 ng/ml. Nng trung bnh thng di 2,5 ng/ml.
Vi trng hc : Ciprofloxacin c hot tnh ph rng trong iu kin phng th nghim (in vitro)
chng li nhiu vi khun gram dng v gram m. Tc dng dit khun ca ciprofloxacin l do
kh nng c ch hot ng ca enzym DNA-gyrase, l enzym cn thit cho s tng hp DNA
ca vi khun.
Ciprofloxacin cho thy kh nng chng li hu ht cc chng vi khun sau trong iu kin
phng th nghim v trn cc nhim trng lm sng (xem phn Ch nh).
Gram dng :
Staphylococcus aureus (gm chng nhy cm vi methicillin v khng methicillin),
Staphylococcus epidermidis,
Streptococcus pneumoniae,
Streptococcus (Nhm Viridans).
Gram m :
Pseudomonas aeruginosa,
Serratia marcescens.
In vitro, ciprofloxacine cho thy c hot tnh i vi hu ht cc chng vi khun sau y ; tuy
nhin, cha bit r { ngha lm sng ca nhng d kin ny.

Gram dng :
Enterococcus faecalis (nhiu chng ch nhy cm trung bnh),
Staphylococcus haemolyticus,
Staphylococcus hominis,
Staphylococcus saprophyticus,
Streptococcus pyogenes.
Gram m :
Acinetobacter calcoaceticus subsp. anitratus,
Aeromonas caviae,
Brucella melitensis,
Campylobacter coli,
Campylobacter jejuni,
Citrobacter diversus,
Citrobacter freundii,
Edwardsiella tarda,
Enterobacter aerogenes,
Enterobacter cloacae,
Enterobacter coli,
Haemophylus ducreyi,
Haemophylus influenzae,
Haemophylus parainfluenzae,
Klebsiella pneumoniae,
Klebsiella oxytoca,
Legionella pneumophila,
Moraxella (Branhamella) catarrhalis,
Morganella morganii,
Neisseria gonorrhoeae,
Neisseria meningitidis,
Pasteurella multicoda,
Proteus mirabilis,
Proteus vulgaris,
Providencia rettgeri,
Providencia stuartii,
Salmonella enteritidis,
Salmonella typhi,
Shigella sonneii,
Shigella flexneri,

Vibrio cholerae,
Vibrio para-haemolyticus,
Vibrio vulnificus,
Yersinia enterocolitica.
Cc loi vi khun khc : Chlamydia trachomatis (ch nhy cm trung bnh) v Mycobacterium
tuberculosis (ch nhy cm trung bnh).
Nh i vi hu ht cc vi khun k kh, bao gm Bacteroides fragilis v Clostridium difficile, hu
ht cc chng Pseudomonas cepacia v mt s chng Pseudomonas maltophilia khng vi
ciprofloxacin.
Nng dit khun ti thiu (MBC) thng khng vt qu nng c ch ti thiu (MIC)
khong hn h s 2. S khng ciprofloxacin trong phng th nghim thng xut hin mun
(t bin nhn i tng bc).
Ciprofloxacin khng gy phn ng cho vi cc khng sinh khc nh cc bta-lactam hay cc
aminoglycosid ; v vy cc vi khun khng vi cc thuc ny c th nhy cm vi
ciprofloxacin.
Cc nghin cu lm sng :
Sau tr liu bng dung dch nh mt Ciloxan, 76% bnh nhn b lot gic mc c kt qu cy vi
khun dng tnh c cha khi v mt lm sng v 92% trng hp lot c hin tng ti
to biu m hon ton. Trong cc th nghim lm sng a trung tm thc hin trong khong
thi gian 3 v 7 ngy, 52% bnh nhn b vim kt mc v c kt qu cy vi khun dng tnh
c cha khi v mt lm sng ; v khi kt thc iu tr, trn 70-80% trng hp c tt c cc
tc nhn gy bnh u b tiu dit.
Sau khi tr liu bng thuc m tra mt Ciloxan, 75% bnh nhn c cc du hiu v triu chng
vim kt mc nhim khun v c kt qu cy vi khun dng tnh c cha khi v mt lm
sng v khong 80% trng hp trong cc tc nhn gy bnh u b tiu dit khi kt thc
iu tr (ngy th 7).
Kh nng sinh ung th, gy t bin, ri lon sinh sn :
Tm th nghim in vitro v kh nng gy t bin c thc hin vi ciprofloxacin cho kt
qu nh sau :
Salmonella / Th nghim vi lp th (m tnh)
- Th nghim sa cha ADN vi E. coli (m tnh)
- Th nghim v s t bin trn t bo Lympho chut (dng tnh)
- Th nghim HGPRT t bo Chinese Hamster (m tnh)
- Th nghim v s bin i ca t bo phi Syrian Hamster (m tnh)
- Th nghim v s t bin trn nm men n bo cerevisiae (m tnh)
- Th nghim v s chuyn i gen v trao i cho ca s gin phn trn nm men n bo
cerevisiae (m tnh)

- Th nghim sa cha ADN t bo gan chut cng (dng tnh)

V hai trong tm th nghim dng tnh, nhng cc kt qu ca ba h thng th nghim sau
y thc hin trong phng th nghim cho kt qu m tnh :
- Th nghim sa cha ADN t bo gan chut cng,
- Th nghim vi nhn (chut nht),
- Th nghim gy cht gen tri (chut nht),
Cc nghin cu di hn v tnh sinh ung th trn chut v chut nht c thc hin hon
tt. Khng c bng chng no cho thy ciprofloxacin c kh nng sinh ung th v sinh u trn
nhng loi ny sau thi gian hai nm cho ung thuc hng ngy.
CH NH
Thuc m v dung dch nh mt Ciloxan c ch nh trong iu tr cc nhim trng do cc
chng vi khun nhy cm trong nhng bnh l sau :
Lot gic mc :
Pseudomonas aeruginosa,
Serratia marcescens*,
Staphylococcus aureus,
Staphylococcus epidermidis,
Streptococcus pneumoniae,
Streptococcus (Nhm Viridans)*.
*Hiu lc i vi vi khun ch c nghin cu khong 10 bnh nhim trng.
Vim kt mc :
Staphylococcus aureus,
Staphylococcus epidermidis,
Streptococcus pneumoniae.
CHNG CH NH
Chng ch nh trn bnh nhn c tin cn qu mn vi ciprofloxacin hay thnh phn khc ca
thuc. C tin cn qu mn vi cc quinolone khc cng b chng ch nh dng ciprofloxacin.
CH PHNG
Ch dng ti ch, khng c tim vo mt.
Ngi ta ghi nhn c phn ng qu mn nng v thng nguy him n tnh mng trn
bnh nhn c iu tr vi quinolone ng ton thn, i khi vi liu u tin. Mt s phn
ng c km theo tnh trng try tim mch, mt tri gic, ph thanh qun hay mt, kh th, ni
my ay v nga. Ch mt s t bnh nhn trong tin cn c phn ng qu mn. Cc phn ng
phn v trm trng cn phi iu tr cp cu ngay bng epinephrine v cc bin php hi sc
khc, bao gm th oxy, truyn dch tnh mch, tim tnh mch khng histamine, corticosteroid,
cc amin hot mch v x tr ng h hp.
THN TRNG LC DNG

Tng qut : Nh vi cc khng sinh khc, dng ciprofloxacin ko di c th gy ra tnh trng bc

pht ca cc vi khun khng nhy cm, k c vi nm. Nu c bi nhim, nn c bin php iu
tr thch hp. Bt c khi no cn nh gi lm sng, nn thm khm cho bnh nhn cng vi s
h tr ca dng c phng i nh n khe v nhum huznh quang, nu c iu kin. Ngay khi
c ni ban da hay mt s du hiu khc ca phn ng qu mn, nn ngng dng
ciprofloxacin. Trong cc nghin cu lm sng trn bnh nhn lot gic mc do vi khun 35
(16,5%) trong s 210 bnh nhn c hin tng kt ta tinh th mu trng khu tr phn nng
ca tn thng gic mc. Hin tng kt ta xy ra trong vng 24 gi n 7 ngy sau khi bt
u iu tr. mt bnh nhn, s kt ta c ra ngay khi va xut hin. S dung gii c
ghi nhn trong 1-8 ngy 17 bnh nhn. S dung gii c ghi nhn trong 10-13 ngy 5 bnh
nhn. Trn 9 bnh nhn, khng c ngy dung gii chnh xc. Tuy nhin, qua thm khm trong
qu trnh treo di, 18-44 ngy sau khi xy ra hin tng ny, ngi ta ghi nhn c s dung gii
hon ton ca cht kt ta. 3 bnh nhn hon ton khng c thng tin v kt qu. Hin tng
kt ta khng cn tr vic tip tc dng ciprofloxacin, v cng nh khng gy nh hng ngoi
ln qu trnh lm sng ca lot hay th lc (xem mc Tc dng ngoi ).
Dng trong nhi khoa :
an ton v hiu qu iu tr khi s dng cho tr di 1 tui (i vi dng dung dch nh
mt) v di 2 tui (i vi dng thuc m tra mt) cha c khng nh.
Mc d ciprofloxacin v cc dn xut quinolones khc gy cc bnh v khp khi th nghim
dng bng ng ung trn mt loi ch sn cn nh, vic dng ti ch trn mt ca
ciprofloxacin trn cc ng vt th nghim cn nh khng cho thy gy ra mt bnh l no trn
khp v khng c bng chng cho thy dng dng trong nhn khoa c mt tc dng no trn
cc khp xng chu trng lng c th.
LC C THAI
Cc nghin cu v sinh sn c thc hin trn chut v chut nht vi liu su ln cao hn
liu thng thng dng cho ngi v cho thy khng c bng chng v ri lon sinh sn hay
tn thng thai do dng ciprofloxacin. Nh i vi hu ht cc khng sinh khc, trn th,
ciprofloxacin (liu 30 v 100 mg/kg dng theo ng ung) gy ra tnh trng ri lon tiu ha
dn n st cn ca th m v lm tng t l xy thai. Khng c hin tng sinh qui thai vi
cc liu s dng. Khi dng qua ng tnh mch vi liu ln n 20 mg/kg, khng c hin
tng c tnh cho m cng nh khng c hin tng nhim c cho phi hay sinh qui thai.
Trong thi kz thai nghn, dung dch nh mt Ciloxan ch nn dng khi cn nhc gia ch li
v nguy c cho thai.
LC NUI CON B
Vn cha c bit ciprofloxacin dng ti ch c c bi tit qua sa ngi hay khng. Tuy
nhin, sau mt liu n 500 mg theo ng ung, tm thy ciprofloxacin trong sa ngi.
Nn lu { hn khi dng thuc m v dung dch nh mt Ciloxan cho b m nui con b.

Mc d ciprofloxacin v cc quinolone khc gy ra bnh l khp trn ng vt cha trng

thnh a s loi c th nghim sau khi cho dng theo ng ung, ciprofloxacin dng nh
ti mt cho ng vt cha trng thnh khng gy ra bnh l khp ; v khng c bng chng
cho thy dng nh mt c bt kz nh hng no ln cc khp chu lc.
TNG TC THUC
Cha c nghin cu c hiu v tng tc thuc c thc hin vi ciprofloxacin nh mt. Tuy
nhin, khi dng ng ton thn mt s quinolone, ngi ta nhn thy c tnh trng tng
nng huyt thanh ca theophylline, ngn cn chuyn ha cafeine, tng cng kh nng tc
dng ca thuc chng ng dng ung, warfarin v cc dn xut ca n, v cng ghi nhn s gia
tng creatinine huyt thanh trn bnh nhn dng ng thi vi cyclosporin.
TC DNG NGOI
Tc dng ngoi lin quan vi thuc thng c bo co nht l cm gic kh chu hay rt ti
ch. Trong cc nghin cu v lot gic mc c dng thuc thng xuyn, khong 17% (dung
dch) v 13% (thuc m) bnh nhn c tnh trng kt ta tinh th mu trng (xem mc Thn
trng lc dng). Di 10% bnh nhn c xy ra cc tc dng ngoi khc, bao gm cng b mi,
c vy/tinh th, cm gic c d vt, nga, sung huyt gic mc v c v kh chu sau khi nh
thuc. Di 1% bnh nhn c cc tc dng ngoi { nh nhum mu gic mc, bnh kt
mc/vim kt mc, phn ng d ng, sng m mt, chy nc mt, s nh sng, thm nhim
gic mc, bun nn v gim th lc.
LIU LNG v CCH DNG
Dung dch nh mt :
Liu dng c khuyn co trong iu tr lot gic mc l : nh 2 git vo mt b bnh mi 15
pht trong vng su gi u, sau nh 2 git vo mt b bnh mi 30 pht trong khong thi
gian cn li ca ngy u tin. Ngy th 2, nh 2 git vo mt b bnh mi gi. Vo ngy th 3
n ngy th 14, nh 2 git vo mt b bnh mi 4 gi. C th tip tc iu tr hn 14 ngy nu
cha c hin tng ti to biu m hon ton.
Liu dng c khuyn co trong iu tr vim kt mc do vi khun l : nh 1 hay 2 git vo ti
kt mc mi 2 gi khi ang thc, trong vng 2 ngy ; nh mt hay hai git vo ti kt mc mi 4
gi khi ang thc, trong 5 ngy tip theo.
Thuc m :
Tra mt on khong 1-1,5 cm vo ti kt mc, 3 ln mi ngy trong hai ngy u tin, sau 2
ln mi ngy cho 5 ngy k tip.
QU LIU
Khi qu liu ti ch do thuc m hay dung dch nh mt Ciloxan c th dng nc m ra
mt.
BO QUN

Dung dch nh mt : bo qun nhit 2-30oC. Trnh nh sng.

Thuc m : 2-25oC.

107.

CIPROBAY

BAYER PHARMA
vin bao film 250 mg : hp 10 vin.
vin bao film 500 mg : hp 10 vin.
dung dch tim truyn 100 mg/50 ml : chai 50 ml.
dung dch tim truyn 200 mg/100 ml : chai 100 ml.
THNH PHN
cho 1 vin Ciprobay 250
Ciprofloxacine hydrochloride monohydrate

291 mg

tng ng : Ciprofloxacine

250 mg

cho 1 vin Ciprobay 500

Ciprofloxacine hydrochloride monohydrate

582 mg

tng ng : Ciprofloxacine

500 mg

cho 1 chai 50 ml
Ciprofloxacine

100 mg

cho 1 chai 100 ml

Ciprofloxacine

200 mg

DC LC
Ciprofloxacin l mt hot cht mi thuc nhm quinolone do Bayer AG pht trin. Cht ny c
ch men gyrase (gyrase inhibitors) ca vi khun.
Vi sinh hc :
Ciprobay c hot tnh mnh, dit khun ph rng. N cn thng tin t nhim sc th (vt cht
di truyn) cn thit cho chuyn ha bnh thng ca vi khun. iu ny lm cho vi khun b
gim kh nng sinh sn mt cch mau chng.
Do c ch tc ng c hiu ny, Ciprobay khng b khng song song vi cc khng sinh khc
khng thuc nhm c ch men gyrase. V vy, Ciprobay c hiu lc cao chng li nhng vi
khun khng cc loi khng sinh nh aminoglycoside, penicillin, cephalosporin, tetracycline v
cc khng sinh khc.
Trong khi s phi hp Ciprobay vi khng sinh h bta-lactam v cc aminoglycosides ch yu
to ra hiu qu b sung v khng thay i trong iu kin in-vitro, th trong iu kin in-vivo,
n thng to ra hiu qu cng hng (nh khi phi hp vi azlocillin), c bit trn ng vt
b gim bch cu trung tnh.
Ciprobay c th phi hp vi cc thuc sau :
Pseudomonas : azlocillin, ceftazidime.
Streptococci : mezlocillin, azlocillin v cc khng sinh h b-lactam c hiu lc khc.
Staphylococci : cc khng sinh h b-lactam, c bit isoxazolylpenicillin, vancomycin.
Vi khun k kh : metronidazol, clindamycin.
PH KHNG KHUN
Ciprobay tc ng bng cch dit khun. Theo cc kho nghim in-vitro :
Cc vi khun sau c xem l c nhy cm :
E. coli, Shigella, Salmonella, Citrobacter, Klebsiella, Enterobacter, Serratia, Hafnia, Edwardsiella,
Proteus (indole dng tnh v indole m tnh), Providencia, Morganella, Yersinia ; Vibrio,
Aeromonas, Plesiomonas, Pasteurella, Haemophilus, Campylobacter, Pseudomonas, Legionella,
Neisseria, Moraxella, Branhamella, Acinetobacter, Brucella ; Staphylococcus, Listeria,
Corynebacterium, Chlamydia.
Cc vi khun sau biu th cc mc nhy cm khc nhau :
Gardnerella, Flavobacterium, Alcaligenes, Streptococcus agalactiae, Streptococcus faecalis,
Streptococcus pyogenes, Streptococcus pneumoniae, Streptococcus viridans, Mycoplasma
hominis, Mycobacterium tuberculosis v Mycobacterium fortuitum.
Cc vi khun sau thng khng :
Streptococcus faecium, Ureaplasma urealyticum, Nocardia asteroides.
Vi mt vi ngoi l, cc vi khun ym kh c nhy cm t va phi (nh Peptococcus,
Peptostreptococcus) n khng (nh Bacteroides).
Ciprobay khng c hiu lc khng Treponema pallidum.

DC NG HC
kh dng sinh hc ca Ciprobay khong 70-80%. Nng ti a trong mu t c sau khi
ung thuc 60-90 pht. Ciprobay hin din vi nng cao ti nhng v tr nhim trng chng
hn nh trong cc dch ca c th v trong cc m. Thi gian bn hy 3-5 gi. Ch cn ung
thuc hai ln mi ngy vo bui sng v bui chiu ti.
Sau khi truyn tnh mch, 75% liu c dng s b bi tit qua nc tiu v thm 14% qua
phn. Hn 90% hot cht s b bi tit trong 24 gi u tin.
Bng sau biu th nng Ciprobay (mg/l) sau khi tim truyn 30 pht v sau khi cho ung.
Thi gian
sau khi kt
thc
truyn v
ung thuc
30 pht

1 gi

2 gi

4 gi

8 gi

12 gi

100 mg TM

0,8

0,6

0,4

0.3

0.1

0.1

200 mg TM

1,7

2,1

0,7

0,4

0,2

0,1

400 mg TM

3,7

4,6

1,7

1,0

0,5

0,2

250 mg ung

0,9

1,3

0,9

0,5

0,3

0,2

500 mg ung

1,7

2,5

2,0

1,3

0,6

0,4

750 mg ung

2,9

3,5

2,9

1,7

0,8

0,5

Cc s liu khc :
Thi gian bn hy trong huyt thanh xp x 4 gi (3-5 gi).
Th tch phn b ( giai on hng nh) xp x 2,8 l/kg.
thanh lc thn xp x 5 ml/pht kg.
gn kt protein xp x 30%.
thm thu dung dch truyn 300 mOsm.
Thnh phn NaCl dung dch truyn 900 mg/100 ml.
CH NH
Cc bnh nhim trng c bin chng v khng bin chng gy ra do cc bnh nguyn nhy cm
vi ciprofloxacin.
- Cc bnh nhim trng ca :

. ng h hp. Trong cc trng hp vim phi do ph cu (Pneumococcus) bnh nhn

ngoi tr, khng nn dng Ciprobay nh l mt thuc u tay. Tuy nhin Ciprobay c th c
dng trong trng hp vim phi do Klebsiella, Enterobacter, Proteus, Pseudomonas,
Haemophilus, Branhamella, Legionella v Staphylococcus.
. tai gia (vim tai gia) v cc xoang (vim xoang), c bit nguyn nhn do vi khun gram m,
k c Pseudomonas hay Staphylococcus,
. mt,
. thn v/hoc ng tit niu,
. c quan sinh dc, k c bnh lu, vim phn ph, vim tin lit tuyn,
. bng (nh nhim trng ng tiu ha hoc ng mt, vim phc mc),
. da v m mm,
. xng khp,
- Nhim trng huyt.
- Nhim trng hoc c nguy c nhim trng (d phng) trn bnh nhn c h min dch suy yu
(nh bnh nhn b suy gim min dch hoc c tnh trng gim bch cu).
- Ch nh cho tnh trng kh nhim rut c chn lc trn bnh nhn suy gim min dch
(Ciprobay dng ung).
CHNG CH NH
Khng c dng Ciprobay trong cc trng hp qu mn cm vi ha tr liu bng
ciprofloxacin hoc cc quinolone khc. Khng c ch nh Ciprobay cho tr em, thiu nin
ang tng trng v ph n mang thai hoc cho con b, v khng c thng tin no v tnh an
ton ca thuc trn nhm bnh nhn ny, v v cc thc nghim trn sc vt cho thy rng
khng th loi tr hon ton nguy c tn thng sn khp ca nhng c th cha pht trin
hon ton v kch thc. Cc thc nghim trn sc vt vn cha thu c bng chng no v
cc nh hng sinh qui thai (d dng).
THN TRNG LC DNG
Ciprobay phi dng mt cch thn trng ngi ln tui. Trong cc trng hp ng kinh hoc
c cc thng tn thn kinh trung ng khc (nh gim ngng co git, tin cn co git, gim
lu lng tun hon no, thay i cu trc no hoc t qu), Ciprobay ch nn dng sau khi
thy ch li ca iu tr u th hn nguy c, v cc bnh nhn ny c th b nguy him do tc
dng ph ln thn kinh trung ng.
TNG TC THUC
Ion st, sucralfate hoc thuc khng acid c cha nhm, magnesium v calcium lm gim s
hp thu ca Ciprobay dng ung. V vy, nn ung Ciprobay 1-2 gi trc khi ung thuc khng
acid hoc ti thiu 4 gi sau khi ung thuc khng acid. S hn ch ny khng p dng cho cc
thuc khng acid khng c cha nhm hydroxide v magnesium hydroxide (nh dng c
thuc chn th th H2).

Dng ng thi Ciprobay v theophylline c th gy ra s gia tng ngoi nng theophylline

trong huyt thanh. iu ny c th dn n cc tc dng khng mong mun do theophylline
gy ra. Nu buc phi dng ng thi hai ch phm, nn kim tra nng theophylline trong
huyt thanh v nn gim liu theophylline mt cch hp l.
T cc th nghim trn sc vt, ngi ta bit rng s phi hp quinolone (cc cht c ch men
gyrase) liu rt cao vi vi thuc khng vim khng phi steroid (ngoi tr acetylsalicylic acid)
c th gy ra co git.
Cho n nay, nhng phn ng nh th vn cha quan st thy bnh nhn ung Ciprobay.
Trong mt s trng hp c bit, ngi ta vn ghi nhn c s gia tng thong qua ca
creatinine huyt thanh khi dng ng thi Ciprobay v cyclosporin. V l , cn phi thng
xuyn theo di nng creatinine huyt thanh (mi tun hai ln) cho nhng bnh nhn ny.
Dng ng thi Ciprobay vi warfarin c th lm tng hot tnh ca warfarin.
Trong nhng trng hp c bit, dng ng thi Ciprobay vi glibenclamide c th lm tng
hot tnh ca glibenclamide (h ng huyt).
Probenecid cn tr s bi tit qua thn ca Ciprobay. Dng ng thi Ciprobay vi probenecid
c th lm tng nng huyt thanh ca Ciprobay.
Metoclopramide lm gia tng hp thu Ciprobay lm cho thi gian t nng ti a trong
huyt tng ngn hn. Khng c nh hng ln kh dng sinh hc ca Ciprobay.
TC DNG NGOI
Cc tc dng ph sau c ghi nhn trong thi gian dng ciprofloxacin, nhng khng nht
thit u xy ra mi bnh nhn.
Cc tc dng ph sau y c thy :
- nh hng ln ng tiu ha :
Bun nn, tiu chy, nn, ri lon tiu ha, au bng, y hi hoc mt cm gic ngon ming.
Nu b tiu chy trm trng v ko di trong hoc sau iu tr, phi i khm bnh v triu chng
ny c th che khut bnh tiu ha trm trng (vim i trng gi mc) cn phi iu tr ngay
lp tc. Trong nhng trng hp ny, phi ngng dng Ciprobay v thay th bng mt tr liu
thich hp (nh ung vancomycin 250 mg dng 4 ln trong 24 gi). Chng ch nh dng thuc
khng nhu ng rut.
- nh hng ln h thn kinh :
Chng mt, nhc u, mt mi, mt ng, kch ng, run ry. Rt him : lit ngoi bin, v m
hi, dng i khng vng vng, co git, trng thi lo u, b c mng, l ln, trm cm, o gic,
mt s trng hp c phn ng tm thn (thm ch tin trin ti hnh vi gy nguy him cho
bn thn).
Cc phn ng ny i khi xy ra sau liu Ciprobay u tin. Trong nhng trng hp ny, phi
ngng dng Ciprobay ngay lp tc v thng bo cho thy thuc.
- Phn ng trn nhng gic quan :

Rt him : mt cm gic v mi, v, ri lon th lc (nh nhn i, nhn mu), tai, ri lon thnh
lc tm thi, c bit tn s cao.
- Phn ng qu mn cm :
Cc phn ng ny i khi xy ra sau liu Ciprobay u tin. Trong nhng trng hp ny, phi
ngng dng Ciprobay ngay lp tc v thng bo cho thy thuc.
Phn ng da nh ni ban, nga, st do thuc.
- Rt him :
Xut huyt dng chm (petechiae), bng xut huyt (haemorrhagic bullae), v nt nh
(papules) vi lp bc chc biu hin s lin quan vi mch mu (vim mch).
Hi chng Stevens-Johnson, hi chng Lyell
Vim thn k, vim gan, hoi t t bo gan rt him khi dn n suy gan e da tnh mng.
Phn ng phn v hay kiu phn v (ph mt, ph mch, ph thanh qun ; kh th tin trin
n tnh trng chong e da tnh mng) c th xy ra, i khi sau liu Ciprobay u tin. Trong
nhng trng hp ny, phi ngng dng Ciprobay ngay lp tc v cn phi iu tr (iu tr
chong).
- nh hng ln h tim mch :
Rt him : nhp tim nhanh, phng mt, cn migrain, ngt.
- nh hng khc :
cc khp : rt him : kh chu khp, cm gic u oi, au c, vim bao gn, hi nhy cm
vi nh sng, gim chc nng thn thong qua k c suy thn tm thi.
- Mt s trng hp him xy ra vim gn Achill trong thi gian dng Ciprobay. Tnh trng
vim gn Achill c th dn n t gn. V vy, khi c du hiu vim gn Achill (nh sng au),
nn ngng dng Ciprobay v i khm bnh.
- nh hng ln mu v s to mu :
Tng bch cu a eosin, gim t bo bch cu, chng gim bch cu ht, thiu mu, gim tiu
cu ; rt him : tng bch cu, tng tiu cu, thiu mu tn huyt, bin i gi tr ca
prothrombin.
- nh hng ln cc tham s xt nghim/cn lng nc tiu :
C th lm tng thong qua cc transaminase v phosphatase kim, cng nh gy vng da tc
mt, c bit trn nhng bnh nhn c tn thng gan trc ; tng thong qua urea,
creatinine hay bilirubin trong huyt thanh ; tng ng huyt : trn nhng ca c bit, c th
c tinh th niu v huyt niu.
- Phn ng ti ch rt him : vim tnh mch.
Lu { cho nhng ngi iu khin phng tin, my mc :
Ngay c khi dng thuc theo ng hng dn, thuc c th nh hng ln tc phn x n
mc gim kh nng iu khin xe c v vn hnh my mc. nh hng cng nhiu hn khi
dng thuc cng vi ru.

LIU LNG v CCH DNG

Liu lng :
Tr khi thuc c k toa theo cch khc, liu hng dn sau y c ngh :
Ciprobay dng ung :
Ch nh

Liu duy nht/hng ngy cho ngi

ln (mg Ciprofloxacin) ung

Nhim trng h hp :
- ty trm trng v vi khun

2 x 250-500

Nhim trng tit niu :

- cp, khng bin chng

2 x 125 n 1-2 x 250

- vim bng quang ph n (tin mn kinh)

liu duy nht 250

- bin chng

2 x 250-500

Lu :
- ngoi c quan sinh dc

2 x 125

- cp, khng bin chng

liu duy nht 250

Nhim trng khc* (xem phn ch nh)

2 x 500

* Nhim trng rt trm trng, e da tnh

mng, nh :

2 x 750

- Streptococcal pneumonia
- Nhim trng ti pht trong x nang (cystic
fibrosis)
- Nhim trng xng v khp
- Nhim trng huyt
- Vim phc mc

c bit khi c s hin din ca Pseudomonas,

Staphylococcus hay Streptococcus
Trong nhim trng tit niu do Chlamydia, nu cn, nn tng liu hng ngy ln n 2 x 750 mg.
Bnh nhn ln tui nn dng liu cng thp cng tt, ty theo trm trng ca bnh v
thanh thi creatinine.
V trm trng ca bnh hoc v nhng l{ do khc, ngi ta ngh nn khi u iu tr
bng ciprofloxacin dng tnh mch, nu bnh nhn khng th dng vin bao film.
Ciprobay dng tim, truyn tnh mch :

Ch nh

Liu duy nht/hng ngy cho ngi ln (mg

Ciprofloxacin) (2 x mi 12 gi/ngy hay 3 x mi
8 gi/ngy)

Tim tnh mch

Nhim trng h hp :
- ty trm trng v vi khun

2 x 200-400

Nhim trng tit niu :

- cp, khng bin chng

2 x 100

- vim bng quang ph n (tin

mn kinh)

liu duy nht 100

- bin chng

2 x 200

Lu :
- ngoi c quan sinh dc

2 x 100

- cp, khng bin chng

liu duy nht 100

Nhim trng khc* (xem phn ch

nh)

2 x 200-400

* Nhim trng rt trm trng, e da

3 x 400
tnh mng, nh :

- Streptococcal pneumonia
- Nhim trng ti pht trong x nang
(cystic fibrosis)
- Nhim trng xng v khp
- Nhim trng huyt
- Vim phc mc
c bit khi c s hin din ca
Pseudomonas, Staphylococcus hay
Streptococcus
Sau khi iu tr bng ng truyn tnh mch c th tip tc chuyn qua ng ung.
Bnh nhn ln tui nn dng liu cng thp cng tt, ty theo trm trng ca bnh v
thanh thi creatinine.
Ri lon chc nng gan v thn :
1. Gim chc nng thn :
thanh thi creatinine < 20 ml/pht hoc nng creatinine huyt thanh > 3 mg/100 ml : 2 x
na n v ca liu bnh thng/ngy hay 1 x 1 liu bnh thng/ngy.
2. Gim chc nng thn + lc mu :
Liu dng ging trng hp gim chc nng thn : trong nhng ngy lc mu sau khi lc mu.
3. Gim chc nng thn + CAPD (thm phn phc mc lin tc nhng bnh nhn ngoi tr) :
- B sung Ciprobay dng dch truyn vo dch lc (ni phc mc) : 50 mg Ciprobay/lt dch lc,
cho dng 4 ln/ngy, mi 6 gi.
- Dng Ciprobay vin bao film (ung) 1 x 500 mg vin bao film (hay 2 x 250 mg vin bao film),
cho dng 4 ln/ngy, mi 6 gi.
4. Gim chc nng gan :
Khng cn chnh liu.
5. Gim chc nng gan v thn :
Liu dng ging trng hp gim chc nng thn : xc nh nng Ciprobay trong huyt
thanh nu c th.
Cch dng :
Ciprobay dng ung :
Ung nguyn vin vi mt t nc. Thuc c ung khng ph thuc vo gi n.
Nu ung thuc lc i, hot cht c th c hp th nhanh hn.
Ciprobay dng tim, truyn tnh mch :

Cch dng ng tnh mch khong 30 pht cho 100 v 200 mg hay 60 pht cho 400 mg.
Dung dch truyn c th dng trc tip hay sau khi pha vi cc loi dch truyn tnh mch khc.
Dung dch truyn c th tng thch vi cc dung dch sau : dung dch nc mui sinh l, dung
dch Ringer v Ringer's lactate, dung dch glucose 5% v 10%, dung dch fructose 10%, dung dch
glucose 5% vi NaCl 0,225% hoc NaCl 0,45%.
Khi dch truyn Ciprobay c pha vi cc loi dch truyn thch hp, dung dch ny nn c
dng ngay sau khi chun b xong, v nhng l do v vi sinh hc v s nhy cm vi nh sng.
Cc tnh trng bt tng hp quan trng :
Tr khi bit chc chn c s tng thch ca thuc vi cc dung dch / thuc, dung dch truyn
cn bn nn dng tch ring. Cc du hiu bt tng thch c th thy c gm : kt ta, i
mu.
Dung dch Ciprobay c th bt tng thch vi mi dung dch / thuc bt n nh v mt vt l
v ha hc pH ca dung dch Ciprobay (nh penicillin, dung dch heparin), c bit khi kt hp
vi dung dch kim (pH ca dung dch Ciprobay truyn : 3,9-4,5).
Liu trnh dng thuc :
Liu trnh iu tr ty thuc vo trm trng ca bnh din tin trn lm sng v din tin vi
trng hc. V cn bn, iu tr nn c tip tc mt cch h thng ti thiu 3 ngy sau khi ht
st hoc ht triu chng lm sng. Liu trnh iu tr trung bnh : 1 ngy cho lu cp, vim bng
quang, n 7 ngy cho nhim trng thn, ng tit niu v bng, sut ton b giai on
gim bch cu ca bnh nhn b gim sc khng, ti a 2 thng trong vim xng v 7-14
ngy trong tt c nhng nhim khun khc.
iu tr nn tin hnh ti thiu 10 ngy trong nhim trng do Streptococcus v nguy c xy ra
bin chng mun. Sau vi ngy iu tr, c th thay th tr liu Ciprobay tnh mch bng
Ciprobay ung.

108.

CITRARGININE

LAPHAL
c/o HYPHENS
Dung dch ung : ng 10 ml, hp 20 ng.
THNH PHN
cho 1 ng

Arginine citrate trung tnh

1g

Btaine

0,5 g

Btaine chlorhydrate

0,5 g

(Alcool 95deg)

(40 mg)

(Saccharose)

(4,4 g)

DC LC
Thuc c tc ng hng gan.
- Arginine : tham gia vo chu trnh urea, gii c amonia.
- B taine : l tc nhn hng m, bo v gan trnh s tch t ca cht bo.
CH NH
iu tr cc ri lon chc nng c ngun gc do gan.
iu tr h tr chng thoi ha m do ru.
CHNG CH NH
Suy thn nng.
CH PHNG
Mi ng thuc c cha 40 mg alcool thylique 95deg.
THN TRNG LC DNG
bnh nhn tiu ng, cn lu { trong mi ng thuc c cha 4,4 g saccharose.
LIU LNG v CCH DNG
1 n 3 ng thuc/ngy, pha long trong na ly nc.

109.

CLAFORAN

HOECHST-MARION-ROUSSEL / ROUSSEL VIETNAM

[AVENTIS PHARMA]
Bt pha tim tnh mch hoc tim truyn tnh mch 1 g : l bt + ng dung mi 4 ml.
THNH PHN
cho 1 n v

Cfotaxime mui Na, tnh theo cfotaxime

1g

(Na)

(2,09 mmol)

ng dung mi : nc ct pha tim

4 ml

DC LC
Claforan l mt khng sinh bn tng hp thuc h btalactamin, nhm cephalosporin th h
th 3.
Ph khng khun :
Cc loi thng nhy cm (nng c ch ti thiu <= 4 mg/l) : Escherichia coli, Salmonella,
Shigella, Proteus mirabilis, P. vulgaris, Providencia, Citrobacter diversus, Klebsiella oxytoca,
Morganella morganii, Streptocoques, S. pneumoniae nhy vi pnicilline, Staphylocoques nhy
vi mticilline, Haemophilus sp, H. influenzae, Neisseria bao gm c chng N. meningitidis v
chng N. gonorrhoeae, Branhamella catarrhalis, Peptostreptococcus, Clostridium perfringens,
Borrelia burgdorferi, Pasteurella multocida, Aeromonas hydrophila, Corynebacterium
diphteriae.
Cc loi nhy cm khng thng xuyn : Enterobacter, Citrobacter freundii, Serratia, Yersinia,
Klebsiella pneumoniae, Streptococcus pneumoniae gim nhy cm hoc khng vi pnicilline.
Cc loi khng (nng c ch ti thiu > 32 mg/l) : Enterocoques, Listeria, Staphylocoques
khng meticilline, Pseudomonas aeruginosa, P. cepacia, Xanthomonas maltophilia,
Acinetobacter baumanii, Clostridium difficile, vi khun k kh Gram -.
CH NH
- Nhim trng nng do vi khun nhy cm :
- ng h hp, k c mi v hng,
- tai,
- thn v ng niu,
- da v m mm,
- xng khp,
- c quan sinh dc, k c lu,
- vng bng.
- Nhim trng huyt, vim ni tm mc, vim mng no.
- D phng nhim trng quanh phu thut.
- D phng nhim trng cc bnh nhn suy gim sc khng.
cc trng hp rt nng c th nguy him n tnh mng, nn phi hp vi aminoglycosides.
CHNG CH NH
Tng cm vi cephalosporin.

THN TRNG LC DNG

- Ht sc cn thn i vi bnh nhn c tng cm vi penicillin hay cc bta-lactam khc do
c th c d ng cho.
- Trnh dng cho ph n c thai hoc cho con b.
- Khi dng thuc trn 10 ngy, phi theo di t bo mu : nu c gim bch cu a nhn trung
tnh phi ngng ngay thuc.
- Nu dng phi hp vi aminoglycosides phi theo di chc nng thn.
- Nu c tiu chy ko di hay trm trng phi ngh n vim i trng gi mc : ngng ngay
thuc v lp tc iu tr vi vancomycine hay metronidazole ung.
LC C THAI
Tnh v hi ca nhm c phalosporine cha c xc lp ph n c thai, tuy nhin cc nghin
cu tin hnh trn nhiu loi ng vt cha cho thy c tc dng sinh qui thai hay c c tnh
trn thai nhi.
LC NUI CON B
Khng nn nui con b bng sa m trong thi gian iu tr v thuc c bi tit qua sa m.
TNG TC THUC
- Probenecid : tng nng v thi gian tc dng ca cefotaxime.
- Cc thuc c thn th d aminoglycosides : cn phi theo di st chc nng thn.
- Th nghim : th nghim Coomb v th ng trong nc tiu bng phng php khng
dng enzym c th cho kt qu dng tnh gi,
TC DNG NGOI
- Huyt hc : c th c gim tiu cu, tng bch cu i toan, v gim bch cu. Cng nh i vi
cc bta-lactam khc, c th c gim bch cu ht v him hn l mt bch cu ht nht l khi
dng lu. Him : thiu mu tn huyt.
- Gan : c th c tng men gan v bilirubin.
- Thn : c th gim chc nng thn, c bit khi phi hp vi aminoglycosides. Him gp vim
thn k.
- Tiu ha : c th c bun nn, nn, au bng, tiu chy. i khi tiu chy l triu chng ca
vim rut hoc vim i trng gi mc.
- Tim mch : trong vi trng hp ring l, c th c lon nhp tim sau khi thuc c truyn
mch nhanh qua tnh mch trung ng.
- Ti ch : vim au ti ni chch.
- D ng da : ni m ay, ni mn, nga. Cng nh i vi cc cephalosporin khc, c vi trng
hp ring l nh ni mn bng nc (hng ban a dng, hi chng Stevens-Johnson v hoi t
biu b do c t) c bo co.
- Phn v : st do thuc v phn ng phn v c th xy ra, i khi c sc.
- Phn ng Herxheimer : nh i vi tt c cc khng sinh khc, khi iu tr cc nhim trng do

Borella, phn ng ny c th xy ra trong nhng ngy u tr liu.

LIU LNG v CCH DNG
Ngi ln v tr em trn 12 tui c chc nng thn bnh thng :
- Liu thng thng l 1 g x 2 ln/ngy.
- Nhim trng vi nhiu tc nhn gy bnh c nhy cm t cao n trung bnh : 1-2 g x 2
ln/ngy.
- Nhim trng rt nng, e da tnh mng v khng nh v c : 2-3 g x 2-4 ln/ngy.
- Bnh lu : 0,5 g (hoc 1 g nu vi khun t nhy cm) liu duy nht.
- D phng nhim trng quanh phu thut : 1-2 g 30-60 pht trc khi bt u m. C th lp
li mt ln nu nguy c nhim trng cao.
- Bnh nhn suy thn : nu h s thanh thi creatinine <= 5 ml/pht : gim 1/2 cc liu duy tr,
liu khi u ty nhy cm ca vi khun v mc nng ca bnh.
- Bnh nhn lc mu : 1-2 g/ngy ty mc nng ca bnh - trong ngy lc mu, ch tim
cefotaxime sau khi lc xong.
Tr em c chc nng thn bnh thng :
- Tr s sinh v tr di 12 tui : 50-100 mg/kg/ngy chia lm 2-4 ln.
- Trong nhng trng hp rt nng e da n tnh mng, c th dng 150-200 mg/kg/ngy.
- Tr s sinh thiu thng : khng nn qu 50 mg/kg/ngy.
- D phng nhim trng trong phu thut : dng nh trn tim mt ln duy nht 30-60 pht
trc khi bt u m. Nu nguy c nhim trng cao, c th lp li mt ln.
Tim tnh mch :
- Phi pha lng nc tim : t nht 2 ml cho 0,5 g, 4 ml cho 1 g v 10 ml cho 2 g.
- Tt nht dng ngay sau khi pha.
- Bm chm trong vng 3-5 pht.
Truyn tnh mch :
- Khi dng liu cao.
- Truyn ngn hn : 2 g pha vo 40 ml nc tim v truyn trong 20 pht.
- Truyn lin tc : 2 g pha vo 100 ml v truyn trong 60 pht.
- Cc dung dch sau y c th dng truyn Claforan : normal saline, Ringer, dextrose 5%,
sodium lactate, Haemaccel, Macrodex 6%, Rheomacrodex 10%.
- Khng c ha sodium bicarbonate chung vi cefotaxime.
- Khng c ha cc khng sinh khc k c aminoglycosides vi cefotaxime.
C th dng Claforan tim tnh mch tim bp.

110.

CLAMOXYL

SMITHKLINE BEECHAM
vin nang 500 mg : hp 12 vin.
bt ung dng gi 250 mg : hp 12 gi.
bt pha xir 250 mg/5 ml : l 60 ml hoc 100 ml hn dch khi pha.
THNH PHN
Vin nang :
cho 1 vin
Amoxicillin trihydrate

500 mg

Bt ung dng gi 250 mg :

cho 1 gi
Amoxicillin trihydrate

250 mg

T dc va cho 1 gi : crospolividone,
aspartam, stearate de magnesium,
lactose, hng thm "chanh-o-du".
Bt pha xir 250 mg/5 ml :
cho 5 ml
Amoxicillin trihydrate

250 mg

T dc va cho 1 mung lng xi r

pha (hoc 5 ml) : crospolividone,
aspartam, stearate de magnesium, gomme
xanthane, carmellose sodique, silice
colloidale khan, natri bezoate, hng
thm "chanh-o-du".
CH NH
iu tr cc nhim khun do cc vi khun nhy cm vi thuc ti cc v tr sau :
ng h hp trn (bao gm c Tai Mi Hng), nh vim amian, vim xoang, vim tai gia ;
ng h hp di, nh t cp ca vim ph qun mn, vim phi thy v vim phi ph
qun ;

ng tiu ha, nh st thng hn ;

ng niu dc, nh vim thn-b thn, lu, sy thai nhim khun hay nhim khun sn khoa.
Cc nhim khun nh nhim khun huyt, vim ni tm mc v vim mng no do vi khun
nhy cm vi thuc nn c iu tr khi u theo ng tim vi liu cao v, nu c th, kt
hp vi mt khng sinh khc.
D phng vim ni tm mc : Clamoxyl c th c s dng ngn nga du khun huyt c
th pht trin vim ni tm mc. Tham kho thng tin k toa y v cc vi khun nhy cm.
CHNG CH NH
Tin s qu mn vi cc khng sinh thuc h b-lactam (cc penicilline, cephalosporin).
CH PHNG v THN TRNG LC DNG
Cc phn ng qu mn trm trng v i khi c th dn n t vong (phn v) c bo co
xy ra trn bnh nhn dng cc khng sinh b-lactam. Nu xut hin phn ng d ng, nn
ngng dng Clamoxyl v p dng tr liu thay th thch hp. c xut hin ban (a dng) i
km vi st ni hch (tng bch cu n nhn nhim khun) nhng bnh nhn dng
amoxycillin. Nn trnh s dng Clamoxyl nu nghi ng c tng bch cu n nhn nhim
khun. c bo co v hin tng ko di thi gian prothrombin d him gp bnh nhn
dng Clamoxyl. Nn theo di cht ch khi s dng ng thi vi cc thuc chng ng mu. Khi
dng liu cao phi duy tr tha ng lng nc thu nhn vo v o thi ra ngoi theo ng
tiu. Nn iu chnh liu cho bnh nhn suy thn (xem thng tin k toa y ).
Clamoxyl c th lm gim hiu lc ca cc thuc trnh thai loi ung.
LC C THAI v LC NUI CON B
Cng nh i vi tt c cc thuc, nn trnh dng trong thai kz tr phi c kin ca bc s cho
l cn thit. C th dng Clamoxyl trong thi kz nui con b.
TNG TC THUC
Probenecid lm gim s bi tit amoxycillin ng thn. S dng thuc ny ng thi vi
amoxycillin c th lm gia tng v k o di nng amoxycillin trong mu.
TC DNG NGOI
Nh cc penicillin khc, tc dng ngoi ca thuc khng thng xy ra hoc him gp v hu
ht l nh v tm thi.
Phn ng qu mn : Ni ban da, nga ngy, m ay ; ban a dng v hi chng StevensJohnson ; hoi t da nhim c v vim da bng nc v trc vy v mn m ngoi da ton
thn cp tnh (AGEP). Nu xy ra mt trong nhng ri lon k trn th khng nn tip tc iu
tr. Ph thn kinh mch (ph Quincke), phn ng phn v, bnh huyt thanh v vim mch qu
mn ; vim thn k.
Phn ng trn ng tiu ha : Bun nn, nn ma v tiu chy ; bnh nm candida rut ;
vim kt trng khi s dng khng sinh (bao gm vim kt trng gi mc v vim kt trng xut
huyt).

nh hng trn gan : Cng nh cc khng sinh thuc h b-lactam khc, c th c vim gan v
vng da mt.
nh hng trn thn : Tinh th niu.
nh hng v huyt hc : Gim bch cu thong qua, gim tiu cu thong qua v thiu mu
huyt tn ; ko di thi gian chy mu v thi gian prothombin.
nh hng trn h thn kinh trung ng : Tng ng, chng mt v co git. Chng co git c
th xy ra bnh nhn b suy thn hay nhng ngi dng thuc vi liu cao.
LIU LNG v CCH DNG
Ty theo ng s dng, tui tc, th trng v tnh trng chc nng thn ca bnh nhn, cng
nh mc trm trng ca nhim khun v tnh nhy cm ca vi khun gy bnh. Thng tin v
liu lng y c cung cp di dng tng liu cho mi ngy, c chia lm nhiu liu s
dng trong ngy. Phc thng s dng nht l ba ln mi ngy.
Ngi ln v tr em trn 40 kg : Tng liu hng ngy l 750 mg n 3 g, chia lm nhiu ln ;
Tr em di 40 kg : 20-50 mg/kg/ngy, chia lm nhiu ln. Nn dng dng Clamoxyl Hn Dch
Nh Git Tr Em cho tr di 6 thng tui.
QU LIU
Cc trng hp qu liu vi amoxicyllin thng khng th hin triu chng. S mt cn bng
in gii/nc nn c iu tr theo triu chng. Trong qu trnh s dng liu cao amoxycillin,
phi duy tr tha ng lng nc thu nhn vo v o thi ra ngoi theo ng tiu gim
thiu kh nng tinh th niu amoxycillin.

111.

CLARINASE REPETAB

SCHERING-PLOUGH
vin nn : v 7 vin, hp 2 v.
THNH PHN
cho 1 vin
Loratadine

5 mg

Pseudophdrine sulphate

120 mg

DC LC
Thuc phi hp khng histamine v chng sung huyt khng gy ng, c tc dng ko di.

Loratadine l mt khng histamine ba vng mnh c tc dng ko di vi tc ng i khng

chn lc trn th th H1 ngoi vi .
Pseudophdrine sulfate l mt trong nhng alcaloide t nhin ca ephedra v l mt cht lm
co mch dng theo ng ung to ra tc dng chng sung huyt t t nhng k o di gip lm
co nim mc b sung huyt ng h hp trn.
Nim mc ng h hp c lm gim sung huyt thng qua tc ng thn kinh giao cm.
CH NH
Gim cc triu chng i km vi vim mi d ng v chng cm lnh thng thng bao gm
nght mi, ht hi, chy mi, nga v chy nc mt.
Clarinase Repetab c khuyn co s dng khi cn phi hp tnh cht khng histamine ca
loratadine v chng sung huyt ca pseudophdrine sulfate.
CHNG CH NH
Chng ch nh nhng ngi xut hin qu mn hay c d vi Clarinase Repetab, vi cc
tc nhn gy d ng hay vi nhng thuc khc c cu trc ha hc tng t. Clarinase Repetab
cng chng ch nh bnh nhn ang dng thuc IMAO hay trong vng 14 ngy sau khi ngng
thuc, bnh nhn glaucome gc hp, b tiu, cao huyt p nng, bnh ng mch vnh nng v
cng gip.
THN TRNG LC DNG
Nn thn trng khi s dng cc thuc ging giao cm cho bnh nhn glaucome, lot d dy gy
hp mn v, nghn mn v t trng, ph i tuyn tin lit, tc nghn c bng quang, bnh tim
mch, tng nhn p hay tiu ng.
Nn cn thn khi s dng cc thuc ging giao cm bnh nhn ang dng digitalis.
Cc thuc ging giao cm c th lm kch thch h thn kinh trung ng, kch ng, co git
v/hoc try tim mch i km vi h huyt p. Bnh nhn suy gan nng nn cho dng liu khi
u thp hn do c th gim thanh thi loratadine ; khuyn co nn s dng liu khi u l 1
vin mi ngy.
Nghin thuc v l thuc thuc : Hin nay cha c s liu chng minh s nghin hay l thuc
thuc do loratadine.
Pseudophdrine sulfate, ging nh cc thuc kch thch h thn kinh trung ng khc, c gy
nghin. Vi liu cao, cc i tng thng c cm gic bay bng, gim ngon ming v cm gic
gia tng nng lc th cht, kh nng tinh thn v cnh gic thn kinh. S dng tip tc cc
thuc kch thch thn kinh trung ng khc s gy ln thuc. Ngng thuc t ngt c th gy
trm cm.
S dng cho tr em
Cha xc nh c tnh an ton v hu hiu ca Clarinase Repetab tr em di 12 tui.
S dng cho ngi gi :
bnh nhn >= 60 tui, cc thuc ging giao cm c kh nng xy ra tc dng ph nhiu hn,

nh gy ln ln, o gic, co git, c ch h thn kinh trung ng v t vong. Do , cn cn

thn khi dng ch phm c cha cht ny cho bnh nhn ln tui.
LC C THAI v LC NUI CON B
Cha xc nh c tnh an ton khi s dng Clarinase Repetab trong thai kz. Do ch nn
dng thuc khi li ch cao hn nguy c c th xy ra cho bo thai.
Do loratadine v pseudo ph drine sulfate c tit qua sa, nn cn nhc quyt nh ngng
cho con b hay ngng dng Clarinase Repetab.
TNG TC THUC
Khi dng ng thi vi ru, loratadine khng tng thm tc dng nh kt qu o c cc
nghin cu tm thn vn ng.
c bo co v s gia tng nng ca loratadine trong huyt tng sau khi dng ng thi
vi ktoconazole, rythromycine hay cimtidine trong cc th nghim lm sng c kim chng,
m khng c thay i c { ngha no v mt lm sng (bao gm ECG). Nn cn thn khi dng
chung vi cc thuc khc c bit c tc dng c ch chuyn ha gan ngoi tr nghin cu
xc nh r rng tng tc thuc.
Khi dng thuc ging giao cm cho nhng bnh nhn ang s dng IMAO, phn ng tng huyt
p, bao gm cn tng huyt p c th xut hin. Tc dng h huyt p ca mthyldopa,
mcamylamine, rserpine v cc alcaloide veratrum c th b gim i do cc thuc ging giao
cm. Cc tc nhn c ch b-adrenergic cng c th tng tc vi cc thuc ging giao cm. S
gia tng tc ng pacemaker (iu nhp) lc ch khi pseudo ph drine dng ng thi vi
digitalis. Cc thuc khng acide lm gia tng tc hp thu pseudophdrine ; kaolin lm gim
tc hp thu pseudophdrine.
Tng tc thuc vi cc xt nghim : Nn ngng dng cc thuc khng histamine khong 48 gi
trc khi lm xt nghim trn da do cc thuc ny c th ngn cn hay lm yu i cc phn ng
dng tnh vi cc cht ch th c hot tnh trn da.
In vitro, s thm pseudophdrine vo huyt thanh cha isoenzyme MB ca tim hay cratine
phosphokinase huyt thanh c ch dn dn tc ng ca enzyme. c ch hon ton sau 6 gi.
TC DNG NGOI
Trong nghin cu lm sng c kim chng vi liu lng khuyn co, t l xy ra tc dng ngoi
{ do Clarinase Repetab cng tng ng nh t l khi dng placebo, vi ngoi l c bo
co cho tc dng mt ng v kh ming. Cc tc dng ph khc i km vi c Clarinase Repetab
v placebo l nhc u v bun ng.
Cc phn ng ph him gp lit k theo t l xut hin gim dn bao gm lo lng, chng mt,
mt mi, bun nn, au bng, chn n, kht nc, tim nhanh, vim hng, vim mi, mn nht,
nga ngy, ni ban, my ay, au khp, l ln, khn ting, tng vn ng, gim cm gic, gim
tnh dc, d cm, rung ry, chng mt, bng mt, h huyt p th ng, tng tit m hi,
au mt, au tai, tai, bt thng v gic, kch ng, lnh m, trm cm, sng khoi, c mng,

tng cm gic ngon ming, thay i thi quen rut, kh tiu, hi, tr, li mt mu, au
li, nn ma, bt thng thong qua chc nng gan, mt nc, tng cn, cao huyt p, nh
trng ngc, au na u, co tht ph qun, ho, kh th, chy mu cam, nght mi, chy mi,
kch ng mi, mt tiu, kh tiu gy au, tiu m, a niu, b tiu, suy nhc, au lng, co
tht chn, kh v chut rt. Trong qu trnh a thuc ra th trng, chng rng tc, phn v
v bt thng chc nng gan c bo co xut hin rt him.
LIU LNG v CCH DNG
Ngi ln v tr em trn 12 tui : mi ln 1 vin, 2 ln mi ngy.
QU LIU
Khi c qu liu nn p dng iu tr triu chng v h tr ngay lp tc v duy tr cc bin php
ny ty theo tnh trng bnh nhn.
Triu chng :
C th i t c ch h thn kinh trung ng (bun ng, ngng th, mt cnh gic thn kinh, tm
ti, ngt, try tim mch) n tnh trng kch thch (mt ng, o gic, rung ry hay co git), thm
ch t vong.
Cc du hiu v triu chng c th l s nh sng, kch ng, tim nhanh, nh trng ngc, kht
nc, m hi, bun nn, chng mt, tai, mt iu ha, nhn m, cao huyt p hay tt
huyt p. Kh nng kch thch c bit r rt tr em, v l nhng triu chng ging nh
atropine (kh ming ; ng t dn v ; bng mt ; st ; v cc triu chng trn ng
tiu ha).
Vi liu cao, tc dng ging giao cm c th lm chng mt, nhc u, m hi, kht nc,
tim nhanh, au trc tim, kh tiu, yu c v cng c, bn chn, cm gic mt mi v mt ng.
Nhiu bnh nhn c th xut hin chng lon tm thn nhim c vi hoang tng v o gic.
Mt vi trng hp b lon nhp tim, try tim mch, co git, ngt v suy h hp.
Gi tr LD50 ca thuc phi hp ny l > 525 v 1839 mg/kg tng ng cho chut nht v chut
ln.
iu tr :
Nn gy nn ngay c khi bnh nhn nn mt cch t pht. Thng ngi ta hay dng cch gy
nn bng xir ipeca. Tuy nhin khng nn gy nn bnh nhn khng c tnh to. Tc ng
ca ipeca c h tr thm bng vn ng th cht v ung thm 240-360 ml nc. Nu bnh
nhn khng nn trong vng 15 pht, nn lp li liu lng ipeca. Phi p dng nhng bin php
thn trng bo v h hp c bit i vi tr em. Sau khi gy nn, c th th dng than hot
tnh trn st vi nc hp ph phn thuc cn li trong d dy. Nu gy nn khng thnh
cng hay b chng ch nh, nn ra d dy. Dung dch nc mui sinh l l dung dch ra c
la chn, c bit trong trng hp tr em. ngi ln c th dng nc my ; tuy nhin,
lng nc a vo nn c tho ra cng nhiu cng tt trc khi a thm lng nc k
tip. Thuc ty mui a nc vo rut v do c th hu hiu trong vic ha tan nhanh

chng cc cht c trong rut. Khng bit c l thuc c thm phn c hay khng. Sau khi
gy nn, bnh nhn nn c theo di v mt y khoa cn thn.
iu tr cc triu chng lm sng v thc th ca qu liu l iu tr v triu chng v iu tr
h tr. Khng nn dng cc tc nhn kch thch (thuc hi sc). Cc thuc tng huyt p c th
s dng iu tr tt huyt p. C th cho dng cc barbiturate tc ng ngn, diazpam hay
parald hyde kim sot ng kinh. St, t bit tr em, c th cn tm p bng nc m
hay dng chn h nhit . C th iu tr ngng th bng h tr thng kh.
BO QUN
Bo qun trong khong nhit t 2-30oC. Trnh qu m.

112.

CLARITYNE

SCHERING-PLOUGH
Vin nn 10 mg : hp 10 vin.
Sir 5 mg/5 ml : chai 60 ml
THNH PHN
cho 1 vin
Loratadine

10 mg

(Lactose)
cho 5 ml
Loratadine

5 mg

(Sacchrasose)
DC LC
Loratadine l 1 khng histamine tricyclique mnh c tc ng ko di vi hot tnh i khng
chn lc trn th th H1 ngoi bin.

CH NH
Clarityne c ch nh trong nhng triu chng lin quan n vim mi d ng nh ht hi,
chy nc mi, v nga mi, cng nh nga v xt mt. Nhng du hiu v triu chng mi
v mt gim nhanh chng sau khi dng ng ung.
Clarityne cng c ch nh trong iu tr cc triu chng, du hiu m ay mn tnh v cc ri
lon d ng ngoi da khc.
CHNG CH NH
Khng dng Clarityne cho bnh nhn c tnh trng qu mn hoc c ng vi mt trong cc
thnh phn ca thuc.
THN TRNG LC DNG
Nhng bnh nhn suy gan trm trng nn dng liu ban u thp hn do gim thanh thi
loratidine. Liu khi u cc bnh nhn ny l 5 mg hay 5 ml mi ngy hoc 10 mg hay 10 ml
mi 2 ngy.
S dng thuc cho tr em: Cha khng nh c tnh an ton v hiu lc ca Clarityne khi
dng cho tr em di 2 tui.
LC C THAI v LC NUI CON B
Cha khng nh c tnh an ton khi s dng thuc trong thi gian mang thai ; Do , ch
dng khi no li ch ca thuc c thy c li hn nhng nguy c c th xy ra cho bo thai.
Do loratadine c bi tit qua sa m v tng nguy c ca thuc khng histamine trn tr s
sinh v sinh non, nn hoc phi ngng cho con b hoc phi ngng thuc trong thi gian cho
con b.
TNG TC THUC
Khi dng ng thi vi ru, loratadine khng c tc dng mnh nh o c cc nghin
cu tm thn vn ng.
Cc th nghim lm sng c kim sot cho thy c s gia tng nng loratadine trong
huyt tng sau khi dng ng thi vi ktoconazole, rythromycine hoc cim tidine, nhng
khng c s thay i ng k (k c thay i trn in tm ). Nn thn trng khi s dng
cng lc vi cc dc phm c bit c tc ng c ch chuyn ha gan cho n khi c kt
qu nghin cu y v tng tc thuc.
nh hng ca thuc n cc kt qu xt nghim :
Nn ngng s dng vin Clarityne khong 48 gi trc khi tin hnh cc tin trnh th nghim
trn da v cc thuc khng histamine c th lm mt hoc gim nhng du hiu ca cc phn
ng dng tnh ngoi da.
TC DNG NGOI
Clarityne khng gy bun ng ng k trn lm sng liu hng ngy 10 mg. Cc tc dng ngoi
{ thng thng bao gm mt mi, nhc u, bun ng, kh ming, ri lon tiu ha nh bun
nn, vim d dy, v cc triu chng d ng nh pht ban.

Trong sut qu trnh tip cn th trng ca vin Clarityne, him thy trng hp rng tc, sc
phn v, chc nng gan bt thng. Tng t, t l tc dng ngoi { i km vi xir Clarityne
cng ging nh kim chng placebo. Trong cc th nghim lm sng c kim chng tr em,
t l cc tc ng lin quan n iu tr nh nhc u, an thn v lo lng, l nhng tc dng rt
him khi xy ra, cng tng t nh placebo.
LIU LNG v CCH DNG
Ngi ln v tr em trn 12 tui : 1 vin (10 mg) 1 ln/ngy hay 2 mung c ph (10 ml) xir
Clarityne mi ngy.
Tr em 2-12 tui :
- cn nng > 30 kg : 10 ml (10 mg = 2 mung c ph) xir Clarityne mi ngy.
- cn nng < 30 kg : 5 ml (5 mg =1 mung c ph) xir Clarityne mi ngy.
QU LIU
Dng qu liu c th b bun ng, nhp tim nhanh, v nhc u. Ung mt ln 160 mg th khng
c cc tc dng ngoi {. Trong trng hp qu liu, nn lp tc iu tr triu chng v iu tr
nng .
iu tr : Bnh nhn nn c gy nn mc d khi qu liu cng c kh nng t nn ma.
Phng php hay c s dng l gy nn bng sir ipeca. Tuy nhin khng nn gy nn
bnh nhn b gim tri gic. Tc ng ca ipeca c h tr bi cc vn ng c hc v bng
cch cho ung t 240 n 360 ml nc. Nu bnh nhn khng i trong vng 15 pht, nn cho
dng li liu ipeca. phng khng ht dch nn vo ng h hp, nht l tr em. Sau khi
i, nn dng than hot dng pha st vi nc hp thu dc phm cn st li trong bao t.
Nu gy nn khng thnh cng hoc c chng ch nh, nn tin hnh sc ra d dy. Dung dch
c chn ra l nc mui sinh l, nht l tr em. ngi ln, c th dng nc ; tuy
nhin phi tho ra cng nhiu cng tt trc khi bm ra t khc. Nc mui ty ra dn
nc vo ng rut bng s thm thu, do n cn c tc ng pha long nhanh chng cc
cht cha trong rut. Loratadine, khng thi c qua ng lc mu bt kz mc no.
Nn tip tc theo di bnh nhn sau khi iu tr cp cu.
BO QUN
Bo qun nhit trong khong 2-30oC.

113.

CLEAN SKIN

ROHTO PHARMACEUTICAL CO., LTD.

c/o CT TNHH ROHTO - MENTHOLATUM (VIT NAM)

Kem bi ngoi da 50 mg/g : tup 30 g.

THNH PHN
cho 1 g kem
Hot cht :
Tinh du tr Melaleuca alternifolia (tea Tree oil)

50 mg

T dc :
Hn hp cc esters ca Hydroxybenzoic Acid

3 mg

DC LC
- Kem Mentholatum Clean Skin l mt cng thc tr mn hu hiu, s dng cc hot cht thin
nhin, c bit l tinh du tr (Tea Tree oil).
- Tinh du tr Melaleuca alternifolia c s dng c trn 50 nm tr mn v mn
trng c.
- Tinh du tr Melaleuca alternifolia mang c tnh a m nn thm thu hiu qu qua da, gip
lm tiu m v nang ti vng da b mn.
CH NH
iu tr mn v mn trng c.
THN TRNG LC DNG
- Ch s dng ngoi da. Trnh thoa vo mt hay mi mt.
- th xem kem c ph hp vi da, hay thoa mt t kem ln phn da mt trc trong cnh
tay v gi trong 8 gi. Nu da b nga hay mn khng nn s dng.
LIU LNG v CCH DNG
Hng dn s dng :
- Ra sch mt.
- Thoa kem Clean Skin ln vng da b mn, v xoa u cho n khi kem thm ht qua da.
- Nhng vng da b mn nhiu, nn thoa nhiu kem Clean Skin hn.
- c c kt qu nhanh chng, nn thoa kem Clean Skin hng ngy ; 3 ln mi ngy l ph
hp nht.
- Nh ra sch mt v thoa kem Clean Skin trc khi i ng.
BO QUN
Bo qun di 30oC.

114.

CLINDAMYCIN IBI 600 mg

IBI
c/o GENESIS PHARMA
Dung dch tim bp, tnh mch hoc truyn tnh mch 600 mg/4 ml : ng 4 ml, , hp 1 ng.
THNH PHN
cho 1 ng
Clindamycine phosphate

712,92 mg

tnh theo : Clindamycine

600 mg

T dc : benzyl alcohol, sodium hydrate,

EDTA, nc.
DC LC
Thuc khng sinh.
CH NH
Clindamycin c ch nh trong iu tr cc nhim trng nng do cc vi khun ym kh nhy
cm, cng nh trong iu tr cc nhim trng nng do Staphylococcus, Streptococcus v
Pneumococcus. iu tr bng clindamycin thng kt hp vi mt khng sinh nhm
aminoglycoside, c th c xem nh l mt tr liu thay th trong cc nhim trng sinh dc v
nhim trng vng chu do Chlamydia trachomatis khi vic s dng khng sinh thng quy,
tetracycline, b chng ch nh.
CHNG CH NH
Thuc chng ch nh dng trn bnh nhn c tin s qu mn vi clindamycin hay lincomycin,
hay vi cc thnh phn khc ca thuc.
Do thnh phn thuc c benzyl alcohol, thuc khng nn dng cho tr di 2 tui.
Do cha cha c y thng tin v tnh an ton, khng nn dng thuc cho ph n c thai
hoc cho con b.
CH PHNG
Thuc ny nn dnh cho bnh nhn d ng vi penicillin.
Clindamycin c chng minh c hiu qu trong iu tr nhim trng do Staphylococcus
khng vi cc khng sinh khc. Tuy nhin, trc khi dng, cn lm khng sinh xc nh
nhy cm ca vi khun i vi khng sinh.
Do kh nng b vim rut, trc khi cho ch nh dng Clindamycin, cn xc nh loi nhim

trng v kh nng c th s dng cc thuc t c hn.

Sau khi dng clindamycin phosphate, mt vi trng hp tiu chy nh c bo co. Triu
chng ny c th bin mt khi ngng dng thuc. Mt vi trng hp tiu chy dai dng v
nng c ghi nhn. Cng vi tiu chy, i khi c ghi nhn s hin din mu v nim mc
trong phn, m trong mt vi trng hp tin trin thnh vim rut cp gy hu qu khng c
li.
Vim rut do khng sinh c th xut hin trong thi gian iu tr, hay t 2 n 3 tun sau khi
ngng dng thuc.
T cc nghin cu cho thy rng mt trong cc nguyn nhn tin pht gy vim rut do khng
sinh l mt loi c t do vi khun Clostridia tit ra. Vim rut thng c triu chng tiu chy
mc nng, dai dng km co tht bng v c mu v nim mc trong phn. Nu khng chn
on v iu tr sm, vim rut c th tin trin thnh vim phc mc, chong v phnh i
trng nhim c.
Vic thm khm ni soi c th pht hin vim rut gi mc. Nu nghi ng vim rut, khuyn
co nn tin hnh ni soi i trng sigma t ng trc trng.
Bnh vim rut c th c xc nh tip bng nui cy phn tm Clostridium difficile trong mi
trng chn lc v bng th nghim tm c t Clostridium difficile.
Cc trng hp vim rut nh c th bin mt mt cch t pht khi ngng dng Clindamycin.
Cc trng hp vim rut trung bnh v nng cn c iu tr ngay vi dung dch in gii v
dung dch protein.
Cc thuc khng nhu ng rut, thuc nhm opium v diphenoxylate km atropine c th gy
ko di v/hay lm nng thm tnh trng bnh.
Clindamycin c chng minh l c hiu qu trong iu tr vim rut gi mc lin quan khng
sinh do Clostridium difficile. Liu dng clindamycin cho ngi ln l 500 mg n 2 g mi ngy,
ung 2-4 ln/ngy trong 7-10 ngy. Trong mt s rt him trng hp, nhp nhanh sau khi dng
clindamycin c bo co.
Do , khi cn dng colestiramin v clindamycin, hai thuc nn c dng vo thi im khc
nhau trong ngy.
Cho n nay cc d liu cho thy rng ngi gi v cc bnh nhn suy yu d b tiu chy hn.
Nu cc bnh nhn ny c iu tr bng clindamycin, phi c bit ch { n s ln i phn.
Clindamycin khng t nng ng k trong dch no ty. Do , khng nn dng thuc trong
iu tr vim mng no.
THN TRNG LC DNG
Clindamycin phosphate nn c dng thn trng trn bnh nhn c tin s bnh ng tiu
ha, c bit l vim rut v bnh nhn c c a d ng. i khi vic s dng thuc khng sinh
c th to ra s pht trin cc khun khng thuc, nht l nm men.
Nu trng hp bi nhim xy ra, cn phi iu tr.

Trong iu tr di hn, nn theo di chc nng gan v thn theo chu kz, cng nh cc x t
nghim t bo mu.
Thi gian bn thi ch thay i nh trn bnh nhn gan thn. Do vy, trn bnh nhn b bnh
thn v gan mc nh hay trung bnh, vic gim liu thng khng cn thit. Ch cn gim
liu trong trng hp suy chc nng gan hay thn nng.
Clindamycin c c tnh c ch thn kinh c, iu ny c th lm tng tc dng ca cc thuc
c cng tc ng ny. Do , nn c bit thn trng khi dng clindamycin vi cc thuc ny.
Trong th nghim cho thy c s i khng gia Clindamycin v erythromycin, v vy khng nn
dng chung hai thuc ny.
Clindamycin khng c tim tnh mch trc tip di dng cha pha long, m phi truyn
trong thi gian t nht 10-60 pht.
TNG TC THUC
Clindamycin lm tng cng tc ng c ch thn kinh c ca cc thuc c cng tc ng ny
nh ether, tubocurarin hay pancuron.
Trong th nghim cho thy c s i khng gia Clindamycin v erythromycin, tc ng hip
ng c bo co vi metronidazol khng Bacteriodes fragilis.
Vic dng ng thi vi gentamycin c th mang li mt tc dng hip ng, khng bao gi l
i khng.
Phn ng cho gia clindamycin v lincomycin c chng minh.
TC DNG NGOI
Cc tc dng khng mong mun sau y c bo co :
- H tiu ha : au bng, bun nn, nn, tiu chy, vng da v thay i chc nng gan.
- Phn ng qu mn : hng ban da dng dt sn, m ay, pht ban ging dng si (thng gp
nht), him gp hng ban a dng, mt vi dng ca hi chng Stevens-Johnson v phn ng
phn v. Nu c bt c phn ng ph no xy ra, nn ngng dng clindamycin. Nu cc phn
ng trm trng, nn c tr liu theo phng thc thng thng vi adrenaline,
corticosteroids, thuc khng histamin.
- Huyt hc : cc trng hp gim bch cu trung tnh (gim bch cu), tng bch cu i toan,
mt bch cu ht v gim tiu cu c ghi nhn, trong c th khng c lin h nguyn
nhn vi clindamycin.
- H tim mch : sau khi tim thuc nhanh ng tnh mch, him trng hp h huyt p v
ngng tim c ghi nhn.
- Thn : d thuc khng l nguyn nhn trc tip, ri lon chc nng thn c ghi nhn
trong mt s trng hp him gp vi ur huyt, thiu niu v/hoc tiu m.
- Phn ng ti ch: kch ng, au v p-xe ti ch c bo co sau khi tim ng tnh
mch.
Cc phn ng ny c th trnh c bng cch tim bp su vng c mng v trnh tim tnh

mch.
- Da v nim mc: c quan st c nga, ni mn, m ay, vim m o v him gp vim
da trc vy v vim da mn nc.
LIU LNG v CCH DNG
Liu v cch dng c xc nh ty thuc mc nhim trng, tnh trng bnh nhn v
nhy cm ca vi khun gy bnh.
Ngi ln : tim bp su hay truyn tnh mch.
Nhim trng nng do cu khun gram dng i kh v vi khun ym kh nhy cm (thng
khng bao gm Bacteroides fragilis, Peptococcus v Clostridia khc ngoi Clostridium
perfringens) : 600-1200 mg mi ngy, chia ra 2, 3 hay 4 ln.
Nhim trng rt nng : thng c xc nh hay nghi ng do Bacteroides fragilis, Peptococcus
v Clostridia khc ngoi Clostridium perfringens: 1200-1700 mg mi ngy, chia ra 2, 3 hay 4 ln.
Khi cn thit, cc liu ny c th tng ln 4800 mg mi ngy tim truyn tnh mch trong cc
nhim trng e da mng sng bnh nhn.
Khng dng tim bp cc liu ln hn 600 mg.
Thuc c th c tim truyn tnh mch nhanh lc u, sau tim truyn tnh mch chm,
theo bng hng dn sau :
t nng clindamycin trong mu cao
hn

Tim IV nhanh

4 mg/ml

10 mg/pht x 30' 0,75 mg/pht

5 mg/ml

15 mg/pht x 30' 1,00 mg/pht

6 mg/ml

20 mg/pht x 30' 1,25 mg/pht

Sau tip tc vi

Nhim trng vng chu : 900 mg mi 8 gi tim truyn tnh mch kt hp vi mt khng sinh
thch hp iu tr vi khun hiu kh gram m. Tip tc iu tr trong t nht 4 ngy v trong 48
gi sau khi quan st thy tnh trng bnh nhn c ci thin.
Nhim Toxoplasmose no trn bnh nhn c nguy c cao do suy gim min dch : 600-1200 mg
clindamycin tim truyn tnh mch mi 6 gi trong 2 tun. Tip tc tr liu ng ung trong 810 tun.
Vim phi do Pneumocystis carinii trn bnh nhn c nguy c cao do suy gim min dch : 600
mg clindamycin tim truyn tnh mch mi 6 gi trong 21 ngy v 15-30 mg primachine ung
ngy 1 ln trong 21 ngy.
Tr em trn 2 tui : tim bp v truyn tnh mch.
Nhim trng nng : 15-25 mg/kg/ngy, chia ra 3-4 ln dng.

Nhim trng rt nng : 25-40 mg/kg/ngy, chia ra 3-4 ln dng.

Liu dng cho tr em c th c tnh bng din tnh b mt c th : 350 mg/m2/ngy trong
nhim trng nng v 450 mg/m2/ngy trong nhim trng rt nng.
Nu tr b tiu chy, ngng dng thuc.
Pha long v tc truyn :
Khng dng ng tim bp khi liu trn 600 mg.
Nng ca clindamycin trong dung dch pha long truyn khng qu 12 mg/ml v tc
truyn khng qu 30 mg mi pht. Vic dng clindamycin tim truyn ng tnh mch nn
tun theo bng sau y :
Liu

Pha long trong

Thi gian dng

300 mg

50 ml

10 pht

600 mg

50 ml

20 pht

900 mg

100 ml

30 pht

1200 mg

100 ml

40 pht

Khng nn dng hn 1200 mg cho 1 ln truyn trong 1 gi.

Tnh tng hp : Clindamycin phosphate tng hp v mt vt l v lm sng trong t nht 24
gi trong dung dch tim truyn dextrose v sodium chloride 0,9% cha cc khng sinh sau y
trong nng thng c s dng: amikacine, aztreonam, cetamandol, cefazolin, cefotaxim,
cefoxitin, ceftazidim, ceftizoxim, netilmycin, piperacilline v tobramycin.
QU LIU
Do cc tc dng ph xy ra khng ph thuc liu lng, qu liu him khi xy ra, c bit nu
thuc c dng ng liu lng ch nh.

115.

COBANZYME

SERB
c/o GALIEN
Vin nang 1 mg : l 14 vin.
THNH PHN

cho 1 vin
Cobamamide hay dibencozide

1 mg

T dc : magnsium starate, lactose.

C nang : s 3.
DC LC
Cht gy ng ha khng thuc nhm ni tit t, c dng cho mi la tui.
Cobamamide l mt coenzyme ca vitamine B12, l cht kch thch h thng men c tc dng
kch thch tng hp protine v gn kt acide amine vo phn t protide. Cht ny kch hot s
tng trng, to thun li cho dinh dng m, lm tng cm gic thm n v tng trng. Hot
cht khng thuc nhm ni tit t, do khng c nhng tc dng ph nh ca cc cht gy
ng ha thuc nhm stroide.
CH NH
Thuc c ch nh s dng nh mt cht kch thch s tng hp protine tr s sinh, tr
em, ngi ln v ngi gi, ch yu trong cc trng hp :
- tr sinh thiu thng, chm tng trng,
- chn n, suy nhc,
- tnh trng suy dinh dng,
- sau phu thut, nhim trng ti pht nhiu ln, thi kz dng bnh sau khi bnh nng.
- thiu mu do thiu cung cp vitamine B12 t thc n.
CHNG CH NH
- C tin s d ng vi cobalamine (vitamine B12 v cc cht cng h).
- U c tnh : do vitamine B12 c tc ng trn s nhn bi t bo v tng trng m, do c
th lm cho bnh tin trin kch pht.
CH PHNG v THN TRNG LC DNG
Trnh s dng thuc ny cho nhng ngi c c a d ng (suyn, chm).
TC DNG NGOI
C th gy phn ng phn v (ni my ay, sc). Mn trng c. Nc tiu (mu ca
vitamine B12).
LIU LNG v CCH DNG
iu tr tn cng : 15 ngy n 6 tun.
- Tr sinh thiu thng v tr cn b : 1 vin mi ngy, c th ha thuc trong bao nang vo sa
hoc thc n tr d ung.
- Tr t 30 thng n 15 tui : 1 n 3 vin mi ngy.

- Ngi ln : 1 n 4 vin mi ngy.

iu tr duy tr : 1 vin mi 10 ngy.

116.

COLCHICINE HOUD

HOECHST-MARION-ROUSSEL
[AVENTIS PHARMA]
Vin nn d b 1 mg : hp 20 vin - Bng B.
THNH PHN
cho 1 vin
Colchicine kt tinh

1 mg

DC LC
Chng bnh thng phong, khng vim (M : h vn ng).
Colchicine lm gim s tp trung bch cu, c ch hin tng thc bo cc vi tinh th urate v
do km hm s sn xut acide lactique bng cch duy tr pH ti ch bnh thng (tnh trng
toan thun li cho s kt ta tinh th urate l nguyn nhn u tin gy bnh thng phong).
DC NG HC
Colchicine ung vo i theo chu trnh rut gan. N gn vo tt c cc m, ch yu l nim mc
rut, gan, thn v ty tng ngoi tr c tim, c vn v phi.
Thi trong nc tiu v nht l trong phn.
Khi liu hng ngy vt qu 1 mg, s gn colchicine dn n tch t trong m c th gy ng
c.
CH NH
- Cn cp ca bnh thng phong.
- Phng nga cn cp bnh nhn thng phong mn tnh, nht l khi thit lp ch iu tr
h acide urique mu.
- Nhng cn cp khc do vi tinh th : vi ha sn khp v thp khp do hydroxyapatite.
- Bnh chu kz.
- Bnh Behcet.
CHNG CH NH
- Suy thn nng.
- Suy gan nng.

CH PHNG v THN TRNG LC DNG

Theo di k bnh nhn suy thn hay suy gan.
Nu iu tr lu di, theo di cng thc mu.
LC C THAI v LC NUI CON B
Lc mang thai, do yu cu bnh l, c th tip tc iu tr cho n cui thai kz.
TC DNG NGOI
- Ri lon tiu ha : tiu chy, bun nn, nn l nhng du hiu u tin ca qu liu. Cn gim
liu hay ngng iu tr.
- M ay v pht ban dng si.
- Ri lon huyt hc, him gp (gim bch cu, gim bch cu a nhn trung tnh, gim tiu
cu).
- V tinh trng.
- Ri lon c-thn kinh, hi phc khi ngng iu tr.
LIU LNG v CCH DNG
- Cn cp ca bnh thng phong :
Ngy 1 : 3 vin (chia ra sng, tra, ti mi ln 1 vin).
Ngy 2 v 3 : 2 vin (sng 1 vin v ti 1 vin).
Ngy 4 v nhng ngy sau : 1 vin bui ti.
- Phng nga cn cp ca bnh thng phong : 1 vin bui ti.
- Nhng cn cp khc do vi tinh th, bnh chu kz, bnh Behcet : 1 vin bui ti.
QU LIU
Liu c vo khong 10 mg.
Liu lun gy t vong l trn 40 mg.
Ng c, him gp nhng nng (t l t vong l 30%), thng l do t .
Triu chng :
- Thi gian tim n : 1-8 gi, trung bnh l 3 gi.
- Ri lon tiu ha : au bng lan ta, nn, tiu chy nng, i khi c mu, dn n mt nc
(toan chuyn ha) v ri lon tun hon (h huyt p).
- Ri lon huyt hc : tng bch cu, ri gim bch cu v gim tiu cu do tn thng ty
xng, hi chng ng mu ni mch ri rc.
- Thng gp th nhanh.
- Hi u vo ngy th 10.
- Nhim c thn cp vi thiu niu v tiu ra mu.
- Din tin kh lng. Thng t vong vo ngy th 2 hoc 3 do ri lon nc-in gii, sc
nhim trng, ngng h hp (lit hng ln) hay try tim mch.
iu tr :
Khng c thuc gii c chuyn bit cho colchicine.

Chy thn nhn to khng hiu qu (th tch phn phi thy c ln).
Theo di lin tc trong bnh vin v lm sng v sinh hc.
Loi b cht c bng cch ra d dy, ri ht dch t trng.
iu tr triu chng n thun : b nc in gii, khng sinh ton thn v khng sinh ng
tiu ha liu cao, gip th.

117.

COLTRAMYL

HOECHST-MARION-ROUSSEL / ROUSSEL VIETNAM

[AVENTIS PHARMA]
Vin nn 4 mg : hp 12 vin.
THNH PHN
cho 1 vin
Thiocolchicoside

4 mg

(Lactose)
(Saccharose)
DC LC
Hp cht tng hp c lu huznh ca mt glucoside thin nhin trch t cy "colchique".
L cht gin c, Coltramyl loi b hay lm gim ng k s co tht c ngun gc trung ng.
CH NH
c ngh iu tr h tr cc co tht gy au trong :
Cc bnh l{ thoi ha t sng v cc ri lon t th ct sng : vo c, au lng, au tht lng.
Cc bnh l chn thng v thn kinh (vi s co cng) v trong phc hi chc nng.
au bng kinh.
CHNG CH NH
C tin s b d ng vi thiocolchicoside.
LC C THAI
Cc nghin cu trn th vt khng cho thy thiocolchicoside c tc dng gy qui thai.
Trn lm sng, cc nghin cu trn ph n c thai cn hn ch nn khng th kt lun rng
dng thuc trong thi kz c thai l hon ton v hi.
Do , vic s dng thuc cho ph n c thai phi c cn nhc vi nhng nguy c c th xy

ra cho bo thai.
LC NUI CON B
Khng nn dng cho ph n ang nui con b do thiocolchicoside c bi tit qua sa m.
TC DNG NGOI
Ni sn ngoi da.
Him gp : ri lon tiu ha, tiu chy, au d dy.
LIU LNG v CCH DNG
Thuc dnh cho ngi ln :
Liu khi u : 4 vin/ngy.
Dng cp tnh : c th tng t t na liu mi 2 ngy cho n gp i liu khi u, hay ngoi l
tng gp ba (iu tr ngn hn).
iu tr di hn : c th gim liu trong ngy.
Chun b cho nhng t liu php vn ng : lu { thi gian cn thit (1-2 gi) thuc c tc
dng.

118.

COMBANTRIN

PFIZER
c/o ZUELLIG
vin nn 125 mg : hp 6 vin.
THNH PHN
cho 1 vin
Pyrantel embonate, tng ng pyrantel
125 mg
base
T dc : tinh bt bp, alginic acid, FDC;
yellow # 6 Alu lake, magnesium stearate,
sodium lauryl sulfate.
DC LC
Pyrantel l thuc khng giun c tnh hu hiu cao chng li cc loi nhim k sinh trng do giun
kim (Enterobius vermicularis), giun a (Ascaris lumbricoides), giun mc (Ancylostoma
duodenale v Necator americanus), v Trichostrongylus colubriformis v T. orientalis. Pyrantel

cng c mt vi tc ng ln giun tc (Trichuris trichiura).

Pyrantel c tc ng c ch thn kinh c cc loi giun nhy cm. Thuc lm bt hot giun a
v lm x chng ra ngoi m khng kch thch giun di chuyn. Trong rut, pyrantel c hiu qu
trn cc th cn non cng nh trng thnh ca cc giun nhy cm. Thuc khng c tc
ng i vi giun trong m.
DC NG HC
Pyrantel t b hp thu qua ng tiu ha. Khi ung mt liu n pyrantel
11 mg/kg, nng nh 50-130 ng/ml t c trong vng 1-3 gi. Sau khi ung, hn 50%
thuc c o thi di dng khng i trong phn ; di 7% c tm thy trong nc tiu
di dng khng i v cc cht chuyn ha.
AN TON TIN LM SNG
c tnh mn : 60 chut cng c cho ung liu hng ngy 100, 300 hay 600 mg mi kg th
trng trong vng 13 tun. Khng quan st c thay i i th hay vi th no c th c cho
l do pyrantel.
Pyrantel dng ch beagle vi liu hng ngy 100, 300 hay 600 mg mi kg th trng trong vng
13 tun. Sau khong thi gian ny, c s gia tng transaminase trong huyt thanh ca 5 con
ch. Chng tng lympho bo nh v r rng c lin h vi liu lng c quan st thy ch
sau 13 tun. Thuc khng to ra nhng thay i v m hc.
Tnh sinh qui thai :
Khng c nh hng ln kh nng th thai, sinh sn, to c quan, s chuyn d hay vic cho
con b chut cng hay s to c quan th dng pyrantel vi mc liu 25 hay 250 mg/kg th
trng.
CH NH
Pyrantel c c bit ch nh trong iu tr nhim k{ sinh trng ng tiu ha vi mt hay
nhiu loi giun sau :
- Enterobius vermicularis (giun kim),
- Ascaris lumbricoides (giun a),
- Ancylostoma duodenale (giun mc),
- Necator americanus (giun mc),
- Trichostrongylus colubriformis v T.orientalis.
Nn dng pyrantel trong iu tr nhim mt hay nhiu loi giun c ngi ln v tr em. Thuc
c dung np tt v khng lm nim mc ming c mu khi ung hay dy bn qun o do
phn. Mt thnh vin ca gia nh hay cng ng nhim bt kz loi giun no trong 5 loi trn
cng c th gy nhim cho nhng ngi khc. Trong nhng trng hp ny, nn dng pyrantel
cho c gia nh hay c cng ng (lm sch s mi trng xung quanh v qun o dit trng
giun cng gip ngn nga ti nhim).
CHNG CH NH

Pyrantel chng ch nh nhng bnh nhn qu mn vi thuc hay vi bt kz thnh phn no

ca thuc.
CH PHNG v THN TRNG LC DNG
Nn dng pyrantel cn thn nhng bnh nhn ri lon chc nng gan, do s gia tng nh
SGOT xy ra trn mt t l nh cc bnh nhn.
nh hng ln kh nng li xe v vn hnh my mc :
Cha c nghin cu v nh hng ca pyrantel ln vic li xe v vn hnh my mc. Khng c
bng chng cho thy rng pyrantel c th nh hng ln nhng hot ng ny.
LC C THAI v LC NUI CON B
Lc c thai :
Mc d cc nghin cu v sinh sn trn th vt khng cho thy c tc dng sinh qui thai, cha
c nghin cu v nh hng ca pyrantel trn ph n c thai. Do , khng nn dng thuc lc
c thai tr phi bc s cho rng thuc thc s cn thit cho bnh nhn.
Lc nui con b :
Khng bit c pyrantel c tit qua sa hay khng ; do nn ngng nui con b nu thy
cn thit phi dng thuc.
TC DNG NGOI
Kinh nghim lm sng cho thy pyrantel c dung np rt tt. Cc tc dng ngoi nu c
thng lin quan n ng tiu ha - chn n, co tht bng, bun nn, nn ma v tiu chy.
Cc tc dng ngoi khc c th xut hin l : nhc u, chng mt, bun ng, mt ng v ni
ban.
LIU LNG v CCH DNG
Liu khuyn co ca pyrantel trong iu tr nhim Enterobius vermicularis, Ascaris
lumbricoides, Ancylostoma duodenal, Necator americanus, Trichostrongylus colubriformis v T.
orientalis l 10 mg mi kg th trng bnh nhn (liu ti a l 1 g), ung mt ln duy nht. Phc
n gin tnh theo th trng nh sau :
Th trng

Vin nn 125 mg

di 12 kg*

12 - 22 kg

1-2

22 - 41 kg

2-4

41 - 75 kg

4-6

Ngi ln trn 75 kg

* Khng nn dng cho tr em di 6 thng tui.

i vi nhng nhim Necator americanus nng hn, liu khuyn co l 20 mg (dng base) mi
kg th trng ung mt ln duy nht mi ngy trong hai ngy lin tip, hay liu duy nht 10 mg
(dng base) cho mi kg th trng mi ngy trong ba ngy lin tip.
Nhim Ascaris lumbricoides c th c iu tr thnh cng vi liu duy nht 5 mg (dng base)
mi kg th trng. Phc liu lng n gin ha i vi giun a tnh theo th trng nh sau
:
Th trng

Vin nn 125 mg

di 12 kg*

12 n 22 kg

1/2-1

22 n 41 kg

1-2

41 n 75 kg

2-3

Ngi ln trn 75 kg

* Khng nn dng cho tr em di 6 thng tui.

Trong cc chng trnh iu tr ln cho cng ng v nhim Ascaris lumbricoides n thun, c
th dng liu duy nht 2,5 mg (dng base) mi kg th trng. Phc liu lng n gin ha
nh sau :
Th trng

Vin nn 125 mg

di 12 kg*

12 n 22 kg

1/4-1/2

22 n 41 kg

1/2-1

41 n 75 kg

1-11/2

Ngi ln trn 75 kg

* Khng nn dng cho tr em di 6 thng tui.

S dng cho tr em :
Khng nn dng cho tr em di 6 thng tui v tnh an ton la tui ny cha c xc nh.
QU LIU

Triu chng thc th v triu chng c nng ca qu liu :

Khng quan st c du hiu ng c c th quy cho vic qu liu pyrantel.
iu tr qu liu :
Khng c cht gii c c hiu cho qu liu vi pyrantel. iu tr triu chng v h tr.

119.

COMBANTRIN

PFIZER
c/o ZUELLIG
vin nn 125 mg : hp 6 vin.
THNH PHN
cho 1 vin
Pyrantel embonate, tng ng pyrantel
125 mg
base
T dc : tinh bt bp, alginic acid, FDC;
yellow # 6 Alu lake, magnesium stearate,
sodium lauryl sulfate.
DC LC
Pyrantel l thuc khng giun c tnh hu hiu cao chng li cc loi nhim k sinh trng do giun
kim (Enterobius vermicularis), giun a (Ascaris lumbricoides), giun mc (Ancylostoma
duodenale v Necator americanus), v Trichostrongylus colubriformis v T. orientalis. Pyrantel
cng c mt vi tc ng ln giun tc (Trichuris trichiura).
Pyrantel c tc ng c ch thn kinh c cc loi giun nhy cm. Thuc lm bt hot giun a
v lm x chng ra ngoi m khng kch thch giun di chuyn. Trong rut, pyrantel c hiu qu
trn cc th cn non cng nh trng thnh ca cc giun nhy cm. Thuc khng c tc
ng i vi giun trong m.
DC NG HC
Pyrantel t b hp thu qua ng tiu ha. Khi ung mt liu n pyrantel
11 mg/kg, nng nh 50-130 ng/ml t c trong vng 1-3 gi. Sau khi ung, hn 50%
thuc c o thi di dng khng i trong phn ; di 7% c tm thy trong nc tiu
di dng khng i v cc cht chuyn ha.

AN TON TIN LM SNG

c tnh mn : 60 chut cng c cho ung liu hng ngy 100, 300 hay 600 mg mi kg th
trng trong vng 13 tun. Khng quan st c thay i i th hay vi th no c th c cho
l do pyrantel.
Pyrantel dng ch beagle vi liu hng ngy 100, 300 hay 600 mg mi kg th trng trong vng
13 tun. Sau khong thi gian ny, c s gia tng transaminase trong huyt thanh ca 5 con
ch. Chng tng lympho bo nh v r rng c lin h vi liu lng c quan st thy ch
sau 13 tun. Thuc khng to ra nhng thay i v m hc.
Tnh sinh qui thai :
Khng c nh hng ln kh nng th thai, sinh sn, to c quan, s chuyn d hay vic cho
con b chut cng hay s to c quan th dng pyrantel vi mc liu 25 hay 250 mg/kg th
trng.
CH NH
Pyrantel c c bit ch nh trong iu tr nhim k{ sinh trng ng tiu ha vi mt hay
nhiu loi giun sau :
- Enterobius vermicularis (giun kim),
- Ascaris lumbricoides (giun a),
- Ancylostoma duodenale (giun mc),
- Necator americanus (giun mc),
- Trichostrongylus colubriformis v T.orientalis.
Nn dng pyrantel trong iu tr nhim mt hay nhiu loi giun c ngi ln v tr em. Thuc
c dung np tt v khng lm nim mc ming c mu khi ung hay dy bn qun o do
phn. Mt thnh vin ca gia nh hay cng ng nhim bt kz loi giun no trong 5 loi trn
cng c th gy nhim cho nhng ngi khc. Trong nhng trng hp ny, nn dng pyrantel
cho c gia nh hay c cng ng (lm sch s mi trng xung quanh v qun o dit trng
giun cng gip ngn nga ti nhim).
CHNG CH NH
Pyrantel chng ch nh nhng bnh nhn qu mn vi thuc hay vi bt kz thnh phn no
ca thuc.
CH PHNG v THN TRNG LC DNG
Nn dng pyrantel cn thn nhng bnh nhn ri lon chc nng gan, do s gia tng nh
SGOT xy ra trn mt t l nh cc bnh nhn.
nh hng ln kh nng li xe v vn hnh my mc :
Cha c nghin cu v nh hng ca pyrantel ln vic li xe v vn hnh my mc. Khng c
bng chng cho thy rng pyrantel c th nh hng ln nhng hot ng ny.
LC C THAI v LC NUI CON B
Lc c thai :

Mc d cc nghin cu v sinh sn trn th vt khng cho thy c tc dng sinh qui thai, cha
c nghin cu v nh hng ca pyrantel trn ph n c thai. Do , khng nn dng thuc lc
c thai tr phi bc s cho rng thuc thc s cn thit cho bnh nhn.
Lc nui con b :
Khng bit c pyrantel c tit qua sa hay khng ; do nn ngng nui con b nu thy
cn thit phi dng thuc.
TC DNG NGOI
Kinh nghim lm sng cho thy pyrantel c dung np rt tt. Cc tc dng ngoi nu c
thng lin quan n ng tiu ha - chn n, co tht bng, bun nn, nn ma v tiu chy.
Cc tc dng ngoi khc c th xut hin l : nhc u, chng mt, bun ng, mt ng v ni
ban.
LIU LNG v CCH DNG
Liu khuyn co ca pyrantel trong iu tr nhim Enterobius vermicularis, Ascaris
lumbricoides, Ancylostoma duodenal, Necator americanus, Trichostrongylus colubriformis v T.
orientalis l 10 mg mi kg th trng bnh nhn (liu ti a l 1 g), ung mt ln duy nht. Phc
n gin tnh theo th trng nh sau :
Th trng

Vin nn 125 mg

di 12 kg*

12 - 22 kg

1-2

22 - 41 kg

2-4

41 - 75 kg

4-6

Ngi ln trn 75 kg

* Khng nn dng cho tr em di 6 thng tui.

i vi nhng nhim Necator americanus nng hn, liu khuyn co l 20 mg (dng base) mi
kg th trng ung mt ln duy nht mi ngy trong hai ngy lin tip, hay liu duy nht 10 mg
(dng base) cho mi kg th trng mi ngy trong ba ngy lin tip.
Nhim Ascaris lumbricoides c th c iu tr thnh cng vi liu duy nht 5 mg (dng base)
mi kg th trng. Phc liu lng n gin ha i vi giun a tnh theo th trng nh sau
:
Th trng

Vin nn 125 mg

di 12 kg*

12 n 22 kg

1/2-1

22 n 41 kg

1-2

41 n 75 kg

2-3

Ngi ln trn 75 kg

* Khng nn dng cho tr em di 6 thng tui.

Trong cc chng trnh iu tr ln cho cng ng v nhim Ascaris lumbricoides n thun, c
th dng liu duy nht 2,5 mg (dng base) mi kg th trng. Phc liu lng n gin ha
nh sau :
Th trng

Vin nn 125 mg

di 12 kg*

12 n 22 kg

1/4-1/2

22 n 41 kg

1/2-1

41 n 75 kg

1-11/2

Ngi ln trn 75 kg

* Khng nn dng cho tr em di 6 thng tui.

S dng cho tr em :
Khng nn dng cho tr em di 6 thng tui v tnh an ton la tui ny cha c xc nh.
QU LIU
Triu chng thc th v triu chng c nng ca qu liu :
Khng quan st c du hiu ng c c th quy cho vic qu liu pyrantel.
iu tr qu liu :
Khng c cht gii c c hiu cho qu liu vi pyrantel. iu tr triu chng v h tr.

120.

CORAMINE GLUCOSE

NOVARTIS
Vin nn ngm dng cho tr em trn 15 tui v ngi ln : hp 20 vin.
THNH PHN
cho 1 vin
Nicthamide

0,125 g

Glucose monohydrate

1,5 g

(Saccharose)

(2,3 g)

DC LC
Thuc chng suy nhc, cc trng hp c th d b mt mi, c bit khi cao, ngt xu.
DC NG HC
- Sau khi ung vi liu 250 mg, nic thamide nhanh chng c hp thu. Sau 15 n 30 pht,
nng trong huyt tng c ghi nhn t 0,6 n 3,0 mg/ml.
Nicthamide sau khi hp thu s c chuyn ha mt phn. Trong nc tiu, ngi ta thy c
c cc sn phm chuyn ha v nicthamide khng b bin i.
- Sau khi tim tnh mch vi liu 250 mg nicthamide, thi gian bn hy o thi tnh trng
khng thay i t 19 n 35 pht.
CH NH
c dng trong nhng trng hp :
- D phng ngt xu.
- Cc tnh trng suy nhc, nht l khi ang trn cao.
CHNG CH NH
- Tr em di 15 tui.
- Qu mn vi nicthamide v cc dn xut ca n.
- Cao huyt p ng mch.
- ng kinh.
- Ph n c thai (xem Lc c thai/Lc nui con b).
CH PHNG
i vi cc test kim tra chng doping dnh cho cc vn ng vin, thuc c th cho phn ng
dng tnh.
THN TRNG LC DNG
Cn thn khi dng cho bnh nhn tiu ng v mi vin nn cha 1,5 g glucose v 2,3 g
saccharose.
LC C THAI

Do cha nghin cu ng vt v cha c nhng d kin lm sng ngi nn cha bit r

nguy c. Do , mt cch thn trng, khng k toa cho ph n c thai.
TC DNG NGOI
Cc tc dng ngoi ca nicthamide ch biu hin khi b qu liu (xem Qu liu).
LIU LNG v CCH DNG
Khng dng cho tr em di 15 tui.
Ngi ln v tr em trn 15 tui : ngm 4-6 vin/ngy.
QU LIU
Khi b qu liu, cc du hiu thng gp nh sau : v m hi, bun nn, nn, hng ban da,
nga, nhy mi, ho (him), tng thng kh, nhp nhanh xoang, cao huyt p ng mch, ri lon
tnh kch thch ca tim (him), lo u, bn chn, tng trng lc c, co c, co git. Cc biu hin
sau cng sau ch thy khi dng mt liu rt ln v c th dn n st cao v tiu hy c vn.
X l{ : a n bnh vin chuyn khoa : ra rut ; theo di : thc, huyt p, nhp tim, in
tm ; iu tr triu chng.

121.

CORDARONE

SANOFI SYNTHELABO VIETNAM

Vin nn d b 200 mg : hp 30 vin - Bng B.
Dung dch tim 150 mg/3 ml : ng 3 ml, hp 6 ng - Bng B.
THNH PHN
cho 1 vin
Amiodarone chlorhydrate

200 mg

cho 1 ng
Amiodarone chlorhydrate

150 mg

DC LC
c tnh chng lon nhp :
- Ko di pha 3 ca ng in th hot ng do lm gim dng ion kali (nhm III theo phn
loi Vaughan Williams) m khng lm thay i nhp tim.
- Gim tnh t ng nt xoang gy nhp chm khng p ng vi atropine.
- c ch alpha v bta adrnergique theo kiu khng cnh tranh.

- Lm chm dn truyn xoang nh, nh v m nt.

- Khng lm thay i dn truyn ni tht.
- Ko di thi kz tr v lm gim tnh kch ng ca c tim m nh, m nt v m tht.
- Lm chm dn truyn v ko di thi gian tr ca ng dn truyn ph t nh xung tht.
c tnh chng cn au tht ngc :
- Gim khng lc ngoi bin mc trung bnh, gim nhp tim do lm gim nhu cu tiu th
oxy.
- c tnh i vn vi alpha v bta adrnergique theo kiu khng cnh tranh.
- Tng cung lng tim do tc dng trc tip ln c trn cc ng mch ca c tim.
- Duy tr cung lng tim do gim p lc ng mch ch v gim khng lc ngoi bin.
Cc c tnh khc :
- Khng c tc dng inotrope m tnh, ch lm gim co bp c tim khi tim trc tip tnh mch.
DC NG HC
Thuc ung :
- Amiodarone gn kt chm, nhng vi mt lng ln vo m.
- Tnh kh dng sinh hc thay i t 30%-80% ty tng bnh nhn (trung bnh l 50%). Sau khi
ung liu duy nht, nng ti a ca thuc trong huyt thanh t c sau t 3-7 gi. Hiu
qu iu tr xut hin sau khong mt tun ty theo liu dn ban u.
- Thi gian bn hy kh di, thay i ty tng bnh nhn (t 20-100 ngy). Trong vi ngy u
tin sau dng thuc, thuc s tch t trong cc m, c bit l m m. Thuc c thi tr sau
vi ngy. Nng thuc trong huyt thanh n nh sau t mt n vi thng ty tng bnh
nhn.
- Do cc c tnh trn, phi s dng liu tn cng nhanh chng t c s ngm thuc vo
m nhm c c hiu qu iu tr.
- Iode trong phn t thuc c thi tr mt phn v c tm thy trong nc tiu di dng
iodure mc 6 mg/24 gi vi liu amiodarone 200 mg/ngy. Phn cn li ca thuc bao gm
hu ht iode s c thi tr qua phn sau .
- Thi tr thuc qua thn khng ng k cho php s dng thuc vi liu thng thng c trn
nhng bnh nhn b suy thn.
- Sau khi ngng iu tr, s thi tr thuc vn cn tip tc trong nhiu thng do phi lu {
n cc tc dng ca thuc c th vn cn ko di t 10 ngy n mt thng sau khi ngng
thuc.
Dng ng tnh mch :
Sau khi tim, nng amiodarone trong mu gim xung nhanh chng v cc m s bt ly.
Hiu qu ti a t c sau 15 pht v gim xung trong vng 4 gi. Nu khng tim lp li,
thuc s c thi tr dn dn. Khi tim thuc lp li hoc tip tc iu tr bng ng ung,
s d tr thuc vo cc m s tip tc.

CH NH
Cordarone c ch nh iu tr cc ri lon nhp nng, khng p ng vi cc iu tr khc
hoc khi khng th s dng cc iu tr khc :
- Ri lon nhp nh (chuyn rung nh hay cung nh v duy tr nhp xoang sau chuyn nhp).
- Ri lon nhp b ni.
- Ri lon nhp tht (ngoi tm thu e da tnh mng, nhp nhanh tht, phng nga cc cn
nhp nhanh tht hay rung tht).
- Ri lon nhp km theo hi chng Wolff-Parkinson-White.
Do cc c tnh v dc l hc ca thuc, amiodarone c ch nh cho cc ri lon nhp ni
trn, c bit khi c bnh tim c bn i km (suy mch vnh, suy tim).
Cordarone tim tnh mch c s dng khi cn c mt p ng nhanh, hoc khi khng th
ung c.
CHNG CH NH
- Nhp chm xoang v bloc xoang nh.
- Hi chng suy nt xoang tr khi c t my to nhp (nguy c ngng xoang).
- Bloc nh tht, ri lon dn truyn c hai hay ba nhnh ca ng dn truyn nu cha c
t my to nhp. Trong nhng trng hp nh vy, c th s dng amiodarone tim tnh
mch nhng khoa sn sc c bit v phi c my to nhp sn.
- Try tim mch, h huyt p trm trng.
- Ri lon chc nng tuyn gip.
- Tin cn mn cm vi iode hay vi amiodarone.
- iu tr vi cc thuc c th gy xon nh.
CH PHNG
Tim tnh mch :
- Vic dng thuc bng ng tim trc tip tnh mch khng c khuyn co mt cch rng
ri v c nguy c gy ri lon huyt ng (h huyt p trm trng, try tim mch), v th, khi c
th, nn truyn thuc qua ng truyn tnh mch.
- Ch tim tnh mch trong nhng trng hp cp cu khi tht bi vi cc iu tr khc v ch
c thc hin khoa sn sc c bit v tim mch di s theo di lin tc in tm .
- Chng ch nh tim tnh mch trong trng hp h huyt p, suy h hp nng, c bnh l{ c
tim hay suy tim (thuc c th lm nng thm cc bnh ny).
- Liu dng khong 5 mg/kg tim tnh mch chm, ti thiu trong 3 pht. Khng c tim lp
li trong vng 15 pht sau khi tim mi u tin, ngay c khi ch tim 1 ng cho ln sau (c th
gy try tim mch khng hi phc).
- Khng trn chung vi cc thuc khc trong cng mt bm tim. Nu c ch nh iu tr tip
th nn cho thuc bng cch truyn tnh mch.
Thuc ung :

- ngi ln tui, thuc c th gy gim nhp tim ng k.

- Cordarone c th to ra cc thay i v in tm : on QT ko di (c lin quan n ko
di thi gian ti cc), c th xut hin sng U ; nhng thay i ny l du chng v hot tnh
dc l ca thuc ch khng phi l du hiu ng c thuc.
- Amiodarone c cha iode c th gy xo trn cc xt nghim chc nng tuyn gip.
THN TRNG LC DNG
Tim tnh mch :
- Ch c s dng amiodarone tim tnh mch nhng khoa sn sc c bit vi s theo di
lin tc (in tm , huyt p).
- S dng thn trng trong trng hp c h huyt p, suy h hp nng, bnh c tim mt b
hay suy tim trm trng.
Thuc ung :
- Trong hu ht trng hp, cc tc dng ph ca thuc c lin quan n dng liu dn u qu
cao, v th phi c bit lu { tm liu duy tr thp nht c hiu qu nhm trnh hoc hn
ch n mc thp nht cc tc dng khng mong mun.
- Phi ch dn cho bnh nhn bit trnh tip xc vi nh sng mt tri hoc phi c cc bin
php bo v trong thi gian dng thuc.
- Vi nhng bnh nhn c tin cn c nhn hoc gia nh b ri lon chc nng tuyn gip, cn
thn trng khi s dng amiodarone nu vic s dng ny l cn thit ; nn dng liu thp nht
c hiu qu v phi theo di cn thn lm sng v cc ch s sinh hc.
LC C THAI
Do tc dng ca thuc ln tuyn gip thai nhi, chng ch nh s dng amiodarone khi mang
thai, tr nhng trng hp ht sc c bit.
LC NUI CON B
Amiodarone c bi tit qua sa vi s lng ng k, v th khng c s dng
amiodarone cho nhng b m ang cho con b.
TNG TC THUC
Chng ch nh phi hp :
- Cc thuc c kh nng gy xon nh : mt s cc thuc chng lon nhp khc (bpridil,
quinidine, sotalol), thuc khng c tc dng chng lon nhp (vincamine, sultopride,
rythromycine tim tnh mch...) v lm tng nguy c xon nh.
Khng nn phi hp :
- Cc thuc c ch bta, vi thuc c ch calci nht nh (vrapamil, diltiazem) v c th gy ri
lon tnh t ng (nhp chm trm trng) v ri lon dn truyn.
- Cc thuc nhun trng kch thch v gy h kali, qua lm tng nguy c gy xon nh.
Thn trng khi phi hp :
- Cc thuc gy gim kali mu : cc thuc li tiu n thun hay phi hp gy h kali mu,

corticoide dng ng ton thn, amphot ricine B tim tnh mch.

- Cc thuc khng ng ung do tng nguy c chy mu.
- Digitalis : do thuc c th gy ri lon dn truyn nh tht v ri lon tnh t ng ; vi
digoxine, thuc c th lm tng nng digoxine trong mu. Cn theo di lm sng, in tm
, v cc ch s sinh hc khi s dng phi hp ; c th cn phi iu chnh liu digitalis.
- Phnytoine : c th lm tng nng phnytoine vi cc du hiu ca qu liu, c bit l cc
du hiu v thn kinh. Cn theo di lm sng v gim liu phnytoine ngay khi c cc du hiu
qu liu.
- Gy m ton thn, oxy liu php : c th gy nhp chm trm trng khng p ng vi
atropine, h huyt p, ri lon dn truyn, gim cung lng tim. c mt vi trng hp suy
h hp nng, i khi gy t vong ngay sau phu thut. V th trc khi phu thut, phi bo cho
bc s gy m bit bnh nhn ang dng amiodarone.
- Ciclosporine : c th lm tng nng ciclosporine trong mu, cn iu chnh liu.
TC DNG NGOI
Tim tnh mch :
Ti ch : c th gy vim tnh mch sau khi truyn tnh mch, tc dng ny c th trnh c
bng cch s dng ng truyn tnh mch trung ng.
Ton thn :
- Nng bng mt, m hi, bun nn (tim tnh mch).
- H huyt p, thng mc va phi v thong qua. Mt vi trng hp h huyt p qu mc
hay try tim mch c ghi nhn sau khi tim qu liu hoc tim qu nhanh.
- Nhp tim chm va phi. Trong vi trng hp, c bit ngi ln tui, nhp tim chm ng
k, him khi gy ngng xoang, cn phi ngng iu tr.
- Gy lon nhp hoc lm nng thm lon nhp c trc mt vi trng hp b ngng
tim. Vi nhng hiu bit hin nay, cha th phn bit c iu ny l do thuc hay iu ny
c lin quan n bnh l{ tim c bn hoc do thiu s iu tr. Nhng tc dng ph ny t c
ghi nhn hn so vi hu ht cc thuc chng lon nhp khc v ni chung ch thng xy ra
trong trng hp tng tc vi mt s thuc nht nh hoc khi c ri lon in gii (xem
Tng tc thuc).
- Tng n thun transaminase, thng mc va phi (gp 1,5-3 ln bnh thng) lc mi
khi u iu tr. Triu chng ny thng thoi trin mt cch t pht hoc khi gim liu.
- Vi trng hp c cc ri lon cp tnh v gan vi tng men transaminase v/hoc vng da,
i khi gy t vong. Phi ngng iu tr v theo di cht ch cc xt nghim v chc nng gan.
- Cc tc dng rt him gp khc c ghi nhn sau khi tim tnh mch bao gm : sc phn v,
tng p ni s lnh tnh, co tht ph qun v/hoc ngng th khi c suy h hp nng, c bit
nhng bnh nhn hen ph qun.
Thuc ung :

- Mt :
Vi tch t gic mc, hu nh lun gp, thng gii hn n vng di ng t v khng cn
thit ngng iu tr, him khi c km theo qung mu khi ra sng hoc cm gic chi mt khi ra
nh sng. Vi tch t gic mc c kh nng hi phc sau khi ngng iu tr.
Mt vi trng hp vim thn kinh th gic c ghi nhn. Hin nay, mi lin h vi
amiodarone vn cn cha c xc lp mt cch chc chn. Nu c gim th lc hoc nhn m,
phi i khm mt ngay.
- Da :
Nhy cm nh sng : phi bo cho bnh nhn bit trnh tip xc vi nh sng mt tri (v
vi cc tia cc tm) trong thi gian iu tr. C th c ban da trong thi gian iu tr bng
quang tuyn.
Ni mn da, thng t c hiu gm c cc trng hp him gp nh vim da trc vy c
ghi nhn nhng cha c xc nhn mt cch chn chn v mi quan h vi thuc.
Cc m sc t da mu xm hay hi xanh c th xy ra nu iu tr ko di vi liu cao hng
ngy, cc m sc t ny s bin mt chm sau khi ngng iu tr.
- Tuyn gip :
Thay i cc ch s sinh ha n thun m khng c cc biu hin lm sng ca ri lon chc
nng tuyn gip th thng gp (tng nng T4, T3 bnh thng hay gim nh). Trong nhng
trng hp nh th khng cn thit phi ngng iu tr.
Nhc gip : chn on c c khi nng TSHu tng ln r rt. Chc nng tuyn gip tr li
bnh thng sau 1-3 thng ngng iu tr. Trong nhng trng hp e da n tnh mng, vn
c th tip tc iu tr vi amiodarone bng cch s dng thm L-Thyroxine. Liu L-Thyroxine
s dng s c hng dn bi nng TSH.
Cng gip : chn on c c khi nng TSHu gim r rt. Phi ngng iu tr amiodarone.
S hi phc trn lm sng xy ra sau 3-4 tun ngng iu tr. Nhng trng hp nng i khi
c th gy t vong cn phi c iu tr khn cp. Vic iu tr ny phi thay i theo tng
bnh nhn : cc thuc chng tuyn gip (c th khng phi lun c hiu qu), liu php
corticoide, thuc c ch bta...
Cc du hiu lm sng sau y, thng nh v gi { n chn on nhc gip hay cng gip
:
- tng cn, gim kh nng hot ng, nhp tim chm qu mc c lin quan n tc dng ca
amiodarone trong trng hp nhc gip.
- st cn, lon nhp cp, au ngc, suy tim huyt trong trng hp cng gip
Bnh nhn phi c theo di trong nhiu thng sau khi ngng iu tr. Cn o nng TSHu
trong trng hp nghi ng c ri lon chc nng tuyn gip.
Nhng bnh nhn c nguy c ri lon chc nng tuyn gip cao (tin cn c nhn hay gia nh
ri lon chc nng tuyn gip) phi c kim tra chc nng tuyn gip u n.

- Phi :
Cc trng hp c tnh phi (vim phi mn cm, vim ph nang/m k, x phi, vim mng
phi, vim tiu ph qun ph hy ton b cu trc phi /Boop), i khi dn n t vong
c ghi nhn.
Thc hin vic kim tra X quang nhng bnh nhn kh th tin trin (lc gng sc) hoc n
thun hoc phi hp vi s suy gim sc khe ton thn khc (mt mi, st cn, st).
Cc ri lon v phi ni chung thng hi phc sau khi ngng sm vic iu tr. C th phi cn
nhc n corticoide liu php. Cc du hiu lm sng thng hi phc sau 3-4 tun, s ci thin
hnh nh X quang v chc nng phi xy ra chm hn (nhiu thng).
Mt t trng hp c hi chng nguy ngp h hp cp ngi ln, i khi c th gy t vong
cng c ghi nhn, hu ht thng xy ra ngay sau phu thut (c th lin quan n tng
tc vi nng oxy cao).
- Thn kinh :
Bnh l thn kinh vn ng v cm gic ngoi bin v/hoc bnh l{ c, thng khng hi phc
khi ngng thuc.
Cc biu hin khc : run ngoi thp, mt ng vn, him khi c tng p lc ni s lnh tnh, c
mng.
- Gan :
Theo di u n cc xt nghim chc nng gan (transaminase) trong sut thi gian iu tr :
- Tng men transaminase n thun, thng mc trung bnh (1,5-3 ln bnh thng) lc mi
bt u iu tr, thoi trin t nhin hoc sau khi gim liu.
- t trng hp c ri lon chc nng gan cp tnh vi tng men transaminase v/hoc vng da,
i khi gy t vong c ghi nhn. Trong nhng trng hp nh th, cn phi ngng iu
tr.
- Cng c nhng bo co v bnh l gan mn tnh (vim gan gi do ru, x gan). Cc biu
hin lm sng v cc thay i v sinh ha c th mc ti thiu (gan to, tng men gan t 1,5-5
ln bnh thng), v th, cn phi theo di u n cc xt nghim chc nng gan trong thi
gian iu tr. Cc bt thng v lm sng v sinh hc thng thoi trin sau khi ngng iu tr
mc d i khi cng c trng hp gy t vong.
- Tim mch :
Nhp tim chm, thng mc trung bnh v lin quan n liu. Trong mt s trng hp (ri
lon chc nng nt xoang, ngi ln tui), cng ghi nhn trng hp nhp chm trm trng
hoc him hn l ngng xoang
Him c cc trng hp ri lon dn truyn (bloc xoang nh, bloc nh tht cc mc khc
nhau).
Gy ra mt lon nhp mi hoc lm nng thm lon nhp c trc mt vi trng hp
b ngng tim. Vi nhng hiu bit hin nay, cha th phn bit c iu ny l do thuc hay

iu ny c lin quan n bnh l{ tim c bn hoc do thiu s iu tr. Nhng tc dng ph ny

t c ghi nhn hn so vi hu ht cc thuc chng lon nhp khc v ni chung ch thng
xy ra trong trng hp tng tc vi mt s thuc nht nh hoc khi c ri lon in gii
(xem Tng tc thuc).
- Cc tc dng ph khc :
Cc ri lon tiu ha lnh tnh (bun nn, nn, ri lon tiu ha) thng xy ra trong giai on
liu tn cng v gim khi gim liu.
Hi u.
t trng hp vim mo tinh c bo co nhng cha xc nh c mi lin quan vi
thuc.
Rt t trng hp c cc biu hin lm sng khc nhau gi { n phn ng tng mn cm: vim
mch mu, bnh l thn c lin quan vi s tng nng creatinine, xut huyt gim tiu cu.
Rt him trng hp thiu mu huyt tn hoc thiu mu bt sn c ghi nhn.
LIU LNG v CCH DNG
Vin nn :
Liu khi u : thng thng 600 mg/ngy, trong 8-10 ngy.
Liu duy tr : nn dng liu thp nht c hiu qu ty theo p ng ca mi bnh nhn, c th
thay i t 100 mg-400 mg/ngy. C th s dng thuc cch ngy (200 mg mi 2 ngy thay cho
100 mg mi ngy), c th ngng thuc 2 ngy mi tun do tc dng iu tr ko di ca thuc.
Truyn tnh mch :
Liu dn u : thng thng l 5 mg/kg pha trong 250 ml dung dch dextrose 5% truyn tnh
mch t 20 pht-2 gi, c th lp li 2-3 ln trong 24 gi. iu chnh tc dch truyn da vo
p ng ca bnh nhn. Cc tc dng iu tr s xut hin sau vi pht, sau gim dn. V th
phi tip tc truyn tnh mch thuc.
Liu duy tr : 10-20 mg/kg/24 gi (thng l 600-800 mg/24 gi, c th n 1200 mg/24 gi),
thuc c pha trong 250 ml dung dch dextrose 5% v truyn trong vi ngy. Bt u ung
amiodarone t ngy u tim truyn tnh mch.
Tim tnh mch : 5 mg/kg, tim tnh mch chm ti thiu trong 3 pht. Khng trn chung vi
cc thuc khc trong cng mt bm tim
QU LIU
Cn qu t thng tin v qu liu cp tnh ca amiodarone. Nhp chm xoang hay cn nhp nhanh
tht t pht c th xy ra. Hu ht bnh nhn khng c cc biu hin lm sng. D sao i na,
do c tnh dc l ca thuc, phi theo di bnh nhn vi thi gian lu, c bit l v tnh
trng tim mch. Khng th thm phn c amiodarone ln cc cht chuyn ha ca n.
BO QUN
Gi ni kh mt, trnh nh sng.

122.

CORTIBION

ROUSSEL VIETNAM
[AVENTIS PHARMA]
Kem dng ngoi da : l 8 g.
THNH PHN
cho 100 g
Dexamethasone acetate

50 mg

Chloramphenicol

2g

TC DNG
Cortibion l mt phi hp cn bng gia dexamethasone acetate v chloramphenicol dng cho
liu php corticoid - khng sinh ti ch.
CH NH
Cc bnh da p ng vi corticoid ti ch v c bi nhim, th d : chm, vt cn trng cn, vim
da tip xc, vim da tit b nhn, vim da d ng.
CHNG CH NH
- Nhim trng nguyn pht do vi khun, siu vi, nm hay k{ sinh trng.
- Tn thng c lot.
- Mn trng c.
- Chng mi .
- Tng cm vi dexamethasone hay chloramphenicol.
THN TRNG LC DNG
- Khng nn thoa lp dy.
- Khng nn thoa trn din tch rng, ni bng kn, m mt, vng v ph n cho con b.
- Khng nn dng cho tr s sinh, nh nhi.
LIU LNG v CCH DNG
- Thoa lp mng 1-2 ln/ngy.
- Khng dng q 8 ngy cho mt t iu tr.
AMEBISMO
AMERIPHARM
c/o O.P.V. (OVERSEAS)

Dung dch ung : chai 237 ml.

THNH PHN
cho 1 mung canh 15 ml
Bismuth subsalicylate

525 mg

CH NH
Gim tiu chy, au d dy, kh tiu, nng v bun nn.
CH PHNG
Nu bnh nhn ang s dng thuc khng ng, thuc tr tiu ng, bnh gout, vim khp,
hy hi kin ca bc s trc khi s dng thuc ny.
Nu tiu chy km theo st cao hoc tiu chy k o di hn 2 ngy, nn hi kin ca bc s.
Nu bnh nhn ang c thai hoc ang cho con b, nn hi kin ca bc s trc khi s dng.
Gi thuc xa tm vi ca tr em.
Trong trng hp qu liu, hy tm s gip chuyn khoa hoc lin h vi trung tm kim
sot ng c ngay lp tc.
Ch : thuc c th lm cho li v phn c mu sm tm thi nhng khng gy hi.
THN TRNG LC DNG
Tr em v ngi ln di 18 tui ang c hoc va lnh bnh thy u hoc cm, khng nn
s dng thuc ny iu tr bun nn v nn.
Nu bun nn v nn xy ra, hy hi kin ca bc s, v y c th l du hiu sm ca hi
chng Reye, mt bnh cnh nghim trng nhng him gp.
Thuc c cha salicylate, trong trng hp ung km aspirin v c cm gic tai, hy ngng s
dng. Thuc khng cha aspirin, nhng nu bnh nhn b d ng vi aspirin th khng nn s
dng v c th xy ra tc dng ngoi .
Thuc c nng natri thp (t hn 3 mg cho mt mung canh) v khng c ng.
LIU LNG v CCH DNG
Lc k trc khi s dng, dng ly nh km chai lng thuc.
Ngi ln : 2 mung canh hoc 30 ml.
Tr em :
- 9-12 tui : 1 mung canh hoc 15 ml
- 6-9 tui : 2 mung c ph hoc 10 ml
- 3-6 tui : 1 mung c ph hoc 5 ml
- Di 3 tui : Hi kin ca bc s.
Ngi ln, tr em trn 12 tui v ngi gi : c th lp li liu nh trn mi gi nu cn thit,
nhng ch ti a 4 liu trong vng 24 gi. Nu triu chng vn cn, nn hi kin ca bc s.
Ung nhiu nc ngn nga tnh trng mt nc thng km theo vi tiu chy.

BO QUN
Trnh thuc ni nng qu 40oC, v khng c trong ngn t lnh

123.

COVATINE

A. B A I L L Y - S P E A B
c/o MARKETING SANPROMEX
Vin bao ng 50 mg : hp 45 vin.
THNH PHN
cho 1 vin
Captodiame chlorhydrate

50 mg

(cht mu E. 127, lactose, saccharose)

DC LC
Thuc an thn gii lo.
Cc nghin cu trn ng vt cho thy captodiame gy tc ng trn h thng lim, do
thuc c vai tr ch yu l iu ha tnh kh v xc cm.
CH NH
c ch nh trong cc tnh trng lo u, cng thng v cc ri lon tm thn thc th.
CH PHNG v THN TRNG LC DNG
Nh i vi tt c cc thuc thuc nhm ny, khng nn ung cc loi nc ung c alcool
trong sut thi gian iu tr mc d cho n nay cha c bo co no ghi nhn v nh hng
ca alcool i vi vic dng thuc ny.
Li xe v vn hnh my mc :
C kh nng gy bun ng (c th nh hng n s tp trung).
LC C THAI v LC NUI CON B
Lc c thai :
Cha c nghin cu trn ng vt v thiu s liu lm sng trn ngi, do nguy c khi dng
thuc trong thai kz cha c bit n ; cn phi thn trng khng k toa cho ph n c thai.
TC DNG NGOI
Him khi xy ra v thng l nh. Dng thuc c th nh hng n s tp trung (c th gy

ng gt ban ngy hay lm cho kh ng) v mt vi trng hp him c th lm thay i v gic.

LIU LNG v CCH DNG
Ngi ln : ung 3 vin/ngy : 1 vin bui sng, 1 vin bui tra v 1 vin bui ti.
Thi gian iu tr thng l 1 thng, hiu qu iu tr c th ch xy ra sau vi ngy iu tr
mt s ngi.

124.

COVERSYL

LES LABORATOIRES SERVIER

Vin nn d b 4 mg : hp 30 vin - Bng B.
THNH PHN
cho 1 vin
Perindopril tert-butylamine

4 mg

(Lactose)
DC LC
Thuc c ch men chuyn angiotensine.
C ch tc ng dc l :
Perindopril l thuc c ch men chuyn angiotensine I thnh angiotensine II, cht gy co mch
ng thi kch thch s bi tit aldostrone v thng thn.
Kt qu l :
- gim bi tit aldostrone,
- tng hot ng ca rnine trong huyt tng, aldost rone khng cn ng vai tr kim tra
ngc m tnh,
- gim tng khng ngoi bin vi tc ng u tin trn c v trn thn, do khng gy gi
mui nc hoc nhp tim nhanh phn x trong iu tr lu di.
Tc ng h huyt p ca perindopril cng c th hin nhng bnh nhn c nng
rnine thp hoc bnh thng.
Perindopril tc ng qua trung gian ca mt cht chuyn ha c hot tnh l perindoprilate, cc
cht chuyn ha khc khng c hot tnh.
Cc c trng ca tc ng h huyt p :

Perindopril c hiu lc mi giai on ca cao huyt p : nh, va v nng ; Perindopril c

ghi nhn lm gim huyt p tm thu v tm trng, t th nm v t th ng.
Tc ng h huyt p ti a t 4 n 6 gi sau khi dng liu duy nht v duy tr t nht trong 24
gi.
Kh nng c ch men chuyn cn rt cao thi im gi th 24 : nm trong khong 80%.
nhng bnh nhn c p ng, huyt p c tr li bnh thng sau 1 thng iu tr, v duy tr
mc n nh khng ti li.
Khi ngng thuc khng xy ra hin tng huyt p tng vt tr li.
Perindopril c c tnh gin mch, khi phc li tnh n hi ca ng mch ln v lm gim ph
i tht tri.
Trong trng hp cn thit, c th phi hp vi thuc li tiu nhm thiazide s c tc dng
hip ng. Ngoi ra, phi hp thuc c ch men chuyn v thuc li tiu nhm thiazide s gim
nguy c h kali huyt so vi khi ch dng mt mnh thuc li tiu.
C ch tc ng trn huyt ng bnh nhn suy tim :
Perindopril lm gim hot ng ca tim :
- do tc ng lm gin tnh mch, do iu chnh s chuyn ha ca prostaglandine : gim tin
gnh ;
- do gim tng khng ngoi bin : gim hu gnh.
Cc nghin cu c thc hin bnh nhn suy tim cho thy rng :
- gim p lc y tht tri v phi,
- gim tng khng ngoi bin,
- tng lu lng tim v ci thin ch s tim,
- tng lu lng mu n c.
Cc nghim php gng sc cng c ci thin.
DC NG HC
Dng ng ung, perindopril c hp thu nhanh chng. T l hp thu chim 65 n 70% liu
dng.
Perindopril c thy phn thnh perindoprilate, l mt cht c ch chuyn bit men chuyn
angiotensine. Thc n c th lm thay i lng perindoprilate hnh thnh. nh hp thu ca
perindoprilate trong huyt tng t c sau 3 n 4 gi. Gn kt vi protine huyt tng
di 30% nhng l thuc vo nng .
Sau khi dng perindopril vi liu duy nht hng ngy trong nhiu ngy, tnh trng cn bng
c n nh li trung bnh sau khong 4 ngy. Thi gian bn hy ca perindoprilate trong
khong 24 gi. Cc nng ca perindoprilate trong huyt tng cao mt cch ng k bnh
nhn c thanh thi cr atinine di 60 ml/pht, do suy thn hoc do cao tui. S o thi thuc
cng chm bnh nhn suy thn.
S thanh thi perindopril do thm phn l 70 ml/pht.

 bnh nhn x gan, ng hc ca perindopril c thay i : thanh thi qua gan ca phn t m
gim cn phn na. Tuy nhin, lng perindoprilate hnh thnh khng gim v khng cn thit
phi chnh liu.
Thuc c ch men chuyn qua c nhau thai.
CH NH
- Cao huyt p.
- Suy tim sung huyt.
CHNG CH NH
- Qu mn cm vi perindopril.
- Tin s b ph mch (ph Quincke) c lin quan n vic dng thuc c ch men chuyn.
- Ph n c thai hoc cho con b : xem Lc c thai v Lc nui con b.
Chng ch nh tng i :
- Hp ng mch thn hai bn hoc hp ng mch thn trong trng hp ch cn duy nht
mt qu thn lm vic.
- Tng kali huyt.
- Phi hp vi thuc li tiu tng kali huyt, mui kali v lithium : xem Tng tc thuc.
CH PHNG
C a b suy gim min dch : nguy c b gim bch cu trung tnh/mt bch cu ht.
Cc thuc c ch men chuyn i khi ngoi l c th gy mt bch cu ht v/hoc gy suy ty
khi chng c s dng :
- liu cao,
- bnh nhn suy thn phi hp vi cc bnh h thng (bnh collagne nh lupus ban ri
rc hoc bnh x cng b), c iu tr bng thuc lm gim min dch v/hoc nhng thuc
c kh nng gy gim bch cu. Trng hp phi hp nhiu loi thuc, cn theo di st mc
dung np mu v thn.
Vic chp hnh tt cc ch liu lng khuyn co c th ngn nga tt nht vic xy ra cc
tai bin trn. Tuy nhin, nu s dng thuc c ch men chuyn trn nhm bnh nhn ny, cn
cn nhc k gia hiu qu iu tr v cc nguy c.
Ph mch (ph Quincke) :
Ph mch mt, u chi, mi, li, thanh mn v/hoc thanh qun i khi cng c ghi nhn
trong mt s him trng hp iu tr bng thuc c ch men chuyn, k c perindopril. Trong
nhng trng hp ny, phi ngng ngay perindopril v theo di bnh nhn cho n khi ht hn
ph. Nu ch b ph mt v li, c th t khi khng cn phi iu tr, c th dng cc thuc
khng histamine lm du cc triu chng.
Nu ph mch phi hp vi ph thanh qun c th gy t vong. Nu ph sang n li, thanh
mn hoc thanh qun, c th gy nght th, cn phi c x l ngay lp tc bng cch tim
di da dung dch adrnaline 1o/oo (0,3 ml n 0,5 ml) v p dng cc bin php cp cu thch

hp.
Khng c tip tc k toa thuc c ch men chuyn nhng bnh nhn ny (xem Chng ch
nh).
Bnh nhn c tin s b ph Quincke khng lin quan n vic dng thuc c ch men
chuyn cng c nguy c cao khi dng loi thuc ny.
Lc mu :
Cc phn ng ging phn v (ph li v mi vi kh th v gim huyt p) cng c ghi nhn
khi lm thm phn dng mng c tnh thm cao (polyacrylonitrile) nhng bnh c iu tr
bng thuc c ch men chuyn. Nn trnh phi hp ny.
THN TRNG LC DNG
- Ho khan c ghi nhn khi s dng thuc c ch men chuyn, c c tnh dai dng v khi khi
ngng thuc. Nguyn nhn do thuc c th c ngh n, tuy nhin nu vic iu tr bng
thuc c ch men chuyn l cn thit, c th duy tr iu tr.
- Tr em : hiu lc v mc dung np ca perindopril tr em cha c thit lp.
- Trng hp suy tim, mt mui-nc, v.v. : nguy c b h huyt p v/hoc suy thn.
C s kch thch h thng rnine-angiotensine-aldost rone c ghi nhn, c bit bnh
nhn b mt mui-nc quan trng (n king theo ch khng c mui hoc iu tr ko di
bng thuc li tiu), bnh nhn c huyt p ng mch ban u thp, trng hp b hp
ng mch thn, suy tim sung huyt hoc x gan c trng ph bng.
Thuc c ch men chuyn c th phong b h thng ny, nht l trong ln s dng u tin v
trong hai tun l u iu tr, c th gy ra tt huyt p t ngt v/hoc, mc d rt him v
thi hn thay i, tng cr atinine huyt tng gy suy thn chc nng i khi cp tnh.
Trong nhng trng hp nu trn, cn bt u iu tr vi liu thp v tng t t (xem Liu
lng v Cch dng).
- Ngi gi : cn nh gi chc nng thn v kali huyt trc khi bt u iu tr (xem Liu
lng v Cch dng). Liu ban u c iu chnh li sau ty theo p ng v huyt p,
nht l trong trng hp mt mui-nc, nhm trnh tt huyt p c th xy ra t ngt.
- Trng hp suy thn (thanh thi cr atinine di 60 ml/pht) : gim liu. nhng bnh nhn
ny v nhng bnh nhn b bnh cu thn, nn theo di nh kz kali v cratinine (xem Liu
lng v Cch dng).
- Bnh nhn b x va ng mch : do nguy c b h huyt p c th xy ra trn tt c bnh
nhn, cn phi c bit thn trng nhng bnh nhn c bnh tim thiu mu cc b hoc suy
tun hon no, bng cch bt u iu tr liu thp.
- Bnh nhn b cao huyt p do thn : nguyn tc iu tr cao huyt p do thn l vn ti
ti mu thn (ti to mch mu thn). Tuy nhin, cc thuc c ch men chuyn c th c ch
nhng bnh nhn ny trong thi gian ch i phu thut iu chnh hoc trng hp khng
th phu thut c. Khi iu tr phi dng liu ban u thp v theo di chc nng thn cng

nh kali huyt, mt vi bnh nhn c th b tng suy thn chc nng, tuy nhin s hi phc li
khi ngng iu tr.
- Bnh nhn suy tim nng (giai on IV) hoc i tho ng l thuc insuline (c khuynh
hng tng kali huyt) : khi iu tr phi c theo di y khoa cht ch v liu ban u phi
thp.
- Bnh nhn cao huyt p vi suy mch vnh : khng ngng thuc chn bta ; phi hp thuc
c ch men chuyn vi thuc chn bta.
- Ghp thn hoc thm phn mu :
Thiu mu vi gim hm lng h moglobine c ghi nhn, v gim nhiu nu dng liu
ban u cao. Tc dng ny dng nh khng ph thuc vo liu lng nhng c lin quan n
c ch tc ng ca cc thuc c ch men chuyn.
Vic gim ny mc trung bnh, xy ra trong thi hn khong 1 n 6 thng, sau mc
n nh. S khi sau khi ngng iu tr. Vic iu tr c th c p dng nhng cn phi kim
tra mu thng xuyn.
- Can thip phu thut : trng hp c dng thuc gy v cm, v thng xy ra hn khi s
dng cc loi thuc gy v cm c th gy h huyt p, thuc c ch men chuyn l ngun gc
ca vic h huyt p. Nn ngng iu tr nu c th, v nn ngng hai ngy trc khi can thip
i vi nhng thuc c ch men chuyn c tc ng ko di nh perindopril.
LC C THAI
Cc nghin cu trn th vt cho thy khng c tc dng gy qui thai, nhng c c tnh trn
phi thai ca nhiu loi.
ph n c thai c iu tr bng thuc c ch men chuyn :
- cha c nghin cu dch t hc rng ri ;
- mt vi quan st ring r ph n c thai trong ba thng u cho thy rng ni chung c th
bo m v phng din khng gy qui thai ngoi tr mt vi trng hp d dng vm s c
lin quan n vic dng lu di thuc c ch men chuyn trong thi gian mang thai.
- dng thuc trong 3 thng gia v 3 thng cui, v nht l nu tip tc cho n khi sinh, d c
nguy c gy tn thng thn c th gy gim chc nng thn ca bo thai vi i khi b thiu
i, suy thn tr s sinh, vi h huyt p v tng kali huyt, thm ch v niu (c hi phc hoc
khng).
T rt ra rng :
Nguy c gy d dng, nu c, rt thp. Khng cn thit phi ph thai khi tnh c pht hin c
thai trong khi ang iu tr. Tuy nhin cn siu m kim tra vm s.
Ngc li, nu pht hin c thai khi ang iu tr bng thuc c ch men chuyn, cn ngng
ngay thuc ny v trong sut thai kz.
LC NUI CON B
Do thiu s liu, chng ch nh perindopril cho ph n nui con bng sa m.

TNG TC THUC
Khuyn khng nn phi hp :
- Thuc li tiu tng kali huyt (spironolactone, triamtrne, mt mnh hoc phi hp...), kali
(dng mui) : tng kali huyt (c th gy t vong), nht l bnh nhn suy thn (phi hp tc
ng lm tng kali huyt). Khng phi hp thuc li tiu tng kali huyt vi thuc c ch men
chuyn, tr trng hp bnh nhn b h kali huyt.
- Lithium : tng lithium huyt c th n ngng gy c (do gim bi tit lithium thn). Nu
bt buc phi dng thuc c ch men chuyn, cn theo di st lithium huyt v iu chnh liu.
Cn thn trng khi phi hp :
- Thuc tr i tho ng (insuline, sulfamide h ng huyt) ; m t cho captopril, nalapril
:
Tng tc dng h ng huyt bnh nhn i tho ng c iu tr bng insuline hoc
sulfamide h ng huyt. Him khi xy ra cc biu hin kh chu do h ng huyt (ci thin
s dung np glucose do gim nhu cu insuline).
Tng cng t theo di ng huyt.
- Baclofne : tng tc dng h huyt p.
Theo di huyt p ng mch v iu chnh liu thuc h huyt p nu thy cn.
- Thuc li tiu : nguy c h huyt p t ngt v/hoc suy thn cp tnh khi dng thuc c ch
men chuyn trng hp bnh nhn trc b mt mui-nc.
Trong cao huyt p ng mch, nu vic iu tr bng thuc li tiu trc gy mt muinc (c bit bnh nhn hoc ang c iu tr bng thuc li tiu, hoc theo ch
n king khng c mui, hoc bnh nhn chy thn), cn phi :
- hoc ngng thuc li tiu trc khi bt u dng thuc c ch men chuyn, v sau c th
dng tr li thuc li tiu h kali huyt nu cn thit,
- hoc dng liu ban u thp thuc c ch men chuyn v tng liu t t.
bnh nhn suy tim sung huyt c iu tr bng thuc li tiu, bt u bng liu rt thp
thuc c ch men chuyn, c th sau khi gim liu thuc li tiu h kali huyt dng phi
hp.
Trong mi trng hp, cn theo di chc nng thn (cratinine huyt) trong cc tun l u
iu tr bng thuc c ch men chuyn.
Mt s phi hp cng cn nn lu { :
- Thuc khng vim khng stroide (do suy lun t indomtacine) : gim tc dng h huyt p
(do thuc khng vim khng stroide gy c ch cc prostaglandine c tc dng gin mch v
phnylbutazone gy gi mui-nc).
- Thuc chng trm cm nhm imipramine (ba vng), thuc an thn kinh : tng tc dng h
huyt p v nguy c h huyt p th ng (hip ng tc dng).
- Corticoide, ttracosactide : gim tc dng h huyt p (do corticoide gy gi mui-nc).

TC DNG NGOI
V phng din lm sng :
- Nhc u, suy nhc, cm gic chng mt, ri lon tnh kh v/hoc ri lon gic ng, vp b.
- H huyt p theo t th hoc khng (xem Ch { phng v Thn trng lc dng).
- Pht ban ngoi da.
- au bao t, chn n, bun nn, au bng, thay i v gic.
- Ho khan c ghi nhn khi s dng thuc c ch men chuyn. Ho c tnh cht dai dng v s
khi khi ngng iu tr. Nguyn nhn do thuc phi c x t n khi c nhng triu chng
trn.
- Ngoi l : ph mch (ph Quincke) : xem Ch { phng v Thn trng lc dng.
V phng din sinh hc :
- Tng va phi ur v cratinine huyt tng, hi phc khi ngng iu tr. Vic tng ny
thng gp hn bnh nhn b hp ng mch thn, cao huyt p c iu tr bng thuc li
tiu, bnh nhn suy thn. Trng hp b bnh cu thn, dng thuc c ch men chuyn c th
gy protine niu.
- Tng kali huyt, thng l thong qua.
- Thiu mu (xem Ch { phng v Thn trng lc dng) c ghi nhn khi dng thuc c ch
men chuyn trn nhng c a c bit (nh gh p thn, lc mu).
LIU LNG v CCH DNG
Perindopril dng vin nn ung trc ba n.
Perindopril c ung mt ln duy nht trong ngy, vo bui sng.
Cao huyt p v cn :
- Nu bnh nhn trc khng b mt mui-nc hoc suy thn (hoc trong cc ch nh
thng thng) : liu hu hiu l 4 mg/ngy ung mt ln vo bui sng. Ty theo p ng ca
bnh nhn, c th iu chnh liu, tuy nhin phi tng t t tng nc liu trong vng 3 n 4
tun l, cho n ti a 8 mg/24 gi, ung mt ln vo bui sng.
Nu cn thit, c th phi hp vi thuc li tiu khng lm tng kali huyt nhm tng tc ng
h huyt p.
- Trong cao huyt p c iu tr trc bng thuc li tiu :
- hoc ngng thuc li tiu trc 3 ngy, sau c th dng tr li nu thy cn thit,
- hoc dng liu ban u l 2 mg v iu chnh liu ty theo p ng v huyt p thu c.
Nn nh lng cratinine huyt tng v kali huyt trc khi iu tr v trong 15 ngy u
iu tr.
- ngi gi (xem Ch { phng v Thn trng lc dng) : dng liu khi u thp (2
mg/ngy, vo bui sng), v tng ln nu cn, cho n 4 mg sau khong 1 thng iu tr.
C th iu chnh liu theo chc nng thn ca bnh nhn trong trng hp m liu c
ngh trn khng ph hp c vi tui tc (xem pha di).

Mc thanh thi cr atinine, c tnh da trn cratinine huyt, thay i theo tui, trng
lng v gii tnh, theo biu thc Cockcroft*, chng hn, phn nh mt cch chnh xc tnh
trng ca chc nng thn ngi gi :
* Thanh thi cratinine = (140 - tui) x trng lng / 0,814 x cratinine huyt
(vi tui c tnh theo nm, trng lng tnh theo kg, cratinine huyt tnh theo mmol/l).
Cng thc ny p dng cho nam gii v i vi ph n th phi ly kt qu nhn cho 0,85.
- Trong cao huyt p do thn : nn bt u liu 2 mg/ngy, sau nh gi li ty theo p
ng ca bnh nhn i vi tr liu.
Cn kim tra cratinine huyt v kali huyt nhm pht hin trng hp suy thn chc nng c
th xy ra (xem Ch { phng v Thn trng lc dng).
- Trng hp suy thn : liu perindopril c iu chnh theo mc suy thn :
- nu thanh thi cratinine >= 60 ml/pht, khng cn phi chnh liu,
- nu thanh thi cratinine < 60 ml/pht : t 30 n 60 ml/pht : 2 mg/ngy ; t 15 n 30
ml/pht : 2 mg, ung 1 ngy ngh 1 ngy.
nhng bnh nhn ny, cn theo di nh kz kali v cratinine, chng hn mi 2 thng trong
thi gian n nh tr liu.
C th phi hp vi thuc li tiu vng quai.
- bnh nhn cao huyt p c chy thn (thanh thi cratinine < 15 ml/pht) : perindopril c
thm tch c (xem Ch { phng v Thn trng lc dng). Mc thm tch l 70
ml/pht.
Dng liu 2 mg ngy chy thn.
Suy tim sung huyt :
Liu khi u tht thp, c bit trong trng hp :
- huyt p ng mch lc u trung bnh hoc thp,
- suy thn,
- h natri huyt, nguyn nhn do thuc (thuc li tiu) hoc khng.
Thuc c ch men chuyn c th c dng phi hp vi thuc li tiu v c th phi hp vi
digitalis.
Nn khi u iu tr bng liu 2 mg ung mt ln vo bui sng, theo di huyt p v c th
tng liu n liu hu hiu thng thng trong khong 2 n 4 mg/ngy, ung mt ln vo
bui sng.
Lu { khng huyt p tm thu t th ng gim di 90 mm Hg.
H huyt p c triu chng c th xy ra bnh nhn suy tim c nguy c (nh suy tim nng,
bnh nhn c iu tr bng thuc li tiu liu cao). Liu ban u phi gim phn na (ng
vi 1 mg/ngy).
Cn kim tra cratinine huyt v kali huyt mi khi c tng liu, sau mi 3 n 6 thng ty
theo mc suy tim, nhm kim tra s dung np ca iu tr.

QU LIU
Thng xy ra nht khi b qu liu l tt huyt p.
Khi huyt p tt nhiu, cn t bnh nhn t th nm, u thp, v truyn tnh mch dung
dch ng trng NaCl hay bng bt c phng tin no khc lm tng th tch mu lu
chuyn.
Perindoprilate, dng c hot tnh ca perindopril, c th thm tch c.

125.

CYSTINE B6 BAILLEUL

BAILLEUL
c/o GALIEN
Vin nn : hp 20 vin.
THNH PHN
cho 1 vin
L-Cystine

0,50 g

Pyridoxine chlorhydrate

0,50 g

DC LC
Cystine B6 Bailleul l mt phi hp ca L-cystine, mt acide amine c lu huznh, v vitamine B6.
L-cystine l mt thnh phn c bn ca cc hin b (18% trong tc, 14% trong mng) v chim
mt t l t hn trong da (2 n 4%). L-cystine tham giam vo qu trnh tng hp kratine (cht
sng) ca tc v mng. N thc y s tng sinh ca cc t bo mm cc vng to cht sng
v c nh hng n s tng trng ca cc hin b. Tc ng ny c chng minh qua
cc th nghim c nh du bng ng v phng x cc nhn ca t bo mm. ngi, cc
nng cao ca cystine, c bit l tc, t c sau khi ung thuc t 4 n 6 tun.
Vitamine B6l mt nhn t cn thit ca L-cystine. N gip cho cystine thm nhp vo vng to
cht sng. S cn bng v dinh dng gia L-cystine v vitamine B6 l cn thit v nu thiu
vitamine B6 s lm cho s thm nhp ca cystine vo trong cc hin b b gim i.
Nh vy, Cystine B6 Bailleul kch thch s tng trng ca tc v mng.
CH NH
iu tr cc bnh hin b (nh tc mng d b gy, ch) : chng rng tc, hot ha s mc
tc, chm sc v gip cho tc v mng tng trng.

THN TRNG LC DNG

Thn trng khi s dng trong nhng trng hp sau :
- Cystine niu.
- Phi hp vi L-dopa.
LIU LNG v CCH DNG
4 vin mi ngy, ung thuc trong ba n trong vng t 2 n 3 thng.
BO QUN
Thi gian bo qun l 3 nm.

THUC VN D

126.

D.T.VAX

AVENTIS PASTEUR
Truyn dch tim : bm tim cha sn hay ng cha mt liu 0,5 ml, l cha 10 liu (5 ml) hay
20 liu (10 ml).
THNH PHN
cho 1 bm tim
Bin c t bch hu tinh khit

ti thiu 30 UI

Bin c t un vn tinh khit

ti thiu 40 UI

Nhm hydroxyde (biu hin nh nhm)

ti a 1,25 mg

Thiomersal

ti a 0,05 mg

Dung dch mui sinh l ca NaCl

va 0,5 ml

DC LC

Vaccin hp ph bch hu v un vn.Vaccin c iu ch t c t bch hu v un vn c

kh c t bng formol v c tinh khit ha.Min dch t c ngay sau mi tim th hai
v duy tr t nht 5 nm sau ln tim nhc li th nht.
CH NH
- Phng nga ng thi bnh bch hu v un vn tr nh v tr em.- Vaccin D.T.Vax c
dng thay th vaccin D.T.Coq/D.T.P khi c chng ch nh dng vaccin ho g.Tr em b nhim
virus lm suy gim min dch ngi (HIV) :Theo khuyn co ca T Chc Y T Th Gii, tr em
nhim HIV c triu chng hay khng c triu chng, nn tim chng D.T.Vax theo lch thng
thng.
THN TRNG LC DNG
Trng hp c phn ng nghim trng ln tim trc, ngi ta khuyn nn s dng dng
vaccin c bin c t bch hu gim cn 1/10 nhng ln tim k tip.
TNG TC THUC
Vaccin D.T.Vax c th tim ng thi vi bt kz mt vaccin no trong Chng Trnh Tim Chng
M Rng m vn c hiu qu v khng nguy him.
TC DNG NGOI
- au ti ch tim him khi gp.
- C th st nh trong vng 24-48 gi sau khi tim.
- Ni nt cng hay nt di da c th xy ra v tn ti mt hay vi tun.
- Ngoi l, cc phn ng c th nng, c bit khi tim nhc thng l do phn ng d ng vi
bin c t bch hu (xem Thn trng lc dng).
LIU LNG v CCH DNG
Liu lng :
- Tim nga c bn : 3 mi tim 0,5 ml vaccin cch nhau 1 thng.
- Tim nhc : 1 mi tim 0,5 ml vaccin lc 1 nm sau mi tim th ba, v sau tim li mi 5
n 10 nm, dng vaccin loi gim liu bin c t bch hu.
Cch dng :

- Lc nh n khi t c huyn dch ng nht trng c v thc hin mi tim.- Tim bp

hay tim di da su.- Bt kz mt l a liu no sau khi m ra phi c dng trong ngy.Thao tc rt thuc ra 1 hay nhiu liu t l a liu thnh cng ch yu ph thuc vo cht
lng ca th thut.- Do l vaccin hp ph, u tin l thuc phi c lc nh, trnh to bt,
nhng t c mt hn hp ng nht.- Sau dng ng v kim tim v trng, rt 1
liu t l nhiu liu, sau khi st trng np ngoi l thuc bng cc cht st trng.- Lp li thao
tc nh trn i vi (nhng) liu cn li.- Gia cc ln thao tc rt thuc ra, d bt kz trng
hp no, trong vng 5 pht sau ln rt thuc sau cng, l thuc cn phi c li vo t
lnh, gi nhit thng thng, t +2oC n +8oC (khng bao gi trong ngn ng lnh).

127.

DAFLON 500 mg

LES LABORATOIRES SERVIER

Vin bao 500 mg : hp 30 vin.
THNH PHN
cho 1 vin
Phn on flavonoide tinh khit, di dng vi th

500 mg

tng ng : Diosmine

450 mg

tng ng : Hespridine

50 mg

DC LC
Thuc tr tnh mch v bo v mch mu.
- V dc l{ : Daflon 500 mg c tc ng trn h thng mch mu tr v tim :
- tnh mch, thuc lm gim tnh cng gin ca tnh mch v lm gim tr tnh mch ;
- vi tun hon, thuc lm bnh thng ha tnh thm ca mao mch v tng cng sc bn
ca mao mch.
- V dc l lm sng : cc nghin cu m i c kim sot trong s dng cc phng php
cho ph p quan st v nh gi hot tnh ca thuc trn ng lc mu tnh mch xc nhn
cc c tnh dc l ca Daflon 500 mg trn ngi.
Tng quan gia liu dng v hiu lc :
Mi tng quan liu dng/hiu lc, c { ngha ng k v phng din thng k, c thit lp
da trn cc thng s ca phng php ghi bin i th tch ca tnh mch : dung khng, tnh

cng gin v thi gian tng mu. Cc kt qu cho thy rng tng quan tt nht gia liu dng
v hiu lc thu c khi dng 2 vin/ngy.
Tc ng tr tnh mch :
Thuc lm tng trng lc ca tnh mch : dng my ghi bin i th tch cho thy c s gim
thi gian tng mu tnh mch.
Tc ng trn vi tun hon :
Cc nghin cu m i c kim sot cho thy rng c s khc nhau ng k v mt thng k
gia thuc v placebo. bnh nhn c cc du hiu mao mch b gin, d v, thuc lm tng
cng sc bn ca mao mch c o bng phng php o sc bn ca mch mu
(angiosterromtrie).
- Trn lm sng : cc nghin cu m i c kim sot cho thy thuc c tc ng iu tr trong
bnh tnh mch, trong iu tr suy tnh mch mn tnh chi di, chc nng v thc th.
DC NG HC
ngi, sau khi ung thuc vi diosmine c nh du vi carbone 14 :
- bi tit ch yu qua phn v bi tit qua nc tiu trung bnh khong 14% so vi liu dng ;
- thi gian bn thi l 11 gi ;
- thuc c chuyn ha mnh, c ghi nhn qua s hin din ca nhiu acide phnol khc
nhau trong nc tiu.
CH NH
iu tr cc triu chng c lin quan n suy tun hon tnh mch bch huyt (nng chn, au,
chn kh chu vo bui sng sm).
iu tr cc du hiu chc nng c lin quan n cn au tr cp.
CH PHNG v THN TRNG LC DNG
Cn au tr cp : cn phn bit vi cc bnh hu mn v thuc khng th thay th c cc tr
liu chuyn bit cho cc bnh hu mn khc. iu tr ngn hn. Nu cc du hiu vn dai dng,
phi khm nghim trc trng v xem xt li s tr liu.
LC C THAI
Cc nghin cu ng vt cho thy thuc khng c kh nng gy qui thai. Mt khc, ngi,
cho n nay khng c mt tc dng xu no c ghi nhn.
LC NUI CON B
Do khng c s liu v kh nng thuc c qua c sa m hay khng, khuyn cc b m khng
nn cho con b trong thi gian iu tr.
TC DNG NGOI
Mt s trng hp gp ri lon tiu ha v ri lon thn kinh thc vt nh, khng cn phi
ngng iu tr.
LIU LNG v CCH DNG
Suy tnh mch (au chn, nng chn, ph chn, gin tnh mch, sau vim tnh mch, vp b

(chut rt)) : 2 vin/ngy, chia lm 2 ln vo bui tra v bui ti trong cc ba n.

Cn au tr cp tnh : 6 vin/ngy, trong 4 ngy u ; sau 4 vin/ngy, trong 3 ngy ; duy tr 2
vin/ngy.
Tr mn tnh : 2 vin/ngy.

128.

DAIVONEX

LEO PHARMA
c/o ZUELLIG
Thuc m bi ngoi da 0,005% : ng 30 g.
THNH PHN
cho 1 g thuc m
Calcipotriol

50 mg

DC LC
Daivonex l dng dng ti ch ca dn xut vitamin D, calcipotriol, cht ny to ra s bit ha
t bo v c ch s tng sinh ca t bo sng. V vy, vng da b vy nn, Daivonex lm cho
s tng sinh v bit ha t bo tr v bnh thng.
Daivonex khng lm vy bn, khng c mi, c dung np tt i vi da bnh thng v trnh
c cc tc dng ph ca steroids.
DC NG HC
Calcipotriol rt t c hp thu qua da.
Kt qu thu c hn 3000 bnh nhn vy nn chng minh rng calcipotriol c hiu qu
cao v c dung np tt.
CH NH
Vy nn thng thng.
CHNG CH NH
Tng mn cm vi bt kz thnh phn no ca thuc m Daivonex.
THN TRNG LC DNG
Khng nn thoa thuc m ln mt v thuc c th gy kch thch da mt. Phi ra tay cn thn
sau khi dng thuc.
LC C THAI v LC NUI CON B
D cc nghin cu sc vt thc nghim khng cho thy c bt kz tc dng gy qui thai no,

nhng s an ton ca thuc m Daivonex khi dng cho ph n c thai khng c bo m.

TNG TC THUC
Thuc m Daivonex l mt thuc ch bin sn dng ngay, do khng nn trn ln vi cc
thnh phn ca thuc khc.
TC DNG NGOI
Tc dng ph nh nh kch thch da ti ch tm thi v him khi vim da vng mt xy ra.
LIU LNG v CCH DNG
Ch nn thoa thuc m Daivonex ln vng da c sang thng 2 ln/ngy. i vi mt s bnh
nhn khi iu tr duy tr ch cn thoa t ln hn. Liu dng hng tun khng vt qu 100 g.
QU LIU
Dng qu nhiu (hn 100 g thuc m Daivonex/tun) c th lm tng calci huyt. Tc dng ny
nhanh chng gim i khi ngng iu tr.
BO QUN
Bo qun nhit phng t 15oC - 25oC.

129.

DAKTARIN oral gel

JANSSEN PHARMACEUTICA
c/o JANSSEN-CILAG
c/o MEGA PRODUCTS
Gel r ming 2 % : ng 10 g.
THNH PHN
cho 100 g
Miconazole nitrate

2g

DC LC
Daktarin hot tnh khng nm i vi vi nm ngoi da thng thng v vi nm men, cng nh
c hot tnh khng khun i vi mt s trc khun v cu khun Gr (+).
Hot tnh ca thuc da trn s c ch sinh tng hp ergosterol vi nm v lm thay i thnh
phn lipid cu to mng, dn n s hoi t t bo vi nm.
DC NG HC
Kh dng sinh hc ng ung thp (25%-30%) v miconazole t c hp thu qua ng rut.
Vi liu 1000 mg ngi tnh nguyn khe mnh, 2-4 gi sau khi a vo c th, nng

trong huyt tng t c 1,16 mg/ml. Nng ny khng iu tr nm nng v nm

ni tng. Phn miconazole hp thu c chuyn ha gn nh hon ton. t hn 1% liu dng
c pht hin l khng bin i nc tiu. Khng c cht chuyn ha hot tnh, thi gian
bn hy sau cng l 20 gi.
CH NH
Gel r ming Daktarin dng cha tr v iu tr d phng nhim Candida khoang ming, hu
v ng tiu ha.
CHNG CH NH
Qu mn vi miconazole hoc bt kz thnh phn no ca thuc. Ri lon chc nng gan.
THN TRNG LC DNG
Nu phi dng ng thi Daktarin v thuc chng ng mu, th tc dng chng ng mu nn
c gim st v iu chnh k.
Nn gim st nng miconazole v phenytoin nu nh chng c dng ng thi.
c bit tr s sinh v tr nh cn phi thn trng chc chn rng gel khng lm tc nghn
c hng. Do , khng nn dng gel thnh sau c hng v liu y nn c phn chia
thnh nhng phn nh hn. Theo di bnh trnh nght th.
nh hng trn kh nng li xe v iu khin my mc :
Daktarin khng nh hng n s tnh to hay kh nng li xe.
LC C THAI v LC NUI CON B
Mc d khng c chng c v vic Daktarin gy c hi cho phi hay gy qui thai sc vt,
nguy c tim tng khi dng thuc ny cho ph n c thai nn c cn nhc vi ch li iu tr
mong mun.
Hin cha c d kin v s bi tit Daktarin trong sa m, v vy cn thn trng khi dng
Daktarin i vi ph n cho con b.
TNG TC THUC
Miconazole c th c ch s chuyn ha ca nhng thuc c chuyn ha bi h thng men
cytochrome 3A v 2C9. iu ny a n s gia tng hoc ko di tc dng ca nhng thuc
, k c tc dng ph.
Th d nh :
- Terfenadine, astemizole v cisapride. Khi nghin cu in-vitro s chuyn ha ca nhng thuc
ny b c ch bi miconazole. V vy, khng nn dng chng ng thi trn nhng bnh nhn
iu tr vi Daktarin.
- Thuc chng ng mu ng ung, thuc ung h ng huyt, phenytoin, cyclosporin v
c th tacrolimus. Nn gim liu ca nhng thuc ny nu s dng ng thi vi miconazole
khi cn thit.
TC DNG NGOI
Ri lon tiu ha nh : bun nn, nn. iu tr di hn c th b tiu chy. Trng hp him, c

th c phn ng d ng.
Trong cc bo co l t v vim gan, khng c trng hp no nguyn nhn lin quan do
Daktarin.
LIU LNG v CCH DNG
Tr s sinh : 1/2 mung c ph mi ln, hai ln mi ngy.
Tr em v ngi ln: 1/2 mung c ph mi ln, bn ln mi ngy.
Dng ngn tay qun gc r thuc vo ming. Khng nn nut thuc ngay m gi trong ming
cng lu cng tt. Tr liu nn c tip tc t nht l mt tun sau khi cc triu chng bin
mt. Trong trng hp nhim Candida ming, rng gi nn c ly ra mi ti ch ra vi gel
Daktarin.
QU LIU
Triu chng :
Miconazole thng khng c c tnh cao. Trong trng hp bin chng qu liu nn ma v
tiu chy c th xy ra.
iu tr :
iu tr triu chng v h tr. Khng c thuc gii c c hiu.
BO QUN
Bo qun 15-30oC.

130.

DANZEN

TAKEDA
c/o MEGA PRODUCTS
vin bao tan trong rut : v 10 vin, hp 500 vin.
THNH PHN
cho 1 vin
Serrapeptase

5 mg

tng ng

10.000 n v

DC LC
Thuc c ngun gc enzyme, c tc ng :
- chng ph n v khng vim,

- phn hy bradykinine v fibrine,

- tng vn chuyn khng sinh vo nhim trng,
- lm long m v tiu m, mu t.
DC NG HC
Danzen qua c hng ro rut, vo tun ton mu bng ng bch huyt v gn ln a-2macroglobuline trong mu.
CH NH
Ngoi khoa :
- Cc triu chng vim v ph n sau phu thut ;
- Tr ni, tr ngoi v sa hu mn ;
- Chn thng v sau phu thut chnh hnh.
Tai mi hng :
- Vim xoang, polyp mi, vim tai gia, vim hng ;
- Sau phu thut chuyn khoa v phu thut to hnh.
Ni khoa :
- Phi hp khng sinh trong cc trng hp nhim trng ;
- Long m trong cc bnh phi nh vim ph qun, hen ph qun, lao.
Nha khoa :
- Vim nha chu, abcs rng, vim ti li rng khn, sau khi nh rng ;
- Sau phu thut rng hm mt.
Ch nh khc :
- Nhn khoa : xut huyt mt, c dch knh ;
- Sn ph khoa : cng tuyn v, rch hoc khu tng sinh mn ;
- Tit niu : vim bng quang, vim mo tinh.
CHNG CH NH
C a d b d ng.
THN TRNG LC DNG
Ngng iu tr nu c phn ng d ng.
Thn trng khi s dng cho bnh nhn c bt thng v ng mu, ri lon trm trng chc
nng thn hoc ang iu tr vi thuc khng ng.
Phi hp vi thuc khng sinh nu c biu hin nhim trng.
TC DNG NGOI
Biu hin d ng ngoi da, c th gy ni m ay, ph Quincke.
i khi gy vi xo trn tiu ha nh bing n, kh chu v bun nn.
LIU LNG v CCH DNG
Mi ln ung 1 vin, mi ngy 3 ln. Khng nghin nt hoc b vin thuc khi ung. Thuc c
th ung trc hoc sau ba n. Liu dng c th tng ty theo ch nh ca Bc s.

131.

DAPHAZYL

XN DP TW5 - DANAPHA
Vin bao phim : v 10 vin, hp 2 v v hp 10 v.
THNH PHN
cho 1 vin
Spiramycin, tnh theo dng khan

750.000 IU

Metronidazol

125 mg

T dc : magnesium stearate, HPMC, mu

erythrosine, PEG 6.000
DC LC
Daphazyl l thuc phi hp gia spiramycin, mt khng sinh thuc h macrolid, v
metronidazol, mt cht khng khun thuc h imidazol c hiu cho cc vi khun k kh. Thuc
c tc dng c hiu vi cc nhim trng rng ming.
CH NH
Daphazyl c dng trong cc trng hp :
- Nhim trng rng ming cp tnh, mn tnh hoc ti pht, c bit l p-xe rng, vim ty,
vim m t bo quanh xng hm, vim quanh thn rng, vim nu, vim ming, vim nha
chu, vim tuyn mang tai, vim di hm.
- Phng nga nhim khun rng ming sau khi phu thut.
CHNG CH NH
Qu mn cm vi imidazol v/hoc spiramicin.
THN TRNG LC DNG
- Trng hp iu tr liu cao hoc ko di cn theo di cng thc bch cu i vi bnh nhn
c tin s ri lon v mu.
- Ngng dng thuc trong trng hp mt iu ha, chng mt, ln tm thn.
- Khng dng cho ph n c thai trong 3 thng u ca thai kz hoc ang nui con b.
TNG TC THUC
- Khng nn phi hp vi disulfiram (gy cn hoang tng), ru v cc thc ung c ru
(hiu ng antabuse).

- iu chnh liu cc thuc chng ng mu khi cn thit phi dng chung vi Daphazyl.
TC DNG NGOI
- H tiu ha : tiu chy, nn, bun nn, au d dy.
- Phn ng qu mn : ni ban, m ay, nga.
- Chng mt, mt iu ha (him gp).
LIU LNG v CCH DNG
Ung thuc trong ba n.
Liu trung bnh :
Ngi ln : 4-6 vin/ngy, chia 2-3 ln.
Tr em :
- 5-10 tui : 2 vin/ngy, chia 2 ln.
- 10-15 tui : 3 vin/ngy, chia 3 ln.
BO QUN
thuc ni kh mt, trnh nh sng.

132.

DBRIDAT

PFIZER
c/o ZUELLIG
Vin nn 100 mg : hp 20 vin.
Bt pha huyn dch ung 4,8 mg/ml : chai 250 ml huyn dch sau khi pha.
Bt pha huyn dch ung dnh cho tr em v nh nhi 4,8 mg/ml : chai 125 ml huyn dch sau
khi pha + dng c lng c khc vch.
THNH PHN
cho 1 vin
Trimbutine malate
Lactose

cho 1 mung caf

100 mg

Trimbutine

24 mg

Saccharose

3g

cho 1 ml huyn dch dnh cho tr em v

nh nhi
Trimbutine

4,8 mg

Saccharose

0,6 g

DC LC
Thuc chng co tht c tc ng trn c.
iu chnh s vn ng ng tiu ha.
Cht ch vn enkphalinergique ngoi bin.
Trimbutine c th kch thch s vn ng rut v cng c th c ch s vn ng ny nu
trc b kch thch.
DC NG HC
Thuc t nng ti a trong mu sau khi ung t 1 n 2 gi.
Thuc c o thi nhanh, ch yu qua nc tiu : trung bnh 70% sau 24 gi.
CH NH
iu tr triu chng au do ri lon chc nng ca ng tiu ha v ng mt.
iu tr triu chng au, ri lon s chuyn vn, bt n rut c lin quan n ri lon chc
nng ca rut.
CHNG CH NH
Phnylctone niu.
CH PHNG v THN TRNG LC DNG
Bnh nhn b tiu ng cn lu { rng mi mung caf huyn dch Dbridat c cha 3 g
saccharose v mi ml huyn dch Dbridat dnh cho tr em v nh nhi c cha 0,6 g
saccharose.
LC C THAI
Cc nghin cu trn ng vt khng cho thy thuc c tc dng gy qui thai. Do thuc khng
c tc dng gy qui thai trn ng vt, nguy c gy d tt khi s dng cho ngi khng th xy
ra. Thc t cho n nay, nhng cht thuc gy d tt khi s dng cho ngi u l nhng cht
c tc dng gy qui thai khi s dng cho ng vt trong cc nghin cu c thc hin trn c
hai loi.

Hin nay cha c s liu thch ng nh gi kh nng gy d tt hay c cho phi thai ca
trimbutine khi s dng cho ph n ang mang thai.
Do , nn thn trng khng dng trim butine trong 3 thng u ca thai kz v ch dng trong
qu 2 v qu 3 ca thai kz khi tht s cn thit.
LC NUI CON B
Trong thi gian dng thuc ngi m vn c th tip tc cho con b.
TC DNG NGOI
Cc nghin cu lm sng ghi nhn rt him khi xy ra cc phn ng da.
LIU LNG v CCH DNG
Ngi ln :
Liu thng thng : mi ln ung 1 mung canh huyn dch hoc 1 vin, 3 ln/ngy.
Liu ti a : 6 mung canh huyn dch ung hoc 6 vin/ngy.
Tr em/Tr cn b :
Tr trn 5 tui : mi ln ung 2 mung caf huyn dch, 3 ln/ngy.
Tr di 5 tui : nn dng dng Dbridat dnh cho tr em v nh nhi 4,8 mg/ml :
Pha huyn dch bng cch b sung nc vo chai (dng loi nc khong khng c gas) cho n
vch khc trn chai v lc k.
Liu thng thng l 1 ml/kg/ngy chia lm 3 ln.
Liu dng cho 1 ln c khc trn dng c lng tnh theo kg cn nng. Mi vch trn dng c
lng tng ng vi liu dng 1 ln cho 1 kg cn nng : v d, vch khc th 10 tng ng vi
liu dng 1 ln ca tr c th trng l 10 kg.
Sau khi lng thuc trong dng c lng, nn cho vo bnh sa hay cho vo mung hoc ly v
cho tr ung.
i vi tr nh nhi, nn pha vo bnh sa hoc bnh nc v cho tr b. Nn lc k chai thuc
trc khi s dng.
BO QUN
Huyn dch ung ch c dng trong vng 4 tun sau khi pha.

133.

DCAPEPTYL 0,1 mg

BEAUFOUR IPSEN
Bt v dung mi pha tim di da : hp 7 l thuc bt v 7 ng dung mi 1 ml - Bng A.
THNH PHN
Thuc bt :

cho 1 l
Triptorline

0,1 mg

T dc : mannitol.

cho 1 hp
Triptorline

0,7 mg

ng dung mi :
cho 1 l
Sodium chlorure

9 mg

Nc ct pha tim

1 ml

cho 1 hp
Sodium chlorure

63 mg

Nc ct pha tim

7 ml

DC LC
- Triptorline l mt dcapeptide tng hp, l mt cht tng t GnRH t nhin (hormone
c gii phng t LH).
- Cc nghin cu c thc hin ngi cng nh ng vt cho thy rng sau khi c mt
s kch thch ban u, dng ko di triptorline s c ch s bi tit hng sinh dc, lm mt
cc chc nng ca tinh hon v bung trng. Sau mt s nghin cu trn ng vt, ngi ta
thy c mt c ch tc ng khc ca thuc nh sau : thuc tc ng trc tip ln cc tuyn
sinh dc bng cch lm gim s nhy cm ca cc th th ngoi bin i vi GnRH.
Ung th tuyn tin lit :
- ngi, dng mi ngy mt liu triptorline, c th lc ban u s lm tng cc nng LH
v FSH trong mu, iu ny dn n h qu l lc u nng cc stroide sinh dc (nh
testostrone v dihydrotestostrone) s tng ln. Nu tip tc iu tr, cc nng LH v FSH
sau s gim a n nng ca cc stroide sinh dc s gim dn n cc gi tr nh b

hon, trong mt thi hn t 2 n 3 tun, cng thi gian vi vic s dng thuc.
- Trong thi gian u iu tr cng c th ghi nhn thy c tng thong qua cc phosphatase
acide.
- Vic iu tr s lm ci thin cc du hiu chc nng v khch quan.
Ph n khng c kh nng th thai :
Dng hng ngy Dcapeptyl s to ra mt giai on khi u l kch thch hng sinh dc (FSH
v LH), tip theo l giai on c ch. Do vic iu tr ny s c ch nh gian pht ca
lng LH v cho php to thnh cc nang non hon chnh, cng nh gia tng s tuyn chn
nang non.
DC NG HC
ngi ln khe mnh :
Triptor line tim di da (0,1 mg) c tan nhanh (Tmax = 0,63 +/- 0,26 gi vi nng trong
huyt tng t nh cao Cmax = 1,85 +/- 0,23 ng/ml). Thuc c o thi vi thi gian bn
hy sinh hc l 7,6 +/- 1,6 g sau khi c phn phi trong 3 n 4 gi.
Thanh thi ton phn trong huyt tng l 161 +/- 28 ml/pht.
Th tch phn phi l 1 562 +/- 158 ml/kg.
bnh nhn b ung th tuyn tin lit :
Dng bng ng tim di da (0,1 mg), cc nng trong huyt tng dao ng gia gi tr
ti a l 1,28 +/- 0,24 ng/ml (Cmax) thng t c khong 1 gi sau khi tim thuc (Tmax) v
gi tr ti thiu l 0,28 +/- 0,15 ng/ml (Cmin) t c sau khi tim thuc 24 gi.
Thi gian bn hy sinh hc trung bnh l 11,7 +/- 3,4 gi nhng thay i ty theo tng ngi, v
thanh thi trong huyt tng l 118 +/- 32 ml/pht phn nh vic o thi chm ca thuc
nhng bnh nhn ny, trong khi th th tch phn phi th vn tng t nh nhng
ngi khe mnh (1 130 +/- 210 ml/kg).
CH NH
Ung th tuyn tin lit c di cn :
iu tr tn cng, trc khi s dng dng c tc dng ko di.
Thuc c hiu qu iu tr tt hn v thng hn nu nh bnh nhn cha tng c iu tr
trc bng ni tit t.
Ph n khng c kh nng th thai :
iu tr h tr bng cch phi hp vi cc gonadotrophine (hMG, FSH, hCG) trong giai on
cm ng s rng trng cho vic th tinh nhn to tip theo l mt qu trnh cy chuyn phi
(Fivete).
CHNG CH NH
Ph n c thai : xem mc Lc c thai v Lc nui con b.
CH PHNG v THN TRNG LC DNG
Ch { phng :

Ung th tuyn tin lit :

Khi bt u iu tr : mt vi trng hp ring r c ghi nhn l c nng ln, thng ch tm
thi, cc triu chng lm sng (nht l au xng) c ghi nhn khi bt u iu tr. Do
cn phi theo di y khoa cht ch trong cc tun l u iu tr, nht l nhng bnh nhn b
tc cc ng bi tit v nhng bnh nhn b di cn ct sng (xem Tc dng ngoi {). Tng
t, cn phi cn nhc k khi iu tr cho nhng bnh nhn c cc du hiu bo hiu b chn p
ty.
Ph n khng c kh nng th thai :
Vic tng s lng nang tuyn do tim triptorline, khi c phi hp vi cc gonadotrophine, c
th tr nn ng k mt s bnh nhn c bm cht kh th thai v c bit trong trng hp
b a u nang bung trng. p ng ca bung trng i vi phi hp triptorlinegonadotrophine c th thay i vi cng mt liu lng bnh nhn ny so vi bnh nhn
khc, v trong mt s trng hp c s p ng khc nhau gia nhng chu kz kinh khi dng
trn cng mt bnh nhn.
Thn trng lc dng :
Ung th tuyn tin lit :
Nn theo di nh kz nng testost rone trong mu khng c vt qu 1 ng/ml.
Vic p ng vi iu tr c th c nh gi trn xng bng xt nghim chp lp lnh
v/hoc chp ct lp in ton ; tuyn tin lit, vic p ng s c nh gi (ngoi cc
kim tra lm sng v khm qua trc trng) bng siu m v/hoc phng php chp ct lp
in ton.
Ph n khng c kh nng th thai :
Vic gy rng trng phi c thc hin di s theo di y khoa cht ch v kim tra sinh hc
v lm sng nghim ngt v thng xuyn : nh lng nhanh nng estrogne trong huyt
tng, chp siu m (xem mc Tc dng ngoi ).
Trng hp c p ng qu mc bung trng, nn ngng chu kz iu tr bng cch ngng
tim gonadotrophine nhng vn tip tc tim triptor line trong 2 n 3 ngy trnh to tr
li tm thi nh ca LH.
LC C THAI v LC NUI CON B
Lc c thai :
- ng vt, cc th nghim khng cho thy thuc c tc dng gy qui thai. Do khng c tc
dng gy qui thai trn ng vt, ngi ta khng ngh rng thuc c th c nguy c gy d dng
trn ngi. Thc t cho n nay, cc cht thuc gy d dng trn ngi u c gy qui thai
trn ng vt trn cc nghin cu c thc hin trn c ng vt v ngi.
- Trn lm sng, dng cc cht ging GnRH trn s gii hn ph n c thai khng thy c tc
dng gy d dng no hay c tnh c bit trn phi c ghi nhn cho n nay. Tuy nhin,
cn phi thc hin thm nhiu nghin cu b sung xc nh cc hu qu c th xy ra trong

thi gian c thai.

TC DNG NGOI
Ung th tuyn tin lit :
- Khi u iu tr (xem mc Ch { phng v Thn trng lc dng) : i khi c th lm nng
ln cc du hiu lm sng v cc triu chng (c bit l au xng). Mt vi trng hp lm
nng ln chng huyt niu b trc , hoc gy tc ng tiu, cm gic yu t hoc gy d
cm cc chi di c ghi nhn i vi mt s cht tng t GnRH khc.
Cc biu hin ny thng l thong qua, s t khi sau 1 n 2 tun vn tip tc iu tr. Tuy
nhin, kh nng xy ra cn kch pht tm thi cc triu chng ko di trong cc tun l iu tr
u cn phi c thn trng lu { nhng bnh nhn b e da xy ra ri lon thn kinh hay
nhng ngi b tc nghn ng tiu.
- Trong thi gian iu tr : cc tc dng ngoi { sau y c ghi nhn : bc ha (khong 35%),
au ti ni tim (khong 2%), bt lc (khong 6%), cn cao huyt p thong qua (di 3%).
Vi cc cht tng t GnRH khc, mt s tc dng ngoi { sau c ghi nhn : st, bun nn, i
ma, pht ban da, nga (khong 3 n 4%) ; yu t cc chi di, chng mt, kh th (di
2%) ; nhc u, nh trng ngc, tiu chy, to bn, ri lon th gic, trm cm, chn n, ra m
hi ban m, m hi lnh, rng tc, ng gt (di 1%).
Ph n khng c kh nng th thai :
Him gp : bc ha, suy nhc.
Nu dng phi hp vi cc gonadotrophine c th gy tng kch thch bung trng. Qu dng
bung trng, au vng khung chu v/hoc au bng c th c ghi nhn (xem mc Ch {
phng v Thn trng lc dng).
LIU LNG v CCH DNG
Ung th tuyn tin lit :
Tim mi ngy 0,1 mg triptorline bng ng di da t ngy 1 n ngy th 7 trc khi
chuyn sang dng dng c tc dng ko di.
Ph n khng c kh nng th thai :
iu tr phi hp vi gonadotrophine, tim di da 1 l/ngy t ngy th hai ca chu kz kinh
nguyt (phi hp vi vic kch thch bung trng giai on u) cho n hm trc ca ngy
c n nh pht ng vic rng trng, c tnh trung bnh khong 10 n 12 ngy.

134.

DCAPEPTYL 3,75 mg

BEAUFOUR IPSEN
Vi ht ng kh v dung mi pha tim bp c tc ng ko di 3,75 mg : l cha cc vi ht
thuc + ng dung mi pha thnh hn dch tim - Bng A.
THNH PHN
L cha cc vi ht thuc :
cho 1 l
Triptorline

3,75 mg

Polymre dl-lactide coglycolide

170 mg

Mannitol

85 mg

Carboxymthylcellulose sodique

30 mg

Polysorbate 80

2 mg

T dc : mannitol.
Dung mi pha hn dch :
cho 1 l
Mannitol

16 mg

Nc ct pha tim lng va

2 ml

DC LC
- Triptorline l mt dcapeptide tng hp, l mt cht tng t GnRH t nhin (hormone
c gii phng t LH).
- Cc nghin cu c thc hin ngi cng nh ng vt cho thy rng sau khi c mt
s kch thch ban u, dng ko di triptorline s c ch s bi tit hng sinh dc, lm mt
cc chc nng ca tinh hon v bung trng. Sau mt s nghin cu trn ng vt, ngi ta
thy c 1 c ch tc ng khc ca thuc nh sau : thuc tc ng trc tip ln cc tuyn sinh
dc bng cch lm gim s nhy cm ca cc th th ngoi bin i vi GnRH.
Ung th tuyn tin lit :
- ngi, dng mi ngy mt liu triptorline c th lc u s lm tng cc nng LH v FSH
trong mu, iu ny dn n h qu l lc u nng cc stroide sinh dc (nh testost rone
v dihydrotestostrone) s tng ln. Nu tip tc iu tr, cc nng LH v FSH sau s gim
a n nng ca cc stroide sinh dc s gim dn n cc gi tr nh b hon, trong mt

thi hn t 2 n 3 tun, cng thi gian vi vic s dng thuc.

- Trong thi gian u iu tr cng c th ghi nhn thy c tng thong qua cc phosphatase
acide.
- Vic iu tr s lm ci thin cc du hiu chc nng v khch quan.
Dy th sm :
- c ch cc hot ng hng sinh dc qu mc ca tuyn yn c biu hin, c hai gii
tnh, qua vic c ch s bi tit estradiol hay testostrone, lm gim nng nh ca LH v ci
thin tng quan gia chiu cao, tui tht v trng lng xng.
- Vic kch thch tuyn sinh dc vo lc u c th gy xut huyt sinh dc nh, c th cn phi
c iu tr bng mdroxyprogestrone actate hay cyprotrone actate.
Lc ni mc t cung :
Dng di hn triptorline s c ch s bi tit estradiol v nh th s lm ngng pht trin cc
m ca ni mc t cung.
Ph n khng c kh nng th thai :
Dng hng ngy Dcapeptyl s to ra 1 giai on khi u l kch thch hng sinh dc (FSH v
LH), tip theo l giai on c ch. S dng triptorline ko theo vic c ch tit FSH v LH
hng sinh dc. Do vic iu tr ny s c ch nh gian pht ca lng LH v cho php to
thnh cc nang non hon chnh, cng nh gia tng s tuyn chn nang non.
DC NG HC
Sau khi tim bp dng c tc ng k o di, ngi ta ghi nhn u tin c mt giai on gii
phng hot cht c b mt ca vi ht, sau l giai on gii phng hot cht u n (Cm =
0,32 +/- 0,12 ng/ml), vi tc gii phng trung bnh ca D-Trp-6-LHRH l 46,6 +/- 7,1 mg/ngy,
kh dng sinh hc ca hn dch ca cc vi ht vo khong 53% trong vng 1 thng.
CH NH
Ung th tuyn tin lit : iu tr ung th tuyn tin lit c di cn.
Thuc c hiu qu iu tr tt hn v thng hn nu nh bnh nhn cha tng c iu tr
trc bng ni tit t.
Dy th sm (trc 8 tui tr gi v trc 10 tui tr nam).
Lc ni mc t cung c quan sinh dc v ngoi c quan sinh dc (t giai on I n giai on
IV). Thi gian iu tr c gii hn trong vng 6 thng (xem mc Tc dng ngoi ). Khng nn
iu tr tip theo bng triptorline hay 1 cht tng t GnRH.
Ph n khng c kh nng th thai :
iu tr h tr bng cch phi hp vi cc gonadotrophine (hMG, FSH, hCG) trong giai on gy
cm ng s rng trng cho vic th tinh nhn to tip theo l mt qu trnh cy chuyn phi
(Fivete).
CHNG CH NH
Ph n c thai : xem mc Lc c thai v Lc nui con b.

CH PHNG v THN TRNG LC DNG

Ch { phng :
Ung th tuyn tin lit :
Khi bt u iu tr : mt vi trng hp ring r c ghi nhn l c nng ln, thng ch tm
thi, cc triu chng lm sng (nht l au xng) c ghi nhn khi bt u iu tr. Do
cn phi theo di y khoa cht ch trong cc tun l u iu tr, nht l nhng bnh nhn b
tc cc ng bi tit v nhng bnh nhn b di cn ct sng (xem Tc dng ngoi {). Tng
t, cn phi cn nhc k khi iu tr cho nhng bnh nhn c cc du hiu bo hiu b chn p
ty.
Ph n khng c kh nng th thai :
Vic tng s lng nang tuyn do tim triptorline, khi c phi hp vi cc gonadotrophine, c
th tr nn ng k mt s bnh nhn c bm cht kh th thai v c bit trong trng hp
b a u nang bung trng. p ng ca bung trng i vi phi hp triptorlinegonadotrophine c th thay i vi cng mt liu lng bnh nhn ny so vi bnh nhn
khc, v trong mt s trng hp c s p ng khc nhau gia nhng chu kz kinh khi dng
trn cng mt bnh nhn.
Thn trng lc dng :
Ung th tuyn tin lit :
- Nn theo di nh kz nng testost rone trong mu khng c vt qu 1 ng/ml.
- Vic p ng vi iu tr c th c nh gi trn xng bng xt nghim chp lp lnh
v/hoc chp ct lp in ton ; tuyn tin lit, vic p ng s c nh gi (ngoi cc
kim tra lm sng v khm qua trc trng) bng siu m v/hoc phng php chp ct lp
in ton.
Lc ni mc t cung :
Trc khi k toa Dcapeptyl 3,75 mg cn phi kim tra chc chn rng bnh nhn khng c thai.
Dng u n mi 4 tun D capeptyl 3,75 mg tc ng ko di s gy v kinh do thiu nng
sinh dc. Nu xy ra bng huyt trong thi gian iu tr l c bt thng, cn phi kim tra
nng estradiol trong huyt tng v nu nng ny di 50 pg/ml, cn kim tra xem c
mt sang thng thc th no hay khng.
Sau khi ngng iu tr, chc nng ca bung trng hot ng tr li v trng rng tr li trung
bnh sau khong 58 ngy sau mi tim cui cng v kinh nguyt c tr li trung bnh sau khong
70 ngy. Nu c th, nn d kin mt bin php nga thai.
Do cn thiu d liu v do thn trng, nn trnh phi hp vi cc thuc lm tng prolactine
huyt (do cc thuc ny c th lm gim nng cc th th tip nhn GnRH trong tuyn yn).
Trng hp s dng ko di, nn kim tra khi lng xng (xem mc Tc dng ngoi ).
Ph n khng c kh nng th thai :
Vic gy rng trng phi c thc hin di s theo di y khoa cht ch v kim tra sinh hc

v lm sng nghim ngt v thng xuyn : nh lng nhanh nng estrogne trong huyt
tng, chp siu m (xem mc Tc dng ngoi {). Trng hp c p ng qu mc bung
trng, nn ngng chu kz iu tr bng cch ngng tim gonadotrophine.
LC C THAI v LC NUI CON B
Lc c thai : trc khi bt u iu tr cn phi chc chn l bnh nhn khng c thai.
TNG TC THUC
Cc thuc lm tng prolactine huyt : xem mc Thn trng lc dng.
TC DNG NGOI
Ung th tuyn tin lit :
- Khi u iu tr (xem mc Ch { phng v Thn trng lc dng) : i khi c th lm nng
ln cc du hiu lm sng v cc triu chng (c bit l au xng). Mt vi trng hp lm
nng ln chng huyt niu b trc , hoc gy tc ng tiu, cm gic yu t hoc gy d
cm cc chi di c ghi nhn i vi mt s cht tng t GnRH khc.
Cc biu hin ny thng l thong qua, s t khi sau 1 n 2 tun vn tip tc iu tr. Tuy
nhin, kh nng xy ra cn kch pht tm thi cc triu chng ko di trong cc tun l iu tr
u cn phi c thn trng lu { nhng bnh nhn b e da xy ra ri lon thn kinh hay
nhng ngi b tc nghn ng tiu.
- Trong thi gian iu tr : cc tc dng ngoi { sau y c ghi nhn : bc ha (khong 35%),
au ti ni tim (khong 2%), bt lc (khong 6%), cn cao huyt p ng mch thong qua
(di 3%).
Vi cc cht tng t GnRH khc, mt s tc dng ngoi { sau c ghi nhn : st, bun nn, i
ma, pht ban da, nga (khong 3 n 4%) ; yu t cc chi di, chng mt, kh th (di
2%) ; nhc u, nh trng ngc, tiu chy, to bn, ri lon th gic, trm cm, chn n, ra m
hi ban m, m hi lnh, rng tc, ng gt (di 1%).
Dy th sm :
C th xy ra cc xut huyt nh ng sinh dc sau mi tim u tin mt phn ba tr gi,
c th cn phi c iu tr bng mdroxyprogestrone actate (40 mg/ngy) hay
cyprotrone actate (100 mg/ngy) trong tun l u iu tr.
Lc ni mc t cung :
Cc tc dng ngoi { nh bc ha, kh m o cho thy thuc c hiu lc phong b tuyn ynbung trng.
Ph n khng c kh nng th thai :
Him gp : bc ha, suy nhc, nhc u.
Nu dng phi hp vi cc gonadotrophine c th gy tng kch thch bung trng. Qu dng
bung trng, au vng khung chu v/hoc au bng c th c ghi nhn (xem mc Ch {
phng v Thn trng lc dng).
LIU LNG v CCH DNG

Ung th tuyn tin lit :

C th p dng hai phc iu tr sau y :
- tim di da mi ngy D capeptyl 0,1 mg c tc ng nhanh trong 7 ngy u, sau tim
bp D capeptyl 3,75 mg c tc ng ko di t ngy th 8, sau tim lp li mi 4 tun ;
- hoc tim bp ngay t u Dcapeptyl 3,75 mg c tc ng ko di, lp li mi 4 tun.
Dy th sm :
Tim bp 50 mg/kg mi 4 tun.
Lc ni mc t cung :
Vic iu tr phi c bt u trong vng 5 ngy u ca chu kz kinh nguyt.
khong cch gia cc mi tim : tim lp li mi 4 tun,
thi gian iu tr : ty theo mc lc ni mc t cung lc bt u iu tr v tin trin ca
bnh trong thi gian iu tr qua cc biu hin lm sng (chc nng v gii phu). Trn nguyn
tc, thi gian iu tr t nht l 4 thng v ti a l 6 thng. Khng nn lp li mt t iu tr
th hai vi triptorline hay vi mt thuc tng t GnRH khc.
Ph n khng c kh nng th thai :
Phc iu tr thng c s dng l tim bp mt l Dcapeptyl 3,75 mg t ngy th hai
ca chu kz. Bt u dng phi hp vi gonadotrophine sau khi gii cm ng tuyn yn (nng
estrogne trong huyt tng di 50 pg/ml), thng khong 15 ngy sau khi tim
Dcapeptyl.
Ghi ch : khi tim dng c tc ng ko di phi thc hin ng theo hng dn s dng. Nu
tim khng ng cch v lm tht thot lng hn dch nhiu hn l lng cn li trong bm
tim th phi bo co.
BO QUN
ch mt.

135.

DECAQUINON

EISAI
c/o DIETHELM
Vin nn 10 mg : v 10 vin, hp 25 v.
THNH PHN
cho 1 vin

Ubidecarenone

10 mg

M T
Ubidecarenone c tn ha hc l 2,3-Dimethoxy-5-methyl-6-decaprenyl-benzoquinone. Cng
thc phn t : C59H90O4. Trng lng phn t : 863,36.
Ubidecarenone tn ti di dng bt tinh th mu vng n cam, khng mi, khng v. N rt
d tan trong chloroform v carbon tetrachloride, tan t do trong dioxane, ether v hexane, tan
mt phn trong acetone v hu nh khng tan trong nc, methanol v ethanol. Khi ra ngoi
nh sng, n b phn hy dn v chuyn sang mu sm.
im nng chy : khong 48oC.
DC LC
Hot cht ca Decaquinon l ubidecarenone (Coenzyme Q10, Ubiquinone 50), cht ny c
phn lp u tin t c tim b vo nm 1957 di dng cc tinh th tan trong cht b o. Sau ,
Cooly v Folkers cng cc cng s chng minh hot tnh ca Ubidecarenone suy gim trong
c tim ngi b bnh tim. Ubidecarenone (CoQ10), sau khi ung, c hp thu thng qua h
thng bch huyt v thm nhp vo ty th trong t bo. Hin nay, ngi ta xc nhn rng
CoQ10 c tc ng trc tip trn c tim b thiu mu cc b v tng cng hiu sut s dng
oxy. Cc tc dng ny ca CoQ10 gip c tim duy tr chc nng sn sinh nng lng mc
cao, ngay c trong cc trng hp b thiu mu cc b, do lm gim cc tn thng ca t
bo c tim do thiu mu gy ra. Trong thc t lm sng, hiu qu ca CoQ10 trn cc ri lon c
tim c kho st bng in tm lc ngh ngi v khi gng sc, ngi ta xc nhn rng
CoQ10 gip khi phc s suy gim chc nng tim. Hn na, cc th nghim lm sng m i c
kim chng cho thy hiu qu ca Decaquinon trong vic ci thin cc triu chng ca suy tim
xung huyt c km theo s suy gim chc nng tm tht tri do thiu mu cc b tim mn tnh
hay bnh tim huyt p cao.
DC L LM SNG
Dc l hc :
Ci thin hiu qu s dng oxy trn c tim b thiu mu cc b :
Thc nghim dng c tm tht ca chut lang cho thy Ubidecarenone ci thin s suy gim
lc co c xy ra trong tnh trng thiu oxygen do tim truyn Tyrode, cng nh ci thin s suy
gim thi gian in th hot ng trong iu kin thiu oxygen.
Kch hot s tng hp ATP trong cc ty th ca t bo c tim :
Ubidecarenone iu chnh h s kim sot h hp v s tng hp ATP ty th t bo c tim b
thiu mu trong mt thc nghim trn ch. N cng ngn cn s gim tng hp ATP trong
thiu mu cc b v ti ti mu, v tng cng tng hp ATP trong mt thc nghim ti
mu khi s dng tim th v tim chut.
Ci thin s suy gim chc nng tim :

Trong mt thc nghim chut, Ubidecarenone c ch s gim thiu lc co bp c tim do

thiu mu cc b v ti ti mu, ng thi ci thin chc nng tim b suy.
Bo v c tim :
Ubidecarenone c tc dng chng oxy ha v lm bn mng t bo; n c tc dng hn ch tn
thng c tim gy ra do doxurobicin hydrochloride chut. N cng c ch s phng thch cc
enzym ca c tim vo mu, gy ra bi thiu mu cc b thc nghim ch.
Tc dng khng aldosterone :
Mt thc nghim chut chng t Ubidecarenone c ch s tit aldosterone v i khng
vi s lu gi Na+ do aldosterone gy ra, dn n s gia tng bi tit Na+ qua ng tiu. Tuy
nhin, Ubidecarenone khng c tc dng trn s bi tit K+.
Nghin cu lm sng :
Hiu qu lm sng :
Trong nhng nghin cu m i v cc nghin cu m, Decaquinon cho thy c hiu qu v
hu ch trong iu tr cc triu chng khch quan v ch quan (ph, xung huyt phi, gan ph
i v cc triu chng au tht ngc) lin quan n suy tim xung huyt trong bnh tim do thiu
mu, do huyt p cao hoc bnh thp tim.
Tc dng khng mong mun v nhng bin i tr s cn lm sng :
Trong s 5.350 bnh nhn iu tr vi Decaquinon, tc dng khng mong mun ch c ghi
nhn trn 78 bnh nhn (1,46%). Thng thng nht l kh chu d dy 21 ca (0,39%), chn n
13 ca (0,24%), bun nn 10 ca (0,19%), tiu chy 6 ca (0,11%), pht ban da 9 ca (0,17%).
Khng c bin i cc tr s sinh ha.
CH NH
Cc triu chng c lin quan n suy tim xung huyt nh v va nhng bnh nhn ang c
iu tr vi phc chun.
CHNG CH NH
n nay, khng c chng ch nh no i vi Decaquinon.
LC C THAI v LC NUI CON B
Kh nng sinh qui thai ca Decaquinon cha c ghi nhn. Trong lm sng, an ton ca
Decaquinon trong thi gian mang thai cha c xc nh.
TNG TC THUC
Cha c bo co no ghi nhn Decaquinon tng tc vi cc thuc khc mt cch ng k v
mt lm sng.
Tng k vin n n Decaquinon c bao ng v tnh tng k ca n cha c ghi nhn.
TC DNG NGOI
Trn h tiu ha :
Kh chu d dy, chn n, bun nn hoc tiu chy c th xy ra nhng khng thng xuyn.
Qu mn :

Nhng triu chng nh pht ban da c th xy ra nhng khng thng xuyn.

LIU LNG v CCH DNG
Liu thng thng i vi ngi ln l ung 1 vin (10 mg Ubidecarenone) x 3 ln/ngy sau cc
ba n chnh.
BO QUN
Do c tnh vt l{ (im nng chy ca hot cht khong 48oC), vin nn Decaquinon phi c
lu tr nhit phng, trnh nh sng v trnh m.

136.

DECOLGEN FORTE - DECOLGEN LIQUIDE

UNITED LABORATORIES
Vin nn : v 20 vin, hp 25 v - v 4 vin, hp 25 v.
Dung dch ung : chai 60 ml, 120 ml.
THNH PHN
cho 1 vin
Paractamol

500 mg

Phnylpropanolamine chlorhydrate

25 mg

Chlorphniramine malate

2 mg

ho 15 ml
Paractamol

300 mg

Phnylpropanolamine chlorhydrate

12,5 mg

Chlorphniramine malate

1 mg

(Alcool)
DC LC
Decolgen l mt thuc gim au, chng sung huyt v khng d ng.
- Parac tamol : c tc ng gim au v h st do lm gim s tng hp prostaglandine bng

cch c ch h thng men cyclooxygnase.

- Chlorph niramine mal ate : c tc ng khng histamine do c ch ln th th H1, nh ,
lm gim s tit nc mi v cht nhn ng h hp trn.
- Phnylpropanolamine : trc tip lm co mch mu mi v ng h hp trn, do lm
gim nght mi.
CH NH
iu tr cm cm, st, nhc u, s mi, nght mi, sung huyt mi, do d ng thi tit, vim
mi, vim xoang, vim thanh qun, au nhc c khp.
Lm gim nhng triu chng thng i theo cc bnh nhim trng ng h hp trn nh st,
nhc u, s mi, au hng, ho, cm gic kh chu, n lnh.
Lm gim ht hi v ngn chn cc d ng ng h hp.
CHNG CH NH
Mn cm vi mt trong cc thnh phn ca thuc.
Lin quan n paractamol : suy t bo gan.
Lin quan n thuc thn kinh giao cm : cao huyt p nng, thiu nng mch vnh nng.
CH PHNG
Lin quan n thuc thn kinh giao cm : ngng thuc trong trng hp nhp tim nhanh, hi
hp, bun nn.
THN TRNG LC DNG
Lin quan n thuc khng histamine : ngi iu khin phng tin giao thng v s dng
my mc cn lu { v nguy c b bun ng khi dng thuc.
Lin quan n thuc thn kinh giao cm : thn trng khi dng cho ngi b cao huyt p, bnh
mch vnh, cng gip, tiu ng, ngi ln tui v bnh nhn tm thn.
Lin quan n paractamol : theo di chc nng thn trong trng hp iu tr ko di hoc
suy thn.
TNG TC THUC
Lin quan n thuc thn kinh giao cm :
Khng nn phi hp :
- IMAO khng chn lc : c th gy cao huyt p.
- Guanthidine v cc thuc cng h : tng tc dng h huyt p.
Lin quan n phdrine :
Thn trng khi phi hp :
- Thuc m dn xut halogne : nu ca phu thut nm trong chng trnh, nn ngng iu tr
vi ngy trc khi can thip (do c th gy cao huyt p kch pht trong phu thut).
Lin quan n thuc khng histamine :
Khng nn phi hp :
- Alcool : ru lm tng tc dng an thn. Vic gim s tp trung c th gy hu qu nng nht

l i vi ngi li xe v ang iu khin my mc.

TC DNG NGOI
Lin quan n thuc khng histamine :
- tc dng atropinique : kh ming, ri lon iu tit, b tiu, l ln ngi ln tui hoc hng
phn tr em ;
- bun ng.
Lin quan n thuc thn kinh giao cm : kh ming, hi hp, lo u, kch thch, mt ng, nhc
u, v m hi.
Lin quan n paractamol : d ng ; him gp : gim tiu cu.
Tuy nhin liu iu tr, thuc thng c dung np rt tt.
LIU LNG v CCH DNG
n Dng vin :
Ngi ln : 1 n 2 vin, 3 n 4 ln/ngy.
Tr em :
p t 7 n 12 tui :1/2 n 1 vin, 3 n 4 ln/ngy.
p t 2 n 6 tui :1/2 vin, 3 n 4 ln/ngy ty theo tui.
n Dng dung dch :
Ngi ln : 2 mung canh, 3 n 4 ln/ngy.
Tr em :
p t 7 n 12 tui :1 mung canh, 3 n 4 ln/ngy.
p t 2 n 6 tui :1 n 2 mung caf , 3 n 4 ln/ngy.
Tr cn b : 1/2 n 1 mung caf , 3 n 4 ln/ngy.
QU LIU
Dng qu liu vi lng ln paractamol c th gy c tnh trn gan mt vi bnh nhn. c
tnh trm trng hay kh nng gy t vong rt him gp tr em do s khc bit trong chuyn
ha paractamol so vi ngi ln. Nu ung nhiu hn 150 mg/kg hay mt lng khng bit
r, nng trong huyt tng ca parac tamol t c 4 gi ngay sau khi ung. Gy nn
bng xir Ipca. Nn p dng phng php iu tr vi actylcysteine. Nn h tr h hp lin
tc cho n khi bnh nhn c a vo nhp vin.

137.

DECOLSIN

UNITED LABORATORIES
Vin nang : v 4 vin, hp 25 v.
THNH PHN
cho 1 vin
Dextromthorphane bromhydrate

10 mg

Phnylpropanolamine chlorhydrate

25 mg

Chlorphnamine malate

1 mg

Guaifnsine

50 mg

Paractamol

325 mg

DC LC
Lm gim ho, chng sung huyt mi, khng histamine, long m, gim au, h st.
CH NH
iu tr cc triu chng i km theo cm lnh hay cm nh ho, nght mi, nhc u, st v kh
chu.
THN TRNG LC DNG
Cn thn trng khi dng cho bnh nhn suy thn hay suy gan, bnh mch mu no, cao huyt
p, tiu ng, cng gip.
LC C THAI v LC NUI CON B
Nh nhiu loi thuc khc, vic dng thuc lc c thai v lc cho con b i hi phi cn nhc
gia li ch tr liu vi cc nguy c c th xy ra.
TNG TC THUC
Tng tc dng lm du thn kinh ca cc thuc c ch thn kinh trung ng, thuc khng
cholinergique nh atropine v cc thuc chng trm cm loi ba vng.
TC DNG NGOI
Tc dng an thn ca thuc thay i t ngy ngt n ng su nhng c th mt i sau vi
ngy.
LIU LNG v CCH DNG
Ngi ln : 3-4 ln/ngy, mi ln ung 1 vin hoc theo s hng dn ca bc s.

138.

DCONTRACTYL

SANOFI SYNTHELABO VIETNAM

vin bao 250 mg : hp 50 vin.
THNH PHN
cho 1 vin
Mphnsine

0,25 g

(Saccharose)

(118 mg)

DC LC
Thuc th gin c c tc ng trung ng.
DC NG HC
Sau khi ung, m ph n sine c hp thu nhanh. Nng ti a trong mu t c sau 1 gi.
Thi gian bn thi l 3/4 gi. M ph n sine c chuyn ha mnh v c o thi ch yu
qua nc tiu.
CH NH
c ngh iu tr h tr cc co tht c gy au trong :
- Cc bnh l{ thoi ha t sng v cc ri lon t th ct sng : vo c, au lng, au tht
lng.
- Cc tnh trng co tht.
CHNG CH NH
Qu mn cm vi cc thnh phn ca thuc.
Ri lon chuyn ha porphyrine.
CH PHNG v THN TRNG LC DNG
Do trong thnh phn t dc ca thuc c tartrazine, trnh dng cho bnh nhn b nhy cm
vi tartrazine v/hoc acide actylsalicylique do c th b d ng cho gia tartrazine v
aspirine.
Cc tc dng ngoi c lin quan thuc thng s nng ln khi dng ng thi vi ru v cc
thuc c ch thn kinh trung ng.
Li xe v iu khin my mc : cn lu { do thuc c th gy bun ng.
LC C THAI v LC NUI CON B
Lc c thai :
Khng nn dng thuc ny trong thi gian mang thai.
Lc nui con b :
Khng nn dng thuc ny trong thi gian cho con b.

TC DNG NGOI
Mt vi trng hp ngoi l c ghi nhn c gy sc phn v.
Him khi b bun ng, bun nn, nn, d ng da.
LIU LNG v CCH DNG
Dng cho ngi ln v tr em trn 15 tui.
Mi ln ung 2 n 4 vin, 3 ln mi ngy (ng vi 6 n 12 vin 250 mg mi ngy), ung vi
mt cht nc.
QU LIU
Triu chng : gim trng lc c, h huyt p, ri lon th gic, khng phi hp c ng tc,
lit h hp.
Cp cu : chuyn ngay n bnh vin v iu tr triu chng.

139.

DECTANCYL 0,5%

HOECHST-MARION-ROUSSEL
[AVENTIS PHARMA]
Hn dch tim 5 mg/ml : l a liu 3 ml - Bng B.
THNH PHN
cho 3 ml
Dexamthasone actate

15 mg

(Alcool benzylique)
DC LC
Corticoide tng hp ch yu c dng do tc dng chng vim. Vi liu cao gy gim p ng
min dch. Tc dng chuyn ha v gi mui ca dexamthasone thp hn so vi
hydrocortisone.
DC NG HC
Dexam thasone ac tate c bo ch di dng hn dch lm cho thuc c tc ng ko di.
CH NH
Cc bnh l cn mt nng corticoide cao ti ch.
Thp hc :
- Tim trong khp : vim khp, thoi ha khp ang bc pht.

- Tim quanh khp : vim gn, vim bao hot dch.

- Tim vo cc phn mm : au gt, hi chng knh c tay, bnh Dupuytren.
- Tim ngoi mng cng : au r thn kinh.
- Tim trong mng cng : au r thn kinh khng p ng vi cc tr liu khc (tim ngoi mng
cng) hoc trong khi chc d ty sng xt nghim dch no ty.
Da liu :
- So li.
Ung bu :
- Tim trong mng cng : vim mng no do bnh bch huyt hay ung bu.
Nhn khoa :
- Tim quanh nhn cu trong mt s bnh vim phn trc nhn cu k c mng mch nho
trung gian.
Tai mi hng :
- Tim ra trong xoang : vim xoang bn cp v mn cn thot dch.
CHNG CH NH
Tuyt i :
- Nhim trng ti ch hoc ton thn, hoc nghi ng c nhim trng.
- Ri lon ng mu nng, ang tr liu chng ng.
- Tng cm vi mt trong cc thnh phn ca thuc.
CH PHNG v THN TRNG LC DNG
Ch { phng :
Do thuc c kh nng khuch tn vo ng ton thn, phi ch { n mt s chng ch nh
ca corticoide ng ton thn, nht l khi tim nhiu im cng lc hay tim lp i lp li
trong thi gian ngn :
- Mt s bnh siu vi ang tin trin (nh vim gan, herpes, thy u, zona).
- Lon tm thn cha kim sot c bng tr liu.
- Vaccin sng.
Liu php corticoide c th to iu kin cho cc bin chng nhim trng khc nhau.
Tim nhiu im hoc tim lp i lp li trong thi gian ngn c th gy ra nhng triu chng
lm sng v sinh hc ca chng tng nng v thng thn (hypercorticism).
Cc vn ng vin cn c thng bo l thuc c th gy phn ng dng tnh gi trong cc
xt nghim kim tra chng dng thuc kch thch tng th lc.
Thn trng lc dng :
- Phi tn trng nguyn tc v trng nghim ngt khi tim thuc.
- C th gy mt qun bnh ca bnh tiu ng, lon tm thn, cao huyt p nng.
- Cn thn khi tim cho nhng bnh nhn c nguy c nhim trng, nht l bnh nhn thm
phn hay c mang cc b phn gi.

- Khng c tim vo gn.

LC C THAI v LC NUI CON B
Lc c thai :
Ch khi no tim nhiu im cng lc hoc tim lp i lp li trong thi gian ngn mi c nguy
c ging nh corticoide dng ng ton thn : thai c th chm pht trin nh. Hn hu c
th c suy thng thn khi tr sinh ra nu dng liu cao.
Lc nui con b :
Trong trng hp dng liu cao, nn ngng cho con b.
TNG TC THUC
Kh nng tng tc gia cc corticoide tim ti ch vi cc thuc khc rt t khi xy ra trong cc
iu kin thng dng. Ch khi tim nhiu im cng lc hoc tim lp i lp li trong thi gian
ngn mi cn quan tm n tng tc vi cc thuc khc.
TC DNG NGOI
Cc tc dng ngoi ton thn rt t khi xy ra khi dng corticoide ti ch do nng trong
mu thp, tuy nhin kh nng tng nng tuyn thng thn (gi nc v mui, mt qun bnh
bnh tiu ng v bnh cao huyt p...) tng theo liu lng v s ln tim.
- Nguy c nhim trng ti ch (ty theo ni tim) : vim khp, vim mng no.
- Teo khu tr m c, m di da v m da. Nguy c t gn nu tim nhm vo gn.
- Vim khp cp do vi tinh th xut hin sm.
- Vi ha ti ch.
- Phn ng d ng ti ch v ton thn.
- Nng bng mt : nhc u v cc cn nng bng vn mch c th xy ra v thng t khi
trong vng mt hai ngy.
LIU LNG v CCH DNG
0,75 mg dexamthasone = 5 mg prednisone.
Dng tim ti ch.
Lc k trc khi dng.
Liu thng dng : 1/4 n 2 ml ty ni tim v ty bnh.
Ch c lp li nu cc triu chng xut hin tr li hay cha khi.
Dng thuc ny khng ph hp cho phun m qua ng h hp.
QU LIU
C th xy ra cc du hiu ca liu php corticoide ng ton thn.
Du hiu :
- lm sng : tng cn, b o ph, teo c, ri lon tiu ha, long xng, cao huyt p, rm lng,
ban xut huyt, mn trng c ;
- thn kinh-tm thn : hay cu gt, bn chn ;
- ni tit v chuyn ha : hi chng Cushing do thuc, ngng tng trng tr em ;

- sinh hc : ng niu, tng ng huyt, h kali huyt.

X tr : gim liu, ngng thuc nu c th bng cch gim liu t t hoc tt nht l iu tr xen
k.

140.

DEEP HEAT RUB PLUS

CT TNHH ROHTO - MENTHOLATUM (VIT NAM)

Kem dng ngoi : tup 30 g.
THNH PHN
cho 1 g
Methyl Salicylate

120 mg

l-Menthol

60 mg

Tinh du Khuynh Dip

20 mg

Tinh du Thng

15 mg

DC LC
Thuc c tc dng gim au tn gc, hiu qu nhanh.
Thoa kem ln ch au v xoa bp k. Nhng hot cht ca thuc s thm nhanh n tn gc v
lm dt cn au. Xoa bp bng kem Deep Heat Rub Plus s cho hiu qu khng vim gim au
rt tt.
c tnh :
Hiu qu khng vim mnh v sc thm thu nhanh :
Hai hot cht Methyl Salicylate v l-Menthol c trong cng thc ca kem Deep Heat Rub Plus
c hp th qua da rt d dng.
Vic thm thu nhanh ln vng b au v tng tun hon mu, gip gim ngay cn au v cng
c.
Kem thm u trn da v to cm gic tht d chu ngay khi dng :
Deep Heat Rub Plus l mt loi kem c tnh kim. Kem c th thm u trn nhng vng da
nhiu lng nh da tay v da chn. Sau khi thoa s cho cm gic tht d chu v hiu qu ny ko
di rt lu.
Nhng ngi c triu chng sau y nn dng kem thoa da gim au :

- au v mi c sau cc hot ng th dc th thao, hoc ngi gi.

- au lng hay au cng vai trong cng vic hoc vic nh.
- au khp khuu tay, u gi v mt c chn.
- au dy thn kinh hay thp khp.
CH NH
au c, au lng, au khp, cng vai, mi c, au dy thn kinh, vt bm, bong gn, cng c,
thp khp.
CHNG CH NH
- Khng thoa thuc chung quanh mt v nim mc mt.
- Khng thoa thuc ln vng da b chm, nhim c hay vt thng.
- Cn thn trng khi ch nh cho bnh nhn c tin cn d ng vi thuc hay m phm nh :
sn, nga, nhim c da...
THN TRNG LC DNG
- Khng thoa qu liu.
- i vi tr em, ch s dng thuc di s gim st ca ngi ln.
- Trnh thoa ln mt. Nu xy ra tnh trng trn, ra k vi nc hay nc m.
- Ch dng ngoi da, khng c ung.
- Ngng dng nu sau khi s dng thuc ny m b sn, nga, kch ng (au, nng v lo t),
sng hoc bong da nh nhng mng m hoi t.
LIU LNG v CCH DNG
Thoa lng kem va ln ch au nhiu ln trong ngy.
BO QUN
- thuc ngoi tm tay tr em.
- y cht np tup thuc sau khi s dng v ni mt, trnh nh nng trc tip.
- trnh s dng nhm ln v bo qun cht lng, khng chuyn thuc ny qua mt vt
ng khc.
- Khng s dng thuc qu hn (in trn np hp).

141.

DPAKINE

SANOFI SYNTHELABO VIETNAM

Dung dch ung 200 mg/ml : chai 40 ml.
Sir 200 mg/mung lng : chai 150 ml.
Vin nn bao tan trong rut 200 mg : hp 40 vin.
Vin nn bao tan trong rut 500 mg : hp 40 vin.
THNH PHN
cho 1 ml dung dch ung
Valproate sodium

200 mg

cho 1 mung lng xir

Valproate sodium

200 mg

cho 1 vin nn bao tan trong rut

Valproate sodium

200 mg

cho 1 vin nn bao tan trong rut

Valproate sodium

500 mg

DC LC
Thuc chng ng kinh, c tc dng ch yu trn h thng thn kinh trung ng.
Thc nghim v lm sng cho thy c 2 kiu tc dng chng co git :
- Tc dng trc tip lin quan n nng valproate trong huyt tng v trong no.
- Tc dng gin tip thng qua cc cht chuyn ha ca valproate trong no bng cch tc ng
ln cc cht trung gian dn truyn thn kinh hoc tc dng trc tip trn mng t bo.
Gi thuyt thng c chp nhn nht l gi thuyt v GABA (g-amino butyric acide) theo
c hin tng tng t l GABA sau khi dng valproate sodium. Valproate lm gim cc giai on
trung gian ca gic ng cng vi s gia tng gic ng chm.
DC NG HC
- Kh dng sinh hc t gn 100% sau khi ung.
- Phn b ch yu trong mu v dch ngoi bo.

- T1/2 : 15-17 gi, thi tr ch yu qua nc tiu sau khi c chuyn ha ti gan qua hin
tng glucurono kt hp v beta oxy ha.
- Nng ti thiu trong huyt thanh t hiu qu iu tr : 40-100 mg/l.
- Gn vo protine ph thuc liu lng v bo ha ca thuc.
- Valproate khng gy ra hin tng cm ng men trong h thng chuyn ha ca cytochrome
P450.
CH NH
ng kinh ton th hay tng phn :
- ton th nguyn pht :
- cn vng thc (cn nh),
- rung git tng trng lc (cn ln),
- rung git c,
- mt trng lc,
- phi hp,
- tng phn : vi triu chng n gin hay phc tp,
- th pht ton th ha,
- cc th hn hp.
Co git do st cao tr em : tr nh nhi hay tr nh c nguy c cao v c t nht mt cn co
git.
Tic tr em.
CHNG CH NH
- Vim gan cp.
- Vim gan mn.
- Tin s gia nh c vim gan nng, nht l vim gan do thuc.
- Qu mn vi valproate sodium.
- Porphyria.
CH PHNG
Bnh gan :
iu kin xy ra :
c nhng bo co him hoi v nhng tn thng gan tin trin nng, i khi gy t vong.
Tr s sinh v tr nh hn 3 tui c iu tr a liu php c bnh ng kinh nng v nht l
mt ng kinh kt hp vi cc sang thng no, chm pht trin tm thn v/hay mt bnh
chuyn ha hay thoi ha c ngun gc di truyn, l nhng bnh nhn c nhiu nguy c. Trn 3
tui nguy c xy ra bnh gan gim c { ngha.
Trong a s trng hp, cc tn thng gan ny thng gp trong vng 6 thng u iu tr.
Du hiu gi :
Chn on sm da ch yu vo lm sng. C 2 kiu biu hin c th xut hin trc khi vng

da :
- cc du hiu ton thn khng c hiu, xut hin t ngt nh mt nhc, chn n, r, ngy
ngt, i khi km vi i ma v au bng,
- ti xut hin nhng cn ng kinh.
Cn phi thng bo cho bnh nhn hay ngi nh ca bnh nhi bit v khi xut hin mt bnh
cnh nh vy phi a ngay bnh nhn n bnh vin, bnh nhn cn c khm v lm ngay
cc xt nghim chc nng gan.
Pht hin :
Trong 6 thng u iu tr, vic theo di chc nng gan phi c thc hin nh kz trong
cc xt nghim phn nh s tng hp protine v nht l t l prothrombine l c gi tr nht.
Khi t l prothrombine h thp bt thng, nht l khi c km vi nhng bt thng sinh hc
khc nh gim fibrinogne v cc yu t ng mu, tng bilirubine v cc men transaminase th
phi ngng iu tr Dpakine ngay (k c khi c iu tr km vi cc dn xut salicyls do c
cng con ng chuyn ha).
THN TRNG LC DNG
- Thc hin vic kim tra sinh ha v chc nng gan trc khi khi u iu tr v theo di nh
kz trong 6 thng c bit l nhng bnh nhn c nguy c cao.
- Cng ging nh a s cc thuc chng ng kinh khc, nht l lc bt u iu tr, ngi ta
thy c tng tm thi v ring l ca cc men transaminase m khng c biu hin lm sng
no. Trong trng hp ny nn thc hin mt tng k sinh hc y (c bit l t l
prothrombine), chnh li liu dng, v lm li cc xt nghim ty theo kt qu ca cc thng s
sinh hc.
- tr di 3 tui, ch nn dng Dpakine n liu php khi nh gi li ch iu tr so vi
nguy c b bnh gan.
- Xt nghim mu (cng thc mu bao gm c m tiu cu, thi gian mu chy v xt nghim
ng mu ton b) cn c thc hin trc khi iu tr, cng nh trc phu thut hay trong
trng hp c vt bm mu hoc chy mu t pht.
- Trong trng hp suy thn, cn lu { n s gia tng nng acide valproique t do trong
huyt thanh v khi phi gim liu.
- Khi c hi chng au bng cp, cn nh lng amylase mu trc khi ngh n phu thut v
c bo co v nhng trng hp him hoi b vim ty cp.
- tr em nn trnh ghi toa ng thi vi cc dn xut salicylate.
- Nn cn nhc li ch/nguy c khi dng valproate cho bnh nhn b lupus ban ri rc.
LC C THAI
Nguy c lin quan n bnh ng kinh v thuc chng ng kinh :
Ngi ta nhn thy nhng ngi m c iu tr bng thuc chng ng kinh s sinh con
vi t l d dng t 2 n 3 ln cao hn t l d dng trong dn s chung (3%). Tuy nhin, mc

d c s gia tng t l tr d dng khi dng a liu php, nhng mi tng quan gia bnh v
iu tr vn khng c g r rng gii thch s gia tng ny. Cc d dng thng gp l st mi
h hm ch v nhng d dng v tim mch.
Vic ngng t ngt mt iu tr chng ng kinh ngi m c th lm bnh nng hn t
gy nguy hi cho con.
Nguy c lin quan n valproate :
sc vt : thuc c th gy sinh qui thai chut, mo, th.
ngi : nguy c b d dng khi dng thuc trong 3 thng u khng cao hn cc thuc chng
ng kinh khc. Da trn nhng nghin cu ring r, valproate dng nh gy ra nhng bt
thng v ng ng thn kinh, thot v mng no ty, gai sng tch i... l nhng d dng c
th pht hin trc khi sinh, vi tn sut l 1%.
T nhng d liu nu trn :
- Khi mun c thai, phi cn nhc li ch nh iu tr thuc chng ng kinh, nn b sung thm
acide folique.
- Trong lc mang thai, khng c ngng thuc chng ng kinh ang c hiu qu. Nn dng
n liu php, dng liu thp nht c hiu qu v chia lm nhiu ln trong ngy.
Phi c bit theo di trc khi sinh pht hin nhng bt thng ca ng thn kinh.
LC NUI CON B
Thuc c th vo c sa m vi nng thp (1-10% nng trong mu), nhng cho ti nay
nhng tr b m c theo di vn khng thy c biu hin lm sng no.
TNG TC THUC
nh hng ca valproate ln cc thuc khc :
- Cc thuc an thn kinh, c ch MAO, chng trm cm : D pakine lm tng hiu qu cc thuc
trn, do phi gim liu cc thuc ny khi cn.
- Phnobarbital : D pakine lm tng nng phnobarbital. Cn theo di lm sng trong 15
ngy u phi hp thuc v gim liu phnobarbital khi c triu chng an thn.
- Primidone : D pakine lm tng nng ca primidone v lm tng tc dng ph ca n. Theo
di lm sng v chnh liu khi cn.
- Ph nytoine : D pakine lm tng nng phnytoine ton phn trong huyt tng v
phnytoine t do.
- Lamotrigine : Dpakine lm gim chuyn ha lamotrigine, do vy cn phi chnh liu.
nh hng ca cc thuc khc ln Dpakine :
- Phnobarbital, phnytoine, carbamazpine lm gim nng ca valproate do phi gim
liu theo nng trong huyt tng khi iu tr phi hp.
- M floquine lm tng chuyn ha Dpakine v c tc dng gy ng kinh.
- Khi dng phi hp valproate vi cc cht gn kt protine mnh nh aspirine s lm tng
nng valproate t do.

- Nng valproate tng (do lm gim chuyn ha ti gan) khi dng phi hp vi
rythromycine hoc cimtidine.
TC DNG NGOI
- Bnh gan : (xem Ch { phng).
- Nguy c gy qui thai.
- c nhng trng hp him hoi b vim ty c bo co.
- Trng thi l ln v co git : vi trng hp c trng thi sng s ring bit hay i km vi s
xut hin tr li cc cn ng kinh, s gim khi ngng iu tr hay gim liu. Hin tng ny
thng xy ra khi dng a liu php hay tng liu t ngt.
- Mt s bnh nhn, khi khi u iu tr, c nhng ri lon tiu ha nh : bun nn, au d
dy, mt sau vi ngy iu tr m khng cn phi ngng thuc.
- Mt vi tc dng ph thong qua v ph thuc liu : rng tc, run ry vi bin nh, gim
tiu cu, tng ammoniaque mu m khng c s thay i cc xt nghim sinh ha v gan.
- Vi trng hp c hin tng gim ring r fibrinogne, ko di thi gian chy mu m
thng khng c biu hin trn lm sng.
- Gim tiu cu, c vi trng hp thiu mu, gim bch cu hay gim c 3 dng mu.
- Tng cn, mt kinh hay kinh nguyt khng u.
LIU LNG v CCH DNG
Liu hng ngy thay i ty theo tui v cn nng ca tng bnh nhn. Liu ti u c xc
nh da vo p ng ca bnh nhn trn lm sng. o nng acide valproique trong huyt
tng gp phn theo di trn lm sng nht l trong trng hp khng kim sot c cn
ng kinh hay nghi ng c tc dng ngai . Nng hiu qu trong huyt thanh trong khong
40-100 mg/l (300-700 mmol/l).
Khi u iu tr :
- Khi bnh nhn cha c iu tr bng mt thuc chng ng kinh khc, liu dng khi u l
liu thp v tng dn ln mi 2-3 ngy t c liu ti a trong 1 tun.
- Khi bnh nhn c iu tr bng thuc khc trc , vic thay i thuc phi c thc
hin t t. Liu Dpakine ti u s t c trong khong 2 tun, trong khi thuc c s c
gim dn trc khi ngng hn.
- C th phi hp vi cc thuc chng ng kinh khc khi cn.
Liu dng :
- Liu khi u thng l 10-15 mg/kg/ngy v tng dn n liu ti u. Liu ti u khong 2030 mg/kg/ngy. Tuy nhin, nu khng kim sot c cn ng kinh vi liu ny, th c th
tng liu ln n trn 50 mg/kg v bnh nhn phi c theo di cn thn.
Tr em : liu thng thng l 30 mg/kg/ngy.
Ngi gi : dc ng hc ca D pakine c thay i, do vy liu c iu chnh da vo vic
kim sot c cn hay khng.

Cch dng :
Vin nn bao tan trong rut, xir hay dung dch ung, ung ngy 2 ln.
QU LIU
Triu chng : hn m nh n su, gim trng lc c, gim phn x, ng t co nh, gim t
ch h hp.
X tr : ra d dy, gy li tiu thm thu, kim sot tim mch, h hp. Chy thn nhn to hay
thay mu khi nng.
Tin lng ni chung thun li.

142.

DPAKINE CHRONO

SANOFI SYNTHELABO VIETNAM

vin nn b c hp 30 vin.
THNH PHN
cho 1 vin
Acide valproique

145 mg

Valproate sodium

333 mg

tng ng : Valproate sodium

500 mg

DC LC
Thuc chng ng kinh, c tc dng ch yu trn h thng thn kinh trung ng.
Thc nghim v lm sng cho thy c 2 kiu tc dng chng co git :
- Tc dng trc tip lin quan n nng valproate trong huyt tng v trong no.
- Tc dng gin tip thng qua cc cht chuyn ha ca valproate trong no bng cch tc ng
ln cc cht trung gian dn truyn thn kinh hoc tc dng trc tip trn mng t bo.
Gi thuyt thng c chp nhn nht l gi thuyt v GABA (g-amino butyric acide) theo
c hin tng tng t l GABA sau khi dng valproate sodium. Valproate lm gim cc giai on
trung gian ca gic ng cng vi s gia tng gic ng chm.
DC NG HC
So vi vin bao tan trong rut, D pakine Chrono c u im :
- Khng c thi gian ch tc dng sau khi ung.
- Hp thu tt hn.

- Kh dng sinh hc tng ng vin bao tan.

- Nng nh trong huyt tng thp hn (Cmax gim 25%, nhng gi n nh dng bnh
nguyn ko di t 4 n 14 gi sau khi dng thuc). Do vic h thp nng nh, nng
acide valproique n nh v phn b ng nht c ngy ln m : nu ung cng mt liu 2 ln
mt ngy, s dao ng nng s gim i mt na.
- Nng huyt thanh (ton phn v t do) tng theo liu (tng quan tuyn tnh).
CH NH
ng kinh ton th hay tng phn :
- ton th nguyn pht :
- cn vng thc (cn nh),
- rung git tng trng lc (cn ln),
- rung git c,
- mt trng lc,
- phi hp,
- tng phn : vi triu chng n gin hay phc tp,
- th pht ton th ha,
- cc th hn hp.
Co git do st cao tr em : tr nh nhi hay tr nh c nguy c cao v c t nht mt cn co
git.
Tic tr em.
CHNG CH NH
- Vim gan cp.
- Vim gan mn.
- Tin s gia nh c vim gan nng, nht l vim gan do thuc.
- Qu mn vi valproate sodium.
- Porphyria.
CH PHNG
Bnh gan :
iu kin xy ra :
c nhng bo co him hoi v nhng tn thng gan tin trin nng, i khi gy t vong.
Tr s sinh v tr nh hn 3 tui c iu tr a liu php c bnh ng kinh nng v nht l
mt ng kinh kt hp vi cc sang thng no, chm pht trin tm thn v/hay mt bnh
chuyn ha hay thoi ha c ngun gc di truyn, l nhng bnh nhn c nhiu nguy c. Trn 3
tui nguy c xy ra bnh gan gim c { ngha.
Trong a s trng hp, cc tn thng gan ny thng gp trong vng 6 thng u iu tr.
Du hiu gi :
Chn on sm da ch yu vo lm sng. C 2 kiu biu hin c th xut hin trc khi vng

da :
- cc du hiu ton thn khng c hiu, xut hin t ngt nh mt nhc, chn n, r, ngy
ngt, i khi km vi i ma v au bng,
- ti xut hin nhng cn ng kinh.
Cn phi thng bo cho bnh nhn hay ngi nh ca bnh nhi bit v khi xut hin mt bnh
cnh nh vy phi a ngay bnh nhn n bnh vin, bnh nhn cn c khm v lm ngay
cc xt nghim chc nng gan.
Pht hin :
Trong 6 thng u iu tr, vic theo di chc nng gan phi c thc hin nh kz trong
cc xt nghim phn nh s tng hp protine v nht l t l prothrombine l c gi tr nht.
Khi t l prothrombine h thp bt thng, nht l khi c km vi nhng bt thng sinh hc
khc nh gim fibrinogne v cc yu t ng mu, tng bilirubine v cc men transaminase th
phi ngng iu tr Dpakine ngay (k c khi c iu tr km vi cc dn xut salicyls do c
cng con ng chuyn ha).
THN TRNG LC DNG
- Thc hin vic kim tra sinh ha v chc nng gan trc khi khi u iu tr v theo di nh
kz trong 6 thng c bit l nhng bnh nhn c nguy c cao.
- Cng ging nh a s cc thuc chng ng kinh khc, nht l lc bt u iu tr, ngi ta
thy c tng tm thi v ring l ca cc men transaminase m khng c biu hin lm sng
no. Trong trng hp ny nn thc hin mt tng k sinh hc y (c bit l t l
prothrombine), chnh li liu dng, v lm li cc xt nghim ty theo kt qu ca cc thng s
sinh hc.
- tr di 3 tui, ch nn dng D pakine n liu php khi nh gi li ch iu tr so vi
nguy c b bnh gan.
- Xt nghim mu (cng thc mu bao gm c m tiu cu, thi gian mu chy v xt nghim
ng mu ton b) cn c thc hin trc khi iu tr, cng nh trc phu thut hay trong
trng hp c vt bm mu hoc chy mu t pht.
- Trong trng hp suy thn, cn lu { n s gia tng nng acide valproique t do trong
huyt thanh v khi phi gim liu.
- Khi c hi chng au bng cp, cn nh lng amylase mu trc khi ngh n phu thut v
c bo co v nhng trng hp him hoi b vim ty cp.
- tr em nn trnh ghi toa ng thi vi cc dn xut salicylate.
- Nn cn nhc li ch/nguy c khi dng valproate cho bnh nhn b lupus ban ri rc.
LC C THAI
Nguy c lin quan n bnh ng kinh v thuc chng ng kinh :
Ngi ta nhn thy nhng ngi m c iu tr bng thuc chng ng kinh s sinh con
vi t l d dng t 2 n 3 ln cao hn t l d dng trong dn s chung (3%). Tuy nhin, mc

d c s gia tng t l tr d dng khi dng a liu php, nhng mi tng quan gia bnh v
iu tr vn khng c g r rng gii thch s gia tng ny. Cc d dng thng gp l st mi
h hm ch v nhng d dng v tim mch.
Vic ngng t ngt mt iu tr chng ng kinh ngi m c th lm bnh nng hn t
gy nguy hi cho con.
Nguy c lin quan n valproate :
sc vt : thuc c th gy sinh qui thai chut, mo, th.
ngi : nguy c b d dng khi dng thuc trong 3 thng u khng cao hn cc thuc chng
ng kinh khc. Da trn nhng nghin cu ring r, valproate dng nh gy ra nhng bt
thng v ng ng thn kinh, thot v mng no ty, gai sng tch i... l nhng d dng c
th pht hin trc khi sinh, vi tn sut l 1%.
T nhng d liu nu trn :
- Khi mun c thai, phi cn nhc li ch nh iu tr thuc chng ng kinh, nn b sung thm
acide folique.
- Trong lc mang thai, khng c ngng thuc chng ng kinh ang c hiu qu. Nn dng
n liu php, dng liu thp nht c hiu qu v chia lm nhiu ln trong ngy.
Phi c bit theo di trc khi sinh pht hin nhng bt thng ca ng thn kinh.
LC NUI CON B
Thuc c th vo c sa m vi nng thp (1-10% nng trong mu), nhng cho ti nay
nhng tr b m c theo di vn khng thy c biu hin lm sng no.
TNG TC THUC
nh hng ca valproate ln cc thuc khc :
- Cc thuc an thn kinh, c ch MAO, chng trm cm : D pakine lm tng hiu qu cc thuc
trn, do phi gim liu cc thuc ny khi cn.
- Ph nobarbital : D pakine lm tng nng phnobarbital. Cn theo di lm sng trong 15
ngy u phi hp thuc v gim liu phnobarbital khi c triu chng an thn.
- Primidone : D pakine lm tng nng ca primidone v lm tng tc dng ph ca n. Theo
di lm sng v chnh liu khi cn.
- Ph nytoine : D pakine lm tng nng phnytoine ton phn trong huyt tng v
phnytoine t do.
- Lamotrigine : Dpakine lm gim chuyn ha lamotrigine, do vy cn phi chnh liu.
nh hng ca cc thuc khc ln Dpakine :
- Phnobarbital, phnytoine, carbamazpine lm gim nng ca valproate do phi gim
liu theo nng trong huyt tng khi iu tr phi hp.
- M floquine lm tng chuyn ha Dpakine v c tc dng gy ng kinh.
- Khi dng phi hp valproate vi cc cht gn kt protine mnh nh aspirine s lm tng
nng valproate t do.

- Nng valproate tng (do lm gim chuyn ha ti gan) khi dng phi hp vi
rythromycine hoc cimtidine.
TC DNG NGOI
- Bnh gan : (xem Ch { phng).
- Nguy c gy qui thai.
- c nhng trng hp him hoi b vim ty c bo co.
- Trng thi l ln v co git : vi trng hp c trng thi sng s ring bit hay i km vi s
xut hin tr li cc cn ng kinh, s gim khi ngng iu tr hay gim liu. Hin tng ny
thng xy ra khi dng a liu php hay tng liu t ngt.
- Mt s bnh nhn, khi khi u iu tr, c nhng ri lon tiu ha nh : bun nn, au d
dy, mt sau vi ngy iu tr m khng cn phi ngng thuc.
- Mt vi tc dng ph thong qua v ph thuc liu : rng tc, run ry vi bin nh, gim
tiu cu, tng ammoniaque mu m khng c s thay i cc xt nghim sinh ha v gan.
- Vi trng hp c hin tng gim ring r fibrinogne, ko di thi gian chy mu m
thng khng c biu hin trn lm sng.
- Gim tiu cu, c vi trng hp thiu mu, gim bch cu hay gim c 3 dng mu.
- Tng cn, mt kinh hay kinh nguyt khng u.
LIU LNG v CCH DNG
Liu hng ngy thay i ty theo tui v cn nng ca tng bnh nhn. Liu ti u c xc
nh da vo p ng ca bnh nhn trn lm sng. o nng acide valproique trong huyt
tng gp phn theo di trn lm sng nht l trong trng hp khng kim sot c cn
ng kinh hay nghi ng c tc dng ngai . Nng hiu qu trong huyt thanh trong khong
40-100 mg/l (300-700 mmol/l).
Khi u iu tr :
- Khi bnh nhn cha c iu tr bng mt thuc chng ng kinh khc, liu dng khi u l
liu thp v tng dn ln mi 2-3 ngy t c liu ti a trong 1 tun.
- Khi bnh nhn c iu tr bng thuc khc trc , vic thay i thuc phi c thc
hin t t. Liu Dpakine ti u s t c trong khong 2 tun, trong khi thuc c s c
gim dn trc khi ngng hn.
- C th phi hp vi cc thuc chng ng kinh khc khi cn.
Liu dng :
- Liu khi u thng l 10-15 mg/kg/ngy v tng dn n liu ti u. Liu ti u khong 2030 mg/kg/ngy. Tuy nhin, nu khng kim sot c cn ng kinh vi liu ny, th c th
tng liu ln n trn 50 mg/kg v bnh nhn phi c theo di cn thn.
Tr em : liu thng thng l 30 mg/kg/ngy.
Ngi gi : dc ng hc ca D pakine c thay i, do vy liu c iu chnh da vo vic
kim sot c cn hay khng.

Cch dng :
Dpakine Chrono c th ung ngy 1 ln m khng cn chia liu.
Dpakine Chrono c th dng cho tr em, nu liu thch hp vi mc ch iu tr.
QU LIU
Triu chng : hn m nh n su, gim trng lc c, gim phn x, ng t co nh, gim t
ch h hp.
X tr : ra d dy, gy li tiu thm thu, kim sot tim mch, h hp. Chy thn nhn to hay
thay mu khi nng.
Tin lng ni chung thun li.

143.

DEPAMIDE

SANOFI SYNTHELABO VIETNAM

Vin bao tan trong rut 300 mg : hp 30 vin - Bng B.
THNH PHN
cho 1 vin
Valpromide

300 mg

DC LC
Valproate tc dng ch yu trn thn kinh trung ng :
- Tc dng an thn.
- Chng ng kinh.
- iu ha kh sc.
DC NG HC
Nng huyt tng ti a t sau khi ung thuc 4 gi.
Thi gian bn hy ca cht chuyn ha chnh 8-20 gi.
Nng huyt tng n nh t sau 48 gi. Thuc khuch tn tt vo no.
Thi tr ch yu qua thn di dng khng chuyn ha hay acid valproic v cc cht chuyn
ha khc.
CH NH
iu tr h tr cc trng hp ng kinh vi biu hin tm thn.
Phng nga cn hng trm cm bnh nhn chng ch nh dng lithium.

Trng thi gy hn do cc ngun gc khc nhau.

CHNG CH NH
- Vim gan cp.
- Vim gan mn.
- Tin s c nhn hay gia nh vim gan nng, nht l vim gan do thuc.
- Tng nhy cm vi valpromide hay cc cht chuyn ha.
- Tiu Porphyri.
CH PHNG v THN TRNG LC DNG
- Thn trng ngi gi, nht l khi c phi hp thuc hng thn hay chng ng kinh khc.
- Khng c dng thc ung c ru khi ung Depamide.
- nhng bnh nhn c nguy c cao, phi th chc nng gan.
Li xe v vn hnh my mc :
Nguy c ng g khi iu tr chng ng kinh a liu php hay khi phi hp vi benzodiazepines.
LC C THAI v LC NUI CON B
Lc c thai :
Cho ti hin ti, cha c d liu no v vic dng Depamide trn ngi mang thai, nhng do
phn ln Depamide c chuyn thnh acid valproic, do vy cn thn trng nh khi dng
sodium valproate :
- Nguy c khi b ng kinh v dng thuc chng ng kinh : T l tr b d dng (st mi, d dng
tim mch) khi m dng thuc chng ng kinh khong 3% (2 n 3 ln cao hn bnh thng). T
l ny cng tng cao khi phi hp nhiu thuc. Ngng thuc t ngt c th lm xu i bnh
ng kinh ca m v gy tc hi n con.
- Nguy c do valproate sodium : T l d dng khi dng valproate sodium khng cao hn so vi
cc thuc chng ng kinh khc. Thng gp l d dng mt, a d dng, d dng chi, khim
khuyt ng thn kinh : thot v mng no ty, gai sng tch i (t l 1-2%).
- Nguy c cho tr s sinh : hi chng xut huyt do gim fibrine.
Do nhng nguy c k trn, cn cn nhc vic dng Depamide cho ph n mang thai. Khi cn
thit phi dng thuc, nn dng n liu php vi liu ti thiu c hiu qu, nu cn b sung
thm folate, cn theo di thai pht hin d dng, kim sot tiu cu, fibrinogen v cc chc
nng ng mu.
Lc nui con b :
Sodium valproate qua sa t 1-10%. Cha ghi nhn c biu hin lm sng no tr b m c
iu tr sodium valproate.
TNG TC THUC
- Depamide lm tng hiu lc cc thuc hng thn, thuc an thn, hay thuc chng trm cm,
do vy lm tng tc dng ph nu khng gim liu dng.
- Phi hp Depamide v lithium khng lm nh hng ti nng lithium huyt tng.

- Phenobarbital, primidone : phi hp vi phenobarbital v primidone s a n tc dng an

thn. Cn kim sot lm sng trong 15 ngy u chnh liu.
- Phenytoin : Depamide lm gim nng phenytoin ton phn huyt tng, lm tng
phenytoin t do c th a n triu chng qu liu.
- Carbamazepine : Valpromide lm tng tc dng c ca carbamazepine. Cn kim tra lm
sng khi bt u phi hp thuc v chnh liu khi cn.
- Lamotrigine : Valproic acid lm gim chuyn ha v tng thi gian bn hy trung bnh ca
lamotrigine, do vy phi chnh liu lamotrigine.
- Zidovudine : Valpromide lm tng nng zidovudine trong huyt thanh v tng c tnh ca
zidovudine.
- Cc thuc chng ng kinh c tc dng cm ng men (phenytoin, phenobarbital,
carbamazepine) lm gim nng acid valproic huyt tng. Cn chnh liu khi phi hp thuc.
- Felbamate : lm tng nng acid valproic huyt tng, do vy phi chnh liu valpromide.
- Mefloquine : lm tng chuyn ha acid valproic v c kh nng gy ng kinh, do vy khi phi
hp chng c kh nng gy cn ng kinh.
- Phi hp vi cc cht gn kt mnh vi protein (aspirin) lm tng nng acid valproic t do
trong huyt tng.
- Cn kim sot prothrombine khi dng chung vi cc khng ng l thuc vitamine K.
- Cimetidine hay erythromycin lm tng nng acid valproic trong huyt tng (do gim
chuyn ha ti gan).
TC DNG NGOI
V cht bin dng chnh ca valpromide l acid valproic, nn tc dng ph ca valproate
sodium c th xy ra trong lc dng Depamide.
- Cc tc dng ph v gan rt him : tng nh cc men gan thong qua v n thun khng km
theo triu chng lm sng. Cng c vi trng hp gy vim gan.
- Nguy c gy qui thai (xem phn Lc c thai).
- Ri lon thn kinh : l ln, mng m, hn m, an thn, nhc trng lc, run ry.
- Ri lon tiu ha : bun nn, au thng v, thng bin mt sau vi ngy iu tr.
- H mu : gim tiu cu, thiu mu, gim bch cu hay gim c ba dng.
- Tng amoniac mu : trung bnh v n thun, khng km theo thay i chc nng gan, khng
cn ngng iu tr.
- Phn ng da : ni ban, hoi t thng b, hi chng Stevens-Johnson, hng ban a dng.
- Rng tc, tng cn nng.
LIU LNG v CCH DNG
Vi hm lng vin 300 mg bao tan trong rut, Depamide c ch nh iu tr cho ngi
thnh nin v trng thnh.
Liu ngh theo tng ch nh :

Ri lon kh sc :
- Cn hng cm :
Liu khi u : 4-6 vin.
Liu duy tr : 2-4 vin.
- Cn trm cm :
Liu khi u : 1-3 vin.
Liu duy tr: 2-4 vin.
iu tr h tr ng kinh vi biu hin tm thn : Trng thi gy hn : trung bnh 2-6 vin, liu
chia lm 2 ln mi ngy, sng v ti, tt nht l ung vo ba n.
Khi u iu tr :
- Nu Depamide c k toa n c, c th cho liu cao ngay t u hay tng liu dn mi 23 ngy.
- Nu bnh nhn c iu tr bng cc thuc hng thn khc, phi tng liu Depamide t
thp n liu a sau 2 tun, ng thi gim dn liu ca thuc kia xung cn 1/2 hay 1/3 liu
khi u.
QU LIU
Triu chng qu liu bao gm hn m t nh n hn m su, nhc trng lc c, gim phn
x, co ng t, suy h hp.
Cc triu chng ny c th thay i v khi qu liu nng c th c co git.
iu tr triu chng : ra d dy vn c ch sau khi dng thuc 10-12 gi, gim st tim v h
hp. Thng th qu liu c th qua khi tr trng hp ng c vi liu qu cao c th a
n t vong.

144.

DEPERSOLON

GEDEON RICHTER
dung dch tim 30 mg/1 ml : ng 1 ml, hp 50 ng - Bng B.
THNH PHN
cho 1 ng 1 ml
Mazipredone chlorhydrate

30 mg

DC LC
Hot cht ca ch phm ny l mt dn xut prednisolon tan trong nc. Tc dng chng vim

ca n mnh hn hydrocortison 4 ln. Sau khi tim tnh mch, thuc c hot tnh prednisolon
mnh. Dng ng tim bp, tc dng pht trin chm hn.
CH NH
Trc ht l nhng hi chng cp tnh, trong bt buc phi dng liu php glycocorticoid
ng tim : sc sau khi bng, chn thng, phu thut hay nhim c. Giai on sc do nhi
mu c tim. D ng nng, sc phn v, sc do truyn mu, cn cp suyn, qu mn cm nghim
trng vi cc thuc. Tnh trng nhim c pht trin do hu qu ca cc bnh nhim khun
(Dng corticoid k o di di s bo v thch hp ca khng sinh). Suy thng thn cp (v d :
cn cp Addison, hi chng Waterhouse-Fridrichsen). D phng hay iu tr h p trong khi gy
m cho nhng bnh nhn suy thng thn mn do iu tr ko di bng steroid. Hn m gan.
CHNG CH NH
- Trong giai on tim chng vaccin. Lot d dy t trng. Long xng. Hi chng Cushing.
Khuynh hng huyt khi. Suy thn. Cao huyt p nng. Herpes simplex. Thy u. Lao tin
trin. Trong lao tim n, thuc ny ch c dng cng vi cc thuc khng lao. Trong bnh tiu
ng, thuc ch c dng trong trng hp c ch nh tuyt i hoc d phng khng
insulin. Trong cc bnh nhim khun, thuc phi c dng mt cch thn trng cng vi s
dng ha liu php v khng sinh liu php c hiu. Glycocorticoid tng i b chng ch nh
dng trong khi mang thai, c bit trong 3 thng u, v n c th gy hi bo thai ; t s li/hi
nn c xem xt.
CH PHNG v THN TRNG LC DNG
Trong cc trng hp nguy him n tnh mng, nu c th, nn tim tnh mch. Nu iu tr
lu di, b kali l tuyt i cn thit, phng trnh chng h kali huyt c th c. phng
nguy c thoi ha v long xng, nn dng ng thi vi Nerobol (Neroboletta). Trong khi
iu tr, nn thng xuyn o huyt p, kim nh nc tiu v phn nu cn. Thi kz kt thc
iu tr, phi gim liu dn dn. Nn iu chnh liu ca thuc chng tiu ng (loi ung) v
thuc chng ng mu trong thi gian dng corticoid. Nu dng ng thi vi thuc li tiu,
phi kim tra s cn bng in gii ni mi (b kali). Trong trng hp dng ng thi vi
salicylate, nn gim liu c hai (liu corticoid thp s lm gim nng salicylate n mc thp
hn).
TNG TC THUC
Chng ch nh phi hp :
- Cc thuc kh dung cng giao cm cho cc tr em b hen (nguy c lit h hp).
Khng nn phi hp :
- Barbiturat cho ngi bnh Addison (c th dn n cn cp).
Thn trng khi phi hp :
- Glycoside tr tim (tng tc dng ca nhau).
- Thuc chng tiu ng loi ung (nguy c h glucose huyt).

- Thuc chng ng mu (tng hiu qu chng ng).

- Salicylate (nng salicylate huyt tng c th gim, nguy c tng thm tc dng khng
mong mun, v d xut huyt).
- Barbiturate (tc dng corticoid c th gim).
- Thuc li tiu (gim kali huyt).
- Thuc chng vim khng steroid (nguy c xut huyt tiu ha).
TC DNG NGOI
Khi tim bp, mn cm ti ch (au thong qua) v thm nhim c th xy ra. Khi iu tr lu
di, sc khng vi nhim khun gim, cao huyt p, glucose-niu, gim kali huyt, cn bng
Nit m tnh (d ha), suy v thng thn, long xng c th xy ra. Tng tit acid, lot.
LIU LNG v CCH DNG
Liu n cho ngi ln :
Trong iu tr sc, truyn dch nh git hay tnh mch chm 30-90 mg (1-3 ng). Nu cn th
tng liu cao hn, 150-300 mg (5-10 ng) trong nhng trng hp c bit. Nu khng th
tim tnh mch c, c th tim su vo c mng. Tuy nhin, trong trng hp ny, tc dng
s chm hn.
Nu cn, c th iu tr lp li bng tim tnh mch 30-60 mg, hoc tim bp, nu c th c.
Trong nhng ch nh khc, dng liu n 30-45 mg (1-1,5 ng) tim tnh mch chm hay tim
su vo c mng. Nu c tin s bnh tm thn, phi cn thn c bit khi dng liu cao hn.
Sau khi kim ch c cn cp, nn tip tc iu tr bng cch dng prednisolon ung vi liu
gim hn.
Liu n cho tr em :
- T 2-12 thng : 3-2 mg/kg th trng, tim tnh mch hay tim su vo c mng.
- T 1-14 tui : 1-2 mg/kg th trng, tim tnh mch hay tim su vo c mng.
Nn tim tnh mch chm trong 3 pht. Khi cn c th lp li sau 20-30 pht.
BO QUN
Bo qun ni mt (8-15oC).

145.

DERMOVATE

GLAXOWELLCOME
Dermovate kem bi da : ng 5 g, 15 g.
Dermovate thuc m bi da : ng 5 g.
Tenovate-G kem bi da : ng 10 g.

Tenovate-M kem bi da : ng 15 g.
THNH PHN
Dermovate cream :
cho 100 g
Clobetasol propionate

0,05 g

Dermovate ointment :
cho 100 g
Clobetasol propionate

0,05 g

Tenovate-G cream :
cho 100 g
Clobetasol propionate

0,05 g

Gentamicin (dng gentamicin sulfate)

0,1 g

Tenovate-M cream :
cho 100 g
Clobetasol propionate

0,05 g

Miconazole nitrate

2,0 g

DC LC
Clobetasol propionate l mt corticoid tc dng rt mnh.
Miconazole nitrate l thuc khng nm v khng khun mnh ph rng c hot tnh cao i vi
vi nm ngoi da (dermatophyte) v nm men gy bnh (nh Candida spp.) v nhiu vi khun
Gram dng k c hu ht cc chng Staphyloccus spp. v Streptococcus spp.
Gentamicin l khng sinh dit khun thuc h aminoglycoside hot tnh trn vi khun Gram
dng v Gram m.
CH NH
Dermovate c bit c gi tr trong iu tr ngn ngy cc bnh da kh iu tr nh :
Vy nn (ngoi tr vy nn dng mng lan rng) ; chm dai dng kh cha ; Liken phng ; Lupus
ban hnh da, v mt s bnh da khc khng p ng tha ng vi cc corticoid hot tnh

k m hn.
Tenovate-G c ch nh trong tt c cc bnh da c ch nh dng Dermovate, nhng khi c,
hoc nghi ng l c, hoc d xy ra nhim khun th pht.
Tenovate-M c ch nh trong tt c cc bnh da c ch nh dng Dermovate, nhng khi c,
hoc nghi ng l c, hoc d xy ra nhim th pht vi nm v/hoc nm men Candida, nh khi
bi thuc c bng kn, v d trong iu tr vy nn.
CHNG CH NH
Mn trng c , mn trng c thng v vim da quanh ming.
Chng nga quanh hu mn v nga vng sinh dc.
Nhim virus da nguyn pht (v d herpes simplex, thy u).
Qu mn vi thuc.
Cc dng Dermovate dng ngoi da khng c ch nh iu tr cc sang thng da nhim
trng nguyn pht gy ra bi nhim vi khun hoc vi nm. Bnh da tr em di 1 tui, k c
vim da v hm da do t lt.
Ch phm cha gentamicin khng nn dng cho bnh vim tai ngoi nu mng nh b thng v
nguy c nhim c tai.
THN TRNG LC DNG
Nn trnh iu tr lin tc di ngy vi Dermovate nu c th trnh c, nht l i vi nh
nhi v tr em, v c th xy ra tnh trng c ch tuyn thng thn, ngay c khi khng bng kn
vng c bi thuc.
Trong trng hp cn s dng Dermovate cho tr em, c khuyn co rng toa iu tr cn phi
c thy thuc kim tra li hng tun.
Cn lu { rng t lt ca tr nh nhi c tc dng nh khi bng kn vng da c bi thuc.
Vng mt d b teo da hn cc vng da khc trn c th khi iu tr ko di bng cc corticoid
tc dng ti ch mnh. Cn ghi nh iu ny khi iu tr cc bnh da nh vy nn, lupus ban
dng a v chm nng. Khi bi thuc ln vng da quanh mt, cn phi thn trng khng
thuc ri vo mt, v c th gy glaucoma.
Cc corticoid tc dng ti ch c th c nguy c gy hi khi c dng iu tr vy nn v mt s
nguyn nhn, bao gm ti pht ny ngc, kh nng ln thuc, nguy c gy vy nn dng mn
m ton thn, v kh nng gy c ti ch hoc ton thn do chc nng hng ro bo v ca da
b h hi. Khi dng corticoid bi da iu tr vy nn, cn phi theo di cn thn tnh trng
bnh nhn.
Khi sang thng vim c nhim trng, nn iu tr khng sinh thch hp. Khi c du hiu nhim
trng lan rng, cn phi ngng s dng corticoid ngoi da v cn phi iu tr khng sinh ng
ton thn. Khi bng kn vng da c bi thuc, da tr nn m v m s to iu kin cho
nhim khun pht trin, v vy cn phi ra sch vng da trc khi bi thuc v t bng sch
ln trn.

S dng Tenovate-G trn din rng nhng bnh nhn cao tui v bnh nhn suy thn c th
c nguy c do nhim c tai.
S dng Tenovate-G trn din rng hoc lp i lp li c th tng nguy c mn cm da do tip
xc.
LC C THAI
Cc corticoid tc dng ti ch khi c s dng trn cc ng vt c thai c th gy ra cc d
dng trong qu trnh pht trin thai. S lin quan gia kt qu thc nghim trn ng vt ny
v thc t trn ngi cha c xc lp ; tuy nhin, khng c s dng cc corticoid bi da
trong thai kz mt cch rng ri, c ngha l vi mt lng ln hoc trong thi gian di.
TC DNG NGOI
Cng nh cc corticoid tc dng ti ch khc, khi c s dng vi mt lng ln ko di, hoc
c iu tr trn mt din tch da rng ln, thuc c th c hp th ton thn vi mt
lng gy nn cc biu hin ca tnh trng cng v thng thn. Tc dng ny d xy ra
hn tr nh nhi v tr em, v trong cch iu tr thuc c bng kn. tr nh nhi, t lt c th
c tc dng nh khi bng kn vng da c bi thuc.
Vi liu lng khng c qu 50 g mi tun l i vi ngi ln, bt c biu hin no ca tnh
trng c ch trc h i-yn-thng thn cng thng thong qua v hi phc nhanh sau khi
ngng liu php iu tr ngn ngy.
iu tr ko di vi liu cao corticoid tc dng mnh c th gy teo da ti ch nh cc vt nt
da, mng da, dn cc mch mu b mt, c bit l khi iu tr thuc c bng kn, hoc trn
vng np gp da.
C nhng bo co ghi nhn s thay i sc t da v rm lng khi s dng cc corticoid bi da.
Trong trng hp him gp, iu tr (hoc ngng iu tr) bnh vy nn bng corticoid c
cho l khi pht dng mn m ca bnh.
Thng thng, Dermovate c dung np tt, nhng nu c du hiu qu mn, nn ngng
dng thuc ngay.
Tnh trng nng thm cc triu chng c th xy ra.
LIU LNG v CCH DNG
Bi mt lp mng thuc ln vng da bnh mt ln hay hai ln mi ngy. Nn ngng iu tr
ngay sau khi t hiu qu mong mun.
Khng nn iu tr lin tc qu bn tun m khng kim tra tnh trng bnh nhn. C th lp li
cc t iu tr ngn hn bng Dermovate kim sot cc t bnh tr li trm trng. Nu
cn iu tr lin tc bng corticoid, nn s dng dng corticoid nh hn.
i vi sang thng rt kh iu tr, c bit vng da dy sng, hiu qu khng vim ca
Dermovate c th c tng cng, nu xt thy cn thit, bng cch bng kn vng da c
bi thuc bng mng film polythene. Thng ch cn bng kn qua m l mang li p ng
mong mun. Sau , bi thuc khng cn phi bng kn, thng thng bnh vn c th tip tc

c ci thin.
QU LIU
Tnh trng qu liu cp tnh rt t khi xy ra, tuy nhin, trong trng hp qu liu mn tnh hoc
s dng sai, cc biu hin cng v thng thn c th xy ra v trong trng hp ny cn
phi ngng ngay thuc corticoid bi da.

146.

DEXAMBUTOL-INH

SERB
c/o GALIEN
vin nn d b : hp 50 vin.
THNH PHN
cho 1 vin
thambutol hu tuyn, dichlorhydrate

400 mg

Isoniazide hay INH

150 mg

T dc : lvilite, glatine, amidon,

magnsium starate, Eudragit L v S.
DC LC
thambutol l mt khng sinh c tc ng chn lc trn cc Mycobacterium loi in hnh
ngi v b (trc khun lao) v loi khng in hnh (c bit l kansasii).
Nng c ch ti thiu (CMI) l 1 mg/ml i vi a s cc dng trc khun lao. nng
ny, thuc c th c xem l mt khng sinh dit khun trn mt s dng.
- Ngi ta tm thy trong m phi cc nng dit khun trn ton b cc dng ca trc khun
Koch.
- thambutol c tc ng trn trc khun lao ngoi hoc trong t bo.
- Khng xy ra tnh trng khng cho vi cc thuc khng lao khc. T l khng nguyn
pht i vi thambutol di 1%.
trnh xy ra tnh trng khng do s dng n tr liu, phi lun lun phi hp
thambutol vi mt hoc nhiu thuc khng lao khc.
Isoniazide l mt khng sinh dit khun c tc ng chn lc trn trc khun Koch. Nng c
hiu lc trong huyt thanh trong khong t 1 n 2 mg/ml, tng ng vi mt liu 5

mg/kg/ngy.
DC NG HC
thambutol :
- hp thu qua ng tiu ha tt v nhanh, trong khong 80% ; nng nh trong huyt thanh
t c gia gi th 2 v th 4 khong 3 mg/ml sau khi ung thuc lc i vi liu 20 mg/kg ;
- o thi : 80% trong nc tiu di dng c hot tnh, 20% trong phn ;
- thambutol tp trung nhiu m, c bit l phi. Nng trong m phi lnh mnh v
phi b nhim lao t c t 5 n 9 ln nng trong huyt thanh ;
- nu c nhim lao mng no, nng trong dch no ty t c bng phn na nng
trong huyt thanh ;
- cn ghi nhn rng thambutol c khuch tn qua nhau thai nhng khng qua sa m ;
- thi gian bn hy trong huyt tng : 6 n 8 gi ngi bnh thng, cao hn ngi suy
thn.
Isoniazide :
- hp thu nhanh qua ng tiu ha, nng nh trong huyt thanh t c sau khi ung
thuc t 1 n 2 gi ;
- khuch tn tt trong tt c cc m, trong dch no ty v trong nhau thai ; INH qua c sa
m v t nng tng t nh nng trong huyt tng ;
Chuyn ha :
Isoniazide c chyn ha ch yu bng cch actyl ha thnh actylisoniazide. S chuyn ha
ny c bit n nh trong tng c th, c xc nh v mt di truyn hc. Thi gian bn hy
ca isoniazide c th thay i nhiu ngi khc nhau t 1 n 6 gi ; c hai nh hp thu
c ghi nhn trn mt dn s ng cho ph p phn ra thnh hai nhm c phn ng actyl ha
xy ra chm v nhm c phn ng actyl ha xy ra nhanh ; vic xc nh tc actyl ha cho
php s dng liu thp nht c hiu qu cho tng ngi : liu ny vo khong 3 mg/kg i vi
nhm c phn ng actyl ha xy ra chm v vo khong 6 mg/kg i vi nhm c phn ng
actyl ha xy ra nhanh. Nu s dng liu isoniazide bng nhau th nguy c xy ra c tnh trn
thn kinh ca nhm c phn ng actyl ha chm l cao hn ; nh hng ca tc actyl ha
trn c tnh trn gan ca isoniazide cha c nh gi r.
Ac tylisoniazide c thy phn thnh actylhydrazine. Mt phn ca ac tylhydrazine c
chuyn ha thnh mt cht chuyn ha khng n nh, chnh cht ny lm cho isoniazide c
c tnh trn gan.
Thi tr :
- theo ng tiu di dng c hot tnh, 10-30 %,
- theo ng mt di dng chuyn ha.
CH NH
Ha d phng :

- phn ng tuberculine dng tnh,

- ngi c phn ng tuberculine m tnh c tip xc vi bnh nhn lao,
- s nhim lao,
- bnh nhn suy gim min dch c th b bc pht lao hay c tip xc vi ngi b bnh lao.
Lao phi - mng phi mi hoc c, lao ti pht, lao nguyn pht.
Lao ngoi phi : mng no, niu - sinh dc, xng - khp, hch, vv.
Nhim Mycobacterium loi khng in hnh.
CHNG CH NH
Tuyt i :
- bit c qu mn cm vi thambutol v isoniazide.
- Vim dy thn kinh th gic.
- Suy gan nng (c bit khi c phi hp vi rifampicine).
Tng i :
- Khng nn phi hp vi carbamaz pine v disulfirame (xem Tng tc thuc).
- Cho con b.
CH PHNG v THN TRNG LC DNG
Ch { phng :
- Trng hp bnh nhn b suy thn, nn iu chnh liu thambutol theo mc thanh thi
cratinine do vic tch t thuc c th dn n qu liu.
- Isoniazide c th khi pht cn ng kinh do qu liu ( nhm ngi c phn ng actyl ha
chm) hoc trn mt c a thun li. Cn theo di cht ch v dng phi hp vi thuc chng
ng kinh trong trng hp ny.
Thn trng lc dng :
- Lin quan n thambutol :
Trc khi k toa thambutol cn phi khm nghim mt bao gm o th lc, th trng, kh
nng phn bit mu sc v soi y mt.
Ln kim tra th 2 c tin vo gia ngy iu tr th 15 v ngy iu tr th 21, ln kim tra
th 3 c in hnh vo thng iu tr th 2, sau cch 2 thng kim tra mt ln.
Ngay khi c du hiu b vim dy thn kinh th gic cn phi ngng ngay vic iu tr bng
thambutol. Cc ri lon thng s gim sau vi thng. Cn c bit theo di ngi c
nhng tn thng trc mt, ngi nghin ru v thuc l, ngi b bnh tiu ng,
nhng bnh nhn c iu tr ng thi vi disulfirame, thuc khng vim, thuc st rt dng
tng hp.
Cn lu { rng suy thn v qu liu l hai yu t ch yu trong vic gy vim dy thn kinh th
gic ca thambutol.
Nn kim tra vic ch nh liu dng v ty tnh hnh, c th iu chnh liu dng theo chc
nng thn (ur, cratinine huyt, thanh thi cr atinine : xem Ch { phng). Phi lm bilan

thn trc khi tin hnh iu tr.

- Lin quan n isoniazide : c tnh trn gan.
Trng hp dng chung vi rifampicine, hot cht ny c th lm xut hin c tnh trn gan
ca isoniazide ; cc cht gy cm ng men khc cng c th c cng tc dng (barbiturate,
thuc gy m). Trong trng hp ny, nn xc nh tc actyl ha ca bnh nhn c th
xc nh liu thp nht c hiu qu. Vic iu chnh liu nn c tnh ton theo nng trong
huyt thanh c ly gi th 3 sau khi ung thuc.
Nu khng th xc nh c liu ti u, nn s dng INH vi liu ti a l 5 mg/kg/ngy. Hn
na, nu c phi hp vi rifampicine cn phi theo di thng xuyn chc nng gan : nh
lng transaminase hng tun trong thng u, sau l hng thng trong nhng thng tip
theo. Nu lng transaminase tng qu 10 ln lng bnh thng, phi ngng tm thi hoc
vnh vin isoniazide. Isoniazide cng c th gy cc bnh l thn kinh ngoi bin, tuy nhin rt
him. Cn c bit kim tra thng xuyn cc du hiu thn kinh ngi nghin ru. C th
s dng pyridoxine phng nga hoc lm gim cc trng hp him bnh l thn kinh m
isoniazide gy ra.
LC C THAI v LC NUI CON B
Lc c thai : nu dng thambutol mt mnh th khng c chng ch nh, nhng nu c phi
hp vi isoniazide th khng c s dng trong nhng thng u, tr trng hp bt buc
phi s dng, trng hp ny phi phi hp vi liu php vitamine. Tc dng trn phi thai ca
thambutol khi c phi hp vi cc thuc khng lao khc th cha c xc nh r.
TNG TC THUC
Lin quan n isoniazide :
Khng nn phi hp :
- Carbamaz pine : tng hm lng carbamazpine trong huyt tng vi cc du hiu qu liu,
do c ch s chuyn ha gan.
- Disulfirame : ri lon cch c x v phi hp ng tc.
Cn thn trng khi phi hp :
- Thuc gy m dng bay hi thuc dn xut halogne : lm tng c tnh trn gan ca
isoniazide. Trong trng hp phu thut theo chng trnh, do thn trng, nn ngng iu tr
bng isoniazide mt tun trc khi phu thut v ch dng thuc tr li sau 15 ngy.
- Glucocorticoide (m t cho prednisolone) : gim nng isoniazide trong huyt tng do tng
chuyn ha gan v gim s chuyn ha ca glucocorticoide. Cn theo di lm sng v sinh
hc.
- Ktoconazole : gim nng ktoconazole trong huyt tng. Nn dng cc thuc ny cch
nhau t nht 12 gi. Theo di nng ca k toconazole v iu chnh liu nu cn.
- Phnytoine : qu liu phnytoine do gim s chuyn ha ca cht ny. Theo di lm sng cht
ch, nh lng phnytoine trong huyt tng v iu chnh liu trong thi gian phi hp vi

isoniazide v sau khi ngng dng thuc ny.

- Pyrazinamide : phi hp c tnh trn gan. Theo di lm sng v sinh hc.
- Rifampicine (c th m rng ra vi cc thuc gy cm ng men khc) : tng c tnh trn gan
ca ca isoniazide do tng tc hnh thnh cht chuyn ha c c tnh ca isoniazide (xem
Ch { phng v Thn trng lc dng).
Lin quan n 2 hot cht chnh :
Cn thn trng khi phi hp :
- Mui v hydroxyde ca nhm : gim s hp thu ca thambutol v isoniazide qua ng tiu
ha ; dng cc thuc ny cch nhau t nht 2 gi.
TC DNG NGOI
Do thambutol :
- Him gp :
Ri lon mt loi gy vim dy thn kinh th gic trc hoc quanh trc, vi gim th lc, m
im trung tm hoc lon sc i vi cc mu xanh v mu (xem Ch { phng v Thn
trng lc dng).
- Ngoi l :
Cc ri lon tiu ha khc nhau, chn n, pht ban da do d ng.
Tng acide urique huyt, gim bch cu.
Do isoniazide :
- Bun nn, nn, au thng v.
- St, au c, au khp, chn n.
- c gan.
- c thn kinh : c biu hin d cm, tng ng, cn sng khoi, mt ng, co git, vim thn
kinh th gic.
LIU LNG v CCH DNG
Nguyn tc chung iu tr lao :
Vic iu tr lao phi tun theo cc nguyn tc sau :
- vic iu tr phi c hng dn v duy tr tt cho n khi c kt qu trc khun lao nhiu
ln m tnh (tiu chun xc nh chc chn khi bnh) ;
- dng thuc sau khi c cc bng chng v vi khun hc xc nhn c lao v lm khng sinh
;
- hiu lc iu tr c m bo bng vic phi hp :
- 3 thuc khng lao (4 thuc khng lao nu l lao c iu tr hay lao ti pht) c hiu qu
nht ung mt ln duy nht cho n khi c kt qu v khng sinh v trong t nht t 2 n 3
thng, nhm trnh xy ra s khng thuc nguyn pht,
- 2 thuc khng lao, ty theo kt qu ca khng sinh , nhm trnh xy ra s khng thuc
thu nhn ;

- thi gian iu tr phi lin tc, t nht trong 6 thng nu 2 thng u iu tr tn cng c dng
rifampicine v pyrazinamide v trong 9 thng nu khng dng hai thuc ny.
Liu lng :
Isoniazide : liu thng thng nu khng c nh lng nng ca thuc trong mu :
- Ngi ln : 5 mg/kg/ngy,
- Tr em : 10 mg/kg/ngy.
Ethambutol : liu thng thng l :
- Ngi ln : 15-20 mg/kg/ngy, c th nng liu n 25 mg/kg/ngy trong cc trng hp :
- lao ti pht,
- trc khun Koch khng vi cc thuc khng lao khc.
Ch dng liu ny trong mt thi gian ngn (di 2 thng) theo ch nh ca bc s v cn tng
cng theo di bnh (xem Ch phng v Thn trng lc dng).
- Suy thn :
Thanh thi cratinine (ml/pht)

Liu hng ngy ca thambutol

> 100

15-20 mg/kg/ngy

< 70-100

15 mg/kg/ngy

70

10 mg/kg/ngy

khi lm thm phn

5 mg/kg/ngy

ngy lm thm phn

7 mg/kg

Trong trng hp ny, nn iu chnh liu sau khi nh lng nng thuc trong huyt thanh.
- Tr em : 25-30 mg/kg/ngy.
Phi hp Dexambutol-INH : khi dng liu hng ngy nn lu { n mc suy thn, giai on
iu tr v nh lng nng isoniazide 3 gi sau khi ung thuc phn bit bnh nhn c
tc actyl ha nhanh hay chm. C th k toa hai thuc ring bit nhau.
QU LIU
- i vi thambutol, khng c du hiu ng c cp tnh. Trng hp c ng c, thambutol
c th c thm tch.
- i vi INH, liu gy cht trn 200 mg/kg.
Cc du hiu ng c ban u bao gm : bun nn, chng mt, ri lon th gic, o gic, c th
dn n hn m vi co cng, gim oxy-m, nhim acide, ctone-niu v tng ng huyt.
X tr cp cu : ra d dy, hi sc tim mch v h hp, dng thuc chng co git v pyridoxine
(20 mg cho mi ln dng mt liu 100 mg INH), iu tr nhim acide, lm thm tch thanh

lc mu.
BO QUN
Trnh m.

147.

DI-ANTALVIC

ROUSSEL VIETNAM
[AVENTIS PHARMA]
Vin nang : hp 20 vin.
THNH PHN
cho 1 vin
Dextropropoxyphne chlorhydrate

30 mg

Paractamol

400 mg

CH NH
au va phi hoc au d di v/hoc khng p ng vi cc thuc gim au ngoi bin.
CHNG CH NH
- Tng cm vi dextropropoxyphne v/hoc paractamol.
- Suy thn nng.
- Tr em di 15 tui.
- Suy gan.
- Ph n cho con b.
CH PHNG v THN TRNG LC DNG
Ch { phng :
C nguy c b l thuc thuc khi dng lu di v khi dng vi liu cao hn liu khuyn co.
Thn trng lc dng :
Khng dng cho bnh nhn c khuynh hng t t, bnh nhn c iu tr vi thuc an thn,
thuc chng trm cm hoc thuc gy c ch h thn kinh trung ng.
Cnh gic cc i tng iu khin phng tin giao thng v s dng my v nguy c b bun
ng v chng mt.
Khng dng qu liu ch nh v trnh ung ru.
Khng dng lu di. Khng dng cng lc vi cc thuc cha paractamol khc.

LC C THAI v LC NUI CON B

Lc c thai :
Nu cn thit c th dng trong thi kz c thai nhng khng nn dng k o di (c nguy c gy
hi chng cai thuc tr s sinh) v tun theo liu khuyn co.
Lc nui con b :
Thuc qua c sa m. Vi trng hp gim trng lc v ngng th c ghi nhn tr
b m c dng dextropropoxyphne vi liu iu tr.
Khng dng cho ph n nui con b.
TNG TC THUC
Chng ch nh phi hp :
- Cc cht i khng morphine : gim tc dng gim au ca morphine v nguy c gy hi
chng cai thuc.
Khng nn phi hp :
- Carbamazepine : tng nng carbamazepine trong huyt tng vi cc du hiu qu liu.
Theo di lm sng v c th gim liu carbamazepine.
TC DNG NGOI
Lin quan n dextropropoxyphne :
- Bun nn, nn.
- Him hn : to bn, au bng, ni ban, nhc u, suy nhc, sng khoi, ri lon th gic nh,
chng mt, bun ng, mt nh hng, h ng huyt, vim gan tc mt.
Lin quan n paractamol :
- Tai bin d ng da : him gp pht ban vi ban hoc ni my ay. Phi ngng thuc ngay.
- Rt him khi gy gim tiu cu.
LIU LNG v CCH DNG
Thuc dnh cho ngi ln.
Nn dng thuc trong ba n, ung vi nhiu nc. Chia cc liu cch nhau t nht 4 gi.
Trung bnh : 4 vin/ngy ; ti a 6 vin/ngy trong cc trng hp au kh tr.
Ngi b suy thn (h s thanh thi cratinine < 30 ml/pht) : dng cc liu cch nhau t nht 8
gi.
QU LIU
Triu chng lm sng :
- Do paractamol : bun nn, nn, chn n, xanh xao, au bng, thng xut hin trong 24 gi
u. Qu liu >= 10 g (150 mg/kg cn nng tr em) c th gy hy t bo gan, c th dn n
hoi t hon ton khng hi phc, vi biu hin suy chc nng gan, toan chuyn ha, bnh no
c th dn n hn m v cht. Transaminase gan tng, bilirubine tng, prothrombine gim.
- Do dextropropoxyphne :
Ri lon tri gic, n l m v hn m.

Bun nn, nn, au bng, c ch h hp c th dn n kh th, ngng th.

Co ng t, co git, ni sng, tm ti, try tim mch v cht do tim ngng p.
X tr cp cu : trong bnh vin :
Ra rut v cho ung than hot tnh.
Dng N-actylcystine, thuc gii c parac tamol, tim tnh mch hoc ung nu c th trc
gi th 10, v dng naloxone, thuc gii c ca dextropropoxyphne.
Gip th.
Khng dng thuc hi sc cng nh thuc kch thch h thn kinh trung ng v c th gy cc
cn co git cht ngi.

148.

DIAMICRON

LES LABORATOIRES SERVIER

vin nn b c 80 mg : hp 60 vin - Bng B.
THNH PHN
cho 1 vin
Gliclazide

80 mg

(Lactose)
DC LC
Sulfamide h ng huyt pht minh ti Php.
V phng din dc l{, Diamicron c hai tc ng c lp nhau : tc ng trn s chuyn ha
v tc ng c bit trn h vi mch.
Tc ng trn s chuyn ha :
Diamicron l thuc gy kch thch bi tit insuline v lm tng tc dng gy bi tit insuline ca
glucose.
Diamicron lm tng p ng ty v gy bi tit insuline pha sm khi c thc n vo c th.
Diamicron do lm gim ng huyt sau cc ba n bnh nhn i tho ng, c ghi
nhn qua cc kt qu kho st ng huyt lin tc, theo chu kz v kt qu nh lng ng
huyt sau cc ba n.
Nguy c gy tt ng huyt c xem l rt thp do Diamicron gy h ng huyt t t v

thi gian bn hy sinh hc trung bnh (12 gi) cho php dng 2 liu mt ngy.
Tc ng trn h vi mch :
- ng vt :
Diamicron ngn nga s hnh thnh huyt khi, tc ng ln mt trong nhng c ch gy bnh
trn h vi mch bnh nhn i tho ng :
- lm chm s xut hin huyt khi thnh mch mu ;
- lm chm s tin trin ca cc huyt khi vn l nguyn nhn gy tc mch hon ton ;
- lm gim ng k thi gian ko di ca chng huyt khi ;
- lm tng tc bin mt ca cc huyt khi.
Diamicron can thip ln ba tc nhn ch yu ca s hnh thnh cc huyt khi :
- ln tiu cu :
Diamicron lm gim ng k s kt dnh tiu cu ln thnh mch v cn tr s hnh thnh nt
tiu cu, giai on u ca s hnh thnh cc huyt khi ;
- ln si fibrine :
Diamicron lm tng s tiu gii si fibrine thnh mch v ngn cn si fibrine lu li dai dng
trn thnh mch ;
- ln s tn cng ca adrnaline :
Diamicron lm bnh thng ha s nhy cm ca mch mu i vi adrnaline v cn tr s
tn cng ca adrnaline vn c bit c hi i vi mch mu ca bnh nhn i tho ng.
- ngi :
- c kt lun trn lm sng v tc dng lm gim s kt dnh v kt tp ca tiu cu,
Diamicron lm chm tc kt tp ca tiu cu, bnh thng ha hot ng tiu gii si fibrine
ni m ca bnh nhn i tho ng tp 1 ln tp 2 ;
- trong bnh vng mc do i tho ng, mt nghin cu c kim sot di hn c thc
hin so snh vi cc thuc gim ng huyt c in. Nghin cu ny cho thy rng, khi t
c cng mt tnh trng cn bng ng huyt, c s khc nhau ng k v mt thng k v
kt lun rng Diamicron lm chm s tin trin ca bnh vng mc do i tho ng, giai
on cha pht trin nhiu ;
- trong bnh thn do i tho ng, dng lu di Diamicron khng lm thay i chc nng
thn ang mc bnh thng hoc n nh v ng thi lm gim ng k protine niu, song
song vi tc ng kim tra tt mc huyt p v ng huyt.
DC NG HC
Diamicron c hp thu nhanh qua ng tiu ha v t nng ti a trong mu sau 2 n
6 gi. ngi, gn kt vi protine huyt tng l 94,2%.
Thi gian bn hy sinh hc trung bnh ca gliclazide trong khong 12 gi ngi, do
Diamicron c th c dng 2 ln trong ngy nhm t c hiu qu tt nht.
Gliclazide c chuyn ha mnh : cht chuyn ha chnh mu chim 2 n 3% liu ung vo

v khng c tc ng h ng huyt nhng c nhng tc ng huyt sinh hc.

Thuc c o thi ch yu qua thn : di 1% liu ung vo c tm thy di dng khng
i trong nc tiu.
CH NH
Diamicron c dng cho tt c bnh nhn i tho ng cn iu tr bng thuc ung : i
tho ng khng c nhim toan ctone hay nhim toan acide lactique, i tho ng tp 2
ngi trng thnh v ngi ln tui khi s kim sot ng huyt khng t c bng ch
n king n thun.
CHNG CH NH
- i tho ng tr em, i tho ng khi pht lc tr.
- Nhim toan, nhim ctone nng.
- Hn m hay tin hn m do i tho ng.
- Suy thn nng.
- Suy gan nng.
- Tin s b d ng bit vi sulfamide.
- Phi hp vi miconazole dng vin (xem Tng tc thuc : nguy c b h ng huyt).
- Ph n c thai : xem Lc c thai.
CH PHNG v THN TRNG LC DNG
- Dng Diamicron vn phi theo ch n king t nng lng v (hoc) t glucide.
- Phi thc hin u n cc kim tra sinh hc thng thng nh kim tra ng huyt lc i
v sau khi n, ng niu trong 24 gi.
- Trng hp c can thip phu thut hoc cc nguyn nhn khc cn tr thuc pht huy tc
dng, cn d tr insuline cp cu.
H ng huyt :
H ng huyt trung bnh hoc nng, k c hn m, c th xy ra trong trng hp :
- Dng thuc khng ng ch nh, trong i tho ng ch cn kim sot bng ch n king
;
- Ng c do dng thuc qu liu, nht l ngi gi ;
- Dinh dng khng y hoc mt cn bng v hydrate carbone ;
- Suy thn v (hoc) suy gan c xc nhn hoc kim tra bng cc xt nghim sinh hc. Tuy
nhin, trong cc kho st lm sng di hn, Diamicron c th c dng vi liu chia nh ra
nhng bnh nhn c ri lon chc nng thn v khng lm trm trng thm tnh trng ny.
trnh vic h ng huyt :
- Nn bt u iu tr i tho ng tp 2 bng mt giai on p dng ch n king t
glucide v t nng lng, thng xuyn kim tra ng huyt lc i v sau khi n, nu c
th ch dng ch n king iu tr ;
- Cng nn ch { n tui tc ca bnh nhn ; ngi gi, tui cng cao th kh nng b h

ng huyt cng ln v kh nng kim sot bng ch n king cng thp ;

- Khi k toa, liu phi c nng t t v tht thn trng trong nhng ngy u iu tr, theo
di ng huyt lc i v sau khi n cng nh ng niu trong 24 gi.
Do vic nh gi li liu lng c th l cn thit :
- Trng hp c biu hin h ng huyt trung bnh hoc nh ( m hi, xanh ti, i cn
co, tim p nhanh, bt n) : trc tin cn cho bnh nhn ngm ng, sau nh gi li
ch tit thc hoc iu tr ty theo nguyn nhn, c th gim liu hoc ngng dng thuc ;
- Trng hp h ng huyt nng (xem Qu liu) ;
- Trng hp ng huyt vn cn cao, tng liu t t v nu vn khng kim sot c, c
th tm thi s dng insuline.
LC C THAI
Chng ch nh.
TNG TC THUC
- H ng huyt nng (hn m) c ghi nhn khi phi hp mt vi loi sulfamide h ng
huyt (glibenclamide, gliclazide) vi miconazole dng ung. Do chng ch nh phi hp
Diamicron vi thuc ny.
H ng huyt cng c bo co trong nhng trng hp :
tng tc ng h ng huyt gy ra bi cc thuc khng vim khng st roide (c bit l cc
salicylate), sulfamide khng khun, coumarine, IMAO, thuc c ch bta, diazpam,
ttracycline, perhexiline malate, chloramphnicol, clofibrate. Ung ru cng c th lm tng
tc dng h ng huyt.
- Cc barbiturate c th lm gim tc ng ca Diamicron.
- Mt vi thuc (corticoide, thuc li tiu, estroprogestatif) c th lm mt cn bng ng
huyt trong chiu hng lm tng ng huyt.
TC DNG NGOI
- Phn ng da-nim mc, c bit l nga, pht ban, ni m ay. Cc triu chng ny s gim
dn v bin mt vi ngy sau khi ngng iu tr.
Mc du mt vi trng hp vim da c bng nc (hi chng Lyell) c ghi nhn khi dng
sulfamide h ng huyt, tuy nhin i vi Diamicron, cho n nay khng c trng hp no
c ghi nhn.
- Ri lon tiu ha rt him khi xy ra : bun nn, ma, au d dy, tiu chy, to bn. Cc ri
lon ny s gim rt nhiu nu dng thuc trong cc ba n.
- Ri lon gan : rt him khi gp vng da tc mt do d ng vi sulfamide h ng huyt :
cho n nay, cha c trng hp no c ghi nhn vi Diamicron.
- Ri lon mu, thng hi phc khi ngng iu tr : cc ri lon ny ngoi l c th xy ra
nhng bnh nhn nhy cm vi sulfamide : gim tiu cu, mt bch cu ht hoc gim bch
cu, thiu mu.

LIU LNG v CCH DNG

Trong tt c cc dng i tho ng khng kim sot c bng ch n king n thun.
i tho ng ngi bo ph :
Trong a s trng hp : 2 vin mi ngy chia lm 2 ln.
i vi Diamicron, liu dng c th linh ng v c th thch nghi trong mi trng hp :
- 1 vin trong i tho ng nh ;
- 3 vin trong i tho ng nng hn.
Trng hp iu tr thay th, ngng thuc c ch nh trc v sau ch nh dng
Diamicron.
Vic n nh ng huyt c lin quan n vic st cn. Trng hp khng n nh c
ng huyt, cn kim tra li ch tit thc c c chp hnh tt khng, v ty tnh hnh c
th iu chnh li liu dng Diamicron.
i tho ng ngi c trng lng bnh thng, khng ph thuc insuline :
p dng ch n king, sau ch nh dng Diamicron. Trong a s trng hp : 2 vin mi
ngy chia lm 2 ln.
i vi Diamicron, liu dng c th linh ng v c th thch nghi trong mi trng hp :
- 1 vin trong i tho ng nh ;
- 3 vin trong i tho ng nng hn, ngoi l c th tng n 4 vin.
Trng hp iu tr thay th, ngng thuc c ch nh trc v sau ch nh dng
Diamicron.
nhng bnh nhn rt kh n nh li ng huyt, c th ngh rng i tho ng tnh
trng rt xu, cn dng n insuline.
QU LIU
V tnh hay c dng thuc qu liu ch yu a n cc biu hin h ng huyt.
Trong cc trng hp nng, nu c biu hin m m thc : phi dng ngay lp tc dung dch
ng u trng 10% hoc 30% bng ng tnh mch, sau a bnh nhn nhp vin.

149.

DIANE-35

SCHERING AG
c/o ZUELLIG
Vin nn : v 21 vin c ghi ngy nh - Bng B.
THNH PHN

cho 1 vin
Cyproterone acetate

2 mg

Ethinylestradiol

0,035 mg

DC LC
Cht cyproterone acetate c trong Diane-35 c ch nh hng ca androgens cng c sn
xut trong c th ph n. V vy, c th iu tr nhng bnh m nguyn nhn ca n l do hoc
tng sn xut androgens hoc do nhy cm c bit vi hormone ny.
Khi dng Diane-35, tnh trng tng chc nng ca tuyn b nhn s gim i. Tnh trng ny
ng vai tr quan trng cho s pht bnh mn trng c v tng tit b nhn. iu ny a n
kt qu l cha lnh cc ban trng c ang c thng sau khi iu tr 3-4 thng. Tnh trng lng
tc nhn qu mc s bin mt sm hn. Rng lng tc thng km vi tng tit b nhn cng
gim i. iu tr bng Diane-35 c ch nh cho ph n tui sinh c biu hin nh ca
chng rm lng, v c bit l c tng nh lng mt ; tuy nhin phi sau vi thng th kt qu
iu tr mi r. Ngoi tc dng khng androgen, cyproterone acetate cng c tc dng r ca
progesteron. V vy, dng n thun cyproterone acetate s dn n ri lon chu kz kinh
nguyt. iu ny c th trnh c bng cch kt hp vi ethinylestradiol trong Diane-35. Hiu
qu ny vn gi c min l vic dng thuc phi theo chu kz nh trong hng dn s dng
thuc. Trong thi gian iu tr bng Diane-35, s rng trng s khng xy ra, v vy c th nga
thai. Do vic dng ng thi mt ni tit t hoc nhng thuc nga thai khc l khng cn
thit.
CH NH
iu tr nhng bnh ph thuc androgen ph n, nh mn trng c, c bit cc dng r v
cc dng c km vi tng tit b nhn hoc km vim, hoc c to thnh cc cc (trng c sn
mn m, mn trng c cc nang), rng tc androgen di truyn v cc dng nh ca chng rm
lng.
Nu chng rm lng ch mi xut hin gn y hoc tr nn nng hn ti mt mc ng k,
cn tm hiu r nguyn nhn c hng iu tr thch hp.
CHNG CH NH
C thai, cho con b, ri lon chc nng gan, vng da hoc nga ko di trong ln c thai trc,
hi chng Dubin-Johnson, hi chng Rotor, tin s hay hin ti ang b u gan,, tin s hay hin
ti ang c qu trnh huyt khi tc mch ng mch hay tnh mch v cc tnh trng thun
li cho s pht trin cc bnh ny (v d cc ri lon ca h thng ng mu vi khuynh hng
hay to huyt khi, cc bnh tim r rt), thiu mu hng cu hnh lim, iu tr hay ang c
ung th v hoc ung th ni mc t cung, tiu ng nng vi cc thay i mch mu, cc ri

lon chuyn ha lipid, tin s nhim herpes lc mang thai, x cng tai vi tnh trng nng hn
lc mang thai.
THN TRNG LC DNG
Thn trng khi s dng trong nhng trng hp : tiu ng, tng huyt p, dn tnh mch, x
cng tai, bnh x cng ri rc, ng kinh, ri lon chuyn ha porphyrin, co cng c, ma git
loi thng thng. Trong nhng trng hp ny, cng nh khi c tin s vim tnh mch, hay
khuynh hng tiu ng, ch dng Diane-35 di s gim st y khoa cht ch.
L{ do ngng dng Diane-35 tc th :
Cc cn au na u xut hin ln u, cc cn nhc u d di bt thng xy ra thng
xuyn hn, cc ri lon t ngt v nhn thc (v d ri lon th gic v thnh gic), du hiu
u tin ca vim tc tnh mch hoc huyt khi nghn mch (v d au bt thng hay sng
cng chn, au nh m khi ht th hay khi ho m khng c l do r rng), cm gic au hoc
tc ngc ; trong khi ch phu thut (6 tun chun b trc ), tnh trng bt ng (v d sau
tai nn). Trong tt c cc trng hp trn c s gia tng nguy c to huyt khi. Cc l do khc
ngng thuc l : xut hin vng da, vim gan khi pht, nga ton thn, cc cn ng kinh
gia tng, huyt p tng ng k, thai kz.
Ghi ch c bit :
Khng dng Diane-35 cho nam gii.
Theo cc hiu bit hin nay, c s kt hp gia vic dng cc ch phm phi hp progesteronestrogen vi nguy c gia tng bnh l huyt khi tc tnh mch v ng mch l khng th loi
tr.
Nguy c tng i ca huyt khi ng mch (v d : t qu, nhi mu c tim) s cng tng
thm khi c ht thuc l nhiu, tui cao v dng ng thi thuc nga thai ung.
nhng trng hp him u lnh ca gan v ngay c nhng trng hp rt him u c tnh ca
gan, mt s ca l t, dn n xut huyt trong bng nguy him n tnh mng, c th xy ra
sau khi dng cc cht ni tit t. Thy thuc phi c thng bo v vic xy ra ca nhng cn
au bng trn bt thng m khng gim ngay trong thi gian ngn.
TNG TC THUC
Barbiturates, phenylbutazone, hydantoins, rifampicin, ampicillin lm gim tc dng ca Diane35. Nhu cu dng thuc tr tiu ng dng ung hay insulin c th thay i khi dng phi hp
vi Diane-35.
TC DNG NGOI
Trng hp him, c th xy ra nhc u, au d dy, bun nn, cm gic cng v, thay i th
trng v tnh dc, hoc trm cm.
ph n d mc bnh, dng lu di Diane-35 i khi c th gy ra nhng mng mu hi nu
trn mt v nhng mng ny s r hn nu tip xc lu vi nh nng mt tri. Do nhng
ph n c khuynh hng ny nn trnh ngoi nng qu lu.

Trng hp ring l c bo co c km dung np vi knh st trng.

LIU LNG v CCH DNG
Trc khi bt u dng Diane-35, cn phi thc hin khm k v ni khoa tng qut, v ph
khoa (k c khm v v lm pht t bo c t cung) v cn phi ghi nhn cn thn tin s gia
nh.
Ngoi ra, tnh trng ri lon h thng ng mu phi c loi tr nu c bt kz ngi no
trong gia nh c bnh l huyt khi tc mch (v d huyt khi tnh mch su, t qu, nhi
mu c tim) t lc tui tr. C thai cng phi loi tr. thn trng, nn thc hin khm kim
tra khong mi 6 thng khi iu tr lu di vi Diane-35.
Bt u iu tr :
i n kz kinh k. Bt u dng thuc vo ngy u tin ca chu kz kinh (= ngy u tin c
kinh).
Chu kz u tin s hi ngn hn thng l, nhng chu kz sau s ko di 4 tun.
Dng v thuc c ghi ngy nh :
Ly vin thuc u tin ra khi v phn c nh du vi ngy tng ng trong tun (v d :
"th 2" tng ng vi ngy th 2 trong tun), n vin thuc ra ngoi qua lp giy nhm, v
nut nguyn vin thuc vi mt t nc. Ung thuc vo gi no trong ngy khng quan trng,
nhng mt khi chn mt thi im c bit, thng l sau n sng hay n ti, th nn dng
thuc ng vo thi im ca mi ngy.
Mi ngy 1 vin trong 21 ngy :
T ngy th nh, mi ngy phi ung 1 vin thuc theo hng mi tn trn v thuc cho n
ht v. Nu qun khng chc l ung hay cha vin thuc ca ngy , ch cn nhn trn v
thuc s bit ngay.
7 ngy khng ung thuc :
Sau khi ung ht 21 vin, c 7 ngy khng ung thuc, trong thi gian ny s xy ra xut huyt
ging kinh nguyt.
Tip tc iu tr :
Sau thi gian ngh 7 ngy, s dng thuc tr li vi v thuc k tip, bt k kinh ht hay vn
cn (thng ht kinh).
Tm li, vic dng thuc theo mt qui trnh n gin l 3 tun ung thuc, 1 tun khng ung
thuc, v mi v thuc mi s bt u vo ngy trong tun ging nh i vi v thuc c.
Ch :
- Ung thuc khng u, i ma hay ri lon tiu ha vi tiu chy, ri lon chuyn ha rt
him khi xy ra hoc dng k o di ng thi vi mt s thuc khc (xem Tng tc thuc) c
th nh hng n tc dng nga thai (triu chng u tin l xut huyt gia chu kz). Cc
thuc nhun trng nh khng lm gim tc dng ca thuc.
- Thi gian s dng : Thi gian s dng thuc ty thuc vo nng ca bnh cnh lm sng ;

thng thng nn iu tr nhiu thng. Nn ung Diane-35 t nht 3 n 4 thng sau khi gim
triu chng. Nu bnh ti pht nhiu tun hoc nhiu thng sau khi ngng thuc, c th dng
li Diane-35.
- Nu xy ra xut huyt gia chu kz : Nu xy ra xut huyt "khng theo lch" trong thi gian
ung Diane-35 th khng c ngng ung thuc. Xut huyt nh thng s t ngng. Tuy
nhin, nu xut huyt nng ging nh hnh kinh th nn hi kin bc s
- Nu qun ung thuc vo gi thng l, phi ung vin thuc ny trong vng 12 gi. Nu
hn 12 gi so vi gi ung thuc hng ngy v nu b nn i hoc tiu chy, phi tip tc ung
vin thuc khc trong v vo gi thng l trnh xy ra xut huyt sm do ngng thuc
trong chu kz ny. Tuy nhin, cng lc ny, bin php nga thai khng dng ni tit t (ngoi l :
phng php tnh theo chu kz v phng php theo di nhit ) cn c p dng thm cho
n khi dng ht v thuc ny, ngn nga c thai xy ra. y l l{ do bt buc ngng
dng Diane-35.
Sau khi dng ht v thuc, c khong thi gian 7 ngy khng ung thuc v lc ny xut huyt
xy ra nh thng l.
Nu khng xy ra xut huyt, cn chc chn phi khng c thai mi tip tc dng thuc.

150.

DIAPHYLLIN

GEDEON RICHTER
dung dch tim 240 mg/5 ml (4,8%) : ng 5 ml, hp 5 ng.
THNH PHN
cho 1 ng 5 ml
Aminophylline

240 mg

DC LC
Diaphyllin lm d dng s vn chuyn ion Ca2+ t bo tng vo khoang gian bo, kt qu l
gin t bo c, lm mt s co tht ph qun, s thng kh ph nang c phc hi. Nh hot
tnh gin c, Diaphyllin lm tng nhp th v su ca nhp th, l kt qu ca s kch thch
trung tm vagus v trung tm vn mch. Nh tc dng trc tip ln tim, Diaphyllin ci thin
c tun hon mch vnh. Song song vi s tng p sut bm mu, s lc cu thn cng tng.
Diaphyllin lm tng th tch nc tiu bng cch lm tng s bi tit Na+ v Cl-.
CH NH

iu tr hen tim v hen ph qun, vim ph qun co tht, vim ph qun mn, suy tim mt b,
kh th kch pht ban m, au tht ngc khi gng sc, bloc nh-tht khng vi atropin pht
trin trn c s thiu mu cc b, lm tm ngng tc dng ca dipyridamol, tnh trng ph, ri
lon tun hon no do va x ng mch, ri lon vi tun hon do cao huyt p, chng i tp
tnh cch hi.
CHNG CH NH
Nhi mu c tim va mi xy ra, lon nhp tim, bnh lot.
CH PHNG v THN TRNG LC DNG
- Hm lng iu tr ca Diaphyllin trong huyt tng l 5-20 mg/ml. Do tc dng trc tip kch
thch tim v thn kinh, Diaphyllin ch c th dng ng tim tnh mch, nhng phi tim rt
chm.
- Trong trng hp thiu niu, nn gim liu. Trong thi gian dng thuc, khong thi gian ng
c th gim. Nu tim ra ngoi tnh mch hay tim trong ng mch, thuc c th lm h hoi
m trm trng, thm ch hoi t. Trong trng hp rung nh mn tnh, vic dng thuc phi
c theo di thn trng do c nguy c nghn mch. Trong trng hp ngi c huyt p
khng n nh, nn dng Diaphyllin di dng truyn dch chm, nhng phi kim sot huyt
p.
TNG TC THUC
Thn trng khi phi hp :
- Cc dn xut khc ca theophyllin hay purine (c th gy ra nhng phn ng khng mong
mun).
- Cc thuc chng cao huyt p (c th gy ra h huyt p).
- Cc thuc cng giao cm, cc xanthine khc (dng song song c th lm tng c tnh ca
thuc).
- Cc thuc phong b th th H2 (lm tng nng ca thuc trong huyt tng).
- Diaphyllin c th lm ngng tc dng ca diazepam.
Thuc c tng k ha hc vi cc hp cht sau : cephalothin, chloropromazine, codein,
corticotropin, dimenhydrinate, doxapram, dihydralazine, tetracycline dng trong vng mt gi,
pethidine, phenytoin, prochlorperazine edysilate, promazine hydrochloride, promethazine
hydrochloride, vancomycin.
Thuc c tng k vt l vi nhng hp cht sau y : adrenaline, anileridine phosphate, acid
ascorbic, chloramphenicol, chlortetracycline, doxycycline, erythromycin, hyaluronidase,
levorphanol, methicillin, morphine, noradrenaline, novobiocin, nitrofurantoin, oxacillin,
penicillin lactate, Ringer-lactate, phenobarbital, procain dng trong vng 24 gi,
succinylcholine, sulfadiazine, sulfafurazole, diethanolamine, thiopentone, vitamin E, mui
warfarin.
TC DNG NGOI

Mt bng, nhc u, bun nn, mt ng, nh trng ngc, kinh git, protein niu v huyt
niu, kch ng, ban xut huyt, ri lon tiu ha, bn chn, co git, lo u, kh th, tng thng
kh phi, h huyt p, try mch, lon nhp tim, t t.
LIU LNG v CCH DNG
Tim chm 240 mg (1 ng) mi ngy, ch dng ng tim tnh mch.
BO QUN
Bo qun nhit t 15oC n 30oC.

151.

DIARSED

SANOFI SYNTHELABO VIETNAM

Vin bao : hp 20 vin.
THNH PHN
cho 1 vin
Diphnoxylate

2,5 mg

Atropine

0,025 mg

DC LC
Diphnoxylate l mt cht chng tiu chy kiu morphine, tc ng trn vn ng tnh ca
rut.
Atropine, vi hm lng trong cng thc, khng c tc dng chng tiu chy, nhng c kt
hp vi diphnoxylate nhm trnh l thuc diphnoxylate.
DC NG HC
Sau khi ung, t nng nh trong mu sau 2 gi. Thi gian bn hy trong huyt tng : 2
gi 50.
Thi tr ch yu qua phn v mt phn qua nc tiu di dng cc cht chuyn ha kt hp.
CH NH
iu tr triu chng tiu chy cp v mn do tng nhu ng rut. iu tr ny khng thay th
cho mt liu php b nc v cc cht in gii khi cn thit.
CHNG CH NH
Lin quan n atropine :
Glaucome gc ng, nguy c b b tiu do ri lon niu o-tuyn tin lit.

Lin quan n diphnoxylate :

- Khng dng cho tr di 30 thng.
- t cp ca vim i trng xut huyt.
- Ph n mang thai v cho con b.
THN TRNG LC DNG
Nn kim tra nhy cm ca tng c nhn vi diphnoxylate, biu hin bng hin tng ng
g.
TNG TC THUC
Diphnoxylate c th lm nng thm cc tc dng c ch thn kinh trung ng ca cc thuc
barbiturate, thuc bnh thn, ru...
TC DNG NGOI
Bun nn, nn, cng trng bng, au u, pht ban ngoi da, kh ming (do atropine), v ng
g (do diphnoxylate) c th xut hin khi dng vi liu cao.
LIU LNG v CCH DNG
Ngi ln :
Tiu chy cp : liu khi u l 2 vin, sau c mi ln i phn lng ung thm 1 vin (ti a 8
vin/ngy).
Tiu chy mn : 1-2 vin/ngy.
Tr em trn 30 thng : 2,5 mg/5 kg/ngy hay 1-4 vin/ngy.
BO QUN
Ni kh mt.

152.

DICLOBERL

BERLIN CHEMIE
c/o SAGOPHA
vin nn tan trong rut 50 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Diclofnac sodique

50 mg

DC LC
Diclofnac l mt thuc khng vim khng stroide thuc dn xut ca acide phnylactique,

nhm acide carboxylique vng c cc tc ng :

- Khng vim, gim au, h st.
- c ch tng hp prostaglandine.
- c ch kt tp tiu cu.
DC NG HC
Cc thng s dc ng hc khng thay i theo tui.
Hp thu :
Diclof nac c nhanh chng hp thu hon ton qua ng ung. Nng ti a trong huyt
tng t c l 1,5 mg/l hai gi sau khi ung.
Phn b :
Gn 99,7% vi protine huyt tng. Diclof nac i vo c hot dch.
Thi gian bn hy thi tr t hot dch l 3-6 gi.
Chuyn ha v bi tit :
ngi cht chuyn ha ch yu l phc cht 4'-hydroxydiclofnac. Bi tit 20-30% liu dng
qua nc tiu. C 3 cht chuyn ha khc c bi tit 10-20% trong nc tiu v vi mt t l
thp qua ng mt.
90% lng thuc ung vo c bi tit trong 96 gi u sau khi ung. 0,7% lng thuc ung
vo c bi tit trong nc tiu di dng khng thay i, 5-10% di dng diclofnac kt
hp, 50% di dng phc hp hydroxyl ha kt hp.
thanh thi huyt tng l 263 ml/pht.
CH NH
- Vim khp cp (k c bnh thng phong).
- Vim khp mn nht l vim khp dng thp (vim a khp mn tnh).
- Vim khp t sng cng khp (bnh Bechterew) v cc bnh vim ct sng khc do thp.
- Tnh trng kch thch trong cc bnh thoi ha khp v ct sng.
- Tnh trng vim, sng, au phn mm sau chn thng sau phu thut.
CHNG CH NH
- Qu mn cm vi diclofnac.
- Ri lon v to mu.
- Lot d dy, rut.
- 3 thng cui ca thai kz.
- Tr em.
- Qu mn i vi sulfite (dng tim).
THN TRNG LC DNG
Cn thn trng khi dng cho ph n c thai trong 6 thng u thai kz, ph n cho con b, cho
cc bnh nhn b suy thn, suy gan, suy tim, hen suyn, nhim trng mn tnh ng h hp,
cao huyt p, qu mn vi cc loi thuc gim au.

TNG TC THUC
Thuc li tiu : gim tc dng thuc li tiu.
Thuc chng cao huyt p : gim tc dng h huyt p.
Glucocorticoide, cc thuc khng vim khc : tng nguy c xut huyt tiu ha.
M thotrexate : tng c tnh ca mthotrexate.
TC DNG NGOI
C th gp :
Ri lon tiu ha : bun nn, i, tiu chy...
D ng : mn da, co tht ph qun.
i khi lo t d dy, xut huyt d dy tim n.
Ri lon to mu : him gp.
Ri lon thn kinh trung ng (him gp) : nhc u, mt mi, mt ng...
Ri lon chc nng gan, thn : him gp.
LIU LNG v CCH DNG
Dng cho ngi ln : mi ln ung 1 vin, t 1 n 3 ln mi ngy.

153.

DICYNONE

SANOFI SYNTHELABO VIETNAM

vin nn 500 mg : hp 20 vin.
dung dch tim 250 mg/2 ml : ng 2 ml, hp 6 ng.
THNH PHN
cho 1 vin
tamsylate

500 mg

(Sulfite)

cho 1 ng
tamsylate
(Sulfite)

250 mg

DC LC
Chng xut huyt v bo v mch mu.
Tng cng sc khng ca mao mch v lm gim tnh thm ca mao mch.
DC NG HC
ngi, tamsylate c hp thu chm qua ng tiu ha. Sau khi ung 500 mg, nng
nh trong huyt tng t c l 15 mg/ml sau 4 gi. Thi gian bn hy o thi trong huyt
tng l khong 8 gi. i vi dng tim, 1 gi sau khi tim (IV hoc IM) 500 tamsylate, nng
trong huyt tng c ghi nhn l 30 mg/ml. Cc thi gian bn hy trong huyt tng
tng ng l 1,9 gi (IV) v 2,1 gi (IM).
T l gn vi protine huyt tng cao, vo khong 95%.
Etamsylate c o thi ch yu qua nc tiu di dng khng b chuyn ha (trn 80%).
CH NH
Dng ung (Dicynone 500 mg) :
Ni khoa :
- iu tr cc triu chng c lin quan n suy tun hon tnh mch bch huyt : chn nng, d
cm, chut rt, au nhc, bt rt khi nm.
- H tr iu tr cc trng hp xut huyt do ri lon chc nng ca tnh bn mao mch :
mng bm mu, m xut huyt, chy mu nu rng, chy mu cam.
Nhn khoa : iu tr cc ri lon nh hng n tun hon vng mc v/hay mch mc.
Ph khoa : iu tr cc ri lon mao mch tnh mch v xut huyt trong ph khoa.
Dng tim (Dicynone 250 mg/2 ml) :
Ni khoa :
- Xut huyt do ri lon chc nng ca tnh bn mao mch.
- Rong kinh khng do nguyn nhn thc th.
Trong phu thut hay trong cc chuyn khoa (tai mi hng, nhn khoa, ph khoa) :
- Gim mt mu trong phu thut, nht l trng hp chy mu tng m do v mao mch,
bnh nhn ang iu tr bng cc thuc c tc dng chng ng mu.
CH PHNG
Nu b st phi ngng thuc ngay.
Thuc c cha sulfite (cht bo qun) c th gy ra hoc lm nng thm cc phn ng kiu
phn v.
LC C THAI
Ch dng thuc khi c thai trong nhng trng hp tht s cn thit.
LC NUI CON B
Khng nn cho con b trong thi gian iu tr.
TC DNG NGOI
C th gy st, nhc u, pht ban da v cc ri lon nh ng tiu ha nh bun nn, nn

hay tiu chy.

LIU LNG v CCH DNG
ng ung : 3 vin/ngy.
ng tim :
Ngi ln :
- Cp cu : 2-3 ng, 3 ln/ngy.
- Tin phu : 1 gi trc khi phu thut : 2 ng, tim bp hoc tim tnh mch.
- Hu phu : 1 ng, tim bp hoc tim tnh mch, 2 ln/ngy.
Tr s sinh v tr em : na liu ngi ln.
Lu { : dung dch tim c th dng :
- ung : pha vi mt t nc.
- chm ti ch.

154.

DIFFERIN Gel

GALDERMA
gel bi ngoi da : ng 15 g, 30 g.
THNH PHN
cho 100 g gel
Adapalene

0,1 g

T dc : carbomer, propylene glycol,

poloxamer 182, disodium edetate, methyl
parahydroxybenzoate, phenoxyethanol,
sodium hydroxyde iu chnh pH=5,
nc ct.
DC L LM SNG
Adapalene l mt hp cht dng retinoid c chng minh l c hot tnh khng vim in
vivo v in vitro ; adapalene bn vng vi oxygen v nh sng v khng c phn ng v mt ha
hc. C ch hot ng ca adapalene, ging nh tretinoin, l gn kt vo cc th th acid
retinoic c hiu ca nhn, nhng khc tretinoin ch khng gn vo protein ca th th trong
bo tng.

Adapalene khi dng trn da c tc dng phn hy nhn mn v cng c tc dng trn nhng
bt thng ca tin trnh sng ha v bit ha ca biu b, c hai trng hp ny u l nhng
yu t gy mn trng c (acne vulgaris). Phng thc tc ng c ngh ca adapalene l
bnh thng ha tin trnh bit ha ca cc t bo nang biu m v do , lm gim s hnh
thnh cc vi nhn mn trng c.
Adapalene c u im hn cc retinoid trong th nghim khng vim tiu chun c in vitro v
in vivo. C ch ca n l c ch cc p ng ha ng ng v ha tng ng ca bch cu a
nhn ngi v c s chuyn ha bng cch lipoxide ha acid arachidonic thnh cc cht trung
gian tin vim. c tnh ny gi rng thnh phn vim qua trung gian t bo ca mn
trng c c th b adapalene tc ng. Cc nghin cu ngi cho nhng bng chng lm
sng v vic adapalene dng trn da c hiu qu trong gim bt phn vim ca mn trng c
(sn v mn m).
ngi, adapalene c hp thu qua da km ; trong cc th nghim lm sng, khng tm thy
c nng adapalene trong huyt tng mc c th o c khi s dng di hn trn
mt vng da rng b mn trng c vi mc nhy cm phn tch l 0,15 ng/ml. Sau khi x l
[14C]-adapalene chut ln (tim tnh mch, tim phc mc, ung v dng ngoi da), th
(tim tnh mch, ung v dng ngoi da) v ch (tim tnh mch v ung), hot tnh phng x
phn b mt s m v c tm thy nhiu nht gan, lch, thng thn v bung trng.
Chuyn ha thuc ng vt cha c xc nh r rng, ch yu theo con ng O-demethyl
ha, hydroxyl ha v lin hp, v o thi ch yu l qua ng mt.
Trong cc nghin cu trn ng vt, adapalene c dung np rt tt khi dng ngoi da trong 6
thng th v 2 nm chut nht. Triu chng ng c ch yu tm thy cc loi ny khi
dng theo ng ung c lin quan n hi chng thng d vitamin A, gm c long xng,
tng phosphatase kim v thiu mu nh. Liu ung adapalene cao khng gy tc dng ngoi
trn thn kinh, tim mch hay h hp ng vt. Adapalene khng gy t bin. Cc nghin cu
sut i vi adapalene c thc hin hon tt chut nht vi liu bi da l 0,6 ; 2 v 6
mg/kg/ngy v chut ln vi liu ung 0,15 ; 0,5 v 1,5 mg/kg/ngy. Khm ph ng k duy
nht l s gia tng c { ngha thng k u t bo a crm lnh tnh ca phn ty thng thn
chut ln c dng adapalene vi liu 1,5 mg/kg/ngy. Cc thay i ny khng c xem l c
lin quan n s s dng adapalene ngoi da.
CH NH
Differin Gel c dng ngoi da iu tr mn trng c khi c nhiu nhn trng c (mn cm
u trng, u en), sn v mn m. Thuc dng c cho mn trng c mt, ngc v lng.
CHNG CH NH
Qu mn vi bt kz thnh phn no ca thuc.
CH PHNG v THN TRNG LC DNG
Tng qut : Nu xut hin phn ng nhy cm hay kch ng trm trng, nn ngng thuc. Nu

mc kch ng ti ch l bo ng, nn hng dn bnh nhn ko di khong cch dng

thuc, tm thi ngng thuc hay ngng hn.
Differin Gel khng nn cho tip xc vi mt, ming, hc mi hay nim mc. Nu thuc dy vo
mt, ra ngay lp tc bng nc m. Khng nn bi thuc ln da b try (da b ct hay b trc)
hay da b eczema cng nh trn bnh nhn b mn trng c nng.
LC C THAI v LC NUI CON B
Khng c thng tin v s s dng adapalene ph n c thai. Do , khng nn dng
adapalene trong thai kz.
Khng bit c rng thuc c tit qua sa ca ng vt hoc ngi hay khng. Do nhiu
thuc c bi tit qua sa m, nn thn trng khi dng Differin Gel cho ph n nui con b.
Trong trng hp ang nui con b, khng nn bi thuc ln ngc.
TNG TC THUC
Khng c tng tc no c bit gia cc thuc khc c s dng ng thi trn da vi
Differin Gel ; tuy nhin, khng nn dng ng thi cc thuc retinoid hay cc thuc khc c
cng phng thc tc ng vi adapalene.
Adapalene bn vng vi oxygen v nh sng v khng c phn ng v mt ha hc. Trong khi
cc nghin cu rng ri trn ng vt v ngi khng cho thy kh nng b tc hi ca nh sng
hay d ng nh sng vi adapalene, tnh an ton ca vic s dng adapalene khi tip xc nhiu
vi nh nng hay tia cc tm cha c xc nh trn c ng vt v ngi. Nn trnh tip xc
nhiu vi nh nng hay tia cc tm.
ngi, adapalene hp thu qua da k m, v do , tng tc vi cc thuc c tc dng ton
thn hu nh khng xy ra. Khng c bng chng v nh hng ca s s dng Differin Gel
ngoi da ln cc thuc dng theo ng ung nh thuc nga thai v khng sinh.
Differin Gel c kh nng gy kch ng ti ch nh, do , s s dng ng thi cc thuc c tc
dng bong da, se da hay nhng thuc c tnh kch ng c th gy kch ng gp. Tuy nhin, cc
thuc iu tr mn trng c trn da nh dung dch erythromycin (vi nng n 4%) hay
clindamycin phosphate (1% dng base) hay dng gel nc benzoyl peroxide vi nng n
10%, c th c s dng vo bui sng trong khi Differin Gel c dng vo bui ti do khng
c s phn hy gia cc thuc cng nh kch ng gp.
TC DNG NGOI
Tc dng ngoi ch yu c th xut hin trn da l kch ng da. Tuy nhin, tc dng ny hi
phc khi ko di khong cch dng hay ngng thuc.
LIU LNG v CCH DNG
Liu lng :
Differin Gel nn c dng trn c vng da b mn trng c mi ngy mt ln trc khi ngh
ngi v sau khi ra sch s, ch khng phi ch chm ln u mn. Nn bi mt lp mng,
trnh tip xc vi mt v mi (xem Ch { phng v Thn trng lc dng). Ch lau tht kh

vng da b mn trc khi bi thuc. Thng thng cn iu tr t 8 n 12 tun.

Vi nhng bnh nhn cn phi ko di khong cch dng thuc hay tm thi ngng iu tr, c
th s dng thng xuyn tr li hoc tip tc tr liu khi xt rng bnh nhn c th dung np
bnh thng vi tr liu tr li.
Nu bnh nhn c s dng m phm, nn dng m phm khng gy nhn mn v khng lm se
da.
Tnh an ton v hiu qu ca Differin Gel cha c nghin cu tr nh v tr s sinh.
Cch dng : Bp nh ng thuc phn ui, ly mt lng gel va trn u ngn tay bi
ln c vng da b mn. ng cht np ng sau khi dng.
QU LIU
Differin Gel khng c dng theo ng ung v ch dng trn da. Nu dng qu nhiu thuc
s khng thu c kt qu nhanh chng hay tt hn m c th b da, bong da hay kh chu.
c tnh cp theo ng ung trn chut nht cao hn 10 g/kg. Khi nut nhm, tr khi ch nut
mt lng nh, nn xem x t n phng php ra d dy thch hp.
BO QUN
Bo qun nhit khng qu 25oC.
Trnh ng lnh khi vn chuyn v tn tr.
Trnh xa tm tay ca tr em.

155.

DIFLUCAN TRIFLUCAN

PFIZER
c/o ZUELLIG
Diflucan vin nang 150 mg : v 1 vin, v 2 vin.
Triflucan vin nang 50 mg : v 7 vin, chai nha 100 vin.
Triflucan dung dch tim truyn 2 mg/ml : l thy tinh 50 ml, 100 ml - Bng B.
THNH PHN
cho 1 vin nang
Fluconazole

150 mg

cho 1 vin nang

Fluconazole

50 mg

cho 1 ml dung dch

Fluconazole

2 mg

DC LC
Fluconazole l mt thuc thuc nhm khng nm mi loi triazole, c ch mnh v c hiu i
vi s tng hp sterol ca nm.
Khi dng ng ung v c theo ng tim tnh mch, fluconazole tc ng trn cc loi
nhim nm khc nhau th vt th nghim. Thuc c chng minh c tc ng chng li
cc nm c hi, nh nhim Candida spp., bao gm nhim Candida ton thn trn th vt b lm
suy gim min dch ; nhim Cryptococcus neoformans, bao gm nhim nm ni s ; nhim
Microsporum spp., v Trichophyton spp. Fluconazole cng cho thy c hot tnh trn cc mu
th vt nhim nm khc nh Blastomyces dermatitides ; nhim Coccidioides immitis, bao gm
nhim nm bn trong hp s ; v vi Histoplasma capsulatum th vt bnh thng v th b
lm suy gim min dch.
Fluconazole c tnh c hiu cao i vi enzyme l thuc cytochrome P-450 nm. Dng 50 mg
fluconazole mi ngy n 28 ngy c chng minh khng lm nh hng n nng
testosterone trong huyt tng nam gii cng nh nng steroide n gii trong tui
c th c con. Dng fluconazole 200-400 mg mi ngy khng c nh hng ng k v mt lm
sng trn nng steroide ni sinh hay trn p ng kch thch ATCH nhng ngi nam tnh
nguyn khe mnh. Cc nghin cu tng tc thuc vi antipyrine cho thy rng liu n hay
nhiu liu fluconazole 50 mg khng lm nh hng chuyn ha ca cht ny.
DC NG HC
Tnh cht dc ng hc ca fluconazole khi dng theo ng ung v ng tim tnh mch
cng tng t nhau. Fluconazole c hp thu d dng sau khi ung v t n nng trong
huyt tng (v sinh kh dng ton thn) trn 90% nng t c sau khi tim tnh mch.
S hp thu theo ng ung khng b nh hng khi dng ng thi vi thc n. Nng nh
trong huyt tng lc i t c t 0,5 n 1,5 gi sau khi ung vi thi gian bn hy o
thi trong huyt tng vo khong 30 gi. Nng huyt tng t l vi liu lng v t n
90% nng n nh vo ngy 4-5 khi dng nhiu ln liu duy nht mi ngy.
Liu tn cng (vo ngy th nht) gp i liu thng thng hng ngy cho ph p t n
khong 90% nng n nh trong huyt tng vo ngy th hai. Th tch phn b o c

gn bng tng lng nc ca c th. Thuc t gn kt vi proteine huyt tng (11-12%).

Fluconazole xm nhp tt vo tt c cc m c th. Nng fluconazole trong nc bt v
m tng t nh nng trong huyt tng. nhng bnh nhn vim mng no do nm,
nng flucoanzole trong dch no ty khong 80% nng tng ng trong huyt tng.
Nng fluconazole da cao trn mc nng trong huyt thanh t c lp sng,
thng b-biu b v m hi. Fluconazole tch t trong lp sng. Vi liu 50 mg mi ngy mt
ln, nng fluconazole sau 12 ngy l 73 mg/g v sau khi ngng iu tr 7 ngy nng vn
cn duy tr 5,8 mg/g. Vi liu 150 mg mi tun mt ln, nng fluconazole trong lp sng vo
ngy th by l 23,4 mg/g v 7 ngy sau liu th hai vn cn gi c l 7,1 mg/g.
Nng fluconazole mng sau 4 thng dng 150 mg mi tun mt ln l 4,05 mg/g mng
khe mnh v 1,8 mg/g mng b nhim nm ; fluconazole vn cn tm thy c trong mng
6 thng sau khi ngng iu tr.
ng o thi ch yu ca thuc l thn, vi khong 80% liu dng xut hin trong nc
tiu di dng khng i. Thanh thi fluconazole t l vi thanh thi creatinine. Khng thy cc
cht chuyn ha trong mu.
Thi gian bn hy trong huyt tng k o di lm c s cho vic tr liu liu duy nht trong bnh
Candida m o dng mi ngy mt ln v mi tun mt ln i vi nhng ch nh khc.
Trong mt nghin cu so snh nng trong nc bt v huyt tng sau liu duy nht 100
mg fluconazole di dng hn dch ung bng cch sc v gi li trong ming 2 pht ri nut
hay dng di dng vin nang, nng ti a trong nc bt ca fluconazole sau khi ung hn
dch t c sau 5 pht v gp 182 ln so vi khi dng vin nang c nng ti a trong nc
bt t c sau 4 gi. Sau khong 4 gi, nng fluconazole trong nc bt l tng t
nhau. Din tch di ng cong AUC (0-96) trung bnh trong nc bt cao hn ng k sau khi
dng dng hn dch khi so snh vi vin nang. Khng c s khc bit ng k trong tc o
thi khi nc bt hay cc thng s dc ng hc trong huyt tng cho c hai dng bo ch.
AN TON TIN LM SNG
Tnh gy ung th :
Khng thy bng chng Fluconazole c kh nng gy ung th chut nht v chut cng c
cho ung trong 24 thng vi liu 2,5 hoc 5 hay 10 mg/kg/ngy (khong 2-7 ln cao hn liu
khuyn co dng cho ngi). Chut cng c c cho dng liu 5 v 10 mg/kg/ngy c t l
ung th gan dng t bo tuyn gia tng.
Tnh gy t bin :
Fluconazole c hay khng c hot ha chuyn ha vn cho kt qu m tnh i vi test v tnh
t bin trn 4 dng S. typhimurium, v h thng u lympho L5178Y chut nht. Nghin cu di
truyn hc t bo in vivo (t bo ty xng chut sau khi cho ung fluconazole) v in vitro (t
bo lympho ngi c cho dng fluconazole vi liu 1000 mg/ml) khng cho thy c bng
chng bin d nhim sc th.

Kh nng sinh sn :
Fluconazole khng lm nh hng n kh nng sinh sn trn chut c v chut ci c cho
ung vi liu hng ngy 5, 10 hay 20 mg/kg hay vi ng tim tnh mch 5, 25 hay 75 mg/kg,
mc d khi pht chuyn d c b tr hon nh vi liu 20 mg/kg theo ng ung. Trong mt
nghin cu dng thuc theo ng tim tnh mch lc sinh vi liu 5, 20 v 40 mg/kg, kh
v ko di thi gian chuyn d c quan st thy mt vi con ci vi liu 20 mg/kg (khong
5-15 ln cao hn liu khuyn co dnh cho ngi) v 40 mg/kg, nhng khng c vi liu 5
mg/kg. Cc ri lon khi chuyn d bao gm s gia tng nh s lng chut con cht khi sanh v
gim s sng st vi nhng mc liu ny. Tc dng trn sinh chut cng l ng nht vi
tnh cht h oestrogne c hiu ca loi khi dng liu cao fluconazole. Khng thy c s
thay i ni tit t nh vy ph n c cho dng fluconazole (xem Dc lc).
CH NH
C th iu tr trc khi c kt qu mu cy v cc xt nghim, tuy nhin, khi c kt qu nn
iu chnh tr liu cho thch hp.
- Cc bnh do Cryptococcus, bao gm vim mng no v nhim Cryptococcus cc v tr khc
(nh phi, da). Cng c th iu tr cc k ch thng thng v bnh nhn b nhim AIDS, cy
gh p c quan hay nhng nguyn do gy suy gim min dch khc.
- Cc bnh Candida ton thn, bao gm nhim Candida huyt, Candida khu tr v cc dng khc
ca nhim Candida xm ln bao gm nhim nm phc mc, ni tm mc, mt, ng h hp
v ng niu. Thuc c th dng trong trng hp cc bnh nhn bnh c tnh, ang cp cu,
dng cc thuc c t bo hay suy gim min dch, hay c nhng tc nhn khc c th dn n
nhim Candida.
- Bnh Candida nim mc bao gm Candida ming hu, thanh qun, ph qun-phi khng xm
ln, Candida niu, Candida da nim mc v Candida ming th teo mn tnh (lot ming do
rng gi). C th dng iu tr cc k ch thng thng v bnh nhn suy gim min dch v
ngn nga ti pht bnh Candida ming hu nhng bnh nhn AIDS.
- Candida sinh dc. Bnh Candida m o cp hay ti pht ; d phng lm gim t l ti pht
Candida m o (3 hay nhiu cn mi nm). Vim quy u do Candida.
- Ngn nga nhim nm do ha tr liu c t bo hay x tr dng trong iu tr cc bnh c
tnh.
- Nm da bao gm nm chn, nm thn, nm i, lang ben, nm mng v trng hp nhim
Candida da khc.
- Nm su, bao gm bnh nm Coccidioides immitis, bnh nm Paracoccidioides, bnh nm
Sporotrichum v nhim nm Histoplasma trn nhng bnh nhn suy gim min dch.
CHNG CH NH
Khng nn dng fluconazole cho nhng bnh nhn qu mn bit vi thuc hay nhng hp
cht c azole. Do cc kt qu nghin cu v tng tc thuc a liu (xem Tng tc thuc),

khng dng ng thi vi terfenadine nhng bnh nhn ang dng fluconazole a liu vi
400 mg mi ngy hay cao hn.
CH PHNG v THN TRNG LC DNG
Trong nhng trng hp him, fluconazole i km vi nhim c gan nng c th gy t vong,
ch yu nhng bnh nhn mc bnh nng. Trong trng hp c tnh trn gan do
fluconazole, khng quan st c mi lin h r rng vi tng liu dng hng ngy, thi gian
ko di tr liu, gii tnh hay tui tc ca bnh nhn. c tnh trn gan ca fluconazole thng
hi phc khi ngng thuc. Bnh nhn c nhng bt thng xt nghim trn chc nng gan
trong khi tr liu vi fluconazole nn c kim tra v s pht trin ca cc tn thng gan
trm trng hn. Nn ngng dng fluconazole nu pht trin cc du hiu v triu chng lm
sng gi cho bnh gan m c th l do fluconazole.
Him khi bnh nhn xut hin nhng phn ng da trc vy nh hi chng Stevens-Johnson v
hoi t nhim c da trong qu trnh iu tr vi fluconazole. Bnh nhn AIDS c nguy c cao
hn v phn ng da trm trng vi nhiu loi thuc. Nu c ni ban bnh nhn c iu tr
vi nhim nm nng c cho l do fluconazole, nn ngng dng thuc ny. Nu bnh nhn
nhim nm xm ln/ton thn b ni ban, nn theo di cht ch v ngng fluconazole nu pht
trin cc sang thng bng nc hay ban a dng. Phn v cng c bo co trong
nhng trng hp him nh vi nhng hp cht azole khc.
Nn c bit cn thn khi dng fluconazole vi liu thp hn 400 mg mi ngy ng thi vi
terfenadine (xem Tng tc thuc).
c nhng bo co v tai bin trn tim bao gm xon nh bnh nhn dng cng lc
fluconazole v cisapride (xem Tng tc thuc).
Trong nhng trng hp him, cng nh cc azole khc, c bo co v phn ng phn v.
Tc ng ln kh nng li xe v thao tc my mc :
Kinh nghim vi fluconazole cho thy rng tr liu hu nh khng lm nh hng n kh nng
li xe hay s dng my mc.
LC C THAI v LC NUI CON B
Khng c nghin cu y v c kim chng r rng trn ph n c thai. c bo co v
cc bt thng bm sinh tr s sinh c m c iu tr trong 3 thng hay lu hn vi liu
cao fluconazole (400-800 mg/ngy) iu tr bnh nm Coccidoides immitis. Mi lin h gia
s s dng fluconazole v cc bin c ny vn khng r rng. Cc tc dng nguy hi c th gy
t vong c quan st trn th vt ch khi dng liu cao i km vi nhng c tnh trn th m.
Cc khm ph ny khng c xem l tha ng vi fluconazole khi dng liu liu iu tr.
Tuy nhin, nn trnh s dng thuc lc c thai tr khi bnh nhn nhim nm nng hay c th
gy t vong m li ch mong i t fluconazole vt hn nguy c c th xy ra cho thai nhi.
Fluconazole c tm thy trong sa m vi nng tng t nh nng trong huyt tng,
do khng c s dng cho ph n ang nui con b.

TNG TC THUC
- Thuc chng ng : Trong mt nghin cu tng tc thuc, fluconazole lm gia tng thi gian
prothombine sau khi dng warfarine trn ngi nam khe mnh. Mc d mc thay i l
nh (12%), nn kim tra cn thn thi gian prothombine bnh nhn dng cc thuc khng
ng loi coumarin.
- Sulfonylurea : Fluconazole cho thy lm ko di thi gian bn hy trong huyt thanh khi dng
ng thi vi cc sulfonylurea (chlorpropamide, glibenclamide, glipizide v tolbutamine) trn
nhng ngi tnh nguyn khe mnh. C th dng ng thi fluconazole v sulfonylurea ung
bnh nhn tiu ng, tuy nhin nn lu { n kh nng xut hin cn h ng huyt.
- Hydrochlorothiazide : Trong mt nghin cu dc ng, dng cng lc nhiu liu
hydrochlorithiazide cho ngi tnh nguyn khe mnh ang ung fluconazole lm gia tng nng
trong huyt tng ca fluconazole ln 40%. Bc s nn lu { n tc ng ny nhng khng
cn phi thay i liu lng ca fluconazole trn nhng ngi dng ng thi cc thuc li
tiu.
- Phenytoin : Dng ng thi fluconazole v phenytoin c th lm gia tng nng phenytoin
n mc ng k v mt lm sng. Nu cn thit phi dng hai thuc ny ng thi, nn
kim tra nng v iu chnh liu lng phenytoin duy tr nng tr liu.
- Thuc trnh thai dng theo ng ung : Hai nghin cu ng hc vi thuc trnh thai phi
hp dng theo ng ung c thc hin vi a liu fluconazole. Khng c nh hng c
lin quan n nng hormone vi liu 50 mg fluconazone, trong khi nng 200 mg mi
ngy, din tch di ng cong ca ethilnyl estradiol v levonorgestrel gia tng ln lt l 40%
v 24%. Do , s s dng a liu fluconazole cc mc ny khng chc l c th c tc
ng ln hiu lc ca thuc trnh thai phi hp ung.
- Rifampicin : Dng ng thi fluconazole v rifampicine lm gim 25% din tch di ng
cong v rt ngn 20% thi gian bn hy ca fluconazole. Nn xem x t tng liu dng
fluconazole bnh nhn ang s dng ripampicin.
- Cyclosporin : Mt nghin cu ng hc trn bnh nhn ghp thn cho thy fluconazole 200
mg dng mi ngy lm gia tng mt cch chm chp nng cyclosporin. Tuy nhin, theo mt
nghin cu dng a liu vi 100 mg mi ngy, fluconazole khng lm nh hng nng
cyclosporin trn bnh nhn ghp ty. Nn kim tra nng cyclosporin trong huyt tng
nhng ngi ang s dng fluconazole.
- Theophylline : Trong mt nghin cu tng tc thuc c kim sot placebo, s dng 200 mg
fluconazole trong 14 ngy dn n s gim bt 18% thanh thi trung bnh trong huyt
tng ca theophylline. Nn theo di cc du hiu ng c theophylline bnh nhn dng liu
cao hay nhng ngi c nguy c gia tng ng c theophylline trong khi dng fluconazole, v
iu chnh liu lng cho thch hp nu c du hiu c tnh.
- Terfenadine : Do s xut hin ca lon nhp tim th pht do ko di khong QTc bnh nhn

dng cc thuc khng nm loi azole ng thi vi terfenadine, cc nghin cu tng tc

c thc hin. Mt nghin cu vi liu hng ngy 200 mg fluconazole khng chng minh
c s k o di on QTc. Mt nghin cu khc vi liu hng ngy 400 mg v 800 mg
fluconazole chng minh rng vic s dng 400 mg fluconazole hay nhiu hn mi ngy lm
gia tng ng k nng terfenadine trong huyt tng khi dng ng thi vi thuc ny.
Chng ch nh dng ng thi fluconazole vi liu 400 mg hay nhiu hn vi terfenadine (xem
Chng ch nh). Nn cn thn theo di trong trng hp dng ng thi terfenadine vi
fluconazole liu mi ngy thp hn 400 mg.
- Cisapride : c bo co v tai bin trn tim bao gm xon nh bnh nhn dng cng lc
fluconazole v cisapride.
- Rifabutin : c bo co v tng tc gia fluconazole dng ng thi vi rifabutin, lm tng
nng rifabutin trong huyt tng. Cng c bo co v chng vim mng mch nho bnh
nhn dng ng thi hai thuc ny. Nn theo di cn thn bnh nhn dng phi hp ny.
- Tacrolimus : c bo co v tng tc khi dng fluconazole ng thi vi tacrolimus lm
tng nng tacrolimus. Cng c bo co v c tnh trn thn bnh nhn dng ng thi
hai thuc ny. Nn theo di cn thn bnh nhn dng phi hp ny.
Zidovudine : c hai nghin cu ng hc dn n kt qu l gia tng nng zidovudine c
l gy nn do vic gim chuyn t zidovudine sang cht chuyn ha ch yu ca n. Mt nghin
cu xc nh nng zidovudine bnh nhn AIDS hay ARC trc v sau khi dng
fluconazole 200 mg mi ngy trong 15 ngy cho thy c mt s gia tng ng k trn din tch
di ng cong ca zidovudine (20%). Mt nghin cu th hai theo cch thc nh du cho
ngu nhin iu tr theo hai phc vi hai giai on nghin cu nng zidovudine cc
bnh nhn nhim HIV. Trong hai trng hp cch nhau 21 ngy, bnh nhn c cho dng
zidovudine 200 mg mi tm gi c hay khng c km theo 400 mg fluconazole mi ngy trong
vng 7 ngy. Din tch di ng cong ca zidovudine gia tng (74%) trong qu trnh s dng
ng thi vi fluconazole. Nn kim sot bnh nhn dng kt hp thuc ny v s pht trin
cc phn ng ph lin quan n zidovudine.
- S s dng fluconazole trn bnh nhn dng ng thi cisapride, astemizole, rifabutin,
tacrolimus hay cc thuc khc chuyn ha bi h thng cytochrome P-450 c th i km theo
s gia tng nng trong huyt thanh ca cc thuc ny. Do khng c thng tin xc nh, nn
cn thn khi dng ng thi vi fluconazole. Nn theo di bnh nhn cn thn (xem Ch {
phng v Thn trng lc dng).
- Cc nghin cu tng tc thuc cho thy rng khi ung fluconazole chung vi thc n,
cimetidine, cc thuc khng acid hay chiu x sau khi ghp ty xng, s hp thu fluconazole
khng b nh hng ng k trn lm sng.
- Cc bc s nn lu { cc tng tc khc c th xy ra do nghin cu tng tc vn cha c
thc hin vi mi loi thuc.

TC DNG NGOI
Ni chung fluconazole c dung np rt tt. Tc dng ngoi { thng gp nht l nhng triu
chng trn ng tiu ha ph thuc vo liu lng. Cc tc dng ngoi ny bao gm bun
nn, au bng, tiu chy v y hi. Triu chng thng gp sau l ni ban. Nhc u cng
i km vi s s dng fluconazole. mt vi bnh nhn, c bit nhng ngi mc nhng
bnh nh AIDS v ung th, quan st c nhng thay i trn xt nghim chc nng thn
v huyt hc v bt thng chc nng gan (xem phn Ch { phng v Thn trng lc dng)
trong qu trnh iu tr vi fluconazole v nhng thuc tng t, tuy nhin { ngha trn lm
sng v mi lin h vi iu tr l cha chc chn. Cc bnh da trc vy (xem Ch { phng v
Thn trng lc dng), ng kinh, gim bch cu, gim tiu cu, v rng tc xy ra nhng mi
lin h nhn qu cha r rng.
Nn ngng thuc nu c ni ban nhng bnh nhn c iu tr nhim nm b mt nghi l
do fluconazole. Nu bnh nhn nhim nm ton thn/xm ln c ni ban, nn kim tra cht ch
v ngng thuc nu xut hin bng nc hay ban a dng.
Cng ging nh nhng hp cht azole khc, c bo co v phn v xut hin trong nhng
trng hp him.
LIU LNG v CCH DNGLiu lng :
Liu fluconazole dng hng ngy c tnh da trn loi nhim nm v mc trm trng. Hu
ht cc trng hp Candida m o p ng vi tr liu liu duy nht. Khi cn dng a liu
iu tr cc trng hp nhim nm khc, nn tip tc cho n khi cc thng s lm sng v kt
qu xt nghim cho thy tnh trng nhim nm hot tnh gim. Tr liu khng y c th
dn n ti pht nhim nm dng hot ng. Bnh nhn AIDS v vim mng no do
Cryptoccocus hay Candida ming hu ti pht thng cn phi tr liu duy tr ngn nga ti
pht.
ngi ln :
- i vi vim mng no do Cryptococcus v nhim Cryptococcus nhng ni khc, liu thng
thng l 400 mg vo ngy u tin sau dng 200-400 mg mi ngy mt ln. Thi gian iu
tr nhim Cryptococcus s ty thuc vo p ng lm sng v kt qu xt nghim nm, nhng
thng ti thiu 6-8 tun i vi vim mng no do Cryptococcus.
ngn nga ti pht vim mng no do Cryptococcus bnh nhn AIDS, sau khi bnh nhn
kt thc liu trnh ban u, c th dng fluconazole mt thi gian vi liu hng ngy 200 mg.
- i vi nhim Candida huyt, Candida ri rc v cc dng nhim Candida xm ln khc, liu
thng thng l 400 mg vo ngy th nht sau l 200 mg mi ngy. Ty theo p ng trn
lm sng, c th gia tng liu n 400 mg mi ngy. Thi gian iu tr da trn p ng lm
sng.
- i vi chng Candida ming hu, liu thng thng l 50 n 100 mg mi ngy mt ln trong
7-14 ngy. Nu cn thit, c th iu tr lu hn trn nhng bnh nhn suy gim min dch

trm trng. i vi bnh Candida th teo ming do rng gi, liu thng thng l 50 mg mt
ln mi ngy trong 14 ngy cng vi cc bin php st khun ti ch cho rng gi.
i vi cc nhim Candida khc ca nim mc (tr trng hp Candida sinh dc xem phn
di) nh vim thc qun, Candida ph qun-phi khng xm ln, Candida niu, Candida da
nim mc... liu hu hiu thng thng l 50 n 100 mg mi ngy dng trong 14-30 ngy.
ngn nga ti pht Candida ming hu bnh nhn AIDS, sau khi hon tt tr liu ban
u, fluconazole c th c cho dng vi liu 150 mg mi tun mt ln.
- iu tr Candida m o, nn ung liu duy nht 150 mg fluconazole.
gim bt t l ti pht Candida m o, c th dng liu 150 mg mi thng mt ln. Thi
gian tr liu nn ty theo tng ngi, khong 4-12 thng. Mt vi bnh nhn c th cn dng
thuc thng xuyn hn.
i vi vim quy u do Candida, nn ung mt liu duy nht 150 mg.
- Liu lng khuyn co cho fluconazole ngn nga Candida l 50 n 400 mg mt ln mi
ngy, ty theo nguy c pht trin nm bnh nhn. i vi trng hp c nguy c nhim nm
ton thn cao nh bnh nhn c kh nng gim bch cu trung tnh ko nng hay ko di,
liu khuyn co l 400 mg mi ngy. Nn dng fluconazole vi ngy trc khi khi pht chng
gim bch cu trung tnh nh d on v tip tc trong 7 ngy sau khi s lng bch cu trung
tnh tng trn 1000/mm3.
- i vi cc trng hp nhim nm da bao gm nhim nm da chn, thn, i v nhim
Candida da, liu khuyn co l 150 mg mt ln mi tun hay 50 mg mt ln mi ngy. Thi gian
iu tr thng l 2 n 4 tun nhng c th cn iu tr lu hn n 6 tun bnh nm da
chn.
i vi lang ben, liu khuyn co l 300 mg mi tun mt ln trong 2 tun ; mt vi bnh
nhn c th cn thm mt liu 300 mg th ba vo tun sau , trong khi, mt vi bnh nhn
khc, c th ch cn mt liu duy nht 300-400 mg. C th dng phc iu tr khc l 50 mg
mi ngy mt ln dng trong 2 n 4 tun.
i vi bnh nm mng, liu khuyn co l 150 mg mt ln mi tun. Nn tip tc iu tr cho
n khi mng b nm c thay th (ngha l mc ln mng mi khng b nhim). S mc tr
li mng tay v mng chn thng cn khong thi gian tng ng l 3 n 6 thng v 6 n
12 thng. Tuy nhin, tc pht trin mng ty theo tng ngi v theo tui tc. i khi cc
mng vn cn b bin dng sau khi c iu tr nhim nm mn tnh.
- i vi cc bnh nm su, c th cn n liu t 200-400 mg mi ngy dng n 2 nm. Thi
gian tr liu ty thuc vo tng ngi nhng k o di t 11 n 24 thng vi nhim
Coccidioidomyces, 2-17 thng vi nhim Paracocidioidomyces, 1-16 thng vi Sporotrichosis v
3-17 thng i vi Histoplasma.
tr em :
Ging nh nhng nhim nm tng t trn ngi ln, thi gian iu tr da trn p ng lm

sng v kt qu xt nghim nm. Khng nn dng qu liu ti a hng ngy ca ngi ln cho
tr em. Nn dng fluconazole mt ln mi ngy.
Liu fluconazole khuyn co cho bnh Candida nim mc l 3 mg/kg mi ngy. C th dng liu
tn cng 6 mg/kg vo ngy th nht thu c nng trng thi n nh nhanh hn.
i vi Candida ton thn v nhim Cryptococcus, liu khuyn co l 6-12 mg/kg mi ngy, ty
theo mc trm trng ca bnh.
ngn nga nguy c nhim nm bnh nhn suy gim min dch do hu qu ca chng gim
bch cu trung tnh do ha tr liu c t bo hay x tr, nn dng liu 3-12 mg/kg mi ngy ty
theo mc v thi gian ko di ca chng gim bch cu trung tnh (xem liu cho ngi ln).
i vi tr em suy thn, nn gim liu hng ngy theo hng dn dnh cho ngi ln ty theo
mc suy thn.
Tr em di 4 tun tui : fluconazole c o thi chm tr s sinh. Trong hai tun tui u
tin c th dng cng liu lng tnh theo kg th trng nh tr ln nhng vi khong cch
mi 72 gi. T tun th 2-4, c th dng liu lng ny mi 48 gi.
ngi gi :
Khi khng c bng chng suy thn, nn dng liu thng thng. i vi bnh nhn suy thn
(thanh thi creatinine < 50 ml/pht) nn iu chnh liu lng nh hng dn bn di.
bnh nhn suy thn :
Fluconazole c o thi ch yu trong nc tiu di dng khng i. Khng cn phi iu
chnh liu trong trng hp dng mt liu n duy nht. bnh nhn suy thn phi dng a
liu fluconazole, nn dng liu tn cng 50 n 400 mg. Sau liu tn cng, liu hng ngy (ty
theo ch nh) c tnh da vo bng sau :
Thanh thi creatinine (ml/pht)

Phn trm so vi liu khuyn co

> 50

100%

11-50

50%

Bnh nhn thm phn thng xuyn

Mt liu sau mi ln lm thm phn

Cch dng :
Fluconazole c th dng theo ng ung hay tim truyn tnh mch vi tc khng qu 10
ml/pht. ng s dng ty theo tnh trng lm sng ca bnh nhn. Khi chuyn t cch dng
theo ng tnh mch sang ng ung hay ngc li, khng cn phi thay i liu hng ngy.
Fluconazole c pha ch trong dung dch sodium chloride 0,9%, mi 200 mg (chai 100 ml)
cha 15 mmol ion Na+ v Cl- mi loi. Do fluconazole c pha long sn trong nc mui sinh
l, bnh nhn cn gii hn natri hay gii hn nc, nn xem xt cn thn tc dch truyn

vo c th.
Tnh tng k :
Fluconazole tim truyn tnh mch tng hp vi cc dch truyn sau :
- Dextrose 20%,
- Dung dch Ringer,
- Dung dch Hartmann,
- Potassium chloride trong dextrose,
- Sodium bicarbonate 4,2%,
- Aminofusin,
- Dch truyn mui sinh l.
Fluconazole c th cho qua ng ng ang truyn cc dung dch lit k trn. Mc d khng
c tng k c hiu c ghi nhn, khng nn trn ln vi bt kz thuc no khc trc khi
truyn.
QU LIU
Mt trng hp qu liu vi fluconazole c bo co. Mt bnh nhn 42 tui nhim HIV b
o gic v c nhng hnh vi dng hoang tng sau khi dng 8200 mg fluconazole. Bnh nhn
c cho nhp vin v n nh tnh trng sau 48 gi.
Khi c qu liu, c th iu tr triu chng (cng vi cc bin php h tr v ra d dy nu cn
thit).
Fluconazole c o thi mnh trong nc tiu. Tng li tiu p lc c th lm gia tng tc
o thi. Lc mu trong vng ba gi c th lm gim nng trong huyt tng xung khong
50%.
BO QUN
Hn dng : vin nang : 3 nm, dch truyn tnh mch : 5 nm.
Ch { c bit khi bo qun : Bo qun di 30oC.

156.

DIGOXIN RICHTER

GEDEON RICHTER
vin nn 0,25 mg : hp 50 vin - Bng A.
THNH PHN

cho 1 vin
Digoxin

0,25 mg

DC LC
Digoxin, thuc nhm glycoside tr tim, c tc dng trn c tim ph thuc vo liu lng. Nh
tc dng lm co si c tim (inotropic), digoxin lm tng sc co tht c tim, ci thin s lm rng
tm tht trong thi kz tm thu, lm gim p sut cui kz tm trng, lm gim kch thc ca
tim b gin. V vy, khi dng trong cc trng hp suy tim sung huyt, digoxin s ci thin
chc nng co tht v lm gim tiu th oxygen ca c tim.Nh tc dng cng vagus trn cc
nt xoang v nt nh-tht, tc l gim tc dn truyn ca cc si hch, nn digoxin lm gim
nhp tim v lm gim dn truyn thn kinh, qua n lm gim nhp tim v dn truyn kch
thch.Nh tc dng kch thch c dng tnh, digoxin lm tng tnh t ng ca c tim, lm tng
s to thnh kch thch d dng (xem Tc dng ngoi ).Vi liu cao, digoxin hot ha h thn
kinh giao cm (xem phn Tc dng ngoi ).
DC NG HC
Hp thu :Digoxin hp thu t ng tiu ha nh khuch tn th ng. Sinh kh dng khong
70%. Dng chung vi thc n lm gim tc hp thu, nhng khng nh hng ti mc
hp thu. Dng ng thi thc n king c cht x vi s lng nhiu (v d : cm) s lm gim
lng digoxin c hp thu. Mt s loi vi khun ng rut bin i digoxin thnh dn xut
bt hot trn tim (v d : dihydroxydigoxin), qua lm gim hiu qu mong mun.Phn phi
:Tc dng xut hin t 0,5 n 2 gi sau khi ung, tc dng ti a ca digoxin pht trin trong
vng 2-6 gi. Digoxin tch ly trong nhiu loi m khc nhau, k c c tim v tc dng ca n c
lin quan cht ch n nhng hm lng trng thi n nh do tch ly trong m cn hn
c lin quan n nng ti a trong huyt tng. Digoxin vt qua c hng ro mu-no
cng nh hng ro nhau thai. Khong 20-25% hm lng thuc kt hp vi protein huyt
tng.Thi tr :Digoxin thi tr qua ng thn. Khi dng ng tim tnh mch, khong 5070% digoxin c thi theo nc tiu di dng khng chuyn ha, phn cn li c thi
di dng cht chuyn ha. S bi tit theo ng thn t l vi tc lc qua cu thn (GFR).
Trong trng hp bnh thng, thi gian bn thi ca digoxin l 1,5-2,0 ngy, nhng c th ko
di n 4-6 ngy nhng ngi bnh v niu. Thm phn mng bng hay truyn mu khng
th thi digoxin khi c th.
CH NH

Suy tim sung huyt : Ch yu trong trng hp suy tim cung lng thp. Digoxin c dng
t c v duy tr tnh trng b, c bit khi suy tim km theo rung nh v cung ng tm
nh.Rung nh.Cung ng tm nh.Nhp tim nhanh kch pht trn tht.
CHNG CH NH
Chng ch nh dng digoxin khi qu mn cm vi cc ch phm digitalis, lon nhp tht trm
trng (rung tht hay nhp nhanh tht), nhp tim chm trm trng, bnh c tim nghn do ph i
(HOCM), hi chng Wolf-Parkinson-White km theo rung nh (digitalis c th lm nhp tim
nhanh tht hoc rung tht n sm hn), vim mng ngoi tim co tht mn tnh, bloc nh-tht
giai on II v III, tng cm xoang cnh hoc hi chng xoang bnh l; khng nn dng digoxin
trc khi cy my to nhp tim, v ch phm digitalis c th gy nhp chm xoang trm trng
hay bloc xoang-nh trong nhng trng hp nh vy.Trong nhi mu c tim cp hoc trong cc
bnh phi trm trng, iu tr digoxin cn lu { c bit, v nhng ngi bnh ny rt mn cm
vi bnh lon nhp tim trm trng do ch phm digitalis gy ra.
CH PHNG v THN TRNG LC DNG
Digoxin nn c ngng 2 ngy trc khi kh rung bng dng in, nu khng, th s rung tht
khng tr liu c th xut hin. Nu bt buc phi kh rung bng dng in cho bnh nhn iu
tr digitalis l iu bt buc, th nn dng in th thp.Test v sc chu ng ca tim c th ch
ra nhng thay i ST-T sai lc nhng bnh nhn iu tr digitalis.Nn kim tra thng xuyn
hm lng cht in gii trong huyt thanh v chc nng thn trong khi iu tr digoxin.Nhp
tim nhanh xoang khng phi l ch nh dng digoxin, tr khi c km theo suy tim.Nhng ch
phm digitalis t hiu qu hn trong nhng trng hp suy tim lu lng cao (tc l trong suy
tim gy ra bi d ng tnh mch, thiu mu, nhim khun hay cng gip).Lon nhp tht
ng thi vi cng gip trng thng khng vi iu tr bng digitalis, trong khi liu thp hn
liu thng thng th li cn thit khi suy gip trng.Chng tng calci huyt, chng h kali
huyt, h magnesi huyt c th lm tng nhim c digitalis, v vy, hm lng ca nhng ion
ny nn c bnh thng ha trc khi bt u iu tr digoxin.Chng h calci huyt c th
lm digoxin mt hiu qu.
LC C THAI v LC NUI CON B
Digoxin khng gy tc dng t bin, qui thai hay ung th. Digoxin xm nhp qua nhau thai, v
vy, nng digoxin trong huyt thanh ca thai nhi tng ng vi nng trong huyt
thanh ca ngi m. Digoxin bi tit mt phn qua sa m.Tr s sinh c nhy cm khc nhau
vi ch phm digitalis.
TNG TC THUC

Corticosteroid, thuc li tiu tc dng trn quai, amphotericin B c th lm h kali huyt, qua
lm tng c tnh digoxin.Nng kali huyt nn c bnh thng ha trc khi iu tr
digitalis.Calcium, c bit l calcium dng ng tnh mch, c th gy lon nhp tim cho nhng
ngi bnh dng ch phm digitalis.Quinidin, verapamil, amiodaron, propafenon,
indomethacin v itraconazole c th lm tng hm lng digoxin huyt tng ca ngi bnh
iu tr digitalis, qua lm tng nguy c nhim c.Mt s khng sinh c th lm tng s hp
thu ca digoxin ng tiu ha.Do lm gim nhu ng rut, propathelin v diphenoxylat s
lm tng s hp thu digoxin v xut hin nhim c.Thuc khng acid, kaolinpectin,
sulfasalazin, neomycin, cholestyramin, v mt s thuc chng tn sinh, metoclopramid lm
gim hp thu digoxin v lm gim hm lng digoxin ti mc mt tc dng.Dng ng thi vi
cc thuc cng giao cm lm tng tai bin lon nhp tht, v c 2 thuc u lm tng hot tnh
iu nhp lc ch.Succinylcholin c th gy phng thch kali t ngt t c v lm lon nhp tim
ngi bnh iu tr digitalis.Dng ng thi thuc chn bta, hay thuc i khng Ca2+ vi
digoxin c th gy ngng tim hon ton, v tc dng ca chng hip ng trn nt nh tht.
TC DNG NGOI
Tn sut tc dng ngoi l 5-20% ; nn nh 15-20% ca tn sut ny c th l trm trng.
Khong 1/2 tc dng ngoi thuc v tim, 1/4 thuc ng tiu ha, trong khi 1/4 cn li lin
quan n nhng triu chng thn kinh trung ng v nhng phn ng bt li khc.
Tc dng ngoi trn tim :
ngoi tm thu tht mt hoc nhiu bnh, au dy thn kinh sinh i hay sinh ba, nhp
nhanh tht, phn ly nh tht, tng nhp nt nh tht, nhp tim nhanh nh c bloc, bloc nh tht.
Tc dng ngoi { trn ng tiu ha :
chn n, bun nn, nn, tiu chy (cc tc dng ny cng c th l nhng du hiu suy tim). Rt
him khi au bng v hoi t xut huyt rut.
Tc dng ngoi trn thn kinh trung ng :
ri lon th gic (hoa mt hay le sng vng), nhc u, suy yu, chong vng, v cm, bnh
tm thn.Cc tc dng ngoi { khc : i khi c chng to v n ng, ni dt sn hay cc phn
ng da khc, gim tiu cu. tr em, nhng du hiu nhim c sm mt phn l nhng triu
chng ng tiu ha, phn khc l lon nhp tim, thng gp l ri lon dn truyn, nhp
nhanh nh c bloc, t hn na l lon nhp tim tht.
LIU LNG v CCH DNG

V nhu cu ca tng ngi bnh vi digitalis rt thay i, liu theo tng c th ty thuc vo
bnh iu tr, vo chc nng thn, mc cng lc nhiu bnh, th trng gy cm m yu, tui
tc, dng ng thi vi cc thuc khc v ty thuc vo p ng ca tng ngi bnh.Nhng
hng dn chung :- iu tr lon nhp tm nh cn liu cao hn iu tr suy tim.- Liu nn da
vo th trng hn l vo khi lng c th, v m m khng thuc khoang phn phi ca
digoxin.- Nu c th, nn lng gi chc nng thn bng cch o thanh thi creatinin.Ngoi th trng, tui tc cng l mt yu t quan trng, khi chn liu cho nh nhi v tr em.Cc bnh km theo v cc thuc dng ng thi phi c lu { khi quyt nh liu ca ch
phm ny (xem Ch { phng v thn trng lc dng v Tng tc thuc).
Ngi ln :
Nn khi u iu tr bng liu duy tr hay liu tn cng.Liu php digitalis nhanh vi liu tn
cng :
- Liu tn cng theo tnh ton nn c chia lm nhiu ln dng trong vng 24 gi. Dng 1/2
liu tn cng cho liu khi u, ri quan st ngi bnh, sau ty thuc vo p ng ca h,
dng nhng phn cn li, chia ra dng mi 6-8 gi.
- Liu thng thng cho ngi bnh cha tng dng digitalis v c chc nng thn bnh thng
: dng liu n khi u 0,5-0,75 mg (2-3 vin nn), ri tip tc bng liu 0,25 mg (1 vin nn)
cho mi 6 gi cho n khi xut hin tc dng mong mun.
- Tng liu tn cng ln n 1-1,5 mg/24 gi (4-6 vin nn/24 gi).
- Nng iu tr trong mu h xung trong khong 0,8-2 ng/ml. kim tra nng thuc
iu tr, nn ly mu mu mi 6-8 gi sau khi ung liu cui cng.
- Khi suy thn, liu tn cng khng c qu 6-10 mg/kg th trng.Liu duy tr sau khi iu tr
digitalis nhanh v iu tr digitalis chm bng liu duy tr :
- i vi nhng ngi bnh c chc nng thn bnh thng, liu hng ngy thng thng l
0,125-0,375 mg (1/2-11/2 vin nn). Trong mt s trng hp, ch yu l vi ngi bnh c
th trng gy, cn liu hng ngy l 0,5 mg (2 vin nn)
.- Khi dng liu duy tr, th nng trng thi n nh c th t c trong vng 6-7 ngy.C
liu tn cng ln liu duy tr u phi gim trong trng hp suy thn, chng gim kali huyt,
thiu nng tuyn gip, v th trng gy cm.Vi ngi bnh cao tui, cng cn gim liu tn
cng v liu duy tr. Mt liu duy tr 0,125-0,25 mg/ngy l to ra tc dng iu tr.
Tr em :

 tr em cng cn chn liu theo tng c th. V nhu cu glycosid ca tng c th rt khc
nhau, nn liu ch dn di y ch a ra nhu cu trung bnh chung theo nhm tui.Tr s sinh
thiu thng c bit nhy cm vi digitalis, trong khi , tr t 1 thng tui n 2 nm tui c
th cn liu cao hn tr ln.Vi tr em c chc nng thn bnh thng v th trng bnh
thng, liu thng thng ca vin n n digoxin nh sau :Liu tn cng :
- t 2-5 tui : 30-40 mg/kg th trng
- t 5-10 tui : 25-35 mg/kg th trng
- trn 10 tui : tnh ton liu theo th trng nh ngi ln (10-15 mg/kg th trng).Nn khi
u bng 1/2 liu tn cng, ri dng phn na cn li chia ra nhiu liu nh, c mi 6-8 gi th
dng mt ln, ty thuc vo p ng iu tr.Liu duy tr : thng l 25-35% liu tn cng.Vin
nn digoxin khng th c b nh mt cch chnh xc, v vy, nu c cc dng bo ch khc
(nh thuc nh git), th nn dng cho tr em.
QU LIU
Qu liu xy ra tng i thng xuyn, v digoxin c ranh gii iu tr hp.
Triu chng :
Bun nn, nn, chn n km theo hay khng km theo tiu chy, au bng, tit nc bt v ra
m hi l nhng du hiu sm ca s qu liu. Nhng triu chng ca h thn kinh trung ng
nh nhc u, au mt, suy yu, v cm, trm cm, o gic, mt nh hng v ri lon nhn
thc/cm nhn mu c th xy ra. Trong s nhng triu chng tim, cc kiu lon nhp tim c
th xut hin.Ngoi tm thu tht, chng nhp i, nhp ba, ri lon dn truyn, chm nhp tim,
bloc nh-tht, nhp tim nhanh nh c hay khng c bloc nh tht, nhp lc ch, nhp tim nhanh
tht, rung tht thng gp. Ko di khong P-Q trong in tm c th l mt du hiu sm.
S gim ST dng thuyn l mt du hiu c trng, tuy nhin khng nht thit l mt du hiu
nhim c, v n n gin ch l hu qu ca iu tr digitalis.
iu tr qu liu :
Trong trng hp qu liu nh, ngng dng digoxin, kim tra bnh nhn v bnh thng ha
nng kali/huyt thng l .Nu cn, c th dng thuc chng lon nhp (atropin, lidocain,
phenytoin, v.v...). Cng cn phi cy my iu nhp hay kh rung bng in, tuy nhin, trong
trng hp sau ny, c nguy c xut hin rung tht khng tr liu.Trong trng hp nhim c
cp ng ung (trong vng 30 pht), bnh nhn nn c gy nn v ra rut. Nu nhim
c c nhn bit 2-3 gi sau khi ung digoxin v/hay quan st thy nhng triu chng nhim

c, th gy nn v t sonde d dy - qua s kch thch cp tnh dy vagus - li c th lm trm

trng thm chng lon nhp tim gy do digoxin.Than hot, cholestyramin, hay cholestipol c
th lm gim hp thu digoxin.Li tiu mnh, thm phn hay truyn mu thng khng t hiu
qu.Qu liu trm trng c th dn n chng tng kali/huyt cht ngi. Trong nhng trng
hp nh th, ngoi vic truyn dch insulin v glucose, thm phn cng nn c xem xt, nu
chng tng kali/huyt c v khng c ci thin.Trong trng hp e da n tnh mng, nn
dng cc khng th c hiu digoxin.
BO QUN
Bo qun thuc nhit 15-30oC.

157.

DIGOXINE NATIVELLE

PROCTER GAMBLE
Vin nn d b 0,25 mg : hp 30 vin - Bng A.
Dung dch ung Tr em/Tr cn b 5 mg/0,1 ml : l 60 ml + pipette nh liu 1/20 ml (0,05 ml) Bng A.
Dung dch tim tnh mch Ngi ln 0,5 mg/2 ml : ng 2 ml, hp 6 ng - Bng A.
Dung dch tim tnh mch Tr em/Tr cn b 0,05 mg/ml : ng 1 ml, hp 6 ng - Bng A.
THNH PHN
cho 1 vin
Digoxine

0,25 mg

(Lactose)

cho 0,1 ml
Digoxine
(thanol)

5 mg

cho 1 ng thuc tim dnh cho Ngi ln

Digoxine

0,50 mg

(thanol)

cho 1 ng thuc tim dnh cho Tr em/Tr

cn b
Digoxine

0,05 mg

(thanol)
DC LC
Glucoside tr tim.
- Tc dng gy co si c dng tnh.
- Tc dng gim nhp t ng k trn xoang v lin quan nhiu n s tng trng lc ca dy
thn kinh ph v v gim trng lc giao cm.
- Tc dng dn truyn trong tim m tnh nt nh-tht, c ngun gc do lm nhp tim chm li
trn tht do lm gim s lung thn kinh i qua nt nh-tht ; khng c tc ng trn s dn
truyn trong tht.
- Tc dng kch thch c tim dng tnh : tng tnh nhy cm ca si c tim liu cao hn liu
iu tr.
Trong suy tim, lu lng tim tng c lin quan n tc dng co si c v nhng tc dng ngoi
tim lm gim tin v hu ti.
Vin Digoxine Nativelle c sinh kh dng n nh, c th hin trn lm sng qua vic ghi
nhn cc hm lng trong mu hu hiu, n nh v khng gy nhng "pic" v ch.
DC NG HC
- Hp thu qua ng tiu ha khong 70-80%.
- Nng digoxine t do trong mu cao, khng gn vi protine huyt tng (80%), do s
gy tc ng nhanh : bt u c tc dng t 10 n 30 pht i vi dng tim v 1 n 2 gi
i vi dng ung.
- Chuyn ha sinh hc gan vi t l thp (khong 10%) thnh cc cht chuyn ha trong
mt s cht c hot tnh.
- o thi ch yu qua thn di dng khng b bin i ; c mt s tng quan cht ch gia
thanh thi digoxine thn v thanh thi cratinine.
- Cc yu t gii hn tc ng : thn (90%), gan (10%).

- Thi gian bn hy trong huyt tng : 1 ngy ri. Nu khng dng liu tn cng ban u,
tnh trng cn bng s t c sau 6 ngy.
- nh lng nng trong trong mu c th quyt nh tip tc iu tr hay khng. Cc
nng tr liu nm trong khong t 0,65 n 2,6 nmol/l. Tuy nhin, cng c th c s ln
nhau gia nhng nng tr liu v nng gy c tnh, do i khi lm cho vic phn tch
kt qu tr nn kh khn.
CH NH
- Suy tim cung lng thp (thng phi hp vi cc thuc li tiu), c bit khi c rung nh.
- Ri lon nhp trn tht : lm chm nhp hay chuyn nhp rung nh hay cung nh.
Lu { : suy tim cung lng cao (thiu mu trm trng, chng tim cng tuyn gip, r ng
mch-tnh mch, thiu vitamine B1) v suy tim c lin quan n mt s cn tr c hc hoc suy
tim do c bnh tim phi mn tnh khng l i tng ch nh ca digitalis.
CHNG CH NH
- Bloc nh-tht 2 v 3 khng dng my.
- ang iu tr vi digitalis gp hin tng tng kch thch tm tht hoc c ch nh calcium
tim mch.
Lu { : trng hp ngoi tm thu tht mt bnh nhn suy tim khng dng digitalis khng phi
l chng ch nh.
- Nhp nhanh v rung tht.
- Rung nh, phi hp vi hi chng Wolff-Parkinson-White.
- Bnh c tim tc nghn.
- Tim hoc truyn calci ng tnh mch bnh nhn ang iu tr bng digitalis : xem Tng
tc thuc.
CH PHNG
Nht thit phi ngng iu tr trong trng hp tng kch thch tm tht (ngoi tm thu) do qu
mn hay qu liu.
Trc khi sc in nn ngng dng digitalis hay cc dn xut : sc in ch c tin hnh sau
thi hn tng ng vi 1 hay 2 thi gian bn hy ca cht glucoside c s dng (1 ngy
ri n 3 ngy).
THN TRNG LC DNG
- H kali huyt c th lm tng c tnh ca digitalis, do cn tm kim nhng yu t gy
thun li cho vic h kali huyt nh thuc li tiu, thuc nhun trng kch thch, corticoide,
amphot ricine B (ng tnh mch) ; nn kim tra kali huyt trc khi bt u iu tr v iu
chnh vic h kali huyt nu c, sau nn kim tra kali huyt u n trong thi gian iu tr.
- Gim liu :
- trong nhng trng hp m s nhy cm vi digitalis v cc dn xut tng : ngi ln tui,
gim oxy m do suy h hp, suy tuyn gip, suy tim tin trin, tng calci huyt, h kali huyt.

- trong trng hp suy gan hay thn.

- lc bt u iu tr, nu trong nhng ngy trc c s dng mt thuc digitalis khc.
- Theo di in tm trong trng hp bloc nh tht 1.
LC C THAI
th vt : cha c nghin cu thc nghim.
ngi : mc d cn thiu nhng kho st dch t hc, cho n nay khng c mt tc dng xu
no c ghi nhn tr s sinh c m c iu tr bng digoxine. Nn theo di cc nng
trong huyt thanh ca sn ph trong 3 thng cui thai kz.
LC NUI CON B
Thuc c bi tit qua sa m rt yu.
TNG TC THUC
Chung cho tt c cc digitalis :
Chng ch nh phi hp :
- Mui calci ng tnh mch : ri lon nhp nng, thm ch t vong.
Thn trng khi phi hp :
- Than hot tnh (thuc bng d dy-rut) : gim hp thu digitalis ng tiu ha. Ung cc
thuc ny xa nhau (khong 2 gi chng hn).
- Colestyramine : gim tc dng ca digitalis (gim hp thu rut v chu kz gan rut). Ung cc
thuc ny cch xa nhau (khong 2 gi chng hn).
- Cc thuc lm h kali huyt : thuc li tiu, thuc nhun trng kch thch, corticoide,
amphot ricine B (ng tnh mch). H kali huyt c th gy thun li c tnh cho digitalis th
hin tc dng. Theo di kali huyt, in tm v xem xt li vic iu tr nu cn.
- Magnsium trisilicate (thuc khng acide) : gim hp thu digitalis ng tiu ha. Ung cc
thuc ny cch xa nhau (khong 2 gi chng hn).
- Amiodarone lm gim tnh t ng (nhp tim chm qu mc) v cc ri lon dn truyn nhtht. Trng hp c s dng digoxine s lm tng digoxine huyt do lm gim thanh thi
digoxine. Theo di lm sng v in tm , kim tra digoxine huyt v iu chnh liu digoxine.
Ring cho digoxine :
Thn trng khi phi hp :
- Mui, oxyde, hydroxyde ca Mg, Al v Ca (thuc bng d dy-rut) : gim hp thu digoxine
ng tiu ha. Ung cc thuc ny cch xa nhau (trn 2 gi sau khi ung digoxine, nu c
th).
- Hydroxyquinidine, quinidine : ri lon tnh t ng (gy lon nhp), gim tnh t ng (nhp
tim chm qu mc) v ri lon dn truyn nh-tht. Ngoi ra cn lm tng digoxine huyt do
gim thanh thi digoxine. Cn theo di lm sng v in tm . Trng hp khng c p ng
nh mong mun, kim tra digoxine huyt v iu chinh liu.
- Salazosulfapyridine : gim digoxine huyt c th n 50%. Cn theo di lm sng, in tm

v digoxine huyt. Nu cn, iu chnh liu digoxine trong thi gian iu tr bng
salazosulfapyridine v sau khi ngng thuc ny.
- Sucralfate : gim hp thu digoxine ng tiu ha. Ung cc thuc ny cch xa nhau (khong
2 gi chng hn).
- Vrapamil (thuc i khng calci) : gy chm nhp tim qu mc v bloc nh-tht do lm tng
tc dng ca digoxine trn tnh t ng v dn truyn v do lm gim o thi digoxine thn
v ngoi thn. Cn theo di lm sng, in tm v digoxine huyt. Nu cn, iu chnh liu
digoxine trong thi gian iu tr bng v rapamil v sau khi ngng thuc ny.
TC DNG NGOI
- C th lm tng tnh kch thch tm tht : xem Ch { phng v Thn trng lc dng.
- Cc biu hin d ng ( da, ban xut huyt gim tiu cu) v chng v to n ng.
- Ri lon tiu ha (bun nn, i ma, tiu chy), nhc u, chng mt v nhn mu l nhng
du hiu u tin ca tnh trng qu liu.
- Trn in tm , hnh dng lm chn ca on ST l bnh thng, n biu hin s ngm
digitalis ch khng phi tnh trng qu liu.
LIU LNG v CCH DNG
n ng ung :
Ngi ln :
p Liu tn cng : 2 n 4 vin/ngy, chia lm nhiu ln.
p Liu duy tr : 1 vin/ngy, chia lm 1 hoc 2 ln.
Tr em (s dng dng dung dch ung) :
p Liu tn cng : trong 1 liu duy nht.
di 3 kg : 15 mg/kg hoc 0,3 ml/kg.
3 n 6 kg : 20 mg/kg hoc 0,4 ml/kg.
6 n 12 kg : 15 mg/kg hoc 0,3 ml/kg.
12 n 24 kg : 10 mg/kg hoc 0,2 ml/kg.
trn 24 kg : 7 mg/kg hoc 0,1 ml/kg.
p Liu duy tr (sau 8 gi + sau ) : 1/3 liu khi u, lp li mi 8 gi. Digoxine huyt ti a
nh nhi : 3 ng/ml v tr em trn 2 tui : 1,5 ng/ml.
Suy thn : gim liu hng ngy ty theo cratinine huyt.
n ng tim tnh mch chm :
Ngi ln :
p Liu tn cng : 1 n 2 ng/ngy.
p Liu duy tr : 1/2 n 1 ng/ngy hoc 3 ngy/tun.
Tr em :
p Liu tn cng : trong 1 liu duy nht .
2,5 n 6 kg : 15 mg/kg.

6 n 12 kg : 12 mg/kg.
12 n 24 kg : 8 mg/kg.
trn 24 kg : 5 mg/kg.
p Liu duy tr : cng 1 liu v tim 3 ln trong 24 gi. Digoxine huyt ti a nh nhi : 3 ng/ml
v tr em trn 2 tui : 1,5 ng/ml.
QU LIU
Triu chng : ri lon tiu ha (chn n, nn, ma, tiu chy), nhc u, chng mt, nhm mu
; nht l cc ri lon tim : tt c cc ri lon dn truyn v tnh kch thch u c th c
quan st.
Hng x l :
Trng hp qu liu iu tr, ngng ngay digitalis (thng l cc ri lon bin mt) v
cho bnh nhn nm ngh trn ging.
Trnh dng thuc chng lon nhp hoc isoprnaline liu cao ; trng hp chm nhp tim : dng
atropine ; trng hp tng tnh kch thch c tim : dng ph nytoine, lidocaine.
Trng hp ng c do v tnh hay c dng liu qu cao : cho bnh nhn nhp vin theo
di trong mi trng chuyn khoa.

158.

DILATREND

HOFFMANN - LA ROCHE
vin nn 6,25 mg : hp 30 vin v 100 vin - Bng B.
vin nn 12,5 mg : hp 30 vin v 100 vin - Bng B.
vin nn 25 mg : hp 30 vin v 100 vin - Bng B.
THNH PHN
cho 1 vin
Carvedilol

6,25 mg

cho 1 vin
Carvedilol

12,5 mg

cho 1 vin
Carvedilol

25 mg

DC LC
Carvedilol - mt cht i khng thn kinh th dch qua nhiu c ch - l mt thuc c ch beta
khng chn lc phi hp vi tnh cht gy gin mch qua tc dng c ch th th a v c tnh
cht chng tng sinh v chng oxy ha.
CH NH
Carvedilol 6,25, Carvedilol 12,5, Carvedilol 25 :
- iu tr suy tim huyt c triu chng : Carvedilol c ch nh trong iu tr suy tim
huyt c triu chng h thp t l t vong v s ln nhp vin do bnh l tim mch, ci thin
cm gic khe khon ca bnh nhn v lm chm tin trin ca bnh. Carvedilol c th c
kt hp vi iu tr tiu chun, v thuc cng c th c s dng trn nhng bnh nhn
khng dung np c thuc c ch men chuyn hay nhng bnh nhn khng th iu tr vi
digitalis, hydralazine hay nitrate.
Carvedilol 25 :
- Cao huyt p nguyn pht : Carvedilol c ch nh iu tr cao huyt p nguyn pht.
Thuc c th s dng n c hay phi hp vi cc thuc iu tr cao huyt p khc, c bit l
vi cc thuc li tiu thuc nhm thiazide.
- iu tr cn au tht ngc.
CHNG CH NH
Khng c s dng carvedilol trong nhng trng hp sau : suy tim khng kim sot, bnh
phi tc nghn mn tnh, hen, ri lon chc nng gan c biu hin lm sng, block nh tht
2-3, nhp tim chm trm trng, hi chng suy nt xoang, chong, nhy cm vi thuc.
Khng nn s dng carvedilol khi c thai, cho con b v hin ti cha kinh nghim trong lnh
vc ny.
THN TRNG LC DNG
Nn kim sot tnh trng suy tim vi iu tr thch hp trc khi khi u iu tr vi carvedilol.
Cnh bo cc tc dng c th xy ra : Cng ging nh cc thuc chng cao huyt p khc,
carvedilol lm gim tnh to (nh kh nng li xe hay vn hnh my mc ca bnh nhn). Hin
tng ny c bit xy ra khi bt u hay thay i iu tr v khi ung ru.
TNG TC THUC
Nh cc thuc c ch beta khc, carvedilol c th lm tng tc dng ca nhng thuc iu tr
cao huyt p hay c tc dng ngoi l gy tt huyt p. Cng ging nh cc thuc c ch beta
khc, nn thn trng khi s dng carvedilol vi nhng thuc chng lon nhp hay cc thuc i
khng calci nh verapamil hay diltiazem. Do , khng nn tim tnh mch cc thuc c ch

knh calci v cc thuc chng lon nhp trong qu trnh iu tr vi carvedilol. Khi phi ngng
iu tr carvedilol cng vi clonidine, nn ngng carvedilol trc vi ngy trc khi gim dn
dn liu clonidine. C th cn phi thn trng khi dng thuc nhng bnh nhn dng cc
thuc cm ng men oxidase nh rifampicin, do nng trong huyt thanh ca carvedilol c th
gim i, hay cc thuc c ch men oxidase nh cimetidine, do nng trong huyt thanh ca
carvedilol c th gia tng. Khi cng s dng carvedilol v digoxin, nng y trng thi n
nh ca digoxin c th tng khong 16% trn bnh nhn cao huyt p. Nn tng cng kim
sot nng digoxin khi bt u iu tr, iu chnh liu hay ngng dng carvedilol. Nn cn
thn khi gy m v tc dng hip ng lm gim co c tim gia carvedilol v cc thuc gy m.
Carvedilol cng c th lm tng tc dng ca insulin hay cc thuc h ng huyt ng
ung. Triu chng h ng huyt c th b che lp hay gim bt (c bit l triu chng tim
nhanh).
TC DNG NGOI
i khi c chng mt, nhc u v mt mi, thng nh v c bit thng xy ra vo lc bt
u iu tr. Mt vi trng hp c bit c trm cm, ri lon gic ng, d cm. Thnh thong
c nhp tim chm, h huyt p t th v him khi ngt - c bit khi mi iu tr. i khi c
nhng ri lon tun hon ngoi vi (lnh tay chn). Him khi c block nh tht, tng nng cc
triu chng bnh nhn b khp khing cch hi ; trong mt s trng hp c bit c s tin
trin suy tim nng hn. i khi c ht hi, nght mi v trn bnh nhn c bnh sn, c th
gy cn hen/kh th. Thnh thong c ri lon tiu ha (vi nhng triu chng nh bun nn,
au bng, tiu chy, v trong vi trng hp l t, c th to bn v nn ma). Vi trng hp
c phn ng da (ngoi ban do d ng, m ay, nga v phn ng ging lichen planus). C th
xut hin cc sang thng da vy nn hay nng thm cc sang thng b sn. Mt vi
trng hp c bit c thay i trn transaminase huyt thanh, gim tiu cu v gim bch
cu. i khi c cc triu chng "dng cm" v au cc chi, gim tit nc mt.
LIU LNG v CCH DNG
Cao huyt p nguyn pht :
Khuyn co s dng liu duy nht mi ngy.
Ngi ln : Liu khuyn co bt u iu tr l 12,5 mg mi ngy mt ln trong 2 ngy u. Sau
, nn dng 25 mg mi ngy mt ln. Nu cn thit, c th tng liu dn trong t nht 2 tun
n liu ti a 50 mg mi ngy mt ln hay chia nhiu ln.
Ngi gi : Liu khuyn co bt u iu tr l 12,5 mg mi ngy mt ln. Liu ny cho kim
sot tha ng mt vi bnh nhn. Nu cha c p ng y , c th tng dn liu tng
nc ti thiu l trong 2 tun cho n liu ti a c khuyn co.
iu tr cn au tht ngc :
Liu khuyn co bt u iu tr l 12,5 mg mi ngy 2 ln trong 2 ngy u. Sau , liu
khuyn co l 25 mg ngy 2 ln. Nu cn thit, c th tng liu dn trong t nht 2 tun n liu

ti a 100 mg chia lm nhiu ln trong ngy (2 ln mi ngy). Liu khuyn co ti a hng ngy
cho ngi gi l 50 mg chia lm nhiu ln trong ngy (2 ln mi ngy).
iu tr suy tim huyt c triu chng :
Cn k liu cho tng trng hp v phi c bc s theo di cht ch trong qu trnh tng liu.
i vi bnh nhn ang dng digitalis, thuc li tiu, cht c ch men chuyn, nn n nh liu
lng cc thuc ny trc khi bt u iu tr vi carvedilol. Liu khuyn co bt u iu tr l
3,125 mg ngy 2 ln trong 2 tun. Nu bnh nhn dung np c vi liu ny, c th tng liu
dn trong tng khong thi gian khng di 2 tun, n liu 6,25 mg ngy 2 ln, theo sau l
12,5 mg ngy 2 ln v sau l 25 mg ngy 2 ln. Nn tng liu n mc ti a m bnh nhn
c th dung np c. Liu ti a c khuyn co l 25 mg ngy 2 ln cho bnh nhn nh hn
85 kg v 50 mg mi ngy 2 ln cho bnh nhn nng hn 85 kg.
Trc khi tng liu, bc s nn nh gi bnh nhn v cc triu chng suy tim hay gin mch
tng nng hn. Suy tim hay b tiu nng hn tm thi nn c iu tr bng cch tng liu
thuc li tiu, mc d i khi c th cn phi gim liu carvedilol. Nu ngng carvedilol hn
2 tun, nn bt u dng li vi liu 3,125 mg mi ngy 2 ln v tng dn liu nh trn. Cc
triu chng gin mch c th c kim sot lc u bng cch gim liu thuc li tiu. Nu
cc triu chng vn ko di, c th gim liu thuc c ch men chuyn, v sau nu cn thit,
gim liu carvedilol. Trong trng hp ny, khng nn tng liu carvedilol cho n khi n
nh c cc triu chng suy tim hay gin mch tr nng hn.
Cha xc nh an ton v hiu qu ca ca carvedilol trn bnh nhn di 18 tui.
BO QUN
Do thuc b i mu khi tip xc vi nh sng, nn gi thuc trong hp kn.

159.

DIPROGENTA

SCHERING-PLOUGH
Kem bi ngoi da : ng 15 g.
Thuc m bi ngoi da : ng 15 g.
THNH PHN
cho 1 g kem
Btamthasone dipropionate

0,64 mg

tng ng : Btamthasone

0,5 mg

Gentamicine sulfate tnh theo gentamicine base

1 mg

cho 1 g thuc m
Btamthasone dipropionate

0,64 mg

tng ng : Btamthasone

0,5 mg

Gentamicine sulfate tnh theo gentamicine base

1 mg

DC LC
B tam thasone dipropionate c tc ng khng vim, tr nga v co mch. Nhng tc ng ny
c biu hin k o di, do cho ph p s dng Diprogenta hai ln mi ngy.
Vi khun hc :
Gentamicine l mt khng sinh dit khun ph rng, chng li nhiu tc nhn gy bnh da
thng thng.
Cc vi khun nhy cm bao gm cc chng nhy cm ca cc Streptococcus (huyt gii beta
nhm A, huyt gii alpha), Staphylococcus aureus (coagulase dng tnh, coagulase m tnh, v
mt vi chng sn xut pnicillinase), v vi khun gram m Pseudomonas aeruginosa,
Aerobacter aerogenes, Escherichia coli, Proteus vulgaris v Klebsiella pneumoniae.
CH NH
Diprogenta c ch nh lm gim cc biu hin vim ca cc bnh da p ng vi corticoide
khi b bin chng do nhim trng th pht, gy ra do cc vi khun nhy cm vi gentamicine
hay khi nghi ng kh nng nhim trng do nhng nguyn nhn ny. Cc ch nh bao gm :
bnh vy nn, vim da do tip xc (dermatitis venenata), vim da d ng (eczma tr em,
vim da d ng), vim thn kinh da (lichen n mn tnh), lichen phng, eczma (bao gm
ecz ma hnh ng tin, ecz ma tay, vim da ecz ma), hm, bnh t a, vim da tit b, vim
da trc vy, vim da do nh nng, vim da ng v nga ngy khng do bm sinh v chng
nga ngi gi.
CHNG CH NH
Diprogenta chng ch nh cho bnh nhn c tin s phn ng qu mn vi bt c thnh phn
no ca thuc.
CH PHNG
Nu b kch ng hay mn cm khi s dng Diprogenta, nn ngng thuc v p dng cc bin
php thch hp.

Trong trng hp b nhim trng, nn s dng mt tc nhn khng khun hay khng nm thch
hp. Nu khng c p ng thun li ngay lp tc, nn ngng dng corticoide cho n khi c
th kim sot c nhim trng ny.
Mi tc dng ngoi { c bo co khi dng thuc corticoide ton thn, bao gm suy thng
thn, cng c th xut hin khi dng corticoide ti ch, c bit tr em v tr s sinh.
S hp thu ton thn ca corticoide dng ti ch c th gia tng nu iu tr trn mt b mt
c th rng hay c dng vi phng php b. Nn cn trng trong nhng trng hp ny
hay khi dng thuc k o di, c bit i vi tr em v tr s sinh.
S dng khng sinh ti ch i khi lm pht trin nhng vi khun khng nhy cm, trong c
cc loi nm. Nu iu ny xy ra hay nu c thm kch ng, qu mn hay bi nhim, nn
ngng iu tr vi gentamicine v p dng bin php thch hp.
Diprogenta khng dng cho nhn khoa.
S dng cho tr em : tr em c th biu hin tnh nhy cm ln hn vi nhng suy gim trc h
i-tuyn yn-tuyn thng thn do corticoide ti ch v vi nhng tc dng ca corticoide
ngoi sinh hn so vi bnh nhn trng thnh v c s hp thu mnh hn do t l vng b
mt da rng ln hn so vi trng lng c th.
S suy gim trc h i-tuyn yn-tuyn thng thn, hi chng Cushing, s chm tng
trng, chm tng cn, v tng p lc ni s c bo co xut hin tr em dng
corticoide ti ch. Cc biu hin ca s suy thng thn trn tr em bao gm nng cortisol
thp trong huyt tng v khng p ng vi kch thch ACTH. Cc biu hin ca tng p lc ni
s bao gm phng thp, nhc u v ph gai th hai bn.
LC C THAI v LC NUI CON B
Do tnh an ton ca corticoide dng ti ch s dng cho ph n c thai cha c xc nh,
thuc thuc nhm ny ch nn dng lc c thai nu li ch tr liu cao hn nguy c c th gy ra
cho thai nhi. Cc thuc thuc nhm ny khng nn dng qu vi mt liu lng ln hay vi
thi gian ko di cho ph n mang thai.
Do khng bit c rng dng corticoide ti ch c th a n s hp thu ton thn c
th tm thy c thuc trong sa m, nn quyt nh ngng cho con b hay ngng thuc, c
lu { n tm quan trng ca thuc i vi ngi m.
TC DNG NGOI
Cc phn ng ngoi ti ch c bo co xut hin vi s s dng corticoide ti ch, c bit
khi dng di lp bng bt, bao gm : cm gic bng, nga, kch ng, kh da, vim nang, rm
lng, ni ban dng trng c, nhc sc t, vim da quanh ming, vim da d ng do tip xc.
Tc dng ngoi xy ra thng xuyn hn vi cch b thuc bao gm : lt da, nhim trng th
pht, teo da, ni vn da v bnh ht k.
iu tr vi gentamicine c th gy kch ng thong qua (ban v nga ngy) thng khng
cn thit phi ngng thuc.

LIU LNG v CCH DNG

Nn bi mt lp mng kem hoc thuc m Diprogenta ln ton b cc vng da b nhim hai ln
mi ngy, vo bui sng v bui ti. i vi mt s bnh nhn, c th dng mt lng thuc t
hn m vn t c liu duy tr.
QU LIU
Triu chng : s dng corticoide ti ch qu mc hay ko di c th n n hot ng chc
nng tuyn yn - thng thn, a n kt qu thiu nng thng thn th pht, v cho cc
biu hin tng tit tuyn thng thn, bao gm bnh Cushing.
Mt liu qu gentamicine duy nht thng khng gy ra cc triu chng qu liu.
Dng gentamicine ti ch ko di c th dn n s bi tng ca cc sang thng do nm hay
vi khun khng nhy cm.
iu tr : bao gm cc bin php iu tr triu chng. Thng cc triu chng tng tit tuyn
thng thn cp l c th phc hi. Nu cn thit, nn iu chnh s mt cn bng in gii.
Trong trng hp ng c mn tnh, nn ngng t t corticoide.
Cc liu php khng khun hay khng nm c ch nh nu c xut hin s pht trin tng
vt vi khun v nm khng nhy cm.
BO QUN
Bo qun trong khong nhit 2-30oC.

160.

DIPROSALIC

SCHERING-PLOUGH
Thuc m bi ngoi da : ng 15 g.
Lotion bi ngoi da : chai 10 ml.
THNH PHN
cho 1 g lotion
Btamthasone dipropionate

0,64 mg

tng ng : Btamthasone

0,5 mg

Acide salicylique

20 mg

(pH)

(5,0)

cho 1 g thuc m
Btamthasone dipropionate

0,64 mg

tng ng : Btamthasone

0,5 mg

Acide salicylique

30 mg

DC LC
Btamthasone dipropionate l mt corticoide tng hp fluor ha, c c tnh khng vim,
chng nga v co mch. Nhng tc ng ny ca Diprosalic c duy tr lu, do cho ph p s
dng thuc hai ln mi ngy.
Acide salicylique dng ti ch c c tnh lm trc lp sng da, ngoi ra c c tnh kim khun
v dit nm.
CH NH
Lotion : c ch nh lm gim cc biu hin vim ca chng vy nn v tit b ca da u.
Lotion cng c ch nh lm gim biu hin vim ca sang thng vy nn khng trn da
u v nhng bnh da khc c p ng vi corticoide.
Thuc m : c ch nh lm gim nhng biu hin vim ca bnh da dy sng v bnh da kh
c p ng vi corticoide nh bnh vy nn, vim da d ng mn tnh, vim thn kinh da (lichen
simplex mn), lichen phng, eczma (bao gm ecz ma hnh ng tin, eczma tay, vim da
eczma), bnh t a, vim tit b da u, bnh vy c thng thng v cc bnh vy c khc.
CHNG CH NH
Diprosalic chng ch nh nhng bnh nhn c tin s qu mn vi bt c thnh phn no
ca thuc.
CH PHNG
Nn ngng thuc nu c kch ng hay mn cm khi s dng Diprosalic.
Khi c nhim khun, nn p dng phng php iu tr thch hp.
Mi tc dng ngoi { c bo co xut hin do s dng corticoide ton thn, bao gm suy
thng thn c th xut hin vi corticoide dng ti ch, c bit tr em v tr s sinh.
Hp th ton thn ca corticoide hay acide salicylic dng ti ch s gia tng nu dng phng
php bng bt.
Nn trnh bi thuc ln vt thng h hay vng da b tn thng. Nn p dng nhng bin
php thn trng thch hp trong cc trng hp ny hay khi dng thuc di ngy, c bit tr
em v tr s sinh.
Khng dng phng php bng kn vi dng Diprosalic lotion.

Ngng dng thuc nu xut hin s kh da qu mc hay gia tng kch ng da.
Khng dng Diprosalic cho nhn khoa. Trnh thuc tip xc vi mt hay nim mc.
S dng cho tr em : tr em c th biu hin tnh nhy cm ln hn vi nhng suy gim trc h
i-tuyn yn-tuyn thng thn do corticoide ti ch v vi nhng tc dng ca corticoide
ngoi sinh hn so vi bnh nhn trng thnh v c s hp thu mnh hn do t l vng b
mt da rng ln hn so vi trng lng c th.
S suy gim trc h i-tuyn yn-tuyn thng thn, hi chng Cushing, s chm tng
trng, chm tng cn, v tng p lc ni s c bo co xut hin tr em dng
corticoide ti ch. Cc biu hin ca s suy thng thn trn tr em bao gm nng cortisol
thp trong huyt tng v khng p ng vi kch thch ACTH. Cc biu hin ca tng p lc ni
s bao gm phng thp, nhc u v ph gai th hai bn.
LC C THAI v LC NUI CON B
Do tnh an ton ca corticoide dng ti ch s dng cho ph n c thai cha c xc nh,
thuc thuc nhm ny ch nn dng lc c thai nu li ch tr liu cao hn nguy c c th gy ra
cho thai nhi. Cc thuc thuc nhm ny khng nn dng qu vi mt liu lng ln hay vi
thi gian ko di cho ph n mang thai.
Do khng bit c rng dng corticoide ti ch c th a n s hp thu ton thn c
th tm thy c thuc trong sa m, nn quyt nh ngng cho con b hay ngng thuc, c
lu { n tm quan trng ca thuc i vi ngi m.
TC DNG NGOI
Cc phn ng ngoi ti ch c bo co xut hin vi s s dng corticoide ti ch, bao gm
: cm gic bng, nga, kch ng, kh da, vim nang lng, rm lng, ni ban dng vim nang b,
gim sc t, vim da quanh ming, vim da d ng do tip xc, lt da, nhim trng th pht, teo
da, ni vn da, bnh ht k, nhy cm da, nt n.
Cc ch phm cha acide salicylique c th gy vim da.
LIU LNG v CCH DNG
Ch dng trn da.
Lotion : Nh vi git lotion Diprosalic ln vng da b nhim, ch nh v khp vo vng da hay da
u. Thng thng nn bi hai ln mi ngy, vo bui sng v bui ti.
Thuc m : Nn bi mt lp mng thuc m Diprosalic bao ph hon ton ln vng da b
nhim, hai ln mi ngy, vo bui sng v ti.
i vi mt vi bnh nhn, c th p dng liu duy tr vi s ln dng thuc t hn.
QU LIU
Triu chng : s dng corticoide ti ch qu mc hay ko di c th n n hot ng chc
nng tuyn yn-thng thn, a n kt qu thiu nng thng thn th pht, v cho cc
biu hin tng tit tuyn thng thn, bao gm bnh Cushing.
S s dng ch phm cha acid salicylic qu nhiu v ko di c th gy ra cc triu chng ng

c salicylate.
iu tr : bin php iu tr triu chng thch hp c ch nh trong trng hp qu liu
Diprosalic. Cc triu chng tng tit tuyn thng thn thng l c hi phc. iu tr mt cn
bng in gii nu cn thit. Trong trng hp ng c mn, nn ngng thuc t t.
Vic iu tr ng c acide salicylique l iu tr triu chng. Nn p dng cc bin php loi
salicylate nhanh chng ra khi c th. Ung natri bicarbonate kim ha nc tiu v gy li
tiu.
BO QUN
Bo qun trong khong nhit t 2 n 30oC. Trnh nh sng.

161.

DIPROSPAN injection

SCHERING-PLOUGH
Thuc tim : ng 1 ml, hp 1 ng - Bng B.
THNH PHN
cho 1 ml
Btamthasone dipropionate tnh theo btamthasone

5 mg

Btamthasone sodium phosphate tnh theo btamthasone

2 mg

DC LC
Diprospan l mt kt hp cc ester b tam thasone tan c v tan yu trong nc cho tc
dng khng vim, tr thp v khng d ng mnh trong vic tr liu cc chng bnh p ng vi
corticoide. Tc ng tr liu tc thi t c do ester tan c trong nc l btamthasone
sodium phosphate c hp thu nhanh sau khi tim. Tc ng ko di ca thuc c th hin
bi btamthasone dipropionate, cht ny ch tan yu trong nc v tr thnh kho d tr dng
cho s hp thu dn dn, do , gip kim sot c cc triu chng trong mt khong thi
gian di.
Kch thc tinh th nh ca btamthasone dipropionate cho php s dng kim nh (cho n
s 26) dng tim trong da v trong sang thng.
Cc glucocorticoide nh b tam thasone gy nhng tc dng chuyn ha su sc, a dng v
lm sa i p ng min dch ca c th i vi nhng kch thch khc nhau.
B tam thasone c c tnh glucocorticoide cao v c c tnh minralocorticoide yu.

CH NH
Diprospan c ch nh iu tr cc chng bnh cp v mn tnh c p ng vi corticoide.
Liu php corticoide ch c tnh cch h tr, ch khng phi l liu php thay th cho tr liu
thng thng. Thuc c ch nh trong cc trng hp sau :
Cc bnh h c xng v m mm : vim khp dng thp ; vim xng khp ; vim bao hot
dch ; vim cng t sng ; vim mm li cu ; vim r thn kinh ; au xng ct ; au dy thn
kinh hng ; au lng ; vo c ; hch nang ; li xng ; vim cn mc.
Bnh d ng : hen ph qun mn (bao gm tr liu h tr cho nhng cn hen) ; d ng bi hay
phn hoa ; ph mch-thn kinh ; vim ph qun d ng ; vim mi d ng theo ma hoc kinh
nin ; cc tng tc thuc ; bnh huyt thanh ; vt t ca cn trng.
Bnh da : vim da d ng (ecz ma hnh ng tin) ; vim thn kinh da (lichen simplex khu tr) ;
vim da tip xc ; vim da nng do nh nng ; ni m ay ; lichen phng ph i ; hoi t m do
i tho ng ; rng tc tng vng ; lupus ban dng a ; vy nn ; u si ; bnh pemphigus ;
vim da dng herpes ; trng c dng nang.
Bnh cht to keo : lupus ban ri rc ; bnh cng b ; vim da-c ; vim quanh ng mch
dng nt.
Bnh tn sn : iu tr gim tm thi bnh bch cu v u bch huyt ngi ln ; bnh bch
cu cp tr em.
Nhng bnh khc : hi chng sinh dc-thng thn ; vim kt trng lot ; vim hi trng on
cui ; bnh sprue ; cc bnh chn (vim bao hot dch c chai cng ; cng ngn chn ci ; nm
ngn chn vo vo trong) ; cc bnh cn phi tim di kt mc ; lon to mu c p ng vi
corticoide ; vim thn v hi chng thn h.
Thiu nng v thng thn nguyn pht hay th pht c th c iu tr vi Diprospan nhng
nn c b sung thm minralocorticoide nu c th c.
Diprospan c khuyn co tim bp trong nhng bnh p ng vi corticoide dng ton thn
; tim trc tip vo m mm khi c ch nh ; tim vo trong khp v quanh khp trong bnh
khp ; tim vo trong sang thng trong nhng bnh da ; v tim ti ch trong mt vi chng
vim v nang nht nh bn chn.
CHNG CH NH
Diprospan c chng ch nh cho bnh nhn nhim nm ton thn, cho ngi c phn ng
nhy cm vi btamthasone hay nhng corticoide khc hay bt kz thnh phn no ca thuc.
CH PHNG
Diprospan khng dng tim tnh mch hay tim di da. Bt buc phi s dng cc k thut v
khun nghim nht khi s dng Diprospan.
C th cn phi iu chnh liu khi c s thuyn gim hay tng nng thm ca din tin bnh,
ty theo p ng ca tng bnh nhn vi phng php tr liu v s tip xc ca bnh nhn
vi stress cm xc hay th cht nh nhim trng nng, gii phu hay chn thng. C th cn

phi theo di n 1 nm sau khi ngng mt qu trnh iu tr corticoide ko di hay dng vi

liu cao.
Thiu nng v thng thn th pht do s dng thuc c th l kt qu ca vic ngng
corticoide qu nhanh v c th gim nguy c ny bng cch h liu dn dn. Thiu nng lin
quan n s s dng thuc nh trn c th tip tc ko di nhiu thng sau khi ngng thuc ;
do , nu xy ra stress trong giai on , nn dng corticoide tr li. Nu bnh nhn dng
corticoide ri, c th s phi tng liu lng.
Do s tit minralocorticoide c th b suy gim, nn dng thm ng thi mui v/hoc mt
minralocorticoide.
Nn dng liu thp nht c th c kim tra tnh trng bnh ; khi c th gim liu, nn
gim t t.
Diprospan cha hai ester b tam thasone, trong c b tam thasone sodium phosphate, phn
tn nhanh chng t ni tim. Do thnh phn tan c trong nc ny ca Diprospan c kh
nng gy tc dng ton thn, cc bc s nn lu { cc im sau khi dng ch phm ny :
Tc dng ca corticoide gia tng bnh nhn gim nng tuyn gip hay x gan.
Nn cn thn khi dng corticoide cho bnh nhn herpes simplex mt v c kh nng gy thng
gic mc.
Cc chng lon tr c th xut hin khi tr liu bng corticoide. Cc chng khng cn bng v xc
cm hay khuynh hng lon tm thn c sn c th b nng hn do corticoide.
Nn cn thn khi dng corticoide trong nhng trng hp sau : lot kt trng khng c hiu,
nu c kh nng tin ti thng, abcs, hay nhng nhim trng sinh m khc ; vim ti tha ;
va mi ni rut ; lot d dy hot ng hay tim n ; suy thn ; cao huyt p ; long xng ;
v nhc c nng.
Do cc bin chng t qu trnh tr liu vi corticoide ph thuc vo liu lng v thi gian tr
liu, nn cn nhc gia li ch tr liu v nguy c c hi trn tng bnh nhn.
Corticoide c th che lp mt vi du hiu nhim trng, v cc nhim trng mi c th xut
hin trong qu trnh s dng. Khi dng corticoide, c th b gim tnh khng v khng th
nh v nhim trng.
S dng corticoide ko di c th dn n c thy tinh th di bao (c bit tr em),
glaucome c th nh hng n dy thn kinh th gic, v c th thc y nhim trng th pht
mt do nm hoc do virus.
Liu trung bnh v liu cao corticoide c lm tng huyt p, gi mui-nc, v s o thi kali.
Cc tc ng ny hu nh t xy ra vi nhng dn xut tng hp tr khi c dng vi liu cao.
Nn cn nhc ch n ung hn ch mui v cung cp thm kali. Tt c corticoide u lm gia
tng s o thi calcium.
Trong qu trnh iu tr vi corticoide, bnh nhn khng nn chng nga u ma. Khng nn
p dng cc bin php min dch cho bnh nhn ang dng corticoide, c bit khi dng vi

liu cao do c th xy ra bin chng thn kinh v thiu p ng khng th. Tuy nhin, cc bin
php chng nga c th thc hin cho bnh nhn dng corticoide nh mt liu php iu tr
thay th, nh i vi bnh Addison.
Nn gii hn vic iu tr bng corticoide trn bnh nhn b lao tin trin, lao cp hay lao lan
ta, trong nhng bnh ny corticoide nn c dng kt hp vi ch khng lao thch hp.
Nu corticoide c ch nh trn bnh nhn mc lao tim n, nn theo di cht ch do c th
xut hin s ti kch hot cn bnh. Trong qu trnh tr liu corticoide ko di, bnh nhn nn
p dng phng php ha d phng. Nu rifampine c s dng trong chng trnh ha d
phng, nn xem xt mt tc dng ca n l lm gia tng chuyn ha, o thi corticoide gan ;
c th cn phi iu chnh liu lng corticoide.
iu tr vi corticoide c th lm thay i s chuyn ng v s lng ca tinh trng.
Do mt vi trng hp him phn ng ging phn v xy ra trn nhng bnh nhn c
iu tr bng cch tim corticoide, nn p dng bin php thn trng thch hp trc khi tim,
c bit khi bnh nhn c tin s d ng thuc.
Khi dng corticoide ko di, nn cn nhc vic chuyn t dng tim sang dng ung sau khi cn
nhc gia cc li ch v nguy c c th xy ra.
Nn lm xt nghim cht dch khp loi kh nng khp b nhim khun. Trnh tim ti ch
vo khp b nhim trng trc . S gia tng ng k chng au v sng ti ch, s gii
hn thm na ca vn ng khp, st v kh chu l nhng du hiu ngh cho chng vim
khp nhim khun. Nu chn on c nhim khun c xc nh, nn p dng liu php
khng khun thch hp.
Khng nn tim corticoide vo cc khp khng c nh, vng b nhim khun hay khong gia
cc t sng. Tim nhiu ln vo khp trong bnh vim xng khp c th lm tng thoi ha
khp. Trnh tim corticoide trc tip vo gn v s a n kt qu l c biu hin bong gn
ko di.
Khi dng liu php tim corticoide vo trong khp, bnh nhn nn cn thn trnh vn ng qu
mc khp hiu qu iu tr c tt.
Nn tim bp Diprospan cn thn trong ban xut huyt gim tiu cu t pht.
Corticoide dng tim bp nn c tim su vo khi c ln trnh teo m ti ch.
Tim corticoide vo m mm, trong sang thng v trong khp c th gy tc dng ton thn
cng nh ti ch.
S dng thuc cho tr em : Bnh nhn ang dng corticoide vi liu lm suy yu min dch nn
c cnh co trnh tip xc vi ngun ly bnh si hay thy u, v nu b tip xc, nn tham
kho kin ca bc s. iu ny c bit quan trng i vi tr em.
Nn theo di cn thn s pht trin v tng trng tr em trong qu trnh tr liu ko di vi
corticoide, do vic dng corticoide c th nh hng n tc pht trin v c ch s sn
xut corticoide ni sinh nhng bnh nhn ny.

LC C THAI v LC CHO CON B

Do nhng nghin cu c kim sot v nh hng ca corticoide ln s sinh sn ngi
cha c thc hin, s dng Diprospan lc c thai hay cho ph n tui c con i hi
rng li ch tr liu ca thuc phi c cn nhc vi nguy c c th xy ra cho b m v thai
nhi. Nhng tr s sinh c m dng nhiu liu corticoide trong lc c thai nn c theo di
cn thn phng cc du hiu suy v thng thn.
V nhng tc dng ngoi khng mong mun do Diprospan c th xy ra cho tr em b sa m,
nn quyt nh hoc ngng thuc hoc ngng cho con b, c lu { n tm quan trng ca
thuc i vi ngi m.
TNG TC THUC
Dng ng thi vi phnobarbital, phnytoine, rifampine hay phdrine c th lm tng
chuyn ha corticoide, v do gim tc dng iu tr.
Bnh nhn dng c hai thuc corticoide v estrogne nn c theo di v tc ng qu mc
ca corticoide.
Dng ng thi corticoide vi cc thuc li tiu lm mt kali c th dn n chng h kali
huyt. Dng ng thi vi glycoside tr tim c th lm gia tng nguy c lon nhp hay ng c
digitalis km theo gim kali huyt.
Corticoide c th thc y kh nng mt kali gy ra do amphotricine B. Trn mi bnh nhn
dng bt c cc kt hp thuc no c k trn, nn kim tra k cng cht in gii trong
huyt thanh, c bit l nng kali.
Dng ng thi corticoide vi nhng thuc chng ng thuc loi coumarine c th lm tng
hay gim tc dng chng ng, c th cn phi iu chnh liu.
Tc dng do kt hp thuc khng vim khng st roide hay ru vi cc glucocorticoide c th
lm tng t l hay mc trm trng ca lot d dy- rut. Corticoide c th lm gim nng
salicylate trong mu. Nn cn thn khi phi hp acide actylsalicylique vi corticoide trong
trng hp gim prothrombine huyt.
C th cn phi iu chnh liu ca thuc tiu ng khi dng corticoide cho ngi mc bnh
tiu ng.
iu tr ng thi vi glucocorticoide c th c ch p ng vi somatotropine.
Tng tc ca thuc vi cc xt nghim phng th nghim : cc corticoide c th lm nh
hng n xt nghim nitroblue tetrazolium tm s nhim khun v cho kt qu m tnh gi
to.
TC DNG NGOI
Cc tc dng ngoi ca Diprospan, cng ging nh nhng tc dng ngoi { c bo co xut
hin vi nhng corticoide khc, c lin quan ti liu lng v thi gian dng thuc. Thng
thng nhng phn ng ny l c th hi phc hay thuyn gim khi gim liu ; mt cch tng
qut, tt nht nn ngng thuc trong nhng trng hp ny.

Ri lon nc v cht in gii : gi natri, mt kali, kim mu gim kali ; gi nc ; suy tim sung
huyt trn nhng bnh nhn nhy cm ; cao huyt p.
H c xng : nhc c, bnh c do corticoide, gim khi c ; gia tng triu chng nhc c
trong bnh nhc c nng ; long xng ; gy ln ct sng ; hoi t v khun u xng i v
xng cnh tay ; gy bnh l{ cc xng di ; bong gn ; tnh khng n nh ca khp (do tim
trong khp lp i lp li nhiu ln).
H tiu ha : lot d dy vi kh nng thng v xut huyt sau ; vim ty ; trng bng ;
vim thc qun lot.
Da : lm chm lnh vt thng, teo da, da mng manh ; c m xut huyt v mng bm mu ;
ni ban trn mt ; tng m hi ; sai lch cc test th da ; cc phn ng nh vim da d
ng, m ay, ph mch thn kinh.
Thn kinh : co git ; tng p lc ni s cng vi ph gai th (u no gi) thng sau khi iu tr di
hn ; chng mt ; nhc u.
Ni tit : kinh nguyt bt thng ; hi chng ging Cushing ; tr em chm pht trin hay gim
pht trin ca phi bn trong t cung ; s khng p ng th pht thng thn v tuyn yn,
c bit trong nhng giai on stress, nh chn thng, phu thut hay bnh tt ; gim dung
np carbonhydrate, lm l ra cc triu chng ca bnh tiu ng tim n, tng nhu cu
insuline hay cc tc nhn h ng huyt trn bnh nhn tiu ng.
Mt : c thy tinh th di bao ; tng p lc ni nhn, glaucome ; li mt.
Chuyn ha : cn bng nit m tnh do d ha protine.
Tm thn : sng khoi, cm gic l lng ; trm cm nng cho n cc biu hin tm thn thc
s ; thay i nhn cch ; mt ng.
Cc tc dng ngoi khc : phn ng ging phn v hay qu mn v h huyt p hay phn ng
ging nh b sc.
Cc phn ng ngoi { c lin quan n vic s dng corticoide ng tim bao gm nhng
trng hp him l b m do vic tim vo trong sang thng xung quanh mt v u, tng sc
t hay nhc sc t, teo da v teo di da, abcs v khun, s xut hin vng thng tn
sau khi tim (sau khi tim trong khp) v bnh khp dng charcot.
LIU LNG v CCH DNG
Liu dng nn c iu chnh ty theo bnh c iu tr, mc trm trng v p ng ca
bnh nhn.
Liu khi u nn duy tr v iu chnh n khi c p ng tt. Nu khng xut hin p ng
lm sng tha ng sau mt khong thi gian dng thuc thch hp, nn ngng dng Diprospan
v bt u phng php tr liu thch hp khc.
Dng thuc ton thn : iu tr ton thn, trong hu ht cc trng hp, tr liu thng bt u
vi 1-2 ml v lp li nu cn thit. Tim bp su vo vng mng. Liu lng v khong cch
dng ty thuc vo mc trm trng ca bnh v p ng vi phng php tr liu. C th

phi cn dng khi u 2 ml trong cc chng bnh trm trng nh lupus ban hay cn suyn
cn gii quyt bng nhng bin php cu cha thch hp.
Nhiu bnh da khc nhau c p ng hu hiu vi mt mi tim bp 1 ml Diprospan c th
c tim lp li ty theo p ng ca bnh.
Trong nhng bnh ng h hp, s bt u gim triu chng xut hin trong vng vi gi sau
khi tim bp Diprospan.
S kim sot hu hiu cc triu chng trong hen ph qun, d ng bi hay phn hoa, vim ph
qun d ng v vim mi d ng t c sau khi tim 1 n 2 ml.
Trong vic iu tr vim bao hot dch cp hay mn, cc kt qu kh quan t c vi 1 n 2
ml Diprosan tim bp, nu cn thit c th lp li phng php iu tr ny.
Dng ti ch : him khi phi dng ng thi Diprospan vi mt thuc gy v cm ti ch. Nu
cn thit dng ng thi vi mt thuc gy v cm ti ch, Diprospan c th c trn ln
(trong bm tim, khng trn trong l thuc) vi 1% hay 2% procaine chlorhydrate hay
lidocaine, nhng thuc khng c cc cht paraben trong cng thc. Cng c th dng cc thuc
gy v cm tng t. Nn trnh dng vi cc thuc gy v cm cha mthylparaben,
propylparaben, ph nol... u tin, liu lng Diprospan cn thit c rt ra t l thuc vo
bm tim. Sau rt thuc gy t vo, v lc bm tim.
Trong vim bao hot dch di c delta, di mm cng vai, mm khy v trc xng bnh
ch dng cp, tim vo bao hot dch 1 n 2 ml Diprospan c th lm gim au v phc hi
ton b chui vn ng trong vng vi gi. Chng vim bao hot dch mn tnh c th c
iu tr vi liu gim thp hn khi cc triu chng cp c kim sot. i vi bnh vim
bao gn, vim gn v vim quanh gn, c th lm gim cc chng ny bng mt mi tim
Diprospan. i vi cc th mn tnh ca cc bnh ny, c th cn thit phi tim lp li nu tnh
trng bnh i hi.
Sau khi tim trong khp 0,5 n 2 ml Diprospan, tc dng gim au nhc v tnh trng cng
nhc i km vi vim khp dng thp v vim xng khp c th t c trong vng 2 n 4
gi. S ko di tnh trng thuyn gim ny, m qu trnh ny thay i kh nhiu trong c hai
chng bnh, t c trong 4 tun hay lu hn trong a s trng hp.
Tim Diprospan trong khp c dung np tt trong cc m khp v quanh khp. Liu lng
khuyn co tim trong khp l : khp ln (khp gi, hng, vai), 1 n 2 ml ; khp to trung bnh
(ch, c tay, c chn), 0,5 n 1 ml ; khp nh (bn chn, bn tay, ngc), 0,25 n 0,5 ml.
Cc chng bnh da c th p ng vi vic tim Diprospan trong sang thng. p ng ca
mt vi sang thng khng c iu tr trc tip c th do tc dng ton thn nh ca thuc.
Trong vic iu tr bng cch tim vo trong sang thng, liu Diprospan tim trong da c
khuyn co l 0,2 ml/cm2, tim u n vi mt bm tim kiu tim tuberculine v mt kim s
26. Liu tng cng Diprospan c tim tt c cc v tr mi tun khng nn vt qu 1 ml.
Diprospan c th c dng mt cch hu hiu trong cc bnh chn c p ng vi phng

php tr liu bng corticoide. Chng vim bao hot dch di ch chai cng c th c kim
sot vi hai mi tim 0,25 ml lin tip nhau. Trong mt s trng hp nh cng ngn chn ci,
nm ngn chn vo vo nhau v vim khp trong bnh goutte cp, tnh trng thuyn gim c
th c bt u rt nhanh chng. Cho hu ht cc loi tim, mt bm tim kiu tim
tuberculine vi kim s 25 thng l thch hp. Cc liu khuyn co cch nhau khong mt tun
: vim bao hot dch di nt chai cng hay mm 0,25 n 0,5 ml ; vim bao hot dch di li
xng gt, 0,5 ml ; vim bao hot dch trn cng ngn chn ci, 0,5 ml ; vim bao hot dch
trn nm ngn chn vo vo nhau, 0,5 ml ; nang bao khp, 0,25 n 0,5 ml ; bnh au thn
kinh Morton (chng au xng t bn chn), 0,25 n 0,5 ml ; vim bao gn, 0,5 ml ; vim
quanh xng hp, 0,5 ml ; vim khp trong bnh goutte cp, 0,5 n 1 ml.
Sau khi c p ng tha ng, nn xc nh liu duy tr thch hp bng cch gim tng lng
nh liu tn cng ban u trong nhng khong thi gian thch hp cho n khi xc nh c
liu thp nht duy tr p ng lm sng y .
Nu bnh nhn phi tip xc vi nhng mi trng stress khng lin quan n chng bnh
hin hu, c th cn phi tng liu Diprospan. Nu phi ngng thuc sau mt thi gian iu tr
lu di, nn gim liu t t.
QU LIU
Triu chng : vic qu liu cp do glucocorticoide, trong c b tam thasone, thng khng
a n tnh trng e da tnh mng. Tr trng hp qu liu trm trng, vic dng qu mc
corticoide trong vng vi ngy hu nh khng gy ra tc hi nghim trng trong nhng trng
hp khng thuc vo loi chng ch nh, nh bnh nhn tiu ng, glaucome, hay lot d
dy tin trin, hay bnh nhn ang dng nhng thuc nh digitalis, thuc chng ng loi
coumarine hay thuc li tiu lm mt kali.
iu tr : cc bin chng t nhng hot ng chuyn ha corticoide hay t nhng tc ng c
hi ca bnh phi dng corticoide ny hay cc bin chng do nhng bnh xy ra ng thi hoc
t nhng tng tc thuc nn c lu { cn thn.
Duy tr y lng nc a vo trong c th v kim sot cc cht in gii trong huyt
thanh v trong nc tiu, c bit ch ti cn bng natri v kali. Nu cn thit, iu chnh li
s mt cn bng in gii.
BO QUN
Lc k trc khi dng.
Bo qun trong khong nhit t 2-25oC. Trnh nh sng v s ng lnh.

162.

DIREXIODE

SANOFI SYNTHELABO VIETNAM

vin nn : hp 100 vin.
THNH PHN
cho 1 vin
Diiodohydroxyquinoline

210 mg

(Saccharose)
CH NH
Bnh l amib ng rut : b sung thuc dit amib m trong bnh l amib ; hoc s dng
n thun i vi ngi lnh mnh c amib trong lng rut.
c ngh trong iu tr bnh tiu chy cp tnh nghi do nhim khun, khng c hin tng
xm ln (suy gim tng trng, st, cc du hiu nhim trng - nhim c...).
CHNG CH NH
Cng gip.
Vim da u chi do bnh rut.
Khng dung np iode.
Tr cn b.
LC C THAI
Khng dng cho ph n mang thai.
CH PHNG
iu tr khng th thiu vic b nc nu cn thit. Lng nc b v ng s dng (ung,
tim tnh mch) ty thuc mc tiu chy, tui v tnh trng ca bnh nhn.
Trng hp tiu chy nhim trng c biu hin lm sng ca hin tng xm ln phi dng
khng sinh khuch tn tt.
Khng iu tr ko di. C th gy chn la chng vi khun khng a khng sinh v c nguy
c b bi nhim.
TC DNG NGOI
Khi dng hydroxyquinoline hoc clioquinol lu di v vi liu cao : vim ty bn cp, bnh thn
kinh ngoi bin, bnh thn kinh th gic c ghi nhn.
Lin quan n s hin din ca iode trong cng thc ca hot cht : ri lon tuyn gip km
theo bu hoc cng gip do qu ti iode ; pht ban ngoi da dng mn.
Nn ma, au d dy, phn ng qu mn.
Thuc c cha iode (134 mg/vin), c th lm thay i kt qu mt s test sinh hc v tuyn

gip trong thi gian di (n 6 thng).

LIU LNG v CCH DNG
Tiu chy :
Ngi ln : 2-3 vin/ngy, chia lm 2 hoc 3 ln, trong ti a 7 ngy.
Tr em trn 30 thng tui : 5-10 mg/kg/ngy, chia lm 3 hoc 4 ln.
Bnh l amib ng rut :
Ngi ln : 2-3 vin, 3 ln/ngy, trong 20 ngy.
Tr em trn 30 thng tui : 5-10 mg/kg/ngy, chia lm 3 hoc 4 ln.
QU LIU
Trng hp ng c cp : au bng, tiu chy, au u, st v lnh run.
iu tr triu chng v mthmoglobinmie.
Ra d dy.

163.

DOBUTAMINE INJECTION ABBOTT

ABBOTT
dung dch tim 250 mg/20 ml : l 20 ml, hp 1 l.
THNH PHN
cho 1 ml
Dobutamine HCl

12,5 mg

M T
Dobutamine tim USP l mt dung dch Dobutamine hydrochlorid trong, khng mu, v trng,
khng c ch nhit t, ch dng tim tnh mch.
Mi ml cha 12,5 mg Dobutamine di dng hydrochlorid v 0,2 mg natrimetabisulfit chng
oxi ha.
Thuc c th cha acid hydrochloric v/hoc natri hydroxid iu chnh pH. pH ca thuc l
3,3 (2,5 n 5,5).
Dobutamine hydrochlorid USP c cng thc ha hc l (+/-)-4- [ 2 -[[3-(p-hydroxyphenyl)-1methylpropyl]amino ]ethyl]-pyrocatechol hydrochlorid. y l mt catecholamin tng hp.
Phn t lng : 337,85
Cng thc phn t : C18H23NO3.HCl
DC LC

Dobutamine hydrochlorid l mt tc nhn c tc dng gy co c trc tip m hot tnh ch yu

l do kch thch cc th th beta ca tim, do to ra cc tc dng tng i yu i vi iu
nhp, tng huyt p, lon nhp v gin mch. Thuc khng gy ra s gii phng cc
norepinephrin ni sinh nh dopamin. cc th nghim trn ng vt, ngoi tc dng co c,
Dobutamine hydrochlorid gy tng nhp tim v lm gim sc cn mch ngoi bin t hn
isoproterenol.
cc bnh nhn b suy chc nng tim, c Dobutamine hydrochlorid v isoproterenol u lm
tng cung lng tim mc nh nhau. Vi Dobutamine hydrochlorid, s gia tng ny thng
khng km theo tng nhp tim ng k (mc d i khi c thy nhp tim nhanh) v th tch tm
thu thng tng. Ngc li, isoproterenol lm tng ch s tim ch yu bng cch tng nhp tim
trong khi th tch tm thu ch bin i t hoc gim.
S dn truyn nh tht c nhn thy trong cc nghin cu in sinh l{ trn ngi v
nhng bnh nhn b rung nh.
Sc cn mch ton thn thng gim khi dng Dobutamine hydrochlorid. C khi thy co mch
ti thiu.
Hu ht cc kinh nghim lm sng vi Dobutamine hydrochlorid l trong thi gian ngn - khng
ko di qu vi gi. mt s lng hn ch bnh nhn c nghin cu trong 24 gi, 48 gi,
v 72 gi, mt s trng hp c xut hin s tng k o di cung lng tim, trong khi nhng
ngi khc cung lng tim tr v gi tr bnh thng.
DC NG HC
Dobutamine bt u c tc dng sau 1-2 pht, tuy nhin phi sau 10 pht mi t n tc dng
ti a ca mi tc truyn.
Thi gian bn hy ca Dobutamine hydrochlorid trong huyt thanh ngi l 2 pht. Chuyn ha
c bn l methyl ha catechol v s kt hp. nc tiu ngi, sn phm thi tr chnh l cc
hp cht ca Dobutamine v 3-0 methyl Dobutamine. Dn cht 3-0 methyl Dobutamine khng
c hot tnh.
S bin i nng catecholamin synap hoc do reserpin hoc do cc thuc chng trm cm
3 vng khng lm thay i tc dng ca Dobutamine trn ng vt, iu ny ch ra rng cc tc
dng ca Dobutamine hydrochlorid khng ph thuc vo cc c ch trc synap.
CH NH
Dobutamine hydrochlorid USP c ch nh khi liu php tim l cn thit tr gip co c
trong thi gian iu tr ngn hn i vi ngi ln b mt b tim do gim kh nng co c tim
trong cc bnh tim hoc do phu thut tim.
cc bnh nhn b rung nh km p ng tht nhanh, phi dng mt ch phm digitalis trc
khi bt u iu tr bng Dobutamine hydrochlorid.
CHNG CH NH
Dobutamine hydrochlorid l chng ch nh cho cc bnh nhn b bnh hp ph i di van

ng mch ch nguyn pht v nhng bnh nhn c mn cm trc vi Dobutamine

hydrochlorid tim USP.
CH PHNG
Tng nhp tim hoc huyt p : Dobutamine hydrochlorid c th gy tng ng k nhp tim,
huyt p c bit l huyt p tm thu. Khong 10% s bnh nhn trong cc nghin cu lm
sng c nhp tim tng 30 nhp/pht hoc hn, v khong 7,5% bnh nhn b tng huyt p 50
mmHg hoc nhiu hn. Thng thng, gim liu s lm mt cc tc dng ny. Do Dobutamine
hydrochlorid lm tng dn truyn nh tht, cc bnh nhn rung nh c nguy c xut hin p
ng tht nhanh. Cc bnh nhn b cao huyt p t trc c th b nguy c tng huyt p qu
mc.
Tc dng gy lc v : Dobutamine hydrochlorid c th thc y hoc lm tng tc dng ngoi
tm thu tht nhng him khi gy ra chng nhp nhanh tht.
Qu mn : C mt vi bo co v cc phn ng mn cm c lin quan n vic s dng
Dobutamine tim USP bao gm ban da, st, tng bch cu i toan, co tht ph qun.
Dobutamine tim USP cha natri metabisulfit, l mt sulfit c th gy ra cc phn ng kiu d
ng, nhng bnh nhn nhy cm, bao gm cc triu chng phn v v cc cn hen e da
n tnh mng hoc t nghim trng. T l nhy cm vi sulfit ca cng ng dn c vn cha
c bit v chc l thp. Nhy cm vi sulfit c thy thng xuyn hn nhng ngi b
hen so vi ngi khng b hen.
THN TRNG LC DNG
Ni chung :
- Trong khi dng Dobutamine tim USP cng nh vi bt kz mt tc nhn adrenergic no, cn
phi kim tra lin tc ECG v huyt p. Thm vo phi kim sot p sut thy phi v cung
lng tim nu c th tng tnh an ton v hiu qu ca vic truyn Dobutamine
hydrochlorid.
Chng gim th tch mu phi c iu chnh bng cc cht lm tng th tch mu thch hp
trc khi bt u iu tr bng Dobutamine.
Khng ci thin c th do s tc nghn c hc ng k, chng hn chng hp van ng mch
ch nng.
S dng sau khi b nhi mu c tim cp : Thc hin nghin cu lm sng vi Dobutamine
hydrochlorid sau khi b nhi mu c tim cp khng khng nh s an ton ca thuc vi
trng hp ny. C mt iu cn quan tm l bt kz tc nhn no lm tng sc co c v lm
tng nhp tim u c th lm tng vng nhi mu do lm nng hn chng thiu mu cc b,
nhng khng bit liu Dobutamine hydrochlorid c tc dng nh vy khng.
Vi xt nghim : Dobutamine ging nh cc thuc ch vn bta khc, c th gy gim nh hm
lng kali huyt, him khi n mc h kali huyt. Theo , cn phi theo di kali huyt.
S dng trong nhi khoa :

Tnh an ton v hiu qu ca thuc tim Dobutamine USP s dng cho bnh nhi vn cha c
nghin cu.
AN TON TIN LM SNG
Tnh gy ung th, t bin gen, gim kh nng sinh sn : Cc nghin cu nh gi tnh gy
ung th hay t bin gen, hoc kh nng nh hng n sinh sn cha c thc hin.
LC C THAI v LC NUI CON B
Lc c thai :
Cc nghin cu v sinh sn thc hin trn chut cc liu ln ti liu bnh thng cho ngi
(10 mg/kg/pht trong 24 gi, tng liu 14,4 mg/kg) v trn th cc liu ln ti gp i liu
bnh thng khng cho thy du hiu no ca tc dng c hi ln bo thai do Dobutamine
hydrochlorid. Tuy nhin, cha c nghin cu y v c kim sot tt trn ph n c thai.
V cc nghin cu v sinh sn trn ng vt khng phi lun lun tin on c cc p ng
trn ngi nn thuc ny ch nn s dng trong khi mang thai nu tht s cn thit.
au v sinh n : Tc dng ca Dobutamine hydrochlorid i vi s au v sinh n vn
cha c bit.
Lc nui con b :
Khng bit thuc c bi tit qua sa m hay khng. V nhiu thuc c bi tit qua sa m
nn cn thn trng khi dng Dobutamine hydrochlorid cho ph n ang cho con b. Nu ngi
m cn iu tr vi Dobutamine hydrochlorid th cn ngng cho con b trong thi gian iu tr.
TNG TC THUC
Cc nghin cu trn ng vt cho thy Dobutamine c th khng c tc dng nu bnh nhn
va mi dng mt s thuc chn beta. Trong trng hp ny, sc cn mch ngoi vi c th
tng.
Cc nghin cu s b cho thy vic s dng ng thi Dobutamine v nitroprussid to ra cung
lng tim cao v thng c p sut thy phi thp hn so vi vic dng thuc n c.
Khng c bng chng v tng tc thuc trong cc nghin cu lm sng trong s dng ng
thi Dobutamine vi cc thuc khc bao gm cc ch phm digitalis, furosemid, spirolacton,
lidocain, nitroglycerin, isosorbid dinitrat, morphin, atropin, heparin, protamin, kali chlorid, folic
acid v acetaminophen.
TC DNG NGOI
Tng nhp tim, huyt p v tc dng ngoi tm thu tht: S tng huyt p tm thu t 10-20
mmHg v tng nhp tim t 5-15 nhp/pht c thy trn hu ht cc bnh nhn (xem phn
Ch { phng). Khong 5% s bnh nhn b ngoi tm thu trong qu trnh truyn. Cc tc
dng ny c lin quan n liu dng.
H huyt p : S gim huyt p t ngt i khi c m t l c lin quan n iu tr bng
Dobutamine. Gim liu hoc ngng truyn s phc hi nhanh huyt p tr li gi tr bnh
thng. Tuy nhin, trong mt s t trng hp, c th cn phi can thip v s hi phc c th

khng t c ngay.
Phn ng ti v tr truyn tnh mch : i khi c hin tng vim tnh mch. Cc bin i kiu
vim ti ch c m t tip theo cc thm nhim t pht. Mt vi trng hp b hoi t da
(ph hy cu trc m da) c bo co.
Cc tc dng khng ph bin : Cc tc dng ph sau y c bo co 1-3% s bnh nhn
: bun nn, au u, au tht ngc, au ngc khng c hiu, nh trng ngc v th nng.
Vi trng hp gim tiu cu c bo co.
S dng Dobutamine hydrochlorid, cng nh cc catecholamin khc, c th to ra s gim nh
hm lng kali huyt tng, nhng t khi n mc h kali huyt (xem Thn trng).
an ton trong thi gian di hn : Tim truyn thuc trong 72 gi cho thy khng c tc
dng bt li no khc so vi tim truyn thi gian ngn hn.
LIU LNG v CCH DNG
Lu { : Khng c cho Dobutamine tim USP vo thuc tim natri bicarbonat 5% hoc bt kz
mt dung dch kim mnh no khc. V c kh nng tng k vt l tim tng nn khng trn
ln Dobutamine hydrochlorid vi cc thuc khc trong cng dung dch. Dobutamine
hydrochlorid khng c dng phi hp vi cc tc nhn hoc cht pha long khc cha c
natri bisulfit v ethanol.
Pha dng v bo qun :
Khi dng, thuc tim Dobutamine USP phi c pha long thm trong mt l truyn tnh
mch c cha t nht 50 ml dung dch bng mt trong cc dung dch truyn tnh mch lm
cht pha long: thuc tim Dextrose 5%, natri chlorid 0,45% USP ; thuc tim Dextrose 5% v
natrichlorid 0,9% USP ; thuc tim Dextrose 10% USP ; thuc tim Isolyte M vi Dextrose 5%;
thuc tim Ringer lactat ; thuc tim Dextrose 5% trong Ringer Lactat, Normosol M trong D5-W,
Osmitrond 20% trong nc pha tim, thuc tim natri chloride 0,9% USP hoc thuc tim natri
lactat USP. Dung dch tim truyn phi c s dng trong vng 24 gi.
Liu khuyn co :
Tc truyn cn lm tng cung lng tim thng t 2,5-15 mg/kg (xem Bng 1). cc
trng hp him, tc truyn c yu cu c th ti 40 mg/kg/pht t tc dng
mong mun.
Bng 1. Tc truyn
Dobutamine cho cc
nng 250, 500 v
1000mg/ml
Tc phn phi thuc Nng

250mg/ml*

500mg/ml**

1000mg/ml***

(mg/kg/pht)

(ml/kg/pht)

(ml/kg/pht)

(ml/kg/pht)

2,5

0,01

0,005

0,0025

0,02

0,01

0,005

7,5

0,03

0,015

0,0075

10

0,04

0,02

0,01

12,5

0,05

0,025

0,0125

15

0,06

0,03

0,015

* 250 mg/ml cht pha long

** 500 mg/ml hoc 250 mg/500 ml cht pha long
*** 1000 mg/ml hoc 250 mg/250 ml cht pha long
Tc truyn theo ml/gi cho cc nng Dobutamine hydrochlorid 500 mg/ml, 1000 mg/ml
v 200 mg/ml c ghi trong Bng 2, Bng 3 v Bng 4..
Bng 2. Tc
truyn (ml/gi)
Dobutamine HCl
nng
500mg/ml

Th trng (kg)

Tc phn
phi thuc
(mg/kg/pht)
2,5

7,5

10

12,5

15

30

18

27

36

45

54

40

12

24

36

48

60

72

50

15

30

45

60

75

90

60

18

36

54

72

90

108

70

21

42

63

84

105

126

80

24

48

72

96

120

144

90

27

54

81

108

135

162

100

30

60

90

120

150

180

110

33

66

99

132

165

198

2,5

7,5

10

12,5

15

30

4,5

13,5

18

22,5

27

40

12

18

24

30

36

50

7,5

15

22,5

30

37,5

45

60

18

27

36

45

54

70

10,5

21

31,5

42

52,5

63

80

12

24

36

48

60

72

90

13,5

27

40,5

54

67,5

81

100

15

30

45

60

75

90

110

16,5

33

49,5

66

82,5

99

Bng 3. Tc
truyn (ml/gi)
Dobutamine HCl
nng
1000mg/ml

Th trng (kg)

Tc phn
phi thuc
(mg/kg/pht)

Bng 4. Tc
truyn (ml/gi)
Dobutamine HCl
nng
2000mg/ml

Th trng (kg)

Tc phn
phi thuc
(mg/kg/pht)
2,5

7,5

10

12,5

15

30

4,5

11

13,5

40

12

15

18

50

7,5

11

15

19

22,5

60

4,5

13,5

18

22,5

27

70

10,5

16

21

26

31,5

80

12

18

24

30

36

90

13,5

20

27

34

40,5

100

7,5

15

22,5

30

37,5

45

110

16,5

25

33

41

49,5

Tc truyn v thi gian iu tr phi c iu chnh theo p ng ca bnh nhn c xc

nh bi nhp tim, s c mt ca hot tnh gy lc v, huyt p, lng nc tiu v, bt c lc
no c th, cn o p lc mch thy phi v tnh mch trung tm v cung lng tim.
Nng ln ti 5000 mg/ml c s dng cho ngi (250 mg/50 ml). Th tch thuc s
dng cn c xc nh da trn yu cu v cht lng ca bnh nhn.

Cc sn phm thuc tim phi c kim tra bng mt v cc tiu phn l v s i mu trc
khi dng cho c dung dch v l ng.
QU LIU
Him c cc trng hp dng Dobutamine qu liu c bo co. Cc hng dn c
cung cp sau y nu c trng hp dng qu liu.
Du hiu v triu chng :
c tnh do Dobutamine thng l do kch thch qu mc th th beta ca tim. Thi gian tc
dng ca Dobutamine ni chung l ngn (T1/2 = 2 pht) v n c chuyn ha nhanh bi
catechol-0-methyl transferase. Cc triu chng ca c tnh c th bao gm chn n, bun nn,
nn, run, lo u, nh trng ngc, au u, th ngn, au ngc, v au tht ngc khng c
hiu. Tc dng co c v iu nhp do Dobutamine trn c tim c th gy ra cao huyt p, lon
nhp nhanh, nhi mu c tim, rung tm tht. H huyt p c th xy ra do gin mch.
iu tr :
Cc thng tin cp nht v iu tr qu liu c th ly t Trung tm kim tra c t khu vc ca
bn. S in thoi ca cc trung tm kim tra c t khu vc c ghi trong PDR (Physician's
Desk Reference). Nhm qun l vic dng qu liu, cn xem xt kh nng qu liu ca cc thuc
a dng, tng tc gia cc thuc v cc nhn t ng hc bt thng ngi bnh.
Vic u tin cn lm khi dng qu liu Dobutamine l ngng dng thuc, lu { ng th,
m bo oxi v thng kh. Cc nh gi v s hi phc cn c tin hnh mt cch chnh xc.
Lon nhp nhanh tht nng c th iu tr khi vi propranolol hoc lidocain. Cao huyt p
thng p ng vi vic gim liu hoc ngng dng thuc.
Bo v ng th bnh nhn, tr gip thng kh v truyn dch. Nu cn, kim tra t m v duy
tr, trong gii hn c chp nhn, cc du hiu sinh tn ca bnh nhn, kh trong mu, cht
in gii trong huyt thanh... Nu thuc b ung, hp thu khng th on trc c c th
xy ra ming v ng tiu ha. Hp thu thuc t ng tiu ha c th c lm gim bng
cch dng than hot, trong nhiu trng hp c hiu qu hn l gy nn hoc ra d dy, nn
dng than hot thay th hoc b sung cho vic lm rng d dy. Dng cc liu than hot nhc
li theo thi gian c th lm tng thi tr mt s thuc c hp thu. Ch { an ton ng
th ca bnh nhn trong khi lm rng d dy hoc dng than hot.
Li tiu mnh, thm phn mng bng, thm phn mu hoc truyn mu qua than hot khng
c xem l c li i vi qu liu Dobutamine.

164.

DOBUTREX

ELI LILLY
Thuc tim 250 mg : hp 1 l - Bng A.
THNH PHN
cho 1 l
Dobutamine hydrochloride

250 mg

DC LC
Dobutrex c thnh phn l dobutamine hydrochloride c tn ha hc l (+/-)-4-[2-[ [3-(phydroxyphenyl-1-methylpropy] amino]ethyl]-pyrocatechol hydrochloride. y l mt
catecholamine tng hp c tc dng ch vn trn cc receptor a-1, b-1, v b-2.
Dobutrex l thuc c tc dng trc tip trn s co si c tim, do ch yu kch thch cc receptor
adrenergic tim; tc dng mc va phi trn : s iu nhp, s tng huyt p, tnh gy
lon nhp v tc dng gin mch. Ngc li vi dopamine, thuc khng lm tng tit
norepinephrine (noradrenaline), v tc ng ca thuc khng ph thuc vo kho d tr
norepinephrine tim. Nghin cu trn sc vt, so vi isoproterenol, tc dng trn s co si c
tim ca Dobutrex t gy tng nhp tim v t lm gim s khng ca mch ngoi bin hn.
ngi, Dobutrex lm tng th tch mi nht bp v cung lng tim, lm gim p lc y
tm tht, gim sc khng ca mao mch phi v ca mch ton thn. ng cong biu din
chc nng ca tm tht thay i nh cao hn v lch v pha tri, phn nh s gia tng sc co
bp c tim.
Nhp tim khng tng nhiu liu thng thng ca Dobutrex ; tuy nhin vi liu cao (thng
vi liu ln hn 10 mg/(kg.pht)) c th gy tng nhp tim ng k.
Huyt p ng mch thng khng thay i khi dng Dobutrex, v tc dng tng cung lng
tim c cn bng ng thi bi s gim sc khng ngoi bin. c nhng bo co v s
tng v h huyt p ng mch. Ngi bnh c tin s cao huyt p, ngay c nhng lc c
huyt p bnh thng hnh nh p ng v huyt p cng nhy hn.
sc vt, Dobutrex ci thin c tnh trng co mch mu phi do thiu oxy. Kt qu l c th
lm tng ti mu cc vng km thng kh. mt vi bnh nhn, tc ng ny ca Dobutrex
c th lm gim bo ha oxygen trong mu ng mch, nhng mc k m hn nu so
vi dopamine hoc isoproterenol ; nhng bnh nhn ny, do Dobutrex lm tng cung lng
tim, nn k o theo lm tng vn chuyn oxygen. Dobutrex c th ngn nga hoc hn ch phn
no tnh trng gim cung lng tim bnh nhn th my vi p lc dng cui kz th ra
(PEEP).
Dobutrex khng c tc dng trn receptor ca dopamine, do khng c tc dng chn lc lm

gin cc mao mch thn v ni tng. Dobutrex c th ci thin lu lng mu n thn, tc

lc cu thn, lu lng nc tiu v s bi tit natri bng cch gia tng cung lng tim v lm
gin mch khng chn lc.
Dobutrex cng lm tng co bp si c tim tr em, tuy nhin p ng huyt ng hc hi khc
so vi ngi ln. Mc du cung lng tim tng tr em, nhng khng mch ton thn v
p lc y tht c khuynh hng t gim hn, trong khi nhp tim v huyt p ng mch li
tng nhiu hn so vi ngi ln. p lc ng mch phi bt c th tng khi truyn Dobutrex
tr em di 12 thng tui.
Dobutrex lm tng dn truyn nh-tht trong nhng nghin cu v in sinh l ngi, v
ngi bnh b rung nh.
Ging nh tt c cc thuc c tc dng trn s co si c tim, Dobutrex lm tng nhu cu tiu
th oxy c tim. Dobutrex cng lm tng lu lng mu mch vnh v tng cung cp oxy cho
c tim. Nhu cu oxy thay i ty thuc vo nhiu yu t, bao gm :
- thay i th tch tm tht, kt qu l xc nh c mc p lc thnh tm tht cn to
nn p lc trong tm tht thi kz tm thu.
- thay i hu ti, thng tng ng vi cc thay i trong huyt p tm thu.
- nhng thay i v nhp tim.
Trn ngi bnh suy tim v gin tim s dng thuc c tc dng lm tng co si c tim, s lm
gim ng knh tm tht, nhu cu oxy c th hi gia tng hoc khng gia tng cht no, kt
qu l hu ti v nhp tim khng gia tng ng k. Ni chung, Dobutrex khng gy mt cn bng
gia cung v cu oxy c sc vt th nghim v ngi bnh tim. S cung cp oxy thng
vt hn s gia tng tiu th oxy khi truyn Dobutrex, do bo ha oxy trong mu xoang
mch vnh tng ln. T s chit xut acid lactic ng mch-tnh mch, mt bng chng gin
tip ca s chuyn ha hiu kh, thng n nh trong sut qu trnh truyn Dobutrex. Trong
mt vi trng hp, chit xut lactate trong c tim c th gim. mt vi bnh nhn c
thy tng sn lactate, iu ny c bit xy ra khi nhp tim v/hoc huyt p ng mch tng
qu mc trong lc truyn Dobutrex hoc khi s suy chc nng tm tht khng gp trc khi
dng thuc.
ngi bnh c cn au tht ngc v khng suy tim, truyn Dobutrex c tc dng ging nh
vn ng gng sc, nhu cu oxy ca c tim tng vt qu kh nng cung cp oxy ca mch
vnh, do s c nhng biu hiu lm sng ca chng thiu mu c tim c hi phc. Nhng
triu chng ny gm cn au tht ngc, ST chnh xung, khim khuyt ti mu khi chp vi
nhp nhnh thallium, v thnh tim c nhng co bp mi bt thng.
ngi bnh nhi mu c tim cp c iu tr vi Dobutrex trong 24 gi, kch thc vng
nhi mu khng lan rng, t l v mc nguy him ca lon nhp tht khng tng, nu so snh
vi cc bnh nhn tng t khng c iu tr vi Dobutrex. sc vt, dng Dobutrex ngay
sau khi ct tht ng mch vnh, din tch vng nhi mu s thu nh li, nu so snh vi nhm

sc vt chng ch s dng dung dch mui hoc dopamine. mt nhm sc vt khc c nhi
mu c tim thc nghim c truyn Dobutrex vi nhng liu lng lm tng nhp tim v tng
co bp c tim, trn in tm c nhng du hiu gia tng thiu mu c tim. Nhng nghin
cu gn y trn sc vt cho thy chc nng ca tim k m i, v kh nng lan rng ca nhng
tn thng c tim trn thc nghim do nhng thuc lm co si c tim, k c Dobutrex, l do
tc dng lm tng nhp tim hn l tc dng gy tng sc co bp c tim. Khi thuc c truyn
vi nhng liu lng gy tng sc co bp c tim ng k, m t gy tng nhp tim, th s khng
c bng chng tn thng thm cho c tim.
Truyn Dobutrex vi tc di 1 gi ngi bnh suy tim sung huyt s lm tng cung lng
tim v gim p lc ng mch phi bt, tuy vy, s ci thin v huyt ng hc khng km theo
gia tng s dung np vn ng. Ngc li, khi thi gian truyn k o di hn (72 gi), hoc truyn
lp i lp li vi nhng khong cch u nhau trong vng vi tun hay vi thng s ci thin
c tnh trng lm sng.
Cha r c ch s ci thin chc nng tm tht khi truyn Dobutrex k o di hay gin on. Tuy
nhin, trn nhng nghin cu truyn Dobutrex ko di thc hin ngi, ghi nhn c cc
thay i v siu cu trc ty th v v ha sinh, c th y l c bn ca s ci thin lu di.
Dobutrex c dng phi hp vi dopamine. Ni chung, cung lng tim cng khng tng
nhiu hn nu dng liu tng ng Dobutrex n thun. Tuy nhin, s phi hp ny
mang li kt qu sau :
- lm tng huyt p ng mch ton thn (c th c li cho ngi bnh huyt p thp).
- gia tng lu lng mu n thn, lu lng nc tiu v s bi tit natri.
- ngn nga p lc y tht tng, thng xy ra khi dng dopamine n thun, v vy lm
gim nguy c ph phi v sung huyt phi, nht l ngi bnh suy chc nng tht tri.
Dobutrex cng c phi hp vi nhng thuc gin mch khc nh nitroglycerin hoc
nitroprusside, c bit cho nhng ngi bnh thiu mu c tim. S phi hp ny c th gip
tng cung lng tim, v lm gim sc khng ca h mch, v gim p lc y tht m tc
dng thy khi dng ring r mt trong hai loi thuc trn. Nhp tim - huyt p khng thay i
hoc c hi tng khi dng phi hp Dobutrex v mt loi thuc gin mch.
Dobutrex l cht ch vn b-adrenergic. Do , tc dng ca thuc c th b i khng bi
nhng cht i khng trn receptor b-adrenergic. Trong qu trnh iu tr bng nhng cht i
khng beta, dng km Dobutrex liu thp c biu hin tc ng ca a-adrenergic mc
khc nhau, nh co mch. Do tng tc thuc, Dobutrex v cc thuc i khng s cnh tranh
vi nhau trn cng receptor beta. S cnh tranh ny c tnh hi phc, do , nu dng
Dobutrex vi liu cao hn s c tc ng cnh tranh mnh hn chng li nh hng ca cc
thuc i khng receptor b-adrenergic.
DC NG HC
Dobutrex bt u tc dng sau 1-2 pht, v d truyn vi bt kz vn tc no, nng vng bn

trong huyt tng v tc dng ti a cng t c sau 10 pht. Nng n nh trong huyt
tng t l thun vi tc truyn dch. ngi bnh b suy tim sung huyt, nu truyn vi
tc 5 mg/(kg.pht), nng trung bnh trong huyt tng s t c khong 100
nanogam/mL.
thanh thi trong huyt tng ngi ln l 2,4 L/pht/m2, th tch phn phi khong 20%
th trng, v thi gian bn thi trong huyt tng di 3 pht. Chuyn ha ch yu qua methyl
ha, sau l phn ng lin hp. Cc cht chuyn ha c thi tr qua thn v mt. Trong
nc tiu, cht chuyn ha ch yu gm cc cht lin hp ca dobutamine v 3-O-methyl
dobutamine. Dn xut 3-O-methyl khng cn hot tnh sinh hc.
Khi truyn lin tc ko di, Dobutrex s ch dung np c mt phn, v tr thnh c { ngha
thng k sau khi truyn 72 gi. ngi bnh suy tim huyt, nh hng ca Dobutrex trn
cung lng tim thi im gi th 72 t c hn 70% so vi thi im cui gi th 2 nu
truyn thuc vi tc u n. Hin tng ny c th do gim s lng receptor badrenergic.
Trn sc vt, mc du nng catecholamine c suy gim ti cc sy-np thn kinh do tc dng
ca reserpine hoc thuc chng trm cm 3 vng, nhng tc ng ca Dobutrex vn khng
thay i; Dobutrex c tc ng trc tip, v hiu qu ca thuc ny khng ph thuc vo cc c
ch tin sy-np.
CH NH
Dng Dobutrex khi cn lm tng sc co bp c tim iu tr tnh trng gim ti mu do gim
cung lng tim, dn n khng p ng nhu cu tun hon. Cng dng Dobutrex khi cn
tng sc co bp c tim iu tr s gia tng bt thng p lc y tht, c nguy c gy
sung huyt phi hay ph phi. Nhng nguyn nhn c th dn n nhng tnh trng gim ti
mu bao gm :
Nguyn nhn do tim :
1) Suy tim cp :
- Nhi mu c tim cp.
- Chong do nguyn nhn tim.
- Sau phu thut tim.
- Dng qu liu thuc gim co bp c tim nh thuc c ch receptor b-adrenergic.
2) Suy tim mn :
- t suy tim mt b cp ca suy tim huyt mn tnh.
- Cn tng co bp c tim tm thi trong suy tim mn t tin trin, Dobutrex c xem nh l
loi thuc iu tr h tr dng ng thi vi cc thuc lm tng co bp c tim dng ung
thng dng, thuc gin mch ton thn v thuc li niu.
Nguyn nhn khng phi do tim :
1) Tnh trng gim ti mu cp th pht sau chn thng, phu thut, nhim khun, hoc

gim th tch mu vi ch s huyt p ng mch trung bnh trn 70 mmHg, v p lc mao

mch phi bt ln hn hoc bng 18 mmHg, m khng c p ng hu hiu sau khi b th
tch tun hon v lm tng p lc y tht.
2) Gim cung lng tim th pht khi bnh nhn th my vi p lc dng cui kz th ra (PEEP).
chn on bnh mch vnh, c th dng Dobutrex thay th cho th nghim gng sc. Nu
dng Dobutrex cho mc ch ny, phi thng bo cho ngi bnh bit v mi nguy him c th
xy ra lin quan n th nghim ny, v bt buc phi c theo di st nh khi lm cc th
nghim chun mc gng sc, bao gm c vic theo di lin tc in tm .
CHNG CH NH
Khng dng cho ngi bnh trc c biu hin qu mn cm vi Dobutrex.
CH PHNG
Tng nhp tim hoc tng huyt p
Dobutrex c th gy tng nhp tim hoc tng huyt p, nht l huyt p tm thu. Nghin cu
lm sng cho thy khong 10% bnh nhn c nhp tim tng khong 30 nhp/pht hoc hn na,
v khong 7,5% bnh nhn c huyt p tm thu tng thm 50 mmHg hoc hn na. Nu gim
liu, thng cc tc dng ny cng s gim tc khc. Nhng ngi bnh b tng huyt p trc
d c p ng mnh vi thuc hn.
Tng dn truyn nh-tht
V Dobutrex lm tng dn truyn nh-tht, nn nhng bnh nhn c cung nh hoc rung nh c
th c p ng tht nhanh.
Lon nhp kiu nhanh tht
Dobutrex c th kch thch cc pht nhp lc ch tm tht; nhng him khi gy nhp nhanh
tht hoc rung tht.
Gim kh nng y tht v kh nng bm mu
Nhng thuc lm tng co bp si c tim, k c Dobutrex, khng ci thin kh nng bm mu
ca tm tht trong trng hp c tc nghn c hc dng chy ca mu vo hoc chy ra khi
tim, hoc c hai. Nu tnh n hi ca c tim gim nhiu, tc dng tng co bp ca c tim cng
khng c hiu qu. Nhng tnh trng trn l do nguyn nhn trn dch mng ngoi tim, hp van
ng mch ch, hp di ng mch ch ph i v cn. u im ca tc dng lm tng co c
tim c th thy mt s trng hp bnh nhn c tim gin, hoc s dng qu nhiu thuc i
khng receptor b-adrenergic.
Qu mn cm
Nhng phn ng sau y c coi l qu mn cm khi dng Dobutrex, nhng him khi xy ra :
mn da, st, tng bch cu i toan v co tht ph qun.
Dobutrex dng dung dch cha sodium bisulfite, cht sulfite ny c th gy phn ng d ng
gm cc triu chng phn v, v nhng t hen t nh cho n nng mt s ngi bnh
nhy cm vi thuc. Tn s nhy cm vi sulfite trong cng ng n nay cha r, c l l thp.

Nhy cm vi sulfite thng gp nhng ngi b hen hn l nhng ngi khng b hen.
THN TRNG LC DNG
Lu { chung
- Trong khi dng Dobutrex cng nh khi ang dng cc thuc catecholamine dng tim khc,
cn theo di cn thn nhp tim, huyt p v tc truyn. Nn theo di trn in tm t khi
bt u truyn cho n khi c p ng n nh.
- Nn iu chnh tnh trng gim khi lng tun hon trc khi dng Dobutrex.
- Tc dng ca Dobutrex c th b gim nu dng km thuc i khng receptor b-adrenergic.
Trong nhng trng hp nh vy, tc dng alpha ca Dobutrex khng b c ch, s gy nn co
mch ngoi bin v tng huyt p. Tri li, nu c ch receptor a-adrenergic, th cc tc dng b1 v b-2 s chim u th, v kt qu l nhp tim nhanh ln v gin mch .
- Dobutamine, cng nh cc cht ch vn khc tc dng trn receptor b-2, c th lm gim nh
nng kali mu, nhng him khi h kali mu. D sao, cng nn theo di nng kali mu.
S dng Dobutrex khi suy tim bin chng ca nhi mu c tim cp : Vic iu tr suy tim v
lm gim th tch tim s gip gim tiu th oxy ca c tim, nhng nu dng bt kz mt thuc
tng co bp c tim no cng c th lm tng nhu cu oxy v lm tng kch thc nhi mu do
tng thiu mu. Kinh nghim lm sng v s dng Dobutrex trong nhi mu c tim cp cho thy
khi dng Dobutrex vi liu khng gy tng qu mc nhp tim v huyt p, th s khng gy mt
tc dng ph no trn c tim. Nn iu chnh liu lng ngn nga tng nhp tim v tng
qu mc huyt p tm thu.
S dng trong ch nh h huyt p : Khi h huyt p do nguyn nhn gim cung lng tim v
ng thi c km tng p lc y tht, th truyn Dobutrex c th gip duy tr c huyt
p.
Khi iu tr tnh trng gim ti mu cp tnh bng b dch y biu hin qua p lc mao
mch phi bt tng, hoc p lc tnh mch trung tm tng, nhng cung lng tim v huyt p
vn khng tng, th Dobutrex c th gip ci thin sc co bp c tim v khi phc li huyt p.
Ni chung, khi huyt p ng mch trung bnh thp hn 70 mmHg m p lc y tht khng
tng, th c th do gim khi lng tun hon, v cn phi truyn b dch vi khi lng thch
hp trc khi dng Dobutrex.
Nu huyt p vn thp v c khuynh hng gim trong khi dng Dobutrex, mc du cung lng
tim v p lc y tht , th nn x t n kh nng c th ch nh dng km cc thuc
co mch ngoi bin nh dopamine hoc norepinephrine (noradrenaline).
S dng trong nhi khoa : Dobutrex c ch nh tr em c tnh trng gim ti mu, do suy
tim mt b, phu thut tim, chong tim v chong nhim khun. ngi ln so vi tr em, tc
ng v huyt ng hc ca Dobutrex khc nhau v s lng ln cht lng (xin c phn
Dc ng hc). tr em, tc dng lm tng nhp tim, tng huyt p d gp hn v nhy hn
ngi ln. p lc ng mch phi bt c th khng gim tr em, hoc cng c th tng, nht

l nh nhi. Dng Dobutrex tr em phi theo di tht st, v lun ghi nh nhng c im
dc ng hc ny.
LC C THAI
Nhng nghin cu v sinh sn trn chut v th khng thy c bng chng tn hi kh nng
sinh sn, nguy him cho bo thai hoc gy qui thai do Dobutrex. Do khng c d liu
nghin cu trn ngi mang thai, v do nhng th nghim v tc ng ca thuc trn kh nng
sinh sn ca ng vt khng cho php suy din ra kt qu p ng trn ngi, nn khng dng
Dobutrex trong thai kz, tr khi li ch ca vic dng thuc qu r rt.
TNG TC THUC
Khng c thng bo r rng v tng tc thuc trong nhng nghin cu lm sng v kt hp
Dobutrex vi nhng thuc khc, bao gm nhng dn xut digitalis, furosemide, spironolactone,
lidocaine, nitroglycerin, nitroprusside, isosorbide dinitrate, morphine, atropine, heparin,
protamine, potassium chloride, acid folic v acetaminophen. Cc tng tc dc ng hc vi
dopamine v cc thuc gin mch c m t trong phn Dc ng hc.
TC DNG NGOI
Tng nhp tim, huyt p v ngoi tm thu tht : Huyt p tm thu tng thm 10-20 mmHg, v
nhp tim tng thm 5-15 nhp/pht c ghi nhn nhiu bnh nhn (xin c phn Ch {
phng-phn tng nhp tim hoc tng huyt p). Khong 5% bnh nhn c ngoi tm thu tht khi
dng Dobutrex. Nhng tc dng ngoi { ny thng ph thuc vo liu dng.
H huyt p : i khi c gim t ngt huyt p khi dng dobutamine. Gim liu hay ngng
thuc c th nhanh chng a huyt p v tr s ban u. Tuy nhin, mt s trng hp cn
phi x tr, v s hi phc c th khng p ng ngay.
Phn ng ti ni truyn : i khi vim tnh mch. C khi vim ti ch do v lch ng
truyn.
Nhng tc dng ngoi t gp khc : 1-3% bnh nhn c nhng tc dng ngoi { nh: bun
nn, nhc u, au ngc khng c hiu, hi hp v th nng.
Cng nh nhng catecholamine khc, Dobutrex c th lm gim nh nng kali mu, him
khi gy h kali mu.
Tnh an ton khi dng lu di : Khng thy c s khc bit khi dng Dobutrex trong 72 gi v
trong thi gian ngn. C bng chng cho thy ch c s dung np thuc mt phn khi dng
Dobutrex sau 72 gi, do cn dng liu cao hn c hiu qu nh lc khi u.
LIU LNG v CCH DNG
Liu lng
phn ln bnh nhn, tng cung lng tim, tc truyn cn khong t 2,5 ti 10
mg/(kg.pht). Thng thng, liu cn ci thin tnh trng huyt ng hu hiu l 20
mg/(kg.pht). Rt him khi cn n liu 40 mg/(kg.pht).
Tc v thi gian truyn nn iu chnh ty theo p ng ca ngi bnh, da vo nhng

yu t lm sng sau : cc thng s v huyt ng hc nh tn s tim, kiu nhp tim, huyt p

ng mch, v nu c th c, o cung lng tim v p lc y tm tht (p lc tnh mch
trung tm, mao mch phi bt v nh tri), cc du hiu ca sung huyt phi, tnh trng ti
mu cc c quan (theo di nc tiu, nhit da v tri gic).
dng nng ln n 5 g/L ngi (250 mg/50 mL). Th tch dch truyn vo ty thuc vo
nhu cu ca ngi bnh.
Nn gim liu Dobutrex dn dn hn l ngng t ngt.
Cch dng
Thi gian bn thi ca Dobutrex ngn, vy nn dng bng ng truyn tnh mch lin tc.
Nng thuc trong huyt tng t n nh trong vng 10 pht sau khi truyn vi tc u
n, hoc sau khi thay i tc . Do , khng cn dng liu np, cng nh tim tnh mch
trc tip liu np.
n v tnh liu
Hu ht cc bo co v Dobutrex u din t liu lng da trn th trng, th d nh
(mg/kg.pht). iu ny rt c ch cho tr em v tr s sinh hn l cho ngi ln. ngi ln,
th trng khng nh hng ng k trn hiu qu ca Dobutrex; v liu dng cn iu chnh ty
tng ngi bnh, nn liu cho ngi ln c tnh d dng vi n v l mg/pht. Liu
Dobutrex c th bt u t 0,1-0,2 mg/pht, v tng dn n 1-2 mg/pht hoc hn na, ty
thuc vo p ng huyt ng hc v p ng trn lm sng ca mi ngi bnh.
+ Dobutrex dng dung dch :
Ghi ch : Khng c pha thm Dobutrex vi dung dch tim sodium bicarbonate 5% hoc bt
kz dung dch kim mnh no khc. V c th c tng k vt l{, nn khng c trn chung
Dobutrex vi cc thuc khc trong cng mt dung dch hoc pha long vi cc dung dch c
cha sodium bisulfite v ethanol.
Pha thuc v tnh n nh : Dobutrex khi s dng cn c pha long na trong chai 50 mL ca
mt trong cc dung dch truyn tnh mch sau : dextrose 5% ; dextrose 5% v natri chloride
0,45% ; dextrose 5% v natri chloride 0,9% ; dextrose 10% ; Isolyte M vi dextrose 5% ; lactate
Ringer ; dextrose 5% trong lactate Ringer ; Normosol M trong D5-W ; Osmitrol 20% trong nc
ct pha tim ; natri chloride 0,9%, hoc natri lactate. Dung dch tim tnh mch ny nn c
s dng trong vng 24 gi. Dung dch cha dobutamine hydrochloride c th c mu hng,
cng hng nu cng lu. S i mu ny do thuc b oxy ha nh, nhng s khng nh
hng n tc dng, nu c dng trong thi gian bo qun ni trn.
+ Dobutrex tim :
Pha thuc : Dobutrex c th pha vi nc ct v khun pha tim, nc dung dch km khun
pha tim, hoc dung dch dextrose 5%. Khi cn truyn trong thi gian di mt th tch nh, cn
pha thuc vi dung dch km khun pha tim c th lm gim nguy c nhim khun dung dch
trn. Khng nn dng dung dch mui pha Dobutrex, v ion chloride c th nh hng n

s ha tan ban u ca Dobutrex. pha thuc, thm 10 mL dung dch vo l s 7051,

Dobutrex, 250 mg. Nu thuc khng ha tan ht, thm 10 mL dung dch pha na. i vi l s
7052, thm 10 mL dung dch.
Pha long thm : Dobutrex pha nng cao n 25 mg/mL vn duy tr c tnh n nh.
Tuy nhin, trong hu ht cc trng hp, Dobutrex nn c pha long na c nng 5
mg/mL hoc thp hn trc khi s dng. Pha long vi dung dch tim truyn dextrose 5%,
natri chloride 0,9%, hoc sodium lactate.
Khng c pha Dobutrex vi dung dch sodium bicarbonate 5% hoc vi bt c dung dch
kim mnh no khc. Do c tng k vt l, khng nn pha trn cng vi cc thuc khc trong
dung dch c cha Dobutrex. Dobutrex khng c dng chung vi thuc hoc dung dch cha
natri bisulfite v ethanol.
Tnh n nh : Thuc c pha c th c d tr trong t lnh trong vng 96 gi, hoc 24 gi
nhit trong phng. Dung dch truyn tnh mch nn dng trong vng 24 gi.
Dung dch c cha Dobutrex c th c mu hng, ngy cng m dn theo thi gian. S thay
i mu ny l do thuc b oxy ha nh, nhng hot tnh ca thuc khng thay i nu c s
dng trong thi gian bo qun nu trn.
Tc truyn da vo nng Dobutrex : Tc truyn cn c iu chnh theo nng
Dobutrex trong l dch truyn. Bng di y s hng dn v tc truyn [mL/(kg.pht)] cn
thit cho 3 loi nng thng dng (250, 500 v 1.000 mg/l) a vo c th cc liu tnh
bng [mg/(kg.pht)].
Tc a thuc vo [mg/(kg.pht)]

Tc dch
truyn a
vo
[mL/(kg.pht)]
250 mg/l*

500 mg/l**

1 g/l***

2,5

0,01

0,005

0,0025

0,02

0,01

0,005

7,5

0,03

0,015

0,0075

10

0,04

0,02

0,01

12,5

0,05

0,025

0,0125

15

0,06

0,03

0,015

* 250 mg/l dch pha long** 500 mg/l hay 250 mg/500 mL dch pha long*** 1000 mg/l hay
250 mg/250 mL dch pha long
QU LIU
Qu liu dobutamine rt him khi xy ra. Sau y l hng dn x tr trong trng hp qu liu
:
Cc du hiu v triu chng : c tnh ca dobutamine hydrochloride thng do tc dng kch
thch qu receptor beta trn tim. Thi gian tc ng ca dobutamine hydrochloride thng
ngn (T1/2 = 2 pht), do thuc b chuyn ha nhanh qua xc tc ca catechol-Omethyltransferase. Cc triu chng ng c c th gm chn n, bun nn, nn, hi hp, nhc
u, run ry, lo u, th nng, au tht ngc, au ngc khng c hiu. Cc tc ng tng co
bp c tim v tng nhp tim ca dobutamine trn c tim c th gy tng huyt p, lon nhp
nhanh, thiu mu c tim, v rung tht.
H huyt p c th l do gin mch.
Nu thuc c dng ng ung, khng phng on c s hp thu thuc ming v
ng tiu ha.
X tr : Khi x tr vic dng qu liu, cn xem xt kh nng qu liu nhiu loi thuc, tng tc
gia cc thuc v dc ng hc bt thng ca thuc i vi ngi bnh. ng tc u tin
trong vic x tr qu liu l ngng thuc, gi thng ng th, bo m thng kh v oxy.
Bt u ngay nhng bin php hi sc. Nhp nhanh tht nguy him c th c iu tr thnh
cng bi propranolol hoc lidocaine. Tng huyt p thng p ng iu tr vi gim liu hoc
ngng thuc.
Bo v ng h hp ca ngi bnh, h tr thng kh v truyn dch. Khi cn, nn kim tra v
theo di du hiu sinh tn ca ngi bnh, cc thng s nh kh mu, nng cc cht in
gii trong huyt thanh... S hp thu thuc qua ung tiu ha c th gim i bng cch dng
than hot; trong nhiu trng hp, than hot c hiu lc hn phng php gy nn hoc ra
rut, nn dng than hot thay th hoc h tr cho ra d dy. Dng than hot lp i lp li
nhiu ln, c th lm tng thi tr mt s thuc c hp thu. Nn bo v ng h hp
ca ngi bnh khi ra d dy hay dng than hot.
Dng thuc li niu mnh, thm phn mng bng, thm phn lc mu hoc truyn mu cha
thy c li trong x tr qu liu dobutamine hydrochloride.

165.

DODCAVIT 0,5 mg/ml

SERB
c/o GALIEN
Dung dch tim bp 0,5 mg/ml : ng 2 ml, hp 6 ng.
THNH PHN
cho 1 ng
Hydroxocobalamine

1 mg

T dc : sodium chlorure, acide actique

bng va pH 4, nc ct pha tim.
DC LC
Chng thiu mu, vitamine B12 (B : mu v cc c quan to mu).
Hydroxocobalamine : yu t to mu.
DC NG HC
Vitamine B12 c hp thu on cui hi trng theo hai c ch, mt c ch th ng khi c s
lng nhiu, v mt c ch ch ng cho php hp thu cc liu sinh l trong s hin din
ca cc yu t ni sinh l cn thit.
nh hp thu trong huyt thanh t c sau khi tim bp mt gi.
Thuc c bi tit ch yu qua ng tiu.
CH NH
Thiu vitamine B12 c xc nhn do c ri lon trong s hp thu : bnh Biermer, d dy b
ct ton b, on cui hi trng b ct, bnh Imerslund.
CHNG CH NH
C tin s d ng vi cobalamine (vitamine B12 v cc cht cng h).
- U c tnh : do vitamine B12 c tc ng trn s nhn bi t bo v tng trng m, do c
th lm cho bnh tin trin kch pht.
TC DNG NGOI
- Phn ng phn v : nga, ni my ay, hng ban, hoi t da, ph c th dn n nng : sc
phn v hoc ph Quincke.
- C th gy mn trng c.
- C th gy au ni tim bp.
- C th lm cho nc tiu c mu (do vitamine B12 c o thi qua nc tiu).
LIU LNG v CCH DNG
Tim bp.
Khng c tim tnh mch.
- iu tr tn cng : 1 mg (1 ng) mi ngy hoc mi tun 3 ln, tim bp. Mt t iu tr gm

10 mg (10 ng).
- iu tr duy tr : 1 mg (1 ng), tim bp mi thng mt ln.
QU LIU
Vitamine B12 khng gy bnh.
BO QUN
Trnh nh sng.

166.

DOGMATIL 50

SANOFI SYNTHELABO VIETNAM

vin nang 50 mg : hp 30 vin - Bng B.
THNH PHN
cho 1 vin
Sulpiride

50 mg

(Lactose)
DC LC
An thn kinh, gii c ch.
DC NG HC
Dng bng ng ung, sulpiride c hp thu trong 4,5 gi ; nng nh ca sulpiride trong
huyt tng l 0,25 mg/l sau khi ung vin nang 50 mg.
Sinh kh dng ca dng ung l t 25 n 35%, c th c s khc bit ng k gia ngi ny
v ngi khc ; cc nng ca sulpiride trong huyt tng c lin quan tuyn tnh vi liu
dng.
Sulpiride c khuch tn nhanh n cc m, nht l n gan v thn ; s khuch tn n no
km, ch yu l n tuyn yn.
T l gn vi protine huyt tng di 40% ; h s phn phi n hng cu v huyt tng l
1. S bi tit qua sa m c c on l 1/1000 ca liu hng ngy. Cc s liu c thc
hin trn ng vt bng sulpiride c nh du (C14) chng t rng s bi tit qua hng ro
nhau thai rt k m. Ngc li vi nhng ghi nhn trn ng vt, sulpiride rt t b chuyn ha
ngi ; 92% liu sulpiride dng bng ng tim bp c tm thy trong nc tiu di dng
khng i.

Dc ng ca sulpiride bao gm giai on hp thu, sau l giai on phn phi, tip theo l
giai on o thi. Thi gian bn hy o thi trong huyt tng l 7 gi ; th tch phn phi l
0,94 l/kg. Thanh thi ton phn l 126 ml/pht.
Sulpiride c bi tit ch yu qua thn, nh qu trnh lc cu thn. Thanh thi thn
thng gn bng vi thanh thi ton phn.
CH NH
Trng thi thn kinh c ch.
CHNG CH NH
Khng k toa cho bnh nhn bit hay nghi ng b u ty thng thn (do c nguy c gy tai
bin cao huyt p nng).
CH PHNG
Nu c st cao, phi ngng iu tr, v du hiu ny c th l mt trong nhng yu t ca "hi
chng c tnh ca thuc lon thn kinh".
THN TRNG LC DNG
Thn trng khi k toa cho ngi ln tui do nhy cm cao vi thuc.
Do thuc ch yu c o thi qua thn, cn thn trng gim liu v khng nn iu tr lin
tc bnh nhn b suy thn nng.
Nn tng cng theo di bnh nhn b ng kinh do thuc c th lm gim ngng gy ng
kinh.
C th dng c nhng cn phi thn trng bnh nhn b bnh parkinson.
LC C THAI
Hn ch s dng trong thai kz v liu dng cn gim vo cui thai kz.
Tr s sinh : cn theo di cc chc nng thn kinh (v tiu ha trong trng hp kt hp vi
cc thuc khng lit rung).
LC NUI CON B
S bi tit qua sa m c c on l 1/1000 ca liu hng ngy.
TNG TC THUC
Chng ch nh phi hp :
- L vodopa : c i khng tng tranh gia lvodopa v cc thuc an thn kinh.
Trong trng hp xy ra hi chng ngoi thp gy bi cc thuc an thn kinh, khng c dng
lvodopa (do cc th th dopaminergic b phong b bi cc thuc an thn kinh), m nn
dng cc thuc khng cholinergic.
nhng bnh nhn b lit rung (parkinson) c iu tr bng l vodopa, trong trng hp cn
c iu tr bng thuc an thn kinh, khng nn tip tc dng lvodopa do c th lm nng
thm cc ri lon tm thn v c th tc ng ln cc th th b phong b bi cc thuc an
thn kinh.
Thn trng khi phi hp :

- Alcool : ru c th lm tng tc dng an thn ca thuc an thn kinh.

Trnh ung ru v cc thuc hay thc ung c cha ru.
Lu { khi phi hp :
- Thuc cao huyt p : tng tc dng h huyt p v c th gy h huyt p t th (do hip ng
tc dng).
- Cc thuc c ch thn kinh trung ng khc : thuc chng trm cm c tc dng an thn,
thuc khng histamine H1 c tc dng an thn, barbiturate, thuc an thn gii lo u, clonidine
v cc thuc cng h, thuc ng, m thadone : tng c ch thn kinh trung ng, c th gy hu
qu xu, nht l nhng ngi phi li xe hay iu khin my mc.
TC DNG NGOI
Trn h ni tit v chuyn ha :
- tng prolactine mu tm thi v c hi phc c th gy v kinh, tit sa, v to nam gii,
gim khoi cm hay lnh cm.
- tng cn.
Trn h thn kinh (cc tc dng ngoi { nu di y rt him khi xy ra khi dng liu khuyn
co) :
- ri lon vn ng sm (vo c co git, cn xoay mt, cng hm...), gim khi s dng vi thuc
khng lit rung tc ng khng cholinergic.
- hi chng ngoi thp, gim mt phn khi s dng vi thuc khng lit rung tc ng khng
cholinergic.
- ri lon vn ng mun khi iu tr ko di.
- bun ng, ng gt, thng c ghi nhn trong thi gian u tr liu.
Trn thn kinh thc vt :
- h huyt p th ng.
LIU LNG v CCH DNG
Dng cho Ngi ln.
Trng thi thn kinh c ch : 2-4 vin/ngy (100-200 mg/ngy).
QU LIU
S qu liu c th c biu hin qua cc du hiu lon vn ng dng co tht gy vo c, li
li, cng kht hm. Trong mt vi trng hp : hi chng lit rung rt trm trng, hn m.
Vic iu tr ch gii hn trong iu tr cc triu chng.

167.

DOLARGAN

SANOFI SYNTHELABO VIETNAM

Dung dch tim 100 mg/2 ml : ng 2 ml, hp 10 ng - Bng gy nghin.
THNH PHN
cho 1 ng
Pthidine chlorhydrate

100 mg

CH NH
- au d di khng ch ng c bng cc thuc gim au khng gy nghin (au hu phu,
chn thng, nhi mu c tim cp).
- Dng tin phu gia tng hiu lc thuc gy m.
- Cn au qun mt, cn au qun thn v niu qun.
- Hen tim v ph phi do suy tm tht tri cp.
- au do u khng ch ng c bng cc thuc gim au nh.
CHNG CH NH
- Suy h hp, chn thng u, tng p sut ni s.
- Hen ph qun, trc khi chn on bnh.
CH PHNG v THN TRNG LC DNG
- Thuc c kh nng gy nghin.
- Dng thuc c th lm tng biu hin ng kinh, nn thn trng d tr mt thuc chng ng
kinh hay cht i khng (naloxone).
- Khng dng trong 2 tun sau khi tr liu bng IMAO.
- Thn trng khi dng cho ngi gi hay bnh nhn yu t.
- Thn trng khi dng cho bnh nhn b nhc gip, suy tuyn thng thn, ph i tuyn tin
lit, suy gan hay thn.
- Trnh li xe hay vn hnh my trong khi iu tr.
TNG TC THUC
IMAO, thuc c ch thn kinh trung ng v thuc chng trm cm 3 vng (tng tc dng c
ch h hp, h huyt p v an thn).
TC DNG NGOI
Sng khoi, bn chn, yu, nhc u, hng phn, run ry, hoang tng thong qua, mt nh
hng, ri lon th gic, c ch h hp, kh ming, bun nn, nn, to bn, bc ha, tim p
nhanh hay p chm, nh trng ngc, b tiu. Phn ng d ng : nga, ni mn v ni m ay
ngoi da.
LIU LNG v CCH DNG
Ngi ln :
ng tim : 50-100 mg, SC hay IM, 1-3 ln/ngy. Nu cn c th tim IV chm trn 2-3 pht,

25-50 mg hay 100 mg.

Tr em t 2-14 thng :
au d di trong phu thut hay do cc nguyn nhn khc : Liu duy nht 1 mg/kg, SC. Dung
dch lytic coctail : 2 mg/kg (km vi chlorpromazine v promthazine).

168.

DOLFENAL

UNITED LABORATORIES
Vin nn 500 mg : v 4 vin, hp 25 v.
THNH PHN
cho 1 vin
Acide mfnamique

500 mg

DC LC
Acide mfnamique, dn xut ca acide anthranilique, l mt thuc khng vim khng stroide
c lin quan v cu trc v dc l vi mclofnamate sodium.
Hot cht c tc ng khng vim, gim au v h st. Ging nh cc khng vim khng
stroide khc, acide mfnamique c ch s tng hp prostaglandine trong m bng cch c
ch cyclooxygnase, mt men xc tc s hnh thnh tin cht prostaglandine (cc peroxyde ni
sinh) t acide arachidonique. Khng ging hu ht cc khng vim khng stroide khc, cc
f namate, trong c acide m f namique ca Dolfenal, cho thy c s tng tranh vi
prostaglandine ti v tr gn ca cc th th prostaglandine v do nh hng mnh n cc
prostaglandine va mi hnh thnh.
Tc ng khng vim ca Dolfenal l do ngn chn s tng hp prostaglandine v phng thch
cht ny trong sut qu trnh vim.
Tc ng gim au ca acide mfnamide c th do c hai c ch trung ng v ngoi bin.
Prostaglandine t ra lm nhy cm cc th th au p ng vi cc kch thch c hc v cc
cht trung gian ha hc khc (nh bradykinine, histamine). Tc dng gim au ca acide
mfnamide l nh tc ng ngn chn s tng hp prostaglandine cng nh ngn chn cc
tc ng ca prostaglandine hnh thnh trc . Ngoi ra, tc ng chng vim ca
Dolfenal c th cng tham gia vo tc ng gim au ca n.
Acide mfnamique lm gim nhit ca c th bnh nhn ang ln cn st. Tc ng gim
nhit c v nh l do vic ngn chn s tng hp prostaglandine h thn kinh trung ng (c

th l vng di i).
CH NH
Dolfenal c ch nh lm gim cc chng au v thn th v au do thn kinh t nh n
trung bnh, nhc u, au na u, au do chn thng, au sau khi sinh, au hu phu, au
rng, au v st theo sau vim cc loi, au kinh, au h v.
CHNG CH NH
Khng dng cho bnh nhn suy thn, suy gan.
THN TRNG LC DNG
Cn thn trng khi s dng thuc cho bnh nhn lot d dy.
TNG TC THUC
Acide m f namique gia tng s p ng i vi cc cht chng ng dng ung, bng cch gy
dch chuyn warfarine ra khi v tr gn protine ca n. Cc bnh nhn ung thuc ny i khi
c bilirubine trong nc tiu gia tng, c th l do s can thip ca cc cht chuyn ha ca
thuc ln tin trnh xt nghim.
TC DNG NGOI
Nh vi tt c cc thuc khng vim khng stroide khc, nhng tc dng ph nh bun nn,
nn ma, tiu chy, au bng v kh tiu, ni ban, nga, nhc u, chng mt, trm cm v
gim bch cu tm thi c th xy ra i vi cc bnh nhn ung Dolfenal. Thuc cng c th
lm bnh hen suyn trm trng hn. Vi liu cao, thuc c th dn n co git cn ln, do ,
nn trnh dng trong trng hp ng kinh.
LIU LNG v CCH DNG
Mi ln ung 1 vin, 3 ln/ngy hay theo s ch nh ca bc s.
Nn ung trong ba n v mi t tr liu khng nn ko di qu 7 ngy.

169.

DRIPTANE

DEBAT
[FOURNIER GROUP VIETNAM]
vin nn d b 5 mg : hp 60 vin.
THNH PHN
cho 1 vin
Oxybutynine chlorhydrate

5 mg

tng ng : oxybutynine

4,54 mg

(Lactose)

DC LC
Oxybutynine l cht chng co tht loi khng cholinergic.
Thuc lm gim s co tht ca c d trusor v nh th lm gim mc v tn s co tht ca
bng quang cng nh p lc trong bng quang.
DC NG HC
Nng ti a trong huyt thanh t c sau khong 30 pht. Nng trong huyt tng t
l thun vi liu s dng.
Thi gian bn hy o thi trong huyt tng di 2 gi.
CH NH
- Tiu gp ph n, c tiu sn hay khng, nht l trong nhng trng hp bng quang khng
n nh, tr trng hp tiu khng kim sot khi gng sc.
- Tiu dm, ch khi c chng c lm sng ca mt s cha trng thnh ca bng quang (c ri
lon i tiu ban ngy).
- Triu chng bng quang thn kinh co tht.
CHNG CH NH
- Tng nhn p gc ng.
- Hi chng tiu kh ni chung, v c bit l u x tin lit tuyn.
- Chng nhc c nng.
- Vim ph qun mn tnh.
- Mt trng lc tiu ha.
- Tr em di 5 tui.
- Ch b tiu dm vo ban m.
CH PHNG v THN TRNG LC DNG
Do c c tnh khng cholinergic, oxybutynine c th gy cc biu hin atropinic tr em (xem
Chng ch nh), ty mc nng nh m quyt nh ngng s dng hoc iu chnh liu.
TC DNG NGOI
Cc tc dng ngoi loi atropinic c th c quan st, c bit tr em, nh kh nim mc
ming, ri lon th gic, gin ng t, gim nhu ng rut, o gic, o thnh, kch ng, c
mng, nhp tim nhanh.
Mt s him trng hp gy co git hoc pht ban ngoi da. Nu cc biu hin ny nghim
trng, cn phi ngng tr liu.
LIU LNG v CCH DNG

Liu khi u :
Ngi ln : 1/2 vin, 3 ln mi ngy.
Tr em trn 5 tui : 1/2 vin, 2 ln mi ngy.
Sau tng dn liu ty theo p ng lm sng v dung np ca bnh nhn.
Liu ti a :
Ngi ln : 3 vin/ngy.
Tr em trn 5 tui : 2 vin/ngy.
QU LIU
Trng hp dng qu liu, c th xy ra :
- tng tc dng ngoi ;
- du hiu ng c atropinic (gin ng t, gim bi tit, lit c trn), iu tr bng cch sc
rut, gy nn, h hp nhn to trong trng hp b ri lon h hp.

170.

DUPHALAC

SOLVAY
c/o KENI - OCA
dung dch ung : gi 15 ml, hp 10 gi v 20 gi.
dung dch ung : chai 200 ml, 500 ml, 1000 ml.
THNH PHN
cho 1 gi
Lactulose

10 g

DC LC
Thuc nhun trng thm thu, h ammoniac huyt.
Lactulose b thy phn bi cc enzyme ca vi khun thnh cc acide hu c, gy gim pH
on gia ca kt trng. Do s hp thu ammoniac rut tng theo pH, vic pH kt trng gim
di tc dng ca lactulose s ko theo gim hp thu ammoniac. pH kt trng gim do
lactulose ko theo s khuch tn ca ammoniac t mu vo rut. Mt khc trong mi trng
acide, ammoniac kt trng (NH3), l dng c th khuch tn c s chuyn thnh mui
ammoni (NH4) l dng khng khuch tn c, iu ny s cn tr vic ammoniac phn tn vo
mu.
S acide ha mi trng trong rut s lm kch thch nhu ng rut, iu ny cho ph p o

thi ammoniac ra khi c th nhanh hn.

DC NG HC
Lactulose l mt disaccharide tng hp. Sau khi ung, cht ny i qua phn trn ca ng tiu
ha m khng b thay i, khng b hp thu. kt trng, di tc dng ca cc vi khun phn
gii ng, lactulose c chuyn thnh cc acide hu c (acide lactique v acide ac tique),
cc cht ny sau c o thi qua phn.
CH NH
- iu tr triu chng to bn.
- Bnh no gan.
CHNG CH NH
- Cc bnh l{ i trng vim thc th (nh vim lo t i trng, bnh Crohn...), hi chng tc
hoc bn tc, hi chng au bng khng r nguyn nhn.
- Ch king galactose do trong thnh phn ca thuc c mt loi ng tng t (8%).
CH PHNG v THN TRNG LC DNG
Khng nn iu tr to bn bng thuc di hn.
Dng thuc trong chng to bn ch l mt h tr cho vic iu tr bng ch v sinh v n
ung :
- n thc n giu cht si v ung nhiu nc,
- tng vn ng v tp thi quen i cu.
nh nhi v tr em, ch k toa thuc nhun trng khi tht s cn thit, do c nguy c lm
mt phn x i cu bnh thng tr.
C th k toa Duphalac dng dung dch cho bnh nhn tiu ng, do trong thnh phn khng
c glucose.
TC DNG NGOI
- Trng bng v phn lng : cc ri lon ny c th xy ra vo thi gian u iu tr, cc hin
tng ny s ngng khi iu chnh liu thch hp.
- Him khi b nga, au hu mn, st cn va phi.
LIU LNG v CCH DNG
ng s dng : ung hoc bm hu mn.
Duphalac c th c ung nguyn cht hoc pha long vi thc ung.
Mt mung canh Duphalac dung dch ung bng 1 gi, bng 10 g lactulose.
To bn :
Liu dng nn c iu chnh tng bnh nhn theo kt qu iu tr thu c.
Liu trung bnh hng ngy nh sau :
- Nh nhi t 0 n 12 thng : 1 mung caf/ngy.
- Tr t 1 n 6 tui : 1 n 2 mung caf/ngy.
- Tr t 7 n 14 tui :

iu tr tn cng : 1 gi/ngy, hay 1 mung canh/ngy,

iu tr duy tr : 2 mung caf/ngy.
- Ngi ln :
iu tr tn cng : 1 n 3 gi/ngy, hay 1 n 3 mung canh/ngy,
iu tr duy tr : 2 n 5 mung caf/ngy.
Gim liu nu b tiu chy.
Bnh no gan :
Trong mi trng hp, liu l{ tng l liu gip cho i phn mm 2 ln/ngy.
Thi gian iu tr thay i theo triu chng bnh.
- iu tr ngoi tr :
Ngi ln : 1 n 2 gi x 3 ln/ngy, iu tr di hn.
- iu tr bnh vin trng hp bnh nhn b hn m hoc tin hn m :
iu tr tn cng bng cch cho vo ng thng d dy hoc tht ra :
- thng d dy : 6-10 gi, nguyn cht hoc pha long vi nc,
- tht ra vi ng thng c bong bng : pha 300 ml thuc vi 700 ml nc m v tht gi trong
20 pht n 1 gi ; sau 12 gi c th lp li thao tc nu cn.
iu tr chuyn tip ng ung : 1 n 2 gi x 3 ln/ngy.
QU LIU
Triu chng : tiu chy.
X l{ : ngng iu tr

171.

DUPHASTON

SOLVAY
c/o KENI - OCA
vin bao 10 mg : hp 20 vin.
THNH PHN
cho 1 vin
Dydrogestrone
(Lactose)

10 mg

DC LC
Dydrogest rone c tc ng ging progestrone trn ni mc t cung v c tc ng tr thai.
Dydrogest rone khng c tc ng ca androgne v ca estrogne.
Dydrogestrone khng nh hng ln ng nhit v s rng trng.
Khng c nh hng c ch s bi tit ca hong th.
DC NG HC
Dydrogest rone dng ng ung c chuyn ha gan thnh cht chuyn ha khng c
hot tnh khc vi prgnandiol (cht chuyn ha ca progest rone). Do khi dng Duphaston
vn c th kim sot c s bi tit progestrone ni sinh bng cch nh lng prgnandiol
trong nc tiu. Dydrogest rone c o thi gn nh hon ton sau 10 gi.
CH NH
- Cc ri lon lin quan n s gim progestrone (nht l hi chng tin kinh nguyt, kinh
nguyt khng u do ri lon hoc khng rng trng, cc bnh v lnh tnh, cc chng au v,
thi kz tin mn kinh...).
- Thi kz mn kinh c xc nhn (b sung iu tr bng estrogne).
- V sinh do suy hong th.
- Da sy thai hoc sy thai lin tip c xc nhn l do suy hong th.
- Lc ni mc t cung.
CH PHNG v THN TRNG LC DNG
Thn trng trong trng hp chc nng gan b h hi nng.
LC C THAI
Thuc ny khng c ch nh trong lc c thai.
Kt qu ca rt nhiu nghin cu dch t hc cho n nay cho php loi b nguy c gy d dng
( b phn niu sinh dc hoc c quan khc) ca estroprogestatif c dng trong thi kz
u thai kz khi m cha bit l c thai.
Cc nguy c trn s phn ha gii tnh ca bo thai (nht l gii tnh n), nguy c c m t
i vi cc loi progestatif c c tc ng androgne mnh th khng th dng suy lun cho
cc progestatif mi c tc ng androgne rt yu, thm ch khng c (nh i vi hot cht
c s dng trong thuc ny).
TNG TC THUC
Khng nn phi hp :
- Cc thuc gy cm ng men : thuc chng co git (carbamazpine, phnobarbital, phnytoine,
primidone) ; barbiturate ; grisofulvine, rifabutine, rifampicine. Cc thuc ny lm gim hiu lc
ca progestatif.
Thn trng khi phi hp :
- Thuc tr tiu ng (insuline, metformine, sulfamide h ng huyt) : do dng progestatif
liu cao c tc dng gy i tho ng.

Thng bo iu ny cho bnh nhn v tng cng t theo di ng trong mu v nc tiu.

C th iu chnh liu thuc tr tiu ng trong thi gian iu tr bng progestatif v sau khi
ngng thuc ny.
TC DNG NGOI
C th gy xut huyt gia cc chu kz kinh nu dng thuc ny sm trong cc chu kz kinh (t
ngy th 5 n ngy th 25 ca chu kz) : khng cn phi ngng iu tr.
LIU LNG v CCH DNG
Theo nguyn tc chung, i vi iu tr suy progestrone : 20 mg/ngy, tng ng vi 2 vin t
ngy th 11 n ngy th 25 ca chu kz, chia lm 2 ln cch xa nhau.
Mt vi ch nh cn c s dng c bit :
- Lc ni mc t cung : 3 vin/ngy, iu tr lin tc hoc gin on (t ngy th 5 n ngy th
25 ca chu kz). Trng hp iu tr lin tc khng bt buc b mt kinh ;
- Bng huyt : 3 vin/ngy cho n khi ngng xut huyt ng sinh dc, dng thm 20 ngy
( trnh xut huyt do ngng thuc t ngt), sau 2 vin/ngy t ngy th 16 n ngy
th 25 ca cc chu kz tip theo ;
- Chu kz kinh nhn to hng thng (trng hp mn kinh c xc nhn) : dng estrogne
t ngy th 1 n ngy th 24 v Duphaston t ngy th 13 n ngy th 24 (2 vin/ngy). Sau
ngng dng thuc cho n ht thng.

172.

DURALYN-CR

RAPTAKOS BRETT
Vin nang phng thch c kim sot 400 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Theophylline khan

400 mg

DC LC
Theophylline (3,7-dihydro-1,3-dimethyl-1-H-purine-2,6-dione) l mt thuc lm dn ph qun
loi xanthin.
Theophylline trc tip lm dn c trn ca ng ph qun v cc mch mu phi. Ngi ta
chng minh rng theophylline c hiu lc trn tnh co tht ca c honh ngi bnh thng
v v ci thin s co tht bnh nhn b bnh tc nghn ng th mn tnh. Theophylline

cng l mt cht kch thch h hp trung ng.

T nhiu nm, c ch tc ng chnh ca cc xanthin c nu ln l s c ch
phosphodiesterase m kt qu l lm gia tng AMP vng. Tuy nhin, nng iu tr tc
dng ny l khng ng k. Cc tc dng khc m dng nh c xy ra cc nng iu tr v
c th c vai tr trong c ch tc dng ca xanthine gm c : c ch adenosin ngoi bo (l
cht gy co tht ph qun), kch thch cc catecholamin ni sinh, i khng vi cc
prostaglandins PGE2 v PGF2, trc tip tc dng ln s chuyn ng ca calci ni bo kt qu l
s dn c trn v c hot tnh ng vn beta adrenergic ln ng th.
DC NG HC
Duralyn-CR l mt ch phm a n v vi nhiu vin hon nh. Mi hon gm mt li vi
nhiu lp thuc v mng c bit xp xen k bao quanh c kh nng kim sot tc khuch
tn ca thuc bn trong. Sau khi ung vo, v nang gelatin tan ra nhanh chng v phng thch
cc vin hon nh vo trong d dy. Nc thm thu vo cc vin hon nh ngay t d dy v
ha tan thuc cho n khi bo ha. Cc vin hon nh sau c ri u dc theo ng rut
v mng thm tch m bo cho thuc khuch tn chm v u ra lng rut xung quanh, c
lp vi thnh phn cha trong rut. Tin trnh ny din ra u n, chm ri ht lp ny n
lp khc cho n khi thuc c khuch tn ra ht, cc vin hon nh xp i v c o
thi ra ngoi. Thuc c phng thch u dc sut ng tiu ha dn n s hp th thuc u
v nng tr liu ca theophylline trong huyt tng c duy tr u trong sut 24 gi sau
ch mt liu ung. Khng c tnh trng thuc phng thch o t.
Hp th : Theophylline c hp th hon ton sau khi ung. Sau khi dng 400 mg Duralyn-CR,
nng nh trung bnh trong huyt tng t n mc khong 4,65 mg/ml sau khong thi
gian trung bnh l 3,83 gi. Din tch di ng biu din nng trong huyt tng (AUC) l
56,64 mg.gi/ml.
Phn phi : Th tch phn phi trung bnh l 0,45 l/kg (khong bin thin l 0,3 n 0,7 l/kg).
Theophylline khng phn b vo m m nhng qua nhau thai d dng v c bi tit qua sa
m. Khong 40% c gn vi protein huyt tng.
Chuyn ha v bi tit : Cc xanthin c bin i sinh hc trong gan (85-90%) thnh 1,3dimethyluric acid, 3 methylxanthin v 1-methyluric acid. Vic bi tit l do thn ; di 15%
thuc c bi tit di dng khng i. Thi gian bn hy ca theophylline b nh hng bi
nhiu yu t c chng minh. Thi gian bn hy c th ko di ngi nghin ru mn
tnh, c bit l ngi b bnh v gan (x gan hay bnh gan do ru), bnh nhn suy tim
sung huyt, v bnh nhn ang dng mt s thuc khc no . ngi nghin ht thuc l
(1-2 gi/ngy) thi gian bn hy trung bnh ngn hn nhiu so vi ngi khng ht thuc. S
gia tng thanh thi kt hp vi vic ht thuc c th do cc thnh phn trong khi iu thuc
kch thch con ng chuyn ha gan.
CH NH

Lm gim triu chng hoc phng nga hen ph qun v tnh trng co tht ph qun cn o
ngc c ngi vim ph qun mn tnh v kh thng phi.
CHNG CH NH
Tng mn cm vi bt kz xanthin no ; vim lo t tiu ha ; ang b bnh ng kinh (tr phi
ang c dng thuc chng ng kinh thch hp).
CH PHNG v THN TRNG LC DNG
Ch { phng :
Khng nn dng theophylline cng lc vi cc xanthin khc. Dng thn trng i vi cc bnh
nhn b thiu oxy mu, tng huyt p, bnh tim, suy tim sung huyt, ngi nghin ru, bnh
nhn cao tui v bnh nhn c tin s lo t tiu ha. i khi theophylline ng ung c th tc
ng nh l mt cht kch ng ti ch ng tiu ha, mc d cc triu chng v tiu ha
thng l do trung ng kt hp vi nng thuc trong huyt thanh cao hn 20 mg/ml.
Thn trng lc dng :
ang cn hen : l mt cp cu y khoa, khng p ng nhanh vi liu thng dng ca cc
thuc dn ph qun thng thng. Mt mnh cc ch phm theophylline ng ung l khng
thch hp vi tnh trng ang ln cn hen.
c tnh : Liu qu cao c th gy c tnh nng. T l xy ra c tnh gia tng c { ngha khi
nng thuc trong huyt thanh cao hn 20 mg/ml. Him khi c nng huyt thanh ny nu
dng theo liu ngh. Tuy nhin, bnh nhn c thanh thi huyt tng ca theophylline
b suy gim do bt kz nguyn nhn no (nh suy chc nng gan ; bnh nhn trn 55 tui, nht
l nam v ngi b bnh phi mn tnh ; suy tim v st cao ko di), ngay c liu thng thng
cng c th lm gia tng nng trong huyt thanh v kh nng gy c. Cc phn ng ph
nghim trng nh lon nhp tht, kinh git hay ngay c t vong c th xy ra nh l du hiu
u tin ca c tnh m khng c cnh bo trc no. Cc du hiu c tnh t trm trng hn
(nh bun nn, bt rt khng yn) c th xy ra khi bt u iu tr nhng thng l thong
qua ; nu cc du hiu ny ko di trong liu trnh duy tr, thng l nng trong huyt thanh
cao hn 20 mg/ml.
Tc dng trn tim : Theophylline c th gy lon nhp tim hay lm nng thm lon nhp tim sn
c. Bt kz mt bin i quan trng no v nhp tim u phi kim tra theo di v kho st su
hn.
Ph n mang thai : Tc dng gy nguy him cho thai hay nh hng trn kh nng sinh n cha
c nghin cu i chng y . Ch nn dng theophylline trong thi gian mang thai khi li
ch l ln hn kh nng gy nguy hi cho thai.
Ph n ang cho con b : Theophylline qua c sa m v c th gy kch ng hay cc du
hiu c tnh khc cho tr ang b m. Cn cn nhc gia vic ngng cho con b vi vic ngng
dng thuc. Cn lu { b m v tc dng ca thuc.
Tr em : an ton v hiu lc ca thuc ny tr em di 12 tui cha c xc nh.

TNG TC THUC
Cc tng tc thuc sau y c chng minh l do theophylline. Cc cht lm gim nng
theophylline trong mu gm c cc barbiturate, than hot, ketoconazol, rifampin, khi thuc
l v sulfinpyrazone. Cc cht lm gia tng nng theophylline mu gm c allopurinol, cc
cht chn beta (khng chn lc), cc cht chn knh calci, cimetidin, cc thuc trnh thai
ng ung, cc corticosteroid, disulfiram, ephedrin, interferon, cc macrolide v cc
quinolone.
TC DNG NGOI
Tc dng ph c gim thiu do dng bo ch p dng cng ngh DRCM. Cc tc dng bt li
hoc c tnh t khi xy ra nu nng theophylline trong huyt thanh di 20 mg/ml. H tiu
ha : bun nn, i ma, au thng v, tiu chy. H thn kinh trung ng: nhc u, d kch
thch, mt ng, run git c, kinh git ton th kiu git rung v co cng. H tim mch : hi hp,
tim nhanh, ngoi tm thu, bng da, h huyt p, lon nhp tht. H h hp : th nhanh. Thn
: li tiu. Cc tc dng khc : rng tc, ni mn.
LIU LNG v CCH DNG
Ngi ln : Mt vin nang mi ngy, tt nht nn trong khong t 6-8 gi ti (do nhp sinh hc
24 gi).
QU LIU
Triu chng : Cc tc dng ph chc chn xy ra : chn n, bun nn, i ma, tnh trng kch
ng, d b kch thch, mt ng, nhc u, tim nhanh, ngoi tm thu, th nhanh, git rung/ co
cng.
X tr khi qu liu : Nu khng xy ra cn ng kinh : gy i, ngay c khi i ma ang xy ra
t nhin. Tuy nhin khng c gy i cho bnh nhn khng tnh to. Nu xy ra ng kinh :
Thng ng th, ngi oxy, tim tnh mch diazepam liu 0,1 n 0,3 mg/kg cho n 10 mg.
Theo di cc du hiu sinh tn, duy tr huyt p v cung cp nc. Nu hn m sau cn
ng kinh : Duy tr ng th v ngi oxy, t ng ni kh qun v ra d dy thay v gy i.
Bm thuc x v than hot qua nng ln ca ng thng d dy. Cung cp ch chm sc nng
ton din (h l cp I) v lng nc trong khi thuc ang c chuyn ha. Nu dng
than hot nhiu ln khng c tc dng, c th ch nh than hot truyn mch (charcoal
hemoperfusion).

173.

DURASAL-CR

RAPTAKOS BRETT
Vin nang phng thch c kim sot 8 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Salbutamol sulfate

8 mg

DC LC
Salbutamol [1-(4-(RS)-hydroxy-3-hydroxymethylphenyl)-2-(t-butylamino) ethanol] l cht ch
vn th th adrenergic b2 (b2-adrenoceptor agonist) c tc dng trn c trn v c xng, gm
c : dn ph qun, dn c t cung v run. Tc dng dn c trn ty thuc vo liu dng v
c cho rng xy ra thng qua h thng adenyl cyclase - AMP vng, vi vic thuc gn vo th
th b-adrenergic ti mng t bo gy ra s bin i ATP thnh AMP vng lm hot ha protein
kinase. iu ny dn n s phosphoryl ha cc protein v cui cng lm gia tng calci ni bo
loi lin kt ; calci ni bo ion ha b gim bt gy c ch lin kt actin-myosin, do lm dn
c trn.
Thuc ch vn b2 nh salbutamol cng c tc dng chng d ng bng cch tc dng ln dng
bo lm c ch s phng thch cc ha cht trung gian gy co tht ph qun nh histamin, yu
t ha ng ng bch cu a nhn trung tnh (NCF) v prostaglandin D2.
Salbutamol lm dn ph qun c ngi bnh thng ln bnh nhn suyn hay bnh phi tc
nghn mn tnh (COPD) sau khi ung. Salbutamol cn lm gia tng s thanh thi tim mao nhy
( c chng minh bnh nhn COPD ln ngi bnh thng).
Salbutamol kch thch cc th th b2 gy ra cc tc dng chuyn ha lan rng: tng lng acid
bo t do, insulin, lactat v ng ; gim nng kali trong huyt thanh.
Salbutamol c l l cht c hiu lc v an ton nht trong s cc thuc dn ph qun loi ging
giao cm.
DC NG HC
Duralyn-CR l mt ch phm a n v vi nhiu vin hon nh. Mi hon gm mt li vi
nhiu lp thuc v mng c bit xp xen k bao quanh c kh nng kim sot tc khuch
tn ca thuc bn trong. Sau khi ung vo, v nang gelatin tan ra nhanh chng v phng thch
cc vin hon nh vo trong d dy. Nc thm thu vo cc vin hon nh ngay t d dy v
ha tan thuc cho n khi bo ha. Cc vin hon nh sau c ri u dc theo ng rut
v mng thm tch m bo cho thuc khuch tn chm v u ra lng rut xung quanh, c
lp vi thnh phn cha trong rut. Tin trnh ny din ra u n, chm ri ht lp ny n
lp khc cho n khi thuc c khuch tn ra ht, cc vin hon nh xp i v c o
thi ra ngoi. Thuc c phng thch u dc sut ng tiu ha dn n s hp th thuc u
v nng tr liu ca salbutamol trong huyt tng c duy tr u trong sut 12 gi sau ch

mt liu ung. Khng c tnh trng thuc phng thch o t.

Salbutamol c hp th d dng qua h tiu ha. Salbutamol c chuyn ha ng k trc
khi vo mu. Cht chuyn ha ch yu l lin hp sulphat l cht dng nh c hnh thnh
trong nim mc rut v bt hot. Khong 10% thuc lu hnh trong mu di dng gn vi
protein. 58-78% lng thuc c gn phng x xut hin trong nc tiu trong vng 24 gi v
65-84% trong 72 gi sau khi ung thuc. 34-47% thuc gn phng x xut hin trong nc tiu
di dng lin hp v khong mt na lng ny nguyn dng. chng minh thuc qua c
nhau thai in vitro ln in vivo.
CH NH
Lm gim v phng nga co tht ph qun bnh nhn mc bnh tc nghn ng th c th
hi bin.
CHNG CH NH
Bnh nhn c tin s tng cm vi salbutamol.
CH PHNG v THN TRNG LC DNG
Nn dng salbutamol cch thn trng i vi bnh nhn tim mch (nht l suy ng mch
vnh, lon nhp tim v tng huyt p) ; bnh nhn kinh git, cng gip hay i tho ng; v
i vi bnh nhn i khi c phn ng vi cc amin ging giao cm.
Ph n mang thai : D khng c bng chng gy qui thai, nu tht s cn thit, ch nn dng
thuc trong ba thng u ca thai kz.
Ph n cho con b : Cha r thuc c c bi tit qua sa m hay khng. Do kh nng sinh
khi u ca salbutamol quan st c trong cc nghin cu trn sc vt, cn phi quyt nh
hoc ngng cho con b hoc tip tc dng thuc.
Tr em : Tnh an ton v hiu lc ca thuc i vi tr em di 6 tui cha c chng minh.
TNG TC THUC
Khng dng salbutamol cng lc vi cc thuc ging giao cm khc v c th gy c hi cho tim
mch. Cn thn trng ti a khi dng cho bnh nhn ang c iu tr bng cc thuc c ch
monoamine oxidase hay cc thuc chng trm cm vng ba v tc dng ca salbutamol ln h
thng mch mu c th b nh hng. Cc thuc chn th th bta v salbutamol c ch tc
dng ca nhau.
TC DNG NGOI
Tc dng ph c gim thiu do dng bo ch p dng cng ngh DRCM. Nhn chung,
salbutamol c dung np tt v cc tc dng c nguy him l him gp. Cc phn ng bt li
ca salbutamol, nu c, tng t vi cc thuc ging giao cm khc, tuy nhin vi salbutamol
t l phn ng trn tim mch thp hn.
Tc dng ph thng gp nht l : bt rt v run. Cc phn ng khc c th c: nhc u, tim
nhanh v hi hp, vp b, mt ng, bun nn, suy nhc v chng mt. Him gp : ni m ay,
ph mch, ni mn v ph hu hng. mt s bnh nhn, salbutamol c th gy bin i v

tim mch (mch, huyt p, mt s triu chng hoc in tm ). Nhn chung, cc phn ng
ph ch thong qua v thng khng cn phi ngng iu tr vi salbutamol.
LIU LNG v CCH DNG
Ngi ln : mi ln mt vin nang, ngy hai ln.
QU LIU
Cc triu chng c th c khi dng qu liu l do kch thch th th bta qu mc, nh nu
mc Tc dng ngoi . C th c : cn gng cng, au hng, tng hay gim huyt p, tim nhanh,
lon nhp tim, bt rt, nhc u, run, kh ming, hi hp, bun nn, chng mt, suy nhc,
kh chu v mt ng. C th c h kali mu.
X tr khi qu liu : ngng dng salbutamol v iu tr triu chng.

174.

DUROGESIC

JANSSEN PHARMACEUTICA
c/o JANSSEN-CILAG
c/o MEGA PRODUCTS
H thng tr liu thm qua da 25 mg/gi : ming 10 cm2, hp 5 ming - Bng nghin.
H thng tr liu thm qua da 50 mg/gi : ming 20 cm2, hp 5 ming - Bng nghin.
THNH PHN
cho 1 ming 10 cm2
Fentanyl

2,5 mg

cho 1 ming 20 cm2

Fentanyl

5 mg

M T
Durogesic l h thng tr liu thm qua da cung cp fentanyl, thuc gim au nhm opioid
mnh, lin tc vo mu trong sut 72 gi.
Durogesic l thuc c dng ming bng dn hnh ch nht trong sut gm 1 lp mng bo v v
4 lp mng c chc nng. T mt ngoi n mt trong dnh vo da, cc lp ny bao gm : lp

mng sau bao phim polyester ; h thng d tr thuc fentanyl (2,5 mg/10 cm2) v cn tiu
chun USP (0,1 ml/10 cm2) c gel ha vi hydroxyethylcellulose ; mng ethylenevinyl acetat
polymer gip kim sot tc phng thch fentanyl ; v lp mng dnh silicone. Trc khi dng,
g b lp mng bo v ra khi lp mng dnh.
Ming dn kch thc 10 v 20 cm2 c thit k phng thch fentanyl 25 mg v 50 mg mi
gi vo mu. Cc thnh phn khc l cc cht tr khng c tc ng dc l{. C di 0,2 ml
alcohol c phng thch t ming dn trong sut 72 gi s dng.
DC LC
Fentanyl l thuc gim au nhm opioid, tc ng ch yu trn th th mc-opioid. Tc ng
iu tr ch yu l gim au v gy ng. Nng Fentanyl trong huyt thanh cho hiu qu gim
au trn bnh nhn cha dng opioid bao gi t 0,3-1,5 ng/ml. Tc ng ph gia tng theo tn
s nng thuc 72 ng/ml. C hai nng hiu qu ti thiu v nng gy c tnh gia
tng cng vi dung np thuc gia tng. Tc pht trin dung np thuc thay i nhiu
gia cc c th.
DC NG HC
Durogesic cung cp thuc Fentanyl qua da lin tc sut 72 gi dn ming dn. Fentanyl c
phng thch tc tng i hng nh, nh bi mng phng thch copolymer v s khuch
tn fentanyl qua lp da. Sau khi bt u dn Durogesic, nng fentanyl trong mu gia tng
dn dn, nng tng dn trong khong 12 n 24 gi v duy tr tng i hng nh i vi
khong thi gian cn li trong thi gian dn 72 gi.
Nng fentanyl trong mu t l vi kch thc ming dn. Sau khi dn lp li ming dn mi
72 gi, nng thuc trong mu hng nh t c mi bnh nhn c duy tr trong sut
cc ln dn k tip ming dn c cng kch thc.
Sau khi g b Durogesic, nng fentanyl trong mu gim dn dn, cn khong 50% sau 17 gi
(t 13 n 32 gi).
S hp th lin tc fentanyl t da gii thch cho s bin mt chm hn ca thuc t huyt
thanh hn l s bin mt ca thuc t huyt thanh sau khi truyn tnh mch. Ngi gi, bnh
nhn b suy nhc c th c thanh thi fentanyl gim v do thuc c th c thi gian bn
hy di nhng bnh nhn ny. Fentanyl c chuyn ha ch yu qua da. Khong 75%
fentanyl c bi tit qua nc tiu, hu ht dng chuyn ha, t hn 10% dng khng i.
Khong 9% liu dng c tm thy trong phn, ch yu dng chuyn ha. Phn khng gn
kt ca fentanyl trong huyt thanh trung bnh khong 13% v 21%.
CH NH
Gim au mnh i hi s dng thuc gim au opioid.
CHNG CH NH
Bnh nhn c bit nhy cm vi fentanyl hoc cht dnh c trong thnh phn ming dn.
CH PHNG v THN TRNG LC DNG

Ch { phng :
Durogesic khng nn dng trong kim sot cn au cp v hu phu bi v khng c c hi
chun liu trong thi gian s dng ngn hn v bi v suy h hp nng v e da tnh mng c
th xy ra.
Thn trng lc dng :
Bnh nhn b tc ng ph trm trng nn c theo di sut 24 gi sau khi g b ming
dn Durogesic, bi v nng fentanyl trong huyt tng gim dn v gim khong 50% sau 17
gi (t 13 n 22 gi).
Suy h hp : Nh cc thuc gim au opioid, vi bnh nhn c th suy h hp ng k vi
Durogesic, bnh nhn phi c quan st cc tc ng ph ny. Suy h hp c th ko di sau
khi g b ming dn. Tn sut suy h hp gia tng khi liu Durogesic gia tng (xem phn Qu
liu lin quan suy h hp). Thuc tc ng h thn kinh trung ng c th gia tng suy h hp
(xem phn Tng tc thuc).
Bnh phi mn tnh : Durogesic c th c nhiu tc ng ph nghim trng trn nhng bnh
nhn c bnh l phi tc nghn mn tnh hoc bnh l phi khc. nhng bnh nhn ny,
thuc opioid c th lm gim h hp v gia tng khng thng kh.
L thuc thuc : S dung np v l thuc thuc v th cht v tm l c th xy ra sau khi ch
nh lp i lp li thuc opioid. S nghin sau khi ch nh thuc opioid th rt him khi xy ra.
p lc ni s gia tng : Durogesic nn c dng thn trng trn bnh nhn c th nghi ng c
tc ng ng CO2 ni s, v d nhng bnh nhn c p lc ni so gia tng, { thc thng tn
hoc hn m. Durogesic nn s dng thn trng trn bnh nhn c khi u no.
Bnh tim : Fentanyl c th gy chm nhp tim v do nn ch nh thn trng trn bnh nhn
lon nhp tim chm.
Bnh gan : V Fentanyl c chuyn ho thnh cht chuyn ha bt hot gan, cho nn bnh
nhn c bnh v gan c th gim chuyn ha thuc. Trn bnh nhn x gan, dc ng hc khi
dn Durogesic n c khng b thay i mc du nng huyt thanh c khuynh hng cao
hn nhng bnh nhn ny. Bnh nhn thng tn gan nn c gim st cn thn du hiu
c tnh fentanyl v nn gim liu fentanyl.
Bnh thn : t hn 10% fentanyl c bi tit dng khng i qua thn, v khng ging
morphine, c nhng cht chuyn ho c hot tnh cha c bit c bi tit qua thn. D
liu t c bng chch fentanyl trn bnh nhn suy thn ngh rng th tch phn b ca
fentanyl c th thay i bi s thm phn. iu ny c th nh hng nng huyt thanh
nu bnh nhn suy thn dng fentanyl, h phi c quan st cn thn du hiu c tnh
fentanyl v nu cn thit nn gim liu fentanyl.
ng dng trn bnh nhn b st/ nh hng bi ngun ngoi nhit : Dc ng hc ngh
rng nng fentanyl trong mu c th gia tng khong 1/3 nu nhit da gia tng n 40oC.
Do , bnh nhn st nn c gim st cc tc ng ph ca opioid. V nu cn thit nn

iu chnh liu Durogesic. Tt c bnh nhn nn c khuyn trnh phn c th c dn

ming dn tip xc vi ngun nhit bn ngoi trc tip, v d : n nhit, tm nng, chai nc
nng, tm hi v tm ni sui nc khong, nc xoy nng.
Tc ng trn kh nng vn hnh my mc : Durogesic c th gy ra nh hng kh nng tr tu
hoc th lc thc hin cc hot ng nguy him, v d : li xe hoc vn hnh my mc.
S dng trn ph n c thai hoc cho con b : an ton ca fentanyl trn ph n c thai cha
c thit lp. Durogesic khng nn dng cho ph n c kh nng mang thai m khng c bin
php trnh thai y , tr phi c s cn nhc gia li ch dng thuc v nguy c c th c ca
thuc. Fentanyl c bi tit qua sa m do khng nn s dng Durogesic cho cc b m
cho con b.
S dng trn tr em : Hiu qu v an ton ca Durogesic trn tr em cha c thit lp.
S dng trn ngi gi : D liu t cc nghin cu phase IV vi fentanyl ngh rng bnh
nhn ln tui c th gim thanh thi, thi gian bn hy di v nhng bnh nhn ny c th
nhy cm i vi thuc hn ngi tr tui. Trong nhng nghin cu Durogesic, ngi ln tui
c dc ng hc fentanyl khng khc bit ng k so snh vi ngi tr mc d nng
thuc trong huyt thanh c khuynh hng cao hn. Ngi ln tui nn c quan st cn thn
du hiu c tnh fentanyl v nu cn thit th gim liu.
TNG TC THUC
S dng ng thi vi cc thuc c ch h thn kinh trung ng bao gm : opioid, gii lo u, an
thn, thuc gy m, chng lon thn, dn c, khng histamin gy ng v ru c th tng thm
tc ng c ch: gim thng kh, h huyt p v ng su hay hn m xy ra. Do , vic s dng
bt kz cc thuc ny phi hp vi Durogesic cn phi theo di v quan st c bit. Fentanyl,
thuc c thanh thi cao, c chuyn nhanh v hon ton ch yu bi men CYP 3A4.
Itraconagole (thuc c ch CYP 3A4 hot tnh mnh) lm gim thanh thi ca fentanyl tim
tnh mch 2/3 ln. S dng ng thi cc cht c ch CYP 3A4 hot tnh mnh, v d ritonavir
vi fentanyl c th gia tng nng fentanyl, iu ny c th gia tng hoc ko di c hai tc
ng iu tr v tc ng ph v c th gy suy h hp trm trng. i vi tnh trng ny, cn
quan tm v quan st bnh nhn chuyn bit.
TC DNG NGOI
Phn ng ph trm trng nht, nh cc thuc opioid mnh, l gim thng kh. Cc phn ng
ph khc lin quan n nhm thuc opioid bao gm : bun nn, nn, to bn, h HA, chm
nhp tim, bun ng, nhc u, nhm ln, o gic, sng khoi, nga, m hi v b tiu.
Phn ng da, v d : mn , ban v nga thnh thong c ghi nhn. Cc phn ng ph
ny thng gii quyt trong vng 24 gi sau khi g b ming dn.
Triu chng rt lui opioid (v d : bun nn, nn, tiu chy, lo lng v cm gic lnh) c th c
vi bnh nhn sau khi chuyn i t cc thuc gim au opioid trc sang Durogesic.
LIU LNG v CCH DNG

Liu lng :
Liu Durogesic nn da vo th trng ca tng bnh nhn v nn c nh gi nh kz u
n sau khi dn.
Chn liu khi u : Kch thc ca ming dn Durogesic khi u nn da vo tin s dng
thuc opioid ca bnh nhn, bao gm mc dung np opioid nu c, cng nh l bnh cnh
lm sng hin ti v tnh trng s dng thuc ca bnh nhn.
Bnh nhn cha tng dng opioid : Nn dng liu Durogesic hm lng nh nht 25 mg/gi khi
khi u.
Bnh nhn dung np opioid : Chuyn i t cc thuc nhm opioid dng ung hoc dng
tim sang Durogesic, trnh t nh sau:
Tnh nhu cu dng thuc gim au 24 gi trc .
Chuyn s lng ny sang liu gim au tng ng Morphin ung bng bng I (xem bng I).
Tt c liu ung v tim bp trong bng ny c nh gi tng ng vi liu 10 mg
morphin tim bp cho hiu qu gim au.
Bng 2 trnh by cc khong liu ca Morphin ung 24 gi c chuyn i thnh liu
Durogesic tng ng. S dng bng ny tnh liu Durogesic tng ng da vo liu morphin
ung 24 gi c tnh ton (xem bng II).
Khng th nh gi s khi tc ng gim au ti a ca Durogesic trong vng 24 gi sau khi
dn trn c hai bnh nhn cha dng opioid v dung np opioid. S chm tr ny l do s
gia tng dn dn nng fentanyl trong huyt thanh trong vng 24 gi sau khi dn liu khi
u. Do , iu tr gim au trc nn c gim b dn dn sau khi dn liu khi u
Durogesic cho n khi t c hiu qu gim au ca Durogesic.
Bng I. Tng quan v
liu

Tn thuc

Morphine

Tng quan v liu

(mg)
IM*

Ung

10,0

30 (liu lp li)**
60 (liu n, gin on)

Hydromorphone

1,5

7,5

Methadone

10,0

20

Oxycodone

15,0

30

Levorphanol

2,0

Oxymorphone

1,0

10 (ng trc trng)

Heroine

5,0

60

Meperidine

75,0

Codeine

130,0

200

Buprenorphine

0,4

0,8 (ngm di li)

* Da trn liu n c nghin cu, trong liu IM ca mi thuc lit k bn trn

c i chiu vi morphine thit lp mi tng quan. Liu ung l liu c khuyn co
khi thay i t ng tim sang ng ung.
** T l gia ng ung/ng IM l 1/3 i vi morphine, da trn kinh nghim iu tr lm
sng nhng bnh nhn b au mn tnh.
Bng II. Liu khuyn co ca Durogesic so vi
liu hng ngy ca morphine
Morphine ng ung, liu trong 24 gi
(mg/ngy)

Liu Durogesic (mg/gi)

45-134

25

135-224

50

225-314

75

315-404

100

405-494

125

495-584

150

585-674

175

675-764

200

765-854

225

855-944

250

945-1034

275

1035-1124

300

* Trong th nghim lm sng, cc s liu v liu hng ngy ca morphine ng ung c s

dng lm c s chuyn i sang liu Durogesic
Chun liu iu tr duy tr : Ming dn Durogesic nn c thay th mi 72 gi. Liu nn c
iu chnh cho tng bnh nhn cho n khi t c hiu qu gim au. Nu hiu qu gim
au cha sau khi dn liu khi u, c th tng liu sau 3 ngy. Sau , c th iu chnh
liu mi 3 ngy. Chun liu nn c gia tng mi ln 25 mg/gi (morphin ung 90 mg/ngy =
Durogesic 25 mg/gi) v nh gi tnh trng au ca bnh nhn. C th dng nhiu hn 1
ming dn Durogesic khi liu trn 100 mg/gi. Bnh nhn c th yu cu thm cc thuc gim
au tc ng ngn tng thi kz cho cc cn au bc pht. Mt vi bnh nhn cn phi dng
thm cc phng php ch nh opioid khc khi liu Durogesic vt qu 300 mg/gi.
Ngng iu tr Durogesic : Nu cn thit phi ngng Durogesic, vic thay th bng cc opioid
khc nn dn dn, bt u liu thp v gia tng dn dn. iu ny l do nng fentanyl
gim dn dn sau khi g b ming dn, nng fentanyl trong mu gim 50% khong 17 gi
hoc lu hn. Ni chung, ngng iu tr thuc gim au opioid nn dn dn ngn nga triu
chng rt lui thuc.
Hng dn s dng :
Nn dn Durogesic vng da khng kch ng, b mt phng, v d ngc, lng, mn sn hoc
cnh tay ca phn trn c th. Nn ta bt lng (khng co) vng da trc khi dn. Phi lm
sch vng da trc khi dn bng nc sch. Khng dng x phng, du dung dch, cn hoc bt
kz tc nhn no khc v c th gy kch ng da hoc lm thay i c tnh da. cho da kh
trc khi dn.
Durogesic nn dn lin ngay khi bc bao b. Nn n ming dn khong 30 giy m bo
ming dn c bm cht, c bit xung quanh ra. Durogesic c mang lin tc n 72 gi.
Nu cn gim au nhiu hn 72 gi, ming dn mi nn c dn ni khc sau khi g b
ming dn trc .
Thn trng khi s dng :
Ming dn Durogesic khng c ct, phn chia hay hy bng bt kz cch no bi v s dn n
s phng thch fentanyl khng cn kim sot.
Hy ming dn : Ming dn s dng nn c gp li 2 mt t dnh vo nhau v hy i.
Ming dn khng s dng na nn gi li khoa Dc bnh vin.

QU LIU
Triu chng : S biu hin qu liu fentanyl th qu rng bi tc ng dc lc hc, tc ng
nghim trng nht l suy h hp.
iu tr : qun l suy h hp, cc bin php tc th bao gm g b ming dn Durogesic,
nh thc bnh nhn bng cch gi hay lay bnh nhn. Sau c th ch nh thuc i vn
opioid c hiu, v d : Naloxon. Suy h hp sau khi qu liu c th lu hn thi gian tc ng
ca thuc i vn. Khong cch gia cc liu ca thuc i vn gii c tim tnh mch nn la
chn cn thn bi v s ti gy ng c kh nng xy ra sau khi g b ming dn. Ch nh lp
li v truyn naloxon lin tc c th rt cn thit. S hon i tc ng gy m c th gy khi
pht cn au cp v phng thch catecholamine.
Nu tnh trng lm sng c chng thc, nn c thit lp v duy tr ng thng kh
chuyn bit, c th bng ng thng kh hng ming hoc ng thng ni kh qun, ch nh
oxy v tr gip hoc kim sot h hp, khi thch hp. Duy tr nhit c th v cung cp dch
y .
Nu xy ra h huyt p trm trng hoc trng din, nn xem xt s gim dung lng mu v
tnh trng ny nn c qun l bng liu php truyn dch thch hp.
BO QUN
Lu gi trong lp bao b kn 15-25oC.

175.

DUSPATALIN

SOLVAY
c/o KENI - OCA
vin bao 100 mg : hp 30 vin.
vin bao 135 mg : hp 50 vin.
THNH PHN
cho 1 vin
Mbvrine chlorhydrate

cho 1 vin

100 mg

Mbvrine chlorhydrate

135 mg

DC LC
Thuc chng co tht hng c.
DC NG HC
Sau khi ung, m b v rine c thy phn gan. Mt phn ln c o thi qua nc tiu
di dng acide v ratrique n thun hoc kt hp. Mt phn nh c tm thy trong mt.
M b v rine c o thi hon ton sau 24 gi.
CH NH
iu tr cc triu chng au c lin quan n ri lon chc nng co tht ng tiu ha v
ng mt.
LC C THAIQua nghin cu ng vt, thuc khng c c tnh trn phi v khng gy qui
thai. ngi, do cn thiu d kin lm sng, cha th c kt lun chnh xc. thn trng,
trnh dng thuc trong 3 thng u thai kz.
LC NUI CON B
Do cn thiu nghin cu lm sng, trnh dng thuc khi nui con b.
LIU LNG v CCH DNG
400 mg/ngy, chia lm 2 hoc 3 ln/ngy.
Trong cc bnh mn tnh, cn c iu tr trong 1 thng hoc lu hn.

176.

DUXIL

LES LABORATOIRES SERVIER

vin bao : hp 30 vin.
THNH PHN
cho 1 vin
Almitrine bismsilate

30 mg

Raubasine

10 mg

DC LC
Duxil lm giu oxygne cho mu ng mch, gii quyt c tnh trng thiu oxy m. Tc ng

ca Duxil c chng t rt tt trong cc kho st trn ng vt c gy thiu oxy m no,

cng nh trong cc nghin cu dc l{ lm sng trn ngi.
ng vt, Duxil gy tng p sut ring phn ca oxy trong mu ng mch (PaO2), do lm :
- tng p sut oxy n m (PO2) v no ;
- tng s dng oxy m no ;
- hng s chuyn ha t bo no theo hng hiu kh vi tng nng lng t bo.
Tc ng ca Duxil trn PaO2, PO2, trn mc s dng oxy no v in no ch yu l do
tc ng ca almitrine. y l mt hot cht chnh ca Duxil, m tc ng ca n c b sung
v cng v thi gian bi mt hot cht chnh khc l raubasine.
ngi, cc nghin cu dc l lm sng cho php kt lun rng Duxil c nhng tc ng nh
sau :
- tng p sut ring phn ca oxy trong mu ng mch (PaO2) ;
- tng bo ha v oxy ng mch (SaO2) ;
- gim s mt bo ha v oxy ng mch khi gng sc, kim tra ng hc c xem nh l
mt trong nhng bin php tt nht hin nay nh gi hiu qu iu tr thiu oxy m.
- tng hm lng trong mu ca 2-3 diphosphoglycrate, l mt dng tn ti ca oxy trong mu
ng mch,
- hot ha s chuyn ha m no c xc nhn qua cc kim tra v glucose, nghin cu
in sinh v no bng in no nh lng.
S ci thin cc thng s o kh c lin quan n s tng hiu sut ca qu trnh trao i kh
ph nang, c gy bi almitrine, hot cht chnh ca Duxil m khng lm bin i cc ch s
thng kh.
Trong cc trng hp sau tai bin mch mu no, cc nghin cu c thc hin nh vo
phng php chp ct lp pht x positron v photon cho thy di tc dng ca Duxil, mi
tng quan ti mu/ chuyn ha t c ti u v c ci thin s ti mu d tr no.
DC NG HC
Almitrine c hp thu nhanh v t nh hp thu trong huyt tng 3 gi sau khi ung thuc.
Thuc ch yu c chuyn ha gan.
Almitrine v cc cht chuyn ha ch yu c bi tit qua mt.
Thuc c o thi qua phn v nc tiu di dng cc cht chuyn ha khng c hot tnh.
Sau khi dng mt liu duy nht, thuc c thi gian bn hy o thi trong khong 40 n 80 gi
; thi gian ny l 30 ngy sau khi dng lp li. Gn kt vi protine huyt tng cao (trn 99%).
Raubasine c hp thu nhanh v t nh hp thu trong huyt tng t 1 n 2 gi sau khi
ung thuc. Sau khi dng liu duy nht, cht ny c thi gian o thi trong khong 7 n 15
gi ; thi gian ny l 11 gi sau khi dng lp li.
CH NH
Duxil c dng iu tr cc triu chng gim st tr tu bnh l ngi gi (nh khng tp

trung, mt tr nh...).
Duxil c ngh trong :
- cc ri lon mng mch-vng mc c ngun gc do thiu mu cc b,
- cc ri lon tin nh c tai c ngun gc do thiu mu cc b.
Duxil c ch nh sau cc tai bin thiu mu no cc b.
CHNG CH NH
Khng phi hp vi IMAO.
CH PHNG v THN TRNG LC DNG
- Nu c cm gic kin b, kim chm hoc t cc chi di xut hin v dai dng cng nh
gim cn trn 5%, cn phi ngng iu tr.
Cc du hiu ny xut hin khi iu tr k o di, sau s gim dn v bin mt khi ngng iu
tr. Rt him khi xy ra ri lon thn kinh ngoi bin : t l xut hin l 5 trng hp trn
100.000 thng iu tr, trng hp ny cn phi ngng iu tr.
- Khng c phi hp Duxil vi cc thuc khc c cha almitrine (nh Vectarion).
- Khng c k toa vt qu liu khuyn co.
- bnh nhn cao huyt p, song song vi iu tr bng Duxil, cn duy tr vic iu tr chuyn
bit bnh cao huyt p.
LC C THAI
Khng nn dng Duxil cho ph n mang thai, c bit l trong cc thng u thai kz, ngoi tr
khi c ch nh ca bc s, trng hp ny li ch ca vic iu tr phi cao hn nhng nguy c
c th xy ra.
TC DNG NGOI
Him khi ghi nhn c nhng tc dng ph nh :
- st cn, ri lon thn kinh ngoi bin vi cc cm gic bt thng chi di hoc b d cm
(cm gic kim chm, kin b, t...). Cc tc dng ny thng xy ra khi iu tr ko di trn 1
nm ; khi gp nhng trng hp ny cn phi ngng iu tr (xem Ch { phng v Thn
trng lc dng) ;
- bun nn, c cm gic nng v nng thng v, kh tiu, ri lon nhu ng rut, ri lon gic
ng kiu mt ng, ng gt, kch ng, lo u, nh trng ngc, cm gic chng mt.
LIU LNG v CCH DNG
Liu thng thng t 1 n 2 vin/ngy, chia 2 ln cch khong u nhau. Nu iu tr di hn
trn 1 nm, cn tham kho Thn trng lc dng.
QU LIU
Trng hp ng c do v tnh hay c dng thuc qu liu, c th xy ra :
- tim p nhanh v h huyt p ;
- th nhanh vi nhim kim h hp.
X l :

- Ra d dy,
- iu tr triu chng cc ri lon quan st c, theo di tim-h hp v o kh lin tc.

177.

DYSKINBYL

LAPHAL
c/o HYPHENS
Vin nang mm 500 mg : hp 30 vin.
THNH PHN
cho 1 vin
Dihydroxydibuthylether

500 mg

DC LC
Thuc c tc ng hng gan, mt.
Dihydroxydibuthylether gia tng s bi tit mt theo mt c ch c lp vi cc acid mt. N
khng c tc ng trn s vn ng ca ti mt v c tc ng hy co tht trn h c, khng c
tc ng ging atropin.
DC NG HC
Th nghim trn ng vt, dihydroxydibuthylether c hp thu nhanh v gn nh hon ton.
Thuc c chuyn ha qua con ng lin hp glucuronide v diglucuronide c bi tit t
mt (chu kz gan rut) v nc tiu. Thuc c o thi ch yu qua nc tiu : trn 90% liu
ung vo c bo tit qua nc tiu trong vng di 24 gi (th nghim trn chut cng,
ch, kh).
CH NH
iu tr triu chng trong cc ri lon kh tiu.
iu tr h tr trong bnh si mt (lm gim cc yu t nguy c gy lng ng cholesterol).
CH PHNG v THN TRNG LC DNG
Khng dng thuc trong trng hp c tc nghn ng mt v suy gan nng.
LIU LNG v CCH DNG
Mi ln 1-2 vin trc 3 ba n chnh.
Ung thuc vi nhiu nc, khng nhai.

BO QUN
Trnh nng v m.

THUC VN E

178.

E.E.S. (ERYTHROMYCIN ETHYL SUCCINATE)

ABBOTT
cm pha nh tng ung 200 mg/5 ml : chai 100 ml.
THNH PHN
cho 5 ml nh tng E.E.S. pha t cm
Erythromycine ethylsuccinate

200 mg

M T
Erythromycin c sn xut t mt chng ca Streptomycef erythraeus v thuc nhm khng
sinh macrolide. Erythromycin ethylsuccinate l erythromycin 2-(ethylsuccinate) cng thc phn
t C43H75O16 v trng lng phn t 862,06.
Dng cm c khuynh hng ti kt hp li trong nc. Khi ti hp li chng tr thnh nh
tng c mi thm hoa anh o.
Thuc cm ch yu l dng cho tr em nhng cng c th dng cho ngi ln.
Nhng thnh phn khng hot tnh :
Acid citric, FD C Red no.3, magnesium aluminium silicat, carboxy-methylcellulose, sodium citrat,
ng ma v hng liu nhn to.
DC LC
Tc dng vi sinh hc :
Nhng th nghim sinh ha chng minh rng erythromycin c ch s tng hp protin ca tc
nhn gy bnh m khng nh hng trc tip n s tng hp acid nhn. Ngi ta chng
minh c s i khng ca erythromycin v clindamycin.
Lu { : c nhiu chng Haemophilus influenzae khng vi erythromycin n c nhng li
nhy cm vi khi s dng phi hp vi sulfonamid. T cu khng erythromycin c th xut
hin trong q trnh iu tr vi erythromycin. Nn nui cy v thc hin nhng th nghim v
tnh nhy cm ca vi khun.
Nhng th nghim v tnh nhy cm trn a :

Nhng phng php nh lng m i hi phi o ng knh vng v khun s cho nhng
nh gi chnh xc nht v tnh nhy cm ca khng sinh. Mt phng thc c ngh l
dng a erythromycin th nghim tnh nhy cm ; nhng iu gii thch v ng knh v
khun ca th nghim a ny c tng quan vi nhng gi tr nng c ch ti thiu ca
erythromycin. Vi phng thc ny, mt bo co "nhy cm" ca phng xt nghim ch ra rng
vi sinh vt gy nhim chc chn p ng vi iu tr. Mt bo co " khng" ch ra rng vi sinh
vt gy nhim chc chn khng p ng vi iu tr. Mt bo co "nhy cm trung gian" gi
rng vi sinh vt gy nhim s nhy cm nu dng liu cao hn.
DC NG HC
Erythromycin kt hp vi nhng cu trc tiu n v ribosom50S ca vi khun nhy cm v c
ch s tng hp protein.
Nh tng erythromycin ethylsuccinate dng ung c hp thu d dng v chc chn. Nng
erythromycin trong huyt thanh t c vo lc i v khng i c th nh nhau.
Erythromycin khuch tn d dng vo hu ht nhng dch c th. Trong trng hp bnh
thng ch t c nng thp trong dch no ty, nhng trng hp vim mng no th
con ng thuc qua hng ro mu no gia tng. Vi chc nng gan bnh thng,
erythromycin tp trung gan v c bi tit qua mt. Khi c ri lon chc nng gan, s bi
tit ca erythromycin t gan vo mt cha c bit r. t hn 5% erythromycin c thi ra
trong nc tiu di dng cn hot tnh. Erythromycin i qua hng ro nhau thai nhng nng
trong huyt tng thai nhi thng l thp, v c tit ra trong sa m.
CH NH
Streptococcus pyogens (lin cu khun beta tan huyt nhm A) : nhim trng ng h hp trn
v di, nhim trng da v m mm t nh n trung bnh.
Benzathine penicillin G dng tim c Hip hi Tim mch Hoa kz xem l thuc chn trong
iu tr v phng nga vim hng do lin cu khun v trong phng nga di hn thp khp cp.
Khi dng ung c a chn iu tr nhng tnh trng trn th penicillin G,V hay
erythromycin l nhng thuc c chn.
Khi dng thuc ung c cho, phi nhn mnh tm quan trng vic iu tr tn th nghim
ngt ca bnh nhn theo ng ch iu tr. Nn thc hin mt t iu tr ti thiu 10
ngy.
Lin cu khun tan huyt a (nhm viridans) : mc d nhng th nghim c nhm chng v hiu
qu lm sng khng c thc hin, nhng Hip hi Tim mch Hoa kz v Hip hi Nha khoa
Hoa kz ngh s dng Erythromycin dng ung trong phc phng nga vim ni tm
mc do vi khun cho nhng bnh nhn tng mn cm vi penicillin c bnh tim bm sinh hay
bnh van tim hu thp hay bnh van tim mc phi khc khi h tri qua nhng th thut nha
nhng th thut ng h hp trn. Erythromycin khng thch hp trc nhng phu thut
ng niu dc hay ng tiu ha.

Lu { : Khi la chn khng sinh phng nga vim ni tm mc do vi khun, bc s hay nha s
nn c ton b thng bo chung ca Hip hi Tim mch Hoa kz Nha khoa Hoa kz.
T cu vng : Nhng nhim trng cp tnh da v m mm t nh n trung bnh. Nhng vi
khun khng thuc c th xut hin trong q trnh iu tr.
Streptococcus pneumoniae (Diplococcus pneumoniae) : nhim trng ng h hp trn (v d
vim tai gia, vim hng) v nhim trng ng h hp di (v d vim phi t nh n trung
bnh).
Mycoplasma pneumoniae (tc nhn Eaton, PPLO) : i vi nhim trng h hp do vi khun ny.
Haemophilus influenzae : Nhim trng ng h hp trn t nh n trung bnh khi dng ng
thi vi sulfonamid liu y (xem nhng thng tin k toa thch hp ca sulfonamid). Vic s
dng ng thi vi sulfonamide l cn thit v khng phi tt c nhng chng Haemophillus
influenzae u nhy cm vi erythromycin nng khng sinh t c vi liu iu tr thng
thng.
Chlamydia trachomatis : iu tr vim niu o nam gii trng thnh do Chlamydia
trachomatis.
Ureaplasma urealyticum : iu tr vim niu o nam gii trng thnh do Ureaplasma
urealyticum.
Treponema pallidum : Erythromycin l mt chn la thay th iu tr giang mai giai on u
cho nhng bnh nhn d ng vi penicillin nn thc hin nhng xt nghim dch no ty trc
khi iu tr giang mai giai on u, v nh l mt phn ca vic theo di sau khi iu tr.
Corynebacterium diphteriae : l mt thuc b sung chng li c t, phng nga bnh hnh
thnh nhng ngi mang mm bnh v dit tr vi khun nhng ngi ny.
Corynebacterium minustissimum : iu tr hng ban do vi khun ny gy ra.
Entamoeba histolytica : ch iu tr amib trong rut. iu tr nhim amib ngoi rut cn dng
thuc khc.
Listeria monocytogenous : nhng nhim trng do vi khun ny.
Bordetella pertussis : Erythromycin c tc dng dit tr vi sinh vt vng mi hu ca nhng
ngi b nhim khun, phc hi li tnh trng khng b nhim trng. Mt s cc nghin cu lm
sng gi rng erythromycin c th hu ch trong phng nga bnh ho g nhng ngi c
nguy c tip xc.
Bnh Legionnaires : Mc d nhng nghin cu c nhm chng v hiu qu lm sng khng c
tin hnh. Nhng trn thc nghim v s liu lm sng s b hn ch gi rng erythromycin
c th c hiu qu trong iu tr bnh Legionnaires.
CHNG CH NH
Erythromycin chng ch nh dng cho bnh nhn c tin s tng mn cm vi khng sinh ny.
CH PHNG
Mt s bo co v ri lon chc nng gan c hay khng c vng da, xy ra khi bnh nhn s dng

nhng sn phm Erythromycin ng ung.

THN TRNG LC DNG
Erythromycin c bi tit ch yu qua gan. Nn thn trng khi s dng Erythromycin cho
nhng bnh nhn c suy chc nng gan (xem phn Dc ng hc v Ch { phng).
Vic s dng erythromycin di hn hay lp i lp li c th dn n tnh trng tng pht trin
nhng nm hay vi khun khng nhy cm. Nu bi nhim da xy ra, nn ngng erythromycin v
tin hnh iu tr bng thuc thch hp.
Khi c ch nh, vic rch rc hay dn lu hay nhng phng thc phu thut khc nn c
tin hnh ng thi vi liu php khng sinh.
Nhng th nghim v xt nghim : Erythromycin gy tr ngi vic xc nh nhng catecholamin
trong nc tiu bng phng php huznh quang.
S dng trong nhi khoa : xem phn Ch nh, Liu lng v Cch dng.
AN TON TIN LM SNG
Kh nng sinh ung th, t bin v suy gim kh nng th tinh : nhng nghin cu ng ung
di hn (hai nm) c thc hin trn chut vi erythromycin dng base khng cung cp bng
chng v kh nng gy ung th. Nhng nghin cu v kh nng gy t bin cha c thc
hin. Khng c tc dng r rng ln kh nng th tinh ca chut c hay chut ci khi chng
c nui dng vi erythromycin nng ln n 0,25%.
LC C THAI v LC NUI CON B
Lc c thai :
Khng c bng chng no v kh nng sinh qi thai hay bt kz tc dng c hi no khc ln s
sinh sn nhng chut ci c nui vi cht n n erythromycin (ln n 0,25%) trc v trong
giai on on giao phi, trong lc c thai v trong sut thi gian cai sa qua hai la lin
tip. Tuy nhin khng c nghin cu no y v c kim st cht ch trn ph n c thai.
Bi v nhng nghin cu v kh nng sinh sn ca sc vt khng lun lun d n trc c
p ng ngi, thuc ny ch nn s dng trong thai kz khi tht s cn thit. ngi,
erythromycin c ghi nhn l i qua hng ro nhau thai, nhng nng trong huyt thanh
bo thai ni chung l rt thp.
Trong lc chuyn d v s thai, tc dng ca erythromycin trong lc chuyn d v s thai cha
c bit.
Lc nui con b :
Erythromycin c bi tit qua sa m, do nn thn trng kkhi dng erythromycin trn ph
n cho con b.
TNG TC THUC
Vic s dng erythromycin nhng bnh nhn ang dng theophylline liu cao c th lm tng
nng theophylline trong huyt thanh v c tnh theophylline tim tng. Trong trng hp
ng c theophylline v/hay nng theophylline trong huyt thanh cao, nn gim liu

theophylline khi iu tr ng thi vi erythromycin.

Vic s dng ng thi erythromycin v digoxin c ghi nhn l lm tng nng digoxin
trong huyt thanh.
Cng c nhng bo co v hiu qu khng ng tng khi nhng thuc khng ng c dng
ng thi vi erythromycin.
Vic s dng ng thi erythromycin v ergotamine hay dihydroergotamine lm tng c tnh
ergot cp mt s bnh nhn, biu hin bi tnh trng co tht mch v ri lon cm gic.
Erythromycin c ghi nhn l lm gim thanh thi ca triazolam v do c th lm gia
tng tc dng dc l ca triazolam.
Vic s dng erythromycin mt s bnh nhn c dng ng thi cc thuc c chuyn ha
bi h thng cytochrom P450 c th lm tng nng nhng thuc carbamazepine,
cyclosporine, hexobarbital, phenytoin trong huyt thanh. Nn theo di cht ch nng ca
nhng thuc c chuyn ha bi h thng cytochrom P450 nu s dng phi hp vi
erythromycin.
Erythromycin lm thay i chuyn h ca terfenadine mt cch ng k khi s dng ng thi ;
v vy phi theo di cn thn khi s dng ng thi erythromycin v terfenadine.
Nn theo di nhng bnh nhn s dng ng thi lovastatin v erythromycin ; mt s trng
hp ly gii c vn c ghi nhn bnh nhn suy yu trm trng.
TC DNG NGOI
Tc dng ph thng gp nht ca erythromycin ng ung l ng tiu ha v c lin
quan n liu lng. Nhng tc dng ph ny bao gm bun nn, au bng, tiu chy v chn
n. Nhng triu chng ca ri lon chc nng gan v/hay nhng kt qu th nghim chc nng
gan bt thng c th xy ra (xem phn Ch { phng). Vim i trng gi mc him gp
nhng bnh nhn iu tr erythromycin.
Cng c nhng bo co ring bit v nhng tc dng ph thng qua trn h thn kinh trung
ng gm l ln, o gic, co git v chng mt. Tuy nhin, cha xc minh c mi tng quan
nhn qu.
Thnh thong nhng bo co trng hp v ri lon nhp tim nh nhp nhanh tht c ghi
nhn nhng bnh nhn tr liu vi erythromycin. C nhng bo co ring bit v triu chng
vim mch khc nh au ngc, chng mt, hi hp, nh trng ngc, tuy nhin cha xc minh
c mi tng quan nhn qu.
Nhng phn ng d ng thay i t ni m ay, pht ban da nh cho n tnh trng phn v c
th xy ra.
C nhng bo co ring bit v mt kh nng nghe c hi phc, ch yu xy ra nhng bnh
nhn c suy chc nng thn v nhng bnh nhn dng erythromycin liu cao.
LIU LNG v CCH DNG
Dng nh tng v vin bao phim erythromycin ethylsuccinate c th dng m khng cn quan

tm n ba n.
Tr em : tui, cn nng nng ca nhim trng l nhng yu t quan trng xc nh liu
thch hp. Nhim trng nh n trung bnh : liu thng dng tr em l 30-50 mg/kg/ngy,
c chia thnh nhng liu bng nhau mi 6 gi. Nhim trng nng, c th tng liu ny ln gp
i. Nu mun dng 2 ln trong ngy th na tng liu trong ngy c cho mi 12 gi. Cng c
th chia lm 3 ln/ngy bng cch dng 1/3 tng liu trong ngy. Bng ph lc di y c
ngh trong nhng trng hp nhim trng t nh n trung bnh
Cn nng

Tng liu hng ngy

di 10 lbs

30-50 mg/kg/ngy
15-25 mg/kg/ngy

10-15 lbs

200 mg

16-25 lbs

400 mg

26-50 lbs

800 mg

51-100 lbs

1.200 mg

trn 100 lbs

1.600 mg

Ngi ln : liu thng dng l 400 mg/6 gi. C th tng liu ti 4 g/ngy ty theo nng ca
bnh. Nu mun dng 2 ln trong ngy th na tng liu trong ngy c cho mi 12 gi. Cng
c th chia lm 3 ln/ngy bng cch dng 1/3 tng liu trong ngy.
Nhm tnh tn liu lng ngi ln, dng t s ca 400 mg erythromycin hot tnh dng
ethylsuccinate vi 250 mg erythromycin hot tnh dng stearate, kim hay estolate.
Trong iu tr nhng nhim khun do lin cu khun, nn s dng erythromycin ethylsuccinate
liu iu tr t nht 10 ngy. Phng nga lin tc chng li s ti nhim lin cu trng nhng
ngi c tin s bnh tim hu thp, liu thng dng l 400 mg cho 2 ln/ngy.
Phng nga tnh trng vim ni tm mc do vi khun nhng bnh nhn bnh tim bm sinh,
hay bnh van tim hu thp, hay bnh van tim mc phi, khi tri qua cc phu thut v rng hay
ng h hp trn, s dng 1,6 g (20 mg/kg tr em) ung 1 gi 30 pht - 2 gi trc th
thut v sau 800 mg (10 mg/kg tr em) ung tip 8 liu mi 6 gi.
Tr vim niu o do C. trachomatis hay U. urealyticum 800 mg x 3 ln/ngy trong 7 ngy.
Tr giang mai giai on u : ngi ln : 48-64 g chia ra ng trong thi gian 10-15 ngy.
Nhim amib rut : ngi ln 400 mg x 4 ln/ngy trong 10-14 ngy; tr em 30-50 mg/kg/ngy
chia ra dng trong 10-15 ngy.

Ho g : mc d cha xc minh c liu lng v thi gian ti u, liu erythromycin s dng

trong nhng nghin cu lm sng c bo co t 40-50 mg/kg/ngy, chia ra dng trong
thi gian 5-14 ngy.
Tr bnh Legionnaires : mc d cha xc minh c liu ti u, liu erythromycin s dng trong
nhng nghin cu lm sng c bo co l nhng liu ngh phn trn (1,6-4 g/ngy
chia ra nhiu ln).
Q LIU
Trong trng trng hp dng q liu nn ngng erythromycin. Tnh trng q liu nn c x
l bng cch o thi ngay lp tc thuc cha hp thu v tt c nhng phng thc thch hp
khc.
Lc mu hay thm phn phc mc khng loi b c erythromycin.
BO QUN
Gi thuc vin v cm (trc khi pha trn ) di 86oF (30oC).

179.

ECAZIDE

BRISTOL-MYERS SQUIBB
vin nn d b : hp 28 vin - Bng B.
THNH PHN
cho 1 vin
Captopril

50 mg

Hydrochlorothiazide

25 mg

(Lactose)
DC LC
Ecazide phi hp mt thuc c ch men chuyn l captopril, v mt thuc li tiu l
hydrochlorothiazide, do tc dng h huyt p c hip ng.
C ch tc ng dc l :
- Captopril :
Captopril l thuc c ch men chuyn angiotensine I thnh angiotensine II, cht gy co mch
ng thi kch thch s bi tit aldostrone v thng thn.
Kt qu l :

- gim bi tit aldostrone,

- tng hot ng ca rnine trong huyt tng, aldost rone khng cn ng vai tr kim tra
ngc m tnh,
- gim tng khng ngoi bin vi tc ng u tin trn c v trn thn, do khng gy gi
mui nc hoc nhp tim nhanh phn x trong iu tr lu di.
Tc ng h huyt p ca captopril cng c th hin nhng bnh nhn c nng rnine
thp hoc bnh thng.
- Hydrochlorothiazide :
Hydrochlorothiazide c ch s ti hp thu ch ng sodium, ch yu ng ln xa, v nh th
lm tng s bi tit sodium v chlorure qua nc tiu, v mc thp hn, s bi tit ca
potassium v magn sium, lm tng bi niu v gy tc dng h huyt p.
c tnh ca tc ng h huyt p :
- Lin quan n captopril :
Captopril c hiu lc mi giai on ca cao huyt p : nh, va v nng ; Captopril c ghi
nhn lm gim huyt p tm thu v tm trng, t th nm v t th ng.
Tc ng h huyt p c c sau khi ung thuc 15 pht v c hiu lc ti a sau khi ung
thuc t 1 n 1 gi 30 pht. Thi gian tc ng ty thuc vo liu, thng t 6 n 12 gi.
nhng bnh nhn c p ng, huyt p c tr li bnh thng sau 15 ngy iu tr, v duy
tr mc n nh khng ti li.
Khi ngng thuc khng xy ra hin tng huyt p tng vt tr li.
- Lin quan n hydrochlorothiazide :
Hydrochlorothiazide cho tc ng li tiu sau khi ung khong 2 gi, cho tc ng ti a sau 4
gi v duy tr tc ng trong 6 n 12 gi.
Khi tng n mt liu no th tc dng iu tr ca hydrochlorothiazide khng tng na,
trong khi th cc tc dng ngoi li tng : trng hp iu tr khng thy c hiu qu,
khng nn tng liu ln qu liu khuyn co.
- Lin quan n dng phi hp :
Qua cc kho st lm sng, dng ng thi captopril v hydrochlorothiazide s cho tc dng h
huyt p quan trng so vi khi dng ring r tng cht.
Dng captopril s c ch trc rnine-angiotensine-aldostrone v lm gim s mt potassium
gy bi hydrochlorothiazide.
Phi hp vi mt thuc li tiu thiazide s cho tc dng hip ng. Ngoi ra dng phi hp
thuc c ch men chuyn v thuc li tiu thiazide s lm gim nguy c h kali huyt gy bi
thuc li tiu nu ch dng mt mnh.
DC NG HC
Lin quan n captopril :
Captopril c hp thu nhanh qua ng ung (nh hp thu trong mu t c trong gi

u tin).
T l hp thu chim 75% liu dng v gim t 30 n 50% khi dng chung vi thc n, tuy nhin
khng nh hng g n tc dng iu tr.
C 30% gn vi albumine huyt tng. Thi gian bn hy khong 2-3 gi.
C 95% captopril b o thi qua nc tiu (trong 40 n 50 di dng khng b bin i).
Captopril qua c nhau thai.
Mt lng rt nh captopril c bi tit qua sa m.
Lin quan n hydrochlorothiazide :
- Hp thu :
Sinh kh dng ca hydrochlorothiazide thay i ty ngi t 60 n 80%. Thi gian cn thit
t nng ti a trong huyt tng (Tmax) dao ng t 1,5 n 5 gi, trung bnh khong 4
gi.
- Phn phi :
Lin kt vi protine huyt tng khong 40%.
Thi gian bn hy rt thay i ty ngi, t 6 n 25 gi.
- o thi :
Thanh thi thn chim khong 90% thanh thi ton phn.
Lng hot cht khng b bin i c tm thy trong nc tiu chim 95%.
ngi suy thn v suy tim, thanh thi thn ca hydrochlorothiazide gim v thi gian bn
hy o thi tng. iu ny cng tng t i vi ngi ln tui, ngoi ra cn c tng nng
ti a trong huyt tng.
CH NH
iu tr cao huyt p trong trng hp tht bi vi n tr liu ch dng mt thuc c ch men
chuyn.
CHNG CH NH
Lin quan n captopril :
- Qu mn cm vi captopril.
- Tin s b ph mch (ph Quincke) do dng thuc c ch men chuyn.
- Ph n c thai hoc cho con b (xem Lc c thai v Lc nui con b).
Chng ch nh tng i :
- Phi hp vi thuc li tiu tng kali huyt, mui kali v lithium : xem Tng tc thuc.
- Hp ng mch thn hai bn hoc ch cn duy nht mt qu thn lm vic.
- Tng kali huyt.
Lin quan n hydrochlorothiazide :
- Qu mn cm vi sulfamide.
- Suy thn nng (thanh thi cr atinine di 30 ml/pht).
- Bnh l no do gan.

Chng ch nh tng i :
- Lithium v cc thuc khng chng lon nhp gy xon nh : xem Tng tc thuc.
CH PHNG
Lin quan n captopril :
C a b suy gim min dch : nguy c b gim bch cu trung tnh/mt bch cu ht.
Cc thuc c ch men chuyn trong c captopril i khi ngoi l c th gy mt bch cu ht
v/hoc gy suy ty khi chng c s dng :
- liu cao (> 150 mg/ngy),
- bnh nhn suy thn phi hp vi cc bnh h thng (bnh collagne nh lupus ban ri
rc hoc bnh x cng b), c iu tr bng thuc lm gim min dch v/hoc nhng thuc
c kh nng gy gim bch cu. Trng hp phi hp nhiu loi thuc, cn theo di st mc
dung np mu v thn.
Vic chp hnh tt cc ch liu lng khuyn co c th ngn nga xy ra cc tai bin trn
(khng vt qu liu captopril 150 mg/ngy). Tuy nhin, nu s dng thuc c ch men chuyn
trn nhm bnh nhn ny, cn cn nhc k gia hiu qu iu tr v cc nguy c.
Ph mch (ph Quincke) :
Ph mch mt, u chi, mi, li, thanh mn v/hoc thanh qun i khi cng c ghi nhn
trong mt s him trng hp iu tr bng thuc c ch men chuyn, k c captopril. Trong
nhng trng hp ny, phi ngng ngay captopril v theo di bnh nhn cho n khi ht hn
ph. Nu ch b ph mt v li, c th t khi khng cn phi iu tr, c th dng cc thuc
khng histamine lm du cc triu chng.
Nu ph mch phi hp vi ph thanh qun c th gy t vong. Nu ph sang n li, thanh
mn hoc thanh qun, c th gy nght th, cn phi c x l ngay lp tc bng cch tim
di da dung dch adr naline 1/1000 (0,3 ml n 0,5 ml) v p dng cc bin php cp cu
thch hp.
Khng c tip tc k toa thuc c ch men chuyn nhng bnh nhn ny (xem Chng ch
nh).
Bnh nhn c tin s b ph Quincke khng lin quan n vic dng thuc c ch men
chuyn cng c nguy c cao khi dng loi thuc ny.
Lc mu :
Cc phn ng ging phn v (ph li v mi vi kh th v gim huyt p) cng c ghi nhn
khi lm thm phn c dng mng c tnh thm cao (polyacrylonitrile) nhng bnh c iu
tr bng thuc c ch men chuyn. Nn trnh phi hp ny.
Lin quan n hydrochlorothiazide :
Trng hp c tn thng gan, thuc li tiu nhm thiazide c th gy bnh l no do gan.
Trong trng hp ny, phi ngng thuc li tiu ngay.
THN TRNG LC DNG

Lin quan n captopril :

- Ho khan c ghi nhn khi s dng thuc c ch men chuyn, c c tnh dai dng v khi khi
ngng thuc. Nguyn nhn do thuc c th c ngh n, tuy nhin nu vic iu tr bng
thuc c ch men chuyn l cn thit, c th duy tr iu tr.
- Tr em : hiu lc v mc dung np ca captopril tr em cha c thit lp bng cc
nghin cu c kim sot. Tuy nhin, captopril vn c s dng iu tr bnh tim mch
tr em. Nn bt u iu tr bnh vin.
- Trng hp suy tim, mt mui-nc, v.v. : nguy c b h huyt p v/hoc suy thn.
C s kch thch h thng rnine-angiotensine-aldostrone c ghi nhn, c bit bnh
nhn b mt mui-nc quan trng (n king theo ch khng c mui hoc iu tr ko di
bng thuc li tiu), bnh nhn c huyt p ng mch ban u thp, trng hp b hp
ng mch thn, suy tim sung huyt hoc x gan c trng ph bng.
Thuc c ch men chuyn c th phong b h thng ny, nht l trong ln s dng u tin v
trong hai tun l u iu tr, c th gy ra tt huyt p t ngt v/hoc, mc d rt him v
thi hn thay i, tng cr atinine huyt tng gy suy thn chc nng i khi cp tnh.
Trong nhng trng hp nu trn, cn bt u iu tr vi liu thp v tng t t.
- Ngi gi : cn nh gi chc nng thn v kali huyt trc khi bt u iu tr (xem Liu
lng v Cch dng). Liu ban u c iu chnh li sau ty theo p ng v huyt p,
nht l trong trng hp mt mui-nc, nhm trnh tt huyt p c th xy ra t ngt.
- Trng hp suy thn (thanh thi cr atinine di 30 ml/pht) : chng ch nh. nhng bnh
nhn c thanh thi creatinine 30-80 ml/pht v nhng bnh nhn b bnh cu thn, nn
theo di nh kz kali v cratinine (xem Liu lng v Cch dng).
- Bnh nhn b x va ng mch : do nguy c b h huyt p c th xy ra trn tt c bnh
nhn, cn phi c bit thn trng nhng bnh nhn c bnh tim thiu mu cc b hoc suy
tun hon no, bng cch bt u iu tr liu thp.
- Bnh nhn b cao huyt p do thn : nguyn tc iu tr cao huyt p do thn l vn ti
ti mu thn (ti to mch mu thn). Tuy nhin, dng captopril c th c ch cho nhng bnh
nhn ny trong thi gian ch i phu thut iu chnh hoc trng hp khng th phu thut
c. Khi iu tr phi dng liu ban u thp v theo di chc nng thn cng nh kali huyt,
mt vi bnh nhn c th b suy thn chc nng, tuy nhin s hi phc li khi ngng iu tr.
- Bnh nhn suy tim nng (giai on IV) hoc i tho ng l thuc insuline (c khuynh
hng tng kali huyt) : khi iu tr phi c theo di cht ch lm sng v liu ban u phi
thp.
- Bnh nhn cao huyt p vi suy mch vnh : khng ngng thuc chn bta ; phi hp thuc
c ch men chuyn vi thuc chn bta.
- Ghp thn hoc thm phn mu :
Thiu mu vi gim hm lng h moglobine c ghi nhn, v gim nhiu nu dng liu

ban u cao. Tc dng ny dng nh khng ph thuc vo liu lng nhng c lin quan n
c ch tc ng ca cc thuc c ch men chuyn.
Vic gim ny mc trung bnh, xy ra trong thi hn khong 1 n 6 thng, sau mc
n nh. S khi sau khi ngng iu tr. Vic iu tr c th c p dng nhng cn phi kim
tra mu thng xuyn.
- Can thip phu thut : trng hp c dng thuc gy v cm, v nht l vi thuc gy v cm
c tim nng lm h huyt p th khi s dng, thuc c ch men chuyn s lm tt huyt p.
Nn ngng iu tr mt ngy trc nu c th khi phu thut i vi nhng thuc c ch men
chuyn c thi gian tc ng ngn nh captopril.
Lin quan n hydrochlorothiazide :
- Cn bng nc v cht in gii :
Natri huyt :
Phi kim tra natri huyt trc khi bt u iu tr v u n sau . Tt c thuc li tiu u
c th gy h natri huyt vi hu qu i khi nng. Vic gim natri huyt lc u c th khng
c triu chng, do cn phi kim tra u n nht l nhng ngi d c nguy c nh
ngi gi, suy dinh dng nng, x gan (xem Tc dng ngoi v Qu liu).
Kali huyt :
Thuc li tiu nhm thiazide c th gy h kali huyt. Cn d bo trc nguy c h kali huyt (<
3,5 mmol/l) nht l nhng ngi d c nguy c nh ngi gi, suy dinh dng hoc c
iu tr bng nhiu loi thuc, bnh nhn x gan vi ph v c trng, bnh nhn mc bnh
mch vnh, bnh nhn suy tim. Trong nhng trng hp ny, h kali huyt lm tng c tnh
trn tim ca digitalis v c nguy c gy lon nhp.
bnh nhn c khong QT di, ngun gc bm sinh hoc do thuc, h kali huyt d gy lon
nhp, c bit l gy xon nh, nht l khi bnh nhn b chm nhp tim.
Trong tt c trng hp, cn kim tra kali huyt thng hn v ln kim tra u tin phi c
tin hnh trong tun l iu tr u.
Calci huyt :
Thuc li tiu nhm thiazide c th lm gim bi tit calci qua nc tiu v gy tng nh v tm
thi calci huyt. Nu calci huyt tng nhiu c th c lin quan vi cng tuyn cn gip trc
khng c bit. Trong trng hp ny, ngng iu tr trc khi thm d chc nng tuyn
cn gip.
- ng huyt : tc dng tng ng huyt ca thuc li tiu nhm thiazide khng ng k.
Tuy nhin, bnh nhn tiu ng, cn phi kim tra ng huyt thng xuyn.
- Acide urique huyt : vic thuc li tiu nhm thiazide lm mt mui-nc s lm gim s o
thi acide urique qua nc tiu. bnh nhn c acide urique trong mu tng cao, khuynh
hng b goutte c th s tng : iu chnh liu lng theo nng acide urique trong huyt
tng.

- Chc nng thn : thuc li tiu thiazide ch c hiu qu tt khi chc nng thn cn bnh
thng hoc ch hng nh (chng hn c suy lun t cch tnh thanh thi cratinine da
theo cratinine huyt). bnh nhn ln tui, gi tr cratinine huyt c nh gi li ty theo
tui tc, trng lng v gii tnh ca bnh nhn, chng hn theo cng thc Cockroft* :
* Thanh thi cratinine =
(140 - tui) x trng lng / 0,814 x cratinine huyt
(vi tui c tnh theo nm, trng lng theo kg, cratinine huyt theo mmol/l).
Cng thc trn c p dng nam gii, cn i vi ph n th s ly kt qu trn nhn vi 0,85.
Gim th tch mu th pht do mt nc v natri gy bi thuc li tiu trong thi gian iu tr
u, s lm gim s lc cu thn. Kt qu l lm tng urea huyt v cratinine huyt. Vic suy
chc nng thn ny ch tm thi v khng gy nh hng g i vi ngi c chc nng thn
bnh thng, nhng c th lm nng thm nu trc chc nng thn b suy.
- Cn lu { cc vn ng vin th thao do thuc c cha hot cht c th cho kt qu dng
tnh khi xt nghim s dng cht kch thch.
Lin quan n captopril v hydrochlorothiazide :
- Suy thn chc nng : nu xy ra trong thi gian iu tr, nn tm ngng thuc v dng tr li
hoc vi liu thp hoc vi thuc ch cha mt trong hai thnh phn.
- H huyt p v mt cn bng nc v cht in gii : nu xy ra trong thi gian iu tr, cn
tng cng theo di cc cht in phn trong huyt tng.
Nu huyt p tt nhiu, cn truyn tnh mch huyt thanh mui ng trng.
H huyt p tm thi khng cn phi ngng iu tr. Sau khi n nh li th tch mu v nng
huyt p ng mch ln n mc mong mun, c th tip tc iu tr vi liu thp hoc ch
dng mt trong hai thnh phn.
- Kali huyt : phi hp thuc c ch men chuyn v thuc li tiu khng th loi hn kh nng
gy h kali huyt, nht l bnh nhn tiu ng hoc suy thn. Nn kim tra u n kali
huyt.
LC C THAI
Chng ch nh cho ph n mang thai do trong thnh phn c thuc c ch men chuyn.
Lin quan n captopril :
Cc nghin cu trn th vt cho thy khng c tc dng gy qui thai, nhng c c tnh trn
phi thai ca nhiu loi.
ph n c thai c iu tr bng thuc c ch men chuyn :
- cha c nghin cu dch t hc rng ri ;
- mt vi quan st ring r ph n c thai trong ba thng u cho thy rng ni chung c th
bo m v phng din khng gy qui thai ngoi tr mt vi trng hp d dng vm s c
lin quan n vic dng lu di thuc c ch men chuyn trong thi gian mang thai.
- dng thuc trong 3 thng gia v 3 thng cui, v nht l nu tip tc cho n khi sinh, d c

nguy c gy tn thng thn c th gy gim chc nng thn ca bo thai vi i khi b thiu
i, suy thn tr s sinh, vi h huyt p v tng kali huyt, thm ch v niu (c hi phc hoc
khng).
T kt lun rng :
Nguy c gy d dng, nu c, rt thp. Khng cn thit phi ph thai khi tnh c pht hin c
thai trong khi ang iu tr. Tuy nhin cn siu m kim tra vm s.
Ngc li, nu pht hin c thai khi ang iu tr bng captopril, cn ngng ngay thuc ny v
trong sut thai kz.
Lin quan n hydrochlorothiazide :
Mt cch tng qut, nn trnh dng thuc li tiu thiazide trong thi gian mang thai v tuyt
i khng k toa khi c ph sinh l trong thi gian mang thai. Cc thuc li tiu c th gy thiu
mu cc b bo thai vi nguy c gy suy dinh dng bo thai.
Tuy nhin, cc thuc li tiu cng l mt thuc ch yu iu tr ph c ngun gc do tim, gan v
thn xy ra ph n c thai.
LC NUI CON B
Mt mt do thiu s liu c lin quan n captopril, mt khc do hydrochlorothiazide c bi
tit qua sa m, do khng c cho con b trong thi gian iu tr.
TNG TC THUC
Lin quan n captopril :
Khng nn phi hp :
- Thuc li tiu tng kali huyt (spironolactone, triamtrne, mt mnh hoc phi hp...), kali
(dng mui) : tng kali huyt (c th gy t vong), nht l bnh nhn suy thn (phi hp tc
ng lm tng kali huyt). Khng phi hp thuc li tiu tng kali huyt vi thuc c ch men
chuyn, tr trng hp bnh nhn b h kali huyt.
Mt cch tng qut hn :
Trnh phi hp thuc c ch men chuyn vi nhng thuc gy c ch min dch v/hoc gy
gim bch cu (xem Ch { phng v Thn trng lc dng).
Lin quan n hydrochlorothiazide :
Khng nn phi hp :
- Cc thuc khng chng lon nhp gy xon nh (astmizole, bpridil, rythromycine IV,
halofandrine, pentamidine, sultopride, terfnadine, vincamine) : xon nh (h kali huyt, chm
nhp tim hay khong QT di l nhng yu t thun li).
S dng cc ch phm khng gy xon nh trng hp c h kali huyt.
Thn trng khi phi hp :
- Cc thuc gy h kali huyt khc : amphot ricine B (ng tnh mch), gluco v
min ralocorticoide (ng ton thn), ttracosactide, thuc nhun trng kch thch : tng
nguy c h kali huyt (hip ng tc dng).

Theo di kali huyt v iu chnh nu cn ; c bit lu { trng hp iu tr bng digitalis.

Dng thuc nhun trng khng gy kch thch.
- Digitalis : h kali huyt thun li cho digitalis gy c tnh.
Theo di kali huyt, in tm v xem xt li vic iu tr nu cn.
- Thuc chng lon nhp gy xon nh : nhm Ia (quinidine, hydroquinidine, disopyramide),
amiodarone, brtylium, sotalol : xon nh (h kali huyt, chm nhp tim hay khong QT di l
nhng yu t thun li).
D phng h kali huyt v iu chnh nu cn : theo di khong QT. Trng hp b xon nh,
khng dng thuc chng lon nhp (gy in tm thu).
- Metformine : nhim acide lactique do metformine c th gy suy thn chc nng c lin quan
n thuc li tiu v c bit nht l thuc li tiu vng quai.
Khng dng metformine khi cratinine huyt qu 15 mg/l (135 mmol/l) nam gii v 12 mg/l
(110 mmol/l) ph n.
- Thuc cn quang c iode : trng hp mt nc gy bi thuc li tiu, nguy c suy thn cp
s tng, c bit khi dng liu cao thuc cn quang c iode.
B nc trc khi dng thuc cn quang c iode.
Lu { khi phi hp :
- Calcium (mui) : c th gy tng calci huyt do gim o thi calci qua thn.
- Ciclosporine : c th gy tng cr atinine huyt m khng lm thay i nng ciclosporine
trong mu, ngay c khi khng c mt mui nc.
Lin quan n captopril v hydrochlorothiazide :
Khng nn phi hp :
- Lithium : tng lithium huyt c th n ngng gy c (do gim bi tit lithium thn). Nu
bt buc phi dng thuc c ch men chuyn v thuc li tiu h kali huyt, cn theo di st
lithium huyt v iu chnh liu.
Thn trng khi phi hp :
- Thuc tr tiu ng : insuline, sulfamide h ng huyt : dng thuc c ch men chuyn c
th lm tng tc dng h ng huyt bnh nhn tiu ng c iu tr bng insuline
hoc sulfamide h ng huyt. Tuy nhin vic tt ng huyt ch xy ra trong nhng trng
hp ngoi l.
- Baclofne : tng tc dng h huyt p.
- Thuc khng vim khng st roide (dng ng ton thn), salicylate liu cao : suy thn cp
bnh nhn mt nc (gim lc cu thn).
B nc cho bnh nhn ; theo di chc nng thn khi bt u iu tr.
Lu { khi phi hp :
- Thuc chng trm cm nhm imipramine (c cu trc 3 vng), thuc an thn kinh : tng tc
dng h huyt p v nguy c h huyt p t th (hip ng tc dng).

- Corticoide, ttracosactide : gim tc dng h huyt p (do corticoide gy gi mui nc).

TC DNG NGOI
V phng din lm sng :
Lin quan n captopril :
- Nhc u, suy nhc, cm gic chng mt, ri lon tnh kh v/hoc ri lon gic ng, vp b.
- H huyt p theo t th hoc khng (xem Ch { phng v Thn trng lc dng).
- Pht ban ngoi da.
- au bao t, chn n, bun nn, au bng, thay i v gic.
- Ho khan c ghi nhn khi s dng thuc c ch men chuyn. Ho c tnh cht dai dng v s
khi khi ngng iu tr. Nguyn nhn do thuc phi c x t n khi c nhng triu chng
trn.
- Ngoi l : ph mch (ph Quincke) : xem Ch { phng v Thn trng lc dng.
Lin quan n hydrochlorothiazide :
- Trng hp suy gan, c th xy ra bnh no do gan (xem Chng ch nh, Ch { phng v
Thn trng lc dng).
- C th lm nng hn lupus ban cp b trc , vim mch gy hoi t, ngoi l c th
gy hi chng Lyell.
- Bun nn, to bn, chng mt, suy nhc, d cm, nhc u : cc triu chng ny him gp v
thng s khi khi gim liu.
- Ngoi l : vim ty, ri lon th gic vo thi iu tr u.
V phng din sinh hc :
Lin quan n captopril :
- Tng va phi ur v cratinine huyt tng, hi phc khi ngng iu tr. Vic tng ny
thng gp hn bnh nhn b hp ng mch thn, cao huyt p c iu tr bng thuc li
tiu, bnh nhn suy thn. Trng hp b bnh cu thn, dng thuc c ch men chuyn c th
gy protine niu.
- Tng kali huyt, thng l thong qua.
- Thiu mu (xem Ch { phng v Thn trng lc dng) c ghi nhn khi dng thuc c ch
men chuyn trn nhng c a c bit (nh gh p thn, lc mu).
Lin quan n hydrochlorothiazide :
- H kali huyt, ch yu trong trng hp mc bi niu mnh, v c bit trm trng trong
mt vi nhm c nguy c (xem Ch { phng v Thn trng lc dng).
- H natri huyt vi gim th tch mu c ngun gc do mt nc v h huyt p t th, thm
ch gy hi chng l ln. Nu ng thi c mt ion chlore c th gy nhim kim chuyn ha do
b tr : mc v t l xy ra tc dng ny rt thp.
- Tng acide urique huyt v ng huyt trong thi gian iu tr : phi hng dn k cho
ngi b goutte hoc tiu ng v nhng lu { khi dng cc thuc li tiu loi ny.

- Tng lipide mu khi dng liu cao.

- Rt him khi xy ra cc ri lon mu : gim tiu cu, gim bch cu, mt bch cu ht, bt sn
ty, thiu mu huyt gii.
- Ngoi l c th gy tng calci huyt.
LIU LNG v CCH DNG
Ngi c chc nng thn bnh thng :
Liu thng thng l 1 vin/ngy, ung 1 ln vo bui sng.
Suy thn :
- Thanh thi cratinine gia 30 v 80 ml/pht : liu ban u thng l na vin/ngy, ung 1
ln vo bui sng.
nhng bnh nhn ny, nn kim tra nh kz kali v cratinine huyt, chng hn mi 2 thng
trong giai on n nh iu tr ;
- Thanh thi cr atinine di 30 ml/pht hoc cratinine huyt trn 250 mmol/l : chng ch nh.
Ngi gi :
Nn khi u iu tr bng liu na vin/ngy, ung 1 ln vo bui sng. Nu liu ny khng
t hiu qu, c th tng nhng khng c vt qu 1 vin/ngy.
QU LIU
Lin quan n captopril :
Thng xy ra nht khi b qu liu l tt huyt p.
Khi huyt p tt nhiu, cn t bnh nhn t th nm, u thp, v truyn tnh mch dung
dch ng trng NaCl hay bng bt c phng tin no khc lm tng th tch mu lu
chuyn.
Captopril c th thm tch c.
Lin quan n hydrochlorothiazide :
Cc du hiu qu liu cp tnh thng l mt cn bng nc v cht in gii (h natri huyt, h
kali huyt). Trn lm sng, c th gy nn, ma, h huyt p, vp b, chng mt, ng g, tnh
trng l ln, a niu hoc thiu niu cho n v niu (do gim th tch mu).
Cc bin php cp cu ban u l tin hnh ra d dy loi thuc nut vo v/hoc cho
dng than hot tnh v cn bng nc v cht in gii cho n khi tr li bnh thng, cc bin
php ny phi c thc hin bnh vin chuyn khoa. Vic iu chnh h natri huyt phi
c thc hin t t.

180.

EDNYT

GEDEON RICHTER
vin nn 5 mg : v 10 vin, hp 3 v.
vin nn 10 mg : v 10 vin, hp 3 v.
THNH PHN
cho 1 vin
Enalapril maleate

5 mg

cho 1 vin
Enalapril maleate

10 mg

DC LC
Sau khi ung, enalapril maleate c thy phn thnh cht chuyn ha hot ng enalaprilate
trong gan. Enalaprilate tc dng ln h renin-angiotensin-aldosterone bng cch c ch men
chuyn. Enalaprilate lm gim sc cn ca ng mch ngoi bin. Trong bnh suy tim Ednyt lm
gim tin v hu ti, cung lng tim c th tng m khng nh hng ng k n nhp tim.
iu tr lu di vi enalapril lm gim chng ph i, triu chng v suy tim v lm tng sc
chu ng khi gng sc.
DC NG HC
S hp thu thuc khng b nh hng ng k bi thc n, liu n hiu qu cho mt ngy
trong a s cc trng hp. Nng huyt tng ti a t c 4 gi sau khi ung, chu kz
bn hy l 11 gi. Thuc c thi qua thn. Khi ngng thuc t ngt khng gy tng huyt p
bt ng.
CH NH
Tt c cc cao huyt p v cn :
Ednyt c th dng mt mnh hay kt hp vi cc thuc chng cao huyt p khc.
Trong cao huyt p nng renin thp, Ednyt t c tc dng.
Cao huyt p thn :
Trong trng hp cao huyt p nng renin cao, hiu qu thuc tng mnh.
Suy tim :
Dng ph tr.
CHNG CH NH
Nhy cm vi enalapril.
C tin s ph thn kinh mch do thuc c ch men chuyn.
Trong trng hp nng kali huyt tng cao, nn lu { n tc dng li kali.

CH PHNG v THN TRNG LC DNG

Cc triu chng h huyt p c th xy ra nhng bnh nhn iu tr trc vi thuc li
tiu hay c tnh trng gim th tch dch (v d nh tot m hi nhiu, nn thng xuyn, tiu
chy, mt mui) hay suy tim v cao huyt p renin cao.
Trong trng hp suy tim, huyt p v chc nng thn phi c kim tra trc v trong khi
iu tr.
Ch { c bit cc bnh nhn ph thn kinh mch.
Khi dng cho cc bnh nhn hp ng mch thn hai bn, kim tra k chc nng thn (c th
xy ra tng nng creatinin huyt tng).
cc bnh nhn chu phu thut hay trong khi gy m bng cc thuc gy h p, Ednyt s ngn
chn s gii phng renin b v th pht to thnh angiotensin II. Nu h p xy ra, nn b
dch.
LC C THAI
Cng nh cc thuc c ch men chuyn khc, Ednyt c th gy hi cho thai nhi.
LC NUI CON B
Enalapril qua sa m, tc dng ln tr em cha c nghin cu.
TNG TC THUC
Chng ch nh phi hp :
- Thuc li tiu li kali (spironolactone, triamteren, amiloride), nng kali huyt tng c th
tng, c bit trong trng hp suy thn, do phi kim tra thng xuyn nng kali huyt.
- C vi d kin cho thy NSAID lm gim tc dng Ednyt.
Thn trng khi phi hp :
- Cc thuc chng cao huyt p khc (cng lc) ch thuc li tiu nhm thiazide.
- Lithium (thanh thi lithium c th gim, cn kim tra nng litium huyt tng thng
xuyn).
- Narcotic (tc dng h p tng).
- Ru (tc dng ru tng).
TC DNG NGOI
Cc tc dng ngoi { thng nh v tm thi khng cn ngng thuc.
Him khi xy ra chong vng, nhc u, mt mi v suy yu, thnh thong h p, h p t th,
ngt do h p, bun nn, tiu chy, chut rt, ho, ni ban. Rt him khi xy ra suy thn, thiu
niu.
Mn cm : ph thn kinh mch c th xy ra di dng ph mt, mi, li, hu, hng v t chi ;
trong nhng trng hp ny, ngng thuc v iu tr h tr ngay.
Nhng thay i cn lm sng : tng tr s men gan v nng bilirubin huyt, tng kali huyt v
gim natri huyt, tng creatinin v urea huyt (kh hi), gim gi tr hemoglobin v hematocrit.
Cc trng hp sau rt him khi xy ra :

H tim mch : nhp tim nhanh, hi hp, lon nhp, au tht ngc, nhi mu c tim, chn thng
mch no do h p mnh.
H h hp : vim ph qun, ho, co tht ph qun, kh th, vim phi, khn ging.
H tiu ha : kh ming, mt s ngon ming, nn, tiu chy, to bn, vim ty, tc rut.
Suy gan : vim gan, vng da.
H thn kinh : trm cm, l ln, mt ng.
Da : hng ban dng vy nn, m ay, nga (do phn ng tng cm), ni ban nh hng ban a
dng, nhy cm nh sng, rng tc.
Cc c quan to huyt : thay i cng thc mu (gim tiu cu, gim bch cu trung tnh, suy
ty, him khi mt bch cu ht).
H sinh dc tit niu : vi trng hp protein niu.
Mn cm :thay i da, st, au c v khp, vim mch, ANA dng tnh, tng bch cu a
eosin.
Cc h c quan khc : m mt, ri lon thng bng, tai, bt lc, thay i v gic, vim li,
tot m hi.
LIU LNG v CCH DNG
Liu hng ngy l 10-40 mg dng mt ln hay chia lm hai. Liu ti a l 80 mg/ngy. Nn bt
u bng liu thp, v c th c triu chng h huyt p.
Cao huyt p :
Liu khi u l 5 mg. C th tng ty theo s p ng huyt p. Liu duy tr c th c xc
nh sau 2-4 tun iu tr.
Trong trng hp iu tr trc vi thuc li tiu, nn ngng trc 2-3 ngy ri mi dng
Ednyt. Nu khng, th gim liu Ednyt cn 2,5 mg di s gim st cht ch. V s h p qu
mnh c th gy ngt, ch { c bit khi c bnh thiu mu c tim cc b hay bnh mch no
(au thc ngc, nhi mu c tim, ngng tim, tn thng mch no c th pht trin).
Suy tim :
Thng kt hp vi digitalis v thuc li tiu. Trong cc trng hp ny nn gim liu thuc li
tiu trc khi dng Ednyt v bnh nhn phi c theo di cn thn.
Liu khi u l 2,5 mg tng dn n liu duy tr. Mt s h p ban u khng phi l chng ch
nh cho vic dng thuc vi liu thch hp sau ny.
Trong trng hp suy thn, liu phi gim v thi gian gia 2 ln dng thuc phi c ko di.
Vi bnh nhn suy thn nng (thanh thi creatinin <=30 ml/pht hay creatinin huyt thanh >=3
mg/dl), liu khi u l 2,5 mg. Liu hng ngy khng nn vt qu 40 mg.
Mc d Ednyt khng c phn ng bt li ln chc nng thn, s h p bi tc dng c ch men
chuyn c th lm trm trng thm suy thn mc. nhng bnh nhn ny, c th xy ra suy
tim cp hu ht u phc hi c theo nhng kinh nghim c c cho n nay. Mt s tng
va phi nng urea v creatinin huyt tng c th thy vi bnh nhn cao huyt p

khng suy thn c bit khi dng ng thi vi thuc li tiu.

cc bnh nhn thm phn phc mc, liu thng thng l 2,5 mg, nhng phi nh rng Ednyt
c th qua mng thm phn.
QU LIU
Nu xy ra h p sau khi qu liu, bnh nhn phi c t t th nm nga v truyn dch
nc mui sinh l{. Trong trng hp rt trm trng (khi dng liu cao gp nhiu ln liu thng
thng), thm phn phc mc loi enalaprilate ra khi h tun hon.

181.

EFFERALGAN

UPSA
vin nn si bt d b 500 mg : v 4 vin, hp 4 v.
dung dch ung 150 mg/5 ml : l 90 ml.
bt pha dung dch ung 150 mg : hp 12 gi.
bt pha dung dch ung 80 mg : hp 12 gi.
ta dc 300 mg : hp 10 vin.
ta dc 150 mg : hp 10 vin.
ta dc 80 mg : hp 10 vin.
THNH PHN
cho 1 vin si bt
Paractamol

500 mg

(Na : 412,4 mg hoc)

(17,9 mEq)

cho 1 mung lng 5 ml

Paractamol

cho 1 gi bt dng cho tr nh

150 mg

Paractamol

150 mg

cho 1 gi bt dng cho tr nh nhi

Paractamol

80 mg

cho 1 ta dc dng cho tr ln

Paractamol

300 mg

cho 1 ta dc dng cho tr nh

Paractamol

150 mg

cho 1 ta dc dng cho tr nh nhi

Paractamol

80 mg

DC LC
Gim au, h st.
DC NG HC
Paractamol :
Hp thu :
Dng ung c hp thu nhanh v gn nh hon ton. Dng ta dc c hp thu ko di.
Sinh kh dng ca c hai dng tng ng nhau. Thuc c phn phi nhanh trong mi
trng lng. Lin kt yu vi protine huyt tng. Thi gian bn hy trong huyt tng t 2
n 2 gi 30 i vi dng ung v t 4 n 5 gi i vi dng ta dc. Nng ti a trong
huyt tng t c sau 30 n 60 pht i vi dng ung v sau 2 n 3 gi i vi dng ta
dc.
Chuyn ha gan : parac tamol c chuyn ha theo 2 ng v c o thi trong nc
tiu di dng lin hp glucuronic (60-80%) v lin hp sulfonic (20-30%), v di 5% di
dng khng i. Mt phn nh (< 4%) c chuyn ha di tc dng ca cytochrome P450

thnh cht chuyn ha, cht ny sau c kh c nhanh chng bi glutathion. Trng hp
ng c do dng liu cao, lng cht chuyn ha ny tng ln.
CH NH
iu tr triu chng cc bnh gy au v/hoc st.
CHNG CH NH
- Qu mn cm vi paractamol.
- Suy t bo gan.
THN TRNG LC DNG
- tr em dng liu 60 mg/kg/ngy, paracetamol ch dng phi hp mt thuc h st khi thuc
khng c hiu qu ny.
- Khi phi theo ch n nht, lu { n lng sodium c trong thuc.
TC DNG NGOI
Vi trng hp d ng : pht ban ngoi da vi hng ban hoc m ay.
Him khi gim tiu cu.
LIU LNG v CCH DNG
Cc ln dng thuc nn cch nhau t nht 4 gi.
Liu thng thng :
- Ngi ln : 0,5-1 g, 3 ln/ngy. Khng dng qu 3 g/ngy.
- Tr em : 60 mg/kg/24 gi, chia lm 4-6 ln/ngy.
Tng liu hng ngy khng c vt qu 80 mg/kg/ngy cho tr di 37 kg.
Suy thn nng (thanh thi cr atinine di 10 ml/pht) : cch khong cc ln dng thuc t nht
8 gi.
QU LIU
- Triu chng : bun nn, i ma, chn n, xanh xao, au bng.
Dng liu qu cao, trn 10 g ngi ln (liu thp hn ngi nghin ru) v trn 150 mg/kg
tr em, dng mt liu, c th gy phn hy t bo gan a n hoi t hon ton v khng
hi phc, nhim toan chuyn ha, bnh l no dn n hn m hoc t vong.
- X tr cp cu :
Chuyn ngay n bnh vin.
Ra d dy loi tr ngay thuc ung.
Dng cng sm cng tt cht gii c N- actylcystine ung hoc tim tnh mch.

182.

EFFERALGAN CODINE

UPSA
vin nn si bt : ng 8 vin, hp 2 ng.
vin nn si bt : hp 100 vin.
THNH PHN
cho 1 vin
Paractamol

500 mg

Codine phosphate

30 mg

tng ng : Codine base

22,5 mg

(Na : 380 mg hoc)

(16,5 mEq)

DC LC
Gim au :
- paractamol : gim au, h st ;
- codine phosphate : gim au trung ng.
Phi hp paractamol v codine phosphate cho tc dng gim au mnh hn rt nhiu so vi
tng hot cht ring bit, v thi gian tc dng cng di hn.
DC NG HC
S hp thu v ng hc ca paractamol v codine khng b nh hng ln nhau khi dng
phi hp.
Paractamol :
- hp thu nhanh v gn nh hon ton rut ;
- phn phi nhanh trong mi trng lng ;
- lin kt yu vi protine huyt tng ;
- nng ti a trong huyt tng t c sau 30 n 60 pht ;
- thi gian bn hy o thi trong huyt tng khong 2 gi ;
- chuyn ha gan : parac tamol c chuyn ha theo 2 ng v c o thi trong nc
tiu di dng lin hp glucuronic (60-80%) v lin hp sulfonic (20-30%), v di 5% di
dng khng i. Mt phn nh (< 4%) c chuyn ha di tc dng ca cytochrome P450
thnh cht chuyn ha, cht ny sau c kh c nhanh chng bi glutathion. Trng hp
ng c do dng liu cao, lng cht chuyn ha ny tng ln.
Codine :
- cod ine c hp thu kh nhanh rut ; nng ti a t c sau 60 pht. Thi gian bn
hy trong huyt tng khong 3 gi ngi ln ;
- codine v cc mui c chuyn ha gan v c bi tit qua nc tiu di dng lin

hp glucuronic khng c hot tnh. Dng lin hp ny t c i lc vi cc th th ca opium.

- codine v cc mui qua c hng ro nhau thai ; t bi tit qua sa m khi dng liu duy
nht, khng c s liu khi dng lp i lp li.
CH NH
Cc cn au va phi hoc d di hoc khng p ng vi cc thuc gim au ngoi bin khc.
CHNG CH NH
- Tr em di 15 kg.
- Tiu phenylcetone (do c aspartam).
Lin quan n paractamol :
- qu mn cm vi paractamol ;
- suy chc nng gan.
Lin quan n codine :
- qu mn cm vi codine ;
- suy h hp.
CH PHNG
- Thn trng khi dng thuc cho bnh nhn suy thn nng.
- S dng ko di c th dn n tnh trng nghin thuc.
THN TRNG LC DNG
- tr em dng liu 60 mg/kg/ngy, paracetamol ch dng phi hp mt thuc h st khi thuc
khng c hiu qu ny.
- Trong trng hp phi theo ch n nht, cn lu { n lng Na c trong thuc.
Lin quan n codine :
- Khng ung ru khi ang dng thuc.
- Trng hp tng p lc s no, dng codine c th lm nng thm tnh trng ny.
- Cn lu { cc vn ng vin th thao rng thuc c cha hot cht c th cho kt qu dng
tnh xt nghim s dng cht kch thch.
Li xe v iu khin my mc : cn thn trng v thuc c th gy bun ng.
LC C THAI
Mc d c mt nghin cu tin cu M cho rng codine c th gy d dng nh, tuy nhin
cho n nay cha c cng trnh no xc nhn gi thuyt ny.
Do thn trng, khng nn s dng cod ine trong 3 thng u ca thai kz.
LC NUI CON B
Do thn trng, khng nn ung thuc khi ang nui con b (mt vi trng hp gim trng
lc vi ngng th c ghi nhn tr s sinh sau khi b sa m m ngi m li dng
codine qu liu iu tr).
TNG TC THUC
Khng nn phi hp :

- Alcool : ru lm tng tc dng an thn ca codine. Vic gim s tp trung c th gy hu

qu nguy him nht l ngi li xe v ang iu khin my mc.
- ng vn - i khng morphine (nalbuphine, bupremorphine, pentazocine) : gim tc dng
gim au do s chn cnh tranh cc th th, vi nguy c xut hin hi chng cai nghin.
Lu { khi phi hp :
- Thuc c ch thn kinh trung ng (gim au h morphine, mt vi thuc chng trm cm,
khng histamine H1 c tc dng an thn, barbiturate, benzodiazpine, clonidine v cc thuc
cng h, thuc ng, thuc an thn kinh, thuc gii lo u khng thuc nhm benzodiazpine) :
tng c ch thn kinh trung ng c th gy hu qu nguy him nht l ngi li xe v ang
iu khin my mc.
- Cc dn xut khc ca morphine (gim au hoc chng ho) : c ch h hp do hip ng tc
dng, c bit hay xy ra ngi gi.
TC DNG NGOI
Lin quan n paractamol :
- Vi trng hp d ng biu hin bi cc pht ban ngoi da vi hng ban hoc m ay, cn
phi ngng thuc.
- Rt him khi gim tiu cu.
Lin quan n codine :
- liu iu tr : c th gy to bn, bun ng, chng mt, bun nn, nn, co tht ph qun, d
ng da, c ch h hp.
- Qu liu iu tr : c nguy c gy l thuc thuc v xut hin hi chng cai nghin khi ngng
thuc t ngt.
LIU LNG v CCH DNG
Ngi ln (trn 15 tui) : 1 n 2 vin ty theo mc au, 1-3 ln/ngy vi mt ly nc ln.
Tr em t 15 kg tr ln (t 3 tui tr ln) : 3 mg/kg/ngy chia lm 4-6 ln. Ti a 1 mg/kg/ln
tng ng vi 6 mg/kg/ngy.
Cc ln dng thuc nn cch nhau t nht 4 gi.
Suy thn nng (thanh thi cr atinine di 10 ml/pht) : cch khong cc ln dng thuc t nht
8 gi.
QU LIU
Qu liu paractamol :
- Triu chng : bun nn, nn, chn n, xanh xao, au bng.
Dng liu qu cao, trn 10 g ngi ln (liu thp hn ngi nghin ru) v trn 150 mg/kg
tr em, dng mt ln, c th gy phn hy t bo gan a n hoi t hon ton v khng
hi phc, nhim toan chuyn ha, bnh no dn n hn m hoc t vong.
- X tr cp cu :
Chuyn ngay n bnh vin.

Ra d dy loi tr ngay thuc ung.

Dng cng sm cng tt cht gii c N- actylcystine ung hoc tim tnh mch.
Qu liu codine :
- Du hiu ngi ln : c ch cp cc trung khu h hp (tm ti, th chm), bun ng, pht
ban, nn i, nga, mt iu ha, ph phi cp.
- Du hiu tr em (ngng gy c 2 mg/kg, 1 ln dng) : gim tn s h hp, cc cn ngng
th, co ng t, co git, du hiu "phng thch histamine", ph mt, ban nga, try mch, b
tiu.
- X tr cp cu :
Tr h hp.
Dng naloxone.

183.

EFFERALGAN vitamine C

UPSA
vin nn si bt d b c cha vitamine C : ng 10 vin, hp 2 ng.
THNH PHN
cho 1 vin si bt c Vitamine C
Paractamol

330 mg

Acide ascorbique

200 mg

(Na : 330 mg hoc)

(14,3 mEq)

DC LC
Gim au, h st.
DC NG HC
Paractamol :
Hp thu :
Dng ung c hp thu nhanh v gn nh hon ton. Dng ta dc c hp thu ko di.
Sinh kh dng ca c hai dng tng ng nhau. Thuc c phn phi nhanh trong mi
trng lng. Lin kt yu vi protine huyt tng. Thi gian bn hy trong huyt tng t 2
n 2 gi 30 i vi dng ung v t 4 n 5 gi i vi dng ta dc. Nng ti a trong
huyt tng t c sau 30 n 60 pht i vi dng ung v sau 2 n 3 gi i vi dng ta

dc.
Chuyn ha gan : parac tamol c chuyn ha theo 2 ng v c o thi trong nc
tiu di dng lin hp glucuronic (60-80%) v lin hp sulfonic (20-30%), v di 5% di
dng khng i. Mt phn nh (< 4%) c chuyn ha di tc dng ca cytochrome P450
thnh cht chuyn ha, cht ny sau c kh c nhanh chng bi glutathion. Trng hp
ng c do dng liu cao, lng cht chuyn ha ny tng ln.
Vitamine C : hp thu tt. Trng hp dng qu nhu cu, lng thuc d c o thi theo
nc tiu.
CH NH
iu tr triu chng cc bnh gy au mc nh v trung bnh v/hoc st.
CHNG CH NH
- Qu mn cm vi paractamol.
- Suy t bo gan.
- Si thn khi liu dng ca vitamine C trn 1 g/ngy.
THN TRNG LC DNG
- tr em dng liu 60 mg/kg/ngy, paracetamol ch dng phi hp mt thuc h st khi thuc
khng c hiu qu ny.
- Khi phi theo ch n nht, lu { n lng sodium c trong thuc.
TC DNG NGOI
Vi trng hp d ng : pht ban ngoi da vi hng ban hoc m ay.
Him khi gim tiu cu.
Vitamine C dng liu cao (trn 1 g/ngy) c th gy :
- ri lon tiu ha (nng rt d dy, tiu chy).
- ri lon tit niu (kt ta si urate, si cystine v/hoc oxalate).
- tn huyt ngi thiu G6PD.
LIU LNG v CCH DNG
Cc ln dng thuc nn cch nhau t nht 4 gi. Do thuc c cha vitamine C, nn trnh ung
thuc vo cui ngy.
Liu thng thng :
Ngi ln v tr em trn 15 tui :
0,5-1 g, 3 ln/ngy. Khng dng qu 3 g/ngy.
Mi ln ung t 1 n 2 vin, ung lp li nu cn cch sau 4 gi, khng vt qu 9 vin mi
ngy.
Tr em : 60 mg/kg/24 gi, chia lm 4-6 ln/ngy.
- 25 n 30 kg (8 n 10 tui) : mi ln ung 1 vin, ung lp li nu cn cch sau 6 gi, khng
vt qu 5 vin mi ngy.
- 30 n 35 kg (10 n 12 tui) : mi ln ung t 1 n 2 vin, ung lp li nu cn cch sau 6

gi, khng vt qu 6 vin mi ngy.

- 35 n 50 kg (12 n 15 tui) : mi ln ung t 1 n 2 vin, ung lp li nu cn cch sau 6
gi, khng vt qu 7 vin mi ngy.
Suy thn nng (thanh thi cr atinine di 10 ml/pht) : cc ln ung thuc cch nhau t nht 8
gi.
QU LIU
- Triu chng : bun nn, i ma, chn n, xanh xao, au bng.
Dng liu qu cao, trn 10 g ngi ln (liu thp hn ngi nghin ru) v trn 150 mg/kg
tr em, dng mt liu, c th gy phn hy t bo gan a n hoi t hon ton v khng
hi phc, nhim toan chuyn ha, bnh l no dn n hn m hoc t vong.
- X tr cp cu :
Chuyn ngay n bnh vin.
Ra d dy loi tr ngay thuc ung.
Dng cng sm cng tt cht gii c N- actylcystine ung hoc tim tnh mch.

184.

ELOMET

SCHERING-PLOUGH
lotion bi ngoi da 0,1% : l 30 ml.
kem bi ngoi da 0,1% : ng 5 g v 15 g.
thuc m bi ngoi da 0,1% : ng 5 g v 15 g.
THNH PHN
cho 1 ml lotion
Mometasone furoate

1 mg

cho 1 g kem
Mometasone furoate

cho 1 g thuc m

1 mg

Mometasone furoate

1 mg

TC DNG
Mometasone furoate l mt corticosteroid c c tnh khng vim, chng nga v co mch.
CH NH
Thuc c ch nh lm gim biu hin vim v nga trong cc bnh da p ng vi
corticosteroid nh bnh vy nn v vim da d ng. Dng lotion ca thuc c th bi c cho
cc sang thng trn da u.
THN TRNG LC DNG
Nu c kch ng hay nhy cm khi s dng Elomet, nn ngng iu tr v thay th bng liu
php thch hp.
Khi c nhim trng, nn phi hp thm vi thuc khng nm hay khng khun thch hp. Nu
khng c p ng tt tc th, nn ngng dng corticosteroid cho n khi nhim trng c tr
khi.
Bt kz tc dng ngoi no xy ra khi dng ng ton thn, k c suy thng thn, cng c
th xut hin vi cc corticosteroid dng ti ch, c bit tr em v tr s sinh.
S hp thu ton thn ca corticosteroid dng ti ch s gia tng nu iu tr trn mt din tch
c th rng hay bng kn sau khi bi thuc. Nn thn trng trong nhng trng hp ny hay khi
dng thuc lu ngy, c bit bnh nhn nhi. Bnh nhn nhi c th biu hin kh nng nhy
cm cao hn vi s suy yu trc h i - tuyn yn - thng thn v hi chng Cushing hn
ngi trng thnh do t l gia din tch b mt da ln hn so vi trng lng c th. Nn
gii hn s dng corticosteroid ti ch cho tr em liu thp nht m vn m bo hiu qu
iu tr. iu tr di hn vi corticosteroid c th lm nh hng n s tng trng v pht
trin ca tr em.
Khng dng Elomet trong nhn khoa.
LC C THAI v LC NUI CON B
Tnh an ton Elomet khi dng cho ph n c thai cha c xc nh. Do , ch dng
corticosteroid ti ch trong thai kz khi li ch mong i cao hn nguy c c th xy ra cho thai
nhi. Khng nn s dng mt lng ln hay dng ko di cc thuc thuc nhm ny cho ph n
ang mang thai.
Hin khng bit c l lng corticosteroid dng ti ch c hp thu vo mu c th
tm thy trong sa m hay khng. Cc corticosteroid dng ton thn c bi tit qua sa m
vi mt lng rt nh khng c kh nng gy nh hng bt li cho tr. Tuy nhin, khi quyt
nh tip tc dng Elomet hay ngng thuc nn lu { n tm quan trng ca thuc vi b m.
TC DNG NGOI
Him khi c bo co v tc dng ngoi ca dng lotion Elomet gm rt bng, vim nang, phn
ng dng vim nang b, nga ngy v cc du hiu ca teo da. Tc dng ngoi { c bo co

vi t l < 1% bnh nhn c iu tr bng lotion Elomet bao gm sn, mn m v nhc nhi.
Him khi c bo co v tc dng ngoi ca dng kem Elomet gm d cm, nga ngy v cc
du hiu qu teo da. Tc dng ngoi { c bo co vi t l < 1% bnh nhn c iu tr
bng kem Elomet bao gm p-xe, rt bng, bnh nng ln, kh da, ban , nht v mn m.
Him khi c bo co v tc dng ngoi ca dng thuc m Elomet gm rt bng, nga ngy,
au nhi v / hay nhc nhi v cc du hiu ca teo da. Tc dng ngoi { c bo co vi t l
< 1% bnh nhn vi thuc m Elomet bao gm d ng tng thm, vim da, ban , nht, tng
kch thc sang thng, bun nn (1 bnh nhn) v huyt trng (1 bnh nhn).
Cc tc dng ngoi { c bo co khng thng xuyn xy ra khi dng cc thuc
corticosteroid ti ch khc nh : Kch ng, rm lng, gim sc t, vim da quanh ming, vim da
tip xc d ng, bong da, nhim khun th pht, vn da v ban ht k.
LIU LNG v CCH DNG
Bi vi git lotion ln vng da b nhim bao gm c nhng v tr trn da u mi ngy mt ln ;
xoa nn nh nhng v u khp cho n khi thuc ngm ht qua da.
Nn bi mt lp mng kem hay thuc m 0,1% ln vng da b nhim mi ngy mt ln.
BO QUN
Bo qun nhit t 2oC n 30oC.

185.

ELOXATIN 50 mg / ELOXATIN 100 mg

SANOFI SYNTHELABO VIETNAM

Bt pha tim 50 mg : hp 1 l.
Bt pha tim 100 mg : hp 1 l.
THNH PHN
cho 1 l
Oxaliplatin

50 mg

Lactose monohydrat

450 mg

cho 1 l

Oxaliplatin

100 mg

Lactose monohydrat

900 mg

DC LC
Tc nhn ngng bo (L: thuc chng ung th-thuc c ch min dch-platinium). Oxaliplatin l
mt thuc chng tn sinh thuc nhm cc hp cht platinium mi, trong platinium nguyn
t to phc hp vi 1,2-diaminocyclohexane ("DACH") v nhm oxalate. Oxaliplatin c ph tc
dng rng trong in vitro gy ra c t bo v in vivo c hot tnh khng u trn nhiu loi u bao
gm u i-trc trng. C hin tng cng lc v hot tnh c t bo gia oxaliplatin vi 5fluorouracil trong c in vitro v in vivo. Oxaliplatin cng cho thy hot tnh trong in vitro v in
vivo ca n trn cc loi ung th khng vi cisplatin. Cc nghin cu v c ch hot ng
ca oxaliplatin - mc d cha hon ton sng t - cho thy cc dn xut mnh l kt qu ca
chuyn ha sinh hc ca oxaliplatin tng tc vi DNA to ra c hai loi kt dnh gia v
trong cc si cho nhau gy ra hin tng ph v s tng hp ca DNA dn n kt qu khng
u v c t bo. Kinh nghim lm sng trn nhng bnh nhn b ung th i-trc trng cha
iu tr g trc cho thy iu tr bng oxaliplatin (85 mg/m2 lp li mi 2 tun) kt hp vi
5-fluorouracil/folinic acid, so vi khi dng 5-fluorouracil/folinic acid n c mang li hiu qu
p ng cao gp i (49% so vi 22%) v k o di c thi gian sng st m bnh khng tin
trin (8,2 so vi 6 thng). Khng c s khc bit c { ngha gia 2 nhm trn bt kz cc thng s
no v cht lng cuc sng. Trn nhng bnh nhn b ung th i-trc trng cha iu tr g
trc , oxaliplatin vi liu 130 mg/m2 mi 3 tun v kt hp vi 5-fluorouracil/folinic acid
cng c nh gi so vi dng 5-fluorouracil/folinic acid mt mnh. Kt qu v hiu qu l
tng ng khi dng oxaliplatin 85 mg/m2 mi 2 tun. Oxaliplatin kt hp vi 5fluorouracil/folinic c t l p ng tt hn gp hai ln (34% vs 12%) v k o di hn thi gian
sng khng c triu chng bnh ca bnh nhn (8,3 vs 4,2 thng). Tuy nhin mc an ton c
khc nhau gia cc ch iu tr.
Huyt hc :

Oxaliplatin kt hp vi 5fluorouracil

85
mg/m2
mi 2
tun

130
mg/m2
mi 3
tun
(EFC2961)

Mi mc
Mi mc
3 4
3

Thiu mu (%)

83

<1

38

Gim bch cu (%)

66

25

13

32

Gim tiu cu (%)

76

<1

22

H tiu ha :

Oxaliplatin kt hp vi 5fluorouracil

130
mg/m2
mi 3
tun
(EFC2961)

85
mg/m2
mi 2
tun

Mi mc
Mi mc
3 4
3

Nn/bun nn (%)

83

<1

38

Tiu chy (%)

66

25

13

32

Vim nim mc (%)

76

<1

22

T l cao ca cc tc dng ph d dy rut gp trn nhng bnh nhn dng ch 3 tun. Tiu
chy s gim dn trong cc chu kz k tip.
DC NG HC
Dc ng hc ca platinium siu lc, biu th hn hp ca tt c thnh phn khng gn kt vi
protein, gm cc loi platinium hot ng hay khng hot ng, hai gi sau khi tim truyn
oxaliplatin vi liu 130 mg/m2 mi 3 tun t 1 n 5 chu kz c nu trong bng di y :
Huyt tng Cmax
Tmax AUC0-48 AUC0-inf
siu lc
(mg/ml) (h) mg/ml.h mg/ml.h

T1/2 a T1/2 b T1/2 xy Vss

(h)
(h)
(h)
(l)

Trung bnh

1,21

SD

0,10

Cl
(l/h)

8,20

11,9

0,28

16,3

273

582 10,1

2,40

4,60

0,06

2,90

19,0

261 3,07

Gi tr trung bnh AUC0-48, Cmax c tnh vo chu kz 5

Gi tr trung bnh AUC0-inf, Vss, Cl c tnh vo chu kz 1
T1/2 l gi tr trung bnh ca tt c cc chu kz c tnh bng cch dng phn tch chia ngn
Vo cui gi th 2 ca tim truyn, 15% platinium dng xut hin trong tun hon, cn li

85% nhanh chng c phn b vo cc m hay c thi tr trong nc tiu. Do gn kt

khng hi phc vi hng cu v protein huyt tng nn thi gian bn hy ca thuc gn lin
vi vng chu chuyn t nhin ca hng cu v albumin huyt tng. Khng c hin tng tch
t thuc sau khi dng liu 85 mg/m2 mi 2 tun hay 130 mg/m2 mi 3 tun v trng thi n
nh t c t chu kz th nht. S khc bit trong v gia cc c th nhn chung l thp. Sinh
chuyn ha in vitro l kt qu ca thoi bin khng qua men v khng c bng chng v s
tham gia ca cytochrome P450 i vi s chuyn ha vng diaminocyclohexane (DAHC).
Oxaliplatin tri qua s chuyn ha hu ht bnh nhn v vo cui gi th 2 khng cn thy
thuc cha c chuyn ha trong huyt thanh siu lc. Sau , mt s cht sinh chuyn ha
gy c t bo l monochloro, dichloro v diaquo DAHC platinium c phn lp trong tun
hon cng vi mt s cht kt hp bt hot. Platinium c bi tit ch yu qua nc tiu, s
thanh thi ch yu l trong vng 48 gi sau khi dng thuc. n ngy th 5, gn 54% ca tng
liu c tm thy trong nc tiu v < 3% trong phn. C hin tng gim c { ngha thanh
thi t 17,6+/-2,18l/h xung 9,95+/-1,91 l/h trong trng hp suy thn cng vi hin tng
gim c { ngha th tch phn phi t 330+/-40,9 xung 241+/-36,11. nh hng ca suy thn
nng ln thanh thi platinium cha c xc nh
CH NH
Oxaliplatin c khuyn dng nh liu php hng u iu tr ung th i-trc trng c di
cn bng cch kt hp vi 5-fluorouracil v folinic acid.
CHNG CH NH
- Chng ch nh dng trn bnh nhn qu mn vi oxaliplatin.
- ang cho con b.
- Suy ty : bch cu a nhn trung tnh di 2x109/l v/hay tiu cu < 100x109/l.
- Bnh thn kinh ngoi bin c ri lon chc nng trc khi dng liu trnh u tin.
- Suy thn nng: thanh thi ca creatinine < 30 ml/pht.
CH PHNG v THN TRNG LC DNG
- Oxaliplatin ch c dng trong cc chuyn khoa ung th hc v nn c tim truyn di
s theo di ca cc bc s chuyn khoa ung th.
- Oxaliplatin khng thy gy ra c tnh trn thn. Tuy nhin do nhng gii hn thng tin v
mc an ton trn bnh nhn b suy thn va, vic dng thuc ch nn c xem x t n sau
khi cn nhc gia li ch v nguy c mang li cho bnh nhn. Khi quyt nh dng thuc phi
theo di cht ch chc nng thn v iu chnh tuz theo c tnh gy ra.
- Bnh nhn c tin s d ng vi cc thnh phn platinium nn c theo di cc triu chng
d ng. Trong trng hp c nhng phn ng ging d ng vi oxaliplatin, phi ngng dng
thuc ngay tc th v trin khai cc iu tr triu chng thch hp.
- Oxaliplatin t gy ra gip da nhng nu thuc b trn ra ngoi mch mu phi ngng tim
truyn ngay tc th.

- c tnh thn kinh ca oxaliplatin nn c theo di k, c bit khi dng kt hp vi cc

thuc khc cng c c tnh thn kinh. Khm thn kinh nn c thc hin trc v sau mi
t s dng. Nhng bnh nhn b lon cm gic vng hu hng (xem mc "Tc dng ngoi ")
trong lc hay trong vng 2 gi sau tim truyn th ln tim truyn k tip nn c cho trn 6
gi. Nu cc triu chng thn kinh (lon cm, d cm) xy ra, liu iu chnh ca oxaliplatin s
dng sau nn tuz thuc vo mc k o di v nng ca cc triu chng ny :
- nu triu chng cui cng ko di trn 7 ngy v gy kh chu gim liu t 85 mg/m2 xung
cn 65 mg/m2.
- nu d cm khng gy ri lon chc nng k o di n chu kz tip theo, liu oxaliplatin gim t
85 mg/m2 xung 65 mg/m2.
- nu d cm km ri lon chc nng tn ti n chu kz tip theo phi ngng iu tr.
- nu cc triu chng ci thin sau khi ngng thuc th nn xem xt dng tr li.
- D phng c tnh d dy rut biu hin bng nn v bun nn bng liu php chng nn.
- Khi c tnh huyt hc xy ra (bch cu a nhn < 1,5x109/l hay tiu cu < 50x109/l), nn tr
hon t iu tr mi cho n khi cc du hiu huyt hc tr v cc gi tr chp nhn c.
Nn lm cng thc mu k c cng thc bch cu trc mi ln iu tr.
- Khi oxaliplatin dng kt hp vi 5-fluorouracil (c hay khng c acid folic), iu chnh liu
thng thng ca 5-fluorouracil nn kt hp vi mc c tnh. Nu c tnh l 4 tiu chy
ca WHO, 3-4 gim bch cu (bch cu < 1,0 x109/l), 3-4 gim tiu cu (tiu cu < 50x109)
liu ca oxaliplatin phi gim i 25% cng vi gim liu ca 5-fluorouracil.
Li xe v iu khin my mc :
Khng c d kin.
LC C THAI v LC NUI CON B
Cho n nay vn cha c thng tin g v an ton ca thuc trn ph n mang thai. Da trn
cc nghin cu tin lm sng, dng nh oxaliplatin c th gy t vong v/hay qui thai trn
bo thai ngi vi liu iu tr, do vy khng nn dng thuc trong thi kz mang thai hoc nu
phi s dng th phi cn nhc gia li ch mang li v nguy c trn bo thai v phi c s chp
thun ca bnh nhn.
TNG TC THUC
Trn nhng bnh nhn dng n liu 85 mg/m2 oxaliplatin ngay trc khi dng 5-fluorouracil,
khng lm thay i mc nguy c ca 5-fluorouracil. In vitro, khng c hin tng cnh tranh
gn kt vi protein huyt tng vi cc cht sau : erythromycin, salicylat, granisetron,
paclitaxel v sodium valproat.
TC DNG NGOI
Cc tc dng ngoi ca oxaliplatin c bo co qua cc nghin cu lm sng trong iu tr
ung th i-trc trng di cn c phn tch trn 244 bnh nhn c iu tr n liu php v
gn 1500 bnh nhn c iu tr phi hp vi 5-fluorouracil.

Huyt hc : oxaliplatin khi dng n liu php (130mg/m2 mi 3 tun) gy ra t c tnh huyt
hc 3-4
Oxaliplatin n liu php

Mi mc

Thiu mu (% bnh nhn)

64

<1

Gim bch cu (% bnh nhn)

15

<1

Gim tiu cu (% bnh nhn)

41

<1

T l gim bch cu v tiu cu s nng hn khi kt hp cng lc vi 5-fluorouracil v folic acid

hn l khi kt hp ring r vi tng loi thuc trn.

Oxaliplatin kt hp vi 5-fluorouracil

85 mg/m2
mi 2 tun
Mi mc 3

Thiu mu (% bnh nhn)

83

<1

Gim bch cu (% bnh nhn)

66

25

13

Gim tiu cu (% bnh nhn)

76

<1

H tiu ha : Khi dng n liu php, oxaliplatin (130 mg/m2 mi 3 tun) bun nn, nn v tiu
chy. Trong phn ln trng hp cc triu chng ny khng nng.
Oxaliplatin n liu php

Mi mc

3 4

Nn, bun nn (% bnh nhn)

69

12

Tiu chy (% bnh nhn)

41

<1

Vim nim mc (% bnh nhn)

<1

<1

Bt thng chc nng gan (% bnh nhn)

46

10

D phng v/hay iu tr cc triu chng ny bng cc liu php chng nn. Khi dng
oxaliplatin kt hp vi 5-fluorouracil (c km hay khng folinic acid), tn xut v mc nng
ca tiu chy v vim nim mc gia tng c { ngha so vi khi dng 5-fluorouracil mt mnh.

Oxaliplatin kt hp vi 5-fluorouracil

85 mg/m2
mi 2 tun
Mi mc 3

Nn/bun nn (% bnh nhn)

71

11

Tiu chy (% bnh nhn)

58

Vim nim mc

42

Mc tng 1-2 ca men gan thng thy trong lc iu tr vi oxaliplatin. Trong cc

nghin cu so snh ngu nhin kt hp gia 5-fluorouracil v folinic acid vi s kt hp vi 5fluorouracid, folinic acid v oxaliplatin, t l gia tng men gan mc 3-4 tng t nhau hai
nhm
H thn kinh trung ng : c tnh gii hn theo liu ca oxaliplatin l c tnh thn kinh. c
tnh ny bao gm cc bnh l thn kinh cm gic ngoi bin nh lon cm v/hay d cm u chi
c km hay khng cm gic vp b, thng khi pht do lnh. Cc triu chng ny xut hin
trn 85% n 95% bnh nhn iu tr. Thi gian tn ti ca cc triu chng ny, thng l gim
i gia cc ln iu tr, gia tng theo s chu kz iu tr. Xut hin au v/hay ri lon chc
nng- ph thuc vo thi gian ca cc triu chng -l ch nh iu chnh liu hay thm ch
ngng thuc. Cc ri lon chc nng nu trn bao gm kh thc hin cc cc c ng tinh t v
c th l hu qu ca gim cm gic. Nguy c xut hin cc ri lon chc nng vi liu cng dn
800 mg/m2 (ngha l 10 chu kz) l < 15%. Cc du hiu v triu chng thn kinh s ci thin khi
ngng iu tr trong phn ln trng hp. Mt hi chng cp tnh do ri lon cm gic vng
hu hng c ghi nhn khi iu tr vi oxaliplatin vi t l 1-2%. Hi chng ny nhn chung
thng xut hin trong vng vi gi khi khi u iu tr nht l khi b lnh. Hi chng ny biu
hin bng cm gic ch quan nh ri lon ngn ng, kh th m khng c bt kz bng chng
khch quan no v ri lon h hp (thiu xy, co tht hng, co tht ph qun). Co tht hm, bt
thng cm gic vng li c th xy ra sau lon vn ngn v cm gic nng ngc cng
c quan st thy. Mc d cc thuc khng histamin v thuc gin ph qun c s dng
trong cc trng hp ny, cc du hiu v triu chng trn nhanh chng hi phc ngay c khi
khng iu tr. Ko di thi gian tim truyn chu kz sau s lm gim t l ca cc hi chng
ny. Cc triu chng khc nh mt phn x gn c v du hiu Lhermittes's cng c quan st
thy khi iu tr bng oxaliplatin.
Phn ng d ng : khng thng gp, i t ni mn n sc d ng c m t vi cc dn
xut platinium. Trong cc th nghim lm sng, cc phn ng kiu d ng xut hin trn 0.5%

bnh nhn iu tr vi oxaliplatin.

c tnh khc : c tnh tai < 1%. Cc ri lon chc nng thn : 3% bnh nhn iu tr vi < 1%
bnh nhn bt thng 3-4. Qua cc nghin cu lm sng v sau marketing, khng thy ri
lon nhp tht vi oxaliplatin. Khi kt hp vi 5-fluorouracil, st mc va nhn thy trn
36% bnh nhn. Hn na, c 23% bnh nhn b nhim trng mc 1-2. St do gim bch
cu xy ra < 2% bnh nhn. Rng tc mc va : 2% bnh nhn dng n liu php khng gia
tng khi kt hp vi 5-fluorouracil so vi khi dng 5-fluorouracil mt mnh. Gim th gic thong
qua gp < 0,1% bnh nhn.
LIU LNG v CCH DNG
Thuc ch dng cho ngi ln.
Liu dng : Liu khuyn co ca Eloxatine nh l liu php hng u l 85 mg/m2 c th ng
tnh mch mi 2 tun. Liu dng nn c iu chnh theo dung np. Phi lun lun dng
oxaliplatin trc fluoropyrimidines. Oxaliplatin tim truyn tnh mch 2-6 gi trong 250-500 ml
dung dch glucose 5%. Oxaliplatin ch yu c dng kt hp vi 5-fluorouracil liu c bn. Cho
mt liu trnh iu tr mi 2 tun, phc kt hp dng 5-fluorouracil liu np v truyn tnh
mch lin tc nn c s dng.
i tng c bit :
Suy thn : oxaliplatin khng c nghin cu trn bnh nhn suy thn nng (xem "Chng ch
nh"). Trn bnh nhn suy thn va, nn khi u iu tr vi liu thng thng. Khng cn
iu chnh liu trn bnh nhn suy thn nh.
Suy gan : oxaliplatin cha c nghin cu trn bnh nhn suy gan nng. Ngi ta khng nhn
thy vic gia tng c tnh do oxaliplatin trn nhng bnh c ri lon chc nng gan qua cc x t
nghim v chc nng gan. Khng cn iu chnh liu trn bnh nhn c bt thng chc nng
gan qua xt nghim trong qu trnh din tin lm sng.
Ngi gi : khng thy tng c tnh nng khi dng oxaliplatin nh l n liu php hay khi kt
hp vi 5-fluorouracil trn nhng bnh nhn trn 65 tui. Nh vy l khng cn iu chnh liu
trn bnh nhn gi.
Cch dng : Nn dng oxaliplatin tim truyn tnh mch. Khng cn b nc khi dng
oxaliplatin. Oxaliplatin pha trong 250-500 ml dung dch glucose 5% tim truyn qua ng tnh
mch ngoi bin hay tnh mch trung tm trong 2-6 gi. Lun tim truyn oxaliplatin trc khi
dng 5-fluorouracil. Khi thuc b thot ra ngoi mch phi ngng tim truyn ngay tc th.
Oxaliplatin phi c pha long trong dung dch dng pha long trc khi s dng.
QU LIU
Khng c antidote ca oxaliplatin. Trong trng hp qu liu, cc tc dng ph c th trm
trng hn. Theo di cc thng s huyt hc v iu tr triu chng.
BO QUN
Dung dch sau khi ha trn n nh v mt ha l trong 48 gi 2-8oC v 30oC. Tuy nhin v

mt vi sinh, sau khi ha trn nn c pha long vo dch truyn dng ngay. Nu cha c
s dng ngay th dung dch ny phi c bo qun 2-8oC khng qu 24 gi. Dung dch thuc
sau khi pha vo chai dch truyn nn c dng ngay.
Quan st k l thuc trc khi dng. Ch khi thy l thuc trong sut khng c cn th mi s
dng.

186.

ENANTONE LP 3,75 mg

TAKEDA
c/o MEGA PRODUCTS
vien nang ng kh v dung mi pha tim (di da hay bp) c tc dng ko di : l thuc bt +
ng dung mi (2 ml) - Bng A.
THNH PHN
Bt :
cho 1 l
Leuprorline

3,75 mg

T dc : glatine, copolymre ca acide

DL-lactique v acide glycolique, Dmannitol.
Dung dch :
cho 1 ng
Carboxymethylcellulose sodium

10 mg

D-Mannitol

100 mg

Polysorbate 80

2 mg

Nc ct pha tim va

2 ml

DC LC
Liu php ni tit ; cht tng t hormone lm gii phng gonadotropin (GnRH). Leuprorline

l mt nonapeptide tng hp, l cht tng t ca GnRH t nhin.

Cc nghin cu c thc hin trn ngi cng nh trn th vt cho thy rng sau khi c
mt s kch thch ban u, dng ko di leuprorline s c ch s bi tit ca tuyn sinh dc,
lm gim s bi tit testostrone ca tuyn sinh dc nam v estradiol ca tuyn sinh dc n.
Thuc gy thoi bin cc m chu nh hng ca ni tit t, k c cc m ca khi u trong ung
th tuyn tin lit v ung th v, cng nh trong lc ni mc t cung. Tc dng ny c th hi
phc li khi ngng iu tr.
Sau mt s nghin cu trn th vt, ngi ta cho rng thuc cn tc ng theo c ch khc
nh sau : thuc tc ng trc tip ln cc tuyn sinh dc bng cch lm gim s nhy cm ca
cc th th hng sinh dc.
ngi, sau khi dng liu u tin, s c mt s tng thong qua s phng thch ca LH v
FSH, iu ny dn n h qu l u tin s lm tng nng cc stroide sinh dc (nh
testostrone v dihydrotestostrone nam gii v estradiol ph n) v sau nng ca
LH v FSH s gim dn n nng ca testostrone thp hn mc khi ct b tinh hon
nam gii v nng estradiol gim thp hn mc sau mn kinh n gii, trong t 3 n 4
tun.
tr em, tc dng c ch cc hot ng sinh dc ca tuyn yn c biu hin, c hai gii
tnh, qua vic c ch s bi tit estradiol hay testostrone, lm gim nng nh ca LH v ci
thin tng quan gia chiu cao v trng lng xng. Vic kch thch tuyn sinh dc vo lc
u c th gy xut huyt sinh dc nh.
DC NG HC
Sau khi tng trong 2 ngy u do hot cht c gii phng nhanh t cc vi nang, nng
trong huyt tng s gim v n nh trong khong 0,3 n 0,5 ng/ml trong vng 1 thng.
CH NH
- iu tr ung th tuyn tin lit c di cn.
- iu tr dy th sm (trc 8 tui tr n v trc 10 tui tr nam).
- Lc ni mc t cung c quan sinh dc v ngoi c quan sinh dc (t giai on I n giai on
IV).
Kinh nghim lm sng v iu tr lc ni mc t cung c gii hn ph n t 18 tui tr ln.
Thi gian iu tr c gii hn trong vng 6 thng (xem phn Tc dng ngoi ).
Khng nn lp li mt t iu tr th hai vi Enantone hay vi mt thuc tng t GnRH khc.
- iu tr ung th v c di cn l thuc vo ni tit t ph n trc giai on mn kinh khi cn
phi ngng chc nng ca bung trng.
CHNG CH NH
- Qu mn vi GnRH, vi cc cht tng t GnRH hay vi mt trong cc thnh phn ca thuc.
- Xut huyt m o khng r nguyn nhn.
- Ph n c thai hay cho con b : xem phn Lc c thai v Lc nui con b.

CH PHNG v THN TRNG LC DNG

Ch { phng :
- Ung th tuyn tin lit :
Khi bt u iu tr : mt vi trng hp c bit c ghi nhn l c nng ln, thng ch tm
thi, cc triu chng lm sng (nht l au xng) c ghi nhn khi bt u iu tr. Do
cn phi theo di cht ch trong cc tun l u iu tr, nht l nhng bnh nhn b tc cc
ng bi tit v nhng bnh nhn b di cn ct sng (xem phn Tc dng ngoi {). Tng t,
cn phi cn nhc k khi iu tr cho nhng bnh nhn c cc du hiu bo hiu b chn p ty.
Trong thi gian u iu tr ghi nhn thy c tng tm thi cc phosphatase acide.
- Lc ni mc t cung v ung th v c di cn :
Trc khi k toa cn phi kim tra chc chn l bnh nhn khng c thai.
Nh vi tt c cc cht tng t GnRH khc, nn theo di nhng bnh nhn c du hiu b
long xng khi iu tr ko di.
- Ung th v c di cn :
Trong thi gian u iu tr ung th v, cng nh vi cc cht tng t GnRH khc, cc du
hiu v triu chng ca bnh c th tm thi tng ln, c th cn c iu tr triu chng.
Thn trng lc dng :
Ung th tuyn tin lit :
- Nn theo di nh kz nng testostrone trong mu v phi khng c vt qu 1 ng/ml.
- Vic p ng vi iu tr c th c nh gi trn xng bng xt nghim chp lp lnh v
(hoc) chp X quang trc ng ; tuyn tin lit, vic p ng s c nh gi (ngoi cc
kim tra lm sng v khm qua trc trng) bng siu m v/hoc phng php chp X quang
trc ng.
Lc ni mc t cung :
Dng u n mi 4 tun Enantone 3,75 mg tc dng ko di s gy v kinh do thiu nng sinh
dc. Nu xy ra bng huyt trong thi gian iu tr l c bt thng, cn phi kim tra nng
estradiol trong huyt tng v nu nng ny di 50 pg/ml, cn kim tra xem c mt sang
thng thc th no hay khng.
Trng hp dng ko di, nn theo di khi lng xng nga trng hp b long xng
(xem phn Tc dng ngoi ).
LC C THAI v LC NUI CON B
Lc c thai :Khng dng thuc khi c thai. Trc khi bt u iu tr cn phi khm chc chn
rng bnh nhn khng c thai.
Cc thng tin c lin quan n cc cht tng t GnRH khi dng trong thai kz nh sau :
- th vt, cc th nghim khng cho thy thuc c tc dng gy qui thai. Do khng c tc
dng gy qui thai trn th vt, ngi ta khng ngh rng thuc c th c nguy c gy d dng
trn ngi. Thc t cho n nay, cc cht thuc gy d dng trn ngi u c gy qui thai

trn th vt trn cc nghin cu c thc hin trn c th vt v ngi.

- Trn lm sng, dng cc cht ging GnRH trn nhng dn s c gii hn ph n c thai khng
thy c tc dng gy d dng no hay c tnh c bit trn phi c ghi nhn cho n nay.
Tuy nhin, cn phi thc hin thm nhiu nghin cu b sung theo di cc hu qu c th
xy ra khi dng thuc trn ph n c thai.
Do nu ph n ang c iu tr m pht hin c thai th phi ngng thuc ngay.
Lc nui con b :
Do cn thiu d liu v s bi tit ca thuc qua sa m v cc tc dng c th xy ra khi tr b
m, khng c s dng thuc ny nu cho con b.
TC DNG NGOI
- Ung th tuyn tin lit :
Khi u iu tr (xem phn Ch { phng v Thn trng lc dng) : i khi c th lm nng
ln cc du hiu lm sng v cc triu chng (c bit l au xng). Mt vi trng hp lm
nng ln chng huyt niu b trc , hoc gy tc ng tiu, cm gic yu t hoc gy d
cm cc chi di c ghi nhn i vi mt s cht tng t GnRH khc.
Cc biu hin ny thng l tm thi, s t khi sau 1 n 2 tun vn tip tc iu tr. Tuy
nhin, kh nng xy ra cn kch pht tm thi cc triu chng ko di trong cc tun l iu tr
u, cn phi c thn trng lu { nhng bnh nhn b e da xy ra ri lon thn kinh hay
nhng ngi b tc nghn ng tiu.
Trong thi gian iu tr, tc dng ngoi { thng gp l bng mt. Ngoi ra, cn ghi nhn : bt
lc, gim kch thc ca tinh hon, nn, ma, ph cc chi, au ton thn.
Vi cc cht tng t GnRH khc, mt s tc dng ngoi { sau c ghi nhn : st, nn, ma,
pht ban da, nga (khong 3 n 4%) ; yu t cc chi di, chng mt, kh th (di 2%) ;
nhc u, nh trng ngc, tiu chy, to bn, ri lon th gic, trm cm, chn n, ra m hi
ban m, m hi lnh, rng tc, ng gt (di 1%).
- Dy th sm :
C th xy ra cc xut huyt nh ng sinh dc sau mi tim u tin tr gi, ch khi no
triu chng ko di trn 1 thng mi phi dng n cc thuc cm li.
- Lc ni mc t cung :
Cc tc dng ngoi nh bng mt, nhc u, thay i dc nng, kh m o, tnh kh khng
n nh, au c, gim th tch v, thay i mt xng (dng thuc ko di c th lm mt
xng, l nguyn nhn dn n long xng).
- Ung th v c di cn :
Cc tc dng ngoi { thng gp c lin quan n tc ng dc l ca thuc : bng mt, ra
nhiu m hi.
Him khi gy tng calci huyt cng nh i vi cc thuc tng t GnRH khc trong thi gian
iu tr cho nhng bnh nhn c di cn xng.

LIU LNG v CCH DNG

- Ung th tuyn tin lit c di cn :
Tim di da hay tim bp mt mi, lp li mi 4 tun.
- Dy th sm :
Tim di da hay tim bp 3,75 mg lp li mi 4 tun. i vi tr em c trng lng di 20 kg,
liu dng l 1,88 mg, hay l phn na th tch ca hn dch sau khi pha mt l thuc bt trong 2
ml dung mi.
- Lc ni mc t cung :
Bt u iu tr vo ngy th nm ca chu kz.
Tim di da hoc tim bp mt mi, lp li mi 4 tun.
Thi gian iu tr : lc ni mc t cung d mc nh th no cng c iu tr ti a trong
6 thng.
- Ung th v c di cn :
Tim di da hoc tim bp mt mi, lp li mi 4 tun.
TH THC THAO TC- t ngn ci ln vch xanh ca ng dung mi v b ng.
- Dng bm tim rt dung mi trong ng ra v bm vo trong l bt pha thnh hn dch.
Dung mi ny c bo ch ring cho Enantone LP 3,75 mg, khng c thay bng mt dung
mi khc.
- Lc k hn dch, trnh to bt.
- Rt ton b hn dch sau khi pha vo bm tim.
- Hn dch sau khi pha c tim ngay, s dng loi kim tim di da hoc bp.

187.

ENDOXAN

ASTA MEDICA
c/o ZUELLIG
vin bao 50 mg : hp 50 vin - Bng A.
bt pha tim 200 mg : hp 50 l - Bng A.
bt pha tim 500 mg : hp 1 l - Bng A.
THNH PHN
cho 1 vin
Cyclophosphamide monohydrate

53,5 mg

tnh theo : Cyclophosphamide khan

50 mg

cho 1 l
Cyclophosphamide monohydrate

213,8 mg

tnh theo : Cyclophosphamide khan

200 mg

cho 1 l
Cyclophosphamide monohydrate

534,5 mg

tnh theo : Cyclophosphamide khan

500 mg

CH NH
Endoxan c s dng trong chng trnh a ha tr liu hay n tr liu trong :
Cc bnh bch cu :
Bnh bch cu dng lympho bo v dng ty bo cp hay mn.
U hch c tnh :
Bnh Hodgkin, ung th hch khng Hodgkin, u tng bo.
U tng c c tnh c di cn v khng di cn :
Ung th bung trng, ung th tinh hon, ung th v, ung th phi t bo nh, u nguyn bo
thn kinh, sarcoma Ewing.
Cc bnh t min tin trin :
Nh vim khp dng thp, bnh khp do vy nn, Lupus ban h thng, x cng b, vim
mch mu h thng (km hi chng thn h), mt s th vim cu thn (km hi chng thn
h), bnh nhc c nng, thiu mu tn huyt t min, bnh ngng kt t lnh.
iu tr c ch min dch trong ghp tng.
CHNG CH NH
Endoxan khng nn s dng nhng bnh nhn sau :
- c bit c qu mn cm vi cyclophosphamide.
- Chc nng ty xng b suy gim trm trng (c bit nhng bnh nhn c iu tr
bng cc thuc c t bo v/hoc x tr).
- Vim bng quang.
- Tc nghn ng dn tiu.
- Nhim trng giai on hot ng.

- C thai v cho con b (xem phn Lc c thai v Lc nui con b).

CH PHNG
Trong qu trnh iu tr vi Endoxan, nu vim bng quang km tiu mu vi th hay i th xut
hin, nn ngng iu tr Endoxan cho n khi bnh thng ha nc tiu.
THN TRNG LC DNG
Trc khi bt u iu tr, cn loi tr hay iu chnh cc tc nghn ng dn tiu, vim bng
quang, nhim trng v ri lon in gii.
Ni chung, Endoxan, ging nh cc thuc km t bo khc, cn c s dng thn trng bnh
nhn ln tui v nhng bnh nhn c x tr trc .
Cng cn thn trng c bit nhng bnh nhn c h min dch suy yu, nh cc bnh nhn
b i tho ng, suy gan hay suy thn mn tnh.
Cn ch cho thuc chng nn i ng lc v v sinh rng ming k cng.
Ch nh lm cng thc mu u n trong qu trnh iu tr : cch 5-7 ngy khi khi u iu
tr, cch 2 ngy trong trng hp bch cu gim < 3000/mm3, c th th hng ngy. Kim tra
mi 2 tun thng trong trng hp iu tr lu di. Phi kim tra u n hng cu trong
cn lng nc tiu.
nh hng ln kh nng li xe v s dng my mc :
Do kh nng c cc tc dng ph khi dng cyclophosphamide, nh bun nn, i ma c th dn
n suy gim tun hon, ngi thy thuc ty tng ngi m quyt nh bnh nhn c th li
xe hay iu khin my mc hay khng.
LC C THAI v LC NUI CON B
iu tr vi cyclophosphamide c th gy ra cc bt thng kiu di truyn nam v n.
Trong trng hp phi ch nh dng thuc v s sng cn ca bnh nhn ngay trong 3 thng
u ca thai kz, cn phi i khm xem xt c cn thit phi ph thai hay khng.
Sau 3 thng u tin ca thai kz, nu iu tr khng th tr hon c v bnh nhn vn mong
mun gi thai, c th tin hnh ha tr liu sau khi thng bo cho bnh nhn nguy c sinh qui
thai c th c d t.
Ph n khng c c thai trong thi gian tr liu. Nu vn c thai trong thi gian iu tr
thuc, bnh nhn cn i khm di truyn hc.
V cyclophosphamide i vo sa m, nn cc b m khng c cho con b trong lc iu tr
thuc.
n ng c iu tr bng Endoxan cn c thng bo v vic d tr tinh trng trc khi
iu tr.
Thi gian trnh th thai ph n v n ng sau khi kt thc ha tr liu ph thuc vo tin
lng ca bnh tin pht v ph thuc vo mc mong mun c con ca bnh nhn.
TNG TC THUC
Tc dng lm h ng huyt ca sulfonyl urea c th b tng ln, cng nh tc ng c ch

ty s tng ln khi dng ng thi vi allopurinol hay hydrochlorothiazide.

iu tr trc hay ng thi phenobarbital, phenytoin, benzodiazepines hay chloral hydrate
nh hng n kh nng tng dn nhp men gan t ty th.
Chng nga ng thi vaccin cm vi dng cc thuc c ch min dch s dn n gim p
ng vi vaccin. Nu dng ng thi cc thuc dn c gy kh cc (nh succinylcholine
halogenide), ngng th ko di c th xy ra xut pht t s gim nng
pseudocholinesterase.
Vic dng ng thi chloramphenicol dn n ko di thi gian bn hy ca cyclophosphamide
v lm tr hon chuyn ha.
iu tr ng thi vi anthracycline v pentostatin s lm tng kh nng gy c tnh ln tim
ca cyclophosphamide. Vic tng tc dng c trn tim cng xy ra sau khi x tr vng tim trc
.
Dng ng thi vi indomethacin cng cn phi rt cn thn, v ng c thuc cp tnh c
thy trong mt ca ring l.
TC DNG NGOI
Bnh nhn iu tr vi Endoxan c th gp cc tc dng ph lit k di y, ph thuc vo liu
v hu ht cc trng hp u c th phc hi c :
Cc tc dng ph v huyt hc :
Trong mi trng hp u phi lu { n cc tc dng sau :
- Gim bch cu km theo nguy c nhim trng e da sng cn.
- Gim tiu cu km tng nguy c xut huyt.
- Thiu mu km gim Hemoglobine trn 2 g/100 ml so vi gi tr ban u.
S lng bch cu v tiu cu thng gim thp nht vo 1 n 2 tun sau khi bt u iu tr
v hi phc trong vng 3 n 4 tun.
Vic phi hp iu tr vi 1 thuc c ch ty khc c th cn phi iu chnh liu. Nn tham
kho cc bng iu chnh liu thuc c t bo theo cng thc mu vo lc bt u chu kz iu
tr v iu chnh liu thp nht thuc km t bo.
Cc tc dng ph v tiu ha :
- Thng c bun nn v i ma.
- Him khi c chn n, tiu chy, to bn v vim ming.
Vim i trng xut huyt v lot nim mc ming c ghi nhn cc ca ring l.
ng niu sinh dc :
Vim bng quang do iu tr Endoxan l tc dng ph thng gp i hi phi ngng iu tr.
Sau khi c thi tr ra nc tiu, cyclophosphamide v cc chuyn ha cht ca chng dn
n nhng thay i ti bng quang, nh ph thnh bng quang, xut huyt di nim mc
ng niu, vim m k km x ha, v c th lm cng thnh bng quang. Vim bng quang
lc u v v trng, nhng c th c s xm nhp th pht ca vi trng sau . Vim bng

quang xut huyt km t vong sau c ghi nhn trong mt s ca ring l. Tn thng
thn (c bit khi c km bnh s suy chc nng thn) l mt tc dng ph him sau khi dng
liu cao.
Lu { : iu tr vi Uromitexan v truyn nhiu nc c th lm gim ng k tn sut v
nng ca cc tc dng ph c cho ng tiu.
c tnh cho gan :
Trong mt s him cc trng hp, tn thng chc nng gan c ghi nhn, th hin bng
s tng cc thng s cn lm sng tng ng (SGOT, SGPT, phosphatase kim, bilirubin).
Tc dng ln h tim mch :
Bnh c tim th pht do cc thuc c t bo gy ra c bit c ghi nhn sau khi dng
cyclophosphamide liu cao (120-240 mg/kg th trng). Hn na, l cc du hiu ch im s
tng c tnh ln tim ca cyclophosphamide sau khi c x tr trc vng tim v dng
ng thi anthracycline hay pentostatin.
Cc u bu th pht :
Nh khi iu tr vi thuc c t bo ni chung, iu tr vi cyclophosphamide s ko theo
nguy c b cc u bu th pht v c xem nh l di chng mun. Nguy c pht trin ung th
ng tit niu cng nh cc thoi ha lon sn ty tin trin mt phn ti bnh bch cu cp
cng tng ln. Cc nghin cu trn ng vt cng chng t nguy c ung th bng quang c th
c gim ng k nh s dng hp l Uromitexan.
Cc tc dng ph khc :
Hi u, mt tc dng ph thng gp, thng l hi phc c. Cc trng hp thay i sc
t lng bn tay, mng tay v bn chn cng c bo co.
Ngoi ra, cc tc dng ph sau cng c quan st :
- Suy gim kh nng sinh tinh trng - i khi bt hi phc - dn n khng c tinh trng hay
gim tinh trng ko di ; ri lon phng non bt hi phc, t xy ra, dn n v kinh.
- Vim phi m k, x ha phi m k mn tnh.
- SIADH (hi chng bi tit ADH khng thch ng, hi chng Schwartz-Bartter) vi h Natri mu
nc.
- Vim da v nim mc.
- Cc phn ng qu mn cm, mt s ca ring l tin trin ti chong.
- Gim th lc tm thi v cc t chng mt.
LIU LNG v CCH DNG
Liu lng phi c iu chnh thch ng vi tng bnh nhn.
Cc khuyn co liu lng sau y ch yu p dng cho n ha tr liu vi cyclophosphamide.
Khi phi hp vi cc thuc km t bo khc c cng c tnh, vic gim liu hay ko di khong
trng tr liu c th tr nn cn thit.
Suy thn hay suy gan nng i hi phi gim liu. Gim liu 25% khi bilirubin huyt thanh t 3,1

n 5 mg/100 ml v gim liu 50% khi lc cu thn di 10 ml/pht c p dng nh l

mt khuyn co ph bin. Cyclophosphamide l cht c th lc c.
Tr phi c n thuc ch nh dng theo mt kiu khc, cc liu lng sau y c khuyn
co :
L Endoxan :
- iu tr lin tc ngi ln v tr em : 3 n 6 mg/kg th trng mi ngy (tng ng vi
120 n 240 mg/m2 din tch c th).
- iu tr gin on : 10 n 15 mg/kg th trng (tng ng vi 400 n 600 mg/m2 din
tch c th) vi khong cch 2 n 5 ngy.
- iu tr gin on liu cao, chng hn 20 n 40 mg/kg th trng (tng ng vi 800 n
1600 mg/m2 din tch c th) v liu cao hn (chng hn trong iu kin trc ghp ty) vi
khong cch 21 n 28 ngy.
Vin bao Endoxan :
iu tr lin tc : 1-4 vin bao (50-200 mg) mi ngy ; nu cn c th dng nhiu hn. Nut
nguyn vin thuc vi mt t nc.
Cch cho v thi gian iu tr :
Endoxan phi do bc s chuyn khoa ung th c kinh nghim ch nh dng.
Thi gian iu tr v khong cch s ty thuc vo ch nh, k hoch ha tr liu kt hp c
p dng, tng trng sc khe ca bnh nhn v s hi phc cng thc mu.
Cn ch truyn nc y cng nh cho dng Uroprotector, Uromitexan.
Vic s dng v pha ch cc thuc km t bo lun lun phi theo ng vi cc quy ch thn
trng an ton c dng cho vic s dng cc thuc c t bo.
Pha dung dch tim :
pha ch mt dung dch ng trng, thm nc tim vo nguyn cht nh sau :
- L 200 mg : pha vi 10 ml nc tim.
- L 500 mg : pha vi 25 ml nc tim.
Nc mui sinh l{ khng c s dng lm dung dch ha tan.
Cht thuc s ha tan ngay nu l thuc c lc mnh sau khi thm nc tim vo. Nu
cht thuc khng ha tan ngay v hon ton, nn dng ng l thuc trong vi pht.
Dung dch c sn cho thuc ng tnh mch thng c dng truyn. i vi truyn
tnh mch thi gian ngn, dung dch Endoxan c thm vo dung dch Ringer, dung dch mui
hay dextrose vi tng th tch 500 ml chng hn.
Thi gian truyn c th thay i t 30 pht n 2 gi, ty thuc vo th tch s dng.
BO QUN
Endoxan khng c bo qun trn +25oC.
Dung dch pha ch phi c s dng trong vng 24 gi sau khi pha ch (khng c lu tr
trn +8oC).

Endoxan khng c s dng sau thi hn dng c ghi trn bao b.

Trong lc vn chuyn hay bo qun Endoxan nguyn cht, nh hng nhit c th dn n
tan chy hot cht cyclophosphamide. Cc l cha cc cht b tan chy c th d dng phn
bit bng mt thng vi cc l cha hot cht cn nguyn vn : cyclophosphamide b tan chy
l mt dch nhy trong hay hi vng (thng thy giai on chuyn tip hay dng cc git
nh trong l b h). Khng dng cc l cha hot cht b tan chy tim.
thuc ngoi tm tay ca tr em.

188.

ENERVON-C

UNITED LABORATORIES
Vin bao phim : chai 30 vin, 100 vin.
THNH PHN
cho 1 vin
Acide ascorbique

500 mg

Thiamine

50 mg

Riboflavine

20 mg

Pyridoxine

5 mg

Cyanocobalamine

5 mg

Nicotinamide

50 mg

Calcium pantothnate

20 mg

Phi hp cc vitamine C, B1, B2, B6, B12, PP, B5.

DC LC
Enervon-C ch cn dng mt vin duy nht trong ngy.
Thuc ha tan d dng trong h tiu ha v phng thch nhanh chng hot cht cho vic hp
th v tun hon n cc c quan trong c th.
Vin bao phim Enervon-C cho mt tc ng hu hiu chng li cc stress.
Thuc c hm lng cao cc vitamine nhm B l nhng thnh phn ch yu cn thit

chuyn i thc n thnh nng lng. 500 mg vitamine C trong thnh phn thuc gip gia tng
sc khng ca c th chng li nhim trng v cc stress. S phi hp cc thnh phn ch
yu lm gia tng nng lc tinh thn, nng cao th cht v to iu kin thun li cho cc hot
ng ca no, h thn kinh v mu, tng hot ng tiu ha v b p li s thiu ht
vitamine.
CH NH
Cung cp cho c th cc yu t c bn cn cho s tng trng v cng c h thng min dch
c th chng li cc stresse : trong giai on tng trng, cc trng hp phi c gng v th
cht v tinh thn, lc c thai v lc nui con b, cc ri lon v tim mch, d dy rut v gan,
cc nhim trng cp tnh v mn tnh, cng gip, tnh trng st v ng c, chn thng,
trc v sau khi can thip phu thut.
Cung cp cho c th cc vitamine trong trng hp thiu do ch n ung khng cn i,
thiu nin trong giai on tng trng, ngi gi, ngi nghin ru kinh nin, bnh nhn i
tho, giai on dng bnh.
D phng v iu tr trng hp thiu vitamine chuyn bit trong cc bnh thiu mu, bnh
Sprue, Bri-Bri, Scorbut, bnh Pellagra, trong v sau khi iu tr bng X quang, trong trng
hp iu tr ko di bng khng sinh, thuc khng lao...
LIU LNG v CCH DNG
1 vin/ngy vo bui sng.

189.

ENGERIX-B

SMITHKLINE BEECHAM
hn dch tim bp 20 mg/ml : l 1 ml.
hn dch tim bp 10 mg/0,5 ml : l 0,5 ml.
THNH PHN
cho 1 liu Engerix-B 20
Khng nguyn b mt virus vim gan B (HBV)

cho 1 liu Engerix-B 10

20 mg

Khng nguyn b mt virus vim gan B (HBV)

10 mg

TNH CHT
Engerix-B, vaccin vim gan siu vi B, l mt hn dch v khun cha khng nguyn b mt ch
yu ca virus vim gan B c lm tinh khit, sn xut bng k thut ti t hp DNA v hp
ph trn hydroxyd nhm. Khng nguyn c sn xut nh vic nui cy t bo nm men theo
cng ngh di truyn (Saccharomyces cerevisiae), cc t bo ny mang gen qui nh khng
nguyn b mt ch yu ca virus vim gan B (HBV). Khng nguyn b mt virus vim gan B
(HBsAg) c tinh ch qua mt s cng on l{ ha. Khi cha qua qu trnh x l ha hc,
HBsAg kt t mt cch t nhin thnh nhng tiu phn hnh cu, ng knh trung bnh 20 nm,
cha nhng polypeptid HBsAg khng glycosyl ha v mt khun lipid gm ch yu l
phospholipid. Nhng th nghim trn phm vi rng chng minh cc phn t ny c nhng
tnh cht c trng ca HBsAg t nhin.
Vaccin c tinh khit ha cao v vt nhng tiu chun ca T chc Y t Th gii i vi
vaccin vim gan B ti t hp. Trong qu trnh sn xut vaccin, khng mt cht liu no t con
ngi c s dng.
DC LC
Engerix-B to khng th c hiu i vi HBsAg (khng th anti-HBs). Hiu gi khng th antiHbs trn 10 IU/ l ng ngha vi hiu qu bo v chng nhim HBV.
Hiu qu bo v nhm nguy c :
Trong cc nghin cu lm sng, hiu qu bo v t 95% n 100% c chng minh tr s
sinh, tr nh v ngi ln c nguy c.
tr s sinh c m mang HBeAg dng tnh, c chng nga ngay sau sinh theo phc 0, 1,
2 hay 0, 1, 6 khng km HBIg th hiu qu bo v c chng minh l 95%. Tuy nhin, vic tim
HBIg cng lc vi vaccin ngay sau sinh s tng hiu qu bo v n 98%.
T l chuyn dng huyt thanh i tng khe mnh :
Khi theo phc 0, 1, 6 thng, >= 96% i tng c chng nga c khng th trong huyt
thanh mc bo v vo thi im 7 thng sau liu u tin.
Khi theo phc c bn 0, 1, 2 thng, v tim mt liu nhc li vo thng th 12, t l i
tng c chng nga c mc khng th huyt thanh dng tnh sau khi tim liu u tin
mt thng l 15%, v sau khi hon tt phc chng nga c bn 1 thng l 89%.
Mt thng sau khi tim liu nhc li, 95,8% i tng c chng nga c lng khng th
huyt thanh mc bo v.
s dng trong nhng trng hp ngoi l, lch chng nhanh 0, 7, 21, cng vi mt liu nhc
li vo thng th 12, t l i tng c tim c khng th huyt thanh mc bo v trong
vng 1 v 5 tun sau khi hon tt lch chng c bn ln lt l 65,2%, v 76%. Mt thng sau khi
tim liu nhc li, 98,6% i tng c chng nga c lng khng th huyt thanh mc

bo v.
Gim t l ung th t bo gan tr em :
T l ung th t bo gan c ghi nhn l gim ng k tr em t 6-14 tui sau khi thc
hin chng trnh tim chng vaccin vim gan B ton quc i Loan. T l khng nguyn vim
gan c ghi nhn l gim r rt (s tn ti ca khng nguyn ny l mt yu t thit yu lm
pht trin ung th t bo gan).
D liu an ton tin lm sng :
Cc th nghim thch hp v tnh an ton c thc hin.
CH NH
Engerix-B c ch nh to min dch ch ng chng nhim tt c nhng ph chng
bit ca HBV trn cc i tng c xem l c nguy c tip xc vi HBV mi la tui. Vim
gan D cng c th c ngn nga qua vic chng nga vi Engerix-B, v vim gan D (gy bi
tc nhn delta) khng xy ra nu khng nhim vim gan B. V lu di, vic chng nga vim gan
siu vi B khng nhng lm gim t l mc bnh ny m cn c cc bin chng mn tnh nh
vim gan B mn tnh th hot ng v x gan. nhng vng c tn sut vim gan B thp, vic
chng nga c ngh c bit cho nhng i tng thuc nhm c nguy c ly nhim cao,
tuy nhin, vic tim chng rng ri cho tt c cc tr nh v thanh thiu nin s gp phn kim
sot bnh vim gan siu vi B trong cng ng. nhng vng c tn sut vim gan B trung bnh
hoc cao, vi phn ln dn s c nguy c nhim HBV, chin lc tt nht l tim chng rng ri
cho tr s sinh, tr nh, thanh thiu nin, cng nh ngi ln thuc nhm c nguy c ly
nhim cao. T chc Y t Th gii, Hi ng T vn Thc hnh Tim chng Hoa kz (ACIP) v Hi
Nhi Khoa Hoa Kz khuyn co rng vic chng nga cho tr s sinh v/hoc thanh thiu nin l
chin lc ti u kim sot bnh vim gan B mi quc gia.
Nhng i tng c ghi nhn l c nguy c ly nhim cao :
- Nhn vin y t.
- Bnh nhn thng xuyn nhn cc ch phm t mu.
- Nhn vin v c dn nhng ni tp trung.
- Ngi c nguy c cao do hnh vi hot ng tnh dc.
- Ngi tim chch ma ty.
- Ngi du lch n vng c vim gan B lu hnh cao.
- Tr sinh t m mang HBV.
- i tng xut x t nhng vng c vim gan B lu hnh cao.
- Bnh nhn thiu mu tn huyt.
- Bnh nhn nhn c quan gh p.
- Ngi tip xc gn gi trong gia nh vi mt trong cc nhm trn hoc vi bnh nhn nhim
HBV cp hay mn tnh.
- i tng c bnh gan mn tnh hoc c nguy c pht trin bnh gan mn tnh (v d : ngi

mang virus vim gan siu vi C, ngi nghin ru).

- Nhng i tng khc : cnh st, nhn vin cu ha, qun nhn v nhng ngi c kh nng
tip xc vi HBV do cng vic hoc cch sng ca h.
CHNG CH NH
Khng nn dng Engerix-B cho nhng i tng c bit l qu mn cm vi mt trong cc
thnh phn ca vaccin, hoc nhng i tng c biu hin mn cm vi vaccin ln tim
trc.
Nhim HIV khng c xem l chng ch nh i vi vic chng nga vim gan B.
CH PHNG v THN TRNG LC DNG
Nh nhng vaccin khc, nn tm hon tim Engerix-B cho nhng i tng ang c bnh st
cao cp tnh. Tuy nhin, tnh trng nhim trng nh khng phi l chng ch nh i vi vic
chng nga.
Do thi kz bnh ca vim gan B di, c th vo lc chng nga bnh nhn b nhim virus
m khng bit. Trong nhng trng hp nh vy, vaccin c th khng ngn nga c s
nhim vim gan B.
Vaccin khng phng nga nhim virus vim gan A, vim gan C, vim gan E hay nhng tc nhn
gy vim gan khc.
p ng min dch i vi cc vaccin vim gan B c c lin quan n mt s yu t, bao gm
tui cao, phi nam, bo ph, thi quen ht thuc l v ng tim vaccin. nhng i tng
k m p ng vi vaccin vim gan B (v d: ngi trn 40 tui...), cc liu b sung c th c
xem xt.
i vi nhng bnh nhn thm phn mu, bnh nhn nhim HIV v nhng ngi b suy gim h
thng min dch, hiu gi khng th anti-HBs c th khng t c y sau liu trnh chng
nga c bn v do nhng bnh nhn ny cn tim thm cc liu b sung (xem "Liu ngh
cho bnh nhn thm phn mu mn tnh" trong phn Liu lng v Cch dng).
Cng nh cc loi vaccin tim khc, phng tin y t v s theo di thch hp phi lun c
chun b sn phng trng hp sc phn v (him gp) xy ra sau khi tim vaccin.
Khng nn tim Engerix-B vo c mng hay tim trong da v cch tim ny c th mang li p
ng min dch k m hn.
Trong bt c trng hp no, cng khng nn tim Engerix-B qua ng tnh mch.
Li xe v vn hnh my mc :
Vaccin khng gy nh hng n kh nng li tu xe v vn hnh my.
LC C THAI v LC NUI CON B
Lc c thai :
D liu trn ngi v vic s dng vaccin ny trong thai kz v nhng nghin cu trn s sinh
sn ca ng vt hin cha c .
Tuy nhin, nh tt c cc vaccin cha virus bt hot, tc hi trn thai nhi c xem nh khng

c.
Ch nm tim Engerix-B trong thai kz khi tht s cn thit v li ch thu c cao hn nguy c
c th xy ra cho thai nhi.
Lc nui con b :
D liu trn ngi v vic tim vaccin trong thi thi kz cho con b v nhng nghin cu trn
s sinh sn ca ng vt hin cha c .
Khng c chng ch nh no cho trng hp ny.
TNG TC THUC
Vic dng ng thi Engerix-B v mt liu HBIg chun khng lm gim hiu gi khng th antiHBs t c, min l chng phi c tim nhng v tr khc nhau.
Engerix-B c th c tim cng lc vi vaccin bch hu - un vn - ho g (DTP), bch hu - un
vn (DT) v/hay vaccin bi lit dng ung (OPV), nu iu ny ph hp thun li vi phc
chng nga do c quan y t c thm quyn quc gia khuyn co.
Engerix-B cng c th c tim ng thi vi vaccin si - quai b - Rubella, vaccin Haemophilus
influenzae tp B, vaccin vim gan A v BCG.
Nhng vaccin tim khc nhau phi lun c tim nhng v tr khc nhau.
Kh nng thay th ln nhau ca cc vaccin vim gan B :
Engerix-B c th c s dng hon tt liu trnh chng nga c bn bt u vi cc vaccin
vim gan B khc c ngun gc t huyt tng hay sn xut bng cng ngh di truyn, hoc
c dng nh mt liu nhc li nhng i tng trc c chng nga c bn vi
cc vaccin vim gan B khc c ngun gc t huyt tng hay sn xut bng cng ngh di
truyn.
TC DNG NGOI
Engerix-B ni chung c dung np tt.
Cc tc dng khng mong mun di y, thng nh v thong qua, c bo co sau khi
thc hin vic chng nga vaccin rng ri. Cng nh cc vaccin vim gan B khc, trong nhiu
trng hp, mi lin h gia vic tim vaccin vi cc tc dng ngoi { khng c thit lp.
Thng gp :
- Ti ni tim : au thong qua, hng ban, chai cng da.
Him gp :
- Ton thn : mt mi, st, kh chu, triu chng nh cm cm.
- H thn kinh trung ng v ngoi bin : chng mt, nhc u, d cm.
- H tiu ha : bun nn, nn, tiu chy, au bng.
- H gan mt : kt qu cc th nghim chc nng gan thay i.
- H c xng : au khp, au c.
- Da v cc phn ph ca da : pht ban, nga, m ay.
Rt him gp :

- Ton thn : phn ng phn v, bnh huyt thanh.

- Tim mch : ngt, h huyt p.
- H thn kinh trung ng v ngoi bin : lit, bnh thn kinh, vim thn kinh (bao gm hi
chng Guillain-Barr, vim thn kinh nhn cu v x ha a dy thn kinh), vim no, bnh
no, vim mng no.
- H c xng : vim khp.
- H h hp : cc triu chng kiu co tht ph qun.
- Da v cc phn ph ca da : ph mch, hng ban a dng.
- H mch ngoi tim : vim mch.
- H bch cu v li ni m : bnh hch bch huyt.
LIU LNG v CCH DNG
Liu lng :
Vaccin liu 20 mg : liu 20 mg (trong 1 ml hn dch) c dng cho i tng t 20 tui tr ln.
Vaccin liu 10 mg : liu 10 mg (trong 0,5 ml hn dch) c dng cho tr em t s sinh n 19
tui (k c 19 tui). tr t 10 n 19 tui, c th s dng liu 20 mg nu i tng c
nh gi l t c kh nng tun th lch tim, v s i tng chng nga t mc khng th bo
v (>= 10 UI /l) sau hai liu tim 20 mg c t l cao hn.
Lch chng nga :
Chng nga c bn :
- t c hiu qu bo v ti u, cn tim bp ba liu. Hai lch chng nga c bn c th
c ngh: lch chng nga c khong cch thi gian gia liu 2 v 3 di hn, nh chng
nga vo cc thng 0, 1 v 6, c th mt nhiu thi gian hn mi mang li hiu qu bo v,
nhng to c hiu gi khng th anti-HBs nhiu hn sau ba liu tim. Lch chng nga ny
c p dng cho tr em t 19 tui tr xung vi Engerix-B liu 10 mg.
- Lch chng nga vo cc thng 0, 1 v 2 s mang li hiu qu bo v nhanh hn v bnh nhn
d tun th lch tim hn. Liu nhc li cn c tim vo thng th 12. tr nh, phc ny
cho php tim vaccin vim gan B cng lc vi nhng vaccin tr em khc.
Hai lch chng c bn trn y c th c iu chnh cho ph hp vi thc hnh tim chng
tng a phng, lin quan n khuyn co v tui chng nga nhng vaccin tr em khc.
Chng nga nhanh :
Trong cc trng hp ngoi l ngi ln, khi cn c hiu qu bo v nhanh chng hn, v d :
nhng ngi i n vng c bnh lu hnh cao v ngi bt u lch chng vim gan B trong
vng mt thng trc khi khi hnh, c th s dng phc gm ba mi tim bp vo cc ngy
th 0, 7 v 21. Khi p dng phc ny, cn tim nhc li mt liu sau mi u tin 12 thng
(xem "T l huyt thanh chuyn dng" trong phn Dc lc).
Liu nhc li :
Hin nay vn cha hon ton xc nh c rng nhng ngi c p ng min dch tt i vi

vaccin vim gan B cn c tim nhc li nhm m bo hiu qu bo v ko di hay khng,

hay s nhc li t nhin s xy ra khi i tng chng nga tip xc vi virus. Mc d s duy tr
ca vic bo v cn cha c bit r, nhng ni chung ngi ta tha nhn rng hiu gi
khng th >= 10 IU/l l c kh nng bo v. Nn tim liu nhc li khi hiu gi khng th antiHBs xung thp hn 10 IU/l, c bit tt c nhng i tng c nguy c.
Thi im tim liu nhc li vaccin vim gan B ty thuc vo hiu gi khng th t c sau
khi hon tt lch chng nga c bn.
Da trn nhng d liu c c, ngh chung cho liu nhc li nh sau :
- Sau khi chng nga c bn theo lch 0, 1, 2 thng, liu nhc li c tim sau liu u tin 12
thng. Trong nhng trng hp c bit nh nu trn, khi s dng lch chng nga c bn
0, 7, 21 ngy, liu nhc li cng c ngh vo thi im 12 thng sau liu u tin. Liu
nhc li tip theo c l khng cn thit trong t nht 8 nm sau phc c bn.
- Sau khi chng nga c bn theo lch 0, 1, 6 thng, liu nhc li c th khng cn thit trong
vng 5 nm.
Liu ngh c bit :
Liu ngh cho tr s sinh c m mang HBV :
Nn bt u chng nga vi Engerix-B (10 mg) cho nhng tr s sinh ny t lc mi sinh, c th
s dng phc 0, 1, 2 thng hoc 0, 1, 6 thng ; Tuy nhin, phc 0, 1, 2 thng mang li p
ng min dch nhanh hn (xem thm trong phn Dc lc v vic dng thm HBIg cng vi
vaccin ngay sau khi sinh nhng tr ny).
Liu ngh cho i tng c bit hoc d on l c tip xc vi HBV :
Trong trng hp i tng va tip xc vi HBV (v d : b m phi kim tim nhim), liu
Engerix-B u tin c th c s dng ng thi vi HBIg, nhng phi tim mt v tr khc.
Nn s dng lch chng nhanh.
Liu ngh cho bnh nhn thm phn mu mn tnh :
Lch chng nga c bn dnh cho bnh nhn thm phn mu mn tnh bao gm 4 liu, mi liu
40 mg, tim vo ngy la chn, 1 thng, 2 thng v 6 thng k t ngy tim mi u tin. Lch
chng nga ny c th c iu chnh nhm m bo hiu gi khng th anti-HBs lun cao
hn mc bo v 10 UI/l.
Cch dng :
Engerix-B nn c tim bp vo vng c delta i vi ngi ln v tr em, hay vo vng trc
bn ca i i vi tr s sinh, nh nhi v nhng tr nh. Trng hp ngoi l, vaccin c th
c tim di da nhng bnh nhn b gim tiu cu hay c nhng ri lon chy mu.
Trong bt c trng hp no cng khng c tim Engerix-B qua ng tnh mch.
Tng k :
Khng nn trn ln Engerix-B vi cc vaccin khc.
Hng dn s dng/ thao tc :

Trc khi tim, vaccin phi c quan st bng mt thng xem c nhng phn t l v/hay
bt thng v mu sc hay khng.
Lc k vaccin trc khi s dng sao cho thu c mt hn dch trng, hi c.
Loi b l vaccin nu thnh phn trong l c biu hin khc.
Khi s dng dng vaccin a liu, mi liu phi c ly bng mt bm tim v mt kim tim v
trng ring. Cng nh i vi cc vaccin khc, cn tn trng tuyt i nguyn tc v khun v
thn trng trong mi ln ly mt liu vaccin trnh nhim cho phn cha trong l. Dng cc
kim tim khc nhau ly v tim vaccin.
BO QUN
Cc l vaccin mi hay s dng mt phn nn c bo qun 2-8oC.

190.

ENHANCIN

RANBAXY
hn dch ung 125 mg/31,25 mg : chai 60 ml.
hn dch ung 250 mg/62,5 mg : chai 60 ml.
vin nn 250 mg/125 mg : v 10 vin, hp 10 v.
vin nn 500 mg/125 mg : v 10 vin, hp 10 v.
THNH PHN
cho 5 ml hn dch Enhancin 156,25
Amoxicillin USP, tng ng vi amoxicillin khan

125 mg

Clavulanate potassium, tng ng vi acid clavulanic

31,25 mg

cho 5 ml hn dch Enhancin 312,5

Amoxicillin USP, tng ng vi amoxicillin khan

250 mg

Clavulanate potassium, tng ng vi acid clavulanic

62,5 mg

cho 1 vin Enhancin 375

Amoxicillin USP, tng ng vi amoxicillin khan

250 mg

Clavulanate potassium, tng ng vi acid clavulanic

125 mg

cho 1 vin Enhancin 625

Amoxicillin USP, tng ng vi amoxicillin khan

500 mg

Clavulanate potassium, tng ng vi acid clavulanic

125 mg

M T
Enhancin l mt hp cht khng khun dng ng ung bao gm mt khng sinh bn tng
hp l amoxicillin v mt cht c ch b-lactamase l clavulanate potassium, s phi hp ny c
tc dng m rng ph khng khun n cc vi khun sinh b-lactamase.
Amoxicillin c cng thc ha hc l (6R)-6a-D- (4 hydroxyphenyl)-glycylamino penicillanic acid
trihydrate. Cng thc phn t l C16H19N3O5S. 3H2O. Khi lng phn t l 419,5.
Clavulanate potassium c cng thc ha hc l Potassium (Z)-(2R,5R)-3-(hydroxy-ethylidene)-7oxo-4-oxa-1-azabicyclo (3,2,0) heptane-2-carboxylate. Cng thc phn t l C8H8NO5K v khi
lng phn t l 237,3.
DC LC
C ch tc dng :
Amoxicillin tc dng bng cch c ch sinh tng hp mucopeptid thnh t bo vi khun. y l
thuc khng khun tc dng trn nhiu vi khun Gram dng v Gram m trong giai on nhn
i ch ng. Tuy nhin n d b ph hy bi b-lactamase v do ph khng khun khng bao
gm nhng vi khun sinh b-lactamase. Clavulanic acid l mt b-lactam c cu trc gn vi
penicillin, c kh nng bt hot nhiu loi b-lactamase thng gp nhng vi khun khng
vi nhng khng sinh thuc nhm b-lactam.
Cng thc kt hp amoxicillin vi clavulinic acid bo v amoxicillin khi s thoi bin bi cc
men b-lactamase v m rng ph khng khun ca amoxicillin i vi nhiu vi khun thng
khng vi amoxicillin v cc khng sinh thuc nhm b-lactam khc.
Ph khng khun :
Nhng vi khun gy bnh sau nhy cm vi phi hp amoxicillin v clavulanate potassium :
Vi khun Gram dng :
Staphylococcus aureus (sinh v khng sinh b-lactamase), S. epidermidis (sinh v khng sinh blactamase), S. saprophyticus, S. pneumoniae, Enterococcus faecalis v S. viridans. Trong s

nhng vi khun ym kh, thuc c hiu qu i vi Clostridia, Peptococcus, Peptostreptococcus.

Vi khun Gram m :
N. gonorrhoea, H. influenzae (sinh v khng sinh b-lactamase), Moraxella catarrhalis (sinh v
khng sinh b-lactamase), E.coli, P. mirabilis, Klebsiella spp., Salmonella spp., Shigella spp. Trong
s nhng vi khun ym kh, thuc tc dng khng Bacteroides bao gm B. fragilis.
S khng :
Cc vi khun Gram m sinh b-lactamase qua trung gian nhim sc th loi 1 (v d nh :
Citrobacter, Enterobacter cloacae, Serratia spp. v Pseudomonas aeruginosa) thng khng
vi phi hp amoxicillin v clavulanate potassium v clavulanate potassium khng c ch blactamase loi 1.
Tnh sinh ung th :
Nhng nghin cu lu di trn sc vt v tnh sinh ung th ca hp cht amoxicillin v
clavulanate potassium cha c thc hin.
Tnh sinh t bin gen :
Cha thc hin nghin cu di hn trn sc vt nh gi kh nng sinh t bin gen ca
phi hp amoxicillin vi clavulanate potassium.
Thai kz/Sinh sn :
S th thai : chut cng v chut nht cho dng phi hp amoxicillin v clavulanate
potassium vi liu gp 10 ln liu thng dng ngi cho thy khng c nh hng ln s
th thai.
Thai kz : chut cng v chut nht c mang cho dng phi hp amoxicillin v clavulanate
potassium vi liu gp 10 ln liu thng dng ngi cho thy khng c mt tc dng ngoi
no.
DC NG HC
C amoxicillin v clavulanate potassium u c hp thu tt sau khi ung v bn vi acid d
dy. Thc n khng nh hng n s hp thu thuc v phi hp ny c th c dng trc
hoc sau khi n. Khi dng ng ung, kh dng sinh hc ca amoxicillin v clavulanate
potassium ln lt khong 90% v 75%. Clavulanic acid c thi gian bn hy thi tr (1 gi) gn
tng ng vi thi gian bn hy thi tr ca amoxicillin (1,3 gi).
Amoxicillin v clavulanic acid c phn b rng ri hu ht cc m v dch trong c th bao
gm dch phc mc, dch nt bng, nc tiu, dch mng phi, dch tai gia, nim mc rut,
xng, ti mt, phi, m sinh sn n v mt. Lng thuc thm nhp vo dch no ty qua
mng no khng vim v vo cht tit ph qun c m thng thp. Amoxicillin v clavulanic
acid qua mng nhau thai d dng v c bi tit qua sa m nng thp.
Amoxicillin gn vi protein huyt thanh khong 17-20%, trong khi 20-30% clavulanic acid gn
kt vi protein huyt thanh. Khong 10% liu amoxicillin v di 50% liu clavulanate c
chuyn ha.

Amoxicillin v clavulanic acid c o thi ch yu di dng khng i qua thn (lc qua cu
thn v tit ng thn). Khong 50-78% amoxicillin v 25-40% clavulanic acid c bi xut
qua nc tiu di dng khng i trong vng 6 gi u sau khi ung thuc.
CH NH
Enhancin c ch nh iu tr nhng nhim khun sau do cc vi khun nhy cm :
- Nhim khun ng h hp di (nh vim phi, vim ph qun).
- Vim tai gia cp.
- Vim xoang.
- Nhim khun ng tiu.
- Nhim khun da v m mm.
CHNG CH NH
Tin s d ng vi khng sinh thuc nhm bta-lactam.
CH PHNG
Phn ng qu mn (phn v) nghim trng i khi gy t vong c bo co nhng bnh
nhn iu tr bng penicillin. D phn ng phn v thng xy ra sau khi dng ng tim hn,
n cng xy ra nhng bnh nhn dng penicillin ung. Nhng phn ng ny d xy ra hn
nhng bnh nhn c tin s nhy cm vi penicillin v/hoc bnh nhn c tin s nhy cm vi
nhiu d nguyn ; cn hi k bnh nhn v tin s nhy cm vi penicillins, cephalosporins v
cc d nguyn khc. Nu phn ng qu mn xy ra, cn ngng ngay phi hp amoxicillin vi
clavulanate potassium v tin hnh cc bin php iu tr thch hp. Trong trng hp xy ra
sc phn v, cn p dng ngay bin php cp cu bng epinephrine, cho th oxygen, tim tnh
mch cc steroid, m thng ng th, k c t ni kh qun. Vim i trng mng gi thng
c bo co xy ra i vi hu ht cc loi khng sinh, k c phi hp Amoxicillin Clavulanate potassium v triu chng bnh din bin c th t nh n nguy him tnh mng.
Do vy, cn thn trng khi chn on i vi nhng bnh nhn tiu chy sau khi dng cc
khng sinh.
THN TRNG LC DNG
Tng qut :
V phi hp amoxicillin v clavulanate potassium c kh nng gy c tnh thp nh khng sinh
thuc nhm penicillin, vic nh gi thng xuyn chc nng ca cc h c quan bao gm chc
nng thn, gan v chc nng ca h to mu l cn thit trong sut thi gian iu tr lu di.
Mt t l cao nhng bnh nhn mc bnh tng bch cu n nhn nhim khun khi dng
ampicillin c triu chng xut hin pht ban da. Do , nhng khng sinh nhm ampicillin
khng nn dng cho nhng bnh nhn b tng bch cu n nhn nhim khun.
Nn lu { n kh nng bi nhim nm hay vi khun c th xy ra trong thi gian dng thuc.
Nu xy ra tnh trng bi nhim (thng l Pseudomonas hay nm Candida), phi ngng dng
thuc v tin hnh cc bin php iu tr thch hp.

S dng trong nhi khoa :

Nhiu khng sinh thuc nhm penicillin c s dng bnh nhi v cho n nay khng thy
mt tc dng ph c bit no i vi tr em. Tuy nhin, tr s sinh v tr nh chc nng
thn pht trin cha hon chnh c th lm chm s bi xut cc penicillin thi qua thn.
S dng trong lo khoa :
Nhiu khng sinh thuc nhm penicillin c s dng bnh nhn ln tui v cho n nay
khng thy mt tc dng ngoi { c bit no i vi ngi ln tui. Tuy nhin, bnh nhn
ln tui thng c tnh trng suy gim chc nng thn lin quan n tui nn cn phi iu
chnh liu khi dng penicillin.
TNG TC THUC
- Probenecid : Ung probenecid ngay trc hay cng lc vi amoxicillin v clavulanic acid s lm
chm tc bi tit amoxicillin ng thn khin nng amoxicillin trong mu tng cao v k o
di. Tuy nhin vic dng cng lc probenecid vi phi hp amoxicillin v clavulanate potassium
khng nh hng n din tch bn di ng cong biu din tng quan gia thi gian v
nng thuc trong mu (AUC), thi gian bn hy hay nng nh ca clavulinic acid trong
mu.
- Allopurinol : T l pht ban da tng ln c bo co bnh nhn tng acid uric mu c
cho dng allopurinol cng lc vi amoxicillin hoc ampicillin. V vy, cc bc s lm sng ngh
nu c th th nn trnh dng cng lc nhng thuc ny.
Thay i gi tr cn lm sng :
- Xt nghim glucose niu : Nng penicillin trong nc tiu cao c th gy nn kt qu xt
nghim dng tnh gi hoc cc kt qu xt nghim tng sai lch khi p dng xt nghim theo
phng php kh ng (Benedict's, Clinitest, hoc Fehling's). Xt nghim tm glucose bng k
thut men (Clinistix hoc Testape) th khng b nh hng.
- Xt nghim antiglobulin trc tip (Coombs) : Kt qu dng tnh gi c th xy ra trong thi
gian iu tr vi bt kz loi penicillin no.
- Xt nghim chc nng gan : Gia tng va phi SGOT, SGPT, phosphatase kim v bilirubin
huyt thanh c ghi nhn mt s bnh nhn dng phi hp amoxicillin v clavulanate
potassium.
TC DNG NGOI
Trn ng tiu ha :
Tiu chy, bun nn, nn ma, kh chu, chn n, y hi, kh tiu, vim d dy, vim ming,
vim li, li en hoc c ta v vim tiu kt trng.
Vim i trng mng gi :
Triu chng vim i trng mng gi do dng khng sinh c th xy ra trong khi v c sau khi
ngng dng phi hp amoxicillin v clavulanate potassium.
Phn ng qu mn :

3% bnh nhn b ni mn trn da v m ay khi dng phi hp amoxicillin-clavulanate

potassium. Cc tc dng ngoi khc l ph mch, phn ng huyt thanh v vim da bong vy
him khi xy ra.
Trn h to mu :
Thiu mu, gim tiu cu, gim bch cu v mt bch cu ht c th xy ra khi dng cc khng
sinh nhm penicillin.
Trn h thn kinh trung ng :
C th xy ra tng hot ng c hi phc, kch ng, lo u, mt ng v chng mt him khi xy
ra.
LIU LNG v CCH DNG
Liu thng thng dnh cho ngi ln :
i vi nhng trng hp nhim khun nng v nhim khun ng h hp, liu ung thng
dng l 500 mg amoxicillin v 125 mg clavulanic acid mi 8 gi, dng trong 7-10 ngy.
Cc nhim khun khc : 250 mg amoxicillin v 62,5 mg clavulanic acid mi 8 gi trong 7-10
ngy.
Liu dng cho tr em :
i vi tr di 40 kg :
6,7 mg amoxicillin v 1,7 mg acid clavulanic/kg th trng ung cch mi 8 gi trong 7-10 ngy.
Trong trng hp nhim khun nng : 13,3 mg amoxicillin v 3,3 mg acid clavulanic/kg th
trng ung mi 8 gi trong 7-10 ngy.
Enhancin dng hn dch c cung cp di dng bt kh. Thuc cn c pha ch theo
hng dn ghi trn nhn chai. Lc u trc khi dng.
QU LIU
Trong trng hp qu liu, c th loi b amoxicillin v acid clavulanic bng cch thm phn
mu.
BO QUN
Bo qun nhit di 25oC, trnh m.
thuc trnh xa tm tay tr em.

191.

ENSURE

ABBOTT
Sa bt dinh dng : hp 400 g.
THNH PHN

Tinh bt bp thy phn, du bp, natri v canxi caseinat, sucrose, khng cht : (kali xitrat, natri
xitrat, magi chlorid, kali chlorid, canxi phosphat tribasic, km sulfat, st sulfat, magi sulfat,
ng sulfat, natri molybdat, chrom chlorid, natri selenit, kali iodid), protein u nnh tinh ch,
hng liu vani nhn to, lecithin u nnh vitamins : (cholin chlorid, ascorbic acid, atocopheryl acetat, niacinamid, canxi pantothenat, pyridoxin hydrochlorid, thiamin hydrochlorid,
riboflavin, vitamin A palmitat, folic acid, biotin, phylloquinon, cyanocobalamin, vitamin D3).
Phn tch thnh phn
Bt (100 g)

Ensure pha chun (250 ml)

kcal

450

251

KJ

1891

1055

Cht m (%)

14,2

14,2

Cht bo (%)

31,8

31,8

Bt ng (%)

54,0

54,0

Cht m (g)

15,9

8,9

Cht bo (g)

15,9

8,9

Linoleic Acid (g)

8,7

4,9

Bt ng (g)

60,7

33,9

Khng cht (g)

2,5

1,4

m (g)

5,0

214

0,23

0,128

Nng lng

Phn b nng lng

Thnh phn dinh dng

Khng cht
Canxi (g)

Pht pho (g)

0,23

0,128

Magi (mg)

90,0

50,2

Natri (g)

0,36

0,20

Kali (g)

0,67

0,37

Clo (g)

0,61

0,34

Km (mg)

5,4

3,0

St (mg)

4,37

2,44

ng (mg)

0,52

0,29

Mangan (mg)

1,2

0,67

It (mg)

34

19

Selen (mg)

20

11,2

Chrom (mg)

20

11,2

Molybden (mg)

38

21,2

Vitamin A (I.U.)

1170

653

Vitamin D (I.U.)

95,0

53,0

Vitamin E (I.U.)

10,7

6,0

Vitamin K1 (mg)

18,0

10,0

Vitamin C (mg)

68,0

37,9

Vitamin B1 (mg)

0,72

0,40

Vitamin B2 (mg)

0,80

0,45

Vitamin B6 (mg)

1,0

0,56

Sinh t

Vitamin B12 (mg)

3,1

1,73

Niacinamid (mg)

10,0

5,58

Pantothenic Acid (mg)

5,0

2,79

Folic Acid (mg)

200

112

Biotin (mg)

150

83,7

Cholin (mg)

136

75,9

CH NH
Ensure - khi pha vi nc, cung cp dng cht y v cn bng c th cho n bng ng
thng hay dng ung nh ngun dinh dng b sung hng ngy. Khi dng Ensure theo ch
nh ca bc s hay chuyn gia dinh dng, nh theo ng ch dn.
Ensure c th dng b sung khu phn n khi cn tng s cung cp nng lng v dng
cht hoc duy tr tt tnh trng dinh dng. Ngoi ra, Ensure cn c th thay th hon ton hay
mt phn ba n kim st/ cn bng nng lng v dng cht dung np.
Ensure thch hp cho ngi ln v tr trn 4 tui, c bit cho bnh nhn cn hi phc nhanh
v nhng ngi n ung km.
LIU LNG v CCH DNG
Ensure khng cha gluten v ng lactose.
Khng dng qua ng tnh mch.
Khng dng cho ngi bnh galactosemia.
Hng dn s dng :
pha 250 ml : cho 210 ml nc chn ngui vo ly. Va t t cho vo ly 6 mung gt ngang
(mung c sn trong hp) hay 55,8 g bt Ensure, va khuy u cho tan ht. Khi pha ng theo
hng dn, 1 ml Ensure cung cp 1 kcal. Mt hp Ensure 400 g pha c khong 7 ly, mi ly
250 ml. C th thm vo s c la, tri cy, u phng... c hng v thm ngon theo { thch.
Ensure nui n qua ng thng :
Dng theo hng dn ca bc s / chuyn gia dinh dng. Khi bt u nui n qua ng thng, lu
lng, th tch v pha lng ty thuc vo tnh trng v s dung np ca ngi bnh. Phi
cn thn nhm trnh s nhim khun trong q trnh chun b v cho n.
BO QUN
Hp m phi c y v bo qun ni kh mt (nhng khng cho vo t lnh) v phi
c dng trong vng 3 tun. Ensure pha phi c dng ngay hay y kn, cho vo t lnh
v dng trong 24 gi.

EPIVIR
GLAXOWELLCOME
Vin nn 150 mg : hp 60 vin.
Dung dch ung 10 mg/ml : chai 240 ml.
THNH PHN
cho 1 vin
Lamivudine

150 mg

cho 1 ml
Lamivudine

10 mg

DC LC
Lamivudine l cht ng ng nucleoside. Lamivudine chuyn ha ni bo thnh lamivudine 5'triphosphate, phng thc tc dng ch yu l lm kt thc chui sao ch p ngc ca HIV.
Triphosphate c hot tnh c ch c chn lc qu trnh nhn ln ca HIV-1 v HIV-2 in vitro, n
cng c tc dng i vi nhng phn lp lm sng ca HIV khng zidovudine.
Mi quan h gia s nhy cm ca HIV i vi lamivudine in vitro v p ng lm sng i vi
iu tr vn ang c tip tc nghin cu. In vitro, nhng th nghim nhy cm cn cha
c chun ha v kt qu c th khc nhau ty theo phng php.
Tng c bo co v gim nhy cm in vitro ca HIV phn lp t nhng bnh nhn iu tr
bng Epivir.
Trong nui cy t bo, lamivudine cho thy tnh hip ng cao vi zidovudine, c ch s nhn
ln ca HIV.
Nhng nghin cu in vitro ch ra rng nhng phn lp virus khng zidovudine c th tr nn
nhy cm vi zidovudine khi chng ng thi khng vi lamivudine. Hn na, in vivo, c nhng
bng chng cho thy rng lamivudine + zidovudine lm chm s xut hin nhng phn lp
khng zidovudine nhng bnh nhn khng iu tr khng retrovirus trc .
In vitro, lamivudine biu l c tnh thp i vi bch cu lymph trong mu ngoi vi, i vi
nhng dng t bo bch cu lymph v bch cu n nhn-i thc bo trng thnh v
nhng t bo ty gc in vitro. V nh vy lamivudine c ch s iu tr cao, in vitro.
DC NG HC
Hp thu :
Lamivudine c hp thu tt t rut, v sinh kh dng ca lamivudine ng ung ngi ln
thng thng l t 80-85%. Sau khi ung, thi gian trung bnh (tmax) t nng ti a

(Cmax) trong huyt tng vo khong 1 gi. liu iu tr tc l 4 mg/kg/ngy (mi 12 gi), Cmax
nm trong khong t 1,5-1,9 mg/ml.
Ung lamivudine cng vi thc n lm chm tmax v gim Cmax (gim khong 47%). Tuy vy, sinh
kh dng ca lamivudine (da trn AUC) khng b nh hng.
Dng cng vi zidovudine lm tng 13% tc dng ca zidovudine v nng nh huyt tng
tng 28%. iu ny c xem nh khng c nh hng ng ch { i vi an ton s dng
thuc ca bnh nhn v v vy khng cn thit phi iu chnh liu.
Phn b :
Theo nhng nghin cu dng ng tim tnh mch, th tch phn b trung bnh l 1,3 l/kg.
Thi gian bn thi l t 5 n 7 gi. thanh thi trung bnh ton thn ca lamivudine xp x
0,32 l/gi/kg, thi qua thn l ch yu (> 70%) theo h thng vn chuyn cation hu c.
Lamivudine biu l dc ng hc dng ng thng khi dng trong khong liu iu tr v kt
hp hn ch vi albumin - protein huyt tng chnh (< 16-36% i vi albumin huyt thanh
trong nhng nghin cu in vitro).
Nhng s liu cn hn ch cho thy lamivudine thm nhp h thn kinh trung ng v vo
c ti dch no ty (CSF). 2- 4 gi sau khi ung, t l trung bnh nng lamivudine trong
CSF/huyt thanh xp x 0,12. Mc thm nhp thc s hoc s lin quan vi bt c hiu qu
lm sng no cn cha r.
Chuyn ha :
Lamivudine thi tr ch yu bng bi tit qua thn dng khng thay i. Kh nng tng tc
thuc ca lamivudine trong chuyn ha v thp v chuyn ha gan t (5-10%) v kt hp protein
huyt tng thp.
Thi tr :
Nhng nghin cu bnh nhn suy thn cho thy s thi tr lamivudine b nh hng bi ri
lon chc nng thn. Ch liu ngh cho nhng bnh nhn vi thanh thi creatinine <
50 ml/pht c trnh by phn liu dng.
CH NH
Epivir kt hp vi Retrovir c ch nh iu tr :
- Ngi ln nhim HIV vi suy gim min dch tin trin (s lng CD4 <= 500 t bo/mm3) m
cha c iu tr chng retrovirus trc .
- Ngi ln nhim HIV vi suy gim min dch tin trin m trc c iu tr bng
Retrovir.
- Tr em nhim HIV (>= 3 thng) vi suy gim min dch tin trin m trc cha c iu
tr hoac c iu tr bng Retrovir.
CHNG CH NH
Epivir chng ch nh nu bnh nhn b d ng vi lamivudine hay bt c thnh phn no c
trong ch phm.

CH PHNG
Khng khuyn co dng Epivir nh mt n tr liu.
Nhng ca vim ty him xy ra. Tuy nhin, vn cn cha r nhng ca l do thuc iu tr hay
chnh do cn bnh HIV gy ra. Vic iu tr bng Epivir cn ngng ngay nu c nhng du hiu
lm sng, triu chng hoc xt nghim bt thng gi cho thy vim ty c th xy ra. Khuyn
co khng nn dng Epivir trong 3 thng u ca thai kz.
Bnh nhn ang s dng Epivir hay bt c iu tr chng retrovirus no khc vn c th b
nhng nhim trng c hi v nhng bin chng khc ca nhim HIV, v v vy vn phi c
theo di cht ch v lm sng bi nhng thy thuc c kinh nghim trong iu tr bnh nhn b
bnh HIV km theo.
Bnh nhn phi c thng bo rng iu tr chng retrovirus hin thi, bao gm c Epivir,
cha c chng minh l c th ngn nga nguy c truyn HIV cho ngi khc qua ng tnh
dc hoc truyn mu. Mi bin php phng thch hp vn phi c tip tc duy tr.
THN TRNG LC DNG
i vi nhng bnh nhn suy thn va - nng, thi gian bn hy sau cng trong huyt tng
tng ln do gim thanh thi. Cn iu chnh liu dng. (Xem phn liu dng cho suy thn).
Nhng bnh nhn b bnh i tho ng cn c thng bo mi liu ca dung dch ung
(150 mg = 15 ml) cha 3 g ng.
Bnh nhn cn c thng bo trong dung dch ung c cha alcohol.
Li xe v s dng my mc :
Khng c nhng nghin cu v tc dng ca lamivudine n kh nng li xe hay vn hnh my.
Hn na, trn c s dc l ca thuc khng th d on l thuc tc dng c hi i vi
nhng hot ng ny. Tuy nhin, phi nh ti tnh trng lm sng ca bnh nhn v nhng tc
dng ph ca Epivir khi cn nhc xem bnh nhn c th li xe hoc vn hnh my c khng.
LC C THAI v LC NUI CON B
Lc c thai :
An ton s dng lamivudine trong thi kz thai nghn ngi cha c chng minh. Nhng
nghin cu v sinh sn ng vt khng cho thy bng chng v tnh gy qui thai, cng khng
thy tc dng i vi kh nng sinh sn c nhng con c v con ci. Lamivudine gy cht
phi sm khi s dng cho th ang c thai vi liu lng dng cho ngi. Lamivudine qua
c nhau thai ng vt nhng khng c thng tin no v vic thuc qua c nhau thai
ngi.
Mc d nhng nghin cu v sinh sn ng vt khng phi lun lun d on c p ng
ca ngi, khng khuyn co dng thuc ny trong 3 thng u ca thai kz.
Lc nui con b :
Nghin cu chut cng ang cho con b ch ra rng sau khi ung, lamivudine c tp trung
gp 4 ln v tit vo sa. Khng r lamivudine c tit vo sa ngi hay khng. Bi thuc c

th vo c sa, khuyn co nhng b m ang dng Epivir khng cho con b sa ca mnh.
Mt s chuyn gia y t khuyn nhng b m nhim HIV khng nn cho con b trong bt kz tnh
hung no trnh truyn nhim cho con.
TNG TC THUC
Kh nng tng tc chuyn ha thp do chuyn ha v kt hp protein huyt tng hn ch v
hu nh thanh thi hon ton qua thn. Ngi ta nhn xt thy Cmax ca zidovudine tng va
phi (28%) khi dng chung vi lamivudine. Tuy nhin, AUC - din tch vng di ng cong
thay i khng ng k. Zidovudine khng tc ng n dc ng hc ca lamivudine.
Cn cn nhc kh nng tng tc vi nhng thuc khc dng ng thi, c bit l khi ng
thanh thi chnh l bi tit ch ng qua thn bi h thng vn chuyn cation hu c, v d nh
trimethoprim. Nhng thuc khc (nh ranitidine, cimetidine) ch thi 1 phn theo c ch ny,
cho thy l khng tng tc vi lamivudine. Nhng cht ng ng nucleoside (nh didanosine
v zalcitabine) ging zidovudine, khng thanh thi theo c ch ny khng chc c tng tc vi
lamivudine.
Khi dng co-trimoxazole vi liu d phng, tc dng ca lamivudine tng 40%, do c thnh
phn trimethoprim ; thnh phn sulphamethoxazole khng nh hng. Tuy nhin, tr phi bnh
nhn suy thn, khng cn chnh liu lamivudine (xem phn Liu v cch s dng). Khi chc chn
l phi dng ng thi, cn theo di lm sng cho bnh nhn. Cn trnh s dng ng thi
Epivir v co-trimoxazole liu cao trong iu tr vim phi do Pneumocystis carinii (PCP) v bnh
do toxoplasmos. Lamivudine khng c tc dng i vi dc ng hc ca co-trimoxazole.
Chuyn ha lamivudine khng cn n CYP3A, nn khng c s tng tc vi nhng thuc
chuyn ha theo h thng ny (tc l c ch men protease).
Khng khuyn co dng ng thi Epivir vi ganciclovir hoc foscarnet tim tnh mch cho n
khi c nhng thng tin mi v vn ny.
TC DNG NGOI
Tc dng ph c bo co trong qu trnh iu tr HIV bng Epivir ring r v khi kt hp vi
zidovudine. Phn ln nhng tc dng ny cha r rng l do thuc hay l hu qu ca chnh
qu trnh tin trin bnh.
Nhng tc dng thng c bo co l au u, mt mi, kh chu, bun nn, a chy, nn,
au bng hoc co cng c, mt ng, st, ho, nhng triu chng v mi, ni ban v au c vn.
Nhng ca vim tu v bnh thn kinh ngoi bin (d cm) tng c ghi nhn, mc d khng
thy ghi nhn mi lin quan n liu Epivir.
Gim bch cu trung tnh v thiu mu (c hai loi u c nhng trng hp nng) tng xy ra
khi dng kt hp zidovudine. C bo co v gim tiu cu, tng thong qua men gan (AST, ALT)
v tng amylase huyt thanh.
LIU LNG v CCH DNG
Ngi ln v thanh nin :

Liu ngh l lamivudine 150 mg (15 ml) x hai ln/ngy kt hp vi zidovudine 600 mg/ngy
chia lm 2-3 ln.
Bnh nhn nhi :
Liu ngh l lamivudine 4 mg/kg x 2 ln/ngy cho ti ti a 300 mg (30 ml)/ngy kt hp vi
zidovudine 360 - 720 mg/m2 mi ngy chia lm vi ln.
(Liu ti a ca zidovudine khng vt qu 200 mg mi 6 gi).
Khng c kinh nghim tr di 3 thng.
i vi nhng bnh nhn dng vin nn khng thch hp c th dng Epivir dung dch ung. C
th ung Epivir vi thc n hoc khng.
Suy thn v gan :
Nng lamivudine huyt tng (AUC) tng ln nhng bnh nhn suy thn mc va nng do gim thanh thi. V vy cn phi iu chnh liu, s dng Epivir dung dch ung cho
nhng bnh nhn c thanh thi creatinine thp hn 30 ml/pht (xem bng)
Liu ngh - Ngi ln
Chc nng thn (Clcr, ml/pht)

Liu u tin

Liu duy tr

Clcr >= 50

150 mg (15 ml) 150 mg (15 ml) x 2 ln/ngy

50 > Clcr >= 30

150 mg (15 ml) 150 mg (15 ml) x 1 ln/ngy

30 > Clcr >= 15

150 mg (15 ml) 100 mg (10 ml) x 1 ln/ngy

15 > Clcr >= 5

150 mg (15 ml) 50 mg (5 ml) x 1 ln/ngy

5 > Clcr

50 mg (5 ml)

25 mg (2,5 ml) x 1 ln/ngy

i vi bnh nhn nhi suy thn liu cng gim theo cng mt phn trm nh trn.
Lamivudine thi tr hu nh hon ton bi chc nng thn v vy khng cn thit phi chnh
liu cho nhng bnh nhn suy gan.
QU LIU
Trong nhng nghin cu cp trn ng vt, dng lamivudine liu rt cao cng khng dn n
hu qu nhim c c quan. Nhng s liu v hu qu ca qu liu cp ngi cn hn ch.
T vong khng xy ra, cc bnh nhn u bnh phc. Khng thy c nhng du hiu v triu
chng c trng cho nhng ca qu liu ny.
Nu xy ra qu liu cn theo di bnh nhn, v p dng nhng bin php iu tr h tr thng
thng. V c th thm tch lamivudine, c th s dng lc mu lin tc iu tr qu liu,
mc d vic ny cha c nghin cu.
BO QUN

Vin nn : Bo qun di 30oC.

Dung dch : Bo qun di 25oC.

192.

EPREX

CILAG
c/o JANSSEN-CILAG
c/o MEGA PRODUCTS
Dung dch tim di da, tnh mch 1000 UI/0,5 ml: hp 6 bm tim cha sn thuc 0,5 ml Bng B.
Dung dch tim di da, tnh mch 2000 UI/0,5 ml: hp 6 bm tim cha sn thuc 0,5 ml Bng B.
Dung dch tim di da, tnh mch 3000 UI/0,3 ml: hp 6 bm tim cha sn thuc 0,3 ml Bng B.
Dung dch tim di da, tnh mch 4000 UI/0,4 ml: hp 6 bm tim cha sn thuc 0,4 ml Bng B.
Dung dch tim di da, tnh mch 10000 UI/ml: hp 6 bm tim cha sn thuc 1 ml - Bng
B.
THNH PHN
cho 1 bm tim 1000 UI/0,5 ml
Epoetine alfa

8,4 mg

cho 1 bm tim 2000 UI/0,5 ml

Epoetin alfa

16,8 mg

cho 1 bm tim 3000 UI/0,3 ml

Epoetin alfa

25,2 mg

cho 1 bm tim 4000 UI/0,4 ml

Epoetin alfa

33,6 mg

cho 1 bm tim 10000 UI/ml

Epoetin alfa

84,0 mg

M T
Epoetin alfa l mt ni tit t glycoprotein c tinh ch c tc dng kch thch sinh hng cu.
Epoetin alfa c sn xut t cc t bo ng vt hu nh c a vo m gen ca
erythropoietin ngi.
CH NH
- iu tr thiu mu do suy thn mn bnh nhn ngi ln thm phn mu, bnh nhn thm
phn phc mc, bnh nhn tin-thm phn v nhng bnh nhn nhi ang thm phn mu.
- iu tr thiu mu bnh nhn ung th khng phi dng ty bo (c hay khng c ho tr liu)
v ngn nga thiu mu cc bnh nhn ung th khng phi dng ty bo ang iu tr vi
mt tc nhn ha tr liu.
- iu tr thiu mu cc bnh nhn nhin HIV ang c iu tr bng zidovudine c mc
erythopoietin ni sinh <= 500 mU/ml.
- Lm nhanh vic ly mu t thn trong chng trnh gi mu trc v lm gim nguy c ca
vic truyn mu d thn nhng bnh nhn c Hct 33-39% m c ln chng trnh cho
mt cuc phu thut ln c chn lc v d kin cn nhiu mu hn lng mu m h c th c
c thng qua k thut ly mu t thn khng s dng Epoetin alfa.
CHNG CH NH
- Cao huyt p khng kim sot c.
- Qu mn cm vi bt c thnh phn no ca thuc.
THN TRNG LC DNG
Nguy c tng huyt p: gim n mc ti thiu nguy c tng huyt p, nn khng ch t l
tng hemoglobin mc khong 1 g/dl/thng v khng nn vt qu 2 g/dl/thng. Nn theo di
nng hemoglobin t nht mt ln mi tun cho n khi t ti mc n nh v sau theo
di nh kz. Nn kim sot huyt p mt cch y trc v trong iu tr Eprex, khng ch
huyt p khi cn thit. Tng cng iu tr cao huyt p khi c cc triu chng bo ng nh
pht sinh nhc u khng thng xuyn hoc nhc u gia tng. Nu khng kim sot c
huyt p, nn ngng s dng Eprex.
c c p ng ti u vi Eprex, cn m bo lng d tr st y trc khi bt u

tr liu. Nn nh gi li d tr st trong sut qu trnh iu tr v b sung thm. V d : st

nguyn t ung 200-300 mg/ngy (100-200 mg/ngy cho bnh nhn nhi) c khuyn co cho
tt c bnh nhn c nng ferritin huyt thanh di 100 mg/l.
Trn bnh nhn suy thn mn, vic iu tr thiu mu c th dn n thm n v lm tng
lng kali v protein n vo. Do c th phi ch nh thm phn chu kz duy tr urea,
creatinin v kali trong gii hn mong mun. Eprex khng lm tng t l tin trin ca suy thn.
Do tng th tch hng cu khi, bnh nhn iu tr Eprex thng cn tng liu heparin trong khi
thm phn.
TC DNG NGOI
- Hi chng "ging cm" : chng mt, ng g, st, nhc u, au c au khp v mi mt.
- Tng huyt p ph thuc vo liu dng hoc lm nng hn tnh trng cao huyt p hin c.
- Huyt khi cu ni trn nhng bnh nhn thm phn mu. Ni ban, chm, my ay, nga
v/hoc ph mch : phn ng da ti ni tim.
LIU LNG v CCH DNG
Liu lng :
Bnh nhn suy thn mn :
- Nng hemoglobin ch nn l 10-12 g/dl ngi ln v 9,5-11 g/dl tr em.
- C th dng Eprex bng ng tim tnh mch (TM) hoc tim di da (TDD). Khi thay i
ng dng thuc, lc u nn s dng liu nh trc ri sau iu chnh liu dng duy
tr nng hemoglobin ch. Trn cc nghin cu lm sng, liu tim di da thng thp hn
20-30% so vi liu tim tnh mch cn thit t cng hiu qu lm sng.
- Trong giai on cha tr, nn tng liu Eprex nu hemoglobin tng < 1 g/dl/thng. Thng
thng ghi nhn mc gia tng hemoglobin c { ngha lm sng sau 2 tun v c th n 6-10
tun mt vi bnh nhn. Mt khi t nng hemoglobin ch, nn gim liu 25 IU/kg/liu
trnh tnh trng hemoglobin vt qu tm ch. Nu nng hemoglobin vt qu 12 g/dl,
nn ngng dng Eprex. C th gim liu bng cch b i mt trong cc liu dng mi tun hoc
bng cch gim s lng thuc mi liu.
Ngi ln
thm phn
mu

Ngi ln tin
Ngi ln thm
(cha) thm phn
phn phc mc
mu

Tr em
thm phn
mu

50 IU/kg

50 IU/kg

50 IU/kg

50 IU/kg

3 ln/tun

2 ln/tun

3 ln/tun

3 ln/tun

Giai on cha tr:

Liu khi u

Tng liu mi 4
tun (IU/kg/liu)

25

Giai on duy tr:

30-100 IU/kg, 25-50 IU/kg,

25

25

25

17-33 IU/kg,

Xem *
di

Liu thng thng 3 ln/tun

2 ln/tun

3 ln/tun

(*)

ng tim

TDD

TM, TDD

TM

TM, TDD

* Giai on duy tr: tr

em thm phn mu:
Liu

(IU/kg, 3 ln/tun)

Trng lng (kg)

Trung bnh

Liu duy tr thng dng

< 10

100

75-150

10-30

75

60-150

> 30

33

30-100

Bnh nhn ung th :

Nng hemoglobin ch nn vo khong 12 g/dl. Eprex c th c dng cho iu tr cc
bnh nhn thiu mu triu chng. Eprex c th cng c s dng nga thiu mu nhng
bnh nhn bt u ha tr liu, c nng hemoglobin trc iu tr thp (< 11 g/dl) v
nhng bnh nhn c s gim r rng hemoglobin trong sut chu kz u tin ca ho tr liu. (V
d : 1-2 g/dl nu mc hemoglobin ban u l 11-13 g/dl hoc gim >= 2 g/dl nu mc
hemoglobin ban u >= 13 g/dl). Liu khi u ca phng nga hoc iu tr thiu mu nn l
150 IU/kg, 3 ln mi tun, tim di da. Nu sau 4 tun iu tr, hemoglobin tng < 1 g/dl, liu
iu tr nn c tng ln n 300 IU/kg trong 4 tun. Nu sau 4 tun iu tr vi liu 300
IU/kg, hemoglobin tng < 1 g/dl, th c kh nng bnh nhn khng p ng v khng nn tip
tc iu tr. Nu hemoglobin tng > 2 g/dl mi thng, hy gim liu Eprex khong 25%. Nu
hemoglobin vt qu 14 g/dl, hy tm ngng iu tr cho n khi hemoglobin gim xung 12
g/dl v ri lp li iu tr Eprex vi liu thp hn 25% so vi liu trc . Nhu cu tip tc liu
php Eprex nn c nh gi li mt cch nh kz, v d nh sau khi hon thnh liu php.
Tnh trng st nn c nh gi trn tt c bnh nhn trc v trong iu tr. Vic b sung st

nn c thc hin khi cn thit. Cc nguyn nhn khc ca thiu mu nn c loi tr trc
khi tin hnh iu tr bng Eprex (xem Thn trng lc dng).
Bnh nhn nhim HIV, c iu tr Zidovudine :
Ngi ta khuyn co nng erythropoietin huyt thanh ni sinh nn c xc nh trc khi
bt u iu tr bng Eprex. D liu sn c cho thy nhng bnh nhn c nng
erythropoietin huyt thanh ni sinh > 500 mU/ml th thng khng p ng vi liu php
Eprex.
- Giai on cha tr: 100 UI/kg, 3 ln mi tun tim di da hoc tim tnh mch trong thi gian
8 tun. Nu s p ng khng c nh { (nhu cu truyn mu gim do hemoglobin tng) sau
8 tun iu tr, liu Eprex c th c tng ln. Vic tng liu nn c thc hin theo tng
mc tng 50-100 IU/kg, tim 3 ln mi tun cc khong thi gian t nht 4 tun. Nu bnh
nhn khng c c s p ng y vi Eprex liu 300 IU/kg, 3 tun mi ln, th
thng h cng khng c c s p ng liu cao hn.
Giai on duy tr : Sau khi t c s p ng nh mong mun, liu dng nn c iu
chnh duy tr hematocrit gia 30-35%, da trn cc yu t nh cc liu zidovudine khc
nhau, s hin din ca nhim trng gian pht hoc cc giai on vim. Nu hematocrit vt
qu 40%, nn tm ngng iu tr cho ti khi hematocrit gim n 36%. Khi vic iu tr c th
bt u li, liu dng nn c gim khong 25% v ri iu chnh li liu duy tr mc
hematocrit mong mun. Tnh trng st nn c nh gi cho tt c bnh nhn trc v trong
khi iu tr v vic b sung st nn c thc hin khi cn thit. Cc nguyn khc gy thiu mu
nn c loi tr trc khi bt u liu php Eprex (xem phn Thn trng lc dng).
Bnh nhn phu thut ngi ln trong chng trnh tin hin mu t thn :
Tt c nhng chng ch nh trong chng trnh hin mu t thn nn c tun th nhng
bnh nhn ang c iu tr b sung Eprex. Eprex nn c tim 2 ln mi tun trong 3 tun
trc khi phu thut nu khong thi gian tin hin mu tin phu thut cho php. mi ln
bnh nhn hin mu, 1 n v mu c ly ra v d tr cho vic truyn mu t thn nu bnh
nhn c hematocrit >= 33% v/hoc hemoglobin >= 11g/dl. Liu iu tr c khuyn co l
600 IU/kg, tim tnh mch 2 ln mi tun. i vi nhng bnh nhn c nhu cu kch thch to
mu mc t hn, liu iu tr 150-300 IU/kg, tim tnh mch 2 ln mi tun cho thy
lm tng hiu qu tin hin mu t thn v lm gim s st gim hematocrit sau ly mu. Tnh
trng st nn c nh gi trn tt c bnh nhn trc khi iu tr bng Eprex. Nu c tnh
trng thiu st xy ra, bnh nhn nn c iu tr b sung st trc khi c cho php tham
gia chng trnh hin mu t thn. nhng bnh nhn thiu mu, nguyn nhn gy ra thiu
mu nn c tm ra trc khi bt u liu php Eprex. Vic b sung st y (v d : t nht
200 mg st nguyn t ung mi ngy) c i hi bt u ngay khi c th v nn tip tc
trong sut qu trnh iu tr.
Hng dn s dng :

Tim di da : Th tch thuc ln nht cho mi v tr tim nn l 1 ml. Nu th tch thuc ln

hn, nn dng nhiu v tr tim. Nn tim cc chi hay thnh bng trc.
Tim tnh mch : nn tim Eprex chm t nht t 1-5 pht, c bit cho nhng bnh nhn c cc
triu chng ging cm. cc bnh nhn thm phn mu, nn tim thuc vo kim fistula lc
hon thnh lt thm phn. trng ra ng ng v bo m vic tim thuc vo h tun
hon c hon ho, sau khi tim Eprex, nn tim thm 10 ml dung dch mui ng trng.
Khng nn dng Eprex truyn tnh mch hoc trn ln vi cc thuc khc.
Tnh tng k :
Khng c ha tan hoc chuyn sang bt c vt cha no khc. Khng c dng kt hp vi
dung dch thuc khc.
BO QUN
Bo qun 2-8oC. Khng ng lnh hoc lc mnh v phi bo v trnh nh sng mt tri. V
Eprex khng c cht bo qun nn ng tim c sn thuc ch nn s dng 1 ln.

193.

EQUAL

MERISANT
Vin nn 19 mg : hp 100 vin, 200 vin.
Cm ung 38 mg : hp 10 gi, 25 gi, 50 gi.
Bt ung 40 mg : hp 1 l.
THNH PHN
cho 1 vin
Aspartam

19 mg

cho 1 gi
Aspartam

38 mg

cho 1 l
Aspartam

40 mg

DC LC
Aspartam l a-L,-aspartyl-L-3-phenylalanine methyl ester. y l mt dipeptid cu to t 2 acid
amin thin nhin : L-aspartic acid v L-phenylalanine (di dng methyl ester).
Tc ng ca Equal ch c bit l cung cp v ngt tng t nh ca ng sucrose nhng
mnh hn gp 200 ln.
Nng lng

S mung c ph ng tng ng

1 vin Equal

< 1/2

1 gi Equal

CH NH
Cht ngt dnh cho ngi tiu ng.
CHNG CH NH
Phenylketonuria.
LIU LNG v CCH DNG
1 vin thay th 1 mung c ph ng. 1 gi thay th 2 mung c ph ng.
QU LIU
Cc th nghim trn ngi cho thy khng tn ti nguy him tim tng no ngay c khi dng
aspartam vi lng ln.

194.

ERCFURYL

SANOFI SYNTHELABO VIETNAM

vin nang 200 mg : hp 28 vin.
hn dch ung 4 % : l 90 ml (18 mung lng 5 ml).
THNH PHN
cho 1 vin
Nifuroxazide

200 mg

(Saccharose)

(72 mg)

cho 1 mung lng 5 ml

Nifuroxazide

220 mg

(Saccharose)

(1 g)

(Ethanol 95deg)
DC LC
Khng khun ng rut.
DC NG HC
Thuc hp thu rt k m qua ng tiu ha nu nim mc rut khng b tn thng.
CH NH
Tiu chy cp tnh do nhim khun, khng c du hiu xm ln (suy gim tng trng, st cao,
du hiu nhim trng - nhim c...).
Trong iu tr tiu chy, vic b nc lun cn thit.
Mc b nc v ng a nc vo c th (ung hoc tim truyn) ty thuc vo mc
tiu chy v c a ca bnh nhn.
CHNG CH NH
C tin s d ng vi dn xut ca nitrofurane.
Tr sinh thiu thng v s sinh (0 n 1 thng tui).
THN TRNG LC DNG
Trng hp tiu chy nhim trng c biu hin lm sng ca hin tng xm ln phi dng
khng sinh khuch tn tt.
Khng iu tr ko di.
TC DNG NGOI
C th gy d ng.
LIU LNG v CCH DNG
iu tr ti a trong 7 ngy.
Ngi ln : 4 vin/ngy, chia lm 4 ln.
Tr em : 3 mung lng/ngy, chia lm 3 ln.
Tr nh nhi t 1 n 30 thng tui : 1 n 3 mung lng/ngy ty theo tui, chia lm 2 n 3
ln.

195.

ERY sachet 125 mg - 250 mg

BOUCHARA
c/o TEDIS
Cm pha hn dch ung dng cho nh nhi 125 mg : hp 24 gi.
Cm pha hn dch ung dng cho tr em 250 mg : hp 24 gi.
THNH PHN
cho 1 gi
Erythromycine thylsuccinate, tnh theo dng base

125 mg

cho 1 gi
Erythromycine thylsuccinate, tnh theo dng base

250 mg

PH KHNG KHUN
Erythromycine l khng sinh thuc h macrolide.
- Cc loi thng nhy cm : Streptocoque, Staphylocoque nhy vi methicilline, Rhodococcus
equi, Branhamella catarhalis, Bordetella pertussis, Helicobacter pylori, Campylobacter jejuni,
Corynebacterium diphteriae, Moraxella, Mycoplasma pneumoniae, Coxiella, Chlamydiae,
Legionella, Treponema pallidum, Borrelia burgdorferi, Leptospira, Propionibacterium acnes,
Actinomyces, Eubacterium, Porphyromonas, Mobiluncus.
- Cc loi nhy cm trung bnh : Haemophilus influenzae v para-influenzae, Neisseria
gonorrhoeae, Vibrio, Ureaplasma urealyticum.
- Cc loi khng : Staphylocoque khng methicilline, Enterobacteriae, Pseudomonas,
Acinetobacter, Mycoplasma hominis, Nocardia, Fusobacterium, Bacteroides fragilis.
- Cc loi nhy cm khng n nh : Streptococcus pneumoniae, Enterococcus, Campylobacter
coli, Peptostreptococcus, Clostridium perfringens.
Erythromycine c hot tnh in vitro v in vivo i vi Toxoplasma gondii.
DC NG HC
Dng cm pha hn dch ung :
Hp thu :
- t l sinh kh dng ca thuc : 60-80% ;
- nh hp thu ti a trong huyt tng : 1-2,5 mg/ml sau khi ung liu 0,5 g, t c sau 1

gi ;
- thi gian bn hy trong huyt tng : khong 2 gi ;
- gn vi proteine huyt tng : 65% ;
- khuch tn n th dch v n m tt : tuyn nc bt, thn, tuyn tin lit, c bit khuch
tn rt tt n m phi, nim mc ph qun, trong amygdale.
- i vo v tp trung vi nng cao trong t bo thc bo (bch cu a nhn trung tnh, bch
cu n nhn, i thc bo ph nang). Do , erythromycine tc ng hu hiu trn vi khun
ni bo.
- erythromycine qua c hng ro nhau thai nhng khng qua c hng ro mu no.
Bin i sinh hc : erythromycine c chuyn ha mt phn gan.
Bi tit :
- bi tit qua mt : 30% liu dng ;
- qua thn : 5% c o thi theo nc tiu trong 24 gi ; nng trung bnh trong nc tiu
t 10 n 30 mg/ml.
Erythromycine c o thi ti a khi nc tiu c pH kim.
CH NH
Nhim trng do chng c xc nh l nhy cm vi khng sinh, ch yu trong :
- nhim trng tai mi hng, ph qun-phi, da.
- nhim trng rng ming v tit niu sinh dc.
Ha d phng cc t ti pht ca thp khp cp.
CHNG CH NH
- D ng vi erythromycine.
- Phi hp vi cc alkaloid gy co mch dn xut ca nm ca g (ergotamine,
dihydroergotamine).
- Phi hp vi terfenadine.
- Phi hp vi astemizole.
CH PHNG v THN TRNG LC DNG
- Thn trng trong trng hp suy gan, nu c th nn kim tra u n chc nng gan v gim
liu.
- Thuc c o thi yu qua thn, do khng cn thit phi gim liu trng hp bnh
nhn b suy thn.
- Phi hp vi ciclosporine : nu c phi hp, gim liu ciclosporine v kim tra chc nng thn
(creatinine huyt). Mc khc, kim tra nng ciclosporine trong mu v iu chnh liu trong thi
gian phi hp v sau khi ngng phi hp.
LC C THAI
Trn lm sng, kt qu nghin cu trn mt s lng ln ph n mang thai cho thy
erythromycine khng c tc dng gy d dng hoc c tnh trn phi (ngoi tr dng estolate).

Do , c th k toa erythromycine cho ph n mang thai nu cn.

LC NUI CON B
Erythromycine c bi tit yu qua sa m.
TNG TC THUC
+ Cc thuc gy co mch dn xut ca nm ca g (dihydroergotamine, ergotamine) : Chng ch
nh (Ng c ergotine vi kh nng gy hoi t u chi)
+ Astmizole, terfnadine : Chng ch nh (Nguy c gy xon nh)
+ Cisapride : Erythromycine gy gim chuyn ha cisapride gan.
+ Bromocriptine : Cn lu { khi phi hp (Tng nng bromocriptine trong huyt tng km
theo cc du hiu qu liu dopamine)
+ Carbamazepine : Khng nn phi hp (Tng nng carbamazepine trong huyt tng km
theo cc du hiu qu liu). Tuy nhin, trong bnh nhim vi khun Legionella, erythromycine
vn l thuc c ch nh u tay : trng hp s dng khng sinh ny, nn theo di lm sng
trong bnh vin chuyn khoa, v nu c th, nn kim tra nng carbamazepine trong huyt
tng.
+ Ciclosporine : Tng nng ciclosporine trong mu v creatinine huyt do c ch chuyn ha
ciclosporine gan.
+ Theophylline (dng base v mui) v aminophylline : Qu liu theophylline (gim o thi
gan) c th gy nguy him c bit l tr em nn khuyn khng nn phi hp. Tuy nhin,
trong bnh nhim vi khun Legionella, erythromycine vn l thuc c ch nh u tay :
trng hp s dng khng sinh ny, nn tng cng theo di lm sng vi kim tra nng
theophylline trong huyt tng.
+ Triazolam : Mt vi trng hp lm tng tc dng ngoi ca triazolam (ri lon tnh kh)
c ghi nhn.
+ Alfentanil : Gim thanh thi alfentanil vi nguy c gy c ch h hp k o di. iu chnh liu
alfentanil.
+ Digoxine : Thn trng lc dng : theo di lm sng v nu c th, kim tra digoxine huyt
(Tng digoxine huyt do tng hp thu)
+ Lisuride : Thn trng lc dng (Nguy c gy qu liu lisuride) vi du hiu qu liu dopamine.
+ Midazolam : Tng nng midazolam trong huyt tng do gim chuyn ha gan, vi tng
cc du hiu an thn, ch yu tr em. Theo di lm sng v gim liu trong thi gian iu tr
vi erythromycine.
+ Warfarine : Nguy c xut huyt. Tng tc dng chng ng ca warfarine do c ch chuyn
ha gan. Kim tra thng hn nng prothrombine v theo di ch s INR. iu chnh liu
thuc ung chng ng mu trong thi gian iu tr vi nhm macrolide v 8 ngy sau khi
ngng thuc.
TC DNG NGOI

Biu hin tiu ha : bun nn, i ma, au d dy, tiu chy.

D ng ngoi da.
Khi dng liu cao, tng tm thi transaminase, him gp trng hp gy vim gan mt.
LIU LNG v CCH DNG
a s cc ch nh cn phi c iu tr t 5 n 10 ngy.
Dng thuc ngay trc ba n, c th ha tan trong sa hoc cc thc n lng.
-Ery 125 mg dnh cho nh nhi : 30-50 mg/kg/ngy.
-Ery 250 mg dnh cho tr em : 30-50 mg/kg/ngy.

196.

ERYLIK

BIORGA
c/o TEDIS
Gel bi ngoi da : tup 30 g.
THNH PHN
cho 100 g
Erythromycin

4g

Tretinoin

25 mg

DC LC
Thuc tr mn trng c tc ng ti ch, phi hp tretinoin v erythromycin :
Tretinoin :
Hot tnh ca tretinoin da trn mt c ch tc ng tng ng vi c ch sinh bnh ca mn
trng c :
- Tretinoin i khng v ngn nga s hnh thnh cc thnh phn ca mn trng c : do kch
thch cc biu m nang, s gia tng cc t bo sng khng lin kt c tng cng. Cc t bo
sng t do c thi ra cng vi b nhn v pha b mt da. Cc nt sng khng th hnh
thnh c v do ngn khng cho hnh thnh cc mn mi.
- Tretinoin lm cho cc thnh phn b ng c tng ra (nhn trng c, nang mn). Ngoi
vic lm bong lp ngoi ca biu m, tretinoin cn tc ng su vo cc biu m nang : n kch
thch s gia tng cc t bo sng t do, ng thi vi vic gim lin kt vo cc nt sng, dn
n vic tng cc nang mn hay nhn trng c.

- Tretinoin rt ngn s tin trin ca cc thnh phn vim (sn, mn m). c thoa vo u
giai on vim, tretinoin lm tng tnh thm ca thnh nang mn vi cc tc nhn gy kch ng
l nguyn nhn gy hin tng vim (cht sng, cc acid bo t do...) v lm rt ngn s tin
trin ca cc nt sn v mn m, cng nh s o thi ca chng. N cng lm trnh chuyn
cc sang thng ny thnh ra cc nang sn.
Erythromycin :
L khng sinh thuc h macrolides, c s dng ti ch trong mn trng c nhm cho tc
ng :
- Khng vim bng cch lm gim, tng ng vi vic gim s lng vi khun, s lng
protease v acid bo t do gy kch ng khi u ca vim.
- Khng khun do tc ng trc tip ln Propionibacterium acnes, do lm gim s lng vi
khun trong nang mn.
CH NH
Mn trng c mc trung bnh.
CHNG CH NH
Qu mn vi mt trong cc thnh phn ca thuc.
CH PHNG v THN TRNG LC DNG
- Do c th xy ra hin tng khng dung np kiu gy ph n v chm, nn thm d kh nng
dung np thuc bng cch bi th ln mt vng da nh khi mi bt u dng thuc.
- Nu xy ra phn ng qu mn hay gy kch ng nng, phi tm thi ngng bi thuc, thm ch
c th ngng hn.
- Nu l bi thuc ln nim mc, mt, ming, trong mi hay trn vt thng h, cn ra ngay
bng nc m.
- Do c th b kch ng khi bi thuc, trnh dng ng thi vi cc loi m phm lm se da, lm
kh da hay c th gy kch ng (nh du thm hay cc loi nc ra c cn).
- Trnh phi nng hay chiu n UV do c th gy kch ng. Tuy nhin vn c th bi thuc nu
vic phi ngi ra nng c gim ti a (i nn, dng kem chng nng) v bi thuc gim li.
Nu bt c d phi phi nng (chng hn nh i bin mt ngy), khng c bi thuc trc
mt ngy, ngy hm v sau mt ngy.
Nu b phng nng, cn i cho da tr li n nh mi tip tc bi thuc.
LC C THAI v LC NUI CON B
Lc c thai :
ng vt : tretinoin c th gy qui thai khi dng ng ung ; dng ng ti ch liu cao
c th gy d tt nh xng sn.
ngi : do thuc c th vo mu (d vi lng rt nh) v do cn thiu nhng s liu dch t
hc cng nh kinh nghim s dng trn lm sng, khng nn dng retinoid ng ti ch cho
ph n c thai. Tuy nhin, theo nhng d liu lm sng cha c y , dng nh retinoid

dng ti ch khng c tc ng gy d tt.

TNG TC THUC
Do c tnh c th gy kch ng ca dng bo ch ny, nn trnh dng chung vi tt c cc
thuc c th gy kch ng ti ch (nht l cc dng lotion c cha cn).
TC DNG NGOI
C th b kch ng, s t khi khi ngng thuc hay thi gian bi thuc gin ra. Sau khi bi thuc
c th c gim gic nng hay cm gic kim chm nh.
LIU LNG v CCH DNG
Liu lng :
Liu khi u l bi 1 ln vo bui ti, sau iu chnh s ln bi thuc ty thuc vo mc
dung np.
Nu b rt nhiu th nn bi thuc cch ngy.
Nu khng xy ra phn ng ti ch th c th tng ln 2 ln/ngy.
Vo cui ca tun th hai cho n cui t iu tr tn cng (tun th 12 n tun th 14),
trung bnh bi thuc mi ngy 1 ln, hay tha hn nu vn b kch ng.
Cn ch nh khong cch gia cc ln bi thuc sao cho trnh xy ra kch ng kh chu ; nu b
ban nh hay hi b trc da, hay cm gic nng rt th vn chp nhn c. Cn d kin cc
phn ng nng hn c th xy ra nhng ngi c da mng, tc hoe hay , v chn cc liu
thch hp hn.
t c kt qu tt nht, bnh nhn phi c thng bo v cc phn ng thng thng
hay xy ra lc bt u iu tr : cm gic rt lc u v ngoi ban thong qua ; cn thng
xuyn xem xt li vic iu tr iu chnh liu cho thch hp v gim ti thiu s kch ng.
Cng cn cho bnh nhn bit rng mn trng c c th s chm ci thin v cn phi duy tr
vic iu tr cho n thng th ba t c kt qu iu tr ti u v sau cn tip tc
iu tr duy tr trnh ti pht.
S ci thin c thy r vo khong tun th 6 v cn tip tc duy tr vic iu tr t c
kt qu iu tr ti a vo khong tun th 12 hay 14.
Vo thi im , hay sm hn, nu tt c cc thnh phn ca mn bin mt, c th chuyn
sang iu tr duy tr bng cch bi thuc 2 hay 3 ln mi tun.
Cch s dng :
Sau khi da c ra sch hay bi kh, bi thuc v thoa nh ln sang thng, trnh bi ln
mt, m mt, mi, trong mi.
Ra sch tay sau khi bi thuc.
Trng hp iu tr bng nhiu loi thuc, cch thc s dng i vi tng loi thuc nn c
cn nhc v iu chnh trnh xy ra tng tc.

197.

ERYTHROGEL 4% (ERYACNE 4% Gel)

GALDERMA
gel bi ngoi da : 30 g.
THNH PHN
cho 100 g gel
Erythromycin base

4g

T dc : butylhydroxytoluen,
hydroxypropyl- cellulose v ethyl alcohol
95%.
DC L LM SNG
Erythromycin l mt khng sinh thuc nhm macrolide c tc dng in vitro v in vivo trn hu
ht cc vi khun hiu kh v k kh gram dng cng nh trn mt vi trc khun gram m.
Erythromycin thng c tnh km khun nhng cng c th c tnh dit khun nng cao
hay trn nhng vi khun nhy cm cao. Erythromycin c ch s tng hp protein ca cc vi
khun nhy cm bng cch gn kt c hi phc vo tiu n v ribosom 50S. Khi bi ln da,
thuc c ch s pht trin ca cc vi khun nhy cm (ch yu l Propionibacterium acnes) trn
da v lm gim nng acid bo t do trong b nhn. Vic gim thnh phn acid bo t do
trong b nhn c th l mt h qu gin tip ca tc ng c ch cc vi khun tit lipase
chuyn triglyceride thnh cc acid bo t do hay c th l mt kt qu trc tip ca tc ng
can thip vo s tit lipase nhng vi khun ny. Cc acid bo t do l nhng cht gy nhn
trng c v c xem l nguyn nhn gy ra nhng sang thng vim (nh sn, mn m, mn
nt, mn bc) ca mn trng c. Tuy nhin, cc c ch hot ng khc nh tc ng chng
vim trc tip ca erythromycin c th tham gia vo s ci thin lm sng ca mn trng c
c quan st khi tr liu ti ch bng erythromycin. Thuc ny khng cho thy c hp thu ton
thn khi bi trn da nguyn vn v khng bit c l erythromycin c c hp thu qua da b
try st, vt thng hay qua nim mc hay khng.
CH NH
iu tr mn trng c.

CHNG CH NH
Qu mn cm vi bt c thnh phn no ca thuc.
THN TRNG LC DNG
Tng qut : Vic s dng cc thuc khng sinh c th i km vi s tng sinh vi khun khng.
Nu xut hin tc dng ny, nn ngng thuc v p dng nhng bin php thch hp.
Erythrogel 4% (Eryacne 4%) ch dng ngoi da v nn trnh tip xc vi mt, mi, ming, vt
thng h v nim mc. Nu v b tip xc, ra k bng nc. Nu xut hin phn ng nhy
cm hay kch ng trm trng, nn ngng thuc.
Nu mc kch ng ti ch tr nn ng k, nn hng dn bnh nhn ko di khong cch
dng thuc, tm thi ngng thuc hay chm dt dng thuc. Nn thn trng khi s dng ng
thi vi cc thuc iu tr mn trng c ti ch khc do c th c tc ng kch ng gp, c
bit vi cc thuc c tc dng bong da, trc vy da hay lm mn da.
LC C THAI v LC NUI CON B
Tnh an ton ca Erythrogel 4% (Eryacne 4%) lc c thai hay ang cho con b cha c xc
nh. Khng bit c rng erythromycin khi dng cho ngi ph n c thai c th gy nguy
hi n thai nhi hoc nh hng n kh nng sinh hay khng. Ch nn dng thuc ny lc
c thai nu tht s cn thit.
Khng bit c erythromycin c tit qua sa m khi dng ti ch hay khng. Tuy nhin, tc
dng ny c quan st khi dng theo ng ung v ng tim. Do , nn cn thn khi
dng Erythrogel 4% (Eryacne 4%) cho b m ang cho con b.
TNG TC THUC
Nn cn thn khi dng cc ch phm iu tr ti ch mn trng c c cha cht c tc dng
bong da, lm trc vy hay lm mn da ng thi vi Erythrogel 4% (Eryacne 4%) do c th xy
ra kch ng gp. S s dng ng thi vi x phng c tnh lm mn da hay c cha dc cht
hoc m phm cha alcohol cng c th gy kch ng hay kh da cho bnh nhn ang iu tr
vi Erythrogel 4% (Eryacne 4%). Do c th xy ra s gn kt tng tranh trn tiu n v
ribosom 50S, khng nn dng ng thi cc ch phm bi da c cha erythromycin v
clindamycin.
TC DNG NGOI
Tc dng ngoi { c bo co xy ra trong iu tr ti ch erythromycin bao gm kh da, nhy
cm, nga ngy, da trc vy, ni ban, da nhn v cm gic rt bng. Kch ng mt cng c
bo co. Mt trng hp phn ng ni my ay lan ta, c th c lin quan n thuc, cn
phi iu tr bng steroid ton thn c bo co. Hu ht cc phn ng ny c l l do
thnh phn ru hay cc t dc khc hn l erythromycin v hi phc khi ngng hay k o
di khong cch dng thuc.
LIU LNG v CCH DNG
Bi mt lp mng Erythrogel 4% (Eryacne 4%) ln vng da b mn c ra sch, hai ln mi

ngy. Thng thng, cn iu tr trong 8 tun nhng nu ti pht, t iu tr c th ko di

lu hn.
QU LIU
Erythrogel 4% (Eryacne 4%) c dng bi ngoi da. Nu dng qu nhiu thuc s khng
thu c kt qu nhanh hay tt hn m c th b da, bong da hay kh chu. c tnh cp
theo ng ung trn chut nht cao hn 10 ml/kg. Khi nut nhm, tr khi ch nut mt lng
nh, nn xem x t n phng php ra d dy thch hp.
BO QUN
Nn bo qun thuc nhit phng (15-30oC), trnh tm tay ca tr em.

198.

ESORID

SUN PHARMA
Vin nn 10 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Cisapride

10 mg

DC LC
Esorid (Cisapride) l mt piperidinyl benzamide bin i c cu trc ha hc lin quan vi
metoclopramide. N l thuc tng cng nng lc vn ng dng ng ung, c tc dng lm
d dng v phc hi s vn ng ca ng tiu ha.
Dc l lm sng :
Cisapride tng cng nhu ng ng tiu ha.
Cisapride c tc ng nh gia tng phng thch mt cch sinh l acetylcholine t tn cng thn
kinh hu hch ca m ri Auerbach's trong c trn ng tiu ha. Cisapride khng c hot
tnh khng dopamin, khng kch thch th th cholin v khng lm thay i ng k nng
prolactin huyt tng. bnh nhn b tro ngc d dy - thc qun, Cisapride lm tng
trng lc c tht thc qun di v nhu ng thc qun ln khong 20 n 50%. Cisapride ci
thin vic lm trng d dy v lm ngn thi gian thc n di chuyn t ming n manh trng.
Cisapride cng kch thch nhu ng y ti ca kt trng v lm tng thi gian thc n di

chuyn kt trng.
DC NG HC
Cisapride c hp thu nhanh chng sau khi ung v t nng nh trong huyt tng t
c trong vng 1 n 2 gi. S hp thu ca Cisapride tng khi c dng chung vi thc n,
do nn ung thuc trc ba n 15 pht. Cisapride c thi gian bn thi l 7 - 10 gi.
Cisapride c chuyn ha mnh qua 2 ng chnh l kh N-alkyl cho nor cisapride v
hydroxyl ha nhn thm cho 3-fluro-4-hydroxy cisapride v 4-fluro-2-hydroxy cisapride. S
bi tit Cisapride v cc cht chuyn ha xy ra bng nhau nc tiu v phn.
CH NH
Suy gim kh nng lm trng d dy, vim thc qun tro ngc, ri lon tiu ha.
CHNG CH NH
Xut huyt tiu ha, tc nghn c hc hay thng rut.
Ph n c thai.
THN TRNG LC DNG
Bnh nhn suy gan hay suy thn : khi u nn dng na liu khuyn co thng thng.
Thn trng khi s dng cho tr em di 12 tui.
LC C THAI v LC NUI CON B
S an ton ca Cisapride cha c chng minh trong thi kz mang thai, do nh nhng
thuc mi khc, khng dng thuc khi mang thai. Mc d Cisapride bi tit ti thiu qua sa
m, khng nn cho con b khi ang dng thuc.
TNG TC THUC
Do lm tng thi gian lm trng d dy, Cisapride c th nh hng n tc hp thu v do
nh hng n sinh kh dng ca cc thuc khc. S hp thu c th b gim d dy, nhng
c th tng rut non. Dng cng lc cisapride vi digoxin c th lm gim nh nng ti a
ca digoxin trong huyt tng v din tch di ng cong. Tuy nhin s gim ny khng c
ngha v mt lm sng v thng k.
Cisapride khng lm thay i s gn kt ca nhng thuc nh propranolol, tolbutamide,
imipramine, warfarin v diphenylhydantoin vi protein huyt tng. Mc d khng c bng
chng trc tip l Cisapride nh hng n nng ca thuc chng ng kinh, vn nn kim
tra nng trong huyt tng ca nhng thuc ny khi dng cng lc vi Cisapride. Cisapride
lm tng hp thu diazepam v ethanol vi s suy gim km theo th nghim tm thn vn
ng. Cisapride n c khng gy bun ng v khng lm ri lon tm thn vn ng. Dng
cng lc vi thuc i khng th th H2 lm tng sinh kh dng ca Cisapride.
TC DNG NGOI
Thuc c dung np tt, tc dng ph rt t, thng gp nht l co tht bng, tiu chy. t gp
hn l au u, chng mt hay mt mi.
LIU LNG v CCH DNG

ng ung.
Liu thng thng cho ngi ln v tr em trn 12 tui l 10 mg, 3-4 ln mi ngy, 15 n 30
pht trc ba n. C th tng liu n 20 mg, 2 n 4 ln mi ngy trong trng hp bnh
nng. Thng iu tr trong 4 tun bnh nhn ri lon tiu ha, nhng bnh nhn ri lon
nng lc vn ng nn iu tr trong t nht 6 tun, thi gian iu tr thng thng cho bnh
tro ngc d dy - thc qun l 12 tun.
bnh nhn thiu nng gan hay thn, nn bt u vi na liu thng thng, sau iu
chnh liu ty theo p ng lm sng.
BO QUN
Bo qun ni mt, trnh nh sng.

199.

ETOMIDATE-LIPURO

B. BRAUN
Nh dch tim tnh mch : ng 10 ml, hp 10 ng - Bng A.
THNH PHN
cho 10 ml nh dch
Etomidate

20 mg

T dc : du u tng, triglycerid c
mch carbon c va, glycerol, lecithin
trng, natri oleat, nc ct pha tim.

DC LC
Thuc nhm thuc ng.
CH NH
Dn m v gy m ngn hn.
Ch :
Trong gy m thi gian ngn, Etomidate-Lipuro phi c phi hp vi mt thuc gim au.
CHNG CH NH
Khng c ch nh Etomidate-Lipuro cho nhng bnh nhn bit l b mn cm vi
etomidate hoc nh dch du.

Trn sc vt th nghim, Etomidate-Lipuro c chng minh l c tim nng to porphyrin.

Do khng c dng cho nhng bnh nhn b ri lon chc nng sinh tng hp nhn Hem
v mt di truyn, tr phi ch nh dng etomidate c xc nh r sau khi cn nhc k
lng gia nguy c tim tng vi li ch mong ch.
Tr mi v tr di 6 thng tui khng c iu tr bng Etomidate-Lipuro tr phi c ch
nh bt buc trong thi gian iu tr ni tr.
Ph n c thai : xem mc Lc c thai v Lc nui con b.
CH PHNG v THN TRNG LC DNG
Ch { phng :
Sau khi dng ko di lin tc etomidate c nguy c suy v thng thn thong qua.
Thn trng lc dng :
Ch c bc s c k nng thnh tho t ng ni kh qun v c sn thit b h hp nhn to mi
c php s dng Etomidate-Lipuro.
Etomidate-Lipuro khng c tc dng gim au. Nu dng trong gy m thi gian ngn, phi
dng mt thuc gim au mnh, th d fentanyl, phi c cho trc hoc cng lc vi
Etomidate-Lipuro ; nn ch thm ti nhng thng tin trong mc Tng tc thuc.
Li xe v vn hnh my mc :
Ngay c khi Etomidate-Lipuro c dng nh hng dn, bnh nhn dng thuc ny s
khng th li xe hay vn hnh my t nht l 24 gi sau khi dng thuc.
LC C THAI v LC NUI CON B
Mc an ton khi s dng Etomidate-Lipuro trong thi gian thai ngh n cha c xc minh.
Do , Etomidate-Lipuro ch nn s dng cho ph n c thai nu khng cn cch la chn no
khc.
Etomidate c bi tit theo sa m. Nu phi dng Etomidate-Lipuro trong thi gian cho con
b, th phi tm ngng cho b v khng c cho b li trc 24 gi sau khi dng thuc ; sa
m tit ra trong thi gian ny phi vt b i.
TNG TC THUC
Tc dng gy ng ca etomidate c tng cng bi cc thuc thuc nhm an thn, opiates,
gim au v ru.
Khng c trn Etomidate-Lipuro vi cc thuc tim khc nu khng kim tra trc v tnh
tng hp ca thuc.
Hn na, Etomidate-Lipuro khng c cho ng thi vi cc thuc tim khc qua cng mt
ng truyn tr phi tnh tng hp ca thuc c chng minh. Do i vi cc thuc
cn phi cho ng thi, th d thuc gim au, phi c cho ln lt qua cng mt ng
truyn hoc qua mt canun tnh mch ring.
C th tim Etomidate-Lipuro vo b dy truyn dung dch ng trng Natri Clorid nhng phi
tm ngng truyn.

TC DNG NGOI
Etomidate c ch sinh tng hp cc steroid ca v thng thn. Sau khi tim mt liu duy nht
etomidate, p ng ca v thng thn i vi cc tc nhn kch thch b gim r rt trong
khong t 4-6 gi.
Sau khi tim mt liu duy nht etomidate trn nhng bnh nhn khng c chun m,
thng quan st thy cc c c ng ngoi mun (chng git rung c). Chng tng ng vi
s thot khi s c ch cc kch thch no trung gian, tng t nh hin tng git rung c
trong gic ng sinh l. C th trnh c cc hin tng trn bng cch cho dng cc thuc
chun m thuc nhm opiates hoc benzodiazepin trc khi dng etomidate.
Thnh thong, sau khi dng etomidate, c th xy ra hin tng bun nn v i ma, tuy nhin
iu ch yu l do cc thuc thuc nhm opiates c dng ng thi hoc c dng
chun m gy ra, hn na c th b ho, nc v rt run.
Him khi sau khi dng etomidate, thy gii phng ra histamin. Cho n nay mi ch gp 3 ca b
tc dng ph nghim trng. Tuy nhin, etomidate vn l thuc c chn u tin i vi
nhng bnh nhn c tin s d ng.
Lc c c gp nhng bo co v hin tng co tht thanh qun sau khi dng etomidate.
Ch :
c bit sau khi dng etomidate liu cao v nu phi hp vi cc thuc an thn kinh trung
ng, i khi c th xy ra hin tng ngng th thong qua.
LIU LNG v CCH DNG
Liu dng c iu chnh theo p ng ca tng c th v tc dng lm sng.
Nn theo nhng hng dn v liu lng sau y :
V nguyn tc, liu c tc dng gy ng nm trong khong 0,15-0,3 mg etomidate/kg th trng,
tng ng vi 0,075-0,15 ml Etomidate-Lipuro/kg th trng.
Tr em di 15 tui v ngi ln tui dng liu duy nht 0,15-0,2 mg etomidate, tng ng vi
0,075-0,1 ml Etomidate-Lipuro/kg th trng. i vi nhng bnh nhn thuc nhm tui ny,
liu chnh xc cng phi c iu chnh theo tc dng lm sng.
i vi nhng bnh nhn b bnh x gan v nhng bnh nhn c chun m bng cc thuc
thuc nhm an thn, nhm opiates hoc nhm gim au th liu dng phi gim i.
Trong trng hp gy m c bit chm dt tnh trng ng kinh lin tc hoc ng kinh
cn lin tip, nn tim nhanh, ngha l trong vng 10 giy, mt liu etomidate (0,3 mg/kg
th trng, tng ng vi 0,15 ml Etomidate-Lipuro/kg th trng). C th tim nhc li liu ny
vi ln, nu cn.
Cch dng v ng dng :
Etomidate-Lipuro nht thit phi c tim bng ng tnh mch v, theo nguyn tc, phi
tht chm (mt liu thng ko di khong 30 giy), v ngt qung, nu cn.
Khng c tim vo ng mch v Etomidate-Lipuro c nguy c gy ra hoi t nu tim vo

ng mch. Tim ngoi tnh mch s rt au.

Trc khi s dng Etomidate-Lipuro nn c s chun m thch hp trnh xy ra chng git
rung c. Nn s dng cc thuc thuc nhm benzodiazepin, v d diazepam bng ng tim
bp khong 1 gi hoc tim tnh mch 10 pht trc khi tim Etomidate-Lipuro.
i vi nhng bnh nhn c biu hin ng kinh hoc c xu hng co git tng ln, nn tim
nhanh Etomidate-Lipuro, ngha l trong vng vi giy, trnh s khuch tn qu chm ca
etomidate vo no. Etomidate c sinh kh dng tt v tc phn b trong no nhanh s ngn
nga c nhng cn co git.
Ch :
Etomidate-Lipuro khng cha cc cht bo qun chng vi khun nm mc. Sau khi m ng
tim, phi rt ngay nh dch vo bm tim trong iu kin v trng v tim ngay, v nh dch
du l mi trng thun li cho vi khun nm mc pht trin. Phn khng dng n phi hy
b.
Lc k ng tim trc khi dng m bo cho hot cht c phn b u.
QU LIU
Trong trng hp b qu liu, c bit nu etomidate li c phi hp vi cc thuc gy m
bng ng h hp, th thi gian ng c th b ko di v c th xy ra ngng th trong thi
gian ngn.
Khi dng Etomidate-Lipuro, nn c sn tt c cc thit b my mc v thuc men thng phi
cn n trong th tc gy m.
BO QUN
Trnh nh sng, nhit di 25oC.

200.

EUMOVATE

GLAXOWELLCOME
Eumovate kem bi da : ng 5 g, 15 g.
Eumosone-G kem bi da : ng 10 g.
Eumosone-M kem bi da : ng 15 g.
THNH PHN
Eumovate cream :
cho 100 g

Clobetasone butyrate

0,05 g

Eumosone-G cream :
cho 100 g
Clobetasone butyrate

0,05 g

Gentamicin

0,1 g

Eumosone-M cream :
cho 100 g
Clobetasone butyrate

0,05 g

Miconazole nitrate

2,0 g

DC LC
Clobetasone butyrate l corticoid tc dng ti ch c s cn bng c o gia hot tnh v an
ton. Dng bo ch Eumovate/Eumosone iu tr chm c hiu qu tt hn so vi
hydrocortisone 1%, hoc cc dng corticoid tng hp hot tnh yu thng c s dng ;
nhng li t c nh hng ln chc nng h i-yn-thng thn, ngay c khi dng
Eumovate/Eumosone cho ngi ln bi vi lng ln v bng kn ton thn. Tt c cc
corticoid ti ch c th gy teo da nu lm dng thuc nghim trng. Tuy nhin, nghin cu
trn ng vt v trn ngi ch ra rng Eumovate/Eumosone v hydrocortisone t gy mng
biu b hn cc corticoid ti ch khc.
Gentamicin l mt khng sinh dit khun thuc nhm aminoglycoside c hot tnh trn vi
khun Gram dng v Gram m.
Miconazole nitrate l mt cht khng nm v khng khun mnh, ph rng, tc dng c hiu
i vi bnh nm do dermatophyte, nm men gy bnh (v d : Candida spp.), v nhiu vi
khun Gram dng, k c phn ln cc chng Streptococcus v Staphylococcus spp.
CH NH
Eumovate thch hp cho iu tr chm (eczema) v vim da tt c cc dng, bao gm :
- chm th tng d ng,
- vim da tip xc vi nh sng,
- vim tai ngoi,
- vim da tin pht do kch thch v d ng (k c hm do qun t),
- nga sn cc,

- vim da tit b nhn,

- phn ng da do cn trng t.
Eumovate c th dng nh iu tr duy tr gia cc t iu tr bng corticoid ti ch mnh
hn.
Eumosone-G c ch nh trong cc trng hp nh trn, nhng khi c, hoc nghi ng c,
hoc d xy ra, nhim khun th pht.
Eumosone-M c ch nh trong tt c cc trng hp c ch nh cho Eumovate, nhng
khi c, hoc nghi ng c, hoc d xy ra, nhim trng th pht do vi khun hoc do nm.
CHNG CH NH
Nhim trng da tin pht do virus (v d : herpes simplex, thy u), v qu mn cm vi cc
ch phm hoc vi bt c thnh phn no ca n.
Khng c dng Eumovate trong iu tr nhng tn thng da do nhim khun hoc nhim
nm tin pht.
Qu mn cm vi thnh phn ca ch phm.
Ch phm cha gentamicin khng nn dng cho vim tai ngoi nu mng nh b thng v
nguy c nhim c tai.
THN TRNG LC DNG
i vi tr nh nhi v tr em, khi c th, cn trnh iu tr ko di lin tc vi corticoid ti ch,
v c th dn n c ch thng thn, ngay c khi khng bng kn. tr nh nhi, t lt c th
tc dng nh bng kn, dn n tng hp thu. Cng nh i vi tt c cc corticoid khc, khng
nn bi thuc ko di trn da mt.
Nu bi ln mi mt, ch { trnh thuc dy vo mt, v c th gy ra glaucoma.
Phi dng khng sinh thch hp iu tr nu nhng tn thng ang c iu tr c biu
hin nhim trng. Ngng dng ngay corticoid ti ch khi c biu hin lan rng nhim trng, v
dng khng sinh ton thn thch hp.
iu kin m v m khi bng kn tn thng to iu kin thun li cho nhim khun, v vy
phi lm sch da trc khi bng li bng bng sch.
LC C THAI
S dng corticoid ti ch cho ng vt c thai c th gy nn s pht trin bt thng ca thai.
Cha xc nh s lin quan ca pht hin ny trn ngi ; tuy nhin, khng nn dng corticoid
ti ch rng ri cho ph n mang thai, c ngha l vi lng ln hoc thi gian di.
TC DNG NGOI
Trong trng hp t gp, khi c du hiu qu mn, nn ngng bi thuc ngay.
Khi dng Eumovate/Eumosone trn din tch da rng, mt vi bnh nhn c th hp thu lng
corticoid gy c ch tuyn thng thn thong qua, mc d Eumovate/Eumosone c
mc hp thu ton thn thp.
C th xy ra teo da cc b vng da m do tng hp thu clobetasone butyrate, nhng ch sau

t dng ko di.
C vi bo co v s thay i sc t da v rm lng khi s dng corticoid ti ch. Tnh trng
nng thm cc triu chng c th xy ra.
LIU LNG v CCH DNG
Bi thuc ln vng da tn thng, ti a l 4 ln mi ngy, cho ti khi c tin trin tt, khi
c th gim s ln bi thuc.
QU LIU
Qu liu cp tnh rt him khi xy ra ; tuy nhin, trong trng hp qu liu mn tnh hoc s
dng sai, cc biu hin cng v thng thn c th xut hin v khi phi ngng corticoid
ti ch.

201.

EURAX

NOVARTIS
kem bi ngoi da 10 % : ng 10 g v 20 g.
thuc nc dng xc 10 % : chai 50 ml.
THNH PHN
cho 100 g kem
Crotamiton

10 g

cho 100 g lotion

Crotamiton

10 g

DC LC
Eurax c tc dng ln nhiu dng nga khc nhau. Thuc c tc dng chng nga nhanh v duy
tr trong khong 6 gi. Nh s dng Eurax, s trnh c cc sang thng gy nga v do
gim nguy c b nhim trng th pht. Eurax c tc dng dit ci gh v tc dng km khun i
vi lin cu khun v t cu khun, do rt tt khi c dng iu tr bnh gh nga b bi
nhim c m. Eurax cng c chng minh rt c hiu qu chng li tc nhn gy bnh chy
rn (Pediculus capitis).
Eurax thm tt qua da sau khi c thoa nh ; thuc khng c cht m v khng li vt bn

sau khi s dng. Dng thuc nc thch hp cho cc sang thng vng c lng hoc h, hoc
sang thng c r dch.
CH NH
Nga do nhiu ngun gc khc nhau nh nga v cn, nga ngi gi, nga vng hu mnsinh dc, nga do d ng, vng da, tiu ng v cc vt t do cn trng. Tr ch, rn.
CHNG CH NH
Qu mn vi cc thnh phn ca thuc.
THN TRNG LC DNG
Khng thuc tip xc vi kt mc. Nu v tnh thuc thuc dnh vo mt, phi ra sch
vi nc. Dng kem khng c ch nh trong cc bnh vim da cp tnh, c dch r, cng
khng c dng trn cc vt thng ngoi da do thuc c th vo ng ton thn.
LC C THAI
Khng nn dng Eurax trong thi gian mang thai, nht l trong 3 thng u thai kz, do kinh
nghim iu tr cn hn ch.
LC NUI CON B
Khng bit c hot cht c c bi tit qua sa m hay khng. Du sao i na, khi cho con
b bng sa m cn trnh bi thuc ln u v v vng da xung quanh.
TC DNG NGOI
Eurax c dung np tt. Ch mt vi trng hp ngoi l gy kch ng da hoc d ng do tip
xc ; ngng iu tr nu c th.
LIU LNG v CCH DNG
nNga : Thoa kem hoc lotion 2-3 ln/ngy ln ch nga cho n khi ht nga. Nu chng
nga vn dai dng, c th dng lu ngy hn, do Eurax c dung np tt qua da. Trng hp
t dng thuc, cn tham vn bc s nu chng nga vn dai dng sau 5 ngy iu tr.
nGh nga : Sau khi ngm ra trong nc nng v lau kh, thoa nh Eurax trn ton thn (tr
mt v da u) cho n khi thuc thm hon ton. Thoa thuc mi ngy mt ln, nn vo
bui ti, trong 3 n 5 ngy ty theo kt qu iu tri, cn lu { quan st nhng ni m ci gh
c bit a thch nh k ngn tay, k ngn chn, c tay, nch, c quan sinh dc. vng da c
m, c th p mt lp bng c thoa Eurax. Trong thi gian iu tr, c th tm trc mi ln
dng thuc. Sau khi ngng iu tr, cn tm tht k v thay ton b mng mn v qun o.
tr nh, khng bao gi c dng qu 1 ln/ngy.
nBnh chy rn da u : Ngy u tin, gi u tht k bng nc nng v du gi u, sau
lau kh. Tip theo, thoa Eurax dng lotion vi lng va , thoa nh ln da u v ln tc,
c bit vng gy v xung quanh tai. Khi thoa thuc nn nhm mt hoc che mt li trnh
tip xc vi thuc. Sau , khng ra, kh tc t nhin v khng gi u trc 24 gi. tr
em, che u bng mt ming khn sau khi thoa thuc trnh cho thuc tip xc vi ngn
tay, qua s vo mt v gy kch ng.

T ngy th 2 n ngy th 7, gi u tht k mi ngy bng nc nng v du gi u. Chi

trng chy rn khi tc cn t bng lc tht kht.
Ngy th 8, kim tra tht k tc v da u. Ch iu tr tip tc mt t na khi pht hin cn
chy, rn hoc trng chy rn. Sau khi iu tr, ch dng chn mn v qun o tht sch.

202.

EXOMUC

BOUCHARA
c/o TEDIS
Cm pha hn dch ung 200 mg : hp 30 gi.
THNH PHN
cho 1 gi
Actylcystine

200 mg

(Aspartam)
DC LC
1. Actylcystine c tc dng iu ha s tit m kiu lm tiu m, tc ng ln pha gel ca
m bng cch ct t cu disulfure ca cc glycoprotine.
2. Actylcystine chng s oxy ha ca cc gc t do sinh ra do vim nhim, tn thng hay t
ngoi vo bng cch trung ha hoc trc tip hoc gin tip qua cht chuyn ha ca n l
glutathion, gip tng cng c ch bo v t nhin ng h hp v khng vim.
3. Ac tylcyst ine c tc ng hip lc vi cc khng sinh (amoxicilline, doxycycline, macrolide,
pnicilline, cephalosporine...), gip dit khun hu hiu v nhanh chng.
4. Ac tylcyst ine ngn tch t Ca++ ni bo, chng kch thch co tht ph qun.
DC NG HC
Sau khi ung thuc, ac tylcyst ine c hp thu nhanh. M phi v cc dch tit ph qun c i
lc c bit i vi actylcystine, nng c hiu lc ca thuc t c khong 3 gi sau khi
ung thuc.
Actylcystine v cc cht chuyn ha ch yu c bi tit qua thn.
CH NH
- Bnh phi : vim ph qun-phi, vim kh ph qun cp v mn, phng nga cc bin chng
h hp bnh nhn nhim khun, a tit ph qun, kh ph thng.

- Bnh tai mi hng : vim xoang, vim mi, vim hng, vim tai thanh dch,...
CHNG CH NH
Phnylctone niu (do c aspartam trong thnh phn ca thuc).
THN TRNG LC DNG
Nn thn trng khi iu tr cho bnh nhn b lot d dy-t trng.
LC C THAI
Cc kt qu nghin cu trn ng vt cho thy thuc khng c tc dng gy qui thai. Tuy
nhin khng th p dng cc s liu ny cho ngi, do cn thn trng khi k toa cho ph n
mang thai.
LC NUI CON B
Trnh dng do thiu s liu v s bi tit qua sa m.
TC DNG NGOI
liu cao, c th b hin tng khng dung np thuc : au d dy, bun nn, tiu chy. Nn
gim liu trong trng hp ny.
LIU LNG v CCH DNG
Ha tan thuc trong 1/2 ly nc.
Ngi ln/Tr em trn 7 tui :1 gi, 3 ln/ngy.
Tr em 2-7 tui :1 gi, 2 ln/ngy.
Tr em < 2 tui :1/2 gi, 2 ln/ngy.

THUC VN F

203.

EXTRA DEEP HEAT

CT TNHH ROHTO - MENTHOLATUM (VIT NAM)

Kem bi ngoi da : tup 30 g.
THNH PHN
cho 1 g kem
Methyl Salicylat

300 mg

Menthol

80 mg

DC LC
Kem Extra Deep Heat vi cng thc cha hm lng cao Methyl Salicylat v Menthol cho sc
nng mnh, lm gin cc mch gn k mt da, nh vy cc hot cht d dng thm qua da lm
gim ngay cc cn au lin quan ti cc bnh thp khp, vim khp, vim m x, au lng, au
c, au khp, cng vai, mi c, bong gn.
Kem khng nhn, khng dy vt, mi thm d chu.
Methyl salicylat c tnh cht in hnh ca cc salicylate, c hp thu nhanh chng qua da v
c tc dng gim au ti ch.
CH NH
- Thp khp, vim khp.
- au lng hay au cng vai trong cng vic.
- au khp khuu tay, u gi v mt c chn.
- au v mi c sau cc hot ng th dc th thao hoc ngi gi.
THN TRNG LC DNG
- Ch dng ngoi, trnh tip xc vi mt hay nim mc.
- Khng thoa ln vng da b try xc, kch ng hay mn cm nh mt, nu c tc dng ph,
ngng s dng.
LIU LNG v CCH DNG
- Xoa kem nh nhng ln vng au cho ti khi kem c hp thu ht qua da.
- Ty nhu cu, c th bi kem Extra Deep Heat nhiu ln trong ngy.
BO QUN
y cht np tup thuc sau khi s dng v ni mt, trnh nh nng trc tip.

204.

FASIGYNE

PFIZER
c/o ZUELLIG
vin nn 500 mg : hp 4 vin.
THNH PHN
cho 1 vin
Tinidazole

500 mg

T dc : alginic acid, cellulose, tinh bt

ng, magnesium stearate, sodium lauryl
sulfate.
Lp bao film : hydroxymethylcellulose,
propylene glycol, titanium dioxide.

DC LC
Fasigyne c thnh phn hot cht tinidazole l mt dn xut thay th ca hp cht imidazole c
tc ng khng nguyn sinh ng vt v khng vi khun k kh. C ch tc ng ca Fasigyne
chng li vi khun k kh v ng vt n bo l do thuc xm nhp vo t bo vi sinh vt v
gy tn hi trn cc chui ADN hay c ch s tng hp ca chng.
Tinidazole c hot tnh trn c nguyn sinh ng vt v vi khun k kh bt buc. Tc ng
khng ng vt nguyn sinh bao gm Trichomonas vaginalis, Entamoeba histolytica v Giardia
lamblia.
Tinidazole c hot tnh chng li Gardnerella vaginalis v hu ht cc vi khun k kh bao gm:
Bacteroides fragilis, Bacteroides melaninogenicus, Bacteroides spp., Clostridium spp.,
Eubacterium spp., Fusobacterium spp., Peptococcus spp., Peptostreptococcus spp., v
Veillonella spp.
DC NG HC
Fasigyne c hp thu nhanh chng v hon ton sau khi ung. Trong nghin cu ngi tnh
nguyn khe mnh c cho ung 2 g tinidazole, nng nh trong huyt thanh trong khong
40-51 mg/ml t c trong vng 2 gi v gim dn cho n 11-19 mg/ml sau 24 gi.
Khi tim tnh mch cho ngi tnh nguyn khe mnh dng 800 mg v 1,6 g tinidazole trong
vng 10-15 pht, nng nh trong huyt tng t 14-21 mg/ml vi liu 800 mg v trung bnh
32 mg/ml vi liu 1,6 g. 24 gi sau khi tim truyn, nng tinidazole trong huyt tng gim
ln lt l 4-5 mg/ml v 8,6 mg/ml cho thy thuc c th s dng mt ln duy nht trong ngy.
Nng trong huyt tng gim chm v tinidazole c th c tm thy trong huyt tng
vo gi th 72 sau khi tim truyn v ung vi nng ln lt l 0,05 mg/ml v n 1 mg/ml.
Thi gian bn thi trong huyt tng ca tindazole khong 12-14 gi.
Tinidazole c phn phi rng ri trong tt c cc m c th, i qua c hng ro mu no
v t ti nng hu hiu trn lm sng tt c cc m. Th tch phn b o c vo
khong 50 lt. Khong 12% tinidazole trong huyt tng gn kt vi proteine huyt tng.
Tinidazole c o thi qua gan v thn. Cc nghin cu trn bnh nhn khe mnh cho thy
rng trong vng 5 ngy, 60-65% liu s dng c o thi qua thn vi 25% di dng khng
i. Khong 12% liu dng c o thi qua phn.

Cc nghin cu trn bnh nhn suy thn (thanh thi creatinine < 22 ml/pht) cho thy rng
khng c s thay i ng k c { ngha thng k trn nhng thng s dc ng hc ca
tinidazole. Do , khng cn iu chnh liu lng cho cc bnh nhn suy thn.
CH NH
D phng :
Ngn nga nhim khun sau phu thut do vi khun k kh, c bit l nhng nhim khun sau
phu thut i trng, tiu ha v ph khoa.
iu tr nhng nhim khun sau :
Nhim khun k kh nh :
- nhim khun trong phc mc : vim phc mc, p-xe.
- nhim khun ph khoa : vim ni mc t cung, vim c t cung, p-xe t cung-bung trng.
- nhim khun huyt.
- nhim khun sau phu thut.
- nhim khun da v m mm.
- nhim khun ng h hp trn v di : vim phi, vim m mng phi, p-xe phi.
Vim m o khng c hiu.
Vim lot li cp tnh.
Bnh Trichomonas ng niu dc c nam ln n.
Bnh Giardia.
Bnh amip rut.
Bnh amip gan.
CHNG CH NH
Fasigyne chng ch nh trong ba thng u tin ca thai kz, b m ang cho con b, nhng
bnh nhn c ri lon thn kinh thc th v nhng bnh nhn c qu mn bit vi bt kz
thnh phn no ca thuc. Ging nh cc thuc c cu trc tng t khc, Fasigyne cng
chng ch nh bnh nhn c tin s hay c ri lon to mu, mc d khng ghi nhn c
bt thng v huyt hc k o di no trn lm sng cng nh trong nghin cu trn th vt vi
tinidazole.
CH PHNG v THN TRNG LC DNG
Ging nh nhng thuc cng nhm, nn trnh dng ru trong khi iu tr vi Fasigyne do c
kh nng phn ng dng disulfiram (bng mt, co tht bng, nn i, nhp tim nhanh).
Cc thuc c cng cu trc ha hc vi Fasigyne thng i km vi cc ri lon thn kinh khc
nhau nh chng mt, chong vng, mt iu ha, bnh thn kinh ngoi bin v him khi gy co
git. Nn ngng thuc nu c bt kz du hiu thn kinh bt thng no trong qu trnh tr liu
vi Fasigyne.
Tc ng ln kh nng li xe v vn hnh my mc :
Cha c nghin cu tc ng ca tinidazole ln kh nng li xe hay vn hnh my mc phc tp

tuy nhin khng c bng chng cho thy thuc c th nh hng ln cc kh nng ny.
TNG TC THUC
Ru c th gy phn ng dng disulfiram v nn trnh dng cho n 72 gi sau khi ngng
Fasigyne (xem Ch { phng v Thn trng lc dng).
LC C THAI v LC NUI CON B
Lc c thai :
Cc nghin cu trn kh nng sinh sn chut c cho dng tinidazole 100 hay 300 mg/kg
khng c nh hng no trn kh nng sinh sn, trng lng chut m v chut con, qu trnh
sinh n, sc sng cng nh vic cho con b. C mt s gia tng nh nhng khng ng k trong
t l sy thai vi liu 300 mg/kg.
Tinidazole i qua hng ro nhau thai. Do khng bit c tc ng ca cc hot cht thuc
nhm ny, chng ch nh s dng tinidazole trong ba thng u thai kz. Khng c bng chng
gy hi ca Fasigyne trong cc giai on sau ca thai kz, tuy nhin cn cn nhc li ch tr liu v
nguy hi c th xy ra cho b m v thai nhi khi s dng thuc trong ba thng gia v cui ca
thai kz.
Lc nui con b :
Tinidazole tit qua sa m, hot cht c th tip tc tit ra trong sa hn 72 gi sau khi dng
thuc. Cc b m khng nn cho tr b sa ti thiu ba ngy sau khi ngng Fasigyne.
TC DNG NGOI
Cc tc dng ngoi { c bo co ni chung l khng xy ra thng xuyn, nh v t khi. Cc
tc dng ngoi trn ng tiu ha bao gm bun nn, nn ma, chn n, tiu chy, li c
v kim loi v au bng.
Cc phn ng qu mn, i khi trm trng c th xut hin trong nhng trng hp him di
dng ni ban da, nga ngy, m ay v ph mch thn kinh.
Cc ri lon thn kinh i km vi s s dng Fasigyne bao gm chng mt, chong vng, mt
iu ha, bnh thn kinh ngoi vi (d cm, ri lon gic quan, gim cm gic) v him khi c co
git.
Ging nh cc thuc tng t, Fasigyne c th gy gim bch cu thong qua. Cc tc dng ph
him c bo co khc l nhc u, mt mi, ru li v nc tiu c mu sm.
LIU LNG v CCH DNG
Liu lng :
Ngn nga nhim khun hu phu :
- Ngi ln :
ng ung : Ung mt liu duy nht 2 g khong 12 gi trc khi phu thut.
- Tr em di 12 tui :
Khng c d liu cho php dng liu d phng nhim khun k kh tr di 12 tui.
Nhim khun vi khun k kh :

- Ngi ln :
ng ung : liu khi u 2 g trong ngy u tin sau 1g mi ngy, dng mt ln duy nht
hay 500 mg hai ln mi ngy.
iu tr trong 5 hay 6 ngy ni chung l , nhng cn phi xc nh thi gian iu tr qua thm
khm lm sng, c bit mt vi ni kh loi b nhim khun.
Nn thm khm lm sng cng nh cn lm sng thng xuyn nu thy cn thit phi tip tc
iu tr hn 7 ngy.
- Tr em di 12 tui :
Khng c d liu cho php dng liu iu tr nhim khun k kh tr di 12 tui.
Vim m o khng c hiu :
- Ngi ln :
Vim m o khng c hiu c iu tr thnh cng vi mt liu ung duy nht 2 g. T l
lnh bnh cao hn cng t c vi liu 2 g ung mt ln mi ngy trong hai ngy lin tip
(tng liu l 4 g).
Vim lot li cp :
- Ngi ln :
Ung liu duy nht 2 g.
Bnh trichomonas ng tit niu :
Khi xc nh nhim khun Trichomonas vaginalis, nn iu tr cng lc vi ngi phi ngu.
- Phc c la chn dnh cho ngi ln :
Ung mt liu duy nht 2 g.
- Tr em :
Dng liu duy nht 50 n 75 mg/kg th trng. i khi c th cn phi lp li liu ny mt ln
na.
Bnh Giardia :
- Ngi ln :
Ung liu duy nht 2 g mi ngy hay mt vin 150 mg hai ln mi ngy trong 7 ngy.
- Tr em :
Ung liu duy nht 50 n 75 mg/kg th trng. i khi c th cn phi lp li liu ny mt ln
na.
Amip rut :
- Ngi ln :
Dng liu duy nht 2 g trong 2 hay 3 ngy hay 600 mg hai ln mi ngy trong 5 ngy. Trong mt
vi trng hp, khi liu dng duy nht mi ngy trong 3 ngy khng hu hiu, c th tip tc
iu tr n su ngy. Khi iu tr hai ln mi ngy trong 5 ngy khng hu hiu, c th tip tc
iu tr cho n 10 ngy.
- Tr em :

Ung mt liu n 50 n 60 mg/kg th trng mi ngy trong ba ngy lin tip.

Amip gan :
Trong vic iu tr amip gan, cng vi iu tr bng Fasigyne c th cn phi ht m.
- Ngi ln :
ng ung : Tng liu thay i t 4,5 n 12 g, ty theo mc tc hi ca Entamoeba
histolytica.
iu tr khi u theo ng ung vi liu n 1,5 n 2 g mi ngy trong 3 ngy.
Trong mt vi trng hp, khi iu tr ba ngy khng c hiu lc, c th tip tc iu tr cho
n 6 ngy.
C th dng theo cch khc l ung 600 mg hai ln mi ngy trong 5 ngy. i khi, nu iu tr
ba ngy khng c hiu lc, c th tip tc iu tr cho n 10 ngy.
- Tr em :
Ung liu duy nht 50 n 60 mg/kg th trng mi ngy trong 5 ngy lin tip.
Cch dng :
Nn ung Fasigyne trong hay sau ba n.
QU LIU
Trong cc nghin cu ngn hn trn chut nht v chut cng, LD50 ln lt > 3600 mg/kg v >
2300 mg/kg theo ng ung.
Du hiu v triu chng qu liu :
Khng c bo co v qu liu trn ngi c ghi nhn vi Fasygine.
iu tr qu liu :
Khng c cht i khng c hiu iu tr qu liu vi tinidazole m ch c iu tr triu
chng v h tr. C th cn phi ra d dy. Tinidazole c th c thm phn d dng.

205.

FELDENE

PFIZER
c/o ZUELLIG
vin nang 10 mg : hp 30 vin.
vin nang 20 mg : hp 15 vin.
vin nn phn tn 20 mg : hp 15 vin.

ta dc 20 mg : hp 15 vin.
dung dch tim bp 2 mg/ml : ng 1 ml v 2 ml.
THNH PHN
cho 1 vin nang
Piroxicam

10 mg

T dc : tinh bt ng, nang gelatin cng,

lactose, magnesium stearate, sodium
lauryl sulfate.

cho 1 vin nang

Piroxicam

20 mg

T dc : tinh bt ng, nang gelatin cng,

lactose, magnesium stearate, sodium
lauryl sulfate.

cho 1 vin nn phn tn

Piroxicam

20 mg

T dc : hydroxypropyl cellulose, lactose,

cellulose vi tinh th, sodium lauryl
fumarate.

cho 1 ta dc
Piroxicam
T dc : glyceride bn tng hp, sp vi
tinh th, propyl gallate.

20 mg

cho 1 ml thuc tim

Piroxicam

20 mg

T dc : ru benzyl, ethanol, acid

hydrochloric, nicotinamide, propylene
glycol, sodium dihydrogen phosphate,
sodium hydroxide, nc.
DC LC
Feldene l mt thuc chng vim khng steroid c tc dng gim au v h st. Feldene c th
c ch ph n, ban , tng sn m, st v au nhc trn th vt th nghim. L thuc c hiu
qu chng vim do tt c cc nguyn nhn. Trong khi c ch tc ng ca thuc cha c
hiu y , cc nghin cu c lp in vitro cng nh in vivo cho thy rng piroxicam tc
ng trn mt s giai on trong ng min dch v p ng vim nh sau :
c ch tng hp prostanoid, gm c prostaglandin, qua s c ch c hi phc enzyme cyclooxygenase.
c ch kt tp bch cu trung tnh.
c ch t bo bch cu a nhn v n nhn di chuyn n vng vim.
c ch enzyme do lysosome phng thch t bch cu b kch thch.
c ch s sn xut anion superoxide ca bch cu trung tnh.
Gim sn xut yu t dng thp ton thn v trong hot dch bnh nhn vim khp dng thp
c huyt thanh dng tnh.
Ngi ta xc lp c rng piroxicam khng tc ng bng cch kch thch trc tuyn yn-h
i. Cc nghin cu in vitro khng cho thy piroxicam c tc ng m tnh no trn chuyn ha
sn.
Trong cc nghin cu trn sng, Feldene hiu qu khi dng nh mt thuc gim au trong cc
cn au do nhng nguyn nhn khc nhau (au sau chn thng, phu thut ct m h v sau
phu thut). Tc ng gim au c khi pht nhanh chng.
Trong chng thng kinh nguyn pht, s gia tng nng prostaglandin ni mc t cung gy co
tht qu t cung lm thiu mu cc b t cung v au. Feldene tc ng nh mt cht c
ch tng hp prostaglandin, cho thy c th lm gim co tht t cung qu v hiu qu
trong iu tr thng kinh nguyn pht.
DC NG HC
Hp thu :
Feldene c hp thu tt sau khi ung hay nht hu mn. Khi c thc n, tc hp thu gim
nh nhng khng nh hng n mc hp thu khi dng theo ng ung. Nng n nh

trong huyt tng c duy tr sut ngy khi dng liu duy nht mi ngy. Khi iu tr lin tc
vi liu 20 mg/ngy trong vng 1 nm, nng trong mu cng tng t nh nng thuc
trng thi n nh.
Nng thuc trong huyt tng t l tng ng vi liu 10 v 20 mg v ni chung t n
mc ti a trong vng ba n nm gi sau khi dng thuc. Mt cch tng qut, mt liu n 20
mg cho nng piroxicam ti a trong huyt tng l 1,5 n 2 mg/ml trong khi nng ti a
trong huyt tng sau nhiu liu lp li 20 mg piroxicam mi ngy thung n nh mc 3 n
8 mg/ml. Hu ht cc bnh nhn t n nng ti a trong huyt tng sau 7 n 12 ngy.
iu tr vi phc liu tn cng 40 mg mi ngy trong hai ngy u sau 20 mg mi ngy
cho mt t l cao (khong 76%) nng n nh trong huyt tng t c ngay sau liu th
nh. Nng trng thi n nh, din tch di ng cong v thi gian bn hy o thi
cng tng t nh khi dng phc 20 mg mi ngy.
Mt nghin cu so snh dng a liu v sinh kh dng ca dng tim vi dng vin nang ung
cho thy rng sau khi tim Feldene vo bp tht, nng trong huyt tng cao hn ng k so
vi nng t c 45 pht sau khi ung vin nang vo ngy th nht, trong 30 pht sau khi
dng thuc vo ngy th hai v 15 pht sau khi dng thuc vo ngy th by. Hai dng thuc
u tng ng sinh hc.
o thi/Chuyn ha sinh hc :
Feldene c chuyn ha rng ri v di 5% liu hng ngy c o thi di dng khng
i trong nc tiu v phn. ng chuyn ha quan trng l hydroxyl ha nhn pyridyl ca
nhnh bn, sau l lin hp vi acid glucuronic v o thi qua nc tiu. Thi gian bn hy
trong huyt tng vo khong 50 gi nam gii.
AN TON TIN LM SNG
Nghin cu c tnh cp v bn cp c thc hin chut cng, chut nht, ch v kh vi
liu trong khong t 0,3 mg/kg/ngy n 25 mg/kg/ngy. Liu 25 mg/kg/ngy cao hn khong
90 ln liu khuyn co dng cho ngi. Chng bnh duy nht quan st c l chng bnh tiu
biu i km vi c tnh trn th vt ca chng vim khng steroid; ngha l, hoi t nh thn
v sang thng d dy rut. V dng c tnh sau cng, kh cho thy khng hon ton hn
vi tc ng ny v ch th mn cm mt cch bt thng.
CH NH
Feldene l mt thuc chng vim khng steroid c ch nh cho nhiu trng hp khc nhau
cn tc ng chng vim v/hoc gim au, nh vim khp dng thp, vim xng khp (bnh
khp, bnh khp thoi ha), vim dnh t sng, bnh c xng cp tnh, gt cp, au sau can
thip phu thut v chn thng cp, thng kinh nguyn pht bnh nhn ln hn 15 tui,
lm h st v gim au gp trong vim cp ng h hp trn.
CHNG CH NH
Lot d dy t trng tin trin.

Khng nn dng Feldene cho nhng bnh nhn qu mn vi thuc. C kh nng xy ra mn

cm cho vi aspirin v cc thuc chng vim khng steroid khc. Khng nn dng Feldene cho
bnh nhn b nhng triu chng nh hen ph qun, polyp mi, ph mch hay ni my ay do
dng aspirin v cc thuc chng vim khng steroid khc.
Khng nn dng Feldene dng ta dc cho nhng bnh nhn b cc sang thng vim trc
trng hay hu mn, hay cho nhng bnh nhn c tin s va mi chy mu trc trng hay hu
mn.
CH PHNG v THN TRNG LC DNG
Cc bin c khng thng xuyn nh lo t d dy t trng, thng v xut huyt tiu ha, gy t
vong trong nhng trng hp him, c bo co vi Feldene. Nn theo di cht ch khi
cho nhng bnh nhn c tin s bnh ng tiu ha trn dng thuc.
Trong nhng trng hp him, cc thuc chng vim khng steroid c th gy vim thn m
k, vim cu thn, hoi t gai thn v hi chng thn h. Cc thuc chng vim khng steroid
c ch tng hp prostaglandin thn, l cht gi vai tr h tr trong vic duy tr ti mu thn
nhng bnh nhn c lu lng mu n thn v th tch mu ton b gim. nhng bnh
nhn ny, s s dng cc thuc chng vim khng steroid c th lm suy thn mt b, l phn
ng tiu biu theo sau vic hi phc tnh trng trc iu tr khi ngng thuc chng vim
khng steroid. Bnh nhn c nguy c cao nht b phn ng ny l nhng ngi suy tim sung
huyt, x gan, hi chng thn h v bnh thn mt b. Nn theo di nhng bnh nhn ny cn
thn khi tr liu vi cc thuc chng vim khng steroid.
Do bo co v cc nh hng xu trn mt ca cc thuc chng vim khng steroid, nn i
khm mt nhng bnh nhn c biu hin cc bnh v th lc trong qu trnh iu tr vi
Feldene.
i vi bnh nhn b phenylketon niu : do trong thnh phn c aspartam, Feldene FDDF cha
0,070 mg v 0,140 mg phenylalanine cho mi liu 10 mg v 20 mg tng ng.
Khi s dng vi mc ch gim au v chng vim trong vim ng h hp trn, nn nh rng
thuc chng vim khng steroid ch l thuc iu tr triu chng. Khi dng bnh nhn b
nhng bnh ny, nn xem x t n vic dng thm mt khng sinh thch hp.
nh hng ln kh nng li xe v vn hnh my mc :
Thuc khng gy nh hng xu khi s dng trong cc trng hp ny.
LC C THAI v LC NUI CON B
Mc d khng quan st c tc dng gy qui thai trn th nghim th vt, khng khuyn
co s dng Feldene trong thai kz. Feldene c ch tng hp prostaglandin v gii phng qua
mt s c ch c hi phc men cyclooxygenase. Tc dng ny, cng nh cc thuc chng vim
khng steroid khc c lin quan n s gia tng t l kh v ko di thi gian th vt c
thai khi dng thuc vo cui thai kz. Cc thuc chng vim khng steroid cng c bit l gy
ng sm ng ng mch tr s sinh.

S hin din ca piroxicam trong sa m c xc nh khi bt u dng thuc v qua mt

thi gian s dng lu di (52 ngy). Piroxicam xut hin trong sa vi t l khong 1-3% nng
trong huyt tng ca ngi m. Khng c s tch t piroxicam trong sa c lin quan n
s tch t trong huyt tng trong qu trnh iu tr. Khng khuyn co dng Feldene cho b
m ang nui con b do tnh an ton trn lm sng cha c xc nh.
TNG TC THUC
Cc thuc chng vim khng steroid c th gy gi natri, kali v nc, v c th can thip vo
hot tnh thi natri qua nc tiu ca cc thuc li tiu. Nn lu { tnh cht ny khi iu tr
nhng bnh nhn suy tim hay cao huyt p do cc chng bnh ny c th gp phn lm xu
hn tnh trng bnh.
Xut huyt c bo co him khi gp khi dng Feldene cho nhng bnh nhn dng thuc
chng ng mu loi coumarin. Nn theo di bnh nhn cn thn khi dng ng thi Feldene
v thuc chng ng mu ung.
Feldene, ging nh cc thuc chng vim khng steroid khc lm gim s kt tp tiu cu v
ko di thi gian chy mu. Nn lu { n tc dng ny khi xc nh thi gian chy mu.
Tng t cc thuc chng vim khng steroid khc, khng nn kt hp Feldene vi
acetylsalicylic acid hay dng ng thi hai thuc chng vim khng steroid do cc s liu khng
chng minh rng s kt hp cc thuc chng vim l tt hn so vi khi dng mt loi
thuc trong khi li gia tng kh nng xy ra tc dng ngoi .
Cc nghin cu trn nam gii cho thy rng s s dng ng thi Feldene vi acetylsalicylic
acid lm gim nng trong huyt tng ca piroxicam n 80% gi tr bnh thng. Dng
ng thi cc thuc khng acid khng c tc dng trn nng piroxicam trong huyt tng.
Tr liu ng thi Feldene v digoxin, hay Feldene v digitoxin khng nh hng n nng
trong huyt tng ca c hai thuc.
Feldene gn kt cht vi protein, v do c th th ch cc thuc gn kt protein khc. Bc s
nn theo di cn thn bnh nhn thay i nhu cu v liu lng khi dng Feldene cho bnh
nhn ang iu tr vi cc thuc c tnh gn kt cao vi protein. Cc thuc chng vim khng
steroid bao gm c Feldene c bo co l lm tng nng n nh trong huyt tng ca
lithium. Nn kim tra nng ny khi bt u iu tr, iu chnh liu v khi ngng dng
Feldene.
Cc kt qu t hai nghin cu c lp cho thy c s gia tng nh hp thu piroxicam khi dng
cimetidine nhng khng c thay i ng k trn nhng thng s thanh thi. Cimetidine lm
tng din tch di ng cong (AUC 0-120 gi) v Cmax ca piroxicam khong 13 n 15%.
Hng s tc o thi v thi gian bn hy khng cho thy s khc bit ng k. S gia tng
nh nhng c { ngha trong hp thu hu nh khng chc chn l c { ngha v mt lm sng.
TC DNG NGOI
Feldene ni chung c dung np tt. Cc triu chng trn ng tiu ha l tc dng ngoi

thng gp nht nhng trong hu ht cc trng hp th khng nh hng n liu trnh iu

tr. Cc tc dng ngoi ny bao gm vim ming, chn n, au thng v, bun nn, to bn,
bng kh chu, trng bng, tiu chy, au bng v kh tiu. Xut huyt tiu ha, thng v lot
(xem Ch { phng v Thn trng lc dng) c bo co xut hin vi Feldene. nh gi
khch quan v nim mc d dy v mt mu rut cho thy rng liu Feldene 20 mg/ngy
dng mt ln hay chia lm nhiu ln t gy kch ng hn mt cch ng k trn ng tiu ha
so vi acetylsalicylic acid.
Dng di ngy vi liu 30 mg hay hn lm gia tng nguy c tc dng ngoi { trn ng tiu
ha.
Ngoi tr cc triu chng trn ng tiu ha, ph n, ch yu l c chn, c bo co
xut hin trn mt t l nh bnh nhn.
Cc tc dng trn h thn kinh trung ng, nh chng mt, nhc u, bun ng, mt ng, trm
cm, lo lng, o gic, thay i tnh tnh, gic m bt thng, l ln tm thn, d cm, v chong
vng c bo co him khi xut hin.
Sng mt, nhn m v kch ng mt c bo co. Soi y mt thng quy v khm n khe
khng cho thy bng chng thay i trn mt. C th tai v kh .
Cc phn ng qu mn trn da, thng di dng ni ban da v nga ngy c bo co.
Him khi c bo co v chng trc mng v rng tc. Phn ng d ng vi nh sng t khi i km
vi tr liu. Cng nh cc thuc chng vim khng steroid khc, hoi t nhim c biu b (bnh
Lyell), v hi chng Stevens-Johnson him khi xy ra. Phn ng mn nc-bng nc cng
him khi c bo co.
Phn ng qu mn nh phn v, co tht ph qun, ni my ay/ph mch, vim mch v "bnh
huyt thanh" him khi c bo co.
Phn ng hu mn-trc trng vi ta dc biu hin ra chng au ti ch, rt bng, nga ngy
v cm gic but mt. xut hin nhng trng hp him xut huyt hu mn.
Gia tng BUN v creatinine c hi phc c bo co.
Gim hemoglobin v hematocrit, khng i km vi chng xut huyt tiu ha r rt, xy ra.
c bo co v chng thiu mu. Gim tiu cu v ban xut huyt khng gim tiu cu
(Henoch-Schoenlein), gim bch cu v tng bch cu i toan c bo co. C mt s
trng hp him thiu mu bt sn v thiu mu huyt tn. Chy mu cam cng c bo co
d rt him.
quan st c cc thay i thng s chc nng gan. Ging nh hu ht cc thuc chng
vim khng steroid khc, mt vi bnh nhn c th tng nng transaminase trong huyt
thanh trong qu trnh iu tr vi Feldene. Mt vi phn ng gan, bao gm vng da v cc
trng hp vim gan gy t vong c bo co. Mc d nhng phn ng ny him gp
nhng nu cc bt thng chc nng gan vn ko di hay ti t hn, nu pht trin cc du
hiu v triu chng cho bnh gan, hay nu biu hin ton thn (nh tng bch cu i toan, ni

ban, vv), nn ngng dng Feldene. Cc trng hp vim ty d him c bo co. nh

trng ngc v kh th cng c bo co d t khi xy ra.
Mt s trng hp hn hu b ANA dng tnh hay gim thnh gic c bo co him khi
xy ra nhng bnh nhn dng Feldene.
Cc bt thng v chuyn ha nh h ng huyt, tng ng huyt, tng hay gim cn
c bo co d him khi xy ra
au thong qua khi tim thnh thong c bo co khi s dng dng tim bp. Cc tc
dng ngoi ti ch (cm gic nng bng) hay tn thng m (to p xe v khun, hoi t m
m) c th thnh thong xy ra v tr tim.
LIU LNG v CCH DNG
Liu lng :
Vim khp dng thp, vim xng khp (bnh khp, bnh khp thoi ha), vim dnh t sng
:
Liu bt u khuyn co l 20 mg dng mt ln duy nht mi ngy. a s bnh nhn c iu
tr duy tr vi liu 20 mg mi ngy. Mt s tng i nh bnh nhn c th cn 10 mg mi ngy.
Mt vi bnh nhn c th cn cho n 30 mg dng mt ln duy nht hay chia lm nhiu ln.
Dng liu 30 mg hay hn trong mt thi gian di c th dn n nguy c gia tng v tc dng
ngoi trn h tiu ha.
Gt cp :
Nn bt u iu tr vi liu duy nht 40 mg , sau dng 40 mg mi ngy, mt ln duy nht
hay chia lm nhiu ln trong 4-6 ngy. Feldene khng ch nh cho iu tr bnh gt lu di.
Ri lon c xng cp :
Nn bt u iu tr vi liu 40 mg mi ngy trong hai ngy u, dng mt ln duy nht hay
chia lm nhiu ln. Nn gim liu n 20 mg mi ngy cho 7-14 ngy k tip ca t iu tr.
au sau phu thut hay chn thng :
Liu khi u khuyn co l 20 mg mi ngy, dng mt ln trong ngy. Trong trng hp cn
khi pht tc ng nhanh, nn bt u vi liu 40 mg mi ngy trong hai ngy u, dng mt
ln duy nht hay chia thnh nhiu liu. i vi giai on iu tr cn li, nn gim liu xung 20
mg mi ngy.
Thng kinh :
iu tr thng kinh nguyn pht khi u sm ngay khi c triu chng vi liu 40 mg mi ngy
dng mt ln duy nht trong hai ngy u. C th tip tc iu tr sau vi liu n hng
ngy l 20 mg t mt n ba ngy k tip nu cn thit.
Vim ng h hp trn :
Liu thng thng dnh cho ngi ln l 10 hay 20 mg ung mi ngy mt ln. Trong trng
hp cn phi pht tc ng nhanh, nn bt u vi liu 40 mg mi ngy mt ln trong hai ngy
u, sau l 10 hay 20 mg mi ngy trong ba n nm ngy.

S dng cho tr em :
Cha xc nh c liu Feldene khuyn co cho tr em.
Cch dng :
Theo ng ung (vin nang, vin nn phn tn) : C th nut nguyn vin nn ha tan vi
nc, hay ha trong mt t nc (50 ml) v ung.
Tim bp : Feldene tim bp thch hp cho iu tr khi u cc bnh cp tnh v cn cp ca
cc bnh mn tnh. iu tr tip tc, nn dng dng thuc ung (vin nang, vin nn hay cc
dng phn tn c) hay ta dc. Liu lng Feldene dng theo ng tim tnh mch cng
tng t nh liu ung.
Nn p dng k thut v khun khi tim bp Feldene v tim vo khi c tng i ln. Tt
nht nn tim vo phn t trn ngoi ca mng. Cng ging nh cc thuc tim bp khc, cn
phi rt ng bm tim trc khi tim vo trnh tim nhm vo mch mu.
Ta dc : Cho mi ch nh, liu lng Feldene ta dc khi s dng ring r cng tng t
nh liu lng cho vin nang Feldene. Ta dc Feldene a ra mt phng cch s dng mi
cho cc bc s khi cn k toa cho mt s bnh nhn hay cho mt s bnh nhn thch dng dng
thuc ny hn.
Phng php dng kt hp
Liu Feldene tng cng hng ngy c s dng di dng vin nang, vin nn d phn tn,
ta dc v thuc tim bp khng c vt qu liu ti a mi ngy nh ch nh phn
trn.
QU LIU
Trong trng hp qu liu Feldene, iu tr h tr v iu tr triu chng c ch nh. Cc
nghin cu chng minh rng vic dng than hot tnh c th lm gim hp thu thuc v ti
thu hi li piroxicam, do lm gim lng thuc trong c th.
TNG K
Khng nn trn dung dch tim bp vi cc thuc khc.

206.

FEMARA

NOVARTIS
vin bao 2,5 mg : hp 30 vin.
THNH PHN

cho 1 vin
Letrozole

2,5 mg

DC LC
Vic loi b cc tc dng kch thch gin tip ca estrogen l i hi u tin phi gii quyt
trong cc trng hp m s pht trin ca cc m khi u ph thuc vo s c mt ca cc
estrogen. ph n mn kinh, estrogen ch yu do hot ng ca cc men aromatase sinh ra,
men ny chuyn cc hormon nam tnh - trc ht l androstenedione v testosterone thnh
estrone (E1) v estradiol (E2). Vic c ch sinh tng hp estrogen trong cc m ngoi vi v bn
thn m ung th v, do , c th c thc hin bng cch c ch men aromatase.
Letrozole l cht c ch men aromatase khng c cu trc steroid. N c ch men aromatase
bng cch gn vi men sc t t bo P450 ca men, dn n s gim sinh tng hp estrogen
trong mi m.
Vi ph n mn kinh khe mnh, cc liu duy nht 0,1 ; 0,5 v 2,5 mg letrozole gim estradiol
trong huyt thanh ti 75-78%. S gim ti a t c trong 48-78 gi.
Vi bnh nhn mn kinh b ung th v, liu hng ngy t 0,1 n 5 mg lm gim nng
estradiol, estrone v estrone sulfate trong huyt tng ti 75-95% mi bnh nhn c iu
tr. Vi liu 0,5 mg v cao hn, nhiu gi tr estrone v estrone sulfate gim ti di gii hn c
th pht hin c, cho thy cc liu ny c ch estrogen cao hn. Vic gim estrogen ny
c duy tr trong sut thi kz iu tr.
Letrozole c ch c bit hot ng ca men aromatase. Khng nhn thy thuc lm phng
hi g n tuyn thng thn sinh steroid. Cng khng thy c s thay i nng no ca
cortisol, aldosterone, 11-desoxycortisol, 17-hydroxyprogesterone v ACTH trong huyt tng
hoc hot ng ca rsine huyt tng trong s cc bnh nhn sau kz mn kinh c iu tr
bng letrozole vi liu hng ngy l 0,1 n 5 mg. Vic kim tra s kch thch ca ACTH c
thc hin sau 6 v 12 tun iu tr vi cc liu hng ngy l 0,1 ; 0,25 ; 0,5 ; 1 ; 2,5 v 5 mg cho
thy thuc khng lm bt sn aldosterone hoc cortisol. Do khng cn b sung
glucocorticoid v mineralocorticoid.
Khng nhn thy c s thay i g ca nng hormon nam tnh trong huyt tng
(androstenedione v testosterone) trong ph n mn kinh khe mnh. sau khi dng cc liu
duy nht 0,1 ; 0,5 v 2,5 mg letrozole hoc thay i nng androstenedione bnh nhn mn
kinh c iu tr vi cc liu hng ngy t 0,1 n 5 mg, chng t vic phong b sinh tng hp
estrogen khng dn ti s tch t cc androgens.
Nng trong huyt tng ca LH v FSH khng b nh hng bi letrozole, chc nng tuyn
gip cng vy.
Trong mt th nghim lm sng c theo di k cng, ngi ta thy cc bnh nhn c iu

tr bng Femara, khi u gim i 23,6% so vi 16,4% khi dng megestrol acetate. So snh cc kt
qu iu tr ta thy liu 2,5 mg letrozole cho kt qu tt nht (p = 0,04).
DC NG HC
Hp thu :
Letrozole c hp thu nhanh chng t ng d dy rut (t l hp thu tuyt i trung bnh l
99,9%). Thc n c lm gim nh t l hp thu theo thi gian, nhng t l hp thu cui cng
khng b thay i. Do , letrozole c th c ung bt kz lc no trong ngy.
Phn phi :
Letrozole c gn vi protein huyt tng vi t l xp x 60%, ch yu vi albumin (55%).
Nng letrozole trong hng cu bng khong 80% nng trong huyt tng. Sau khi ung
2,5 mg letrozole c ng v 14C, xp x 82% ca tnh phng x trong huyt tng, tng ng
vi hp cht khng thay i. Do , s tip xc ton thn vi cc sn phm chuyn ha l thp.
Letrozole c phn b nhanh chng v rng ri ti cc m. Th tch phn phi trng thi
bn vng l khong 1,87 +/- 0,47 l/kg.
Chuyn ha v thi tr :
Vic thi tr bng cch chuyn ha thnh mt sn phm chuyn ha khng cn hot tnh dc
lc l cch thi tr chnh ca letrozole (CLm = 2,1 l/gi) nhng tng i chm so vi lng
mu chy qua gan (khong 90 l/gi). Cc isoenzymes 3A4 v 2A6 ca sc t t bo P450 c kh
nng chuyn letrozole thnh sn phm chuyn ha ny. S hnh thnh t i cc sn phm
chuyn ha khng xc nh c v vic thi tr thuc trc tip theo ng thn v phn ch
ng vai tr nh trong vic thi tr letrozole.
Sau khi ung hng ngy 2,5 mg, nng n nh t c trong vng 2-6 tun v nng ny
c gi nguyn trong mt thi gian tng i di nn c th kt lun c l khng xy ra s
tch ly thuc.
Tui tc khng nh hng ti dc ng hc ca letrozole.
Nghin cu trn bnh nhn b bnh gan, thn v ung th v. Vi bnh nhn b km chc nng
thn khc nhau, sau khi ung mt liu duy nht 2,5 mg thuc, khng thy c nh hng g ti
dc ng hc ca letrozole.
Vi bnh nhn km chc nng gan, mc hp thu thuc vn trong phm vi hp thu ca
nhng ngi bnh thng.
Vi bnh nhn b ung th v, nng ca letrozole khng thy b nh hng.
an ton :
Nghin cu trn cc loi ng vt chun, khng thy c c tnh ton thn hay c quan ch.
i vi loi gm nhm, letrozole gy c tnh cp vi liu 2.000 mg/kg. Vi ch, ta thy cc du
hiu ca c tnh va phi khi dng liu 100 mg/kg.
Dng liu 0,3 mg/kg vi c hai loi, thuc khng c tc dng ph.
Trong mt nghin cu 104 tun v kh nng gy ung th ca thuc, ngi ta khng thy c u

no c lin quan ti vic iu tr chut c c.

Vi chut ci, ngi ta thy letrozole lm gim t l u lnh v c tnh ca thuc i vi sinh
sn cha c nghin cu y .
CH NH
iu tr ung th v tin trin ph n mn kinh t nhin hay nhn to, trc c iu tr
bng cc thuc khng estrogen.
CHNG CH NH
Qu mn vi hot cht hay vi t dc ca thuc.
Thi kz ni tit trc khi tt kinh.
Ph n c thai v cho con b.
CH PHNG v THN TRNG LC DNG
Ngi ta cha nghin cu Femara cc bnh nhn c thanh thi cratinine < 10 ml/pht. Do
letrozole gn yu vi protein huyt tng, ngi ta cho rng thuc c th b loi tr khi h
thng tun hon bng thm phn. Do , phi xem xt k li, hi i vi cc bnh nhn ny
trc khi dng Femara.
Li xe v vn hnh my mc :
Femara khng nh hng r ti nhng ngi li xe v vn hnh my mc. Tuy nhin, khi dng
Femara c th thy mt mi v chng mt. Do , bnh nhn dng Femara cn c thng bo
l kh nng th lc v tinh thn i hi cho vic vn hnh my mc hoc li xe c th b nh
hng.
LC C THAI v LC NUI CON B
Cha c y cc d liu v ti sinh sn trn ng vt i vi letrozole, khng c ch nh
Femara cho ph n c thai v cho con b.
TNG TC THUC
Cc nghin cu v tc dng tng h trn lm sng vi cimetidine v warfarin cho thy dng
Femara cng cc thuc ny khng c tc dng tng h g ng k. Bn cnh , trong mt th
nghim rng hn i vi cc bnh nhn dng cc thuc khc (nh benzodiazepine, barbiturate,
furosemide, omeprazole) cng khng c tc dng tng h no v lm sng. Hin cha c th
nghim lm sng v dng Femara vi cc thuc chng ung th khc.
TC DNG NGOI
Trong cc th nghim lm sng, cc tc dng ph thng nh n trung bnh v him c
trng hp nghim trng phi ngng iu tr. Nhiu tc dng ph c th c lin quan n
bn thn bnh tt hoc cc hu qu dc l{ bnh thng ca vic thiu estrogen (nh nng,
tha tc).
Bng di y cho thy theo trnh t gim dn, tn s ca cc tc dng ph c th lin quan ti
thuc, theo cc nghin cu, c bo co l trn 2% (ca Femara hoc megestrol acetate)

trong mt th nghim c kim sot vi Femara (2,5 mg/ngy) v megestrol acetate (160
mg/ngy) trong 33 thng.
Tc dng ph

Femara (n =
174%)
6,9
6,3
6,3
5,2
5,2
3,4
3,4
2,9
2,9
2,3
2,3
2,3
1,7
1,7
1,7
1,1
1,1
1,1
0,6
0,6
0,6
0
0

Megestrol acetate (n = 189%)

Nhc u
4,8
Bun nn
4,2
Ph ngoi vi
3,7
Mt mi
6,3
bng
3,7
Tha tc
1,1
(1)
Ban
0,5
Nn
1,6
Kh tiu
1,6
Tng trng
8,5
(2)
au c xng
1,1
Ch|n n
1,1
Chy m|u }m o
3,2
Kh h
2,6
To bn
2,1
Chng mt
3,7
Tng ngon ming
3,7
Tng m hi
2,1
Khn ting
5,8
(3)
Vim tnh mch huyt khi
3,7
C vt }m o
2,1
Cao huyt p
2,6
Nga
2,6
(1) Gm : ban , rt sn.
(2) Gm : au cnh tay, lng, chn, xng.
(3) Gm : vim tnh mch huyt b mt v su.
Cc tc dng ph khc c coi l c th c lin quan ti thuc v c bo co t nht 3
bnh nhn c iu tr bng Femara, vi tn s di 2% gm st cn v ph.
LIU LNG v CCH DNG
Ch dng cho ngi ln.
Bnh nhn ln v c tui :
Liu gi l 2,5 mg mt ln mi ngy. Khng cn iu chnh liu lng g cho bnh nhn ln
tui.
Bnh nhn yu gan hay thn :
Khng cn iu chnh liu lng g nu thanh thi cratinine >= 10 ml/pht (xem phn Dc

ng hc).
QU LIU
Khng c kinh nghim g khi dng qu liu Femara. Hin cha c iu tr c hiu no khi dng
qu liu ; ch p dng iu tr triu chng v h tr.

207.

FENISTIL 24

NOVARTIS
Vin nang tc dng ko di 4 mg : hp 20 vin.
THNH PHN
cho 1 vin
Dimethindene maleate

4 mg

DC LC
Dimethindene maleate l mt dn cht ca phenindene, l cht khng histamin H1.
Dimethindene maleate cng c tc dng khng kinin, khng cholinergic nh v an thn, nhng
khng c tc dng chng nn.
V vy, n lm gim s tng tnh thm mao mch trong cc phn ng qu mn tc thi.
Khi c dng kt hp vi thuc khng histamin H2 n s phong b tc dng ca histamin tun
hon.
Nu dng dimethindene phng nga, cc phn ng gy bi phn hoa s gim.
Mt nghin cu v s c ch s ni mn v hng ban da gy bi histamin cho thy tc dng
ca mt liu duy nht Fenistil 24 ko di t nht 24 ting.
Trc nghim v s tnh to v kh nng lm vic cha khng nh c s khc nhau ng k
no gia vic dng gi dc v Fenistil 24 liu khuyn co. Thuc c tc dng an thn nh
nu dng vo bui sng v khng c tc dng ny nu dng vo bui ti.
DC NG HC
Nng thuc ti a trong huyt thanh sau khi dng mt liu duy nht Fenistil 24 s t c
trong khong 7 n 12 gi. Thi gian bn hy khong 11 gi.
Khng c s tch t thuc v dc ng hc c dng tuyn tnh khi dng Fenistil 24 nhc li mi

ngy 1 ln.
cc nng khong 0,09-2 mg/ml, t l dimethindene maleate gn vi protein huyt tng
l khong 90%. Cc phn ng chuyn ha gm s hydroxy ha v s metoxy ha.
Dimethindene v cc cht chuyn ha ca n c thi tr qua mt v nc tiu.
Th tch phn phi (VD) l 293 lt. H s thanh thi ton phn (Cltot) l 311 ml/pht hoc 19
l/gi.
Phn thuc khng o thi qua nc tiu l 90% hay 0,90.
CH NH
iu tr triu chng nhng ri lon c tnh cht d ng da v ng h hp nh my ay,
nga km theo cc bnh da pht ban (eczema v cc trng hp c lin quan), vim mi theo
ma v vim mi k o di.
CHNG CH NH
Qu mn vi mt trong cc thnh phn ca thuc.
THN TRNG LC DNG
Cn thn trng i vi bnh nhn tng nhn p, b tiu do ri lon niu o-tin lit tuyn hoc
hen mn tnh.
Tuy nhin, cc th nghim v kh nng thc hin cng vic ch ra rng Fenistil 24 liu khuyn
co, ni chung khng lm nh hng ti tp trung, ch . Fenistil 24 c th lm gim s tnh
to hoc gy mt, c bit khi thuc c dng vo bui sng. Do , cn lu { khi dng thuc
cho cc li xe hay ngi lm cng vic i hi s tp trung ch { (nh ngi vn hnh my
mc).
Khng dng dng bo ch ny cho tr di 12 tui m nn dng dng git.
LC C THAI v LC NUI CON B
Cc nghin cu v s sinh sn ng vt cho thy Fenistil 24 khng gy nguy c i vi bo
thai nhng cha c nghin cu kim chng no c thc hin vi ph n c thai. Ch dng
Fenistil 24 trong thi kz mang thai nu thy vic iu tr thc s l cn thit v nhng li ch
mong i vt tri hn nhng nguy c c th xy ra.
Mt nghin cu tin hnh trn ng vt cho thy mt lng nh dimethindene v/hay cc cht
chuyn ha ca n c bi tit vo sa m. V vy, khng nn dng Fenistil 24 trong thi gian
cho con b.
TNG TC THUC
Tc dng an thn ca cc thuc c ch h thn kinh trung ng nh thuc an thn, thuc ng
v ru c th c tng cng khi dng vi Fenistil 24. Dng cng lc vi cc cht c ch
MAO c th lm tng tc dng khng cholinergic v c ch h thn kinh trung ng ca cc
thuc khng histamin. V vy, khng nn dng cng lc cc loi thuc ny.
Cc thuc chng trm cm 3 vng v khng cholinergic c th to ra tc dng khng histamin v
t lm nng hn bnh glaucom v chng b tiu tin.

TC DNG NGOI
Trong cc th nghim kim chng trn lm sng vi Fenistil 24, i khi tnh trng mt mi,
bun ng thong qua c ghi nhn vi t l tng ng vi khi dng gi dc.
Him khi au u, kch thch, bun nn v cc triu chng khc v tiu ha, kh ming v chng
mt cng c xy ra. Sau khi cc dng Fenistil 24 khc c lu hnh trn th trng thy
trong rt him trng hp xy ra ph, pht ban, co c v ri lon h hp.
LIU LNG v CCH DNG
Ngi ln v tr em trn 12 tui :
Liu thng thng hng ngy l 1 vin v dng vo bui ti. Nn nut c vin thuc ch khng
nhai.
Vi nhng bnh nhn lm vic vo ban m th nn dng thuc trc khi i ng. Khng dng
dng bo ch ny cho tr em di 12 tui m nn dng dng git. Thi gian iu tr khng qu
25 ngy.
BO QUN
Trnh nh sng nng v m, khng dng thuc qu thi hn ghi trn bao b.

208.

FITOVIT

J.B. CHEMICALS PHARMACEUTICALS LTD.

c/o CNG TY TNHH DC PHM TIN PHC
Vin nang : v 10 vin.
Syr : chai 120 ml, 240 ml.
THNH PHN
cho 1 vin
Withania somnifera

760 mg

Emblica officinalis

360 mg

Asparagus racemosus

200 mg

Tinospora cordifolia

140 mg

Tribulus terrestris

100 mg

Picrorhiza kurroa

40 mg

Cyperus scariosus

60 mg

Bacopa monniera

200 mg

Terminalia chebula

80 mg

Piper longum

100 mg

Myristica fragrans

40 mg

cho 10 ml syr
Withania somnifera

380 mg

Emblica officinalis

180 mg

Asparagus racemosus

100 mg

Tinospora cordifolia

70 mg

Tribulus terrestris

50 mg

Picrorhiza kurroa

20 mg

Cyperus scariosus

30 mg

Bacopa monniera

100 mg

Terminalia chebula

40 mg

Piper longum

50 mg

Myristica fragrans

20 mg

M T
Fitovit, thuc tng lc phi hp cc thnh phn tinh chit t dc tho thin nhin m h
thng thuc c i n (Ayuveda) cht lc v s dng t khong 5000 nm trc cng
nguyn. Thuc c tc dng ti t v cn bng sc khe b mt do ri lon cc b phn chc
nng ca c th. Cc thnh phn tho dc ny c nghin cu v s dng lu di vi

nhng kt qu tt m khng gy tc dng ph.

DC LC
Dng phi hp cc tho dc c tc ng :
- Chng stress.
- Bi b c th, chng suy nhc.
- Tng cng tr nh.
- Kch thch n ngon, gip tiu ha.
- Kch thch h thng min dch.
- Gip pht trin c th tr em.
- Tng cng th lc.
- Ci thin chc nng gan.
- Chng x va ng mch giai on u.
- Tng cng kh nng sinh dc.
Tc dng ca tng thnh phn :
Withania somnifera :
Kch thch h thng bo v c th, chng stress, chng vim nhim v kch thch h thng min
dch, tng cng sinh dc.
Emblica officinalis :
Kch thch tiu ha, gim chng kh tiu, to s ngon ming, thm n ; gim cholesterol mu ;
tng cng sc khng ca c th vi vi sinh vt gy bnh.
Asparagus racemosus :
Kch thch tiu ha, bo v nim mc d dy, chng lot do stress ; kch thch h thng min
dch; tng cng sinh dc.
Tinospora cordifolia :
Tng cng sinh lc, kch thch min dch, ci thin chc nng gan ; tc dng gim au, khng
vim.
Tribulus terrestris :
Chng x va ng mch, gim cholesterol v lipid ton phn trong mu ; tc dng tng lc.
Picrorhiza kurroa :
C tnh khng vim, iu ha vn ng ng tiu ha.
Cyperus scariosus :
Kch thch s ngon ming, thm n, kch thch tiu ha.
Bacopa monniera :
Ci thin qu trnh trao i cht no, tng tr nh.
Terminalia chebula :
Ci thin qu trnh trao i cht no, tng tr nh, tng th lc, bo v gan.
Piper longum :

Tng lc, kch thch h thng bo v c th, ci thin qu trnh trao i cht no, kch thch h
thng to mu ; c tnh khng vim, khng d ng, long m.
Myristica fragrans :
Kch thch tiu ha, tng lc, tng cng sinh dc.
CH NH
- Suy nhc ton thn, suy gim h thng bo v c th, hi chng suy nhc do nhng ngun
gc khc nhau.
- Trng thi cng thng tm l ko di, trm trng v th xc v tm thn, thi kz dng bnh,
hi phc sau t bnh nng.
- Cc ri lon no, sa st tr nh, gim kh nng ch { tp trung.
- Gip pht trin c th tr em.
- Giai on u ca x va ng mch c tng lng cholesterol v lipid ton phn trong huyt
tng.
- Ri lon ng tiu ha (n khng ngon, st cn, chng kh tiu), gim kh nng sinh dc.
CHNG CH NH
Khng c.
TNG TC THUC
Khng c.
TC DNG NGOI
Qu mn cm mt vi c th.
LIU LNG v CCH DNG
Vin nang : 1 hoc 2 vin mi ngy.
Syr : 1-3 mung/ngy.

209.

FLAGENTYL

XNLD RHNE POULENC RORER

[AVENTIS PHARMA]
Vin bao phim d b 500 mg : hp 4 vin.
THNH PHN
cho 1 vin
Secnidazole

500 mg

DC LC
Cht dn xut tng hp nhm nitro-imidazol.
C hot tnh dit k sinh trng : Entamoeba histolytica, Giardia intestinalis, Trichomonas
vaginalis, Hot tnh dit vi khun k kh : Bacteroides, Fusobacterium, Clostridium,
Peptostreptococcus, Veillonella...
DC NG HC
Nng huyt thanh ti a t 3 gi sau khi ung mt liu duy nht 2 g secnidazol (di dng
vin 500 mg). Thi gian bn hy huyt thanh khong 25 gi. Thi tr chm, ch yu qua nc
tiu (50% liu dng c thi tr trong 120 gi). Xuyn qua nhau thai v i vo sa m.
CH NH
Bnh amib rut v gan.
Bnh giardia.
Vim m o v niu o do trichomonas vaginalis.
Vim m o khng c hiu (nhim khun m o).
CHNG CH NH
Qu nhy cm i vi dn xut imidazol.
Ph n c thai, ph n cho con b.
LC C THAI v LC NUI CON B
Lc c thai :
Nhng nghin cu ng vt cho thy secnidazole khng gy qui thai. Tuy nhin tnh gy d
dng ngi cha khng nh.
V mt lm sng, cha c nhng bng chng xc ng nh gi tnh gy d dng hoc c vi
phi thai khi s dng secnidazole trong thi kz mang thai.
thn trng, khng nn s dng secnidazole ph n c thai.
Lc nui con b :
Khng thy secnidazole i qua sa m.
Tuy nhin nhng dn cht imidazole khc qua sa m, ngi ta m t nhng trng hp
nm candida ming v tiu chy gp nhng tr b sa m ngi m ang iu tr vi dn
xut imidazole.
Do , nn ngng cho con b trong thi gian iu tr.
THN TRNG LC DNG
- Trnh ung ru trong thi gian iu tr vi secnidazole.
- Khng dng ngi c tin s ri lon th tng mu.
Ngi li xe v vn hnh my mc :
Him trng hp chng mt khi iu tr vi secnidazole.
TNG TC THUC
Khng nn phi hp :

- Disulfiram : v gy cn hoang tng, l ln.

- Alcool : hiu ng antabuse (nng, , nn ma, tim p nhanh).
Thn trng khi phi hp :
- Thuc chng ng mu ng ung (nh warfarine) : gia tng tc dng thuc chng ng
mu v tng nguy c xut huyt, v gim s d ha gan.
Kim tra thng xuyn hm lng prothrombine v theo di INR. iu chnh liu dng thuc
chng ng trong khi iu tr vi secnidazol n 8 ngy sau khi ngng iu tr.
TC DNG NGOI
Cc tc dng ph khng mong mun thng gp khi iu tr bng dn xut imidazol gm :
- Ri lon tiu ha : bun nn, au d dy, ming c v kim loi, vim li, vim ming.
- Ni m ay.
- Gim bch cu nh, hi phc khi ngng thuc.
- Him khi : chng mt, hin tng mt phi hp v mt iu ha, d cm, vim a dy thn
kinh cm gic-vn ng.
i vi Flagentyl, cho n nay ch thy c cc ri lon tiu ha (nn, ma, au d dy).
LIU LNG v CCH DNG
- Bnh amib cp tnh, c triu chng (dng histolytica) v bnh giardia :
Ngi ln : 2 g, mt liu duy nht vo u ba n.
Tr em : 30 mg/kg mt liu duy nht.
- Bnh amib khng triu chng (dng minuta v dng bo nang) : ung cng liu nh trn trong
3 ngy.
- Amib gan :
Ngi ln : 1,5 g/ngy, ung 1 ln hoc nhiu ln vo u cc ba n, trong 5 ngy.
Tr em : 30 mg/kg/ngy, ung 1 ln hoc nhiu ln vo u cc ba n trong 5 ngy.
Trong giai on mng m, cn dn lu m song song vi iu tr bng Flagentyl.
- Vim m o v niu o do Trichomonas vaginalis v nhim khun m o : 2 g, mt liu duy
nht. iu tr ng thi ngi c quan h gii tnh : 2 g, mt liu duy nht.

210.

FLAGYL oral

XNLD RHNE POULENC RORER

[AVENTIS PHARMA]
vin bao phim 250 mg : hp 20 vin.
THNH PHN

cho 1 vin
Mtronidazole

250 mg

DC LC
Mtronidazole l thuc khng khun thuc h nitro-5 imidazole.
PH KHNG KHUN
- Cc loi thng nhy cm : Peptostreptococcus, Clostridium perfringens, Clostridium difficile,
Clostridium sp, Bacteroides sp, Bacteroides fragilis, Prevotella, Fusobacterium, Veillonella ;
- Cc loi nhy cm khng thng xuyn : Bifidobacterium, Eubacterium ;
- Cc loi khng : Propionibacterium, Actinomyces, Mobilincus.
- Hot tnh dit k sinh trng : Entamoeba histolytica, Giardia intestinalis, Trichomonas
vaginalis.
DC NG HC
Hp thu :
Sau khi ung, m tronidazole c hp thu nhanh, t nht 80% sau 1 gi. Vi liu tng ng,
nng huyt thanh t c sau khi ung v tim truyn nh nhau. kh dng sinh hc khi
ung l 100% v khng b nh hng bi thc n.
Phn b :
Khong 1 gi sau khi ung 500 mg, nng huyt thanh ti a t trung bnh 10 mg/ml.
Thi gian bn hy huyt thanh : 8-10 gi.
t lin kt vi protine huyt tng : < 20%.
Th tch phn b cao, khong 40 lt (hoc 0,65 lt/kg).
Khuch tn nhanh, mnh, vi nng phi, thn, gan, mt, dch no ty, nc bt, tinh dch,
dch tit m o gn bng nng huyt thanh.
M tronidazole qua c hng ro nhau thai v qua sa m.
Chuyn ha sinh hc :
M tronidazole c chuyn ha ch yu gan, b oxyde ha cho ra 2 cht chuyn ha chnh :
- cht chuyn ha alcool, l cht chuyn ha chnh, c tc dng dit vi khun k kh (khong
30% so vi mtronidazole), thi gian bn hy : 11 gi.
- cht chuyn ha acide, c tc dng dit khun khong 5% so vi mtronidazole.
Bi tit :
Nng cao gan v mt, thp kt trng. t bi tit qua phn. Bi tit ch yu qua nc tiu
do mtronidazole v cc cht chuyn ha oxyde ha hin din trong nc tiu t 35 n 65%
liu dng.
CH NH
- Bnh do amib.

- Bnh ng niu-sinh dc do trichomonas.

- Vim m o khng c hiu.
- Bnh do Giardia intestinalis.
- iu tr cc nhim trng do vi khun k kh trong phu thut.
- iu tr d phng nhim trng do vi khun k kh trong cc trng hp phu thut c nguy c
cao.
- Dng lin tc vi ng tim truyn iu tr hoc phng nga nhim trng do vi khun k
kh.
CHNG CH NH
Qu mn cm vi imidazole.
CH PHNG
- Ngng tr liu khi b mt iu ha, chng mt hoc ri lon tm thn.
- C th lm nng thm trng thi thn kinh nhng ngi b bnh v thn kinh trung ng
hoc ngoi bin nng, n nh hoc tin trin.
- Khng ung ru (hiu ng antabuse).
THN TRNG LC DNG
Theo di cng thc bch cu khi c tin s ri lon th tng mu hay khi iu tr liu cao
v/hoc k o di. Trng hp b gim bch cu, vic tip tc iu tr ty thuc vo mc nng
ca nhim trng.
LC C THAI
Nhng nghin cu ng vt cho thy m tronidazole khng gy qui thai v khng c i vi
phi thai.
Nghin cu trn hng trm ph n c thai s dng m tronidazole trong 3 thng u thai kz,
khng c trng hp gy d dng no ; v nghin cu s dng sau 3 thng ny khng thy c
i vi phi. Do , m tronidazole khng chng ch nh ph n c thai trong trng hp cn
thit.
LC NUI CON B
Trnh dng mtronidazole khi nui con b bng sa m do thuc c bi tit qua sa m.
TNG TC THUC
Khng nn phi hp :
- Disulfiram : v c th gy cn hoang tng v ri lon tm thn.
- Alcool : hiu ng antabuse (nng, , nn ma, tim p nhanh).
Thn trng khi phi hp :
- Cc thuc chng ng mu dng ung (nh warfarine) : tng tc dng thuc chng ng mu
v tng nguy c xut huyt (do gim chuyn ha gan). Kim tra thng xuyn hm lng
prothrombine. iu chnh liu dng ca thuc chng ng trong thi gian iu tr vi
m tronidazole n 8 ngy sau khi ngng iu tr.

Cc phi hp cng nn lu { :
- 5 Fluoro-uracil : lm tng c tnh ca 5 Fluoro-uracil do gim s thanh thi.
Xt nghim cn lm sng :
Mtronidazole c th lm bt ng xon khun, do lm sai kt qu xt nghim Nelson.
TC DNG NGOI
Him, tuy nhin i khi cng c ghi nhn :
ri lon nh ng tiu ha : bun nn, bing n, ming c v kim loi, au thng v, i ma,
tiu chy.
Ngoi l :
- nhng phn ng da-nim mc : ni m ay, cn bng vn mch, nga, vim li vi cm
gic kh ming ;
- nhng du hiu thn kinh-tm thn : nhc u. chng mt, ln, co git ;
- vim ty, hi phc khi ngng iu tr.
Khi dng liu cao hay iu tr di ngy, c th thy :
- gim bch cu.
- bnh thn kinh cm gic ngoi bin, cc triu chng ny lun lun gim ri ht hn khi ngng
iu tr.
Ngoi ra, nc tiu c th nhum mu nu do cc sc t hnh thnh do chuyn ha ca
thuc.
LIU LNG v CCH DNG
Bnh amib :
Ngi ln : 1,5 g/ngy, chia lm 3 ln.
Tr em : 30-40 mg/kg/ngy, chia lm 3 ln.
Trong bnh amib gan, giai on mng m, cn dn lu m song song vi iu tr bng
mtronidazole.
iu tr lin tc trong 7 ngy.
Bnh do trichomonas :
- ph n (vim m o v niu o do trichomonas) : liu duy nht 2 g hoc iu tr phi hp
trong 10 ngy : 500 mg/ngy, chia lm 2 ln, v t thm 1 vin trng vo bui ti. Cn iu tr
ng thi cho c ngi c quan h tnh dc, ngay c khi khng c triu chng bnh.
- nam gii (vim niu o do trichomonas) : liu duy nht 2 g hoc 500 mg/ngy chia lm 2
ln, ung trong 10 ngy.
Rt him khi cn phi tng liu n 750 mg hoc 1 g/ngy.
Bnh do Giardia intestinalis : iu tr lin tc trong 5 ngy.
- Ngi ln : 750 mg - 1 g/ngy.
- Tr em
- t 10 n 15 tui : 500 mg/ngy ;

- t 5 n 10 tui : 375mg/ngy ;
- t 2 n 5 tui : 250 mg/ngy.
Vim m o khng c hiu :
- 500 mg, 2 ln/ngy, ung trong 7 ngy. iu tr ng thi cho c ngi c quan h tnh dc.
- Trong mt s trng hp vim m o, c th kt hp ung v t ti ch 1 vin trng/ngy.
Nhim trng do vi khun k kh :
(iu tr u tay hoc chuyn tip)
- Ngi ln : 1-1,5 g/ngy.
- Tr em : 20-30 mg/kg/ngy.
D phng nhim vi khun k kh trong phu thut :
M tronidazole c dng phi hp vi mt thuc c tc ng trn vi khun ng rut.
- Ngi ln : 500 mg mi 8 gi, bt u dng thuc 48 gi trc khi phu thut, liu cui cng
12 gi sau phu thut.
- Tr em : 20 n 30 mg/kg/ngy, cng phc nh ngi ln.

211.

FLIXONASE

GLAXOWELLCOME
thuc xt mi dng phun m 0,05% : bnh xt 60 liu.
THNH PHN
cho 1 liu
Fluticasone propionate

50 mg

DC NG HC
Sau khi ung, 87-100% liu ung c o thi qua phn, ti a 75% di dng ban u ty
theo liu lng. Rt t cht chuyn ha ch yu c tc dng.
Nu dng ng tim tnh mch, s thanh thi hot cht xy ra nhanh chng, c th do o
thi qu mc gan. Tc bn hy ca qu trnh o thi trong huyt tng vo khong 3 gi.
Th tch phn phi khong 260 lt.
Fluticasone propionate khng c hoc gy nh hng rt t ln trc h i-tuyn yn-thng
thn khi dng ti ch (trn da) hay trong mi.
CH NH
Dng d phng v iu tr chng vim mi d ng theo ma bao gm d ng bi hay phn hoa

(st c kh) v vim mi quanh nm. Polyp mi. Thuc c kh nng khng vim nhng khi dng
ti ch nim mc mi khng thy c tc dng ton thn.
CHNG CH NH
Qu mn vi bt kz thnh phn no ca thuc.
THN TRNG LC DNG
Nhim trng ti ch : Cn iu tr thch hp cc nhim trng ng h hp nhng khng to ra
chng ch nh c hiu trong vic iu tr bng Flixonase.
Tc dng hon ton ca Flixonase ch c th t c sau vi ngy. Cn theo di bnh nhn khi
chuyn t iu tr stroide ton thn sang s dng Flixonase nu c nhng bng chng cho
thy c s suy yu v chc nng thng thn.
Mc d trong hu ht cc trng hp, Flixonase c th kim sot chng vim mi d ng theo
ma, ca nhng tc nhn gy d ng ma h, nhng c th trong mt vi trng hp nht
nh, cng cn c nhng tr liu b sung thch hp, c bit khi kim sot cc triu chng
mt.
LC C THAI
Cha c y bng chng v tnh an ton ca thuc khi dng cho ph n mang thai. Trong
nghin cu trn sc vt, tc dng ngoi v kh nng sinh sn c trng cho corticost roide
tc ng mnh ch c ghi nhn khi dng ng ton thn liu cao ; dng ti ch bn trong
mi khng gy nh hng ton thn. Tuy nhin, ging nh cc thuc khc, s s dng
Flixonase trong thai kz ngi cn c cn nhc gia li ch tr liu v cc nguy c c th xy
ra.
LC NUI CON B
Ngi ta khng bit c kh nng fluticasone propionate tit qua sa m cng nh khng c
cc s liu thu c t nghin cu trn sc vt. Tuy nhin, khi dng bn trong mi ng vt
linh trng, thuc khng c tm thy trong huyt tng v do , hu nh khng c kh
nng tm thy trong sa.
TC DNG NGOI
Khng c tc dng ngoi { chnh no c bo co xut hin do dng Flixonase. Nh i vi cc
thuc xt mi khc, cc kch thch v kh mi hng, gim khu v v kh nng nhn bit mi,
chy mu mi c bo co xut hin rt him.
LIU LNG v CCH DNG
Flixonase ch c dng xt bn trong mi.
Ngi ln v tr em trn 12 tui :
n Phng nga v iu tr vim mi d ng theo ma v vim mi quanh nm : xt hai ln vo mi
l mi, mi ngy mt liu, tt nht vo bui sng. Trong mt vi trng hp c th cn xt hai
liu, mi liu hai ln xt vo mi l mi. Liu ti a mi ngy khng nn vt qu 4 ln xt vo
mi l mi.

Ngi gi :c th dng liu bnh thng cho ngi ln.

Tr em di 12 tui :
n Phng nga v iu tr vim mi d ng theo ma v vim mi quanh nm : liu khuyn co l
mt ln xt vo mi l mi mi ngy. Liu ti a mi ngy khng nn vt qu 2 ln xt vo mi
l mi.
c y li ch tr liu, cn dng thuc u n. Nn gii thch cho bnh nhn rng thuc
khng c tc dng ngay lp tc v tc dng lm gim bnh ti a ch t c sau 3-4 ngy iu
tr.
QU LIU
Khng c s liu v tc ng ca qu liu cp hay mn tnh vi Flixonase. Th nghim vi nhng
ngi tnh nguyn ht vo bn trong mi 2 mg fluticasone propionate hai ln mi ngy trong
vng 7 ngy khng gy nh hng no ln chc nng ca trc h i-tuyn yn-thng thn.
BO QUN
Trong 2 nm, di 30oC.

212.

FLIXOTIDE

GLAXOWELLCOME
kh dung 25 mg/liu : ng xt 60 liu v 120 liu.
kh dung 50 mg/liu : ng xt 60 liu v 120 liu.
kh dung 125 mg/liu : ng xt 60 liu v 120 liu.
kh dung 250 mg/liu : ng xt 60 liu v 120 liu.
THNH PHN
cho 1 liu
Fluticasone propionate

25 mg

cho 1 liu
Fluticasone propionate

50 mg

cho 1 liu
Fluticasone propionate

125 mg

cho 1 liu
Fluticasone propionate

250 mg

DC LC
C ch tc dng :
Fluticasone propionate dng qua ng ht vi liu khuyn co c tc ng khng vim
glucocorticoid mnh ti phi, lm gim cc triu chng v cn hen ph qun, m khng c cc
tc dng ngoi { nh khi dng corticosteroid theo ng ton thn.
Chc nng thng thn :
Lng hormone thng thn tit ra hng ngy vn duy tr trong gii hn bnh thng trong qu
trnh iu tr di hn vi fluticasone propionate ht ngay c khi dng vi liu cao nht c
khuyn co cho tr em v ngi ln. Sau khi chuyn t cc steroid ht khc sang fluticasone
propionate ht, lng hormone tit hng ngy dn dn c ci thin mc d trc kia hay
hin ti c dng gin on cc steroid ng ung, do chc nng thng thn tr v hot
ng bnh thng khi dng fluticasone propionate ht. D tr thng thn vn duy tr bnh
thng trong qu trnh iu tr di hn fluticasone propionate ht khi o bng s tng bnh
thng trong mt test kch thch. Tuy nhin, s suy yu d tr thng thn tn ti sau cc iu
tr trc c th k o di ng k v yu t ny cng cn c lu { (xem Ch { phng v
Thn trng lc dng).
S liu an ton tin lm sng :
c tnh cho thy ch l nhng loi nh hng tiu biu ca cc corticosteroid mnh v ch xy
ra khi dng vi liu cao hn rt nhiu so vi liu c ngh cho iu tr. Khng tm thy
c nh hng no mi qua cc test v c tnh vi liu lp li, cc nghin cu v sinh sn
hay nghin cu v tnh sinh qui thai. Fluticasone propionate khng gy t bin in vitro v in
vivo v khng cho thy kh nng sinh khi u loi gm nhm. Thuc khng gy kch ng v
khng gy nhy cm trn mu th vt.
DC NG HC
Sau khi dng theo ng ung 87 - 100% liu dng c o thi qua phn vi 75% hp cht
di dng khng c hp thu ban u ty theo liu dng. C mt cht chuyn ha ch yu
khng c hot tnh. Sau khi tim tnh mch c mt s thanh thi nhanh chng trong huyt
tng gi cho s o thi mnh gan. Thi gian bn hy o thi trong huyt tng vo

khong 3 gi. Th tch phn b khong 250 lt.

CH NH
Ngi ln :
iu tr d phng trong :
Hen ph qun nh (gi tr PEF cao hn 80% so vi bnh thng vi thay i sng chiu di
20%).
Bnh nhn cn dng thuc gin ph qun khng u n nay s dng nhiu hn bnh thng.
Hen ph qun va (gi tr PEF 60-80% so vi bnh thng vi thay i sng chiu 20-30%).
Bnh nhn cn dng thuc tr hen ph qun thng xuyn. Bnh nhn b hen ph qun khng
n nh hay nng hn khi s dng thuc d phng hin c hay ch n thun dng mt loi
thuc gin ph qun.
Hen ph qun nng (gi tr PEF di 60% so vi bnh thng vi thay i sng chiu 30%).
Bnh nhn b hen ph qun nng mn tnh. Khi dng fluticasone propionate ht, nhiu bnh
nhn b l thuc corticosteroid ng ton thn kim sot y cc triu chng c th
c gim ng k hay khng cn cn phi dng corticosteroid ng ung.
Tr em :
Bt kz tr em no cn dng thuc hen ph qun d phng, bao gm nhng bnh nhi khng
c kim sot vi cc thuc d phng hin c.
CHNG CH NH
Flixotide Inhaler v Accuhaler chng ch nh bnh nhn c tin s qu mn vi bt c thnh
phn no ca thuc.
THN TRNG LC DNG
Vic kim sot hen ph qun nn theo chng trnh iu tr bc thang v p ng ca bnh
nhn nn c kim sot trn lm sng v bng cc xt nghim chc nng phi. Hin tng gia
tng s dng cc cht ch vn b-2 tc ng ngn hn dng theo ng ht kim sot cc
triu chng cho thy c s suy gim kim sot hen ph qun. Trong nhng trng hp ny, nn
nh gi li phc iu tr. Gim kim sot hen ph qun t ngt v tng dn c kh nng e
da n tnh mng v nn cn nhc n vic tng liu corticosteroid. nhng bnh nhn c
xem l c nguy c, nn kim tra lu lng nh k hng ngy.
Flixotide Inhaler v Accuhaler khng dng cho cn hen ph qun cp m dng kim sot
thng quy di hn. Bnh nhn s cn mt thuc gin ph qun theo ng ht tc ng nhanh
v ngn hn lm gim triu chng hen ph qun cp.
Nn kim tra k thut s dng ng ht ca bnh nhn bo m s ng b gia nht xt vi
ng tc ht vo a thuc vo phi mt cch ti u.
Chc nng thng thn v d tr thng thn thng trong khong gii hn bnh thng khi
dng fluticasone propionate ht. Tuy nhin, mt vi nh hng ton thn c th xut hin vi
mt t l nh bnh nhn ngi ln sau khi iu tr ko di vi liu hng ngy ti a c

khuyn co. Bnh nhn chuyn t cc steroid khc dng theo ng ht hay ung sang
fluticasone propionate ht vn cn c nguy c suy gim d tr thng thn trong mt thi gian
ng k.
Bnh nhn c cp cu ni khoa hay ngoi khoa m trong qu kh cn phi dng liu cao
cc steroid ht khc v/hoc c iu tr gin on vi cc steroid ung vn cn c nguy c
suy d tr thng thn trong mt thi gian ng k sau khi chuyn sang fluticasone propionate
ht. Mc suy thng thn c th i hi phi c kin cc chuyn gia trc khi la chn
bin php iu tr. Nn lun lun lu { n kh nng suy gim p ng thng thn cn tn ti
li trong cc trng hp cp cu, v cn phi cn nhc n cc trng hp chn lc c kh
nng gy stress v khi iu tr corticosteroid thch hp cn c quan tm.
tr em dng cc liu khuyn co fluticasone propionate ht, chc nng thng thn v d tr
thng thn thng vn trong gii hn bnh thng. Khng quan st c tc dng ngoi
ton thn v c bit l khng lm chm s pht trin tr em c cho dng fluticasone
propionate ht. Tuy nhin, khng nn xem nh cc nh hng c th c ca cc iu tr trc
hoc iu tr cch qung vi corticoid ng ung.. Tuy nhin, dng fluticasone propionate
ht c th s lm gim n mc ti thiu nhu cu steroid ung.
Vic thiu p ng hay tng nng hn tnh trng hen ph qun nn c iu tr bng cch gia
tng liu fluticasone propionate ht v nu cn thit, cho dng mt steroid ton thn v/hoc
khng sinh nu c nhim khun.
i vi vic chuyn bnh nhn ang s dng corticosteroid ung sang Flixotide ng ht :
- Vic chuyn bnh nhn b l thuc steroid ung sang Flixotide Inhaler v Accuhaler v vic
kim sot sau cn c bit thn trng, do vic hi phc chc nng suy v thng thn do
iu tr steroid ton thn ko di c th cn mt thi gian ng k.
- Nhng bnh nhn c iu tr vi steroid ton thn trong mt thi gian di hay vi liu
cao c th suy v thng thn. Nn kim tra u n chc nng v thng thn nhng ngi
ny v thn trng gim dn liu dng steroid ton thn ca h.
- Sau khong mt tun, bt u gim dn dn lng steroid ton thn. Nn gim liu thch hp
vi mc steroid ton thn duy tr v gim trong khong thi gian khng di mt tun. i
vi liu duy tr prednisolone (hay thuc tng ng) 10 mg hay t hn, nn gim liu khng
qu 1 mg cho mi ngy v gim trong khong thi gian khng di mt tun. i vi liu duy
tr prednisolone cao hn 10 mg, c th gim mt cch thn trng vi mc gim cao hn vi
gim cch qung mt tun.
- Mt vi bnh nhn cm thy kh chu mt cch khng c hiu trong qu trnh ngng gim
thuc mc d c s duy tr hay thm ch ci thin h hp. H nn c khuyn khch tip tc
s dng fluticasone propionate ht v ngng dn setroid ton thn, tr phi c nhng du hiu
khch quan ca thiu nng thng thn.
- Bnh nhn b khng dng steroid ung nhng vn cn b suy chc nng v thng thn

nn mang theo trong ngi mt th lu { rng h c th cn dng thm steroid ton thn
trong cc giai on stress nh cn hen ph qun kch pht nng ln, nhim trng h hp, bnh
chnh ti pht, phu thut, chn thng, vv.
- S thay th iu tr steroid ton thn bng iu tr theo ng ht i khi lm l ra cc d ng
nh vim mi d ng hay eczema c kim sot trc bng thuc dng ton thn. Cc
d ng ny nn c iu tr triu chng vi cc thuc khng histamine v/hoc thuc dng ti
ch, bao gm cc steroid dng ti ch.
Khng nn ngng iu tr vi Flixotide Inhaler v Accuhaler mt cch t ngt.
Cng ging nh cc corticosteroid ht khc, cn c bit thn trng i vi bnh nhn b lao
phi tin trin hay tim n.
nh hng n kh nng li xe v vn hnh my mc :
Fluticasone propionate hu nh khng c nh hng no n kh nng li xe v vn hnh my
mc.
LC C THAI v LC NUI CON B
Bng chng v tnh an ton ca fluticasone propionate trong thai kz ngi l cha y .
Cc nghin cu v s sinh sn th vt ch cho thy cc tc dng c trng cho cc
glucocorticoid khi tip xc ton thn vi liu cao hn rt nhiu so vi liu iu tr theo ng
ht c khuyn co. Cc xt nghim v kh nng gy tn hi ln s di truyn cho thy
khng c kh nng t bin. Tuy nhin, cng ging nh cc thuc khc, ch nn xem xt s
dng fluticasone propionate trong thai kz nu li ch mong i cho ngi m cao hn mi nguy
c c th gy ra cho thai nhi.
Khng bit c l fluticasone propionate c tit ra trong sa m hay khng cng nh khng
c s liu no t cc nghin cu trn th vt. Tuy nhin, xt v c tnh dc ng hc, vic
fluticasone propionate tit vo sa hu nh khng th xy ra.
TNG TC THUC
Cha c nghin cu tng tc thuc c hiu no c thc hin. Tuy nhin, do nng
t c trong huyt tng qua ng ht rt thp, hu nh khng c kh nng xy ra tng
tc thuc.
Khng c bo co v tng tc thuc c nghi ng no trong chng trnh trin khai trn lm
sng.
TC DNG NGOI
Bnh candida ming v hng (bnh ta ming) xy ra mt vi bnh nhn. Cc bnh nhn ny
c th cn phi sc ming bng nc sau khi dng ng ht. Bnh candida triu chng c th
c iu tr vi thuc khng nm ti ch trong khi vn tip tc dng Flixotide Inhaler v
Accuhaler.
mt vi bnh nhn fluticasone propionate ht c th khn ging. Sc ming bng nc ngay
sau khi ht thuc c th c ch.

Cng ging nh cc tr liu theo ng ht khc, co tht ph qun kch pht c th xut hin
cng vi gia tng th kh kh ngay sau khi dng thuc. Nn iu tr ngay lp tc vi thuc gin
ph qun ng ht tc dng nhanh. Ngng thuc ngay lp tc v nh gi tnh trng bnh
nhn, v nu c th, nn p dng iu tr thay th.
LIU LNG v CCH DNG
Flixotide Inhaler v Accuhaler ch ng dng theo ng ht.
Bnh nhn nn c cho bit v bn cht d phng ca iu tr vi fluticasone propionate ht
v nn dng thuc ny u n ngay c khi khng c biu hin triu chng. Tc dng iu tr
khi pht trong vng 4 n 7 ngy.
Nn iu chnh liu lng fluticasone propionate ty theo p ng ca tng bnh nhn.
Nu bnh nhn cm thy vic iu tr vi thuc gin ph qun tc dng ngn hn tr nn km
hiu qu hay h cn ht thuc nhiu hn bnh thng, nn hi kin ca bc s.
Thuc c thit k sao cho mi liu k toa ti thiu l 2 ln ht.
Liu lng :
Ngi ln v tr em trn 16 tui : 100 n 1000 mg hai ln mi ngy.
Nn dng liu bt u cho bnh nhn ty thuc vo mc trm trng ca bnh :
Hen ph qun nh : 100 n 250 mg hai ln mi ngy
Hen ph qun va : 250 n 500 mg hai ln mi ngy
Hen ph qun nng : 500 n 1000 mg hai ln mi ngy
Sau c th iu chnh liu t n tnh trng kim sot hay gim n liu thp nht c
hiu qu ty theo p ng ca tng ngi.
Mt cch khc, liu fluticasone propionate bt u c th c xc nh bng na tng liu
hng ngy beclomethasone dipropionate hay tng ng c dng qua ng ht nh liu.
Tr em trn 4 tui : 50 n 100 mg hai ln mi ngy.
Nn dng liu fluticasone propionate bt u cho tr em ty theo mc ca bnh, c th l
50 hay 100 mg hai ln mi ngy.
Sau c th iu chnh liu t n tnh trng kim sot hay gim n liu thp nht c
hiu qu ty theo p ng ca tng ngi.
Cc nhm bnh nhn c bit :
Khng cn iu chnh liu lng cho bnh nhn ln tui hay nhng ngi b suy gan hay suy
thn.
QU LIU
Cp tnh :
Vic ht phi thuc vi liu cao vt qu liu khuyn co c th dn n suy chc nng thng
thn tm thi. Trng hp ny khng cn phi cp cu. nhng bnh nhn ny c th tip tc
iu tr fluticasone propionate theo ng ht vi liu va kim sot hen ph qun ; chc
nng thng thn s phc hi vi ngy sau v c th kim tra bng cch o lng cortisol

huyt tng.
Mn tnh :
S dng fluticasone propionate vi liu hng ngy cao qu 2 mg trong mt thi gian di c th
dn n mt mc suy thng thn no . C th ch nh kim tra d tr thng thn.
Nn tip tc iu tr vi fluticasone propionate vi liu va kim sot hen ph qun.
BO QUN
Flixotide Innhaler v Accuhaler nn c bo qun trong iu kin nhit t 2 n 30oC,
trnh ng lnh v nh nng trc tip.
Flixotide Inhaler : Cng ging nh hu ht cc thuc ht trong ng xt p lc, tc dng tr liu
ca thuc ny c th b gim bt khi ng b lnh. ng xt khng c m thng, lm v hay
t ngay c khi trng rng.

213.

FLUDITEC

INNOTECH
c/o ZUELLIG
Sir dng cho tr em v nh nhi 2% : chai 125 ml.
Sir dng cho ngi ln 5% : chai 125 ml.
THNH PHN
cho 1 mung caf Fluditec 2%
Carbocistine

100 mg

(Saccharose)

(3,5 g)

cho 1 chai Fluditec 2%

Carbocistine

2,5 g

(Saccharose)

(87,5 g)

cho 1 mung canh Fluditec 5%

Carbocistine

0,75 g

(Saccharose)

(5,25 g)

cho 1 chai Fluditec 5%

Carbocistine

6,25 g

(Saccharose)

(43,75 g)

DC LC
Cht tan m (R : h h hp).
Carbocistine c tc dng iu ha s tit m kiu lm tan m. Thuc tc ng trn giai
on gel ca cht nhy c l bng cch ct t cu ni disulfures ca cc glycoprotine, v do
to thun li cho s khc m.
DC NG HC
Sau khi ung, carbocist ine c hp thu nhanh : nng nh trong huyt tng t c
sau 2 gi. kh dng sinh hc yu, di 10% liu s dng, c th do s chuyn ha trong lng
rut v tc dng quan trng ca ln u tin qua gan. Thi gian bn hy thi tr thuc l
khong 2 gi. Thuc v cc cht chuyn ha ca n c thi tr ch yu qua thn.
CH NH
iu tr nhng ri lon ca s tit ph qun, nht l trong cc bnh ph qun cp tnh : vim
ph qun cp, giai on cp tnh ca cc bnh phi-ph qun mn.
CHNG CH NH
C tin s qu mn cm vi mt trong nhng thnh phn ca thuc (nht l vi
parahydroxybenzoate de mthyle v cc mui khc ca parahydroxybenzoate).
CH PHNG v THN TRNG LC DNG
Ch { phng :
- S kt hp thuc lm tan m vi thuc chng ho v/hoc thuc lm kh s tit m (tc
dng ging atropine) l khng hp l.
- Ho khc m l yu t c bn bo v ph qun-phi nn cn c tn trng.
Thn trng lc dng :
- Cn thn trng nhng bnh nhn b lot d dy t trng.
- Trng hp bnh nhn b tiu ng hoc ang c ch n gim ng, cn tnh ton

lng saccharose a vo.

LC C THAI v LC NUI CON B
Lc c thai :
Cc nghin cu trn ng vt th nghim cho thy r thuc khng gy qui thai.
Trong trng hp thuc khng gy qui thai ng vt th nghim th c l tc dng gy d
dng ngi cng khng xy ra.
Tht vy, ngy nay, nhng cht gy d dng ngi u c pht hin l nhng cht gy qui
thai ng vt th nghim trong cc nghin cu c theo di k loi vt v loi ngi.
Trn lm sng, hin nay khng thy xut hin bt kz tc dng gy d dng hoc c cho thai
no.
Tuy nhin, vic theo di cc ph n c thai c dng carbocistine trong thai kz khng y
loi tr tt c cc nguy c.
Do vy, ch dng carbocistine cho ph n c thai khi cn thit.
TC DNG NGOI
Kh nng c hin tng khng dung np thuc v tiu ha (au d dy, bun nn, tiu chy).
Trong trng hp ny, cn gim liu.
LIU LNG v CCH DNG
Thi gian iu tr khng qu 8 n 10 ngy m khng c kin ca bc s.
Fluditec 2% :
- Tr em trn 5 tui : 300 mg/ngy, chia lm 3 ln, hoc mi ln 1 mung caf x 3 ln/ngy.
- Tr em t 2 tui n 5 tui : 200 mg/ngy, chia lm 2 ln, hoc mi ln 1 mung caf x 2
ln/ngy.
- Tr nh nhi v tr em t 1 thng n 2 tui : 20-30 mg/kg/ngy, chia lm 1 hoc 2 ln, hoc
mi ln 1 mung caf x 1 ln/ngy.
Fluditec 5% :
Dng cho ngi ln.
Mi ln dng 750 mg x 3 ln/ngy, hoc mi ln ung 1 mung canh x 3 ln/ngy.

214.

FML-NEO

ALLERGAN
Hn dch tra mt : l 5 ml - Bng B.
THNH PHN

cho 1 ml
Fluoromtholone

1 mg

Nomycine sulfate tnh theo nomycine base

3,5 mg

DC LC
Fluoromtholone l mt corticoide, c tc dng c ch p ng vim gy ra do cc tc nhn
kch thch.
Nhm corticoide ni chung c tc dng c ch ph n, ng fibrine, gin n mao mch, s
vn chuyn bch cu, hot ng thc bo, tng sinh mao mch, tng sinh nguyn bo si,
ng collagne v s hnh thnh so i km vi qu trnh vim. Corticoide tc ng bng cch
cm ng sinh tng hp phospholipase ca nhng cht trung gian chnh ca phn ng vim nh
prostaglandine v leucotrine bng cch c ch s phng thch tin cht ca nhng cht ny l
acide arachidonique. Acide arachidonique c phng thch t cc phospholipide bi men
phospholipase A2. Corticoide v cc dn xut ca n c th to mt s tng vt p lc ni nhn.
Trong cc nghin cu lm sng mt ca bnh nhn c iu tr bng dexamthasone 0,1%
v fluoromtholone 0,1%, fluorometholone cho thy c xu hng gy tng nhn p t hn so
vi dexamthasone.
Nomycine l mt khng sinh dit khun ph rng tc ng ln nhiu loi vi khun Gram m v
Gram dng khc nhau nh Staphylococcus aureus, Escherichia coli, Haemophilus influenzae,
Klebsiella/Enterobacter spp., Neisseria sp, Proteus v Corynebacterium. M, cht tit v cc sn
phm trong qu trnh tng trng ca vi khun khng lm khng sinh mt hot tnh.
CH NH
- FML-Neo hu hiu trong vic iu tr vim kt mc nhim trng do cc mm bnh nhy cm
vi nomycine.
- FML-Neo c th c s dng trong iu tr cc bnh vim bn phn trc ca mt c nguy
c hay c th c bin chng do cc vi khun nhy cm vi nomycine.
- FML-Neo c dng sau khi ly d vt mt, cng nh c dng trc v sau phu thut
mt c kh nng nhim trng bi cc vi khun nhy cm vi thuc.
CHNG CH NH
Nhim trng mt cp tnh c sinh m khng c iu tr do cc mm bnh khng nhy cm
vi nomycine. Cc bnh ca gic mc v kt mc do virus nh herpes simplex nng cp (vim
gic mc dng ui gai), vaccinia, varicella v hu ht cc bnh c ngun gc virus khc. Lao
mt. Nm mt. Qu mn vi bt kz thnh phn no ca thuc.
CH PHNG
- Trong cc bnh do vi khun khng vi nomycine, dng corticoide c th che lp du hiu

nhim trng hoc lm cho nhim trng nng thm. Vic s dng ko di c th a n s
pht trin tng vt ca cc vi khun khng nhy cm.
- Mt s bo co trong y vn hin nay cho thy c s gia tng ph bin ngi nhy cm vi
n omycine. Do nn ch { n kh nng xy ra phn ng nhy cm ny.
- Nu c du hiu xut hin phn ng c hi khc, ngng dng thuc.
- Nhim trng kt mc do vi nm c bo co xut hin trong mt s trng hp dng
corticoide ti ch ko di, do nn lu { n nguy c xm nhim vi nm nu c du hiu lot
gic mc k o di khi hoc ang dng corticoide trong mt thi gian di.
- Mt s bnh khc nhau v mt v vic s dng corticoide lu di c bit nh l mt nguyn
nhn gy nn mng gic mc v cng mc. S dng corticoide ti ch khi ang b mng m kt
mc hay cng mc c th gy thng.
- Cc nhim trng sinh m cp tnh khng c iu tr mt c th b che khut, tng cng
hay hot ha khi c s hin din ca corticoide. Nhim trng mt th pht c th xut hin t
cc mm bnh c phng thch t cc m mt.
- Dng corticoide iu tr cho bnh nhn c tin s herpes simplex cn phi c bit thn
trng v nn thc hin khm bng knh hin vi n khe (slit-lamp microscopy).
- Cc bo co trong y vn chng minh rng chng c bao sau th thy tinh xy ra sau khi
dng nhiu hay dng ko di corticoide ti ch mt.
- Dng ko di corticoide ti ch c th lm tng nhn p. Mc d cc s liu hin nay chng
minh rng s gia tng p lc ni nhn ni chung khng l vn vi nhng bnh nhn c
iu tr vi fluorom tholone 0,1%, cng nn thng xuyn kim tra nhn p ca nhng bnh
nhn ny.
THN TRNG LC DNG
Dng ko di corticoide ti ch c th lm tng nhn p. Nn kim tra nh kz nhn p v thy
tinh th khi s dng FML-Neo ko di.
Tr em : cha xc nh c tnh an ton v hu hiu khi dng cho tr em.
LC C THAI
Cha xc nh c tnh an ton ca vic s dng corticoide ti ch lc c thai.
TC DNG NGOI
Cc phn ng thng thng xut hin bao gm tng nhn p vi kh nng gy glaucome v c
thy tinh th di bao sau.
LIU LNG v CCH DNG
Nh mi ln 1 git vo ti kt mc pha trc, 2-4 ln/ngy. Trong 24 n 48 gi u tin, c
th gia tng liu mt cch an ton n 1 git dng trong mi gi. Cn thn khng nn ngng
thuc sm.
Lc k trc khi s dng.

BO QUN
Bo qun nhit 15-25o C ; trnh ng lnh.

215.

FONZYLANE

LAFON
c/o GALIEN
vin bao 150 mg : hp 20 vin.
vin bao 300 mg : hp 10 vin.
dung dch tim 50 mg/5 ml : ng 5 ml, hp 2 ng.
THNH PHN
cho 1 vin
Buflomdil chlorhydrate

150 mg

(Saccharose)

cho 1 vin
Buflomdil chlorhydrate

300 mg

(Saccharose)

cho 1 ng
Buflomdil chlorhydrate

50 mg

DC LC
Thuc gy gin mch trc tip tc ng hng c.
Tc ng trn mch mu ca buflom dil c lin quan n hai thnh phn dc l{ : tc ng c
ch adrnaline a-1 v a-2 v mt tc ng trc tip trn cu trc ca t bo c ca h vi tun
hon :
- Do tc ng c ch adrnaline a-1 khng chuyn bit, buflom dil i khng ti ch vi tc

ng gy co mch ca adrnaline, ca chng stress v thi tit lnh. Tc ng ny ch yu

c tm thy cc ng mch giu th th a trn cc ng mch ngoi bin ca cc c trn
ng tun hon phn phi mu.
- Do tc ng chuyn bit trn h vi tun hon c lin quan n tc dng trn s chuyn ng
ca dng calci cc t bo c xung quanh mch mu, buflomdil m cc c tht trc mao
qun b co tht trc v do hi phc li hot ng chc nng ca h vi tun hon c
v da.
- Tc ng iu ha vn mch :
Ngoi tc ng gin mch ngoi bin, hot ha no b, buflom dil cn c tc ng iu ha
huyt lu, bao gm :
ci thin kh nng bin dng hng cu v nhn ca mu,
c ch s ngng kt tiu cu.
- Tm li : vi cc c tnh dc lc hc nu trn, buflom dil c a dng v thch hp nht
trong iu tr cc bnh mch mu ngoi bin v no. Buflom dil cng nh hng n s lng
v cht lng ca mu trong vic nui dng cc vng b thiu mu (do nghn mch hoc do
hin tng b cp mu bi dng cc thuc gin mch qu mnh) nhng li khng gy nh
hng c tnh cch h thng.
ng vt :
- Nghin cu quay phim kho st vi th nh lng (microcinmatographie quantitative) trc
tip trn g m ca chut lang cho thy c tng ng knh ca cc vi mch t 16 n 20%
sau khi s dng ti ch buflomdil.
- Tim trong ng mch, trong tnh mch v trong t trng ch tnh to hoc b gy m,
buflom dil lm tng lu lng mu ng mch i nhng cng lm tng lu lng mu n
da v c vi gim tng khng ngoi vi. S tng ny cao hn ng k so vi cc thuc cng nhm
c s dng i chng.
ngi :
- Thc hin cc xt nghim soi mao mch sau khi iu tr bng buflom dil ng ung hoc
tim tnh mch cho thy rng c tng v s lng v kch thc ca cc quai mao qun v lm
gin cc c tht trc mao qun, ng thi tng vn tc tun hon ca hng cu.
- Buflomdil khng gy chuyn ng khi lng quan trng ca mu, do khng lm thay i
ng k ng lc mu tim (huyt p ng mch tm thu v tm trng, tn s tim, p lc
pht mu tm tht, lu lng tim ton phn v tm thu, ch s tim, lm vic ca tht tri).
iu ny c kim chng ng vt v ngi bng phng php thng tim.
DC NG HC
S chuyn ha ca buflom dil c nghin cu chut cng v ch bng phng php
phn tch l ha v bng cch nh du bng C14, ngi bng phng php kim nh l ha,
buflom dil c hp thu nhanh rut, lu li ch yu trong huyt tng ( chut cng v ch,

50% sn phm cn tnh trng t do).

- Thi gian bn hy o thi huyt tng tng i ngn : t 1,47 n 2,60 gi.
- Vn tc o thi v mc gn kt khng ty thuc vo ng s dng.
- Th tch phn phi trong ton c th cho thy thuc c phn phi rng v n m nhiu.
- o thi nhanh qua thn (6-18%), nhng nht l qua cc ng chuyn ha khc (mt, vv ).
- ngi suy thn nng, thi gian bn hy o thi huyt tng l 5,38 gi +/- 3,41.
CH NH
Ch nh chnh :
Cc ri lon tun hon no :
- Suy gim tr nh ngi c tui.
- Suy tun hon no tht l th pht do x ha ng mch hoc tng huyt p.
- Sau tai bin mch mu no : nhm ci thin vi tun hon.
- Ri lon tin nh : hoa mt, chng mt, tai.
Tc ng mch ngoi vi :
- Vim tc ng mch : nh tc ng mch chi di mn tnh gy chng i khp khing cch
hi.
- Cc trng hp suy ng mch ngoi bin trong i tho ng.
Bnh Raynaud .
Cc ch nh khc :
- Cc au do lon dng.
- Bnh thn do i tho ng.
- Phu thut v, chuyn, ghp cc vt da.
- D phng sau thiu mu c tim.
CH PHNG v THN TRNG LC DNG
Gim liu bnh nhn suy thn.
bnh nhn suy thn c thm tch, buflom dil c thanh thi rt thp, khong 5 n
10%. Kim tra trong vng 4 tun vi 3 ln thm tch/tun cho thy buflomdil khng b tch t.
Dung np trn lm sng v sinh hc c xc nhn l tt.
TC DNG NGOI
Cc tc dng ph ca buflomdil rt him gp v ch tm thi : ri lon nhu ng d dy-rut,
bun nn, nhc u, chng mt, cm gic kim chm u chi v nng da.
LIU LNG v CCH DNG
ng tim bp hoc tim tnh mch chm : tim mi ln 1 ng, ngy 2 ln vo bui sng v
bui ti.
ng truyn tnh mch trong dung dch NaCl 0,9% hoc glucose 5% : 2-8 ng/ngy.
ng ung :
2 n 4 vin/ngy.

Suy thn : gim na liu, hay 1 n 2 vin/ngy.

QU LIU
Khng c hin tng ng c no c pht hin khi dng liu cao trong nhng iu kin
thng thng.
Trng hp c tnh ung mt lng thuc rt ln, c th gy kch ng hoc kch thch no vi
cn co git. X l bng cch dng benzodiazpine.

216.

FORANE

ABBOTT
Dung dch bay hi 100% : chai 100 ml, chai 250 ml - Bng B.
THNH PHN
Isoflurane

100%

M T
Isoflurane.
Florane l mt thuc m bay hi khng c kh nng bc chy.
Forane c tn ha hc l 1-chloro-2,2,2-trifluoroethyl, difluoromethyl ether.
TNH CHT
Tnh cht vt l :
- Trng lng phn t 184,5.
- Nhit si 760 mmHg l 48,5oC.
- Ch s khc x n0 1,2990-1,3005.
- T trng 25oC l 1,496.
p sut hi bo ha (mmHg) :
- nhit 20oC l 238.
- nhit 25oC l 295
- nhit 30oC l 367
- nhit 35oC l 450
H s ha tan 37oC :
- Nc / Kh : 0,61.
- Mu / Kh : 1,43
- Du / Kh : 90,8.
H s ha tan 25oC i vi cao su v nha tng hp :

- Cao su ng dn / Kh : 62,0.
- Cao su butyl / Kh : 75,0.
- Nha PVC / Kh : 110,0.
- Nha PE / Kh : ca 2,0.
- Nha Polyurethane / Kh : ca 1,4.
- Nha Polyolefin / Kh : ca 1,1.
- Nha Butyl acetate / Kh : ca 2,5.
tinh khit o bng php sc k kh : trn 99,9%.
Kh nng bc chy trong O2 v N2O :
9J/giy v 23oC : Khng th bc chy.
900J/giy v 23oC : Khng th bc chy nhng nng thng dng gy m.
Nng ti thiu trong ph nang (MAC) :
Tui

100% O2

70% N2O

26 +/-1 4

1,28

0,56

44 +/- 7

1,15

0,50

64 +/- 5

1,05

0,37

Forane l mt dung dch khng mu, bn vng m khng phi thm vo cht n nh. Forane
c mi hi cay ging ether. Bng php sc k{ kh ngi ta khng thy s thay i thnh phn
ca nhng mu ng trong nhng chai trong sut em phi gin tip di nh sng mt tri
trong 5 nm hay chiu tia cc tm trong 30 gi.
Khng lm tiu hao cht kim khi cho Forane tip xc trn 6 thng vi sodium methoxide nng
1N trong ru methanol, iu ny chng minh rng Forane c bn cao i vi cht kim
mnh. Forane khng b phn hy khi dng chung vi vi ht thn kh v khng lm n mn
nhm, thic, thau, ng, st.
DC LC
Khi m nhanh v c bit l hi tnh sm. Mc d mi hi cay c th gii hn tc khi m,
nhng thuc khng kch thch tng tit nc bt v dch ph qun qu mc. Phn x hu, thanh
qun c lm gim mt cch nhanh chng. m thay i nhanh khi gy m vi Forane. Nhp
tim c duy tr n nh. H hp s suy gim khi gy m su v nn c theo di mt cch
cht ch.
Trong lc khi m, huyt p c chiu suy gim nhng s tr v bnh thng khi phu thut. S
suy gim trong khi duy tr m c lin quan trc tip vi su khi gy m, nhng nhp tim vn
c duy tr n nh. Khi p dng phng php h hp ch huy v duy tr PaCO2 bnh thng,

cung lng tim c duy tr n nh khng ph thuc vo vic tng m, l nh c ch

tng nhp tim b tr. Khi bnh nhn t th, s ng CO2 c th lm tng nhp tim v xut
lng tim qu mc.
S ti mu c duy tr khng i trong khi gy m nh vi Forane, nhng c khuynh hng
tng khi gy m mc su hn. S gia tng p lc dch no ty c th c ngn chn hoc
lm gim bt bng cch tng thng kh trc v trong khi gy m.
Nhng thay i trn in no v hin tng co git cc kz him xy ra khi gy m vi
Forane.
Forane lm xut hin s nhy cm ca c tim i vi adrenaline trong mt phm vi nh hn so
vi Enflurane. Mc gii hn khi tim di da c ngh ln n 50 ml dung dch adrenaline
1/200.000 vn khng khi pht nhng cn lon nhp tht khi bnh nhn c gy m vi
Forane.
Tnh trng dn c va trong phu thut bng m bnh thng, nhng s dn c nhiu
hn khi dng phi hp vi nhng liu nh thuc dn c tim tnh mch. Tt c nhng thuc
dn c thng dng u c pht huy tc dng bi Forane, hiu qu r rng nht i vi
thuc gin c khng kh cc.
Neostigmine tc dng ngc li vi thuc dn c khng kh cc nhng khng lm nh hng
n tnh cht dn c ca Forane. Tt c nhng thuc dn c thng dng u tng hp vi
Forane.
Forane c th c dng dn u v duy tr trong gy m ton din. Cha c d liu y
c gi tr xc nh vai tr ca Forane trong thai kz, gy m sn khoa hn l trong gy m m
ly thai.
DC NG HC
Forane c chuyn ha t trong c th ngi. giai on hu phu, ch c 0,17% Forane c
tm thy trong nc tiu di dng chuyn ha.
Gi tr Fluor v c / huyt thanh cao nht thng di 5 mmol/l, xy ra khong 4 gi khi gy
m v tr v gi tr bnh thng trong vng 24 gi. Khng c bo co no cho thy c du hiu
tn thng thn sau khi dng Forane.
CH NH
Dng trong gy m ng h hp.
CHNG CH NH
Khng nn dng khi bit bnh nhn nhy cm vi Forane hoc c tin cn st cao c tnh khi
gy m vi Forane.
V m c th thay i nhanh chng v d dng vi Forane, ch nn dng nhng bnh bay hi
m c th d on chnh xc v hp l{ lng thuc m gy ra, hoc p dng nhng k thut
c th theo di st nng kh ht vo, th ra trong sut cuc gy m.
C th p dng s suy gim huyt p v h hp khi gy m su trong mt vi ch nh. Kinh

nghim lm sng khi dng Forane khng ghi nhn c bng chng gy c cho gan, ngay c
sau khi dng ko di. Tuy nhin kinh nghim trong vic gy m lp li nhiu ln bng Forane b
gii hn v cha chng minh c nh hng ca vn ny ln chc nng gan.
Cng nh vi nhng thuc gy m h Halogen khc, Forane phi c ch khi dng cho
nhng bnh nhn c tng p lc ni s. Trong nhng trng hp ny nn tng thng kh cho
bnh nhn.
Forane pht huy tc dng ca thuc dn c khng kh cc.
LC C THAI v LC NUI CON B
Nhng nghin cu v sinh sn loi vt c a ra sau khi lp li nhiu ln vic gy m vi
Forane.
Nghin cu trn chut chng minh rng thuc khng nh hng ln kh nng th thai, thai
kz, lc chuyn d v kh nng sng st ca chut con.
Cha c bng chng pht hin thuc gy nn d tt bm sinh.
Kt qu thu c cng tng t khi th nghim trn th.
S tng quan ca nhng nghin cu ny trn con ngi th cha c bit r. An ton trong
thai kz cha c xc nh. So snh s mt mu nhng bnh nhn sinh non c gy m vi
Forane v nhng thuc m dng hi khc cho kt qu tng t. Cha c nhng d liu y
xc nh r vic s dng Forane trong gy m sn khoa ngoi tr vic gy m m bt thai.
TC DNG NGOI
Lon nhp tim.
Tng s lng bch cu, ngay c khi khng c nhng stress phu thut.
Nng fluor v c / huyt thanh tng t trong v sau khi gy m vi Forane do thuc b phn
hy trong c th. Vi nng thp nh vy (trung bnh 4,4 mmol/lt nh trong mt nghin
cu) kh c th gy c cho thn khi m n cn thp di ngng cho php.
Nh nhng thuc gy m h Halogen khc, s suy gim h hp v tun hon c ghi nhn.
Cn theo di st huyt p v h hp.
Cn c nhng phng tin my mc chn on v iu tr s suy gim h hp v huyt p
gy ra bi gy m su. Nhng tc dng ngoi { trong giai on hi tnh (run, bun nn, i ma)
t gp hn cc thuc m khc.
LIU LNG v CCH DNG
Nn dng bnh bc hi c hiu c chia dnh ring cho Forane kim sot nng thuc
m mt cch chnh xc.
Nng ti thiu trong ph nang (MAC) thay i theo tui. Bng sau y cho thy gi tr MAC
trung bnh tng ng vi tng nhm tui khc nhau :
Tui

MAC trung bnh trong oxy

0-1 thng

1,6%

1-6 thng

1,87%

6-12 thng

1,8%

1-5 tui

1,6%

tui 20

1,28%

tui 40

1,15%

tui 60

1,05%

Tin m :
Nn chn la thuc tin m ty theo tng trng hp c th, lu { n tc dng lm suy gim
h hp ca Forane. Dng nhng thuc anti-cholinergic l mt vn cn nhc. Nhng trong
gy m tr em li c khuyn nn dng.
Khi m :
u tin s dng mt loi thuc ng tc dng ngn hoc mt loi thuc dn u gy m tim
ng tnh mch v tip theo sau bng hn hp hi m Forane.
Forane c th c ha ln vi oxy hoc hn hp O2 / N2O.
Nn bt u khi m vi Forane nng 0,5%. Nng 1,5-3% thng ch nn ko di t 710 pht trong gy m.
Duy tr :
t m cn thit trong phu thut c th duy tr nng 1-2,5% Forane trong hn hp
O2 / N2O. C th tng thm 0,5-1% Forane khi ch dng vi O2.
m ly thai, 0,5-0,7% trong hn hp O2 / N2O l thch hp duy tr m cn thit.
Trong iu kin bnh thng huyt p ng mch trong sut giai on duy tr m c khuynh
hng nghch o vi nng Forane trong ph nang. Huyt p h thp c th gy ra bi gy
m su v trong tnh hung ny nn iu chnh bng cch gim bt nng Forane trong khi
ht vo.
i vi bnh nhn ln tui :
Cng nh nhng thuc m khc, cn gim nng Forane khi duy tr m cho bnh nhn ln
tui.
Xem lin quan gia MAC v tui bng bn trn.
BO QUN
Bo qun ni mt. y kn nt khi s dng xong.

217.

FORLAX

BEAUFOUR IPSEN
Bt pha dung dch ung : hp 10 gi v 20 gi.
THNH PHN
cho 1 gi
Macrogol 4 000

10 g

(T dc Saccharin sodium, hng v cam

bi)
DC LC
Cc cht macrogol cao phn t l nhng polymer di thng trn cc phn t nc c gn
vo bng nhng cu ni hydro. Chng lm tng lng nc trong rut khi ung vo.
Th tch nc trong rut khng c hp thu nn dung dch c tnh nhun trng.
DC NG HC
Do trng lng phn t ln, nn Macrogol khng b hp thu v cng khng b chuyn ha ti
ng tiu ha.
CH NH
iu tr triu chng to bn ngi ln.
CHNG CH NH
Bnh vim rut thc th (vim lo t i-trc trng, bnh Crohn ...), hi chng tc hay bn tc,
hi chng au bng khng r nguyn nhn.
THN TRNG LC DNG
Ni chung, thuc to bn khng khuyn dng lu di. Thuc iu tr bn ch ph tr cho vic
iu tr bng ch n ung v sinh thch hp :
- Thm nhiu cht x ca rau qu vo thc n v ung nhiu nc,
- Hot ng thn th v tp thi quen i cu.
Forlax c th c k toa cho bnh nhn tiu ng hay bnh nhn theo ch n khng c
galactose v khng cha ng hay polyol.
TNG TC THUC
Forlax c th lm gim hp thu ca cc thuc ung cng lc.
Thng thng, nn dng Forlax cch xa nhng thuc khc t nht 2 gi.

TC DNG NGOI
- Trong trng hp qu liu, tiu chy xut hin v ngng trong vng 24 n 48 gi sau khi
chm dt iu tr, vic iu tr c th c tip tc vi liu thp hn.
- au bng c th c, nht l bnh nhn b ri lon chc nng rut (hi chng rut d b kch
thch).
LIU LNG v CCH DNG
1 n 2 gi mi ngy.
Mi gi pha vo trong 1 ly nc.
Forlax c hiu qu trong vng 24 n 48 gi sau khi ung.
BO QUN
Khng cn iu kin bo qun c bit.
xa tm tay tr em.
Khng dng qu thi hn s dng c ghi r trn gi thuc.

218.

FORTEC

DONGKWANG
c/o IC VIET NAM
vin nn 25 mg : v 10 vin, hp 5 v.
THNH PHN
cho 1 vin
PMC (Biphenyl-dimethyl-dicarboxylate)
25 mg
DC LC
- c ch s hy hoi t bo gan, ci thin ng k s suy gim chc nng gan v cc triu chng
vim gan : gim nhanh SGPT v cc triu chng lm sng.
Fortec lm bn vng mng t bo gan nh c ch s peroxyd ha lipid bng cch hy cc cc
gc t do v mi lin kt cng ha tr gia cc cht gy c cho gan v lipid ca microsom gan.
- Tng cng chc nng kh c ca gan.
Tng to ra cc cytochrome P450 trong li ni bo (c vai tr quan trng trong c ch kh c
ca gan).
- Kch thch hot ng ti to t bo gan.
Lm gia tng khi lng gan v protein ca microsom.
- Tng cng p ng sinh min dch.

C hiu qu ng k vi cc tn thng gan do cc cht gy c min dch nh : CCl4,

ketoconazol.
- Bo v t bo gan khi thng tn do cc cht c nh ru, cc thuc c vi gan
(acetaminophen, khng sinh, khng nm, khng ung th, thuc nga thai...).
DC L LM SNG
Hiu qu trn nng SGPT :
Sau iu tr vi Fortec trong vng 1, 2 v 3 thng, t l bnh nhn c SGPT bt thng tr v
gii hn bnh thng tng ng vi thi gian nu trn l : 79,8%, 81,8% v 85%, trong khi t
l ny nhm chng l 17%, 18% v 15%. S khc nhau gia nhm dng Fortec v nhm chng
c { ngha rt ln v thng k (p < 0,01).
Hiu qu trn nng bilirubin huyt v a-fetal protein (a-FP).
Nghin cu trn bnh nhn c bilirubin huyt tng v nng a-fetal protein cao cng vi c
tng SGPT trc lc dng Fortec. Kt qu cho thy :
- 80% bnh nhn c nng bilirubin cao tr v gii hn bnh thng (< 1 mg/dl) , 5% c ci
thin v 15% khng p ng sau iu tr bng Fortec.
- Trong s cc bnh nhn c a-fetal protein cao, 87,5% c a-FP tr li mc bnh thng (< 25
ng/ml), 6,25% c ci thin v 6,25% khng p ng iu tr.
Hiu qu trn xt nghim lm c thymol (TTT - thymol turbidity test) v xt nghim ln bng
thymol (TFT - thymol flocculation test) :
Nghin cu trn 382 bnh nhn, ngi ta thy trong 61 bnh nhn c bt thng v TFT trc
lc iu tr th 24 bnh nhn (39,3%) tr v bnh thng, 14 bnh nhn (25%) c ci thin v 23
bnh nhn (46,7%) khng p ng.
Trong s 156 bnh nhn c bt thng v TTT, 45 bnh nhn (28,8%) tr v bnh thng, 25
bnh nhn (16%) c ci thin v 86 bnh nhn (55,2%) khng p ng.
Hiu qu trn albumin huyt thanh v g-globulin :
i tng nghin cu gm nhng bnh nhn c nng albumin huyt thanh thp, trong
s bnh nhn c iu tr vi Fortec l 30 bnh nhn v nhm chng 32 bnh nhn. Sau iu
tr, t l albumin tng v g-globulin gim ng k trong nhm dng Fortec trong khi khng c
nhng thay i ng k no v albumin v g-globulin nhm chng.
Hiu qu trn cc tn thng gan :
Nhng sinh thit gan bng kim nh c tin hnh trn bnh nhn vim gan mn hot ng
trc v sau 8 thng iu tr vi Fortec vin n n. Nhn chung, sau iu tr vi Fortec, nhng tn
thng nh s thoi ha a acid v cc th a acid cng nh s hoi t tp trung ri rc trong
gan gim bt.
So snh gia Fortec vi Glycyrrhizin (SNMC) v Silymarin (Legalon) :
Trong mt nghin cu song song v hiu qu lm sng ca Fortec v SNMC, ngi ta chn
nhng bnh nhn c cc triu chng suy gim chc nng gan, cc biu hin bnh l bt thng

trong sinh thit gan v b bnh hn 6 thng. Kt qu cho thy s bnh nhn c ci thin v
ci thin ng k nhm dng Fortec chim 87,5%, nhiu hn ng k so vi nhm dng
SNMC (68%).
Hiu qu iu tr ca Fortec v Silymarin trong vim gan virus B cng c so snh. 90% s
bnh nhn dng Fortec c nng SGPT tr v bnh thng, trong khi ch c 20% bnh
nhn dng Silymarin l c nng SGPT tr v bnh thng.
Nh vy, hiu qu ca Fortec trn iu tr suy gan mn tin trin v vim gan mn n nh th
tt hn so vi SNMC v Silymarin.
Hiu qu ca Fortec trn cc triu chng ca vim gan virus B :
Fortec ci thin ng k cc triu chng lm sng bnh nhn vim gan : au vng gan,
chng bng, mt mi, chn n.
Hiu qu ca Fortec trn vim gan do thuc :
Trong ha tr liu thai trng (choriocarcinoma) vi thuc chng ung th liu cao nh MTX, 5FU
v kenshenmycin (KSM), mt s bnh nhn thy c s gia tng nng SGPT v thm ch
c vng da do gan b tn thng trong qu trnh iu tr. Fortec c th nghim iu tr
nhng trng hp m ha cht chng ung th gy ra hin tng vim gan.
82,6% bnh nhn trong nhm dng Fortec c SGPT tng cao tr li mc bnh thng trong
vng 10 ngy. Trong khi , ch c 39,1% bnh nhn nhm chng tr li bnh thng v 2
bnh nhn cht do hn m gan. Nhm dng Fortec khng c bnh nhn t vong.
Phi hp gia Fortec vin nn vi thuc khng ung th c th nghim trong iu tr thai
trng trong vng 3 thng. Kt qu cho thy ch c 13,6% trng hp iu tr kt hp vi Fortec
vn cn tng SGPT trong khi 59,9% trng hp nhm chng c tng SGPT. Kt qu ny cho thy
rng Fortec c hiu qu d phng v iu tr vim gan do thuc khng ung th.
CH NH
- Vim gan do virus (cp v mn tnh, bao gm c virus vim gan B).
- Vim gan do ru.
- Vim gan do thuc (khng sinh, chng nm, sulfamid, chng lao, chng ung th...).
- Gan nhim m.
- Ri lon chc nng gan (mt mi, kh , chn n...).
CHNG CH NH
Khng c chng ch nh.
TNG TC THUC
Khng c tng tc thuc.
TC DNG NGOI
Trong 328 bnh nhn nghin cu, khng pht hin tc dng ph no, tr 2 trng hp bun
nn nh.
LIU LNG v CCH DNG

Ngi ln v tr em trn 12 tui : 1-2 vin/ln x 3 ln/ngy, ung sau ba n.

Tr em :
2-6 tui : 1-2 vin/ngy.
6-12 tui : 2-3 vin/ngy.
Tr em di 2 tui cn tham kho kin bc s.
Sau khi SGPT v bnh thng, nn duy tr tr liu bng Fortec trong vng 6 thng n 1 nm.

219.

FORTRANS

BEAUFOUR IPSEN
Bt pha dung dch ung : hp 4 gi, hp 50 gi.
THNH PHN
cho 1 gi
Macrogol 4000
64 g
Sodium sulfate khan
5,7 g
Bicarbonate sodium
1,68 g
Sodium chlorure
1,46 g
Potassium chlorure
0,75 g
T| dc : saccharine sodium,
hng v tri cy.
DC LC
Thuc c dng dng dung dch ung, pha vi mt lng nc nhiu, s gy tiu chy m
bo tho rng i trng.
DC NG HC
Cht Macrogol 4000 (Polyethyleneglycol 4000) trong cng thc khng c hp thu. Cht in
gii trong cng thc lm cho dung dch ung vo khng gy trao i in gii gia rut v huyt
thanh.
CH NH
Ra i trng, chun b cho :
- Cc thm d v ni soi, X quang.
- Phu thut i trng.
CHNG CH NH
- Tng trng suy yu nh : Tnh trng mt nc hay suy tim nng.

- Bnh i trng lm cho nim mc rut suy yu nng, ung th i trng tin trin.
- Tc rut hay lit rut.
- Chng ch nh tr em do cha c kt qu nghin cu thch hp.
THN TRNG LC DNG
ngi gi tng trng suy yu, ch nn dng khi c s theo di ca Bc s.
TNG TC THUC
Tiu chy do ung Fortrans c th gy ri lon hp thu ng k nhng thuc ung cng lc.
TC DNG NGOI
Bun nn v nn c th xy ra lc mi bt u ung thuc, s gim i khi tip tc ung thuc.
i khi c cm gic chng bng.
LIU LNG v CCH DNG
Liu lng :
Mi gi c ha tan trong 1 lt nc. S lng dch cn thit gy tiu chy nc trong l 3
n 4 lt.
Cch dng :
Dng ng ung.
Mi gi c ha tan vo mt lt nc ung. Nu phu thut thc hin vo bui sng, th dung
dch c ung trong bui chiu ngy hm trc. Nu phu thut vo bui chiu, th dung dch
c ung trong cng ngy v phi ung xong trc khi m 3 gi. Cn ung ba n bn lt dung
dch m bo ra tht sch rut. Trong mi trng hp, bnh nhn phi tun th theo ng
toa thuc ca Bc s.

220.

FORTUM

GLAXOWELLCOME
Bt pha tim bp, tnh mch v tim truyn tnh mch 1 g : hp 1 l bt.
THNH PHN
cho 1 l
Ceftazidime pentahydrate tnh theo lng khan
1g
(Na)
(53 mg)
DC LC
Ceftazidime l mt khng sinh dit khun thuc h c phalosporine, khng vi hu ht cc blactamase v c tc ng chng li nhiu vi khun gram m v gram dng.
Thuc c ch nh cho iu tr nhim khun do mt hay nhiu vi khun nhy cm. Do c ph

khng khun rng, ceftazidime c th c dng n c nh mt thuc u tay, trong khi ch

i kt qu ca cc th nghim tnh nhy cm. Trong vim mng no, nn lm xt nghim v
tnh nhy cm trc khi quyt nh dng ceftazidime nh mt tc nhn duy nht. Thuc c th
dng cho cc nhim khun do cc vi khun khng vi cc khng sinh khc bao gm cc
aminoglycoside v nhiu cphalosporine. Tuy nhin, nu c, thuc c th c dng mt
cch an ton khi kt hp vi mt aminoglycoside hay cc khng sinh b-lactam khc, nh trong
trng hp c gim bch cu trung tnh nng, hay vi mt khng sinh c tc ng chng li cc
vi khun k kh khi nghi ng c s hin din ca Bacteroides fragilis (xem Ch { phng).
Vi khun hc : ceftazidime c tnh dit khun, tc ng ln protine ca mng t bo ch v
gy nn s c ch tng hp mng t bo. Nhiu chng v mu phn lp gy bnh do s nhim
khun trong bnh vin c nhy cm vi ceftazidime in vitro, bao gm nhng chng khng
vi gentamicine v cc aminoglycoside khc. Hot cht bn vng cao vi hu ht cc blactamase quan trng trn lm sng do cc vi khun c gram dng v gram m sn sinh ra v
do , c hot tnh ln nhiu chng khng ampicilline v c falotine. Ceftazidime c tc ng
ni ti cao in vitro v tc ng trong mt mc MIC hp vi hu ht cc nhm vi khun vi
nhng thay i ti thiu trn MIC cc mc cht cy truyn khc nhau. Ceftazidime cho
thy c tc ng in vitro chng li cc vi khun sau :
Gram m : Pseudonomas aeruginosa, Pseudonomas sp (cc loi khc), Klebsiella pneumoniae,
Klebsiella sp (cc loi khc), Proteus mirabilis, Proteus vulgaris, Morganella morganii (trc kia
l Proteus morganii), Proteus rettgeri, Providencia sp., Escherichia coli, Enterobacter sp,
Citrobacter sp, Serratia sp, Salmonella sp, Shigella sp, Yersinia enterocolitica, Pasteurella
multocida, Acinetobacter sp, Neisseria gonorrhoeae, Neisseria meningitidis, Haemophilus
influenzae (bao gm cc chng khng ampicilline), Haemophylus parainfluenzae (bao gm
cc chng khng ampicilline).
Gram dng : Staphylococcus aureus (cc chng nhy cm mticilline), Staphylococcus
epidermidis (cc chng nhy cm mticilline), Micrococcus sp, Streptococcus pyogenes,
Streptococcus nhm B, Streptococcus pneumoniae, Streptococcus mitis, Streptococcus sp
(ngoi tr Streptococcus faecalis).
Cc chng k kh : Peptococcus sp, Peptostreptococcus sp, Streptococcus sp, Propionibacterium
sp, Clostridium perfringens, Fusobacterium sp, Bacteriodes sp (nhiu chng ca Bacterium
fragilis b khng). Ceftazidime khng c hot tnh in vitro vi cc staphylocoque khng
mticilline, Streptococcus faecalis v nhiu Enterococcus khc, Listeria monocytogenes,
Campylobacter sp hay Clostridium difficile.
In vitro, hot tnh ca phi hp ceftazidime v cc khng sinh aminoglycoside cho thy t
nht c tc ng h tr; c bng chng ca s hip ng trn mt vi chng c xt nghim.
Tnh cht ny c th quan trng trong vic iu tr bnh nhn b st gim bch cu.
CH NH

Nhim khun ton thn trm trng : nhim khun huyt, vim phc mc, vim mng no,
nhim khun bnh nhn ung th mu hay tng c c suy gim min dch, v trn bnh nhn
ang c cp cu vi cc bnh c hiu nh phng nhim khun.
Nhim khun ng h hp : vim phi, ph qun ph vim, vim mng phi nhim khun,
vim mng phi m, abcs phi, dn ph qun bi nhim, vim ph qun v trong nhim khun
phi trong bnh x nang.
Nhim khun tai mi hng : vim tai gia, vim tai ngoi c tnh, vim xng chm, vim xoang
v cc nhim khun tai v hng nng khc.
Nhim khun ng tiu : vim thn-b thn cp v mn, vim b thn, vim tuyn tin lit,
vim bng quang, vim niu o (ch vim niu o nhim vi khun), abcs thn v cc nhim
trng i km vi si bng quang v si thn.
Nhim khun da v m mm : vim qung, abcs, vim t bo, phng v vt thng nhim
trng, vim v, lot da.
Nhim khun ng tiu ha, mt v bng : vim ng mt, vim ti mt, m ti mt, abcs
bng, vim phc mc, vim ti tha, vim kt trng, cc bnh nhim trng hu sn v vng
chu.
Nhim khun xng v khp : vim xng, vim xng c, vim khp nhim khun, vim bao
hot dnh nhim khun.
Thm phn : nhim trng do thm phn mu v phc mc v thm phn phc mc lu ng
lin tc (CAPD).
Phng nga trong phu thut tin lit tuyn (qua niu o).
CHNG CH NH
Qu mn bit vi cc khng sinh cphalosporine.
CH PHNG
Ging nh nhng khng sinh b-lactam, trc khi dng ceftazidime, nn kim tra cn thn v
tin s phn ng qu mn vi ceftazidime, cphalosporine, pnicilline hay nhng thuc khc.
Ch nn dng ceftazidime mt cch thn trng vi bnh nhn c phn ng qu mn loi I hay
qu mn tc thi vi p nicilline. Ngng thuc nu xy ra phn ng d ng vi ceftazidime. Cc
phn ng qu mn trm trng c th cn dng ti pinphrine (adrnaline), hydrocortisone,
khng histamine hay cc bin php cp cu khc.
THN TRNG LC DNG
Nn dng thn trng cc khng sinh cphalosporine liu cao cho bnh nhn ang c iu
tr ng thi vi cc thuc gy c trn thn, nh cc aminoglycoside hay cc thuc li tiu
mnh, nh furos mide, do c nghi ng rng cc kt hp ny tc ng c hi ln thn.
Kinh nghim lm sng s dng ceftazidime cho thy rng hu nh thuc khng gy nguy hi vi
liu iu tr c khuyn co. Khng c bng chng rng ceftazidime c tc ng ngoi ln
thn vi liu iu tr thng thng; tuy nhin, do phn ln thuc c o thi qua ng

thn, cn gim liu ty theo mc ca suy gim chc nng thn trnh cc hu qu lm
sng ca vic gia tng cc nng khng sinh nh co git (xem phn liu lng trong trng
hp suy thn trong phn Liu lng).
Ceftazidime khng can thip vo cc xt nghim da trn c s men tm glucose niu. C th
quan st c s can thip yu vo cc phng php kh ng (cc test Benedict, Fehling,
Clinitest). Ceftazidime khng lm nh hng th nghim picrate kim tm cratinine.
Kt qu dng tnh trong test Coombs i km vi s s dng ceftazidime trong khong 5%
bnh nhn c th can thip vo cc xt nghim mu cho.
Ging nh nhng khng sinh ph rng khc, s dng ko di ceftazidime c th a n bi
nhim cc vi khun khng nhy cm (nh Candida, cc Enterococcus) c th cn gin on vic
iu tr hay p dng cc bin php thch hp. Cn thit lp li vic kim tra tnh trng bnh
nhn.
LC C THAI v LC NUI CON B
Khng c bng chng trn th nghim v tc ng gy bnh phi hay sinh qui thai c quy
cho ceftazidime. Tuy nhin, cng ging nh mi thuc khc, nn dng cn thn trong nhng
thng u thai kz v cho tr va mi sanh. Ch s dng trong thai kz khi cn nhc gia li ch
v nhng nguy c c th xy ra. Ceftazidime c bi tit qua sa m nng thp v do ,
nn cn thn khi dng ceftazidime cho ngi m nui con b.
TC DNG NGOI
Kinh nghim trong cc th nghim lm sng cho thy rng ceftazidime ni chung c dung
np tt. Cc tc dng ngoi t xy ra, bao gm :
Ti ch : vim tnh mch hay vim tnh mch huyt khi khi tim tnh mch ; au v/hoc vim
sau khi tim bp.
Qu mn : dt sn hay ni ban, my ay, st, nga ngy v rt him khi ph mch v phn v
(co tht ph qun v/hoc tt huyt p).
Tiu ha : tiu chy, bun nn, nn ma, au bng v rt him khi b ta ming hay vim kt
trng.
Cc tc dng ngoi c th lin quan n ceftazidime hay c bnh cn hc khng chc chn
bao gm :
Tit niu : bnh candida, vim m o.
H thn kinh trung ng : nhc u, chng mt, d cm v mt v gic. c mt vi bo co v
co git xy ra cho bnh nhn b suy thn m khng gim liu ceftazidime thch hp.
Cc thay i trn xt nghim cn lm sng c ghi nhn xy ra thong qua trong qu trnh
iu tr vi ceftazidime bao gm : gim bch cu trung tnh, phn ng dng tnh vi test
Coombs khng c lc mu, tng tiu cu v gia tng nh mt hay nhiu men gan, ALT (SGPT),
AST (SGOT), LDH, GGT v phosphatase kim.
Ging nh nhng c phalosporine khc, i khi quan st c s gia tng thong qua ca ur

huyt, BUN v/hoc cratinine huyt thanh. Rt him khi gp chng gim bch cu, gim bch
cu trung tnh, gim tiu cu v tng lympho bo thong qua.
LIU LNG v CCH DNG
Khuyn co chung : ceftazidime c dng theo ng tim, liu lng ty thuc vo mc
trm trng, tnh nhy cm v loi nhim trng; tui tc, trng lng v tnh trng hot ng
chc nng thn ca bnh nhn.
Ngi ln : liu ceftazidime thng c dng l 1-6 g/ngy : chng hn 500 mg, 1 g hay 2 g
mi 12 hay 8 gi theo ng tim tnh mch hay tim bp. Trong cc nhim trng ng tiu
v nhiu nhim trng khc km trm trng hn, thng ch dng 500 mg hay 1 g mi 12 gi l
. Trong a s trng hp nhim trng, nn dng 1 g mi 8 gi hay 2 g mi 12 gi. Trong
nhng nhim trng rt trm trng, c bit bnh nhn b suy gim min dch, bao gm ngi
b gim bch cu trung tnh, nn dng 2 g mi 8 hay 12 gi.
Bnh x nang : ngi ln b x nang c chc nng thn bnh thng b nhim trng phi
pseudomonas, nn dng liu cao 100-150 mg/kg/ngy chia lm 3 ln. Liu 9 g/ngy c
dng mt cch an ton cho ngi ln c chc nng thn bnh thng.
Tr em v tr s sinh : liu thng thng cho tr em trn 2 thng tui l 30-100 mg/kg/ngy,
chia lm 2 hay 3 ln.
Cc liu ln n 150 mg/kg/ngy cho ti ti a 6 g mi ngy c th c dng cho tr nhim
trng b suy gim min dch hay b bnh x nang hay tr b vim mng no.
Tr s sinh v tr di 2 thng tui : trong khi kinh nghim lm sng vn cn gii hn, mt liu
25-60 mg/kg/ngy chia lm 2 ln cho thy hu hiu. tr s sinh, thi gian bn hy trong
huyt thanh ca ceftazidime c th di hn 3-4 ln so vi ngi ln.
Liu lng trong trng hp suy thn : ceftazidime c o thi qua thn hu nh ch yu
do lc cu thn. Do , bnh nhn suy thn, nn gim liu ceftazidime b vo s o
thi chm ca n, ngoi tr trng hp suy thn nh, ngha l tc lc cu thn (GFRglomerular filtration rate) ln hn 50 ml/pht. Trn bnh nhn nghi ng l c suy thn, c th
dng liu tn cng khi u 1 g ceftazidime. Nn kho st GFR xc nh liu duy tr thch
hp.
Liu duy tr c khuyn co : Bng 1
Liu duy tr khuyn co ca ceftazidime trong suy thn
Thanh thi
cratinine
(ml/pht)
50-31
30-16

Cratinine trung bnh

trong huyt thanh
mol/l (mg/dl)
150-200
(1,7-2,3)
200-350
(2,3-4,0)

Liu n v
ceftazidime c
khuyn co (g)
1,0

Khong
cch dng
thuc (gi)
12

1,0

24

15

350-500
0,5
24
(4,0-5,6)
<5
> 500
0,5
48
(> 5,6)
Cc gi tr ny ch l hng dn v c th khng tin on chnh xc tnh trng chc nng thn
mi bnh nhn c bit ngi gi khi m creatinine huyt thanh c th dn n s nh gi
qu mc chc nng thn.
bnh nhn nhim trng trm trng, c bit ngi b gim bch cu trung tnh thng s
dng 6 g ceftazidime mi ngy, nu suy thn, n v liu lng Bng 1 c th gia tng 50%
hay rt ngn khong cch dng thuc mt cch hp l. nhng ngi ny, nn kim tra nng
ceftazidime trong huyt thanh v nng ti thiu khng nn vt qu 40 mg/l.
Khi ch c gi tr cratinine trong huyt thanh, c th dng cng thc sau (ng thc Cockcroft)
c lng thanh thi cratinine. Mc cratinine huyt thanh nn i din cho mt tnh
trng n nh chc nng thn:
Nam :
Thanh thi cratinine (ml/pht) =
khi lng (kg) x (140 - tui tnh bng nm) / 72 x cr atinine huyt thanh (mg/dl).
N : 0,85 x gi tr nam.
chuyn cratinine huyt thanh t mmol/l thnh mg/dl, chia cho 88,4.
tr em, nn iu chnh thanh thi cratinine theo din tch b mt c th hay khi c th
khng c m v gim khong cch dng liu trong trng hp suy thn nh i vi ngi ln.
Thi gian bn hy trong huyt thanh ca ceftazidime trong qu trnh lc mu trong khong 3-5
gi. Nn lp li liu duy tr thch hp sau mi ln lm thm phn.
Liu lng dng khi thm phn phc mc : cng c th dng ceftazidime trong thm phn phc
mc v thm phn phc mc lu ng lin tc (CAPD). Cng nh khi dng ceftazidime tim tnh
mch, c th phi hp thuc vi dch thm phn (thng 125-250 mg cho 2 lt dung dch thm
phn).
Cch dng : ceftazidime c th c dng tim tnh mch hay tim bp su vo khi c ln nh
phn t trn ngoi ca mng hay hai bn i.
Hng dn pha thuc : xem Bng 2 v th tch thm vo v nng cc dung dch, iu ny c
th rt hu ch khi cn dng cc liu c chia nh.
Hng dn th tch dung mi dng pha
Kch c l
thuc
1 g IM
IV

Th tch dung mi* phi thm vo

(ml)
3,0
10,0

Nng trung bnh

(mg/ml)
250
90

* Thng l nc ct pha tim.

Tt c mi c l c cung cp u di p sut gim. Khi ha tan thuc, kh carbone dioxide
c gii phng v pht sinh mt p lc dng. d dng s dng, nn p dng k thut pha
nh sau :
L 500 mg IM/IV, 1 g IM/IV v 2 g IV bolus : m kim qua np l v bm vo th tch dung mi
c khuyn co. Chn khng trong l c th gip dung mi i vo d dng hn. Rt kim ra.
Lc ha tan : carbone dioxide c gii phng v thu c mt dung dch trong sut trong
khong 1-2 pht.
Dc ngc l. Vi ng tim c nn cht, m kim qua np l v rt ton b th tch dung
dch v bm tim (p lc trong l c th h tr cho vic rt thuc). Cn bo m rng kim phi
trong phn dung dch v khng i ra ngoi phn khng kh trn. Dung dch c rt ra c
th cha cc bng kh carbone dioxide nh; c th b qua khng { n chng.
L tim truyn tnh mch 2 g : c th pha l thuc ny tim truyn ngn hn (nh n 30
pht) nh sau : m kim qua np l v bm vo 10 ml dung mi. Chn khng c th gip dung
mi i vo d dng. Ly kim ra.
Lc ha tan; carbone dioxide c gii phng v thu c mt dung dch trong sut trong
khong 1-2 pht.
m kim thng kh qua np l gii phng p sut bn trong, v vi s thng kh sn sng,
thm 40 ml dung mi. Ly kim thng kh v kim bm tim ra; lc l v bt u tim truyn nh
bnh thng.
Ghi ch: bo m tnh tit trng ca ch phm, iu quan trng cn ch { l khng m kim
thng vo np l trc khi ha tan thuc.
Cc dung dch ny c th tim trc tip vo tnh mch hay a vo ng ca b dy tim truyn
nu bnh nhn ang dng cc dch tim truyn. Ceftazidime tng hp vi hu ht cc dch
truyn tnh mch thng dng.
Ch khi dng :
Cc l thuc tim Fortum khng cha cht bo qun v nn c dng nh ch phm dng liu
duy nht.
gi cho vic thc hnh v dc khoa tt, nn dng dung dch thuc tim Fortum va mi
pha. Nu khng th thc hin c, dc tnh tha ng ca thuc c duy tr trong 18 gi
nhit phng (di 25oC) hay 7 ngy nu trong t lnh khi pha trong nc ct pha tim
hay vi mt trong cc thuc tim sau : vi nng ceftazidime trong khong 1 mg/ml v 40 ml
: thuc tim 0,9% NaCl, M/6 Lactate natri, phi hp Lactate natri (dung dch Hartmann), 5%
dextrose, 0,225% NaCl v 5% dextrose, 0,45% NaCl v 5% dextrose, 0,9% NaCl v 5% dextrose,
0,18% NaCl v 4% dextrose, 10% dextrose, dextran 40 trong 0,9% NaCl, dextran 40 t l 10%
trong 5% dextrose, dextran 70 t l 6% trong 0,9% NaCl, dextran 70 t l 6% trong 5% dextrose,
(ceftazidime t bn vng trong dung dch Natri bicarbonate hn cc dch tim tnh mch khc ;

khng khuyn co dng dung mi ny).

Vi nng trong khong gia 0,05 mg/ml v 0,25 mg/ml trong dch thm phn phc mc
(Lactate) BPC 1973. Khi pha tim tnh mch, dng thuc tim 0,5% hay 1% lignocaine
chlorhydrate. Khi trn ln vi nng 4 mg/ml vi cc cht sau, c hai thnh phn u duy tr
c hot tnh ca chng : hydrocortisone (hydrocortisone natri phosphate) 1 mg/ml trong
thuc tim 0,9% NaCl hay 5% dextrose, cefuroxime (cefuroxime natri) 3 mg/ml trong thuc
tim 0,9% NaCl, cloxacilline (cloxacilline natri) 4 mg/ml trong thuc tim 0,9% NaCl, hparine 10
mg/ml hay 50 mg/ml trong thuc tim 0,9% NaCl, kali chlorure 10 mEq/l hay 40 mEq/l trong
thuc tim 0,9% NaCl.
Thuc cha trong l 500 mg c pha vi 1,5 ml nc ct pha tim, c th c thm vo vi
thuc tim mtronidazole (500 mg trong 100 ml) v c hai u duy tr c hot tnh. Khng
nn trn ceftazidime v aminoglycoside trong mt b tim truyn hay trong mt bm tim.
Cc dng dch c mu vng nht n h phch ty theo nng , dung mi v iu kin bo
qun c dng.
Nu lm ng theo nhng khuyn co trn th tc dng ca thuc khng b nh hng bi
nhng thay i v mu sc.
Trnh nh sng.
xy ra trng hp kt ta khi ha vancomycin vo dung dch ceftazidime. V vy nn thn
trng x sch dng c tim truyn khi s dng hai thuc ny.
QU LIU
Nng trong huyt thanh ca ceftazidime c lm gim bng cch thm phn.
BO QUN
Nn bo qun cc l thuc Fortum nhit di 25oC. i khi vic bo qun nhit
khng cao hn 30oC n 2 thng cng khng lm hi n ch phm.

221.

FRAXIPARINE

SANOFI SYNTHELABO VIETNAM

Dung dch tim 2850 UI anti Xa/0,3 ml : bm tim cha 0,3 ml (loi khng phn vch), hp 10
ng - Bng B.
Dung dch tim 3800 UI anti Xa/0,4 ml : bm tim cha 0,4 ml (loi khng phn vch), hp 10
ng - Bng B.
Dung dch tim 5700 UI anti Xa/0,6 ml : bm tim cha 0,6 ml (loi c phn vch), hp 10 ng -

Bng B.
THNH PHN
cho 1 ml
Nadroparine calcium
9500 UI anti Xa
(pH = 5)
DC LC
Fraxiparine l mt hparine c trng lng phn t thp c to ra bng cch phn ct
hparine chun. Thuc l mt glycosaminoglycan vi trng lng phn t trung bnh khong
4300 dalton. Thuc c t l hot tnh chng yu t Xa so vi yu t IIa cao. Fraxiparine c tc
dng chng huyt khi va tc th va lu di.
DC NG HC
Cc hot tnh dc ng hc c xc nh bng cch o hot tnh chng yu t Xa trong huyt
thanh. Nng thuc ti a t c trong huyt thanh khong 4-6 gi sau khi tim di da.
Thi gian bn hy thi tr sau khi dng lp i lp li l 8-10 gi. Hot tnh chng yu t Xa ko
di t nht 18 gi sau khi tim di da.
Tnh kh dng sinh hc ca thuc gn nh hon ton (khong 98%).
CH NH
- Phng nga thuyn tc mch do huyt khi, c bit trong phu thut chnh hnh v phu
thut tng qut bnh nhn ni khoa c nguy c cao (suy h hp v/hay nhim trng h hp
v/hay suy tim), nm vin khoa sn sc c bit.
- iu tr cc huyt khi thnh lp tnh mch su.
- Ngn nga cc mu ng trong tun hon ngoi c th khi chy thn nhn to.
- iu tr cn au tht ngc khng n nh v nhi mu c tim khng sng Q.
CHNG CH NH
- Mn cm vi nadroparine.
- Tin cn xut huyt gim tiu cu vi nadroparine.
- Cc du xut huyt hoc tng nguy c xut huyt c lin quan n cc ri lon v cm mu
ngoi tr ng mu ni mch lan ta khng phi do hparine gy ra.
- Tn thng cc c quan d gy chy mu (chng hn lot d dy tin trin).
- Xut huyt no.
- Vim ni tm mc nhim trng cp tnh.
Chng ch nh tng i khi phi hp vi cc thuc salicylate, thuc khng vim khng
corticoide, ticlopidine.
CH PHNG
- Do hparine c th gy xut huyt gim tiu cu, phi theo di u n s lng tiu cu
trong qu trnh iu tr vi Fraxiparine.

- Vi trng hp him gp xut huyt gim tiu cu, i khi rt nng c bo co. Cc
trng hp ny c th phi hp hoc khng vi huyt khi ng mch hay tnh mch v cn
phi ngng iu tr.
- Nn cn nhc chn on trong trng hp xut huyt gim tiu cu cng nh cc tnh trng
lm xu thm huyt khi nguyn pht trong khi ang iu tr hoc trong trng hp c ng
mu ni mch lan ta hoc c huyt khi xy ra trong khi iu tr. Nhng tc dng ny c l do
c ch min dch-d ng v trong ln iu tr u tin, cc tc dng ny thng xut hin vo
khong t ngy 5 n ngy 21, cng c th xy ra sm hn nu c tin cn xut huyt gim tiu
cu do hparine.
- Khi c tin cn xut huyt gim tiu cu xy ra vi hparine (h parine kinh in hay hparine
c trng lng phn t thp), c th dng Fraxiparine nu tht s c ch nh phi iu tr vi
hparine. Trong nhng trng hp nh vy, phi theo di lm sng cn thn v nh gi s
lng tiu cu t nht mi ngy mt ln. Ngng iu tr ngay lp tc nu c xut huyt do gim
tiu cu v c mt vi bo co v kh nng xut huyt tr li c th xy ra sm.
- Khi xy ra xut huyt gim tiu cu do h parine (h parine kinh in hay hparine c trng
lng phn t thp), vic thay th bng cc hparine c trng lng phn t thp khc phi
c xem xt nu cn thit tip tc s dng hparine. Trong nhng trng hp nh th, nn
theo di hng ngy v ngng iu tr cng sm cng tt v c mt vi bo co v vic xut
huyt gim tiu cu li tip tc sau khi thay th thuc. Cc xt nghim v kt tp tiu cu in
vitro ch c gi tr gii hn.
THN TRNG LC DNG
- S dng thuc cn thn trong trng hp c suy gan, suy thn, cao huyt p nng, tin cn
lot d dy hay tn thng cc c quan khc c xu hng chy mu, cc bnh l mch mu ca
hc vng mc, giai on hu phu sau phu thut no, ty sng hoc mt.
- Cn nhc gim liu bnh nhn suy thn nng.
- Hparine c ch tit aldosterone ca thng thn, gy tng kali mu, c bit cc bnh
nhn c tng kali hay c nguy c tng kali (nh tiu ng, suy thn mn, tin ri lon toan
mu hay dng thuc tng kali mu nh c ch men chuyn, khng vim khng stroide).
Nguy c tng kali mu tng theo thi gian iu tr nhng thng hi phc. Cn theo di kali
mu cho i tng nguy c.
- Nguy c t mu ty/ngoi mng cng tng cao nu t ng thng ngoi mng cng hay dng
phi hp vi cc cht nh hng n cm mu : khng vim khng stroide, c ch tiu cu,
khng ng. Nguy c s tng ln do chn thng hay do thc hin chc d ty sng, chc d
ngoi mng cng nhiu ln.
V vy thc hin ng thi vic c ch thn kinh trung ng bng gy t ty sng v iu tr
bng khng ng phi c cn nhc cn thn :
- bnh nhn ang iu tr khng ng, li ch ca c ch thn kinh trung ng bng gy t

ty sng phi c cn nhc vi cc nguy c.

- bnh nhn d nh phu thut vi gy t ty sng, li ch ca iu tr khng ng cng phi
c cn nhc vi cc nguy c.
- bnh nhn chu th thut chc d ty, gy t ty sng hay gy t ngoi mng cng, cn lu
khong thi gian va gia vic chc d, lun v rt kim (dy) chc d.
LC C THAI
Nhng nghin cu trn ng vt khng cho thy tc dng sinh qui thai hay c ln thai. Tuy
nhin, cc thng tin v cc d kin lm sng ngi c lin quan n vic thuc c truyn
c qua nhau thai khng vn cn hn ch. Do , khng nn s dng Fraxiparine ph n c
thai trng hp cn thit.
LC NUI CON B
Do cc thng tin v s bi tit ca thuc qua sa v qua vo c th tr s sinh vn cn hn
ch nn cng khng c s dng Fraxiparine trong thi gian ang cho con b.
TNG TC THUC
Khng nn s dng cng lc vi aspirine, (hoc cc salicylate khc), thuc khng vim khng
corticoide v thuc chng tiu cu v lm tng nguy c xut huyt.
Trong trng hp khng trnh c s phi hp thuc, phi theo di lm sng v cc ch s
sinh hc cn thn.
Thn trng khi s dng Fraxiparine cho cc bnh nhn ang iu tr thuc khng ng ung,
cc thuc corticoide dng ng ton thn v dextran. Khi dng khng ng ung trn bnh
nhn dng nadroparine, cn tip tc dng h parine cho n khi ch s INR n nh theo mc
tiu.
TC DNG NGOI
Cc tc dng ph chung cho cc ch phm hparine khc :
- Xut huyt thy r hay khng thy r, thng gp cc bnh nhn c nguy c cao (xem thm
chng ch nh v tng tc thuc).
- Mt vi trng hp xut huyt gim tiu cu, i khi nng c ghi nhn (xem Ch {
phng).
- Vi trng hp c hoi t da, thng xy ra v tr tim chch vi hparine hay cc hparine
c trng lng phn t thp c bo co, chng c th biu hin bng cc m xut huyt
ri rc hoc bng cc mng lan ta hoc gy au, c hoc khng km cc du hiu ton th.
Trong nhng trng hp nh vy, phi ngng iu tr ngay lp tc
- T mu v tr tim chch, i khi l nhng nt cng. Cc nt ny mt i sau vi ngy.
- Cc phn ng mn cm da hay ton thn i khi cn phi ngng iu tr
- Tng men transaminase, thng ch thong qua.
- Mt vi trng hp ngoi l c tng aldost rone c bo co hoc c triu chng hoc
phi hp vi tng kali mu, c hoc khng c tng natri mu v thng hi phc sau khi ngng

iu tr.
LIU LNG v CCH DNG
Cn c bit ch cc ch dn v liu dng i vi cc ch phm hparine c trng lng phn
t thp do s dng cc h thng n v khc nhau (n v hay mg).
Khi c tim di da, v tr tim thng thng l thnh bng trc bn, lun phin gia bn
phi v bn tri. Vo v gi da thnh bng bng ngn ci v ngn tr tay tri. m xuyn kim
qua lp da vo, ch vn vo da trong khi tim. Khng s dng Fraxiparine tim bp.
Phng nga thuyn tc mch do huyt khi :
Phu thut tng qut : liu 0,3 ml mi ngy, trong t nht 7 ngy, trong tt c mi trng hp,
nn phng nga qua khi giai on nguy c hoc t nht cho n khi bnh nhn i li c.
Liu u tin c tim t 2-4 gi trc khi phu thut.
Phu thut chnh hnh : liu u tin c tim 12 gi trc khi m v 12 gi sau khi m xong.
Nhng ngy sau tim 1 ln/ngy trong t nht 10 ngy, trong tt c mi trng hp, nn phng
nga qua khi giai on nguy c hoc t nht cho n khi bnh nhn i li c. Liu dng
c iu chnh theo cn nng c th v da vo bng di y :
Cn nng
(kg)

Th tch Fraxiparine tim di da

mi ngy mt ln
trc phu thut v n ngy th 3
< 50
0,2 ml
50-69
0,3 ml
>= 70
0,4 ml
Bnh nhn ni khoa khoa sn sc c bit :

t ngy th 4 tr i
0,3 ml
0,4 ml
0,6 ml

Cn nng (kg) Th tch Fraxiparine tim di da mi ngy 1 ln

<= 70
0,4 ml
> 70
0,6 ml
iu tr cc huyt khi thnh lp tnh mch su :
Tim Fraxiparine di da ngy 2 ln (mi 12 gi) trong thi gian thng thng l 10 ngy vi
liu ty thuc vo cn nng ca c th :
Cn nng
(kg)
< 50
50-59
60-69
70-79
80-89
>= 90

Th tch Fraxiparine tim di da mi ln, ngy 2 ln

0,4 ml
0,5 ml
0,6 ml
0,7 ml
0,8 ml
0,9 ml

iu tr bng khng ng ng ung nn c khi u cng sm cng tt tr khi c chng

ch nh.
Ngn nga cc mu ng trong tun hon ngoi c th khi chy thn nhn to : liu ti u
c tnh ton ty theo mi bnh nhn v ty theo iu kin k thut chy thn nhn to. Tim
Fraxiparine liu duy nht vo ng dn mu ng mch trc khi chy thn nhn to.
Cn nng (kg) Th tch Fraxiparine tim trc khi chy thn nhn to
< 50
0,3 ml
51-69
0,4 ml
>= 70
0,6 ml
Vi nhng bnh nhn c nguy c xut huyt, c th s dng na liu Fraxiparine. Nu thi gian
chy thn nhn to k o di hn 4 gi, c th cho thm mt liu nh Fraxiparine trong thi gian
chy thn nhn to. Trong nhng ln chy thn nhn to sau, nn iu chnh liu khi cn, da
vo hiu qu thy c trong ln chy thn trc .
- iu tr cn au tht ngc khng n nh v nhi mu c tim khng sng Q :
Nadroparine c chch di da ngy 2 ln (mi 12 gi) vi liu 86 UI anti-Xa/kg mi ln chch
phi hp vi aspirine (liu khuyn co 75-325 mg ung, sau khi dng liu np t 160-325 mg).
Khi u iu tr vi nadroparine bng chch bolus tnh mch sau l chch di da.
Thi gian iu tr thng khong 6 ngy cho n khi lm sng n nh, vi liu iu chnh theo
cn nng nh bng di y :
Cn nng
(kg)

Liu dng
Tim bolus tnh mch
Tim di da (mi 12 UI anti-Xa tng
khi u
gi)
ng
< 50
0,4 ml
0,4 ml
3800
50-59
0,5 ml
0,5 ml
4750
60-69
0,6 ml
0,6 ml
5700
70-79
0,7 ml
0,7 ml
6650
80-89
0,8 ml
0,8 ml
7600
90-99
0,9 ml
0,9 ml
8550
>= 100
1,0 ml
1,0 ml
9500
V khng c cc d liu lm sng v vic phi hp thuc nadroparine vi thuc tan huyt khi,
khi cn phi dng thuc tan huyt khi nn ngng iu tr vi nadroparine.
QU LIU
Xut huyt l biu hin lm sng chnh ca qu liu. Phi m s lng tiu cu v o cc ch s
ng mu khc. Xut huyt nh him khi cn iu tr c hiu, thng ch cn gim hoc s
dng cc liu sau tr hn.
Nn cn nhc s dng protamine sulfate ch trong cc trng hp trm trng hn. Protamine
sulfate s trung ha mt lng ln tc dng khng ng ca Fraxiparine, nhng mt vi hot

tnh khng Xa vn cn tn ti. 0,6 ml protamine sulfate s trung ha c khong 0,1 ml

Fraxiparine
BO QUN
Gi ni kh mt.

222.

FRUCTINES

DB PHARMA
c/o GALIEN
vin ngm mu cam : hp 30 vin.
THNH PHN
cho 1 vin
Sodium picosulfate

0,005 g

DC LC
Thuc nhun trng kch thch.
Thuc c tc dng iu chnh trao i nc - in gii rut v kch thch c nng vn ng
ca i trng.
CH NH
iu tr chng to bn.
CHNG CH NH
- Bnh l{ vim i trng (vim trc trng c lot, bnh Crohn...), hi chng tc rut hoc bn
tc, hi chng au bng khng r nguyn nhn.
- Tr em di 12 tui.
CH PHNG v THN TRNG LC DNG
Vic dng thuc iu tr to bn ch l mt bin php h tr cho ch v sinh - tit thc :
- n thc n giu cht si thc vt, ung nhiu nc,
- hot ng th lc ng mc v tp phn x i cu mi sng.
Khng nn dng lu di thuc nhun trng qu 10 ngy.
Dng lu di thuc nhun trng c th dn n hai loi ri lon :
- bnh do thuc nhun trng vi bnh i trng chc nng nng, bnh nhim hc t trc i

trng, ri lon nc in gii km h kali trong mu ; ri lon ny him khi xy ra ;

- tnh trng l thuc vi nhu cu thng xuyn v thuc nhun trng, i hi tng liu v to
bn nghim trng trong trng hp ngng thuc ; tnh trng l thuc ny xy ra ty theo bnh
nhn, c th bc s khng hay bit.
LC C THAI v LC NUI CON B
Lc c thai :
Thuc khng cho tc dng gy qui thai trong cc th nghim trn ng vt. Do cn thiu s
liu ngi, khng nn k toa cho ph n ang mang thai.
Lc nui con b :
Khng c s liu v s bi tit qua sa m, khng nn dng thuc trong thi gian cho con b.
TNG TC THUC
Khng nn phi hp :
- Thuc chng lon nhp gy xon nh : bpridil, thuc chng lon nhp nhm Ia (loi
quinidine), sotalol, amiodarone : gy xon nh (h kali huyt cng nh nhp tim chm v
khong QT di l nhng yu t thun li cho s xut hin xon nh).
- Vincamine (khng phi thuc chng lon nhp nhng cng gy xon nh) : gy xon nh (h
kali huyt cng nh nhp tim chm v khong QT di l nhng yu t thun li cho s xut hin
xon nh).
Nn s dng thuc nhun trng khng gy kch thch.
Thn trng khi phi hp :
- Digitalis : h kali huyt gy thun li cho cc tc dng c ca digitalis.
Nn theo di kali huyt v kim tra in tm nu c th.
Nn s dng thuc nhun trng khng gy kch thch.
- Cc thuc gy h kali huyt khc : amphot ricine B (ng tnh mch), corticoide (gluco,
min ralo : ng ton thn), ttracosactide, thuc li tiu h kali huyt (n tr hay phi hp) :
c nguy c tng mc h kali huyt (do hip ng tc dng).
Theo di kali huyt v iu chnh kali huyt nu cn.
Nn s dng thuc nhun trng khng gy kch thch.
TC DNG NGOI
C th gy tiu chy, au bng, nht l ngi b bnh i trng.
C th gy h kali huyt.
LIU LNG v CCH DNG
Ngi ln : 1 vin (nu cn c th dng 2 vin).
Tr em t 12 n 15 tui : 1/4-1 vin.
C th ngm hoc nhai vo bui ti lc i ng hoc cng c th dng vo bui sng.

223.

FUCICORT

LEO PHARMA
c/o ZUELLIG
kem bi ngoi da : ng 5 g, 15 g.
THNH PHN
cho 1 g kem
Acid fusidic

20 mg

Betamethasone valerate

1 mg

DC LC
Phi hp steroid v khng khun dng ngoi da.
DC NG HC
Fucicort thm tt vo su trong da, kh nng dung np cao, him khi xy ra tng mn cm.
Fucicort dng kem khi s dng khng vy thuc trn da, khng lm vy bn.
CH NH
Fucicort c ch nh iu tr nhng bnh l vim da do nhim trng hoc c th do nhim
trng. Bnh l vim da gm : vim da d ng, vim da tit b nhn, vy nn, da chy nng, chm
dng a, vim da tip xc, lupus ban dng a, chm do ng, liken n mn tnh.
CHNG CH NH
Chng ch nh dng corticosteroids ti ch trong trng hp nhim trng da do virus, lao v
nm, vim da quanh ming, trng c v nhng tnh trng lo t da, v trong trng hp c
tng mn cm vi bt kz thnh phn no ca thuc.
THN TRNG LC DNG
Ch dng ngoi da, khng bi ln mt.
Khng nn dng lin tc lu di, c bit mt, cc np gp, vng b hm, tr nh nhi v tr
ln. Steroid ti ch khng nn dng nhiu ph n c thai. Nhng bt thng v phi thai
c ghi nhn sc vt thc nghim do hp thu thuc vo ton thn.
TC DNG NGOI
Him khi xy ra tng mn cm vi thuc. Nh cc corticosteroids ti ch khc, vic iu tr qu
v lu di c th gy ra nhng thay i kiu teo da khu tr, nh cc vt nt da, da mng
hoc dn mch mu nng, c bit khi bng kn hoc khi thng tn xy ra cc np gp da.
Hp thu vo ton thn, gy c ch tuyn thng thn do tng corticosteroids c th xy

ra khi dng ko di hay dng qu nhiu, c bit khi dng c bng kn. Tr nh nhi v tr ln c
nguy c c bit khi dng thuc ny. Cn thn khi dng steroid ti ch vng gn mt. Tng
nhn p c th xy ra nu thuc vo mt.
LIU LNG v CCH DNG
Sang thng h : thoa 2-3 ln/ngy.
Sang thng kn : thoa t ln hn.

224.

FUCIDIN

LEO PHARMA
c/o ZUELLIG
kem bi ngoi da 2% : ng 5 g, 15 g.
thuc m bi ngoi da 2% : ng 5 g, 15 g.
THNH PHN
cho 1 g kem
Acid fusidic

20 mg

cho 1 g thuc m
Acid fusidic

20 mg

DC LC
Fucidin l thuc khng khun ti ch s dng ngoi da, c hot cht chnh l acid fucidic c cu
trc steroid, thuc nhm fusinadines.
Fucidin c tc dng dit khun ch yu trn cc mm bnh vi khun thng gy cc nhim
trng ngoi da.
DC NG HC
Acid fusidic c c tnh ng thi thn nc v thn m nn thm rt tt vo da, ti nhng lp
su ca da v hin din trong tt c cc lp m da v di da.
Fusidin thch hp cho nhng trng hp nhim trng da nng v su.
Fusidin dng kem v thuc m khi s dng khng vy thuc trn da, khng lm vy bn.
CH NH

Fucidin c ch nh iu tr nhim trng da do t cu trng, lin cu trng v cc vi sinh

vt khc nhy cm vi Fucidin. Ch nh quan trng nht l : chc, vim nang lng, vt thng
nng, bnh nm do Corynebacterium minutissimum, nht, vim nang ru, vt thng do chn
thng hoc phu thut, vt bng, cm nht, vim tuyn m hi, vt lo t do gin tnh mch,
vim quanh mng, v trng c thng.
THN TRNG LC DNG
Ch dng ngoi da, khng bi ln mt, thi gian iu tr nn gii hn trong vng 7 ngy, ngoi
tr trng hp iu tr mn trng c, trnh hin tng chn lc chng vi khun nhy cm.
TC DNG NGOI
Fucidin c dung np rt tt. C mt tn sut rt nh xy ra phn ng tng mn cm vi
thuc.
LIU LNG v CCH DNG
Kem v thuc m.
Thoa Fucidin ln vng thng tn 2-3 ln/ngy, thng dng trong 7 ngy, ngoi tr iu tr
trng c, thi gian iu tr cn lu hn ty theo bn cht ca bnh ny. C th bng hoc khng
bng vng thng tn.

225.

FUGACAR

JANSSEN PHARMACEUTICA
c/o JANSSEN-CILAG
c/o MEGA PRODUCTS
Vin n n nhai c 500 mg : hp 1 vin.
Vin nn v ngt tri cy nhai c 500 mg : hp 1 vin.
Hn dch hng v scla 500 mg : chai 10 ml.
THNH PHN
cho 1 vin
Mbendazole

cho 10 ml hn dch

500 mg

Mbendazole

500 mg

CH NH
Nhim mt hay nhiu loi giun : giun a, giun tc, giun mc, giun kim.
CHNG CH NH
Tng mn cm vi thuc.
THN TRNG LC DNG
Khng dng cho tr em di 2 tui.
Khng dng cho ph n trong 3 thng u thai kz hoc ang cho con b v bnh nhn suy
gim chc nng gan.
nh hng trn kh nng li xe v iu khin my mc :
Fugacar khng nh hng n s tnh to hay kh nng li xe.
TNG TC THUC
S dng cng lc vi cimetidine c th c ch chuyn ha mebendazol ti gan, kt qu l lm
tng nng thuc trong mu, c bit khi dng ko di.
TC DNG NGOI
au bng tiu chy thong qua c ghi nhn nhng him, khi nhim nhiu giun.
LIU LNG v CCH DNG
Cng mt liu dng cho ngi ln v tr em trn 2 tui.
C th nhai vin thuc trc khi nut, hoc nghin nh ri trn vi thc n.
Cc trng hp nhim mt hay nhiu loi giun sau : giun a, giun mc, giun tc, giun kim :
ung 1 vin duy nht Fugacar 500 mg hoc 1 liu duy nht hn dch Fugacar choco 10 ml.
BO QUN
Bo qun 15-30oC.

226.

FUGEREL

SCHERING-PLOUGH
Vin nn 250 mg : hp 100 vin.
THNH PHN
cho 1 vin

Flutamide

250 mg

DC LC
Flutamide l cht chng androgne c hiu, khng st roide, dng ng ung.
Flutamide c tc ng khng androgne bng cch c ch s thu nhn androgne v/hoc c
ch cc lin kt nhn ca androgne trn cc m ch.
DC NG HC
Phn tch huyt tng, nc tiu v phn ca 3 ngi nam tnh nguyn ung 1 liu duy nht
200 mg flutamide c nh du tritium cho thy thuc c hp thu nhanh v hon ton v
bi tit ch yu qua nc tiu. C t nht 6 cht chuyn ha c nhn bit trong huyt tng.
Cht chuyn ha chnh trong huyt tng, dn xut a-hydroxy c tc ng sinh hc, c thi
gian bn hy t 5-6 gi. Cht chuyn ha chnh trong nc tiu l 2-amino-5-nitro-4(trifluoromethyl)-phnol.
Cc nam tnh nguyn tr tui tham gia vo cc nghin cu m i kho st cc tc ng
dc lc ca flutamide ng ung hoc gi dc bng cch kim tra cc thng s c hiu
nh : mu thng qui v sinh ha nc tiu, cc nng ni tit t trong huyt tng, cc yu
t ng mu, s lng tinh trng, tnh vn ng v hnh thi hc. Cc thng s ny c kim
tra trc khi dng thuc, nhiu ln trong thi gian nghin cu v 6 tun sau khi ngng thuc.
Mi nhm iu tr c cho gi dc, 125 hoc 500 mg flutamide 3 ln/ngy trong 6 tun. Mc
d khng c nhng thay i ng k trong cc xt nghim ny, s tng cc nng
testostrone v estradiol trong huyt tng lin quan vi liu dng thuc c ghi nhn. Nhm
c dng liu cao hn th c s xut hin ca vic gim lng tinh trng. nhm ny c hin
tng au v, v to nam v mt s bnh nhn c hin tng tit sa non.
Hiu lc : trn c hai nghin cu lm sng cng khai v m i nhiu trung tm khc nhau,
cc bnh nhn c tin s ung th tuyn tin lit tin trin c cho iu tr vi flutamide. Cc
i tng c nghin cu bao gm bnh nhn khng c iu tr cng nh nhng bnh
nhn khng p ng hoc bnh nhn tr nn t p ng i vi cch iu tr thng thng (ct
b tinh hon v/hoc estrogne). Theo cc chn lc lm sng ny, flutamide chng minh c
p ng lm sng thch hp.
CH NH
Dng nh mt phng php iu tr duy nht (c hay khng c ct b tinh hon) hay dng kt
hp vi mt cht ch vn LHRH (luteinizing hormone- releasing hormone) kim sot chng
ung th tuyn tin lit tin trin cho nhng bnh nhn khng c iu tr trc hay cho
nhng bnh nhn khng p ng hay tr nn khng vi phng php iu tr bng
hormone.
Thuc cn dng nh mt thnh phn trong phng php iu tr carcinome tuyn tin lit B2C2 (T2b-T4) gii hn ti ch, Fugerel cng c ch nh lm gim kch thc khi u, tng cng

kim sot khi u v ko di khong thi gian khng biu hin bnh.
CHNG CH NH
Bnh nhn c phn ng mn cm vi flutamide hay bt c thnh phn no ca thuc.
CH PHNG
Tn thng gan : do c bt thng transaminase, vng da mt, hoi t gan v bnh no do
gan c bo co xut hin khi s dng flutamide, nn xem xt thc hin cc xt nghim
chc nng gan nh kz. Nn lm cc xt nghim thch hp ngay khi c triu chng u tin ca
ri lon chc nng gan (nh nga ngy, nc tiu sm mu, thng xuyn chn n, vng da,
au phn t pha trn bn phi hay c nhng triu chng "ging nh b cm" khng gii thch
c).
Nu bnh nhn c bng chng cn lm sng ca tn thng gan hay vng da, khng c di cn
c chng minh bng sinh thit, nn ngng dng hay gim liu Fugerel. Tn thng gan
thng l c hi phc sau khi ngng thuc v mt vi bnh nhn hi phc sau khi gim liu.
Tuy nhin cng c bo co v nhng trng hp t vong do tn thng gan trm trng i km
vi s s dng flutamide.
Flutamide khng cho thy kh nng gy bin d trong xt nghim Ames, test sa cha ADN, xt
nghim trao i chromatide ch em in vivo hay xt nghim t vong tnh tri chut.
Sau mt thi gian iu tr ko di chut, Fugerel gy u tuyn k t bo tinh hon v s gia
tng ph thuc liu lng ca u tuyn v hay carcinome tuyn v. Khng bit c s lin
quan ca nhng khm ph ny trn ngi.
Trong phng php iu tr dng Fugerel phi hp vi cht ch vn LHRH, nn lu { tc dng
ngoi c th xy ra ca mi thuc. Bnh nhn khng nn gin on vic s dng thuc hay
thay th thuc khc m khng hi kin ca bc s.
TNG TC THUC
Cha c ghi nhn.
TC DNG NGOI
Bnh nhn c iu tr duy nht vi Fugerel : cc tc dng ngoi { thng c ghi nhn nht
vi Fugerel l hin tng v to nam v/hoc au v, i khi c km theo s tit sa. Cc du
hiu ny bin mt khi ngng iu tr hoc khi gim liu.
Fugerel c nguy c thp trn h tim mch v khi c so snh vi DES (diethylstilbestrol), nguy
c ny thp hn mt cch ng k.
Mt s tc dng ngoi t gp hn : bun nn, nn ma, tng s ngon ming, mt ng, mt
mi, bt thng chc nng gan thong qua v vim gan .
Mt s tc dng ngoi him gp : gim hot ng tnh dc, chn n, nn nao d dy, au nh
b lot, nng, tiu chy, to bn, ph n, vt bm mu, herps zoster, nga ngy, hi chng
ging lupus, nhc u, hoa mt, ng khng vng, kh chu, mt m, kht nc, au ngc, lo
lng, trm cm, ph bch huyt.

Him gp hin tng gim lng tinh trng.

Liu php dng thuc kt hp : tc dng ngoi { thng gp nht gp c khi dng kt hp
Fugerel vi mt cht ch vn LHRH l cn bng ha, gim tnh dc, bt lc, tiu chy, bun nn
v nn ma. Tr trng hp tiu chy, cc tc dng ngoi { ny c bit c xy ra vi cht
ch vn LHRH khi dng ring r vi t l tng t.
T l cao chng to v nam gii quan st c trong s s dng flutamide ring r c gim
ng k khi dng thuc kt hp. Trong cc xt nghim lm sng, khng quan st c c s
khc bit gia nhm dng gi dc v nhm dng phi hp flutamide v cht ch vn LHRH.
Him khi bnh nhn mc chng thiu mu, gim bch cu, bnh ng tiu ha khng c
hiu, chn n, kch ng v ni ban ni tim, ph n, cc triu chng thn kinh c, vng da, triu
chng bnh ng tit niu sinh dc, cao huyt p, tc dng ngoi ln h thn kinh trung
ng (bun ng, trm cm, l ln, lo lng, u t) v gim tiu cu.
Thm vo , cc tc dng ngoi { c bo co trong qu trnh a Fugerel xm nhp th
trng bao gm : thiu mu tn huyt, thiu mu i hng cu, mthmoglobine huyt, phn
ng cm quang bao gm ban , ni ban dng bng nc v hoi t biu b v thay i mu
nc tiu thnh mu h phch hay vng chanh, cc tc dng ny c th quy cho flutamide
v/hay cc cht chuyn ha ca n. Cng c th quan st thy chng vng da mt, bnh no
do gan v hoi t gan. Thng cc bnh gan l c hi phc sau khi ngng dng thuc ; tuy
nhin, c nhng bo co v trng hp t vong do cc tn thng gan trm trng i km
theo s s dng flutamide.
c hai bo co v khi u v c tnh nam xy ra trn bnh nhn c iu tr vi Fugerel.
Mt trong nhng trng hp l s gia tng nng hn nt u c sn tm thy u tin 3-4
thng trc khi bt u iu tr ring l vi Fugerel trn mt bnh nhn ph i tuyn tin lit
lnh tnh. Sau khi ct b, tuyn c chn on l mt carcinome ng bit ha km. Bo co
cn li bao gm chng to v nam gii v mt nt u tm thy trong khong thi gian tng
ng sau 2 v 6 thng, sau khi bt u tr liu, nt u c ct b v chn on l mt khi u ng
bit ha va trong giai on T4NOMO, G3, khng c di cn tin trin.
Cc kt qu xt nghim bt thng c bo co bao gm s thay i chc nng gan, gia tng
BUN v him khi gia tng cr atinine huyt thanh.
LIU LNG v CCH DNG
Liu khuyn co trong trng hp iu tr duy nht mt loi thuc hay dng kt hp l mi ln
mt vin nn 250 mg, 3 ln mi ngy, cch khong 8 gi. Trong kt hp vi cht ch vn LHRH,
c th bt u c hai thuc cng mt lc hay dng Fugerel trc 24 gi ri mi dng cht ch
vn LHRH.
Trong kim sot carcinome tuyn tin lit gii hn ti ch, liu khuyn co l dng mt vin nn
250 mg, 3 ln mi ngy, cch khong 8 gi. Nu c iu tr vi cht ch vn LHRH, nn bt u
dng Fugerel cng mt lc hay trc 24 gi. Nn dng Fugerel 8 tun trc khi x tr v tip

tc dng trong sut qu trnh x tr.

QU LIU
Triu chng : trong cc nghin cu trn th vt vi flutamide dng ring r, cc du hiu qu
liu bao gm km hot ng, dng lng, th chm, mt iu ha, v/hoc chn n, an thn,
nn ma v mthmoglobine mu.
Cha thit lp c cc triu chng qu liu hoc nguy him n tnh mng lin quan vi vic
dng duy nht 1 liu flutamide.
iu tr : do flutamide lin kt cht ch vi prot ine, phng php thm phn c th khng
hu hiu lm trong vic iu tr qu liu.
Nh trong trng hp x l qu liu vi bt kz thuc no, nn cn nhc kh nng ca nhiu tc
nhn. Nu bnh nhn khng t nn ma c, nn gy nn nu bnh nhn ang trong tnh
trng cn tnh. Chm sc h tr tng qut, bao gm kim tra du hiu sinh tn v theo di cht
ch bnh nhn.
BO QUN
Bo qun trong khong nhit 2-30oC. Trnh nh sng v qu m.

227.

FUROSEMID

SANOFI SYNTHELABO VIETNAM

Dung dch tim 20 mg/2 ml : ng 2 ml, hp 25 ng.
THNH PHN
cho 1 ng
Furosmide

20 mg

CH NH
Ph do ngun gc tim, gan hay thn ; ph phi ; ph no ; nhim c thai ; cao huyt p nh
hay trung bnh (trong trng hp cao nh, dng n c hay phi hp vi cc thuc cao huyt
p khc).
Liu cao dng iu tr suy thn cp hay mn, thiu niu, ng c barbiturate.
CHNG CH NH
Mt in gii, tin hn m, hn m gan, suy thn do ng c cc c t t gan, thn. Tng nhy
cm vi furosmide hoc cc sulfamide khc.

CH PHNG v THN TRNG LC DNG

Khi dng liu cao v ko di, cn kim sot in gii , b thm thc phm giu kali (tri cy,
rau) hay b kali. Huyt p v cung lng tim ca bnh nhn try mch phi tr v bnh thng
trc khi iu tr.
Furosmide phi c dng thn trng trong bnh nhn ph i tin lit tuyn v n c th gy
tt nghn ng niu cp.
Khi iu tr lu di nhng bnh nhn tiu ng, cn theo di ng huyt v tng liu
insuline nu cn.
Thn trng trong nhng bnh nhn c ri lon chuyn ha acide urique.
Trong mt vi trng hp cao huyt p c tnh, c th phi hp vi mt Natri, dng li tiu khi
s c hi.
Trong x gan c chng, lm thay i qu nhanh cn bng nc in gii c th a n hn
m gan.
Ru, barbiturate v diazpam c th lm tng tc dng h p t th ca furosmide.
Khi khi u iu tr, khng nn li xe hoc vn hnh my mc nng.
Khi tim truyn, khng c pha furosmide vi cc loi thuc khc.
LC C THAI v LC NUI CON B
6 thng u thai kz, ch s dng khi thy c li ch r rt. Furosmide c ch s tit sa v
hin din trong sa.
TNG TC THUC
Khng nn dng chung vi lithium, cphalosporine, aminoglycoside. Dng thn trng vi cc
thuc h p, thuc tiu ng ung, corticoide, digitalis.
TC DNG NGOI
Nn, bun nn, tiu chy, kh tiu, ri lon th gic, tai, ic thong qua, vp b, d cm, h
huyt p t th ng, vim ty cp, tn thng gan, tng nhy cm vi nh sng. Tiu qu
nhiu s a n chong vng, mt mi, yu c, kht nc v tng s ln i tiu. Him gp d
ng da, c ch ty xng (thiu mu, gim bch cu, gim tiu cu). Ri lon nc in gii.
LIU LNG v CCH DNG
Liu dng ty thuc vo tnh trng ca bnh nhn v p ng khi iu tr.
- Ngi ln : 1-2 ng (20-40 mg)/ngy, tim bp hay tim mch chm. Khi cn c th lp li sau
mi 2 gi.
- Suy thn : Liu khi u 240 mg, ngy 2 ng, pha long trong 250 ml nc mui sinh l hay
dung dch Ringer truyn tnh mch trong 1 gi (tc 80 git/pht). Nu khng hiu qu, th
sau 1 gi, c th truyn tip 500 mg. Nu vn khng hiu qu, th sau 1 gi, c th truyn tip
1000 mg trong 4 gi. Nu vi liu ti a 1000 mg, m vn khng hiu qu, bnh nhn cn phi
c lc thn nhn to. Liu hiu qu c th c lp li mi 24 gi hoc chuyn sang dng

ng ung.
- Tr em : 0,5-1 mg/kg/ngy.

THUC VN G

228.

GAMAXCIN

SIGMA PHARMA
c/o IC VIET NAM
Vin nn : hp 100 vin.
THNH PHN
cho 1 vin
Aluminium hydroxyde

250 mg

Magnesium trisilicate

120 mg

Magnesium hydroxyde

120 mg

Simethicone carbohydrate

9,5 mg

CH NH
Gim cc triu chng kh tiu, nng rt vng thng v, cc triu chng gy cm gic kh chu
vng d dy, au do lo t d dy v cc triu chng do tng acid dch d dy.
THN TRNG LC DNG
Thn trng khi s dng cho bnh nhn ang thm phn mu ko di.
TNG TC THUC
Khi dng chung, lm thay i s hp thu ca mt s thuc nh tetracycline, indomethacine,
digoxine, isoniazide...
LIU LNG v CCH DNG
Nut hoc nhai 1-2 vin sau ba n 1-1,5 gi v khi i ng, hoc khi c cc triu chng k trn.

229.

GASTROPULGITE

BEAUFOUR IPSEN
Bt pha hn dch ung : hp 30 gi, hp 60 gi.
THNH PHN
cho 1 gi
Attapulgite de Mormoiron hot ha

2,5 g

Gel Aluminium hydroxyde v magnesium carbonate c sy kh

0,5 g

DC LC
Vi kh nng m trung ha, Gastropulgite c tc dng khng acide khng hi ng.
Nh kh nng bao ph ng u, Gastropulgite to mt mng bo v v d lin so trn nim
mc thc qun v d dy.
Ngoi ra Gastropulgite cn c tc dng cm mu ti ch, chng lot v sinh cht nhy.
Tt c tnh cht ny ng gp vo vic bo v v hi phc nim mc d dy.
Gastropulgite khng cn quang do khi tin hnh thm d bng X-quang, khng cn thit phi
gin on iu tr.
Gastropulgite khng nhum mu phn v khng lm ri lon nhu ng rut.
CH NH
iu tr triu chng lot d dy-t trng, vim d dy, thot v honh, hi lu d dy-thc qun,
di chng ct d dy, au thng v, nng, d dy khng dung np thuc.
CHNG CH NH
Khng c chng ch nh.
THN TRNG LC DNG
Thn trng khi dng cho bnh nhn b suy thn v bnh nhn phi lm thm phn mn tnh v
nguy c bnh l{ no do ng aluminum.
TNG TC THUC
Thn trng khi phi hp :
- Thuc khng sinh (cycline ; fluoroquinolone) ; thuc chng lao (ethambutol v isoniazide ;
lincosanide) ; khng histamine H2 ; atenolol, metoprolol, propranolol ; chloroquine ; diflunisal ;
digoxine ; diphosphonate ; fluorure de sodium ; glucocorticoide (prednisolone v
dexamethasone) ; indometacine ; kayexalate ; ketoconazole ; thuc an thn kinh nhm
phenothiazine ; penicillamine ; mui st. Ngi ta nhn thy s hp thu cc thuc ny ng

tiu ha gim nu dng ng thi bng ng ung. Do thn trng, nn ung thuc cch nhau
khong 2 gi v cch 4 gi i vi fluoroquinolone.
TC DNG NGOI
S hp thu ca aluminium, khi dng lu di, c th l ngun gc lm gim phosphore, nhng
trong nhng th nghim lm sng gn y khng thy c s gia tng aluminium trong mu hay
nc tiu khi iu tr.
Lng phosphore v calcium trong mu khng thay i.
LIU LNG v CCH DNG
Ngi ln : 2 n 4 gi/ngy, pha trong na ly nc, ung trc hoc sau cc ba n v khi c
triu chng au.
Tr em : 1/3 n 1 gi, 3 ln mt ngy ty theo tui.

230.

GELDNE

PFIZER
c/o ZUELLIG
Gel dng ngoi da 0,5% : ng 50 g.
THNH PHN
cho 100 g
Piroxicam

500 mg

(Ethanol 95%)

(25 g)

DC LC
Piroxicam l thuc khng vim khng stroide thuc h oxicam.
Dng xoa bp ngoi da, piroxicam c tc dng khng vim v gim au.
DC NG HC
ngi, sau khi bi liu duy nht 3 g Geldne (tng ng 15 mg piroxicam) v lau phn d sau
8 gi, nh hp thu trong huyt tng trung bnh l 147 ng/ml, t c khong 23 gi sau khi
bi thuc, chim t l 1/15 so vi ung cng liu.
Sau khi bi 2 g gel, 2 ln/ngy (tng ng vi liu hng ngy l 20 mg piroxicam), cc nng
trong huyt tng tnh trng cn bng t c t 300 n 400 ng/ml tng ng khong 5%

so vi nng quan st c khi dng 20 mg piroxicam bng ng ung hoc tim bp. Nh
i vi dng ung, thi gian bn hy trong huyt tng khong 50 gi.
Mt lng ln c o thi qua nc tiu di dng chuyn ha.
CH NH
Geldne c ch nh trong trng hp vim v au trong thoi ha khp, sau chn thng
hoc cc ri lon cp tnh ca h c xng nh vim gn, vim bao gn, vim quanh khp,
bong gn, au tht lng.
CHNG CH NH
Khng s dng Geldne nhng bnh nhn nhy cm vi dng gel hoc piroxicam di bt kz
dng bo ch no, khng s dng vi bnh nhn c phn ng cho vi aspirine v cc khng
vim khng stroide khc.
Khng s dng Geldne nhng bnh nhn khi dng aspirine v cc khng vim khng
stroide khc c cc triu chng nh hen, vim mi, ph hoc ni m ay.
CH PHNG
Nu c phn ng da ti ch phi ngng thuc ngay v chuyn sang ch iu tr cn thit
khc. Khng bi ln mt, nim mc, vt thng h.
THN TRNG LC DNG
Khng dng di lp bng bt.
LC C THAI v LC NUI CON B
Mc d khng c tc ng sinh qui thai ca piroxicam dng ng ung khi th nghim trn
ng vt nhng tnh an ton trong thi kz mang thai v cho con b cha c xc nh. Khng
nn s dng piroxicam cho ph n c thai v cho con b.
TC DNG NGOI
Phn ng d ng ti ch (nga, da, ban, da trc vy) him gp. Da hi c mu vng thong
qua, c th gy bn qun o nu khng xoa cho tan ht gel.
LIU LNG v CCH DNG
Dng ngoi da.
Bi thuc ln ch tn thng v xoa nh 2-4 ln/ngy vi lng tng ng 15-20 mg
piroxicam/ngy.

231.

GELOFUSINE

B. BRAUN
Dung dch tim truyn : chai 500 ml.
THNH PHN
cho 1000 ml dch truyn
Succinyl gelatin (gelatin lng ci tin)
Trung bnh trng lng ca phn t lng
Trung bnh s lng ca phn t lng
Natri clorid
Natri hydroxyd
T| dc :
Nc ct pha tim
Nng in gii :
Natri
Clorid
Tnh cht ha l :
Nng p lc thm thu l thuyt
pH
im ha gel

40 g
30.000
23.200
7,01 g
1,36 g

154 mmol/l
120 mmol/l
274 mOsm/l
7,1-7,7
<= 3oC

DC LC
Thuc nhm keo thay th th tch huyt tng.
CH NH
Dng lm dung dch keo thay th th tch huyt tng trong cc trng hp :
- phng v iu tr tnh trng gim th tch mu tuyt i v tng i (v d sau khi b sc
do chy mu hoc chn thng, b mt mu trc-sau khi m, b bng, b nhim trng).
- phng h huyt p (v d trong trng hp c lin quan vi gy t ngoi mng cng hoc
ty sng).
- Pha long mu.
- Tun hon ngoi c th (my tim-phi nhn to, thm phn mu).
- Tng s lng bch cu trong liu php bch cu.
CHNG CH NH
Khng c dng Gelofusine trong cc trng hp :
- bit l b mn cm vi gelatin.
- Tng th tch mu.
- nc.
- Suy tim trm trng.
- Ri lon ng mu trm trng.
Ch c dng Gelofusine vi iu kin ht sc thn trng trong cc trng hp :

- Tng natri mu, v trong thnh phn ca gelofusine c b sung natri.

- Tnh trng mt nc, v trong cc trng hp vic u tin l cn phi iu chnh cn bng
nc-in gii.
- Ri lon ng mu, v vic s dng thuc dn n tnh trng pha long cc yu t ng mu.
- Suy thn, v thuc ch yu c bi tit qua thn.
- Bnh gan mn, v vic tng hp albumin v cc yu t ng mu trong gan c th b nh
hng v vic s dng thuc li cng lm chng b pha long hn.
THN TRNG LC DNG
Cn phi lu { n nhng phng nga sau y :
Cc cht in gii cn c b p hoc b sung nu cn.
Cc kim sot cn thit :
Cn phi theo di ion huyt thanh v cn bng nc-in gii, c bit l trong trng hp
tng natri mu, tnh trng mt nc v suy thn.
Trong trng hp c ri lon ng mu v bnh gan mn cn phi theo di cc ch s ng
mu v albumin huyt thanh.
Do kh nng cc phn ng d ng (phn v/th phn v) c th xy ra, vic theo di ngi bnh
l thc s cn thit.
S dng trong nhi khoa :
Hin cha c kinh nghim g khi ch nh cho tr em di mt tui.
LC C THAI v LC NUI CON B
Khng c du hiu no chng t Gelofusine gy c cho thai nhi. Tuy nhin, do khng th loi
tr kh nng c th xy ra phn ng d ng (phn v/th phn v), ch nn s dng cho thai ph
sau khi cn nhc gia ri ro v ch li.
Hin cha c thng tin no ni v hin tng Gelofusine i vo sa m.
TNG TC THUC
Cc tng k c th xy ra khi trn chung vi cc thuc khc.
TC DNG NGOI
Ging nh tt c cc dung dch keo thay th th tch, phn ng d ng (phn v hoc th phn
v) vi mc nghim trng khc nhau c th xy ra sau khi truyn Gelofusine. Chng biu
hin nh l cc phn ng ca da (ni m ay) hoc c th gy bng mt v c. Rt him khi
xy ra trng hp b tt huyt p, sc hoc ngng tim v h hp.
Cc nguyn tc chung trong phng nga v iu tr cc tc dng ph gy d ng (phn v/th
phn v) :
Bng 1 : Cp v biu hin lm sng :
Cng
/Cp

Phng thc biu

hin

Cc du hiu v triu chng lm sng


Ia

phn ng khu tr trn

da
Ib
phn ng ton thn
dng nh
II
phn ng tim mch
v/hoc phi
v/hoc d dy rut
III
phn ng ton thn
nguy cp
IV
phn ng ton thn
e da tnh mng
Bng 2 : Bin php x l :
Cng
/Cp

Ia
Ib
II

III

IV

ban khu tr
lo u, nhc u, ng , ni m ay ton pht,
ph nim, ri lon cm gic
tim mch p nhanh, tt huyt p
kh th, bt u co tht ph qun
bun nn, i ma
h huyt p nghim trng v b sc
kh th nghim trng v co tht ph qun
ngng h hp v ngng tim

Cc bin php v liu php ha

dc
Ngng truyn v ty theo cp , tin
hnh cc bin php sau :- Cung cp
oxy / t ng ni kh qun- Truyn cc
tinh / Truyn cc cht keo (albumin
ngi)- Tim cc cathecholamin (liu
dng v cch dng xem ct bn phi)Hi sc cp cu tim-phi

- cc khng histamin H1/H2 thch hp

- epinephrin, v d epinephrin nut
hoc tim IV chm 0,5-1 ml
epinephrin 1:10.000- cc
corticosteroid tim IV thch hp- cc
khng histamin H1/H2 nu cn
cc catecholamin, v d tim IV chm
1 ml epinephrin 1:10.000, tim nhc
li nu cn vi tng liu khng vt
qu 10 mltrng hp co ph qun
nghim trng :theophyllin tim IVcc
corticosteroid tim IV thch hpcc
khng histamin H1/H2 nu cn
- hi sc c bn- hi sc tch cccc
catecholamin, v d 10 ml epinephrin
1:10.000 tim IV, tim nhc li nu
cn- lu { n cc thuc khc nh
:noradrenalin, dopamin,
dobutaminnatri bicarbonat

LIU LNG v CCH DNG

Liu lng, tc truyn v thi gian truyn ph thuc vo yu cu ca tng c th ngi
bnh v c iu chnh theo yu cu hin hnh bng cch theo di cc ch s thng thng
ca h tun hon (v d huyt p).
pht hin sm cc phn ng d ng (phn v/th phn v) c m t di dng cc tc

dng khng mong mun, 20-30 ml u tin phi c truyn tht chm cho bnh nhn di s
gim st cht ch.
Di y l nhng khuyn co v liu dng dnh cho ngi ln :
Cc ch nh
phng tnh trng gim th tch mu v
h huyt p, iu tr tnh trng gim th
tch mu dng nh (v d mt mu v
huyt tng khng nhiu lm)
iu tr tnh trng gim th tch mu trm
trng
Trong cc trng hp cp cu c cc ch
nh sng cn i vi ngi bnh

Liu trung bnh

500-1000 ml

1000-2000 ml

Truyn nhanh 500 ml (bng p lc), v

sau khi cc ch s ca h tun hon
c ci thin th truyn thm b
p li th tch b thiu ht.
Pha long mu (ng th tch)
Lng Gelofusine dng ty thuc vo
th tch mu b ly i. Tuy nhin v
nguyn tc, khng c dng qu 20
ml/kg th trng trong mt ngy
Tun hon ngoi c th
Ty thuc vo vic s dng h thng
tun hon no, nhng thng l 500
n 1500 ml.
Lm tng lng bch cu trong liu php 500-1000 ml cho mi ln lm liu php
bch cu
bch cu.
Trng hp ngi bnh b ri lon ng mu, suy thn v bnh gan mn, cn phi iu chnh
liu lng theo tnh trng lm sng ca c th, va phi x t n cc kt qu iu tra ha-lm
sng.
Liu ti a hng ngy :
Liu iu tr ti a c xc lp bi tc dng pha long. Vic ch thay hng cu hoc truyn
nguyn c mu c coi l bin php cui cng khi t l th tch huyt cu tt xung di 25%
(30% trong trng hp ngi bnh c nguy c b bnh tim mch hoc bnh phi).
Tc truyn ti a :
Tc truyn ti a ph thuc vo tnh trng tun hon - tim mch c th ca tng ngi
bnh.
Ch :
Nu dng p lc truyn th trc khi truyn phi lm m Gelofusine ln n nhit c th
(bng qun p lc, bm truyn).
Cch dng v ng dng :
Truyn tnh mch.
QU LIU

Vic dng qu liu lng cc dung dch thay th th tch c th dn n tnh trng tng th tch
mu khng ch nh km theo chc nng tim v phi b suy gim lin tc. Ngay khi cc triu
chng h tun hon b qu ti bt u biu hin, v d kh th, tc nghn tnh mch c, phi
ngng truyn ngay lp tc.

232.

GEMZAR

ELI LILLY
Bt ng kh pha tim 200 mg : hp 1 l - Bng A.
Bt ng kh pha tim 1 g : hp 1 l - Bng A.
THNH PHN
cho 1 l
Gemcitabine hydrochloride,
tng ng Gemcitabine

200 mg

cho 1 l
Gemcitabine hydrochloride,
tng ng Gemcitabine
1g
DC LC
Gemzar c hot cht chnh l gemcitabine, c tn quc t chung l 2'-deoxy-2', 2'difluorocytidine monohydrochloride (ng phn beta).
Tc dng c t bo i vi cc mu t bo nui cy :
Gemcitabine c c tnh ng k trn nhiu loi t bo u ca ngi v chut c nui cy. Tc
dng c t bo c trng giai on ranh gii G1/S. In vitro, tc dng c t bo ca
gemcitabine ph thuc vo nng v thi gian dng thuc.
Tc dng khng u trong cc mu tin lm sng :
i vi cc mu khi u loi vt tc dng khng u ca gemcitabine ph thuc thi biu dng
thuc. Khi dng liu mi ngy, gemcitabine gy cht vt th nghim m tc dng khng u rt t.
Tri li, khi dng liu cch 3 hoc 4 ngy 1 ln, gemcitabine liu khng gy cht li c tc dng
khng u rt tt trn nhiu loi u chut.
Chuyn ha t bo v c ch tc ng :
Gemcitabine (dFdC) c bin dng trong t bo bi men nucleoside kinase thnh
diphosphate (dFdCDP) v triphosphate (dFdCTP) nucleoside hot tnh. Tc dng c t bo ca

gemcitabine l do dFdCDP v dFdCTP c ch qu trnh tng hp ADN. Trc ht, dFdCDP c

ch men ribonucleotide reductase, l men duy nht xc tc cc phn ng to ra
deoxynucleoside triphosphate tng hp ADN. c ch men ny s lm gim nng
deoxynucleoside ni chung, c bit l nng dCTP. Th hai l, dFdCTP cnh tranh vi dCTP
gn vo ADN (self-potentiation). Tng t, mt lng nh gemcitabine cng c th gn vo
ARN. Nh vy, gim nng ni bo ca dCTP khin cho vic gn dFdCTP v ADN d dng hn.
Thc cht ADN polymerase epsilon khng th loi b gemcitabine v sa li chui ADN ang
pht trin. Sau khi gemcitabine gn vo ADN, 1 nucleotide na gn thm vo chui ADN ang
pht trin. Sau khi gn thm nucleotide ny, s tng hp ADN thc s b c ch hon ton
(masked chain termination). Sau khi gn vo ADN, gemcitabine thc y qu trnh hy dit t
bo theo chng trnh nh trc, c gi l "apoptosis".
DC NG HC
Dc ng hc ca gemcitabine c nghin cu trn 353 bnh nhn, gm 121 n v 232
nam tui t 29 n 79. Trong s cc bnh nhn ny, khong 45% b ung th phi khng phi t
bo nh v 35% b ung th ty.
Khi dng gemcitabine, liu t 500-2592 mg/m2, truyn trong 0,4 n 1,2 gi, cc ch s dc
ng hc ghi nhn c nh sau :
Nng nh trong huyt tng (t c khong 5 pht sau khi truyn xong) : 3,2-45,5
mg/ml.
Th tch phn b ca khoang chnh : 12,4 l/m2 i vi n v 17,5 l/m2 i vi nam (t l khc
bit gia ngi ny v ngi khc l 91,9%)
Th tch phn b ca khoang ngoi vi : 47,4 l/m2, ch s ny khng thay i theo gii tnh.
gn kt protein huyt tng : khng ng k.
thanh thi ton thn : t 29,2 l/gi/m2 n 92,2l/gi/m2 ty theo tui v gii tnh (t l khc
bit gia ngi ny v ngi khc l 52,2%). thanh thi n thp hn nam khong 25%.
Mc d c thi nhanh, nhng thanh thi nam ln n hnh nh gim dn theo tui. Vi
liu ngh 1.000 mg/m2, truyn trong 30 pht d thanh thi c thp nhng cng khng cn
gim liu (c nam ln n).
Thi tr qua ng tiu : Di 10% thuc c thi tr dng khng thay i.
thanh thi thn : 2-7 l/gi/m2.
Thi gian bn hy : t 42 n 94 pht, ty theo tui v gii tnh. Vi thi biu dng thuc
ngh, gemcitabine hu nh c thi tr hon ton trong vng 5-11 gi k t lc bt u
truyn. Khi dng 1 tun 1 ln, gemcitabine khng tch t trong c th.
Chuyn ha :
Gemcitabine c chuyn ha nhanh chng ti gan, thn, mu v cc m khc do men cytidine
deaminase.
Chuyn ha ni bo ca gemcitabine to ra gemcitabine mono, di, v triphosphate (dFdCMP,

dFdCDP, dFdCTP) trong dFdCDP v dFdCTP c xem l c hot tnh. Cc sn phm ca

chuyn ha ni bo ny khng tm thy trong huyt tng hay nc tiu.
Sn phm chuyn ha ban u 2'-deoxy-2', 2' difluoroudine (dFdU) khng c hot tnh v tm
thy trong huyt tng v nc tiu.
Dc ng hc ca dFdCTP :
dFdCTP c th tm thy trong cc bch cu n nhn mu ngoi bin. Cc thng tin sau y
cp n nhng t bo ny:
Thi gian bn hy ca s thi tr cui cng : 0,7-12 gi.
Nng ni bo ca dFdCTP tng t l thun vi liu gemcitabine 35-350 mg/m2/30 pht, liu
gemcitabine ny to ra nng n nh ca dFdCTP l 0,4-5 mg/ml. Khi nng ca
gemcitabine trong huyt tng cao hn 5 mg/ml th nng ni bo ca dFdCTP khng tng
thm na. iu ny gi rng s to thnh dFdCTP bo ha trong cc t bo. Khi dng liu
1.000 mg/m2/30 pht, khong 30 pht sau khi ngng truyn nng gemcitabine t c
trong huyt tng trn 5 mg/ml v ln hn 0,4 mg/ml trong mt gi tip theo.
Dc ng hc ca dFdU :
Nng trong huyt tng (t c 3-15 pht sau khi truyn xong vi liu 1.000 mg/m2) : 2852 mg/ml.
Nng khi dng 1 tun 1 ln : 0,07-1,12 mg/ml, khng c s tch t thuc r rt.
Nng huyt tng 3 pha so vi ng cong theo thi gian, thi gian bn hy trung bnh ca
pha cui : 65 gi (33 n 84 gi).
T l dFdU c hnh thnh t hp cht ban u : 91-98%.
Th tch phn b trung bnh ca khoang trung tm : 18l/m2 (11-12 l/m2).
Th tch phn b n nh trung bnh (Vss) : 150 l/m2 (96 - 228 l/m2).
Phn b ti m : rt nhiu.
thanh thi trung bnh : 2,5 l/h/m2 (1-4 l/h/m2).
Thi tr qua ng tiu : ton b.
S thi tr ca thuc :
T l thuc t c 1 tun sau khi tim truyn gemcitabine l : 92-98% trong 99% l dFdU
s bi tit qua thn v 1% liu lng c bi tit qua phn.
D liu v tnh an ton tin lm sng
Trong cc nghin cu dng nhiu liu lp li vi thi gian 6 thng chut v ch, thng thy
qu trnh to mu b c ch. Hin tng ny c lin quan vi tnh cht c t bo ca thuc v
c th hi phc sau khi ngng thuc. Mc nh hng ty thuc vo liu lng v thi biu
dng thuc.
Tnh gy ung th, t bin, nh hng kh nng sinh sn
Trong cc nghin cu in vitro, gemcitabine lm h hi nhim sc th, gm gy nhim sc t.
Gemcitabine gy ra chng gim tinh trng chut c, chng ny ty thuc liu lng, thi

biu dng thuc v c th hi phc. Trong cc nghin cu trn th vt, mc d gemcitabine c

nh hng kh nng sinh sn th ging c, nhng cha thy c nh hng kh nng sinh sn
ca th ging ci. Cc nghin cu di ngy trn sc vt nh gi kh nng gy ung th ca
gemcitabine cha c tin hnh.
Dng thuc trong thi gian mang thai v cho con b : Loi B3
Tnh an ton ca thuc trn ph n mang thai cha c xc nh. Cc nghin cu trn vt th
nghim cho thy thuc c c tnh trn s sinh sn, v d gy khuyt tt bm sinh, hoc c cc
nh hng khc trn qu trnh pht trin ca phi v bo thai, qu trnh mang thai, trn s
pht trin chu sinh v sau sinh.
CH NH
Gemcitabine c ch nh cho bnh nhn ung th phi khng phi t bo nh di cn hoc tin
trin ti ch.
Gemcitabine c ch nh cho bnh nhn ung th ty dng tuyn, di cn hoc tin trin ti
ch.
Gemcitabine c ch nh cho bnh nhn ung th ty khng vi 5-FU.
Bnh nhn dng gemcitabine c th c ci thin trn lm sng, hoc tng t l sng hoc c hai.
Tc dng iu tr khc
Gemcitabine cng c tc dng trong carcinome phi t bo nh th tin trin, tuyn tin lit,
bung trng, v. C mt s p ng vi thuc trong iu tr ung th bng quang v thn tin
trin.
CHNG CH NH
Chng ch nh s dng gemcitabine bnh nhn nhy cm vi thuc.
CH PHNG
Thi gian truyn ko di v s ln dng thuc tng lm tng c tnh.
Gemcitabine c th gy c ch ty xng vi biu hin gim bch cu, tiu cu v thiu mu.
Tuy nhin hin tng c ch ty xng ch l ngn hn, thng khng cn gim liu v him
khi phi ngng thuc (xem phn Liu lng v Cch dng, Tc dng ngoi ).
Phn ng qu mn : phn ng phn v him khi xy ra.
THN TRNG LC DNG
Nn theo di st bnh nhn dng gemcitabine. Cn c cc phng tin xt nghim cn lm
sng theo di tnh trng bnh nhn. C th cn phi iu tr cc bnh nhn c biu hin tc
dng c ca thuc.
nh hng kh nng li xe v iu khin my mc
Gemcitabine c bo co l gy chng ng g, t nh n trung bnh. Khi bnh nhn tnh
trng ng g khng nn li xe, iu khin my mc.
LC C THAI v LC NUI CON B
Trnh dng gemcitabine cho ph n c thai hoc cho con b v c th gy c cho bo thai

hoc tr b m.
TNG TC THUC
Trong mt th nghim ring l bnh nhn ung th phi khng phi t bo nh dng Gemzar
liu 1.000 mg/m2 trong 6 tun lin tip km vi x tr vng ngc xy ra vim phi v vim
thc qun nng e da tnh mng c bit l trn cc bnh nhn nhn liu x tr ln. Cha xc
nh c ch iu tr ti u s dng Gemzar an ton khi bnh nhn cn kt hp Gemzar
vi x tr.
Xt nghim cn lm sng : Thn trng khi khi u iu tr cho cc bnh nhn b suy ty xng.
Ging nh cc thuc iu tr ung th khc khi p dng phng php ha tr liu phi hp hoc
lin tc nn lu tm n kh nng suy ty tng dn. Nn theo di s lng tiu cu, bch cu
v bch cu ht trc mi liu gemcitabine. Nn ngng thuc hoc thay i cch iu tr khi
pht hin suy ty do thuc. Phn hng dn iu chnh liu c trnh by phn Liu lng
v Cch dng. S lng t bo mu ngoi vi c th tip tc gim sau khi ngng thuc.
TC DNG NGOI
Mu :
V gemcitabine gy c ch ty xng, nn c th gy thiu mu, gim bch cu, tiu cu.
Ty xng thng b c ch t nh n trung bnh, biu hin r trn s lng bch cu ht.
Chng tng tiu cu cng thng c bo co.
ng tiu ha :
Bt thng v men transaminase ca gan xy ra 2/3 bnh nhn, nhng thng nh, khng
tin trin, v him khi phi ngng thuc. Tuy vy, nn cn thn khi dng gemcitabine cho bnh
nhn suy gan (xem phn Liu lng v Cch dng).
Bun nn, bun nn km nn xy ra trn 1/3 bnh nhn. Khong 20% bnh nhn c tc dng
ph ny cn iu tr, him khi phi gii hn liu dng, v rt d iu tr bng cc thuc chng
nn.
Thn :
Protein niu v huyt niu nh xy ra trong khong 1/2 s bnh nhn, nhng him khi c
ngha trn lm sng, thng khng km theo thay i creatinine huyt thanh hay BUN. Tuy
nhin, vi trng hp suy thn khng r cn nguyn c bo co, do , cn thn khi dng
gemcitabine cho bnh nhn b suy gim chc nng thn (xem Liu lng v Cch dng).
D ng :
Ni ban xy ra trong khong 25% bnh nhn, ban km nga xy ra trong khong 10% bnh
nhn. Ban thng nh, khng cn hn ch liu dng, c p ng vi iu tr ti ch. Trc vy
da, ni mn nc, lot him khi c bo co.
Cha n 1% bnh nhn b co tht ph qun sau khi truyn gemcitabine. Co tht ph qun
thng nh v thong qua, c th cn iu tr bng thuc tim. Khng nn dng gemcitabine
cho bnh nhn nhy cm vi thuc (xem phn Chng ch nh). Khong 10% bnh nhn b kh

th trong vng vi gi sau khi dng gemcitabine. Kh th thng nh, ngn hn, him khi phi
gii hn liu dng, thng t khi khng cn iu tr c hiu. C ch ca chng kh th ny
cha c bit v s lin quan vi gemcitabine cng khng r rng.
Cc tc dng ph khc :
Triu chng ging nh cm c bo co trong khong 20% bnh nhn, thng nh, ngn hn,
him khi phi gii hn liu dng trong 1,5% bnh nhn c triu chng nng. St, nhc u,
au lng, n lnh, au c, suy nhc, chn n l nhng triu chng ph bin nht. Ho, vim
mi, k c m hi, mt ng cng thng c bo co. St, suy nhc cng thng xy ra
ring l. C ch ca c tnh ny cha r. Cc bo co cho thy paracetamol c th lm gim
triu chng. Ph/ph ngoi bin c bo co trong khong 30% bnh nhn. Vi trng hp
ph mt c bo co. Ph phi him thy (1%). Ph/ph ngoi bin thng nh n trung
bnh, t khi phi gii hn liu, i khi gy au, thng hi phc sau khi ngng thuc. C ch ca
c tnh ny cha r. Triu chng ny khng km theo bt c du hiu no ca suy tim suy gan
hay suy thn.
Cc tc dng ph sau y cng thng c bo co : Nhi mu c tim, suy tim sung huyt, ri
lon nhp c bo co trong cc nghin cu, nhng khng c bng chng r rng l
gemcitabine gy ra c tnh trn tim.
LIU LNG v CCH DNG
Ung th phi khng phi t bo nh
Ngi ln : liu ngh ca gemcitabine l 1.000 mg/m2 truyn tnh mch trong 30 pht. Lp li
liu ny mi tun 1 ln trong 3 tun lin tip, tip theo ngng 1 tun. Sau lp li chu kz 4
tun ny. Gim liu thuc da vo mc c tnh xy ra trn bnh nhn.
Ung th ty
Ngi ln : liu ngh ca gemcitabine l 1.000 mg/m2 truyn tnh mch trong 30 pht. Lp li
liu ny mi tun 1 ln trong 7 tun, sau ngng 1 tun. Dng tip liu ny mi tun 1 ln
trong 3 tun, ri ngng 1 tun. C nh th lp li chu kz 4 tun ny. Gim liu thuc da vo
mc c tnh xy ra trn bnh nhn.
Trc mi liu dng nn theo di s lng tiu cu, bch cu v bch cu ht. Khi c biu hin
ca c tnh trn mu, nu cn thit c th gim liu hoc ngng dng thuc theo thang im
sau:
S lng bch cu ht
S lng tiu cu
% liu bnh
(x106/l)
(x106/l)
thng
> 1.000
v > 100.000
100
500-1.000
hoc 50.000-100.000
75
< 500
hoc < 50.000
ngng thuc
Nn kim tra nh kz chc nng gan v thn cho bnh nhn dng gemcitabine, gm
transaminase v creatinine huyt thanh.

Gemcitabine c dung np tt trong khi truyn, ch vi trng hp c phn ng ti ni tim

truyn, khng c cc bo co v trng hp hoi t ni tim truyn. Gemcitabine dng d
dng cho bnh nhn ngoi tr.
Bnh nhn ln tui : Gemcitabine dung np tt bnh nhn trn 65 tui. Khng c bng chng
cho thy cn phi iu chnh liu cho bnh nhn ln tui, mc d tui tc nh hng n
thanh thi v thi gian bn hy ca gemcitabine.
Suy gan v thn : cn thn khi dng gemcitabine cho bnh nhn suy gim chc nng gan hoc
thn. Cha c nghin cu trn bnh nhn suy gan hoc suy thn nng.
Tr em : Gemcitabine cha c nghin cu tr em.
Hng dn s dng / X l thuc
Ch dng Sodium Chloride 0,9% khng c cht bo qun pha bt gemcitabine v trng. Mc
d khng nhn thy tnh tng k ca thuc, khng nn trn ln gemcitabine pha vi cc
thuc khc. Do kh nng ha tan ca gemcitabine, pha gemcitabine vi nng ti a l 40
mg/ml. Trnh pha thuc nng ln hn 40 mg/ml v c th thuc khng c ha tan hon
ton.
pha thuc, thm t nht l 5 ml Sodium Chloride 0,9% vo l 200 mg v t nht l 25 ml
Sodium Chloride 0,9% vo l 1 g. Lc ha tan thuc.
Lng thuc c pha thch hp nh trn c th pha long thm na bng dung dch
0,9% Sodium Chloride. Nn gi dung dch gemcitabine pha nhit phng (15 - 30oC) v
nn dng trong vng 24 gi. B i phn thuc khng s dng. Khng nn gi lnh dung dch
gemcitabine pha v thuc c th b kt tinh. Nn quan st cc thuc trc khi dng pht
hin cc phn t nh trong thuc hoc s thay i mu sc ca thuc.
Nn cn nhc cc phng php thch hp x l v hy b cc thuc chng ung th. Mt s
sch c ni dung hng dn v vn ny c xut bn. Khng phi tt c nhng hng
dn ny c mi ngi ng l cn thit v ph hp.
QU LIU
Khng c thuc gii c iu tr qu liu gemcitabine. c tnh ca thuc trn lm sng chp
nhn c khi dng tng liu n 5,7 g truyn tnh mch trong 30 pht mi 2 tun. Khi nghi
ng qu liu, nn theo di s lng t bo mu ca bnh nhn. p dng cc bin php iu tr
h tr cho bnh nhn khi cn thit.
BO QUN
Bo qun thuc nhit phng (15-30oC).

233.

GENOPTIC

ALLERGAN
Thuc nh mt 0,3% : l 5 ml.
THNH PHN
cho 100 ml
Gentamicine sulfate tnh theo gentamicine

300 mg

(Benzalkonium chlorure)

(10 mg)

DC LC
Gentamicine sulfate l khng sinh tan trong nc thuc nhm aminoside, ni chung c hot
tnh trn nhiu loi vi khun gy bnh Gram dng v Gram m. Vi khun Gram dng nhy
cm vi gentamicine bao gm cc Staphylococcus coagulase dng tnh v coagulase m tnh
trong c nhng dng c xem l khng vi pnicilline ; Streptococcus nhm A tn huyt
bta v khng tn huyt ; v Diplococcus pneumoniae.
Cc vi khun Gram m nhy cm vi gentamicine bao gm nhng dng nht nh ca
Pseudomonas aeruginosa, cc dng Proteus indole dng tnh v indole m tnh, Escherichia
coli, Klebsiella/Enterobacter sp., Haemophilus aegyptius (Koch-Weeks bacillus), Aerobacter
aerogenes, Moraxella lacunata (diplobacillus ca Morax-Axenfeld), Neisseria sp., trong c
Neisseria gonorrhoeae v Serratia marcescens.
CH NH
Nhim trng ti ch phn ngoi ca mt v phn ph ca mt do nhng chng vi khun nhy
cm bao gm vim kt mc, vim gic mc, v vim gic-kt mc, lot gic mc, vim m mt,
vim kt mc-m mt, vim tuyn Meibomius cp v vim ti l.
CHNG CH NH
Khng dng cho bnh nhn bit c qu mn vi bt kz thnh phn no ca thuc.
CH PHNG
Khng dng tim.
Khng bao gi dng Genoptic tim di kt mc hoc tim vo tin phng ca mt.
THN TRNG LC DNG
S dng khng sinh ti ch ko di c th to iu kin cho s pht trin nhanh ca cc mm
bnh khng nhy cm nh nm.
Nu c tai bin ny, hay nu c kch ng hoc qu mn vi bt kz thnh phn no ca thuc,
ngng s dng thuc v p dng tr liu khc thch hp.
TC DNG NGOI

C th gy kch ng thong qua khi s dng dung dch nh mt v khun Genoptic.

LIU LNG v CCH DNG
Nh 1 hoc 2 git vo mt b nhim bnh mi 4 gi. Trng hp nhim trng nng, c th tng
liu ln n 2 git mt ln mi gi.
BO QUN
Bo qun nhit 2-3o C

234.

GENURIN

RECORDATI
c/o GROWENA-IMPEX
Vin n n bao ng 200 mg : hp 30 vin.
THNH PHN
cho 1 vin
Flavoxate hydrochloride

200 mg

TNH CHT
Flavoxate l thuc chng co tht c tc dng i khng trc tip s co tht c trn ca bng
quang v ng tit niu-sinh dc. Thuc c tng hp trong cc phng th nghim ca
Recordati, Industria Chimica e Farmaceutica, S.p.A., Milano-Italy.
V mt ha hc flavoxate c cng thc l 4 H-1-benzopyran-2-phenyl-3 methyl-4-oxo-8-carboxylic acid 2-(1-piperidinyl) ethyl ester hydrochloride.
Flavoxate l mt thuc dn c trn ging papaverine. Tuy nhin, thuc c tnh cht chng co
tht mnh hn v t c tnh hn cc alkaloid ca thuc phin. C ch tc ng ca flavoxate l
s kt hp ca tc ng hng c, tc ng gy t ti ch v khng calcium. Flavoxate lm dn
trc tip c trn, c l l do c ch men phosphodiesterase v do tc ng khng calcium.
Dc ng hc :
Sau khi ung, flavoxate t nng nh trong mu trong vng 20 pht. Thuc phn b thp
trong m no nhng cao trong gan, thn v bng quang. Cht chuyn ha chnh ca n l 3methyl-flavone-8-carboxylic acid (MFCA). 12 gi sau khi ung khong 55% thuc c bi tit
di dng MFCA v/hoc cht chuyn ha dng kt hp trong nc tiu. Flavoxate khng
tch t trong c th.
Hiu qu lm sng :

o bng bng quang k cc bnh nhn bnh thng cng nh c bnh l bng quang do thn
kinh thy rng cc hiu qu iu tr - tc l tng dung tch lm gim p lc bng quang - xy ra
trong vng 2 gi.
So snh cc p ng lm sng sau khi dng flavoxate (200 mg) v propantheline (30 mg), cc
tc gi thy rng thuc khng h cholin lm kh vng khu hu trong khong 2/3 s bnh
nhn trong khi khng c tc gi no bo co c nhng triu chng ny hoc cc than phin khc
khi dng flavoxate. Hin tng b tiu ng k thng gp nhng bnh nhn c iu tr
bng cc thuc khng h cholin li khng xy ra vi nhng bnh nhn c iu tr bng
flavoxate.
Cc nghin cu sau chng minh rng flavoxate c tc dng khng h muscarin rt yu,
khong 2.000 ln t hn so vi oxybutinin.
Flavoxate lm gim p lc trong bng quang nhiu hn so vi emepronium bromide. C hai
thuc u lm gim s khi u cm gic mc tiu v lm tng tng dung tch bng quang, tiu
lt nht vo ban ngy nhng flavoxate c hiu qu hn. Flavoxate ci thin hn v tnh trng
tiu ngt qung, tiu gp thng i km vi s mt tnh n nh ca c tht bng quang hoc
i km vi s ri lon chc nng c vng so vi emepronium . Bnh nhn iu tr bng
flavoxate cng t b tc dng ph hn so vi iu tr bng emepronium bromide.
Thc nghim so snh flavoxate dng liu 2 vin 100 mg bn ln mi ngy vi phenazopyridine
dng liu 2 vin 100 mg, ba ln mi ngy cho thy p ng tt hn xy ra i vi bnh nhn b
vim tuyn tin lit (t l 66% bnh nhn dng flavoxate so vi 31% dng phenazopyridine),
vim bng quang cp, vim niu o v/hoc vim tam gic bng quang (t l 80% so vi 56%).
CH NH
- Dng gim triu chng trong : kh tiu, tiu gp, tiu m, tiu lt nht v tiu ngt qung
trong cc bnh l ca bng quang v tin lit tuyn nh vim bng quang, au bng quang,
vim tin lit tuyn, vim niu o, vim niu o-bng quang, vim niu o-tam gic bng
quang ;
- H tr trong iu tr chng co tht trong cc bnh l{ nh : si thn v si niu qun, cc ri
lon co tht ng niu do t ng thng tiu v soi bng quang v trong di chng phu thut
ng tiu di ;
- Gim cc tnh trng co tht ng sinh dc ph n nh : au vng chu, au bng kinh,
tng trng lc v ri lon vn ng t cung.
CHNG CH NH
- C tin s d ng vi thuc.
- Chng ch nh cho nhng tnh trng tc nghn sau : tc hi trng hoc t trng, rut khng
gin, nhng sang thng gy tc rut hoc gy lit rut, xut huyt tiu ha.
THN TRNG LC DNG
- bnh nhn b nhim trng ng tit niu-sinh dc cng lc, nn dng flavoxate

hydrochloride phi hp vi tr liu bng khng sinh thch hp.

- Nn dng thuc cn thn nhng bnh nhn tng nhn p, c bit l dng tng nhn p gc
hp v nhng bnh nhn b cc bnh l tc nghn nghim trng ng tiu di do chn p.
Tc ng ln kh nng li xe hay vn hnh my mc : Nhng bnh nhn iu khin xe hoc
my mc, hoc tham gia vo cc cng vic cn s ch phi c bo trc v cc tc dng
ph c th xy ra nh : ngy ngt, m mt v chng mt.
S dng cho tr em : Khng nn s dng Genurin cho tr nh nhi v tr em di 12 tui v
cha xc nh c hiu qu iu tr v tnh an ton ca thuc i vi bnh nhn cc nhm
tui ny.
LC C THAI
Nghin cu trn ng vt cho thy rng thuc khng c tc dng ph no i vi ng vt
mang thai hoc i vi phi thai. Tuy nhin, cng ging nh bt c loi thuc no khc, phi
cn thn khi dng thuc trong trng hp c thai, c bit l trong ba thng u ca thai kz.
TC DNG NGOI
Tc dng ph him gp, bao gm : bun nn v nn i (thng khng xy ra khi ung thuc lc
no), kh ming, chng mt, nhc u, ngy ngt (thng s ht khi gim liu hoc cho ung
thuc tha ra), cm xc khng n nh, ri lon iu tit mt, tng nhn p, ni m ay hoc
cc bnh ngoi da khc, l ln c bit ngi ln tui, ri lon tiu tin, nhp tim nhanh, st,
tng bch cu a nhn i toan v c th gy to bn liu cao.
LIU LNG v CCH DNG
Mi ln ung 1 vin Genurin 200 mg, 3-4 ln mi ngy.
Flavoxate c hp thu nhanh chng. p ng lm sng s thay i ty thuc vo bn cht v
mc nghim trng ca cc triu chng c chn on v ty thuc vo tng trng ca
bnh nhn. Nhng hiu qu iu tr trn h c bng quang s xut hin trong vng t 2 n 3
gi.
i vi nhng bnh nhn b nhim trng, vic iu tr thng c ko di song song vi
nhng thuc chng nhim trng (ngha l k o di 1 tun hay hn).
Nhng bnh nhn c triu chng mn tnh bng quang, cn phi ko di vic duy tr t
c kt qu ti u. Nu triu chng c ci thin, c th gim liu.
QU LIU
Bnh nhn dng qu liu flavoxate nn c ra d dy trong vng 4 gi sau khi dng thuc.
Nu qu liu trm trng hoc nu chm tr trong vic ra d dy, th phi iu tr bng thuc
thuc nhm ging thn kinh i giao cm.
BO QUN
Tn tr nhit phng khng qu 30o C. ngoi tm tay tr em.

235.

GINKOR FORT

BEAUFOUR IPSEN
Vin nang : hp 30 vin.
THNH PHN
cho 1 vin
Cao ginkgo biloba

14 mg

Heptaminol chlorhydrate

300 mg

Troxerutine

300 mg

T dc : magnesium stearate, acide

silicique.
Thnh phn ca v nang : oxyde st vng,
indigotine, titane dioxyde.
DC LC
Tr tnh mch v bo v mch mu (tng trng lc tnh mch v sc chu ng ca mch mu
v gim tnh thm) km theo tnh c ch ti ch i vi vi ha cht trung gian gy au
(histamine, bradykinine, serotonine), men tiu th v gc t do gy vim v thoi ha si
collagen. Nh c heptaminol chlorhydrate, Ginkor fort gip mu tnh mch tr v tim phi.
CH NH
c ngh trong cha tr triu chng suy tnh mch v mch bch huyt :
- Ri lon chc nng : chi di nng n, vp b, d cm, au nhc.
- Ph n.
c ngh cha tr du hiu chc nng ca cn tr.
CHNG CH NH
V c heptaminol : bnh cng gip, phi hp vi IMAO, cao huyt p nng.
THN TRNG LC DNG
Theo di huyt p khi bt u iu tr bnh nhn cao huyt p nng (v c heptaminol).
LC C THAI
Th nghim trn ng vt cho thy khng c tc dng gy qui thai. ngi, nghin cu trn
ph n c thai 3 thng u cn cha y , do nguy c do dng thuc cha c kt

lun. Tuy nhin, cho n nay vn khng ghi nhn trng hp no tr b d dng do m dng
thuc trong 3 thng u mang thai.
TNG TC THUC
Khng c phi hp vi :
- IMAO : nguy c gy cn cao huyt p do c heptaminol.
LIU LNG v CCH DNG
Suy tnh mch bch huyt : 1 vin x 2/ngy, trong cc ba n. i vi tr, iu tr tn cng : 3-4
vin/ngy, trong 1 tun.
QU LIU
Trng hp lm dng thuc qu , v tnh hoc hu (20 vin mt ln/50 kg) cn theo di
huyt p v nhp tim ti bnh vin.

236.

GLUCOBAY 50 100

BAYER PHARMA
Vin nn 50 mg : hp 100 vin - Bng B.
Vin nn 100 mg : hp 100 vin - Bng B.
THNH PHN
cho 1 vin
Acarbose

50 mg

cho 1 vin
Acarbose

100 mg

DC LC
Acarbose l mt pseudotetrasaccharide, c ngun gc vi khun. nim mc rut non, acarbose
tc ng bng cch c ch cnh tranh men a-glucosidase, lm gim qu trnh thoi ging
carbohydrate (di, oligo v polysaccharide) thnh monosaccharide l dng c th hp thu c.
Do , acarbose c tc dng lm gim ng huyt sau n, khng lm tng insulin huyt, khng
gy khng insulin, bo tn t bo beta, gim nng HbA1c, triglycerides v gim cc bin
chng do tiu ng.

DC NG HC
Sau khi ung, acarbose c phn hy rut bi cc enzyme ca vi khun v enzyme nim
mc ng tiu ha. Acarbose v cht chuyn ha ca n c thi tr qua phn, ch 1-2% liu
c hp thu qua nim mc ng tiu ha v thi tr hon ton qua thn.
Acarbose t lin kt vi protein huyt tng (khong 15%). Thi gian bn hy o thi bng
ng ung l t 6 n 8 gi.
Do hp thu k m qua ng tiu ha v c chuyn ha rut, dc ng hc ca acarbose
khng b thay i ngi gi, suy thn hoc suy gan.
CH NH
Bnh nhn tiu ng type 2 :
- iu tr n c khi ch n king v vn ng khng hiu qu.
- iu tr phi hp vi cc thuc h ng huyt dng ung khc.
Bnh nhn tiu ng type 1 :
- h tr liu php insulin.
CHNG CH NH
Qu mn vi acarbose.
Bnh ri lon ng rut mn tnh lin quan n ri lon tiu ha v hp thu.
Cc bnh l{ c nguy c din tin xu hn do hin tng tng sinh hi trong rut (nh hi chng
Roem-held, thot v, nghn rut v lot rut).
CH PHNG
Phi tun th ch n king mc d ang dng Glucobay.
Khng c ngng thuc khi khng c kin ca bc s v c th lm tng ng huyt.
Glucobay khng lm h ng huyt bnh nhn ch iu tr bng n king.
Nu cc triu chng h ng huyt xy ra bnh nhn iu tr phi hp Glucobay vi
sulfonylureas hay melformin hay insulin th dng glucose, khng dng sucrose.
iu tr vi Glucobay nn c ghi vo th xc nhn tiu ng.
THN TRNG LC DNG
- Bnh nhn suy thn nng.
- Tr em di 18 tui.
- Ph n c thai : mc du thuc khng gy qui thai cng nh khng c c tnh i vi bo
thai cc ng vt th nghim, do thn trng (nh vi tt c cc loi thuc mi), khng nn ch
nh cho ph n mang thai.
- Ph n cho con b : khng nn ch nh cho ph n ang nui con b mc du thuc c bi
tit qua sa m rt thp.
TNG TC THUC
Khng mt tng tc no c ghi nhn vi antipyrine, glibenclamide, digoxine, propranolol,
warfarine v cc estroprogestarif.

Dng ng thi vi cc thuc gy hp th ng tiu ha (than hot tnh) hoc cc thuc c

ngun gc men tiu ha c th lm gim tc dng ca acarbose.
Dng ng thi vi neomycine s lm cc tc dng ngoi d xy ra hn (y hi).
TC DNG NGOI
Trng bng v y hi, thnh thong tiu chy, au bng.
Nu khng theo di ch n king theo toa ca bnh tiu ng th cc tc dng ph rut
c th tng ln.
Nu cc triu chng kh chu pht sinh d n king theo toa, nn tham vn kin bc s v
liu dng d tm thi hay vnh vin cng nn c gim xung.
Trong vi trng hp c s tng cc men transaminase khi iu tr vi Glucobay. Tc dng ny
hon ton bin mt khi chm dt iu tr.
LIU LNG v CCH DNG
Ung hoc nhai ngay khi bt u n vi mt t nc.
Khng hn ch thi gian dng thuc.
Liu dng c bc s iu chnh ty theo dung np v p ng tng bnh nhn.
Liu khi u : mi ln 1 vin 50 mg, 3 ln/ngy hay mi ln na vin 100 mg, 3 ln/ngy.
Liu duy tr : mi ln 2 vin 50 mg, 3 ln/ngy hay mi ln 1 vin 100 mg, 3 ln/ngy.
Liu ti a : mi ln 2 vin 100 mg, 3 ln/ ngy.
Liu dng c th tng trong vng 1 n 2 tun hoc sau mt t iu tr. Nu c triu chng
kh chu mc d n king ng cch, khng nn tng liu. Nu cn nn gim liu mt t.
QU LIU
iu tr triu chng cc ri lon tiu ha (tiu chy). Trnh dng thc ung hay thc n c cha
carbohydrate trong 4 n 6 ngy sau khi qu liu.

237.

GROVIT - GROVIT PLUS

USV
c/o PYMEPHARCO
Thuc git (Grovit) : chai 15 ml.
Sir (Grovit Plus) : chai 100 ml.
THNH PHN
cho 0,6 ml thuc git (1 git)
Vitamin A (dng palmitat)

3.000 UI

Vitamin B1 (Thiamin mononitrat)

Vitamin B2 (Riboflavin natri phosphat
tng ng vi Riboflavin)
Vitamin B6 (Pyridoxin hydrochloride)
Vitamin C (Acid ascorbic)
Vitamin D3 (Cholecalciferol)
Vitamin E (a-Tocopheryl acetat)
Nicotinamide
Dexpanthenol
(C thm mt lng vitamin d thch
hp b p li lng hao ht trong
qu trnh bo qun)
Cc vitamin tan trong du c bo ch
di dng tan trong nc.
T dc : sodium hydroxide, propylene
glycol, glycerol, polysorbate 80, propyl
gallate, butylated hydroxy anisole,
flavour raspberry, flavour apricot,
flavour pineapple, flavour caramel,
flavour butter scotch, disodium edetate,
thiourea.

cho 5 ml xir
Vitamin A (dng palmitat)
Vitamin B1 (Thiamin hydrocloride)
Vitamin B2 (Riboflavin)
Vitamin B6 (Pyridoxin
hydrocloride)
Vitamin C (Acid ascorbic)
Vitamin D3 (Cholecalciferol)
Nicotinamide
Dexpanthenol
Citrus Bio-flavonoid compound
(C thm mt lng vitamin d
thch hp b p li lng hao
ht trong qu trnh bo qun)
T| dc: alpha tocopheryl acetate,
methyl hydroxy benzoate, sodium
hydroxide, propylene glycol,
sucrose, sodium bicarbonate, liquid

2 mg
1 mg
1 mg
40 mg
400 UI
5 mg
10 mg
3 mg

2.500 UI
2 mg
1 mg
1 mg
50 mg
200 UI
15 mg
2,5 mg
5 mg

glucose, sodium benzoate, propyl

hydroxy benzoate, disodium
edetate, coconut oil, butylated
hydroxy anisole, acacia, sodium
lauryl sulphate, mixed fruit flavour,
orange oil terpeneless, saccharine
sodium.
DC LC
Vitamin l nhng hp cht hu c cn thit cho s tng trng bnh thng v duy tr s sng
cho con ngi. Chc nng ca vitamin c th chia lm hai loi : duy tr cu trc bnh thng v
cc chc nng chuyn ha thng thng. Tt c cc vitamin u khng th c tng hp
trong cc m ca c th ngi. Khng c ngun t nhin no cha mt t l cn xng tt c cc
vitamin cn cho s dinh dng ca con ngi. Do , nhm p ng nhu cu dinh dng cho
s tng trng bnh thng v cho s pht trin v duy tr sc kho tt, b sung vitamin l iu
cn thit.
Xir v thuc git Grovit cung cp c cc vitamin tan trong nc ln cc vitamin tan trong du
di dng dung dch nc, v vy bo m cc vitamin tan trong du c hp th tt hn.
CH NH
Xir Grovit c ch nh iu tr tnh trng thiu vitamin v dng nh mt ngun b sung dinh
dng trong ch n, p ng nhu cu vitamin gia tng trong cc trng hp nh tr ang
ln, chm sc sau phu thut v cc bnh nhim trng nng.
Thuc git Grovit c ch nh iu tr tnh trng thiu vitamin v dng nh mt ngun b
sung dinh dng trong ch n ca tr em. Vitamin E c a vo ch phm c bit hu
ch i vi tr sinh non hoc sinh thiu cn.
CHNG CH NH
Khng dng thuc git hay xir Grovit nu c hin tng qu mn i vi bt kz vitamin no
hoc l c ri lon tha vitamin trc .
TNG TC THUC
Cha c thuc no c bit c gy tng tc vi thuc git hay xir Grovit.
TC DNG NGOI
C th xy ra phn ng d ng sau khi dng thiamin.
LIU LNG v CCH DNG
Thuc git Grovit :
Tr nh (t 0 n 7 tui) : khi u 0,3 ml mt ln mi ngy, c th tng n 0,6 ml mt ln
mi ngy.
Xir Grovit :
Tr em : 1 mung c ph (5 ml) mi ngy.

THUC VN H

238.

HAEMACCEL

HOECHST-MARION-ROUSSEL
[AVENTIS PHARMA]
Dung dch tim truyn tnh mch : chai 500 ml.
THNH PHN
cho 1 lt
Polygline

35 g

Sodium

145 mEq

Potassium

5,1 mEq

Calcium

6,25 mEq

Chlore

145 mEq

CH NH
iu tr cp cu sc gim th tch : sc xut huyt, mt mu, mt huyt tng, c c mu,
gim th tch trong v sau phu thut. C th dng phi hp trong tim phi nhn to hoc lc
mu.
Ch nh trong phng nng.
CHNG CH NH
Tng cm vi glatine.
Suy tim ; chong tim ; cao huyt p cha n nh.
THN TRNG LC DNG
Trong trng hp duy tr th tch huyt tng lu di, khng nn truyn khi hmatocrite gim
di 30% (ti a l 25%).
Khi hmatocrite gim thp hn na, cn truyn b sung hng cu lng hoc mu ton phn.

Mu c cht chng ng citrate khng nn pha vi Haemaccel.

TNG TC THUC
Lin quan n calcium :
Trong trng hp s dng cng vi glycoside tr tim, cn phi lu { tc dng ng vn ca
calcium.
TC DNG NGOI
Biu hin d ng da, biu hin tim mch him hn.
St, run.
LIU LNG v CCH DNG
Lng Haemacel cn truyn ty thuc vo th tch tun hon b mt.
Ngi ln :
D phng chong : 500-1500 ml.
Chong gim th tch : ti a 2000 ml.
Trng hp khn cp cung cp th tch theo yu cu.

239.

HALOG-NOMYCINE crme

BRISTOL-MYERS SQUIBB
kem bi ngoi da : ng 30 g.
THNH PHN
cho 1 ng
Halcinonide

30 mg

Nomycine sulfate

75 mg

DC LC
Liu php phi hp khng sinh v corticoide iu tr ti ch.
Halcinonide l mt corticoide c hai gc halogen c tc ng khng vim nhanh v mnh.
Nomycine l mt khng sinh dit khun thuc h aminoside c tc ng trn staphylocoque
v trc khun Gram - .
T dc ca kem Halog-n omycine c bo ch rt c bit, bao gm hai pha :
- 50% hot cht c bo ch di dng dung dch trong pha nc ca t dc v s cho tc
dng ngay khi s dng ;

- 50% c bo ch di dng vi tinh th, to hn dch trong pha du, s gii phng hot cht
t t v ko di.
Nh vy c th dng thuc mt ln m tc ng c duy tr trong 24 gi. Loi t dc bao
gm 2 pha ny c i lc vi nc v du tng ng nhau (t l gn bng 1), nh th cho
ph p iu tr ng thi nhng bnh da cp tnh c rn nc cng nh cc sang thng kh, c
trc vy.
Halcinonide l hot cht ch yu ca kem Halog-nomycine. Nomycine c tc dng iu tr cc
nhim trng phi hp nhng khng c ch nh nga nhim trng. u th ca phi hp
ny so vi liu php corticoide n thun ch c chng minh trong nhng ngy iu tr u
tin v khi nhim trng, nht l do staphylocoque, c mt vi khun cao. iu ny thng xy
ra trong cc bnh ngoi da c rn nc, gy nga, thng l mn tnh. Tuy nhin, nu c l lot
nhiu cn phi phi hp thm vi khng sinh ng ton thn.
CH NH
Bnh da do vim, kh hoc r dch, c bi nhim cn phi iu tr bng corticoide ti ch, trong
vng 8 ngy u iu tr.
CHNG CH NH
- Bao gm cc chng ch nh ca liu php corticoide ti ch. Tt c cc nhim trng nguyn
pht da do vi khun, virus hoc vi nm. S dng dng phi hp ny c th lm nng thm cc
nhim trng nu trn. Ngoi ra cn lm thay i cc triu chng lm cho vic chn on sau
ny kh khn hn.
- Khng dng cho trng hp lot chn, vt thng khng trng lc, mng m hoi t hoc
mn trng c .
- Qu mn cm vi mt trong cc thnh phn ca thuc, nht l vi nomycine.
- Khng bng kn khi thoa thuc trong trng hp iu tr bnh da c bi nhim.
CH PHNG
S c mt ca corticoide khng ngn cn c cc biu hin d ng da vi khng sinh (nu
c), nhng c th lm thay i cc du hiu lm sng.
Nhy cm da vi khng sinh (nu c) c th nh hng n vic s dng sau ny theo ng
ton thn ca mt khng sinh c lin quan ging nhau v phng din khng nguyn.
Nu bi thuc trn din tch rng hoc bi thuc qu dy hoc bng kn li sau khi bi s to
iu kin cho corticoide hay/v khng sinh ngm vo mu c th s gy tc dng ton thn ca
cc cht y. iu ny nn c c bit quan tm khi iu tr cho tr cn b hoc tr cn nh
tui.
THN TRNG LC DNG
Thi gian iu tr : thng khng nn iu tr qu 8 ngy v :
- Khng thy c li ch g khi iu tr qu thi hn ny.
- iu tr ko di do lm ln trn mt din tch rng c th cho cc tc dng ngoi { nh khi

dng liu php corticoide ng ton thn.

- Dng lu di corticoide loi I, II v III trn mt c th gy vim da do corticoide.
- Do trong thnh phn c khng sinh nn c th gy chn lc chng khng.
Tr cn b :
Nn trnh dng corticoide c tc dng mnh (loi I v II), v cng nn lu { n kh nng b bt
kn ngu nhin c th xy ra di cc np gp da hoc di t lt.
Trnh thuc chm vo kt mc.
TC DNG NGOI
Do corticoide :
Rt him khi xy ra nu iu tr ngn hn.
C th lm cho da rp, pht ban dng trng c hoc mn m, rm lng, mt sc t da, vim
da quanh ming hoc lm xut hin hoc lm nng thm mn trng c (xem Ch { phng
v Thn trng lc dng).
C th gy cc vt rn da (ch yu gc chi v thng xy ra thiu nin) ngay trong 10 ngy
u iu tr vi corticoide c tc dng mnh (loi I v II).
Do khng sinh :
Nomycine c th gy chm d ng do tip xc, thng xy ra nht l khi iu tr lu di v khi
iu tr vim da do ng, nht l quanh vt lo t. Cc sang thng chm c th xut hin ri
rc cch xa ni bi thuc.
C th xy ra d ng cho vi cc khng sinh khc thuc h aminoside.
Nn lu { v kh nng gy c tnh ton thn ca n omycine (xem Ch { phng v Thn
trng lc dng) cng quan trng khi bi thuc ln din tch rng hoc do da b try st hoc
dng cho tr nh nhi.
LIU LNG v CCH DNG
Trung bnh bi thuc 1 ln mi ngy, xoa nh thuc ngm tt. C th tng s ln bi thuc
trong nhng trng hp kh tr. Khng nn iu tr qu 8 ngy v khng nn bi ln din tch
qu rng hoc bi lp thuc qu dy.

240.

HELMINTOX

INNOTECH
c/o ZUELLIG
Vin bao d b 125 mg : hp 6 vin.

Vin bao d b 250 mg : hp 3 vin.

THNH PHN
cho 1 vin
Pyrantel pamoate tnh theo pyrantel

125 mg

cho 1 vin
Pyrantel pamoate tnh theo pyrantel

250 mg

DC LC
Thuc dit giun c tc ng trn Enterobius vermicularis, Ascaris lumbricoides, Ankylostoma
duodenale v Necator americanus. Helmintox tc ng bng cch phong b thn kinh c, lm
t lit giun v tng chng ra theo phn bi nhu ng rut. Pyrantel pamoate tc ng ng
thi ln c dng cha trng thnh v trng thnh ca giun. Thuc khng tc ng ln u
trng ca giun khu tr trong m.
DC NG HC
Hp thu qua rut rt yu : nng pyrantel trong huyt tng rt thp (0,05-0,13 mg/ml) v
t c sau 1 n 3 gi.
Sau khi ung, trn 50% sn phm c bi tit qua phn di dng khng b bin i. Di 7%
c tm thy trong nc tiu di dng khng b bin i v di dng cht chuyn ha.
Thuc khng lm cho phn c mu .
CH NH
Nhim giun kim, giun a, giun mc.
THN TRNG LC DNG
Khng nn dng trong trng hp b suy gan.
LC C THAI
Tuy c mt lng nh qua c nim mc tiu ha vo mu, v mc du cc nghin cu
ng vt khng cho thy thuc c tc ng gy qui thai, tnh v hi khi dng Helmintox trong
thai kz cha c xc nhn. Do ch dng thuc ny trong trng hp cn thit.
TNG TC THUC
- Khng nn iu tr ng thi vi lvamisole do pyrantel pamoate c th lm tng c tnh ca
lvamisole.
- Piprazine c th i khng vi tc dng dit giun ca pyrantel : trnh dng phi hp hai hot
cht ny.

TC DNG NGOI
C th gy ri lon tiu ha (10-15%) : chn n, bun nn, i ma, au bng, tiu chy, tng
transaminase nh v tm thi.
Him gp hn : nhc u, chng mt, suy nhc, ri lon gic ng, pht ban ngoi da.
LIU LNG v CCH DNG
Dng vin 125 mg : thng c dng cho tr em.
n Nhim giun kim, giun a : 10 mg/kg, liu duy nht tng ng 1 vin loi 125 mg/10 kg (tr
di 18 thng nn dng dng hn dch ung). i vi nhim giun kim, nn dng tip mt liu
th 2 vo khong 2 n 3 tun l sau liu u tin.
n Giun mc :
p Nhim nh Ankylostoma duodnale : 10 mg/kg, liu duy nht.
p Nhim nng Ankylostoma duodnale hoc nhim Necator americanus : 20 mg/kg (chia 1 hoc
2 ln) trong 2 n 3 ngy, tng ng 2 vin loi 125 mg (hay 1 vin loi 250 mg)/10 kg/ngy.
Dng vin 250 mg : thng c dng cho ngi ln.
n Nhim giun kim, giun a : 10 mg/kg, liu duy nht.
Ngi ln di 75 kg : 3 vin loi 250 mg/ngy.
trn 75 kg : 4 vin loi 250 mg/ngy. i vi nhim giun kim, nn dng tip mt liu th 2 vo
khong 2 n 3 tun l sau liu u tin.
n Giun mc :
p Nhim nh Ankylostoma duodnale : 10 mg/kg, liu duy nht.
p Nhim nng Ankylostoma duodnale hoc nhim Necator americanus : 20 mg/kg (chia 1 hoc
2 ln) trong 2 n 3 ngy, tng ng :
Ngi ln di 75 kg : 6 vin loi 250 mg/ngy.
trn 75 kg : 8 vin/ngy.

241.

HEMOHES 6% - 10%

B. BRAUN
Dung dch tim truyn 6% : chai 500 ml.
Dung dch tim truyn 10% : chai 500 ml.
THNH PHN
cho 1000 ml dch truyn Hemohes 6%

Hydroxyethyl starch

60 g

Trung bnh trng lng ca phn t lng

200.000

Trung bnh s lng ca phn t lng

80.000

H s thay th phn t gam

0,5 (0,45-0,55)

Natri clorid

9g

T dc :
Nc ct pha tim
Nng in gii :
Natri

154 mmol/l

Clorid

154 mmol/l

Tnh cht ha l :
Nng p lc thm thu l thuyt

310 mOsm/l

pH

4-7

cho 1000 ml dch truyn Hemohes 10%

Hydroxyethyl starch
Trung bnh trng lng ca phn t lng
Trung bnh s lng ca phn t lng
H s thay th phn t gam
Natri clorid
T dc :
Nc ct pha tim
Nng in gii :
Natri
Clorid
Tnh cht ha l :
Nng p lc thm thu l thuyt
pH

100 g
200.000
80.000
0,5 (0,45-0,55)
9g

154 mmol/l
154 mmol/l
310 mOsm/l
4-7

DC LC
Thuc nhm dung dch keo thay th th tch huyt tng.
CH NH
Dng lm dung dch keo thay th th tch huyt tng trong cc trng hp :
- phng v iu tr tnh trng gim th tch mu (v d sau khi b sc do chy mu hoc chn
thng, b mt mu trc-sau khi m, b bng, b nhim trng).
- phng h huyt p (v d trong trng hp c lin quan vi gy m ton thn, gy t ngoi
mng cng hoc ty sng).
- Pha long mu.
- Tun hon ngoi c th.
CHNG CH NH
Khng c dng Hemohes trong cc trng hp :
- bit l b mn cm vi Hydroxyethyl Starch.
- Tng th tch mu.
- nc.
- Suy tim trm trng.
- Ri lon ng mu trm trng.
Ch c dng Hemohes vi iu kin ht sc thn trng trong cc trng hp :
- Tng natri mu, v trong thnh phn ca Hemohes c b sung natri.
- Tnh trng mt nc, v trong cc trng hp vic u tin l cn phi iu chnh cn bng
nc-in gii.
- Ri lon ng mu, v vic s dng thuc dn n tnh trng pha long cc yu t ng mu.
- Suy thn, v y l ng bi tit bnh thng ca Hydroxyethyl Starch.
- Bnh gan mn, v vic tng hp albumin v cc yu t ng mu trong gan c th b nh
hng v vic s dng thuc li cng lm chng b pha long hn.
THN TRNG LC DNG
Cn phi lu { n nhng phng nga sau y :
Cc cht in gii cn c b p hoc b sung nu cn.
Cc kim sot cn thit :
Cn phi theo di ion huyt thanh v cn bng nc-in gii, c bit l trong trng hp
tng natri mu, tnh trng mt nc v suy thn.
Trong trng hp c ri lon ng mu v bnh gan mn cn phi theo di cc ch s ng
mu v albumin huyt thanh.
Do kh nng cc phn ng d ng (phn v/th phn v) c th xy ra, vic theo di ngi bnh
l thc s cn thit.
S dng trong nhi khoa :
Hin cha c kinh nghim g khi ch nh cho tr em di mt tui.

LC C THAI v LC NUI CON B

Sau khi dng nhc li liu cao hng ngy trn ng vt, c du hiu chng t gy c cho thai
v gy qui thai. C th iu ny c lin quan ti vic dng liu cao qu mc v ko di, mc d
khng loi tr kh nng l do tc dng ring ca thuc gy ra. Hn na, do nguy c gy ra cc
phn ng d ng (phn v/th phn v), m iu ny th cng khng b loi tr, ch nn s dng
Hemohes trong lc c thai nu cn nhc thit hn gia li ch mong ch vi ri ro tim tng
em li cho thai nhi.
Cho n nay vic s dng sn phm ny cc b m ang trong thi kz cho con b vn cha
thu c kinh nghim g.
TNG TC THUC
Khi s dng cho nhng bnh nhn cha xc nh c nhm mu, cn phi ly mu mu
phn loi kiu mu v xc nh cc ngng kt bt thng trc khi truyn mt lng ln
Hydroxyethyl Starch ( trnh kt qu dng tnh gi).
C th thy nng a-amylase huyt thanh tm thi tng cao khong gp 3 ln gii hn trn
ca mc bnh thng sau khi truyn cc dung dch Hydroxyethyl Starch. S d c s tng cng
hot ng ca a-amylase l do c s to phc enzym-cht nn gia amylase v Hydroxyethyl
Starch, lm chm s bi tit qua thn v do khng c coi iu l triu chng ca thiu
nng ty.
TC DNG NGOI
Ging nh tt c cc dung dch keo thay th th tch, phn ng d ng (phn v hoc th phn
v) vi mc nghim trng khc nhau c th xy ra sau khi truyn Hemohes. Chng biu hin
nh l cc phn ng ca da (ni m ay) hoc c th gy bng mt v c. Rt him khi xy
ra trng hp b tt huyt p, sc hoc ngng tim v h hp.
Cc nguyn tc chung trong phng nga v iu tr cc tc dng ph gy d ng (phn v/th
phn v) :
Bng 1 : Cp v biu hin lm sng :
Cng
/Cp

Ia
Ib
II

III

Phng thc biu

hin

Cc du hiu v triu chng lm sng

phn ng khu tr trn

da
phn ng ton thn
dng nh
phn ng tim mch
v/hoc phi
v/hoc d dy rut
phn ng ton thn

ban khu tr
lo u, nhc u, ng , ni m ay ton pht,
ph nim, ri lon cm gic
tim mch p nhanh, tt huyt p
kh th, bt u co tht ph qun
bun nn, i ma
h huyt p nghim trng v b sc

nguy cp
IV
phn ng ton thn
e da tnh mng
Bng 2 : Bin php x l :
Cng
/Cp

Ia
Ib
II

III

IV

kh th nghim trng v co tht ph qun

ngng h hp v ngng tim

Cc bin php v liu php ha

dc
Ngng truyn v ty theo cp , tin
hnh cc bin php sau :- Cung cp
oxy / t ng ni kh qun- Truyn cc
tinh / Truyn cc cht keo (albumin
ngi)- Tim cc cathecholamin (liu
dng v cch dng xem ct bn phi)Hi sc cp cu tim-phi

- cc khng histamin H1/H2 thch hp

- epinephrin, v d epinephrin nut
hoc tim IV chm 0,5-1 ml
epinephrin 1:10.000- cc
corticosteroid tim IV thch hp- cc
khng histamin H1/H2 nu cn
cc catecholamin, v d tim IV chm
1 ml epinephrin 1:10.000, tim nhc
li nu cn vi tng liu khng vt
qu 10 mltrng hp co ph qun
nghim trng :theophyllin tim IVcc
corticosteroid tim IV thch hpcc
khng histamin H1/H2 nu cn
- hi sc c bn- hi sc tch cccc
catecholamin, v d 10 ml epinephrin
1:10.000 tim IV, tim nhc li nu
cn- lu { n cc thuc khc nh
:noradrenalin, dopamin,
dobutaminnatri bicarbonat

LIU LNG v CCH DNG

Hemohes phi c truyn vo c th qua ng tnh mch.
Tng liu lng, tc truyn v thi gian truyn ph thuc vo lng mu hoc huyt tng
b mt v tnh trng ca ngi bnh, v nu cn th phi iu chnh bng cch theo di cc ch
s thng thng ca h tun hon (v d huyt p). Nn nh rng truyn qu nhanh hoc dng
liu cao khng thch hp s gy nguy c qu ti cho h tun hon, c bit l vi Hemohes 10%
lm tng p sut thm thu keo.
pht hin sm cc phn ng phn v cng sm cng tt, 20-30 ml Hemohes u tin phi
c truyn tht chm cho bnh nhn di s gim st cht ch.
Liu ti a hng ngy :
Khng c dng qu liu ti a hng ngy l 2 g Hydroxyethyl Starch/kg/ngy. Liu ny tng
ng vi 33 ml dung dch 6%/kg/ngy (= 2500 ml/ngy i vi ngi nng 75 kg) hoc 20 ml
dung dch 10%/kg/ngy (= 1500 ml/ngy i vi ngi nng 75 kg)

Tc truyn ti a :
Tc truyn ti a ph thuc vo tnh trng lm sng. nhng bnh nhn b sc xut huyt
cp tnh c th truyn vi tc ln n 20 ml/kg/gi (tng ng vi 0,33 ml/kg/pht) v
trong tnh trng tnh mng ngi bnh b e da th truyn nhanh 500 ml (truyn bng p lc).
Nu dng bin php truyn p lc, phi rt hoc ui ht khng kh ra khi chai trc khi
truyn.
Cn phi h thp ng k tc truyn cho cc ch nh trc-sau khi m v cho nhng ngi
bnh b bng v sc nhim trng.
QU LIU
Vic s dng qu liu cc dung dch thay th th tch c th dn n tnh trng tng th tch
mu khng ch nh c lin quan vi s suy gimlin tc chc nng tim v phi. Trong trng
hp ny phi ngng truyn ngay lp tc v cn nhc vic cho dng thuc li tiu.

242.

HPADIAL

BIOCODEX
c/o TEDIS
vin bao 50 mg : hp 40 vin.
THNH PHN
cho 1 vin
Acide dimcrotique (dng mui
magnsium)
T dc : saccharose, lactose, polyvidone,
tinh bt bp, keo silice, calcium carbonate,
acide alginique, ester palmitostarique
ca glycrol, bt talc.
Lp bao vin : glatine, saccharose, bt
talc, lactose, tinh bt bp, tinh bt go,
gomme arabique, sp carnauba.

DC LC

50 mg

Li mt, chng co tht ng mt.

CH NH
iu tr triu chng cc ri lon kh tiu km theo au do c nng : trng bng vng thng
v, chm tiu, , y hi, bun nn.
CH PHNG v THN TRNG LC DNG
Khng dng trong trng hp tc nghn cc ng mt, suy gan nng v suy thn nng.
Nu xy ra tiu chy hay au bng trong thi gian iu tr, nn tm thi ngng dng thuc.
TC DNG NGOI
C th b tiu chy khi dng liu cao.
LIU LNG v CCH DNG
Dnh cho ngi ln.
Mi ln ung 1 vin, trc 3 ba n chnh hay khi c cc ri lon.
QU LIU
Dng thuc qu liu c th lm tng s vn chuyn thc n trong rut a n tiu chy.

243.

HEPASEL

BEIJING UNION
c/o UNICO ALLIANCE
Vin nang 7,5 mg : hp 90 vin, 900 vin.
THNH PHN
cho 1 vin nang
Biphenyl-dimethyl-dicarboxylate

7,5 mg

M T
Hepasel l dimethyl-4,4'-dimethoxy-5,6,5',6'-dimethylenedioxy-biphenyl-2,2'-dicarboxylate
(DDB). y l mt cht tng hp tng t vi schizandrin C, c chit xut t Fructus
Schizandrae chinensis, mt dc tho c truyn ca Trung Quc. Hepasel dng tinh th trng,
c cng thc l C20H16O10 v c phn t lng l 418,96.
DC LC
Biphenyl-dimethyl-dicarboxylate (DDB) c chng minh qua cc th nghim trn chut v

th l c tc ng bo v chng li cc tn thng gan gy bi cc cht ha hc, nh

prednisolone, carbon tetrachlorid, thioacetamide v D-galactosamine. DDB c ch s peroxid
ha lipid ca microsom gan gy bi carbon tetrachlorid v c ch lin kt cng ha tr ca
carbon tetrachlorid gn vo cc lipid microsom. Ngoi ra, DDB cn lm tng ng k kh nng
gii c ca gan v chng li tc ng gy t bin cc cht ha hc c kh nng gy ung th,
nh aflatoxin B v benz(a)pyrene. c tnh ca DDB rt thp. Khng c tc ng gy qui thai
hay t bin no c ghi nhn.
Hiu qu lm sng : Gim nhanh SGPT : 80-85% bnh nhn c mc SGPT tng cao tr v mc
bnh thng sau khi iu tr.
Lm cho albumin huyt thanh v globulin (A/G) tr v cc gi tr bnh thng v ci thin kt
qu ca Thymol Test (TFT).
Lm gim cc gi tr tng cao ca a-fetal protein (a-FP) v bilirubin vi kt qu iu tr tt c
ghi nhn trn 80% bnh nhn.
Lm gim cc triu chng, nh au gan, mt mi, trng bng v chn n.
Ci thin cc thay i bnh l gan nh thoi ha i toan, th i toan, hoi t gan khu tr v ri
rc, c kim tra qua cc xt nghim sinh thit gan c thc hin trc v sau khi iu tr.
Hepasel c hiu qu tt trong vic iu tr vim gan do thuc (thuc tr ung th, thuc khng
lao...).
Tc ng lm gim SGPT ca DDB c ghi nhn l tt hn nhiu so vi silymarin v
glycirrhizin.
Mt nghin cu lm sng so snh tc dng gia Nissel v Hepasel cho thy t thng th 3 th
kt qu ca hai nhm khng khc bit g lm (p < 0,05). Sau 6 thng iu tr, vn nhn thy hai
nhm c hiu qu iu tr tng ng nhau (p > 0,05). Do vin nang c hp thu tt hn
(gp 3 ln vin n n), nn d hm lng ch bng 1/3 vin nn (7,5 mg/25 mg), s lng thuc
hp thu ca hai vin ny vn nh nhau.
CH NH
Vim gan siu vi, vim gan do nghin ru hay do dng thuc, gan nhim m, x gan, au gan.
TC DNG NGOI
Khng c tc dng ngoi { no c ghi nhn vi Hepasel.
LIU LNG v CCH DNG
Mi ln ung 1-2 vin, ngy 3 ln.
BO QUN
Bo qun ni mt, kh v trnh nh nng trc tip.

244.

HEPT-A-MYL

SANOFI SYNTHELABO VIETNAM

vin nn 187,8 mg : hp 20 vin.
THNH PHN
cho 1 vin
Heptaminol chlorhydrate

187,8 mg

DC LC
Thuc hi sc tim mch.
CH NH
c ngh iu tr triu chng trong h huyt p t th, c bit trong trng hp do dng
thuc hng tm thn.
CHNG CH NH
Cao huyt p nng.
Cng gip.
THN TRNG LC DNG
Cn lu { cc vn ng vin do thuc c cha hot cht gy kt qu dng tnh trong cc x t
nghim kim tra s dng cht kch thch.
LIU LNG v CCH DNG
Dng cho ngi ln : mi ln 1-2 vin, 3 ln/ngy.

245.

HERBESSER 30 mg / HERBESSER 60 mg

TANABE SEIYAKU
[FOURNIER GROUP VIETNAM]
Vin nn 30 mg : v 10 vin, hp 10 v.
Vin nn 60 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin

Diltiazem hydrochloride

30 mg

T dc : lactose, du hydro ha,

macrogol 6000, magi stearat.

cho 1 vin
Diltiazem hydrochloride

60 mg

T dc : lactose, du hydro ha,

macrogol 6000, magi stearat.
M T
Diltiazem hydrochloride c tn ha hc (2S,3S)-3-acetoxy-2,3-dihydro-2-(4-methoxyphenyl)-5(2-dimethyl aminoethyl)-1,5-benzothiazepine-4(5H)-one monohydrochloride. Cng thc phn
t: C22H26N2O4S.HCl.
Diltiazem dng tinh th hay bt kt tinh trng. Khng mi, rt tan trong acid formic, d tan
trong nc, methanol v chloroform. Tan k m hn trong acetonitrile, tan t trong ethanol kh
nc v acetic anhydrite v hu nh khng tan trong ether.
im nng chy: khong 210-215oC (phn hy).
DC LC
Herbesser 30 v Herbesser 60 l sn phm khng canxi loi benzothiazepine, pht trin bt
ngun t Cng ty hu hn Tanabe Seiyaku. Thuc c ch trong iu tr cn au tht ngc, cc
dng au tht ngc bin th v tng huyt p v cn, nh lm dn ng mch vnh, gim co
tht mch vnh v lm dn mch mu ngoi bin, v.v. c cho l do tc dng i khng canxi
ca Diltiazem hydrochloride.
DC L
Nhng li ch iu tr ca Diltiazem hydrochloride nh l ci thin thiu mu cc b c tim v
gim huyt p cho l c lin quan n kh nng lm dn mch mu do c ch dng ion canxi
vo trong t bo c trn ca mch vnh v mch mu ngoi vi.
Cc hiu qu trn thiu mu c tim cc b :
Cc hiu qu v ci thin cn bng cung-cu oxy ca c tim :
- Tng lu lng mu mch vnh n vng c tim b thiu mu bng cch lm dn nhng
nhnh tun hon bng h v ng mch vnh ln ( ch).
- c ch co tht mch vnh ( kh, ngi).
- Gim tiu th oxy ca c tim, m khng gim cung lng tim bng cch gim hu gnh v nhp
tim do tc dng dn mch ngoi bin v lm gim nhp tim ( ch).

Hot ng bo v c tim :
Duy tr chc nng ca tim v chuyn ha nng lng ca c tim. Gim kch thc vng nhi
mu thng qua c ch s xm nhp qu nhiu ca dng ion canxi vo cc t bo vng c tim
thiu mu (chut).
Tc dng ln huyt p :
- H thp t t i vi huyt p cao mc d c nh hng rt t i vi huyt p bnh thng
(chut, ngi). c ch tng huyt p do vn ng qu mc (ngi).
- H huyt p m khng gim dng mu n no v thn ( ch, ngi).
- c ch ph i c tim v mch mu trong khi h huyt p ( chut cng).
Tc dng trn nhp xoang v h thng dn truyn c tim :
Ko di nh cc khong nhp xoang t pht v thi gian dn truyn nt nh tht, khng nh
hng n thi gian dn truyn b His-Purkinje ( ch, ngi).
DC L LM SNG
Nghin cu lm sng :
Cn au tht ngc v au tht ngc bin th :
Li ch ca Herbesser 30 v Herbesser 60 trong iu tr au tht ngc c chng minh vi
cc nghin cu so snh m i, nghin cu so snh m n v nghin cu m. Li ch ca n
trong iu tr au tht ngc bin th c chng minh qua cc nghin cu m bao gm c qu
trnh thm d bng in tm Holter.
Tng huyt p :
Li ch ca Herbesser 30 v Herbesser 60 trong iu tr tng huyt p v cn c chng minh
qua 4 nghin cu so snh m i vi mt gi dc, reserpine v propanolol i chng.
Phn ng ph :
442 trng hp (4,6%) c phn ng ph c bo co trong tng s 9630 trng hp. Cc
phn ng ph hay gp nht c tn s xut hin nh sau :
D dy-rut : 1,4% (kh chu d dy 0,2%, to bn 0,2%, au bng 0,1%...).
H thng tim mch : 1,4% (chng mt 0,5%, tim p chm 0,4%, bc ha 0,2%; block nh tht
0,2%).
Qu mn 1,25%, au u 0,2%...
NGHIN CU PHI LM SNG
c tnh :
c tnh vi liu duy nht (LD50 mg/kg) : xem bng
ng vt th nghim

ng s dng

Ung

Di
da

Tnh
mch

Gii tnh

c Ci c Ci

Ci

Chut nht, dng ddY

740 640 260 280 61

58

Chut cng, dng Wistar

560 610 520 550 38

39

c tnh vi liu nhc li : Khi liu 2, 10, 25, v 125 mg/kg/ngy v 10, 20 v 40 mg/kg/ngy
Diltiazem HCl c dng qua ng ung ln lt cho chut cng dng SD v ch sn trong 6
thng.
- Vi chut cng: c nhng trng hp t vong trong nhm dng liu 125 mg/kg/ngy. Nhm
dng liu 25 v 125 mg/kg/ngy c nhng biu hin suy gim chc nng i vi gan v thn
nhng trong nhm 2 mg v 10 mg/kg/ngy khng b nh hng.
-Vi ch sn: Nhm dng liu 40 mg/kg/ngy c nhng trng hp cht v bt thng v in
tm . GOT v GPT tng thong qua trong nhm dng 20 mg/kg/ngy.
Sinh qui thai :
- i vi chut cng dng CFY, trc khi giao phi, trong thi gian mang thai v cho con b, khi
dng thuc Diltiazem HCl qua ng ung vi liu 12,5 mg, 25 mg, 50 mg v 100 mg/kg/ngy,
khng thy tc dng bt li ln chc nng sinh sn ca chut b m v khng xy ra cht thai,
qui thai, v chm pht trin i vi thai v chut con.
- Trong giai on hnh thnh cc c quan bo thai, dng Diltiazem HCl ng ung vi liu 10,
25, 100, 200 v 400 mg/kg/ngy v 10, 50, 100, 200 v 400 mg/kg/ngy theo th t cho 2 loi
chut sau :
- Chut nht dng ICR-JCL.
- Chut cng dng Wistar
Hu qu gy cht thai thy xut hin trong tt c cc nhm chut nht v trong nhm chut
cng dng 200 v 400 mg/kg/ngy. Tnh trng gy qui thai quan st thy trong nhm chut
nht dng liu 50, 100, 200 v 400 mg/kg/ngy, nhng i vi chut cng khng thy c qui
thai thm ch vi nhm s dng liu 400 mg/kg/ngy.
- Dng trong giai on chu sinh v sau sinh liu 50,100, 200 v 400 mg/kg/ngy Diltiazem HCl
bng ng ung cho chut cng dng Wistar. Tnh trng chung ca chut m tr nn xu i, t
l sinh v t l cho b gim v t l sng st cng nh s tng trng ca chut con gim trong
nhm 200 v 400 mg/kg/ngy, nhng khng c thay i ng ch { i vi nhm s dng liu
10, 50, v 100 mg/kg/ngy.
Tnh khng nguyn :
Khng quan st thy tnh khng nguyn ca Diltiazem HCl trn chut lang, chut nht v chut
cng.

Bin i gen :
Tnh gy bin i gien ca Diltiazem HCl khng quan st thy thng qua test t bin ngc
(reverse) v sa cha (repair) vi vi khun, test sai lch nhim sc th trong t bo ng vt c
v nui cy hoc t bo nhn nh trn chut nht.
Gy ung th :
Khng quan st thy tnh gy ung th ca Diltiazem hydrochloride qua th nghim trn chut
nht.
DC NG HC
Nng huyt tng :
i vi ngi ln kho mnh khi ung 2 vin Herbesser (60 mg Diltiazem HCl) th nng
huyt tng t nh cao sau 3-5 gi. Thi gian bn hy khong 4,5 gi. Ung ko di Diltiazem
HCl 90 mg (3 vin 30 mg)/ngy cho bnh nhn th nng huyt tng ca thuc 2-4 gi sau
khi ung l khong 40 ng/mL.
Chuyn ha :
Khi dng Herbesser ngi ln khe mnh theo ng ung, Diltiazem HCl chuyn ha ch yu
bi cc qu trnh kh amin oxy ha, kh methyl oxy ha, kh acetyl v tip hp ha.
CH NH
Cn au tht ngc, au tht ngc bin th.
Tng huyt p v cn (t nh n trung bnh).
CHNG CH NH
- Bnh nhn ang c block nh tht II hay III hoc block xoang nh.
- Ph n c thai v ph n nghi ng c thai.
THN TRNG LC DNG
Thn trng chung :
- Do c bo co rng cc triu chng nng ln sau khi t ngt ngng thuc khng canxi, liu
dng nn gim t t v nn quan st cn thn cc triu chng nu nh ngng iu tr
Herbesser 30 v Herbesser 60. Bnh nhn cn c nhc nh khng c ngng thuc m
khng c s hng dn ca thy thuc.
- Thn trng khi s dng cho nhng bnh nhn c nhp tim chm nghim trng (di 50
ln/pht) hoc c block nh tht I.
Dng cho ngi gi :
V h thp huyt p qu mc l iu khng mong mun ngi gi, nn bt u iu tr vi
liu thp, v Herbesser 30 v Herbesser 60 phi c dng di s gim st cn thn.
Dng trong thi gian mang thai v cho con b :
- Do hu qu gy qui thai v gy cht thai ca Diltiazem c chng minh qua cc th
nghim trn ng vt, nn chng ch nh i vi ph n ang c thai hoc ph n nghi ng c
thai.

Khng dng Herbesser 30 v Herbesser 60 cho cc b m ang cho con b v c bo co rng

Diltiazem hydrochloride bi tit qua sa m. Nu cn thit phi dng thuc, trnh cho con b.
Dng trong nhi khoa :
Tnh an ton ca Herbesser 30 v Herbesser 60 i vi tr em khng c xc lp.
TNG TC THUC
Herbesser 30 v Herbesser 60 cn dng cn thn khi iu tr kt hp vi cc thuc sau y :
Thuc h p : hiu qu ca thuc h p s tng.
Thuc c ch bta hoc cc ch phm ca Rauwolfia : nhp tim chm c th xy ra.
Carbamazepine : nng huyt tng ca carbamazepine c th tng v c th gy nhng
triu chng ng c do carbamazepine nh bun ng, bun nn, nn v chng mt.v.v.
Ch phm digoxin : nng trong huyt tng ca digoxin tng.
TC DNG NGOI
422 trng hp (4,6%) c phn ng ph c bo co trong tng s 9630 trng hp. Cc
phn ng ph thng gp nht l :
- Tim mch : hoa mt, nhp tim chm, bc ha, block nh tht (khng thng xuyn), nh trng
ngc (him khi xy ra), .v.v.. Trong nhng trng hp ny, cn gim liu hoc ngng thuc.
- Tm thn kinh : mt mi, au u, au u m (khng thng gp), yu t (him gp) .v.v.
c th xy ra.
- Gan : him khi vng da v gan to xy ra. Herbesser 30 v Herbesser 60 cn c ngng trong
nhng trng hp ny. GOT, GPT c th tng nhng khng thng xuyn.
- Qu mn vi thuc : triu chng qu mn nh l: ni ban (t gp) v hng ban a dng (him)
c th xy ra. Trong nhng trng hp ny, nn ngng thuc.
- D dy-rut : kh chu d dy, to bn, au bng, chua (nng) v chn n (t gp), phn
mm, bun nn, tiu chy v kht nc (him gp) .v.v. c th xy ra.
LIU LNG v CCH DNG
Cn au tht ngc, au tht ngc bin th :
Thng thng, i vi ngi ln 30 mg Diltiazem hydrochloride ung 3 ln mi ngy. Nu cn,
c th tng ln 60 mg mi ln.
Tng huyt p v cn (cc trng hp t nh n trung bnh) :
Thng thng, i vi ngi ln 30-60 mg Diltiazem hydrochloride, ung 3 ln mi ngy. Liu
ca thuc c th c iu chnh theo tui ca bnh nhn v mc nghim trng ca cc
triu chng.
Ch v cch dng : nut vin thuc, khng nhai.
BO QUN
Bo qun di 30oC, trnh nh nng.

246.

HERPEVIR

SANOFI SYNTHELABO VIETNAM

Vin nn 200 mg : v 5 vin, hp 4 v - Bng B.
THNH PHN
cho 1 vin
Acyclovir

200 mg

DC LC
Acyclovir c tc dng chng virus Herpes simplex type I v type II, virus varicella-zoster. Tc
dng ny do men Thynidine Kinase ca virus bin i Acyclovir trong t bo thnh dng
monophosphate, sau thnh diphosphate v triphosphate c hot tnh. Dng triphosphate c
ch s tng hp v nhn i ca DNA bng cch c ch men DNA polymerase ca Herpes virus
cng nh bng cch kt dnh vi DNA ca virus. Virus Epstein-Barr v virus Cytomegalo cng
nhy cm vi acyclovir nhng t hn Herpes virus v Varicella-Zoster virus. Acyclovir khng c
tc dng trn nhng loi virus tim n.
DC NG HC
Khong 15-30% ca Acyclovir ung vo c hp thu qua ng tiu ha. Vi liu 200 mg/4
gi s cho nng ti a trong huyt thanh khong 0,56 mg/ml. Nng trong huyt thanh n
nh vo khong ngy th 2. Thi gian bn hy 3,3 gi. Thuc qua c nhau v hin din trong
sa m. Thuc thi tr qua thn.
CH NH
- iu tr nhim virus Herpes simplex (Herpes quanh ming, Herpes mi v Herpes sinh dc,
Herpes genitalis) v nhim virus thy u v gii n (varicella-zoster virus).
- Phng nga nhim virus Herpes nhng ngi b gim min dch.
CHNG CH NH
Qu mn vi cc thnh phn ca thuc.
THN TRNG LC DNG
bnh nhn suy thn hay ngi ln tui : phi gim liu.
LC C THAI v LC NUI CON B
Lc c thai :
Th nghim trn sc vt liu cao cho thy Acyclovir gy qui thai. Acyclovir khng c dng
cho ph n mang thai tr trng hp cn nhc li ch tht cn thn.

Lc nui con b :
Thuc qua c sa m. V vy cn thn trng khi cho Acyclovir trn ph n ang cho con b.
TC DNG NGOI
Pht ban ngoi da, ri lon tiu ha : tiu chy, chn n, nn v bun nn, au hng mt mi,
nhc u, chng mt.
LIU LNG v CCH DNG
- iu tr nhim virus nguyn pht : 1 vin, ung 5 ln/ngy, ko di t 5-10 ngy.
- iu tr phng nga ti pht nhng bnh nhn suy gim min dch : 1 vin, 2-5 ln/ngy, ko
di trong 6 thng.
BO QUN
Gi ni kh ro,nhit khng qu 25oC.

247.

HEXAPNEUMINE

DOMS-RECORDATI
sir ngi ln : chai 200 ml.
sir tr em : chai 200 ml.
sir nh nhi : chai 100 ml.
THNH PHN
cho 1 chai sir ngi ln
Pholcodine

266 mg

Biclotymol

396 mg

Guaifnsine
hay Gaiacolate de glycryle

400 mg

Chlorphnamine malate

26,6 mg

T dc : saccharose, thanol 95deg, mi

thm, parahydroxybenzoate de mthyle
sod.

cho 1 chai sir tr em

Pholcodine

200 mg

Biclotymol

300 mg

Guaifnsine
hay Gaiacolate de glycryle

400 mg

Chlorphnamine malate

20 mg

T dc : saccharose, thanol 95deg, mi

thm, parahydroxybenzoate de mthyle
sod.

cho 1 chai sir nh nhi

Biclotymol

100 mg

Guaifnsine
hay Gaiacolate de glycryle

200 mg

Chlorphnamine malate

5 mg

Paractamol

500 mg

Sir Tolu

10 g

T dc : saccharose, thanol 95deg,

mi thm, parahydroxybenzoate de
mthyle sod.

DC LC
Thuc ho c tc dng khng khun :
- Pholcodine : chng ho trung ng, dn xut ca morphine : c ch trung tm h hp nhng t
hn cod ine.
- Chlorphnamine malate : khng histamine do tc ng ln th th H1 ngoi bin, chng li s

co tht ph qun, tc dng ging atropine v lm m du.

- Biclotymol : dn xut ca phnol, c tc dng khng khun.
- Gaiacolate de glycryle : kch thch tit dch ph qun.
Sir nh nhi : cng thc khng c cha pholcodine, ngc li c s hin din ca paractamol
lm gim st v sir Tolu lm long m.
T dc c cha mt t cht nhy vi c tnh tng nh nhu ng gip o thi cc cht nht
d dy v trnh nn ma.
CH NH
Sir ngi ln v tr em : iu tr cc chng ho khan gy kh chu, c bit ho do d ng v do
kch thch.
Sir nh nhi : iu tr triu chng, h st v an thn trong cn ho khan gy kh chu, st khun
trong cc bnh l h hp, hot tnh c tr hin thi cha c chng minh.
CHNG CH NH
Lin quan n pholcodine :
- Cng nh cc loi thuc ho khc : suy h hp bt kz mc no (do tnh cht c ch trung
tm h hp, v s cn thit cho bnh nhn ho nhm trnh ng ph qun).
- Khng dng cho tr nh nhi.
- Ho suyn.
Lin quan n paractamol :
- Tr nh nhi : khng dng trong trng hp c suy t bo gan.
Lin quan n chlorphnamine :
- Nguy c glaucome gc ng.
- Nguy c b tiu do ri lon niu o-tin lit tuyn.
CH PHNG
- Ho m, l mt yu t c bn ca s khng ph qun-phi, nn tn trng.
- Trc khi k toa mt loi thuc chng ho, phi tm k nguyn nhn gy ho, nht l cc trng
hp i hi mt tr liu chuyn bit nh suyn, dn ph qun, kim sot xem c b tc nghn
ph qun, ung th, bnh l ni ph qun, suy tht tri bt kz nguyn nhn, thuyn tc phi, ho
do bnh tim, v khi cn ho khng vi mt loi thuc ho k vi liu thng thng, khng
nn tng liu m phi kim tra li tnh trng lm sng.
THN TRNG LC DNG
Ngi ln tui : liu ban u gim cn phn na liu thng thng, c th tng thm mt phn
t, ty theo s dung np v nhu cu.
Ngi ln v tr em : khng c ung cc cht c cha cn trong thi gian iu tr.
Nh nhi : trnh s dng ko di.
Tr s sinh : cha c mt d kin no c t ra v nguy c ca pholcodine m s dng
thuc ho ny.

Liu lng ng c trong mi liu :

Ngi ln v tr em : 1 mung caf cha 4 g - mt mung canh cha 12 g.
Nh nhi : 1 mung caf cha 3,75 g.
Ngi li xe v iu khin my mc : phi lu { ngi li xe v s dng my mc v nguy c
bun ng khi s dng thuc ny.
LC C THAI v LC NUI CON B
Lc c thai : hin nay, do cha c th nghim trn ng vt v cc d kin lm sng, khng th
xc nh nguy c gy qui thai ca pholcodine, ngoi ra, tnh v hi khi s dng chlorphnamine
ph n c thai cha c xc nh, do v l{ do thn trng khng nn s dng thuc ho ny
trong ba thng u ca thai kz.
Lc nui con b : v l do thn trng khng nn dng thuc v thiu cc d kin.
TNG TC THUC
Lin quan n chlorphnamine :
Khng nn phi hp :
- Alcool : alcool lm tng tc dng an thn ca thuc khng histamine H1. S gim tp trung v
cnh gic c th gy hu qu nguy him cho ngi li xe v iu khin my mc.
Trnh ung ru v nhng thuc khc c cha alcool.
Lu { khi phi hp :
- Atropine v nhng cht c tc ng ging atropine : cc thuc chng trm cm nhm
imipramine, thuc lm m du thn kinh gc phnothiazine, chng co git Parkinson, khng
choline, chng co tht dng atropine, disopyramide : tng cc dng ngoi ca atropine nh
gy b tiu, to bn, kh ming.
- Cc thuc khc gy trm cm h thn kinh trung ng : cc thuc chng trm cm c tc dng
an thn, barbiturate, benzodiazpine, clonidine v cc thuc cng h, thuc ng, dn xut ca
morphine (thuc gim au v chng ho), thuc an thn kinh, thuc gii lo u khng thuc nhm
benzodiaz pine : tng trm cm h thn kinh trung ng c th a n hu qu nguy him
cho ngi li xe v s dng my mc.
Lin quan n phnylphrine :
Khng nn phi hp :
- Guanthidine v cc thuc cng h : tng tc dng cao huyt p ca phnylphrine, gy gin
ng t nghim trng v k o di (tng tc dng do c ch trng lc giao cm gy bi
guanthidine). Nu bt buc phi phi hp, cn tng cng theo di bnh nhn.
TC DNG NGOI
Lin quan n pholcodine : pholcodine c tt c cc tc dng ph ca cc thuc ho c opium
khc, nhng vi liu iu tr, tc dng ph mc t hn. C th gy to bn, bun ng,
chng mt, bun nn, nn ma, co tht ph qun, d ng da, suy h hp (xem Chng ch nh).
Qu liu iu tr, pholcodine s gy nguy c l thuc thuc v hi chng cai thuc khi ngng

thuc t ngt.
Lin quan n chlorphnamine :
- Bun ng ban ngy.
- Tc dng atropine gia tng qunh ca cht tit ph qun, kh ming, ri lon t th, to
bn, b tiu, l ln hay kch ng ngi ln tui.
- Tc dng d dy-rut, c bit khng dung np tiu ha.
Him gp :
- Mt vi trng hp ri lon vn ng mun c ghi nhn sau khi dng ko di mt vi loi
khng histamine nhm phnothiazine.
- Him gp cc trng hp gim bch cu v mt bch cu ht.
- Hin tng kch ng tr em v tr nh nhi.
LIU LNG v CCH DNG
Hm lng pholcodine :
Sir ngi ln : 20 mg mi mung canh.
Sir tr em : 15 mg mi mung canh, 5 mg mi mung caf.
iu tr triu chng phi ngn (vi ngy).
Liu dng c chia ra trong ngy.
Ngi ln : 60 n 120 mg pholcodine mi ngy, tc 3 n 6 mung canh chia u trong ngy.
Tr em :
- t 30 thng n 8 tui : 0,5 mg pholcodine/kg/ngy, tc 1 n 2 mung caf mi ngy, chia
lm 2 ln.
- t 8 n 10 tui : 1 mg pholcodine/kg/ngy, tc 4 n 6 mung caf mi ngy, chia u trong
ngy.
- t 11 n 15 tui : 2 n 3 mung canh/ngy, chia u trong ngy.
Tr nh nhi :
1 n 3 mung caf mi ngy, ty theo tui, chia lm nhiu ln trong ngy.
QU LIU
Lin quan n pholcodine :
- Du hiu : bun nn, nn ma, ni m ay, bun ng.
- iu tr : naxolone, h hp h tr.
Lin quan n chlorphnamine :
- Du hiu :
tr : du hiu ch yu l kch thch biu hin kch ng, o gic, mt iu ha vn ng, mt
s phi hp, ma vn v co git. Nhng du hiu ny xy ra tng cn, run v ng tc ma vn
c th l tin triu. ng t c nh v dn, da ( mt), st l nhng du hiu thng thy
bo hiu tnh trng ng c atropine. giai on cui c th xut hin du hiu hn m v
nng hn l try tim mch v h hp. T vong trong vng 2 n 98 gi.

 ngi ln : bnh cnh lm sng khc hn : tnh trng trm cm v hn m c th tip sau giai
on kch thch v co git. St v da him gp.
- iu tr triu chng : ty trng hp, h hp h tr hay nhn to, dng thuc chng co git.
Lin quan n paractamol :
- Du hiu :
Tr nh nhi : nu s dng liu qu cao paractamol s gy hy t bo gan c th dn n hoi
t hon ton v khng hi phc. Thng thng cc du hiu lm sng xy ra trong vng 24 gi.
- iu tr : phi iu tr bnh cn trong vng vi gi ngay sau khi dng thuc. Khi pht hin ng
c cp phi chuyn ngay vo khu iu tr chuyn khoa.
Du hiu sinh ha thng tn gan c th xut hin mun.

248.

HEXASPRAY

DOMS-RECORDATI
c/o MARKETING SANPROMEX
Thuc phun hng : dng kh nn, chai 30 g.
THNH PHN
cho 1 l
Biclotymol

0,75 g

(alcool benzylique, dtate de sodium,

glycyrrhizinate d'ammonium, tinh du hi,
saccharine sodique, cellulose dispersible,
lcithine de soja, glycrol, alcool 95deg,
nc ct, parahydroxybenzoate de
mthyl)
DC LC
Hexapray cha hot cht l biclotymol, c cc c tnh sau :
- khng khun : do tc dng dit khun in vitro, biclotymol c tc dng in vivo trn
staphylocoque, streptocoque, micrococci, corynebacteria ;
- khng vim : cc nghin cu dc hc bng cch i chiu cc cht tham kho vi mu chng,
chng minh rng biclotymol c tc dng khng vim ni ti ng k ;

- gim au : biclotymol c c tnh gim au, khng cn phi hp thm thuc t ti ch.
DC NG HC
Hexapray c hp thu chm qua nim mc ming, in vitro v in vivo, do thuc c tc ng
ko di.
CH NH
iu tr h tr ti ch, cc chng vim v nhim trng c gii hn nim mc ming v hu
hng.
Trng hp c biu hin nhim trng ton thn, phi iu tr khng sinh.
CHNG CH NH
Khng dng thuc phun hng cho tr nh nhi (do nguy c gy co tht thanh qun).
CH PHNG
Khng nn iu tr lu di do c kh nng gy mt thng bng h tp khun bnh thng
ming vi nguy c gy lan ta vi khun hoc nm (bnh nm candida).
THN TRNG LC DNG
Thng khng nn dng thuc qu 10 ngy ; qu thi hn ny, nn nh gi li vic iu tr.
Lc chai trc khi s dng.
LIU LNG v CCH DNG
Ngi ln v tr em : mi ln xt 2 nht x 3 ln mi ngy.
BO QUN
Khng l thuc ni c nhit cao.

249.

HICONCIL

BRISTOL-MYERS SQUIBB
vin nang 500 mg : hp 12 vin.
bt pha xir 250 mg/5 ml : chai 60 ml xir sau khi pha (12 mung lng 5 ml).
THNH PHN
cho 1 vin
Amoxicilline trihydrate tnh theo amoxicilline

500 mg

(Lactose)

cho 1 mung lng

Amoxicilline trihydrate tnh theo amoxicilline

250 mg

(Saccharose)

(2,15 g)

(Na)

(5,7 mg)

DC LC
Amoxicilline l khng sinh dit khun c ph khng khun rng h bta-lactamine, nhm
pnicilline A.
PH KHNG KHUN
Cc vi khun nhy cm thng xuyn (CMI <= 4 mg/ml) :
Hn 90% cc dng vi khun c tnh nhy cm.
Streptocoques A, B, C, F, G ; Streptococcus bovis ; Streptocoques th khng phn nhm ;
Streptococcus pneumoniae nhy cm vi pnicilline ; Enterococcus faecalis, Listeria
monocytogenes ; Corynebacterium diphteriae, Erysipelothrix rhusopathiae, Eikenella ; Neisseria
meningitidis, Bordetella pertussis ; Clostridium sp., Propionibacterium acnes ;
Peptostreptococcus, Actinomyces ; Leptospires, Borrelia, Treponema ; Salmonella typhi,
Eubacterium, Actinobacillus actinomycetemcomitans.
Cc vi khun khng (CMI > 16 mg/ml) :
t nht 50% cc dng vi khun c tnh khng.
Staphylocoques, Branhamella catarrhalis ; Klebsiella pneumoniae v oxytoca, Enterobacter,
Serratia, Citrobacter diversus, Citrobacter freundii ; Providencia rettgeri ; Morganella morganii,
Proteus vulgaris, Providencia, Yersinia enterocolitica ; Pseudomonas sp., Acinetobacter sp.,
Xanthomonas sp., Flavobacterium sp., Alcaligenes sp., Nocardia sp., Campylobacter sp. ;
Mycoplasmes, Chlamydiae, Rickettsies, Legionella, Mycobacteries ; Bacteroides fragilis.
Cc vi khun nhy cm khng thng xuyn :
S khng mc phi ca vi khun c t l thay i. Phi lm khng sinh xc nh
nhy cm.
Enterococcus faecium, Streptococcus pneumoniae pni-I hoc R, Escherichia coli, Proteus
mirabilis, Shigella, Vibrio cholerae ; Haemophilus influenzae, Neisseria gonorrhoeae ;
Fusobacterium, Prevotella ; Veillonella ; Capnocytophaga ; Porphyromonas.
Lu { : mt vi loi vi khun khng c mt trong ph khng khun do khng c ch nh lm
sng.

Nm 1995 Php, c 30-40% cc loi pneumocoques gim tnh nhy cm i vi pnicilline

(CMI > 0,12 mg/ml). Tnh trng gim nhy cm ny c lin quan n tt c cc bta-lactamine
theo nhng t l khc nhau v cn c lu { c bit trong iu tr vim mng no do tnh
trm trng ca bnh v vim tai gia cp do trong bnh ny tn sut cc dng vi khun gim
nhy cm c th vt qu 50%.
DC NG HC
Hp thu : dng ng ung, amoxicilline c hp thu khong 80%. Thc n khng nh hng
n s hp thu ca thuc.
Phn phi :
- Nng nh trong huyt thanh t c 2 gi sau khi ung 500 mg l 7-10 mg/ml v sau khi
ung mt liu 1 g l 13-15 mg/ml. Nng trong huyt thanh t l vi liu ung vo.
- bnh nhn c chc nng thn bnh thng, thi gian bn hy trung bnh khong 1 gi.
- Khuch tn n a s cc m v cc mi trng sinh hc ; khng sinh c tm thy trong
dch tit ph qun, xoang, nc i, nc bt, th dch, dch no ty, thanh mc, tai gia nng
tr liu.
- Amoxicilline qua c hng ro nhau thai v c bi tit qua sa m.
- T l kt dnh vi protine khong 17%.
Chuyn dng sinh hc : sau khi vo c th, mt phn amoxicilline c chuyn ha thnh acide
p nicilloique tng ng. Khong 20% liu ung vo c tm thy trong nc tiu di dng
ny.
Bi tit : t l thuc hp thu c bi tit di dng c hot tnh :
- a s trong nc tiu (70 n 80%, sau 6 gi).
- trong mt (5 n 10%).
CH NH
Hiconcil c ch nh trong cc nhim trng do vi khun nhy cm, bao gm cc nhim khun
ng h hp, tai mi hng v ming, nhim khun thn v tit niu, nhim khun ph khoa,
nhim khun tiu ha v mt.
Trong trng hp vim mng no, nhim trng huyt v vim ni tm mc, Hiconcil c s
dng nh dng chuyn tip theo sau khi dng dng tim.
CHNG CH NH
- D ng vi pnicilline.
- Nhim virus nhm herps, nht l bnh tng bch cu n nhn nhim trng (tng nguy c b
phn ng da).
- Phi hp vi allopurinol (tng nguy c b phn ng da).
CH PHNG
- Ngng tr liu nu xut hin cc biu hin d ng.
- Mt s trng hp c ghi nhn c cc phn ng qu mn (phn v) nng c th gy t

vong khi iu tr bng nhm p nicilline A. Do phi hi tin s d ng thuc trc khi dng
thuc.
- T l d ng cho gia pnicilline v cphalosporine chim t 5 n 10%. Do dt khot
khng k toa pnicilline cho bnh nhn c d ng vi cphalosporine.
THN TRNG LC DNG
- Nn lu { nguy c xy ra d ng cho vi khng sinh nhm c phalosporine (xem Ch {
phng).
- Trng hp bnh nhn b suy thn, cn chnh liu theo mc thanh thi cratinine hoc
theo cratinine huyt (xem Liu lng).
LC C THAI v LC NUI CON B
Amoxicilline qua hng ro nhau thai v qua sa m vi s lng rt t.
TNG TC THUC
Chng ch nh phi hp :
- Allopurinol : tng nguy c gy phn ng da.
Xt nghim cn lm sng :
Dng amoxicilline liu rt cao c th lm bin i mt vi thng s sinh hc :
- gim kt qu nh lng ng huyt,
- nh hng n kt qu nh lng protide ton phn trong huyt thanh bng phn ng mu,
- cho kt qu dng tnh gi khi nh lng ng niu bng phng php bn nh lng
bng sc k.
TC DNG NGOI
Nh vi tt c cc pnicilline :
- biu hin d ng : ni m ay, tng bch cu a acide, ph Quincke, kh th, him khi gp sc
phn v,
- ri lon tiu ha : bun nn, ma, tiu chy, nhim nm candida.
Cc biu hin khc c th c ghi nhn, nhng him hn :
- thay i cng thc mu c th hi phc : thiu mu, gim tiu cu, gim bch cu,
- vim thn k cp tnh,
- tng transaminase va phi v tm thi,
- rt him trng hp b vim i trng gi mc.
LIU LNG v CCH DNG
Liu lng :
Ngi ln : 1 g n 1,5 g hay 2 g/ngy, chia lm 2-3 ln.
Tr em trn 30 thng tui : 25 n 50 mg/kg/ngy, chia lm 3 ln.
Tr di 30 thng tui : 50 mg/kg/ngy, chia lm 3 ln. Khng dng qu 3 g/ngy.
Suy thn : thanh thi cr atinine <= 10 ml/pht : 8 n 15 mg/kg mi 12 n 24 gi hoc gi liu
bnh thng nhng tng khong cch gia cc ln dng.

Trng hp nhim trng nng hoc mn tnh : tng s ln dng thuc.

Ngi ln : 2 g/ngy.
Tr em/Nh nhi : ti a 100 mg/kg/ngy ; chia lm 3 hoc 4 ln.
iu tr chuyn tip trong trng hp nhim trng huyt, vim ni tm mc v vim mng no
: tng s ln dng thuc.
Ngi ln : ti a 6 g/ngy.
Tr em/Nh nhi : ti a 150 mg/kg/ngy.
Cch dng :
Vin nang : ung thuc vi mt t nc trc ba n.
Bt pha xir : cho nc khong khng c gaz hoc nc un si ngui vo chai cho n mc
vch trn chai. Sau lc u nhiu ln cho n khi bt thuc ha tan ht. Nu thy mc nc
thp hn vch th chm thm nc vo cho n ngang vch. Khi bn c 60 ml dung
dch thuc (12 mung lng), tng ng 3 g amoxicilline.
Sau khi pha, xir c th gi c 1 tun nhit phng.
BO QUN
Sau khi pha, xir c th gi c 1 tun nhit phng.

250.

HIRMEN

SEOUL PHARM
c/o IC VIET NAM
vin nang mm : v 5 vin, hp 12 v.
THNH PHN
cho 1 vin
Sodium chondroitine sulfate

90 mg

Pyridoxine HCl

25 mg

Inositol

30 mg

g-Oryzanol

5 mg

Cyanocobalamine

30 mg

Riboflavin tetrabutyrate

6 mg

Fursultiamine

50 mg

Calcium pantothenate

15 mg

Nicotinamide

50 mg

DC LC
Hirmen c tc dng dinh dng thn kinh ngoi bin, hu hiu vi cc au dy thn kinh :
Fursultiamine phi hp vi vitamin B6, B12 c tc dng dinh dng thn kinh ngoi bin :
- Tng cng tc dn truyn lung xung ng thn kinh, bo v bao myelin ca si dy thn
kinh.
- Kch thch qu trnh ti to v chc nng t bo thn kinh do gia tng chuyn ha protein,
lipid, glucid, to nng lng cho t bo thn kinh.
Fursultiamine kch thch nhanh hn s ti sinh dy thn kinh :
Tim fursultiamine sau khi ct v ni dy thn kinh ta ca th con. T l lot do t th nhm
dng fursultiamine 2,5 mg/kg l 29%, 15 mg/kg l 12% trong khi nhm chng l 42%. Thi
gian cn thit in c tr li bnh thng nhm dng fursultiamine l 30 ngy, trong
khi thi gian ny nhm chng l gn 50 ngy.
Fursultiamine ci thin cc ri lon chc nng dy thn kinh trong bnh tiu ng :
Gy tiu ng thc nghim bng Alloxan trn chut chu ch khng ch vitamin B1 trong
khu phn. Tim fursultiamine v thiamine vo phc mc vi cc liu khc nhau trn 2 nhm.
So snh cng nhm chng khng tiu ng cho thy :
- Fursultiamine (TTFD) ci thin tc dn truyn lung thn kinh vn ng tt hn so vi
thiamine.
- Hiu qu ca fursultiamine (TTFD) trn tc dn truyn lung thn kinh vn ng ph thuc
vo liu s dng v t kt qu tt hn vi liu 35,90 mg/kg tr ln.
Hirmen ngn nga v cha tr au mi c bp, mi mt :
Fursultiamine ci thin cc ri lon chuyn ha c, tng cng kh nng hot ng tim tng
ca c, cho hiu qu gim au, l co-enzyme ca co-carboxylase, tham gia chuyn ha pyruvic
acid, lactic acid ng trong c khi hot ng (gy nhc mi c) thnh acetylcoenzyme A trong
chu trnh Krebs sinh nng lng.
Hirmen ngn nga v cha tr cc thng tn sn khp, vim thoi ha khp gy nhc mi
khp :
Chondroitin l mt glycosaminoglycan (GAG) tham gia vo cu trc mng t bo, c trong thnh
phn ca si chun cc mch mu ln, chim t l ln trong cht cn bn ca m sn v xng,
m bo cho sn xng khng nhng c chc m cn c tnh n hi, l nguyn liu quan

trng trong qu trnh ti to m sn, xng. C tc ng ngn nga s thoi ha t bo. Duy tr
tnh n hi ca cc cu trc c nhiu si chun (gn, cn c, dy chng). Ngoi ra chondroitin
cn tham gia cc cu trc trong sut v n hi ca mt, duy tr cc hot ng sinh l ca mt.
Trong thoi ha khp : chondroitin c ch elastase, yu t trung gian trong qu trnh thoi ha
m sn, ng thi kch hot qu trnh tng hp proteoglycan (cu trc cn bn ca m lin kt)
bi cc t bo sn.
Hiu qu lm sng ca chondroitin sulfat trong iu tr thoi ha khp gi v hng :
Hiu qu ca chondroitin sulfat c nh gi trn 120 bnh nhn thoi ha khp gi v khp
hng bng phng php ngu nhin, m i c i chng trong 3 thng, ko di thm 2 thng
khng dng thuc theo di hiu qu ko di ca thuc. Chn mc tiu th thuc chng vim
non-steroid (liu tng ng vi liu diclofenac) l thng s chnh. Trong 3 thng iu tr, cc
bnh nhn dng chondroitin sulfat vi liu 4 vin/24 gi v gim c mc s dng thuc
chng vim non-steroid v s gim liu ny k o di c 2 thng tip theo m khng cn dng
chondroitin sulfat. Cc thng s nghin cu khc nh : nh gi mc au bng bc thang
Huskisson, ch s au chc nng ca Lequesne cng c nh gi bi c bc s v bnh nhn
v u c kt qu chung l cc triu chng au thuyn gim. S dung np ca thuc tt. Nghin
cu ny ch ra li ch ca s dng chondroitin sulfat trong iu tr thoi ha khp gim c
liu thuc chng vim non-steroid, thuc c tc dng ko di.
Hirmen hiu qu chng mt mi, tnh trng stress, to bn :
- Tnh trng thiu ht sinh t rt d dng xy ra trong cuc sng hin ti nu khng c b
sung y , gy ra u oi, mt mi, n ng km, lm vic gim hiu sut, gim kh nng chu
ng v sc khng.
- Hirmen b sung cc sinh t, ngn nga cc ri lon chuyn ha do thiu ht cc sinh t gy ra.
c bit Hirmen cha g-oryzanol c hiu qu lp li cn bng thn kinh giao cm v ni tit,
fursultiamine kch thch m ri thn kinh Auerbach, calcium pantothenate tham gia hnh thnh
acetylcholin, tc dng bnh thng ha nhu ng rut, chng to bn mn tnh.
CH NH
- au nhc dy thn kinh, t chn tay, vim dy v a dy thn kinh, ri lon chc nng thn
kinh do bnh i ng, d cm u chi (paresthesia), au do Herpes.
- au mi c bp, cng c, mi mt.
- au nhc khp (au lng, au mi vai, gy, khp gi, hng), thoi ha khp, vim khp mn
tnh.
- Suy nhc c th, tnh trng stress, thi kz dng bnh, ph n cho con b, bnh t ph do
thiu vitamin B1, to bn mn tnh.
LIU LNG v CCH DNG
Ngi ln v tr em trn 8 tui : ung 1 vin, 2 ln mi ngy trong hoc sau ba n.
Thuc tc dng chm nhng duy tr lu di. Liu trnh nn duy tr u n tng t 4-6 tun.

251.

HISTODIL

GEDEON RICHTER
dung dch tim 200 mg/2 ml : ng 2 ml, hp 10 ng.
THNH PHN
cho 1 ng
Cimetidine

200 mg

DC LC
Tc dng tr liu ca cimetidine c t trn c s cc th th H1 v H2. Histamin lm co tht
nhiu c trn nh c trn ph qun v ng mch nhng n lm gin cc c trn khc k c
cc c trn ca cc mao mch nh. Histamin cng l mt cht kch thch rt mnh s tit dch
v. Cc thuc khng histamin quen thuc i khng s co tht lin quan n th th H1 tr s
tit acid l khng p ng vi nhng cht i khng ny. l nhng th th H2.
Cimetidine l thuc i khng th th H2 ung v khng c u tin, c ch cnh tranh vi th
th H2 ca nhng t bo vch. Kt qu l, cimetidine c ch s tit pentagastrin b kch thch
v cha b kch thch, histamin v acetylcholin, acid d dy. C ch tc ng ca n l duy nht
trong s cc thuc chng lo t c trong vic gim tit acid d dy bng cch c ch theo c
ch sinh l{ qua lm tng qu trnh lnh lo t d dy t trng, lot cht d dy. Do kim sot
c s tng tit, thuc thch hp phng nga v ph tr phn ng ph lot v lot cht do
thuc.
CH NH
c ch nh iu tr xut huyt t trng cp v lot d dy khng do u c tnh, lot cht. Km
ch xut huyt ng tiu ha trn do phn hi thc qun v cc xut huyt khc trong hi
chng Zollinger-Ellison, xut huyt d dy t trng hu phu.
CHNG CH NH
Chng ch nh tuyt i cha c bit. Trong suy gan, suy thn, suy tun hon nng phi
gim liu km theo kim tra cht ch. Khng nn iu tr Histodil cho tr em.
Ph n ang mang thai v cho con b : ch dng sau khi xem x t khng gy nguy him n
tnh mng.
CH PHNG v THN TRNG LC DNG
Dng cimetidine cng vi thuc chng ng mu cn phi iu chnh liu thuc chng ng, v
tc dng chng ng tng ln c th a n xut huyt.

Sau khi ngng thuc nhng triu chng ti pht c th xy ra.

Nu phi dng antacid, nn dng 1 gi sau khi dng Histodil v dng ng thi lm gim tc
dng cimetidin.
Tng k :
Thuc tim tng k vi pentobarbital v gentamycine.
TNG TC THUC
Do c tnh c ch enzyme, cimetidine c ch s phn ct oxy ha nhiu thuc dng ng thi
tiu th gan :
- Cimetidine lm tng thi gian tc dng ca thuc chng ng mu dng ung, phenytoin,
theophyllin, benzodiazepine v thuc chn bta.
- Sinh kh dng ca cimetidine b gim bi antacid v metoclopramide.
TC DNG NGOI
Vim gan (i khi l do mt), tiu chy tm thi, au c, chong vng v hng ban. Nng
creatinin v transaminase huyt tng c th tng tm thi. Nu ri lon tim mch hay tim
qu nhanh th lon nhp tim v h p c th xy ra.
LIU LNG v CCH DNG
Trong nhng trng hp xut huyt cp ng tiu ha trn, tim tnh mch hay truyn dch
Histodil thm 48 gi na sau khi ngng xut huyt. Ch tim khi khng th ung c. Tc
truyn dch nh git khng c vt qu 75 mg cimetidine/gi. Khi pha tim tnh mch, pha 1
ng (200 mg) vo 20 ml dung dch nc mui sinh l, tim chm. Liu c th lp li mi 4-6 gi.
Liu trung bnh hng ngy l 800-1200 mg, tng liu hng ngy khng vt qu 2 g.
cc bnh nhn suy thn nng, liu gim theo gim thanh thi creatinin. Vi cc bnh nhn
ri lon tim mch, nn u tin truyn dch ngt qung. Sau khi ngng iu tr ng tim nn
tip tc bng ng ung.
BO QUN
Bo qun ni ti v lnh.
Hn dng : 3 nm.

252.

HIVID

HOFFMANN - LA ROCHE
Vin nn 0,375 mg : hp 100 vin - Bng A.
Vin nn 0,750 mg : hp 100 vin - Bng A.
THNH PHN

cho 1 vin
Zalcitabine

0,375 mg

cho 1 vin
Zalcitabine

0,750 mg

DC LC
Khng rtrovirus.
C ch tc ng :
Zalcitabine l mt hp cht tng hp, c cu trc tng t 2'-dsoxycytidine, l mt nucloside
t nhin, trong nhm hydroxyle v tr 3' c thay th bng nguyn t hydrogne. trong
t bo, zalcitabine c chuyn i thnh mt cht chuyn ha c hot tnh, l
didsoxycytidine 5' triphosphate (ddCTP) bng cc enzyme ca t bo.
Cht didsoxycytidine 5' triphosphate bt chc cht nn t nhin ca men transcriptase o
ngc ca VIH l dsoxycytidine triphosphate (dCTP), v hm li qu trnh sao chp ca VIH in
vitro do c ch cnh tranh trn s tng hp ADN ca virus nh tc ng lm t chui ngay t
u.
Cc nghin cu so snh tc ng khng virus ca zalcitabine trn cc virus VIH-1 v VIH-2 in
vitro khng cho thy c s khc bit no ng k trn tnh nhy cm gia hai loi virus khi tc
ng c nh gi da trn hiu lc gy c tnh trn t bo virus. Mi lin quan gia mt
bn l tc ng c ch VIH bi zalcitabine in vitro, v mt bn l s c ch qu trnh sao chp
ca VIH trn bnh nhn b nhim hoc trn p ng lm sng vi iu tr, hin cha c
thit lp.
DC NG HC
Dc ng hc ca zalcitabine c nh gi qua cc nghin cu trn bnh nhn ngi ln
b nhim VIH sau khi dng cc liu ung 0,01 mg/kg, 0,03 mg/kg v 1,5 mg v dng ng
tim tnh mch liu 1,5 mg (trong 1 gi).
Hp thu v sinh kh dng :
Bnh nhn b nhim VIH, sau khi ung thuc, c sinh kh dng trung bnh tuyt i trn
80%.
S hp thu zalcitabine liu 1,5 mg bng ng ung (n = 20) b gim khi dng chung vi thc
n, kt qu l nng ti a trung bnh trong mu (Cmax) s gim 39%, t 25,2 ng/ml xung
cn 15,5 ng/ml, v tng gp i thi hn trung bnh cn thit t c nng ti a
(Tmax), t 0,8 gi (lc i) ln 1,6 gi (khi c thc n). Din tch di ng cong phn nh

mc trung bnh hp thu cng gim 14%. nh hng trn lm sng ca s gim ny cha c
bit n.
Phn phi :
Sau khi tim tnh mch mt liu 1,5 mg zalcitabine, th tch phn phi tnh trng cn bng
trung bnh l 0,634 l/kg (+/- 0,127). Gn kt vi protine huyt tng di 4%, iu ny c
ngha l khng chc c xy ra tng tc vi cc thuc c gn kt cao vi protine huyt tng.
Cc nng o lng c ca zalcitabine c pht hin trong dch no ty t 2 n 3,5 gi
sau khi truyn tnh mch 0,06 mg/kg hoc 0,09 mg/kg. Tng quan gia cc nng (dch no
ty - huyt tng) c ghi nhn trong khong 9-37% (trung bnh 20%), iu ny cho thy rng
hot cht thuc i qua c hng ro mu no.
Chuyn ha v o thi :
Zalcitabine c phosphoryl ha trong t bo thnh zalcitabine triphosphate, l cht nn ca
men transcriptase o ngc ca VIH. Nng ca zalcitabine triphosphate rt thp khng th
nh lng c sau khi dng vi liu iu tr ngi.
S chuyn ha ca zalcitabine ngi khng c nh gi hon ton. Zalcitabine khng b
chuyn ha ng k gan. Bi tit qua thn l ng o thi chnh, chim khong 70% liu
ung c nh du bng ng v phng x trong 24 gi u. Thi gian bn hy o thi trung
bnh l 2 gi v dao ng t 1 n 3 gi tng bnh nhn.
Thi gian bn hy trong t bo ca cht chuyn ha c hot tnh (ddCTP) trong khong t 7 n
10 gi.
Sau khi tim tnh mch, thanh thi hon ton trong c th trung bnh l 285 ml/pht.
Lng zalcitabine c nh du c o thi qua phn di 10%.
Cc kt qu ghi nhn c ngi suy thn (thanh thi cr atinine di 55 ml/pht) cho thy
rng thi gian bn hy ca zalcitabine di hn (cho n 8,5 gi) so vi ngi c chc nng thn
bnh thng. Sau khi dng liu duy nht, nh hp thu trong huyt tng cao hn mt vi
bnh nhn.
bnh nhn c chc nng thn bnh thng, dc ng hc ca zalcitabine khng b bin i
sau khi dng cc liu lp li 3 ln/ngy. S tch t ca hot cht trong huyt tng khng ng
k.
AN TON TIN LM SNG
Kh nng gy ung th :
Cc u bch huyt bo tuyn c c quan st chut sau khi dng di hn ddC vi liu
1000 mg/kg/ngy. Tuy nhin, cho n nay khng pht hin c gy u bch huyt bo trong cc
nghin cu lm sng.
Kh nng gy t bin :
Cc test Ames c thc hin trn cc chng khc nhau c hoc khng gy hot ha s chuyn
ha, khng ghi nhn thy mt kh nng gy t bin no. Cc test trn t bo phi ca chut

lang Trung quc (vi c hoc khng gy s chuyn ha hot ha) v trn cc t bo ca u bch
huyt bo ca chut cng khng ghi nhn mt kh nng gy t bin no. Mt test v s tng
hp ADN khng c trong chng trnh, c thc hin trn cc t bo gan ca chut cng,
khng ghi nhn c tng kh nng hi phc cc sang thng ca ADN.
Cc bch huyt bo mu ngoi bin ngi c iu tr bng zalcitabine, c hoc khng c
s chuyn ha hot ha ; nng >= 1,5 mg/ml, mc gy sai lc nhim sc th tng ph
thuc vo liu c pht hin. liu ung t 2500 n 4500 mg/kg zalcitabine gy rn nt
(clastogne) trong cc test trn vi nhn (micronucleus) chut.
Kh nng sinh sn :
Kh nng th tinh v sinh sn c nh gi chut cng nhng nng trong huyt
tng cao, theo gi tr ca din tch di ng cong, cho n gp 2142 ln nng t c
ngi khi dng liu iu tr ti a khuyn co. Khng mt tc dng ngoi { no c ghi nhn
nhng nng ny trn kh nng th thai v sinh sn. liu cao hn, c ghi nhn c kh
nng gy cht phi v gy qui thai. liu thp hn (nng trong huyt tng tng ng vi
485 ln nng t c ngi khi dng liu iu tr ti a khuyn co), t l gy c tnh
trn phi rt thp v khng c tc dng gy qui thai.
CH NH
Hivid (zalcitabine) c ch nh n liu php ngi ln b nhim VIH, giai on pht bnh
v c biu hin khng dung np zidovudine hoc tht bi khi iu tr vi zidovudine.
S khng dung np v mu c lin quan n zidovudine c nh ngha nh sau :
- gim hm lng hmoglobine t nht 2 g/100 ml hoc nng tng cng ca hmoglobine
thp hn 8,5 g/100 ml.
- gim bch cu trung tnh t nht 200 t bo/mm3 hoc nng tng cng di 750 t
bo/mm3.
S khng dung np trn lm sng bao gm hoc c tn thng c vi tng cc enzyme c,
gim khi ngng zidovudine, hoc c cc triu chng trn ng tiu ha, hoc xut hin tt c
cc triu chng lm sng khc bit c lin quan n zidovudine.
CHNG CH NH
Hivid b chng ch nh bnh nhn bit b qu mn vi mt trong cc thnh phn ca vin
thuc.
CH PHNG v THN TRNG LC DNG
Tnh dung np ca Hivid cha c thit lp tr em di 13 tui v bnh nhn b nhim VIH
nhng khng c triu chng.
Bnh thn kinh ngoi bin :
Biu hin ng c chnh ca Hivid trn lm sng l gy cc bnh thn kinh ngoi bin. Bnh
thn kinh ngoi bin c lin quan n Hivid l bnh thn kinh cm gic-vn ng c c
trng ban u bi s n v lon cm gic kiu cm gic rt bng cc u ngn. Sau l

cc cm gic au nhi cp tnh hoc c cm gic rt bng ko di v trm trng nu khng

ngng dng thuc. Bnh thn kinh c th tin trin theo hng gy cc cn au nng cn phi
dng n cc dn xut opium lm du, v c th khng hi phc c, nht l nu khng
ngng sm Hivid. mt vi bnh nhn, cc triu chng bnh thn kinh c th tip tc v tin
trin thm trong mt thi gian mc du ngng dng Hivid. Nu Hivid c ngng sm, bnh
thn kinh thng thng s c hi phc t t.
Nn khuyn bnh nhn nu c biu hin ca bnh thn kinh t trung bnh n nng vi cc
triu chng km theo cc du hiu c th, nn trnh mi s iu tr bng Hivid.
Hivid phi c s dng tht thn trng nhng bnh nhn c mt bnh l thn kinh ngoi
bin trc . Hivid cng phi c s dng tht thn trng nhng bnh nhn c hm lng
CD4 thp (CD4 < 50 t bo/mm3) do c nguy c cao pht trin cc bnh thn kinh ngoi bin khi
iu tr bnh Hivid. Nn c bit theo di nhng bnh nhn ny.
Vim ty :
Vim ty gy t vong c quan st khi iu tr bng Hivid. Vim ty l mt bin chng t
xy ra hn khi iu tr bng Hivid vi t l di 1% bnh nhn. Tng amylase huyt cng xy ra
(nguyn nhn ln ln) vi t l di 1%.
Phi thn trng khi s dng Hivid cho bnh nhn c tin s b vim ty hoc c yu t gy
nguy c lm tng kh nng b vim ty.
Bnh nhn c tin s b vim ty hoc tng amylase huyt phi c theo di tht thn trng
khi iu tr bng Hivid. Phi ngng vic iu tr nu amylase huyt tng cao vi lon ng
huyt, tng triglyc ride, gim calci huyt hoc cc thng s khc cho thy sp xy ra vim ty,
cho n khi t c chn on lm sng. Vic iu tr bng Hivid cng phi c gin on
nu dng chung vi mt thuc khc c th gy vim ty (chng hn pentamidine ng tnh
mch).
S dng Hivid tr li sau khi loi tr chng vim ty. Nu xy ra vim ty khi iu tr bng
Hivid, cn ngng vnh vin Hivid nhng bnh nhn ny.
Cc biu hin c tnh nghim trng khc :
Mt vi trng hp t gp lot thc qun v phn ng qu mn (phn ng phn v, ni m ay
khng c cc du hiu khc ca phn v) c m t bnh nhn c iu tr bng Hivid.
Cn xem xt kh nng phi ngng tm thi Hivid nu chng lot thc qun khng p ng vi
nhng iu tr chuyn bit c s dng nhm loi cc nguyn nhn gy bnh c hi.
Mt vi trng hp t gp bnh l{ c tim v suy tim sung huyt c quan st bnh nhn
c tr bng Hivid. Hivid phi c s dng thn trng nhng bnh nhn c tin s b bnh
l{ c tim v suy tim sung huyt.
Nhng trng hp him gy nhim toan acide lactique khi khng c gim oxy huyt cng nh
nhng trng hp him gy chng gan to nghim trng vi nhim m c bo co khi
iu tr bng cc cht tng t nucloside (zidovudine, zalcitabine). Cc tnh hung ny c th

e da n tin lng sng cn.

Mt khc, nhng trng hp suy gan phi hp vi vim gan siu vi B tim n khi iu tr bng
Hivid cng c ghi nhn.
Do , vic iu tr bng Hivid phi c thn trng bnh nhn b bnh gan trc , c
cc bt thng v men gan, c tin s nghin ru hoc vim gan. Vic iu tr bng Hivid phi
c gin on hoc ngng vnh vin, do thn trng, trong nhng trng hp sau : nng ln
cc kt qu v test chc nng gan, gan nhim m, gan to tin trin, nhim toan acide lactique
khng gii thch c.
Thng tin cho bnh nhn :
Bnh nhn phi c thng bo rng Hivid khng th cha khi nhim trng do VIH, rng h
vn c th b nhng bnh c lin quan n nhim trng do VIH giai on pht bnh, ch yu
l cc nhim trng c hi, v rng Hivid khng c chng minh lm gim c mc v tn
xut xy ra cc bnh ny.
Rt kh phn bit c s xut hin ca mt vi triu chng l nguyn nhn do tc dng ngoi
ca thuc hay do biu hin ca mt bnh tim n, bnh nhn cn bo cho bc s tt c nhng
bin chuyn ca tnh trng bnh ca mnh.
Bnh nhn cn bit rng khi s dng Hivid hoc cc thuc khng r trovirus khc cng phi lun
lun p dng cc bin php ngn nga ly lan VIH.
Cn gii thch cho bnh nhn v nhng triu chng u tin ca bnh thn kinh ngoi bin v
vim ty v yu cu bnh nhn thng bo ngay cho bc s nu c xy ra cc triu chng ny. V
s pht trin ca bnh thn kinh ngoi bin c lin quan n liu, bnh nhn cn tun th v
ch liu lng c ch nh vi Hivid.
Khi iu tr bng Hivid, ph n trong tui sinh phi p dng cc bin php trnh thai hiu
qu.
Cc tnh hung lm sng c bit :
Suy thn :
Tnh dung np v hiu lc ca Hivid khng c thit lp bnh nhn suy thn.
Suy gan :
Bnh nhn b bnh gan trc hoc c tin s b nghin ru, dng Hivid c th lm nng
thm cc ri lon chc nng gan.
Trong nhi khoa :
Tnh dung np v hiu lc ca Hivid cha c thit lp tr em di 13 tui.
LC C THAI
Tnh v hi ca Hivid trn ph n mang thai hin cha c xc nhn. Tc dng gy qui thai
ca zalcitabine c ghi nhn trn sc vt mc rt cao ; tuy nhin cc nghin cu thc
nghim khng nh gi tnh v hi trn s sinh sn, trn s pht trin ca phi hoc ca
bo thai, trn tin trnh ca s mang thai v trn s pht trin cn v sau khi sanh.

Hivid ch c s dng cho ph n mang thai nu li ch mong i cao hn cc nguy c c th

xy ra cho bo thai.
Ph n trong tui sinh , khi iu tr bng Hivid phi p dng cc bin php trnh thai hiu
qu.
LC NUI CON B
Ngi ta khng bit rng zalcitabine c c bi tit qua sa m hay khng. Do c rt nhiu
cc thuc c bi tit qua sa m v do zalcitabine tim tng nhiu tc dng ngoi cho tr
b sa m, nn quyt nh hoc ngng cho con b hoc ngng iu tr, tuy nhin cn lu { n
tm quan trng ca vic iu tr i vi ngi m.
TNG TC THUC
Phi hp Hivid vi cc thuc c th gy bnh thn kinh ngoi bin, nu c th, cn nn trnh.
Cc thuc c th gy bnh thn kinh ngoi bin bao gm : chloramphnicol, cisplatine,
dapsone, disulfirame, thionamide, glutthimide, vng, hydralazine, iodoquinol, isoniazide,
mtronidazole, nitrofurantoine, phnytoine, ribavirine v vincristine.
Phi hp Hivid v didanosine khng c khuyn co.
Cc thuc nh amphot ricine, foscarnet v aminoside c th tng nguy c gy cc bnh thn
kinh ngoi bin v cc tc dng ph ca Hivid bng cch nh hng ln s thanh thi ca
zalcitabine thn.
Trng hp dng mt trong cc thuc ny vi Hivid, cn theo di lm sng v sinh hc thng
xuyn v iu chnh liu nu c thay i chc nng thn ng k.
Vic iu tr bng Hivid phi c gin on khi cn dng mt thuc c kh nng gy vim ty.
c bo co v trng hp b t vong do vim ty t ngt c lin quan n s dng Hivid v
pentamidine ng tnh mch : trng hp iu tr mt bnh phi do Pneumocystis carinii
bng pentamidine ng tnh mch, phi ngng iu tr bng Hivid (xem Ch { phng v
Thn trng lc dng).
TC DNG NGOI
Tc dng ngoi chnh l bnh thn kinh ngoi bin, chim 20-30% trng hp (xem Ch {
phng v Thn trng lc dng).
Cc tc dng ngoi { khc thng c bo co (> 3%), bao gm :
- ng tiu ha : lot ming (7,8%), kh nut, chn n, tiu chy, au bng, bun nn, to bn ;
- da v cc phn ph : pht ban, nga, v m hi ;
- h thn kinh trung ng v ngoi bin : nhc u, chng mt ;
- h vn ng : au c, au khp ;
- cc du hiu tng qut : gim cn, mt mi, st, r t run, au ngc ;
- ng h hp : vim hu ;
- cc tc dng ngoi trn kt qu sinh hc : thiu mu, gim bch cu, gim bch cu trung
tnh, tng bch cu a osine, gim tiu cu, tng TGP, tng TGO, tng phosphate kim.

Cc tc dng ngoi t gp hn hoc him hn (< 3%) c bo co, bao gm :

- cc du hiu tng qut : suy nhc, au n, au sau xng c, bt n, ph n ;
- h tim mch : cao huyt p, nh trng ngc, ngt, rung nh, nhp tim nhanh, bnh c tim ;
- ng tiu ha : kh ming, lot thc qun, kh tiu, vim li, au thc qun, au trc trng,
tr, lo t trc trng, y hi, lo t li, tng th tch bng, bt thng nu rng, vim ming,
hi, vim bao t, xut huyt ng tiu ha, vim ty, tng th tch cc tuyn nc bt, vng
da, vim thc qun ;
- gan : tn thng t bo gan, vim gan, bt thng cc chc nng gan ;
- h vn ng : au vai, vp b chn, au bn chn, au cnh tay, vim khp, bnh khp, lnh
cc u chi, au c tay, vim c ;
- h thn kinh : tng trng lc, run ry (ch yu bn tay), rung c cc b, co git, mt iu
ha, bt thng trong s phi hp cc ng tc, d cm Bell, kh pht m, tng ng, nhc na
u, au thn kinh, vim thn kinh, trng thi t m, chng mt ;
- tm thn : ln ln, kh khn trong s tp trung, mt tr nh, mt ng, ng g, trm cm, kch
ng, mt nhn cch, xc cm khng n nh, cu gt, lo u, sng khai, lp d, sa st tr tu ;
- h h hp : ho, kh th, tm ti ;
- da : vim da, rng tc, ni m ay, ban da dng sn, tn thng da, mn trng c, pht ban
c bng nc, phn ng vn mch ;
- c quan cm gic : hng v gic, kh mt, bt thng th gic, au mt, mt thng mt,
tai, ic, lon khu gic ;
- ng niu : i tiu nhiu ln, bt thng chc nng thn, suy thn cp tnh, u nang thn,
bnh goutte, bnh thn do ng c, a niu, si thn, tng ur huyt.
LIU LNG v CCH DNG
Ngi ln : liu khuyn co i vi Hivid l 0,75 mg bng ng ung mi 8 gi (ng vi liu
hng ngy l 2,25 mg).
Theo di bnh nhn :
m cng thc mu v lm bilan sinh hc thng xuyn. Theo di amylase huyt bnh nhn
c tin s b tng amylase huyt, vim ty hoc ung nhiu ru, cng nh bnh nhn truyn
cc cht dinh dng qua ng tnh mch hoc bnh nhn c biu hin c nguy c b vim
ty. Nn tp trung theo di v pht hin cc du hiu v triu chng ca bnh thn kinh ngoi
bin, c bit bnh nhn c t l CD4 thp l i tng c nguy c b bnh thn kinh ngoi
bin cao khi iu tr bng zalcitabine.
Suy thn v suy gan :cha kinh nghim ngh vic iu chnh liu ; tr em di 13 tui
cng tng t.
QU LIU
Cp tnh :
Kinh nghim cn rt hn ch trong trng hp b qu liu Hivid cp tnh ; cc hu qu cng

khng c bit. Khng c thuc gii c chuyn bit. Ngi ta cng khng bit rng
zalcitabine c c loi qua bin php thm tch phc mc hay thm phn mu khng.
Mn tnh :
Trong cc nghin cu ban u trong zalcitabine c dng vi liu cao gp 25 ln (0,25 mg
mi 8 gi) so vi liu khuyn co, mt bnh nhn phi ngng dng Hivid sau 1,5 tun do b
pht ban v st.
Trong cc nghin cu u tin pha I, tt c cc bnh nhn c iu tr bng Hivid vi liu
khong gp 6 ln liu khuyn co hin nay b bnh thn kinh ngoi bin sau 10 tun, 80% bnh
nhn nhn liu gp i khuyn co hin nay u b bnh thn kinh ngoi bin sau 12 tun.

253.

HOLOXAN

ASTA MEDICA
c/o ZUELLIG
bt pha tim 1 g : hp 1 l.
THNH PHN
cho 1 l
Ifosfamide

1g

CH NH
Ch c cc bc s c kinh nghim v Ung th hc mi ghi n ch nh dng Holoxan. Thuc
c ch nh dng trong cc trng hp u c tnh khng th m c m nhy vi ifosfamide,
nh carcinoma bung trng, u tinh hon, sarcoma m mm, ung th v, carcinoma ty, u thn
dng m thng thn, carcinoma ni mc t cung, lymphomas c tnh.
CHNG CH NH
Holoxan b chng ch nh trong nhng trng hp :
- c bit c qu mn cm vi ifosfamide.
- Chc nng ty xng b suy gim trm trng (c bit nhng bnh nhn c iu tr
bng cc thuc c t bo v/hoc x tr).
- Nhim trng hot ng.
- Suy chc nng thn v/hoc tc nghn ng tiu.
- Vim bng quang.
- C thai v cho con b (xem phn Lc c thai v Lc nui con b).

CH PHNG
Trong qu trnh iu tr vi Holoxan, nu vim bng quang km tiu mu vi th hay i th xut
hin, nn ngng iu tr Holoxan cho n khi bnh thng ha nc tiu.
THN TRNG LC DNG
Trc khi bt u iu tr, cn loi tr hay iu chnh cc tc nghn ng tiu, vim bng
quang, nhim trng v ri lon in gii.
Ni chung, Holoxan cng ging nh cc thuc km t bo khc, cn c s dng thn trng
bnh nhn ln tui v nhng bnh nhn c x tr trc .
Cng cn thn trng c bit nhng bnh nhn c h min dch suy yu, nh bnh nhn i
tho ng, suy gan hay suy thn mn.
Nhng bnh nhn b di cn no, c triu chng no v/hoc b suy gim chc nng thn phi
c theo di cht ch.
Cc bin php v/hoc cc xt nghim sau c ch nh lm hn ch hay lm gim bt cc
tc dng bt li :
- Dng thuc chng i kp thi.
- Xt nghim cng thc mu u n.
- Kim tra u n cc thng s chc nng thn.
- Kim tra u n xt nghim tng phn tch nc tiu v cn lng nc tiu.
Trong trng hp tn thng gan hay thn trc khi bt u iu tr, vic s dng Holoxan
phi c cn nhc trn tng bnh nhn. Ngi ta khuyn co cc bnh nhn ny khi c
iu tr vi Holoxan cn phi c theo di thng xuyn hn.
Phi kim tra u n ng huyt bnh nhn i tho ng iu chnh vic iu tr kp
thi.
Nht thit phi bo m bi niu tha ng.
St v/hoc gim bch cu nng i hi phi iu tr d phng bng khng sinh v/hoc khng
nm.
Cn lu { v sinh rng ming k cng.
nh hng ln kh nng li xe v s dng my mc :
Holoxan c th nh hng ln kh nng li xe v s dng my mc ca bnh nhn. iu ny c
th xy ra do nh hng trc tip ca bnh no do dng thuc hay do nh hng gin tip ca
bun nn v i, c bit l khi c s dng ng thi cc thuc c tc ng ln thn kinh trung
ng hay ru.
LC C THAI v LC NUI CON B
Trong trng hp phi ch nh dng thuc v s sng cn ca bnh nhn ngay trong 3 thng
u ca thai kz, cn phi i khm xem xt c cn thit phi ph thai hay khng.
Sau 3 thng u ca thai kz, nu iu tr khng th tr hon c v bnh nhn vn mong
mun gi thai, c th tin hnh ha tr liu sau khi thng bo cho bnh nhn nguy c sinh qui

thai c th c d t.
Cc b m khng c cho con b trong lc iu tr vi Holoxan.
Cc bin php nga thai :
Ifosfamide c th gy ra cc d dng bm sinh. Khng nn c thai trong thi gian iu tr thuc.
Nam gii iu tr vi Holoxan phi c thng bo v vic d tr tinh trng trc khi iu tr.
Ph n khng nn mang thai trong lc iu tr. Nu vn mang thai trong thi gian iu tr
thuc, bnh nhn nn i khm di truyn hc. Thi gian nga thai sau khi kt thc ha tr liu
ph thuc vo tin lng ca bnh tin pht v ph thuc vo mc mong mun c con ca
bnh nhn. Nn i khm v di truyn hc.
TNG TC THUC
c tnh ln ty xng c th tng ln do s tng tc vi cc thuc km t bo khc hay vi x
tr. Ifosfamide c th lm tng phn ng da vi tia x.
Cho trc hay s dng ng thi cc thuc c i vi thn nh cisplatin, aminoglycosides,
acyclovir hay amphotericin B c th lm tng tc dng c i vi thn ca ifosfamide cng
nh cc tc dng c i vi huyt hc v thn kinh (trung ng).
Do tc dng c ch min dch ca ifosfamide, c th c s gim p ng vi thuc chng nga.
Chng nga virus sng c th gy ra tn thng do chng nga.
S dng ng thi ifosfamide c th lm tng tc dng khng ng ca warfarin v do lm
tng nguy c xut huyt.
Ging nh cyclophosphamide, tc tng tc sau c th xy ra :
- Tc ng c ch ty c th b tng ln do dng ng thi allopurinol hay hydrochlorothiazide.
- Hiu qu v tc dng c c th tng ln do dng ng thi chlorpromazin, triiodothyronine
hay thuc c ch aldehyde dehydrogenase nh disulfiram.
- Vic iu tr thuc ny c th lm tng tc dng h ng huyt ca cc sulfonylurea.
- iu tr trc hay ng thi vi phenobarbital, phenytoin hay chloral hydrate nh hng
n kh nng dn nhp men gan qua ty th v do lm chuyn ha nhanh hn ifosfamide.
- Vic iu tr thuc ny c th lm tng nhanh tc dng dn c ca suxamethonium.
TC DNG NGOI
Bnh nhn iu tr vi Holoxan c th gp cc tc dng ph sau :
c ch ty xng :
Cc mc c ch ty xng khc nhau c th xy ra (gim bch cu, gim tiu cu, thiu
mu), ph thuc vo liu. Thng cn phi lu { n gim bch cu km nguy c nhim trng
e da s sng v gim tiu cu km nguy c xut huyt. S lng bch cu v tiu cu thng
gim thp nht vo 1 n 2 tun sau khi bt u iu tr v hi phc trong vng 3 n 4 tun.
Vic phi hp iu tr vi cc thuc c ch ty khc c th cn phi iu chnh liu. iu tr cao
mt ln thng dn n gim bch cu nhiu hn l ch iu tr phn liu nh. cc bnh
nhn c iu tr t trc (bng ha tr v/hoc x tr) hay cc bnh nhn c km suy

chc nng thn, c th b c ch ty nng n hn. iu tr vi ifosfamide cng nh vi cc

thuc km t bo khc, cn phi lm cng thc mu trc mi t ha tr cng nh trong
khong thi gian gia cc t iu tr. Ty theo kt qu xt nghim mu m s c iu chnh
liu cho thch hp (xem bng)
Lu { : Hng dn gim liu trong c ch ty
S lng
bch cu

S lng
tiu cu

> 4000

> 100.000 100% liu d nh

4000-2500

100.00050.000

50% liu d nh

< 2500

< 50.000

Hon iu tr cho n khi cng thc mu v bnh thng hay

hng quyt nh ty tng bnh nhn

c tnh ln thn v ng tiu :

Vim bng quang xut huyt (tiu mu vi th v i th) l bin chng thng gp, ph thuc
vo liu ifosfamide s dng.
Lu { : Liu phn nh, b nc y , duy tr thng bng nc in gii v c bit l dng
km thm mesna (Uromitexan) c th lm gim ng k tn sut v mc nng ca vim
bng quang xut huyt.
Cc ri lon chc nng thn km tng creatinine trong huyt thanh, gim thanh lc
creatinine v tiu m thnh thong c xy ra, hay thng gp hn l cc ri lon chc nng
ng thn km tng acid amin trong nc tiu, tiu phosphate, toan ha hay tiu m. Cc bnh
thn nng him gp. Cc yu t nguy c c th c ca ri lon chc nng cu thn l dng
thuc liu cao v iu tr thm cc thuc cha platinum. Cc yu t nguy c ca ri lon chc
nng ng thn l ct b thn trc , iu tr thm cc thuc cha platinum hay x tr ng
thi vng bng gm c hai thn hay l mt thn cn li. Nn thn trng khi s dng ng thi
cc thuc c kh nng gy c cho thn nh aminoglycosides, acyclovir hay amphotericin B.
Cc thuc ny khng lm tng ri lon ng thn, nhng c th gy ra suy gim hn na chc
nng cu thn.
Trong cc trng hp him, cc bnh nhn b ri lon ng thn mn tnh c th c hi chng
Fanconi dn n bnh ci xng hay nhuyn xng ngi ln. Cc yu t m ng l liu

thuc tch t cao v nh tui (c bit l di 3 tui). Do , chc nng cu thn v ng thn
phi c nh gi v kim tra trc khi bt u iu tr, trong v sau khi iu tr.
Trong qu trnh iu tr lu di vi ifosfamide, cn thit phi c bi niu y v kim tra y
chc nng thn. iu ny phi c p dng c bit tr em. Trong trng hp c
bnh thn, nu vn phi tip tc iu tr vi ifosfamide th tn thng thn bt hi phc c th
xy ra. Khi , i hi phi c s nh gi thn trng gia nguy c v li ch ca vic dng
thuc.
Cng cn phi thn trng bnh nhn b ct thn mt bn, nhng bnh nhn c chc nng
thn b tn thng v bnh nhn c iu tr trc vi nhng thuc c cho thn
(nh cisplatin). cc bnh nhn ny, tn sut v nng ca c tnh i vi ty-thn v no
s tng ln.
H thn kinh trung ng :
Trong 10-20% trng hp, bnh no xy ra v pht trin trong vng vi gi n vi ngy sau khi
bt u iu tr. Yu t nguy c gm tnh trng sc khe km, tn thng chc nng thn
(creatinin > 1,5 mg/dl), iu tr trc bng cc thuc c i vi thn (nh cisplatin) v tc
nghn sau thn (nh cc khi u vng chu). Cc yu t nguy c khc c th c l ln tui, tin
cn nghin ru, albumin hay hydrogen carbonate huyt thp, ri lon chc nng gan hay iu
tr ng thi cc thuc chng nn i vi liu cao. Triu chng ph bin nht ca bnh no l
tnh trng bun ng c th tin trin ti ng g v hn m. Cc triu chng khc c th l yu
mt, hay qun, lon thn trm cm, mt nh hng, vt v, l ln, o gic, triu chng tiu
no, tiu khng t ch v co git. Cc bnh no thng c th hi phc v t bin mt trong
vng vi ngy sau liu ifosfamide cui. Din tin nng him gp, v t vong ch thy trong cc
trng hp ring l c lin quan vi vic dng thuc liu rt cao. Vi ch iu tr phn liu
nh, cc bnh no t gp hn v t nng hn.
Lu { : Do c tnh trn h thn kinh trung ng ca ifosfamide, bnh nhn phi c theo di
k. Trong trng hp c bin c bnh no, phi ngng iu tr vi ifosfamide v khng c
iu tr tr li. Trong trng hp c bnh no do ifosfamide, nu c nn ngng dng cc
thuc c tc dng ln h thn kinh trung ng (nh thuc chng nn, thuc an thn, gy ng
hay khng histamine) hoc phi dng vi thn trng c bit.
Cc tc dng ph khc :
Bun nn v i ma l cc tc dng ph ph thuc vo liu. Cc dng trung bnh n nng c
th thy trong khong 50% trng hp. Mt tc dng ph thng gp khc l rng tc c th
hi phc c, xy ra trong 100% bnh nhn, ph thuc vo liu v thi gian iu tr. Do tc
ng ca c ch alkyl ha, Holoxan c th gy ra tn thng phn no bt hi phc s to tinh
trng hay gim tinh trng ko di, cn trn ph n l gy ri lon phng non bt hi phc, t
gp hn, dn n v kinh v gim nng ni tit t sinh dc n.
Ngoi ra, c th c :

- X ha phi m k mn tnh trong mt s trng hp ring l. Ph phi do c ch d ng c tnh c bo co trong mt s trng hp.
- SIADH (hi chng bi tit ADH khng thch ng, hi chng Schwartz-Bartter) km h Natri
mu v nc gp trong mt mt s ca ring l. H kali mu c ghi nhn trong mt s ca.
- Vim ty c ghi nhn trong mt s trng hp ring l.
- Vim da v vim nim mc him gp.
- Phn ng qu mn cm him gp, c mt s trng hp ring l dn n chong.
- Gim th lc v c cn chng mt trong mt s trng hp him.
Tng men gan v/hoc nng bilirubin thnh thong cng c th xy ra. Chn n, tiu chy,
to bn, vim tnh mch hay st c th gp nhng him hn. Bnh a dy thn kinh, vim phi,
gim th lc hay tng phn ng vi tia x cng thy ring l. C cc bo co ghi nhn c lon
nhp trn tht hay lon nhp tht, thay i on ST v suy tim sau khi dng ifosfamide liu rt
cao v/hoc sau khi iu tr trc hay iu tr ng thi vi anthracyclines. Trong tnh
hung ny, mt ln na cn nhn mnh s cn thit phi theo di u n in gii, v c bit
thn trng khi iu tr cc bnh nhn c tin s bnh tim. Nh iu tr thuc c t bo ni
chung, c bit l cc thuc alkyl ha, iu tr ifosfamide c nguy c b cc u bu th pht
nh l di chng mun.
LIU LNG v CCH DNG
Ch c cc bc s c kinh nghim iu tr trong khoa ung th mi c ghi n iu tr thuc
ny. Liu phi c iu chnh thch ng cho tng bnh nhn. Trong iu tr mt thuc ngi
ln, cch iu tr ph bin nht c da trn vic phn thnh liu nh. Khi khng c n ch
nh ring cho tng c nhn, cc khuyn co sau c th dng nh l nguyn tc ch o.
Thng thng, Holoxan c cho tim tnh mch cc phn liu 1,2-2,4 g/m2 din tch c th
(cho n 60 mg/kg th trng) hng ngy trong 5 ngy lin tip (thi gian truyn khong 30-120
pht, ph thuc vo th tch). Holoxan cng c th c cho liu cao duy nht thng l truyn
ko di 24 gi. Liu thng thng l 5 g/m2 din tch c th (125 mg/kg th trng) v khng
c vt qu 8 g/m2 din tch c th (200 mg/kg th trng) cho mi t. Liu cao duy nht c
th gy ra c tnh cao hn i vi huyt hc, thn-niu v thn kinh trung ng.
Cn cn thn bo m nng ifosfamide ca dung dch khng c vt qu 4%.
Trong iu tr phi hp vi cc thuc km t bo khc, liu phi c iu chnh cho thch ng
vi kiu phc iu tr.
Lu { :
Do c c tnh ln h niu, trn nguyn tc ifosfamide nn c dng phi hp vi mesna. Cc
c tnh khc v hiu qu ca ifosfamide khng b mesna lm nh hng. Nu vim bng quang
km tiu mu vi th v i th xut hin trong qu trnh iu tr, nn ngng tr liu cho n khi
bnh nhn c hi phc.
Do hiu qu km t bo ca ifosfamide xy ra ch sau khi c hot ha gan, s khng c nguy

him lm tn thng m khi dng thuc khng phi bng ng tnh mch.
Cch cho thuc v thi gian iu tr :
Cc t iu tr c th c lp li mi 3-4 tun. Khong cch gia cc t s ph thuc vo
cng thc mu v vo s hi phc khi cc phn ng bt li v tc dng ph.
Nn duy tr thuc bo v ng niu mesna (Uroprotector, Uromitexan) nh hng dn.
Cn xt nghim u n cng thc mu, chc nng thn, tng phn tch nc tiu v cn lng
nc tiu.
Cn ch nh dng thuc chng nn i kp thi, qua lu { nh hng ln h thn kinh trung
ng khi dng phi hp vi Holoxan.
Pha ch dung dch tim :
Vic s dng Holoxan phi lun lun c s an ton cn trng nh trong s dng cc thuc c
t bo khc.
pha ch dung dch tim ng trng 4%, thm nc tim vo nguyn cht vi t l 1 g
thuc bt Holoxan pha trong 25 ml nc ct pha tim.
Thuc s ha tan nhanh nu lc mnh l thuc 0,5 n 1 pht sau khi thm nc tim vo.
Nu thuc khng ha tan ngay v hon ton, nn dng ng l thuc trong vi pht. Dung
dch pha ch c th gi c khong 24 gi nu bo qun nhit khng qu 8oC (trong t
lnh). Dung dch Holoxan truyn tnh mch trong mt thi gian ngn (khong 30-120 pht)
c pha ch bng cch pha dung dch trn vi 250 ml dung dch Ringer hay dung dch glucose
5% hay nc mui sinh l{. truyn lu hn trong 1 n 2 gi, nn pha long vi 500 ml dung
dch Ringer hay dung dch glucose 5% hay nc mui sinh l{. truyn lin tc 24 gi liu cao
Holoxan, dung dch Holoxan pha ch, chng hn 5 g/m2, phi c pha long vi 3 lt dung dch
glucose 5% v/hoc nc mui sinh l.
Lu { c bit :
Do tc ng alkyl ha, ifosfamide l mt cht gy t bin v cng c kh nng gy ra ung th.
Do , cn trnh tip xc vi da v nim mc.
BO QUN
Holoxan khng c bo qun trn +25oC.
Holoxan khng c s dng sau thi hn dng c ghi trn bao b.
Dung dch pha ch phi c s dng trong vng 24 gi sau khi pha ch (khng c lu tr
trn +8oC).
thuc ngoi tm tay ca tr em.

254.

HONVAN

ASTA MEDICA
c/o ZUELLIG
Dung dch tim 300 mg/5 ml : ng 5 ml, hp 10 ng, 50 ng.
Vin nn 120 mg : hp 50 vin.
THNH PHN
cho 5 ml thuc tim
Fosfestrol tetrasodium

300 mg

cho 1 vin
Fosfestrol tetrasodium

120 mg

DC LC
Fosfestrol (mui diethylstilboestrol diphosphate tetrasodium, DESPP) c th c xem nh l
dng vn chuyn tan trong nc ca oestrogen tng hp diethylstilboestrol (DES), cht ny
c chuyn thnh dng hot ng nh s phn tch men ca nhm acid phosphoric qua
phosphatase acid.
Dng oestrogen cho n ng dn n c ch hi lu m tnh (vn cha uc hiu hon ton)
trc h i - tuyn yn - sinh dc, c th qua ng tng tc vi cc th th androgen - lm
gim bi tit LH tuyn yn v gim sn xut testosterone. Nng testosterone gim ti mc
c thy sau khi thin. Ngoi ra cn c s can thip trc tip vo vic sn xut ra androgen t
tinh hon. Oestrogen cng gy ra tng nng prolactin v cc globulin kt hp vi hormon
sinh dc trong huyt thanh dn n s chuyn dch v pha testosteron bt hot. Cc thay i
cng xy ra trong vic phn tch steroid gan, trong h thng vng ni m v tnh trng min
dch.
Ngoi cc c tnh v ni tit, fosfestrol v cc chuyn ha cht ca n DES monophosphate v
DES cho thy c tc dng c t bo ng k trong nhiu loi m bu. Liu trung bnh c
hiu qu tc dng c t bo trc tip v hiu qu chng gin phn l khong 0,5 mg/ml DES.
Trong m tin lit tuyn DES c ch hot tnh ca DNA polymerase v c tc dng c ch tng
hp DNA v RNA.
c tnh :
LD50 (tim tnh mch) l 300 mg/kg chut nht, 340 mg/kg chut v 570 mg/kg th.
th, tim tnh mch liu duy nht 100 mg/kg diethylstilboestrol diphosphate khng gy ra

triu chng c no hay thay i g trn cng thc mu (bao gm c s lng tiu cu). ch
cng vy, khng thy c tnh sau khi tim tnh mch liu duy nht 50 mg/kg diethylstilboestrol
diphosphate.
Trong cc th nghim v c tnh ln cc chng ng vt, s dng tim DES c dung np tt
ti ch ln ton thn. Dng 200 mg/kg tim di da hng ngy chut trong 20 ngy khng
gy ra tn thng c quan no.
chut nht, diethylstilboestrol gy ra s hnh thnh cc t bo phn chia khng in hnh
ty xng v phi. Liu fosfestrol n 300 mg/kg gy ra t bin ch tinh trng. liu 600
mg/kg fosfestrol gy ra t bin tri c th t vong. Cc nghin cu in vivo t bo ty xng
cho thy c s tng sai lch nhim sc th ph thuc liu, c bit l chut ci. Tn thng
tiu sc v xa b tiu sc cng thng gp hn cc con vt ci liu 100 mg/kg.
Do diethylstilboestrol c kh nng c c tnh di truyn.
DC NG HC
Cc chuyn ha cht chnh ca fosfestrol l DES monophosphate, DES, v cc dng lin hp DES
monoglucuronide, DES monosulphate v DES glucuronide sulphate.
Sau khi cho tim tnh mch, DES diphosphate v DES monophosphate c th ch c hi phc
trong huyt thanh sau mt thi gian rt ngn (t1/2 = 5 pht i vi diphosphate v 30 pht i
vi monophosphate).
Sau khi cho ung, DES disphosphate v DES monophosphate khng th pht hin c trong
huyt thanh, do khi pht vn chuyn sinh hc nhanh km thy phn ester trong nim mc
rut. S phn b v nng DES v cc chuyn ha cht ca n cng ging nh sau khi dng
ng tnh mch. 90-95% DES i vo tun hon gan - rut. Thuc thng c o thi khi
tun hon gan - rut trong 24 gi, mc d c th thy nh th hai v nh th ba trong mu
n 2 hay 3 ngy. 30-40% DES hin din trong mu c gn vi hng cu. Ch c cc
glucuronide v cc cht lin hp hn hp vi thnh phn t hn (5-10%) c bi tit qua thn.
Cc cht lin hp khc, cng nh DES t do c bi tit qua ng mt. Cc cht lin hp c
th hot ng nh mt tin cht theo cng kiu nh fosfestrol, phng thch DES vo t bo u
bu.
Tnh kh dng sinh hc :
ch, tnh kh dng sinh hc ca diethylstilboestrol sau khi ung Honvan cao hn l sau khi
ung stilboestrol. Hiu qu lm sng ca ung Honvan c bo co trong nhiu trng
hp.
CH NH
Ung th biu m tuyn tin lit di cn.
CHNG CH NH
Tuyt i :
c bit d ng vi sodium fosfestrol hay vi cc thnh phn t dc khc.

Tng i :
Tng ng mu, suy tim tim n trc hay c biu hin, tn thng chc nng gan hay
thn.
Cn thn nga thai :
Fosfestrol c th gy ra cc bt thng kiu di truyn. Ngi ta khuyn co khng nn c con
trong hay sau khi iu tr. Do , n ng phi iu tr fosfestrol v mong mun c con nn d
tr tinh trng trc khi bt u iu tr.
THN TRNG LC DNG
Chc nng gan bnh thng khng b nh hng bi Honvan. Tuy nhin, nu bnh nhn c
tin s bnh gan, nn thc hin xt nghim chc nng gan trc khi bt u iu tr Honvan.
Nu kt qu bt thng, nn i cho cc gi tr tr v bnh thng trc khi bt u iu tr
Honvan, hoc nu cn thit phi bt u iu tr ngay th cc xt nghim chc nng gan phi
c kim tra lin tc trong thi gian iu tr.
LC C THAI v LC NUI CON B
Fosfestrol c th gy ra cc bt thng kiu di truyn. Ngi ta khuyn co khng nn c con
trong hay sau khi iu tr.
TNG TC THUC
Honvan dng dung dch tim khng c trn ln vi cc dung dch truyn c cha mui canxi
hay magn.
TC DNG NGOI
Bng rt, nga hay au vng hu mn - sinh dc hay xy ra. Cc triu chng ny v hi v ht
nhanh chng. Ngoi ra, cc triu chng tiu ha nh bun nn v i ma cng c thy.
iu tr fosfestrol c th gy ra cc du hiu n ha, i khi c chng v to au.
Cc tc dng ph khc bao gm cc bin chng tim mch, huyt khi thuyn tc (nh huyt
khi tnh mch su chn), ph ngoi vi, dch v phn ng qu mn cm (thng di dng
ni mn da).
c nhng bo co ring l ghi nhn c thiu mu tn huyt, ri lon chuyn ha porphyrin
biu hin mun da, vng da mt v tn thng chc nng gan.
Cng nh cc thuc khc c s dng iu tr u bu, nguy c sinh u th pht cng khng
th c loi tr hon ton khi iu tr Honvan.
LIU LNG v CCH DNG
Liu lng :
Liu phi c iu chnh ty tng ngi, v phi phn bit gia iu tr ban u v iu tr
duy tr.
iu tr ban u :
Liu tim tnh mch hng ngy.
iu tr nn c bt u vi 1200 mg fosfestrol tetrasodium tim tnh mch chm trong 10

ngy. Nu khng th tim fosfestrol hng ngy iu tr ban u cng c th cho qua ng
ung (360-480mg fosfestrol tetrasodium 3 ln mi ngy).
Vin Honvan phi c ung trc ba n, vi nc va .
Cc bnh nhn c tng trng sc khe km v cc bnh nhn c suy tim, suy chc nng gan hay
thn hay i hi bt u iu tr ngay, nn bt u cho vi liu bng na liu thng thng ban
u.
iu tr duy tr :
Sau khi iu tr ban u tim tnh mch, c th gim liu hay chuyn sang iu tr fosfestrol
ung, ph thuc vo cc du hiu lm sng. Nn khi u iu tr ung 120-240 mg fosfestrol 3
ln mi ngy.
Liu hng ngy ca fosfestrol tetrasodium khng nn di 240 mg.
Cch cho thuc v thi gian iu tr :
Bnh nhn nn nm nga khi tim tnh mch chm Honvan. Mt ng (5 ml) thng c tim
t nht l 2 pht.
Kch thch vng hu mn sinh dc c kim sot bng cch cho dng khng histamine, hay
pha long fosfestrol trong dung dch dextrose trc khi tim.
Vin bao phim nn c ung vi nc va trc ba n.
QU LIU
Khng c bo co ghi nhn ng c Honvan. Trong cc nghin cu v c tnh mn tnh trn
th vt, khng c tn thng c quan no c tm thy chut ngay c vi liu 200
mg/kg/ngy tim di da trong 20 ngy.

255.

HUMULIN

ELI LILLY
Humulin R :
dung dch tim 40 UI/mL : hp 1 l 10 mL - Bng B.
dung dch tim 100 UI/mL : hp 5 cartridge 1,5 mL - Bng B.
Humulin N :
hn dch tim 40 UI/mL : hp 1 l 10 mL - Bng B.
hn dch tim 100 UI/mL : hp 5 cartridge 1,5 mL - Bng B.
Humulin L :
hn dch tim 40 UI/mL : hp 1 l 10 mL - Bng B.
Humulin M3 (30/70) :

hn dch tim 40 UI/mL : hp 1 l 10 mL - Bng B.

Humulin 70/30 :
hn dch tim 100 UI/mL : hp 5 cartridge 1,5 mL - Bng B.
THNH PHN
Humulin R
Dng l 40 UI/mL
cho 1 mL
Human Insulin
M-cresol chng ct
Glycerol
Nc pha tim v
Dng cartridge 100 UI/mL
cho 1 mL
Human Insulin
M-cresol chng ct
Glycerol
Nc pha tim v
Humulin N
Dng l 40 UI/mL

40 UI
2,5 mg
16 mg
1 mL

100 UI
2,5 mg
16 mg
1 mL

cho 1 mL
Human Insulin
M-cresol chng ct
Glycerol
Phenol
Protamine sulphate v c tng h{m lng protamine base l
Dibasic sodium phosphate
Oxide km v cho tng h{m lng Zn2+
Nc pha tim v
Dng cartridge 100 UI/mL
cho 1 mL
Human Insulin
M-cresol chng ct
Glycerol
Phenol

40 UI
1,6 mg
16 mg
0,65
mg
0,108
mg
3,78
mg
40 mg
1 mL

100 UI
1,6 mg
16 mg
0,65

Protamine sulphate v c tng hm lng protamine base l

Dibasic sodium phosphate
Oxide km v cho tng hm lng Zn2+ l
Nc pha tim v
Humulin L
Dng l 40 UI/mL
cho 1 mL
Human Insulin
Sodium acetate
Sodium chloride
Oxide km v cho tng hm lng Zn2+ l
Methyl parahydroxybenzoate
Dch treo ht Insulin v khun
Nc pha tim v
Humulin M3 (30/70)
Dng l 40 UI/mL

40 UI
1,6 mg
7 mg
0,084 mg
1 mg
v to tinh th
1 mL

cho 1 mL
Human Insulin
M-cresol chng ct
Glycerol
Phenol
Protamine sulphate v c tng hm lng protamine base
Dibasic sodium phosphate
Oxide km v cho tng hm lng Zn2+ l
Nc pha tim v
Humulin 70/30
Dng cartridge 100 UI/mL
cho 1 mL
Human Insulin
M-cresol chng ct
Glycerol
Phenol
Protamine sulphate (xp x)
Dibasic sodium phosphate (heptahydrate)

mg
0,348
mg
3,78
mg
40 mg
1 mL

40 UI
1,6 mg
16 mg
0,65 mg
0,0756
mg
3,78 mg
40 mg
1 mL

100 UI
1,6 mg
16 mg
0,65 mg
0,244 mg
3,78 mg

Oxide km v cho tng hm lng Zn2+ l

Nc pha tim v

40 mg
1 mL

TNH CHT
Humulin (human insulin c ngun gc t ti kt hp DNA, Lilly) l mt hormone polypeptid gm
chui A c 21 amino acid v chui B c 30 amino acid, ni vi nhau bng hai cu ni sulfur.
V phng din vt l, ha hc, sinh hc v min dch hc, Humulin ging nh insulin c tit
t ty ngi, hi khc vi insulin ca b v heo v thnh phn amino acid. Dng trnh by ca
Humulin : dng l v dng cartridge.
Humulin R : (insulin tc dng nhanh) human insulin dng dung dch trung tnh c ngun gc t
ti kt hp DNA.
Humulin N : (insulin tc dng chm) human insulin dng dch treo (NPH) c ngun gc t ti kt
hp DNA.
Humulin L : (insulin tc dng chm) human insulin dng dch treo tinh th insulin - km, c
ngun gc t ti kt hp DNA.
Humulin 70/30 : Dng hn hp, gm c 70% dch treo (human insulin c ngun gc t ti kt
hp DNA) v 30% dng dung dch tc dng nhanh (human insulin dng trung tnh c ngun gc
t ti kt hp DNA).
ng gi
Humulin R : Dung dch human insulin dng nc trong sut khng mu v khun, trung tnh
c iu chnh pH t 6,6 n 8,0 ; 40 n v/mL trong l 10 mL ng np cao su, v dng
100 n v/mL trong cartridge 1,5 mL s dng trong bt Becton Dickinson-BD (ng hp
gm 5 ng).
Humulin N : Dung dch treo mu trng v khun, cha human insulin dng tinh th tc dng
chm trong dung dch sulfate m ng trng, c iu chnh pH t 6,9 n 7,5 ; 40 n
v/mL trong l 10 mL ng np cao su v dng 100 n v/mL trong cartridge 1,5 mL s dng
trong bt BD (ng hp gm 5 ng).
Humulin L : Dung dch treo mu trng v khun, cha tinh th human insulin dng trong sut
khng nh hnh trong dung dch m acetate trung tnh, c iu chnh pH t 7,0 n 7,8
; 40 n v/mL trong l 10 mL ng np cao su.
Humulin M3 (30/70) : Hn hp dung dch treo v khun NPH 30% v human insulin tc dng
nhanh 70% c iu chnh pH t 6,9 - 7,5 ; 40 n v/mL trong l 10 mL ng np cao su.
Humulin 70/30 : Hn hp dung dch treo v khun NPH 70% v human insulin tc dng nhanh
30% c iu chnh pH t 6,9 - 7,5 ; 100 n v/mL trong cartridge 1,5 mL s dng
trong bt BD (ng hp gm 5 ng).

DC LC
Dng insulin liu thch hp cho bnh nhn tiu ng kt hp vi th dc v ch n king c
th duy tr tm thi kh nng chuyn ho i vi cc cht carbonhydrate, m v m, tch ly
glycogen gan v chuyn glucose thnh m. Bnh nhn tiu ng dng Insulin liu thch hp
nhng khong thi gian u n, ng huyt s c duy tr mc hp l{, nc tiu tng
i khng c ng niu v cc th ketone, cng nh phng nga c chng toan ha mu
v hn m do tiu ng.
Cc th nghim cho thy loi human insulin sinh tng hp bng k thut ti kt hp DNA khng
gy nhng phn ng min dch khi so snh vi insulin c ngun gc t ng vt. Human insulin
dng sinh tng hp khng c ln cc protein du ch dng vt m trong tt c cc insulin c
ngun gc ng vt thng c.
Cc phng php tinh khit c lm nghim tc khi sn xut human insulin dng sinh tng
hp loi ra c cc protein ca E. coli pht hin c nh nhng phng php hin c.
Ngay c khi protein ca E. coli ch hin din rt t, cc kho st lm sng cho thy l cng khng
pht hin c khng th ca protein E. coli, nn cng khng th b quy cho l do dng human
insulin dng sinh tng hp. Human insulin dng sinh tng hp khng loi c p ng
khng nguyn khi dng cho chut cng v chut lang mn cm vi polypeptid ca E. coli.
Mc du human insulin t to ra tnh khng nguyn hn l insulin b hoc heo, nhng khng
phi l khng c tnh khng nguyn.

DC NG HC
Humulin R l mt ch phm c thi gian tc dng ngn. Thi gian bt u c tc dng khong
sau 30 pht, ko di t 6 n 8 gi v tc dng nh t 2 n 4 gi.
Humulin N l mt ch phm c thi gian tc dng trung bnh, bt u tc dng khong sau 1
gi, k o di 16 n 18 gi v tc dng nh t 4 n 10 gi.
Humulin L l mt ch phm c thi gian tc dng trung bnh. Bt u c tc dng khong sau 1
gi, k o di n 24 gi v tc dng nh t 6 n 12 gi.
Humulin 70/30 l mt loi insulin c thi gian tc dng trung bnh, vi thi im bt u c tc
dng sau khi dng thuc nhanh hn dng NPH n thun. Thi gian tc dng ko di t 16 n
18 gi v tc dng nh khong 2 n 12 gi.

CH NH
- Dng cho bnh nhn tiu ng c nhu cu insulin duy tr s n nh ng huyt.
- Kim sot ban u bnh tiu ng v tiu ng lc c thai.

CHNG CH NH
Humulin R, Humulin N, Humulin L, Humulin M3 (30/70) v Humulin 70/30 chng ch nh dng
trong trng hp c h ng huyt.
D ng vi cc thnh phn ca thuc.

CH PHNG
T cc dng insulin khc chuyn sang
Mt s t bnh nhn dng insulin c ngun gc ng vt chuyn sang dng insulin c ngun gc
t ti kt hp DNA c th cn phi gim liu, nht l nhng bnh nhn cn c kim sot
cht ch v d b h ng huyt. C th gim ngay liu u tin, hoc trong nhng tun u
tin. Nu nhu cu insulin gim s c nguy c h ng huyt, c thy thuc ln bnh nhn u
cn bit n kh nng ny. Nguy c c th c xem nh l t xy ra nu liu dng hng ngy
di 40 n v. Cc bnh nhn khng vi insulin dng liu trn 100 n v/ngy nn nhp vin
khi cn chuyn sang dng insulin khc.
Cc kho st v dc hc cho thy, nhng bnh nhn n nh vi hn hp insulin tc dng
nhanh v insulin tc dng chm loi b v heo, th thi gian bt u c tc dng ca human
insulin sm hn v thi gian tc dng ngn hn so vi insulin ng vt. C th cn iu chnh
li t l thnh phn khi chuyn sang dng dng human insulin. Mt vi bnh nhn c phn ng
h ng huyt sau khi c chuyn sang dng Humulin ghi nhn l cc triu chng cnh
gic sm ny t r rt hn so vi dng insulin c ngun gc ng vt.

THN TRNG LC DNG

Cn pht hin ngay v x tr thch hp cc bin chng ca vic dng insulin, bo m an
ton v kim sot c hiu qu bnh tiu ng khi iu tr bng insulin.
S ln dng v liu dng hng ngy, thi im s dng thuc cng nh th dc v n king l
nhng vn m cc thy thuc cn gim st trc tip v lin tc.
Trong nhng trng hp c bit (nh gia tng gng sc, n khng .v.v...), liu insulin dng
hng ngy cho bnh nhn c th l liu qu cao. Bnh nhn nn lun mang theo trong mnh
mt t ng glucose. V triu chng, xin xem phn Qu liu.
Trong trng hp cc bnh nhim khun nh cm lnh, mn nht v.v... nhu cu v insulin tng,
bnh nhn phi nn hi kin thy thuc ng lc phng trnh nhng bin chng nguy
him.
Cc bnh l{ nh bnh to cc, hi chng Cushing, cng gip v u ty thng thn s lm cho
vic kim sot bnh tiu ng phc tp hn.
Ri lon th gic trong bnh tiu ng khng c kim sot do thay i khc x s c

phc hi nu c tr liu hiu qu giai on sm. Vi tun l sau khi khi u iu tr bng
insulin, cn bng thm thu gia thy tinh th v cc dch nhn cu c th khng n nh, do
nn hon vic chn knh eo mt trong vng t 3 n 6 tun.
Nhu cu insulin c th tng, gim hoc khng thay i khi bnh nhn dng thuc li niu.
Nhu cu insulin c th tng khi au m hoc c xo trn v cm xc hoc khi bnh nhn dng
ng thi cc thuc gy tng ng huyt nh : ung thuc nga thai, steroid, hormone tuyn
gip, hormone tng trng, glucagon hoc adrenaline.
Tc dng gy h ng huyt ca insulin cng c th b i khng bi phenytoin. Nhu cu
insulin c th gim bnh nhn b suy gan hoc thn, hoc nu bnh nhn c dng ng thi
cc thuc gy h ng huyt nh : cc steroid tng chuyn ha, thuc c ch MAO,
guanethidine, ru, propranolol (che lp tc dng), nhng thuc khc tc dng ln th th badrenergic hoc salicylate vi liu hng ngy t 1,5 g n 6 g.

LC C THAI
Cn theo di lin tc bnh nhn tiu ng ph thuc insulin trong sut thai kz. Nhu cu
insulin thng gim trong 3 thng u v tng trong 6 thng cui ca thai kz.

TC DNG NGOI
Nn dng cc ch phm ca Humulin lm gim bt tn sut xy ra cc phn ng ph thng
gp khi dng insulin c ngun gc ng vt. Tuy vy, c mt s rt t bo co bnh nhn phn
ng qu mn i vi human insulin, nhng li dung np c insulin c ngun gc ng vt.
Cc phn ng c ghi nhn nh sau :
D ng ti ch : nga, ni ban, da, cng da.
D ng ton thn : phn ng dng phn v, ni m ay.
Teo t chc m.
Ph i t chc m.

LIU LNG v CCH DNG

Liu dng cho bnh nhn phi do thy thuc quyt nh v ty theo nhu cu ca tng bnh
nhn. Tim di da, thng c bnh nhn a thch hn, nn tim vng trn cnh tay, i,
mng, hoc bng. Nn thay i cc v tr tim, cho cng mt v tr khng c dng hn
mt ln trong thng.
Nn cn thn m bo khng chch thuc nhm vo mch mu. Khng nn xoa nn ch
chch thuc.

Loi Humulin ng trong l :

Humulin R l mt insulin c tc dng ngn, c th dng ng tim tnh mch, tim bp hoc
tim di da. Humulin N, Humulin L, Humulin M3 (30/70) v Humulin 70/30 ch nn dng
ng tim di da hoc tim bp.
Humulin R c th c dng kt hp vi Humulin N ty thuc vo nhu cu chuyn ha tng
bnh nhn v s do thy thuc quyt nh. Hn hp Humulin R v N thng c dng theo
cng thc 2 ln/ngy.
Humulin N, Humulin L c th c dng nh l mt liu duy nht trong ngy trc ba n
sng, thng l thi gian tim thuc thch hp nht.
Tc dng ca nhng hn hp insulin ny vi cc insulin c ngun gc ng vt cha c kho
st, v c khuyn l khng nn thc hin iu ny.
Humulin N, Humulin L, Humulin M3 (30/70) v Humulin 70/30 - Nn ln l thuc trong lng bn
tay trc khi dng cho thuc tr li dng dch treo.

Dng cartridge
Humulin R, N v 70/30 dng cartridge c ng gi dng 1,5mL (100 n v/mL) dng vi
bt Becton Dickinson (BD) v dng ny thit k khng th trn vi bt kz insulin no khc.
Humulin N v 70/30 dng cartridge nn ln trong lng bn tay trc khi dng thuc c
tr li dng dch treo.
Humulin R, N v 70/30 dng cartridge ch nn dng tim di da.

QU LIU

Triu chng :
H ng huyt c th xy ra nu bnh nhn dng qu nhiu insulin, tr ba n, tp th dc
hoc lm vic qu mc trc ba n, hoc b nhim khun, b bnh (nht l b nn ma hay
tiu chy), hoc nhu cu insulin ca c th thay i v mt l do no khc. Cc triu chng gm
b ph, ln ln, hi hp, m hi, nn ma, i, ngt v chng mt. Bnh nhn cng c th
b nhc u, ng g, mt, lo u, nhn m, nhn i, t mi, mi hoc cc chi. Cc triu chng c
th xut hin khi nng ng huyt di 40 mg/100 mL, nhng cng c th xy ra khi
ng huyt tt t ngt ngay c khi nng glucose trong mu vn cn trn 40 mg/100 mL.
Biu hin lm sng ca h ng huyt c th b che khut i do s dng ng thi thuc
propranolol, hoc cc thuc c ch th th b-adrenergic khc.
X tr :
H ng huyt mc trung bnh, p ng c khi ung glucose, ng hoc ngh ngi.

Trng hp h ng huyt tng i trm trng c th cn phi b sung thm dng glucagon
tim bp hoc tim di da, cch mi 20 pht tim 1 n v cho 2 hoc 3 liu. Nu bnh nhn
b hn m, cn phi tim tnh mch 10 - 20 gam dung dch dextrose v khun.

BO QUN
Cc ch phm Humulin ng trong l (l mi hoc cha m np) nn bo qun t lnh t
2oC n 8oC. Khng nn vo ngn lm ng, ni nng qu, hoc ngay di nh nng mt
tri.
Vi nhng iu kin trn, thuc c hiu lc trong 2 nm tnh t ngy sn xut. Cc l thuc
Humulin khi ang dng c th nhit trong phng c n 30 ngy, hoc trong t
lnh c n 3 thng m khng mt hiu lc. Insulin m np v bo qun nhit trong
phng m khng c dng sau mt thng, nn loi b i.
Pha trn cc loi insulin - Nn rt loi insulin tc dng ngn (Humulin R) vo bm tim trc
phng trnh thuc tc dng di hn (Humulin N) ln vo. Nn tim hn hp ngay sau khi pha
trn thuc.
Dng cartridge : Nn c bo qun t lnh, nhit t 2oC n 8oC. Bo qun nhit
ny c th c 2 nm.
Khng Humulin t ng.
Humulin R, N v 70/30 dng cartridge khi ci vo bt BD, hoc c em theo nh l mt ng
d tr, khng cn t lnh, nhng phi gi ch mt (di 30oC), trnh ch qu nng hoc
ngay di nh mt tri. Humulin R, N v 70/30 dng cartridge nu khng bo qun trong t
lnh, th nn loi b i sau 21 ngy d cc ng ny vn cn cha insulin.

256.

HYDRITE

UNITED LABORATORIES
Vin nn : v 4 vin, hp 25 v.
Vin nn : hp 100 vin.
THNH PHNcho 1 vin
Sodium chlorure
Sodium bicarbonate
Potassium chlorure
Dextrose khan

0,35 g
0,25 g
0,15 g
2,00 g

Na+
K+
ClHCO3Glucose

45 mEq
10 mEq
40 mEq
15 mEq
55,5

Cng thc trn s cho nng cht in gii v glucose trong dung dch nh sau :
Pha 1 vin/200 ml
Nng (mEq/lt)
CH NH
Thay th nc v cht in gii mt trong cc bnh tiu chy cp, nn ma v tiu hao do bin
dng khi luyn tp nng nhc hay in kinh.
THN TRNG LC DNG
Trong trng hp mt nc nghim trng, ch c p dng liu php b nc bng ng
ung khi liu php tim truyn khng c sn thc hin.
Cn tun theo ng cch pha v khi lng dung dch cho ung ngh. Mt dung dch
long qu v/hoc khi lng cho ung t hn nh ngh s khng cung cp y nc,
cc cht in gii v glucose. Trong khi mt dung dch m c qu v mt khi lng cho ung
nhiu hn nh yu cu c th dn n s qu ti nc v cht in gii c bit tr s sinh
v tr em cn nh tui.
TC DNG NGOI
Nu cch pha v khi lng dung dch cho ung c theo ng th khng c tc dng ngoi .
LIU LNG v CCH DNG
Vin nn pha thnh dung dch c mi v d ung.
n Hng dn xc nh mt nc v bin php b nc nu cn thit :

Du hiu lm sng
V ngoi ca bnh nhn

mt nc
nh
tnh to, th
v kht nc

Nhp mch

nhanh v mnh

H mt
Da, mi

hi trng
da kh, ti nh,
mi kh

dn ca da

bnh thng

va
ng lm, yu
t v rt kht
nc
rt nhanh v
yu
trng va
da kh v
lnh, mi hi
xanh
nho da ln,
co li gn

nng
hn m v rt
yu
rt nhanh v
kh bt
rt trng
da lm m,
rt lnh v kh
nho da ln, co
li chm (hn 3

Lng nc tiu

S lng dung dch mt cn

c b trong vng 6-8 gi
(khi xut hin cc du hiu k
trn)
Liu php b nc cn thit

c th bnh
thng hay t
hn 1 ml/kg/gi
nh nhi (di 3
tui) : 50 ml/kg ;
tr em : 30
ml/kg
ng ung

nh tc khc
t (t hn 0,5
ml/kg/gi)

giy)
khng tiu

nh nhi : 100 nh nhi : 150

ml/kg ; tr
ml/kg ; tr em :
em : 60 ml/kg 90 ml/kg

ng ung
truyn dch hay
hay truyn
truyn bng
dch (khi nn ng qua mi
ma nng)
ti d dy
Nu mt nc ng trng, da lnh v m. Trong khi mt nc u trng, da m v nho.
n Liu php b thiu : B nc trong vng 6-8 gi u tin c mc ch b nc v cht in
gii mt.
Trong giai on ny, nu bnh nhn cn ung c th nn khuyn khch ung cng nhiu cng
tt. Nu nh nhi c th mt v ang cn b, vic cho n ny c th xen k vi dung dch ung,
nc cho cng c ch b sung liu php b nc s khi. Liu lng dung dch ung hay
dung dch tim truyn trong liu php b thiu c th cn c trn trng lng c th ca tr
(tnh theo kg) nhn cho lng nc (tnh gn ng theo ml) mt ty theo bnh cnh ca s
mt nc. Nu khng c cn th theo hng dn v cch tnh liu dng Hydrite. Lng dung
dch b tnh c s c cho ung trong vng 6-8 gi. Nu vic b nc thnh cng trong
khong thi gian ny, mi du hiu mt nc phi bin mt tr lng nc tiu cn c thi
gian bnh thng tr li.
Nu s mt nc c ci thin trong vng 6-8 gi v tiu chy cng nh i ma ngng li, tr
nn c tip tc iu tr tip theo bng liu php duy tr. Nu cn tiu chy th p dng bin
php b tch cc v tip tc cho n khi ngng tiu chy, sau dng tip liu php duy tr.
n Liu php duy tr : Khi tiu chy ngng v thnh cng trong vic thay th nc b mt,
bnh nhn phi tip tc ung dung dch. Liu php duy tr gip b nc v cht in gii
mt i qua bin dng v hi phc li s nui dng v qua , kim sot tc ng v dinh
dng do tiu chy. Lng dung dch glucose-cht in gii duy tr l 100 ml/kg th trng
cho nh nhi v 60 ml/kg th trng cho tr em cng nh ngi ln v c cho ung trong vng
24 gi sau khi b nc thnh cng. Nn tip tc cho b nu tr b sa m. Nu tr b sa b
th cng c th cho b li nhng nn gii hn khong 150 ml mi 4 ting v c pha long vi
nc hoc dung dch glucose-cht in gii. Tuy nhin, nu tiu chy li xut hin sau mi ln
cho b sa b (c bit vi sa kh ly bt cht b o) th nn trnh cho n loi sa b .
Cng khng nn cho n thc n rn nu a tr t chi n hay cha thc tnh to nh trong
nhng trng hp mt nc nghim trng. Khi bnh nhn c th n c ri th c th bt u

cho n thc n rn nh vn n lc cha bnh. Ng cc, chui, rau chn, khoai ty l nhng
ngun nng lng tt. Khi bt u cho n thc n rn nn cho n lng nh v n no s kch
thch tiu chy.
n Liu php b ch ng : Thng tiu chy chm dt sau mt hai ngy nhng c th ko di
hn mc du cc du hiu mt nc bin mt. Mc ch ca bin php ny l b p tc
khc lng nc v in gii mt i nu c xy ra. Liu lng dch ung b ngh (xem bng)
p dng cho mi trng hp tiu chy vi lng ln phn lng.
Nu trng lng ca bnh nhn c theo di mi 8 gi, trng lng c th mt i tng
ng lng nc mt lin tc. Lng nc mt i ny cn c thay th trong vng 2 gi vi
mt lng tng ng dung dch glucose-cht in gii duy tr nc.
n Liu lng ngh v cch ung dung dch Hydrite : S dng trng lng ca bnh nhn
tnh th tch cn dng. Nu khng c cn, nn theo bng hng dn liu dng Hydrite.
n Liu php b thiu (6-8 gi u tin) : Pha 2 vin Hydrite trong 200 ml nc chn ngui,
nu cn khi lng ln th dng s vin t l vi lng nc (v d 10 vin trong 1000 ml).
Khi lng (ml) dung dch
Hydrite cn
Nhm tui (trng
Mt nc nh : nh nhi : 50
Mt nc va : nh nhi :
lng tnh gn ng
ml/kg ; tr em v ngi ln : 30 100 ml/kg ; tr em : 60
bng kg)
ml/kg
ml/kg
1-3 thng (3-5)
150-250
300-500
3-6 thng (5-7)
250-350
500-700
6-12 thng (7-10)
350-500
700-1000
1-3 nm (10-15)
500-750
1000-1500
3-6 nm (15-20)
450-600
800-1200
7-12 nm (22-30)
650-900
1300-1800
> (30-50)
900-1500
1800-3000
n Liu php duy tr : (khi tiu chy v i ma ngng sau khi p dng liu php b thiu).
Pha 1 vin Hydrite trong 200 ml nc chn ngui, nu cn khi lng ln hn, dng s vin
t l vi lng nc (v d 5 vin trong 1000 ml).
Hng dn liu dng Hydrite : (Khi lng cho ung trong vng 24 gi xen k vi sa m, sa
b (nu dung np c), nc, nc cho, nc qu, tr, nc tht...).
Cn c trn th trng bnh nhn, khi lng cn duy tr l :
Nh nhi : 100 ml/kg/ngy.
Tr em v ngi ln : 60 ml/kg/ngy.
Nu khng c sn cn th theo hng dn cc th trng gn ng trong liu php b thiu.
S dng liu duy tr b nc v cht in gii mt i trong cc trng hp luyn tp nng
nhc hay in kinh.

n Liu php b ch ng : (sau khi dng liu php b thiu nhng cn tiu chy).
Pha Hydrite nh trong liu php duy tr.
Hng dn liu dng Hydrite (Ung dung dch Hydrite cho n khi ngng tiu chy, sau cn
p dng b nc duy tr).
p Liu dng thc t :
Nh nhi : 50 ml ;
Tr em : 100 ml ;
Ngi ln : 200 ml.
p C th cn c trn tn s i tiu tnh th tch dung dch Hydrite cn thit b :
Tn s i tiu

Th tch dung dch Hydrite theo th trng

thc t hay th trng tnh gn ng
100-200 ml/kg/ngy (5-10 ml/kg/gi)

Nu bnh nhn i tiu 1 ln

mi 2 (hay hn 2) gi
Nu tn s l hn 1 ln mi 2
15 ml/kg/gi
gi (tiu chy nng)
Nu sau vi gi tiu chy vn
10 ml/kg/gi theo ng tim truyn v 20
cn nng
ml/kg/gi theo ng ung
p Hoc cn c trn trng lng mt i (nu theo di c th trng) :Trng lng mt i (v d
250 g) = tnh trng mt nc ; c b bng 250 ml dung dch Hydrite cho ung trong vng 2
gi sau khi tnh c trng lng mt.
n iu tr phng nga (dng b nc v cht in gii ngay lc bt u c tiu chy) : theo
nh ch dn v liu lng nh liu php b ch ng.
Ch dn c bit :
- Cn pha vin Hydrite ngay trc khi dng. Dung dch cn tha nn b tr khi c
trong t lnh trong vng mt gi sau khi pha. Nu bo qun trong t lnh, dung dch Hydrite c
th c gi ung cho 24 gi. khng nn dng sau thi hn .
- Dng nc ngui pha vin Hydrite. Sau khi pha, khng bao gi un si dung dch Hydrite.
- Khi pha vin Hydrite vo nc ta c mt dung dch c. Cn lc lun hoc khuy k trc
khi cho ung.
- Cn tn tr vin Hydrite ni kh mt.

257.

HYDROCORTISON RICHTER

GEDEON RICHTER
hn dch tim 125 mg/5 ml : l 5 ml, hp 1 l - Bng B.
THNH PHN

cho 1 l 5 ml
Hydrocortisone acetate

125 mg

Lidocaine chlorure

25 mg

DC LC
Thuc khng vim loi steroid c tc ng ko di.
CH NH
Vim xng-khp, cc kiu vim n khp (u gi, khuu tay, hng), vim khp do thp khp
v cc nguyn nhn khc (ngoi tr khi km bnh lao hay lu). Hen ph qun. Vim ph qun
tc nghn. Vim quanh khp xng b vai v xng cnh tay, vim bao hot dch, vim mm
trn li cu, vim dy chng m o, vim dy chng.
Trc khi phu thut cng lin khp, ph tr ti ch cho liu php corticoid ton thn. Vim
mng hot dch do lao (ngoi vic iu tr lao).
CHNG CH NH
Trong thi gian tim chng, lot d dy t trng, long xng, bnh Cushing, nguy c to huyt
khi, suy thn, cao huyt p trm trng, herpes simplex, thy u, lao tin trin. Chng ch nh
tng i khi mang thai, c bit trong 3 thng u, v thuc c th gy nguy hi cho thai. T s
li/hi nn c cn nhc. Qu mn cm vi cc thnh phn ca thuc.
CH PHNG v THN TRNG LC DNG
Trong trng hp lao tim n, nn dng thm thuc km trc khun lao. Trong tiu ng, ch
dng khi c ch nh tuyt i hay loi tr s khng insulin. Trong cc bnh nhim khun,
iu tr ng thi vi cc khng sinh hay ha tr liu l cn thit. Nu dng lu di, phi b sung
kali. gim nguy c d ha v long xng, nn dng thuc tng ng ha.
Trong khi iu tr, phi kim tra huyt p thng xuyn, cn xt nghim phn v nc tiu. Nn
ngng thuc dn dn v xem xt liu php ACTH (test di da). Trong liu php corticoid, phi
iu chnh liu thuc chng tiu ng loi ung v thuc chng ng dng ung. Khi dng
ng thi thuc li tiu, phi kim tra cn bng in gii v b sung kali. Nu liu corticoid
gim, th liu cc salicylate dng ng thi cng phi gim (s gim liu steroid lm gim nng
salicylate trong huyt thanh n mt mc thp hn).
Lc trc khi dng.
TNG TC THUC
Khng nn phi hp :
- Barbiturate ( nhng bnh nhn Addison, cn cp tnh s trm trng hn).
Thn trng khi phi hp :
- Thuc chng tiu ng dng ung (h glucose huyt c th xy ra).

- Thuc chng ng dng ung (tc dng chng ng c th tng).

- Salicylate (nng salicylate trong huyt thanh c th gim ; c th thm tc dng ngoi
nh xut huyt tim n).
- Barbiturate (tc dng corticoid gim).
- Thuc li tiu ( tng chng gim kali huyt).
TC DNG NGOI
au khp, bnh khp do steroid, gim sc khng vi nhim khun, cao huyt p, glucose
niu, h kali huyt, cn bng nitrogen m tnh (d ha), suy v thng thn, long xng, tng
tit acid v lot c th xy ra.
LIU LNG v CCH DNG
Liu n cho ngi ln : ty thuc vo ln ca khp v trm trng ca bnh, tim 5-25
mg trong khp hay quanh khp.
Liu tim bp : tim su vo c mng 125-250 mg/24 gi. Trong bnh ri lon h hp, tim
trong 3 ngy ; trong bnh thp khp, tim 5-6 ngy.
Liu n cho tr em :
- t 3 thng - 1 nm : 25 mg (1 ml).
- t 2-6 tui : 25-50 mg (1-2 ml).
- t 7-14 tui : 50-75 mg (2-3 ml).
C th tim quanh khp, hay vo cc khp nh vi liu thp hn.
Thuc c tc dng trong vng 6-24 gi v ko di trong nhiu ngy, thm ch nhiu tun. Nu c
tin s bnh tm thn, phi c bit thn trng.

258.

HYPERIUM

LES LABORATOIRES SERVIER

vin nn 1 mg : hp 30 vin.
THNH PHN
cho 1 vin
Rilmenidine

1 mg

DC LC
Rilmenidine l mt oxazoline c c tnh tr tng huyt p, tc ng ng thi trn trung tm

iu ha vn mch ca hnh no v ngoi bin. Rilmenidine c tnh chn lc cao hn trn cc

th th ca imidazoline so vi cc th th a2-adrenergic no, do khc bit vi cc cht ch
vn a2.
Thc nghim trn chut tng huyt p di truyn cho thy tc dng h huyt p ca rilmenidine
ph thuc vo liu dng. Trong th nghim trn ng vt, rilmenidine ch gy tc dng trn
thn kinh trung ng nh thng thy cc thuc ch vn a2 khi dng n liu cao hn liu tr
tng huyt p. Tc dng c ch thn kinh trung ng dng nh khng ng k. Vic tch bit
gia tc ng tr tng huyt p v tc dng trn thn kinh c xc nhn ngi.
Rilmenidine c tc ng tr tng huyt p ph thuc vo liu trn huyt p ng mch th tm
thu v th tm trng t th nm v t th ng.
liu iu tr 1 mg/ngy ung mt ln hoc 2 mg/ngy chia lm 2 ln, cc nghin cu c i
chng vi gi dc cho thy thuc c hiu lc tr tng huyt p trn chng tng huyt p nh
v va. Hiu lc ca thuc c duy tr qua m v khi c gng sc. Cc kt qu ny c
xc nhn qua cc nghin cu di hn u cho kt qu iu tr tt.
liu 1 mg/ngy, cc nghin cu c i chng vi gi dc cho thy rng thuc khng nh
hng n s tp trung ; mt s trng hp ngu nhin nh bun ng, kh ming, to bn th
xy ra vi tn sut tng t nh nhm gi dc.
liu 2 mg/ngy, cc nghin cu c i chng vi thuc ch vn a2 c dng liu cho tc
dng h p tng t nhau cho thy nhng tc dng ph xy ra thp hn ng k v mc v
tn sut i vi nhm s dng rilmenidine.
liu iu tr, rilmenidine khng nh hng n cc chc nng ca tim, khng gy gi mui nc v khng lm xo trn s cn bng chuyn ha :
- thuc duy tr tc dng h huyt p trong 24 gi sau khi ung thuc vi gim khng lc ngoi
bin ton phn, khng lm thay i lu lng tim. Cc ch s v tnh co bp v in sinh l ca
tim khng b thay i ;
- thuc khng nh hng n kh nng thch ng khi thay i t th, c bit l ngi gi, v
p ng sinh l ca tn s tim khi gng sc ;
- thuc khng lm thay i lu lng mu thn, qu trnh lc cu thn v cc chc nng ca
thn ;
- thuc khng lm thay i s iu ha glucid, k c ngi b tiu ng l thuc insulin hoc
khng, v khng lm thay i cc thng s ca chuyn ha lipid.
DC NG HC
Hp thu :
- nhanh : sau khi ung mt liu duy nht t 1 gi 30 n 2 gi, thuc t nng ti a trong
huyt tng l 3,5 ng/ml ;
- hon ton : sinh kh dng tuyt i ca thuc l 100%, khng b gim tc dng sau vng
chuyn ha qua gan u tin ;

- u : s khc bit v mc chuyn ha gia ngi ny v ngi khc rt thp v thc n

khng lm thay i sinh kh dng ca thuc ; t l hp thu khng thay i khi dng liu
khuyn co.
Phn phi :
T l gn vi protein huyt tng di 10%.
Th tch phn phi l 5 l/kg.
Chuyn ha :
Rilmenidine b chuyn ha rt t. Cc cht chuyn ha c tm ch dng vt trong nc tiu,
ch yu l do s thy phn vng oxazoline hoc do b oxy ha. Cc cht chuyn ha khng c
hot tnh ch vn a2.
o thi :
Rilmenidine c o thi ch yu qua thn : 65% liu dng c bi tit qua nc tiu di
dng khng b bin i. S thanh thi thn chim 2/3 thanh thi ton phn.
Thi gian bn hy l 8 gi : thi gian ny khng b liu dng hay s ln dng lp li lm thay i.
Thuc c thi gian tc dng ko di, duy tr mt cch ng k trong 24 gi sau ln dng cui
cng, ngi tng huyt p c iu tr vi liu 1 mg mi ngy.
Sau khi ung nhiu liu lp li, tnh trng cn bng t c ngay t ngy th 3 ; nghin cu v
nng trong huyt tng trong 10 ngy cho thy tnh n nh ca thuc.
Theo di di hn cc nng trong huyt tng bnh nhn b tng huyt p (iu tr trong
vng 2 nm) cho thy rng nng ca thuc trong huyt tng lun tnh trng n nh.
- ngi gi : cc nghin cu dc ng hc bnh nhn trn 70 tui cho thy rng thi gian
bn hy ca thuc l 12 gi.
- ngi b suy gan : thi gian bn hy l 11 gi.
- ngi b suy thn : do thuc ch yu c o thi ch yu qua thn, nn nhng bnh
nhn ny tc o thi ca thuc b chm li ty thuc vo mc suy thn. bnh nhn b
suy thn nng (thanh thi creatinin di 15 ml/pht), thi gian bn hy vo khong 35 gi.
CH NH
Tng huyt p.
CHNG CH NH
- Tnh trng trm cm nng.
- Suy thn nng (thanh thi creatinin di 15 ml/pht), do thn trng v hin nay cha c
nghin cu trn nhm bnh nhn ny.
CH PHNG v THN TRNG LC DNG
Khng ngng thuc t ngt m phi gim liu t t.
Cng nh tt c cc thuc tr tng huyt p khc, nhng bnh nhn c tin s b bnh mch
mu gn y (t qu, nhi mu c tim) khi dng thuc phi c kim tra y khoa u n.
Khng nn ung ru trong thi gian iu tr.

Trong suy thn, nu thanh thi creatinin trn 15 ml/pht th khng cn phi chnh liu.
Do cha c kinh nghim trn y vn, khng nn k n cho tr em.
Li xe v iu khin my mc : Cc nghin cu so snh vi gi dc khng cho thy thuc c
nh hng n s tp trung khi dng liu iu tr (1 hoc 2 vin mi ngy). Trng hp vt
qu liu ny hay c phi hp vi nhng thuc c th lm gim tp trung, cn phi bo trc
cho nhng ngi li xe hay iu khin my mc v kh nng b bun ng.
LC C THAI v LC NUI CON B
Nh i vi cc thuc mi c lu hnh, nn trnh dng cho ph n c thai mc du th
nghim trn ng vt khng cho thy thuc c tc dng gy qui thai hay c phi.
Thuc c bi tit qua sa m, do khng nn dng thuc trong thi gian cho con b.
TNG TC THUC
Khng nn phi hp :
- IMAO.
- Thuc chng trm cm 3 vng : phi tht thn trng khi phi hp, tc ng tr tng huyt p
ca rilmenidine c th b i khng mt phn.
C th phi hp :
- Do quan st thy khng c tng tc vi mt s liu php khc nn c th dng phi hp :
thuc tr tiu ng loi ung, insuline, thuc h acid uric mu, thuc h lipid mu, thuc
chng lon nhp, thuc chng ng mu, thuc gim au, thuc khng vim, cc thuc tr tng
huyt p khc, c bit l cc thuc li tiu, dihydralazine v thuc chn bta, c ch calci, c
ch men chuyn.
TC DNG NGOI
liu 1 mg/ngy, trong cc nghin cu c kim sot, cc tc dng ngoi xy ra vi tn sut
tng t nh nhm dng gi dc.
liu 2 mg/ngy, trong cc nghin cu c kim sot, so snh vi clonidine liu 0,15-0,3
mg/ngy hay amethyldopa liu 500-1000 mg/ngy, cc tc dng ngoi { c ghi nhn xy ra
vi tn sut t hn ng k so vi ca clonidine v amethyldopa.
Cc tc dng ngoi him khi xy ra, lnh tnh v ch thong qua khi dng liu iu tr, bao
gm : suy nhc, nh trng ngc, mt ng, bun ng, mt khi gng sc, au d dy, kh
ming, tiu chy, ni ban ; ngoi l : lnh u chi, h huyt p t th, ri lon dc nng, lo u,
hi chng trm cm, nga, ph, chut rt, nn, ma, bc ha.
LIU LNG v CCH DNG
Liu khuyn co l 1 vin mi ngy, ung 1 ln duy nht vo bui sng.
Trng hp cha t kt qu iu tr nh mong mun th c th tng ln 2 vin mi ngy, chia
lm 2 ln (bui sng v ti), ung vo u ba n.
Thuc c th dng c cho ngi ln tui b tng huyt p v ngi tiu ng b tng huyt
p.

 ngi suy thn, nu thanh thi creatinin trn 15 ml/pht th khng cn phi chnh liu.
Phi dng thuc lin tc.
QU LIU
Khng c trng hp qu liu no c bo co. Cc triu chng d kin c th l b h huyt
p v ri lon s tp trung. Vic tr liu ngoi bin php ra d dy c th dng cc thuc ging
giao cm. Thuc t c thm phn.

259.

HYPNOVEL

HOFFMANN - LA ROCHE
Dung dch tim truyn tnh mch ngi ln 50 mg/10 ml : ng 10 ml, hp 6 ng.
Dung dch tim bp, tnh mch v ng trc trng 5 mg/ml : ng 1 ml, hp 6 ng.
Dung dch tim bp, tnh mch v ng trc trng 5 mg/5 ml : ng 5 ml, hp 6 ng.
THNH PHN
cho 1 ng 10 ml dung dch tim
Midazolam

50 mg

cho 1 ng 1 ml dung dch tim v ng

trc trng
Midazolam

5 mg

cho 1 ng 5 ml dung dch tim v ng

trc trng
Midazolam

5 mg

DC LC
Hypnovel l thuc an thn, gy ng, gii lo u, gin c v chng co git.
DC NG HC
- Midazolam hon ton chuyn ha trong c th ngi. Dng chuyn ha quan trng nht vi

s lng ln l a-hydroxymethyl, tn ti di dng t do v c hot tnh dc l : chnh cht

ny to nn tc dng dc l ca midazolam, nhng tc dng khng ko di v thi gian bn
hy rt ngn.
- Sau tim bp, midazolam ti hp thu vo mu nhanh v hon ton.
- Sau tim tnh mch, nng midazolam trong huyt tng gim 10 % so vi nng ban u
trong vng 2 gi, v l do thi gian bn hy phn phi rt ngn (t1/2 a = 0,5 gi).
- Gn kt vi protine 98 % v nh hng ch yu vo albumine m khng ph thuc nng
midazolam.
- Bi tit ca midazolam ch yu qua nc tiu v lng tng cng ph thuc vo cc dng
chuyn ha sinh hc (Hydroxy ha tip theo sau gn kt vi acide glucuronique).
- Thi gian bn hy thi tr huyt tng (t1/2 beta) t 2-3 gi v c th tng ln ngi nhiu
tui, bnh nhn suy tim, suy gan v suy thn.
CH NH
1. Hypnovel 5 mg/1 ml v 5 mg/5 ml :
ngi ln :
Gy m ton thn :
- Dn m v duy tr m trong gy m ton thn.
- Tin m.
An thn khng gy m ton thn :
- Cc th thut gy kh chu v lm au : ni soi, t catheter tim, chc d sinh thit.
- Gy t cc b v gy t ty sng.
tr em :
Tin m bng ng trc trng trc khi gy m ton thn.
2. Hypnovel 50 mg/10 ml :
An thn k o di trong khoa sn sc tch cc cc bnh nhn th my.
CHNG CH NH
- Nhc c.
- C tin cn khng dung np v qu mn vi benzodiazpine.
Hypnovel 50 mg/ 10 ml : khng dng cho tr em < 15 tui.
THN TRNG LC DNG
Lu { : Bnh nhn khng c ung ru, li xe v vn hnh my trong vng t nht 12 gi sau
khi dng thuc, bi thuc c th gy bun ng nhiu.
Thn trng :
- c ch h hp : cn h tr h hp ngay lp tc nht l khi dng ng tnh mch. Thn trng
khi tim bp, nht l ngi nhiu tui hoc tng trng suy yu, hoc bnh nhn c suy h
hp sn (xem phn tc dng ngoi ).
c bit cn tn trng liu lng khuyn co trn khi dng cho ngi ln tui.

- iu chnh li tnh trng gim th tch tun hon khi cn.

LC C THAI v LC NUI CON B
Nh cc benzodiaz pine tim khc, thuc ny khng c dng trong 3 thng u ca thai kz,
tr khi ti cn thit.
TNG TC THUC
Khng phi hp :
Vi ru : v cn lm tng tc dng gy ng ca benzodiazpine.
C th gy nguy him nu li xe hoc vn hnh my. Trnh dng thc ung hoc dc phm c
cha cn.
Phi hp cn thn trng :
- Cc thuc gy trm cm h thn kinh trung ng : cc dn cht gim au, gim ho gc
morphine, barbiturique, mt vi thuc chng trm cm, thuc khng histamine H1 c gy ng,
cc thuc gii lo u ngoi nhm benzodiazpine, thuc lit thn kinh, clonidine v cc thuc c
cha clonidine. S tng tnh trm cm trung ng c th dn n hu qu trm trng, nht l
khi li xe v vn hnh my.
- Vi cisapride : lm tng thong qua hiu qu gy ng ca benzodiazpine do lm tng tc
hp thu. C th gy nguy him nu li xe hoc vn hnh my.
Phi hp c cn nhc :
- Vi rythromycine : tht thn trng v c th lm tng nng midazolam trong mu.
TC DNG NGOI
Cc tc dng ph ny cng nh cc thuc benzodiazpine tim khc :
- Bun ng.
- Tc dng c ch h hp :
Gim thng kh phi.
Vi trng hp ngng th c bo co ch yu l do cc ch nh gy ng khng c gy m
ton thn, v v khng chun b my gip th cc i tng c nguy c (ngi ln tui, ngi
c tng trng bt n, ngi c suy h hp t trc) hoc khi phi hp vi cc thuc gy trm
cm h thn kinh trung ng sau khi tim tnh mch hoc tim bp nhanh.
- Tc dng trn huyt ng :
Thay i nhp tim, thng lm tng nhp tim.
Lm gim tm thi sc cn thnh mch, thng thy r ngi cao huyt p.
Gin tnh mch ch dn n gim tin ti.
Cc bin i ny dn n gim nh huyt p ng mch.
Khi dng liu cao c th lm gim sc bp c tim.
- au nhi ti ni tim.
- Cc phn ng nghch thng xy ra mt s ngi : cc phn ng ny c th gp sau khi dng
benzodiazpine.

- Cc biu hin ngoi da : him thy.

LIU LNG v CCH DNG
Hypnovel 50 mg/10 ml.
A. Ngi ln :
n Gy m ton thn :
p Liu ban u dn m : Tim tnh mch trong 15-30 giy : 0,15-0,30 mg/kg.
Trong phn ln cc k thut gy m, sau khi tim tin m v/hoc sau khi tim hn hp lit
thn-gim au : 0,20-0,25 mg/kg.
Trong trng hp khng dng thuc tin m, Midazolam c tim trc tt c cc thuc gy
m khc : 0,25-0,30 mg/kg.
Sau tin m, khi p dng k thut gy m khng su, thng b sung bng mt thuc dn m
chnh (th d thuc gy m ng ht) hoc khi khng cn t ni kh qun : 0,15-0,20 mg/kg.
p Liu b sung dn m : Nu hiu qu ca liu u khng t yu cu, c th tim thm mt
hoc nhiu ln, thng vi lng bng phn na liu ban u. Nn ch trong vi pht (t nht 3
pht) trc khi quyt nh tim tip : v l do c s thay i v thi gian tc dng dn m ca
midazolam, nn cc liu tim li sm hn c th lm tng liu khng cn thit v ko di tc
dng.
p Liu duy tr m : Ty theo yu cu, trong qu trnh gy m, khi nhng biu hin m gim i,
thng ngi ta tim lp li bng na liu ban u (c th gim liu na sau nhiu ln tim lp
li).
Ty theo tui, cc liu ny gim t 20-30 % ngi ln tui.
n Tin m trc gy m ton thn :
ng tim bp (thng s dng) : 30 pht trc khi dn m : trung bnh 0,1 mg/kg, thay i
ty tui v s khe mnh ca bnh nhn, 0,07 mg/kg ngi nhiu tui v 0,12 mg/kg ngi
tr v khe mnh.
Tim tnh mch (t s dng) : dng khi cp cu, vi pht trc khi dn m : 0,05 mg - 0,1 mg/kg.
n Gy ng khng gy m ton thn :
p Gy ng nng (bnh nhn cn hp tc c) :
- Tim tnh mch, vi pht trc khi lm th thut :
ngi tr v ngi c tng trng tt : 0,05 mg/kg - 0,1 mg/kg.
ngi ln tui v suy yu : 0,025 n 0,05 mg/kg.
- Tim bp, 20-30 pht trc khi lm th thut :
ngi tr v ngi c tng trng tt : 0,05mg - 0,12 mg/kg.
ngi ln tui v suy yu : 0,025-0,07 mg/kg.
p Gy ng su (c can thip ngoi khoa bng gy t ti ch) :
- Tim tnh mch :
ngi tr v ngi c tng trng tt : 0,15 mg/kg - 0,20 mg/kg.

 ngi ln tui v suy yu : 0,075 n 0,15 mg/kg.

B. Tr em :
n Tin m trc gy m ton thn :
ng trc trng, 15 pht trc khi dn m : 0,30-0,40 mg/kg, trung bnh 0,35 mg/kg.
Hypnovel 50 mg/10 ml :
ng tnh mch - dng cho ngi ln v tr em > 15 tui.
Midazolam c th pha vo cc dung dch khc truyn v c th dng theo nhiu k thut
khc nhau : truyn nh git, bm th tch, bm tim in.
Liu lng phi ph hp vi p ng lm sng, tnh trng sinh l, tui v cc thuc phi hp.
- Liu ban u : 0,03-0,3 mg/kg.
ngi ln tui hoc bnh nhn tnh trng khng n nh, liu ban u c th gim hoc b
hn.
- Liu duy tr : 0,03-0,2 mg/kg/gi.
Liu ny c th gim ngi ln tui ty theo tnh trng lm sng.
Liu trnh khng nn ko di qu 7 ngy.
QU LIU
Ngng th, ng qu su hoc hn m ty theo lng thuc tim vo v c a.

260.

HYPOSTAMINE

PROMEDICA
c/o GALIEN
vin nn : tube 20 vin.
THNH PHN
cho 1 vin
Tritoqualine

100 mg

T dc : tinh bt bp, lactose

monohydrat, talc, gelatine, magnesium
starate.
DC LC
Khng histamine ton thn : c ch histidine d carboxylase trn c th sng, lm ngng s

hnh thnh histamine ni sinh t histidine trong m v lm gim hm lng histamine trong
huyt thanh v trong m. Hypostamine khng gy tc ng trn cc th th H1, tc ng chng
d ng ca thuc nh th da trn mt c ch khc vi c ch tc ng ca cc thuc khng
histamine thng thng. Hypostamine khng c tc dng lm trm du v gy phn ng dng
atropine nh thng gp a s cc thuc thuc nhm ny. Do dng thuc s khng gy
bun ng v khng c chng ch nh nhng bnh nhn b glaucome hay b bnh tuyn tin
lit.
DC NG HC
Tritoqualine c hp thu rut sau khi c ha tan trong dch d dy ; nng ti a
trong cc c quan v trong huyt thanh t c t 1 n 2 gi sau khi ung thuc v ch cn
khong 10% sau 7 n 8 gi.
CH NH
iu tr triu chng cc biu hin d ng khc nhau :
- vim mi co tht (c chu kz hoc khng theo chu kz),
- m ay.
CHNG CH NH
- Tr em di 15 tui.
- Chng ch nh tng i : ph n c thai.
LC C THAI v LC NUI CON B
Khng nn dng.
LIU LNG v CCH DNG
- 2 n 6 vin/ngy (1 n 4 vin tr em), chia lm 2-3 ln.
- Nu bit trc c nhng thi im c th b d ng, ung Hypostamine d phng : 1
n 2 vin trc khong 15 n 30 pht.

261.

HYPOSULFENE

L.D.P
c/o KENI - OCA
vin bao : hp 60 vin.
THNH PHN
cho 1 vin

Sodium thiosulfate

0,33 g

(Gluten)
(Saccharose)
DC LC
- Gii mn cm.
- Thng mt.
- C vai tr dinh dng.
- Gii c.
CH NH
- Cc biu hin d ng ng tiu ha : nn ma, co tht.
- To bn.
- Bnh ngoi da.
- Cc bnh mn tnh ng h hp.
- Ng c do kim loi nng (bismuth, arsenic, thy ngn, vng, thalium).
THN TRNG LC DNG
nhng bnh nhn c c a khng dung np gluten, cn lu { rng c s hin din ca cht
ny trong thnh phn ca vin thuc.
LIU LNG v CCH DNG
4 n 8 vin/ngy, chia lm nhiu ln. Ung thuc trong cc ba n.

262.

HYTROL

SUN PHARMA
Vin nn 5 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Enalapril maleate

5 mg

T dc: Acid maleic USP, tinh bt kh BP,

lactose khan USP, talcum BP, silicon dioxid
keo NF, magnesi stearat BP.

DC LC
Tc dng dc l :
Hytrol, mt cht c ch Enzym chuyn loi mi, iu tr hiu nghim trn din rng cc tnh
trng cao huyt p thng gp v suy tim xung huyt mn tnh.
Tc dng ln chng cao huyt p :
Hytrol h thp sc khng tiu ng mch h thng v huyt p trung bnh tm trng v tm
thu trong nhng trng thi cao huyt p khc nhau. Mc d s gim ban u c xu hng
tng quan dng tnh vi hot tnh huyt tng (PRA) v nng Angiotensin II trc iu
tr, iu tr tip theo vi Hytrol lm gim huyt p ng k v do tc dng chng cao huyt
p ca Hytrol tng quan mt phn hoc khng lin quan ti kt qu PRA trc iu tr. Huyt
p gim cao im trong khong 4-5 gi sau khi ung Hytrol.
Tc dng ln suy tim xung huyt mn tnh :
Hytrol gy gin tiu ng mch h thng dn n gim hu ti tng hiu sut tim, ch s tim v
c ch s cng nng, th tch tm thu.
Hytrol gim r rt khng mch thn v do tng lu lng mu thn. Natri-niu gy ra bi s
tng lu lng mu thn v gim kch thch ch tit Aldosterone bng Angiotensin II. Th tch
d ca dch c th co bp dn n gim lng tr v tim phi qua tnh mch. Hytrol c ch
men chuyn gy gin tnh mch cng ng gp thm vo s gim ny. p ng i vi Hytrol
cng lin quan ti s gim p sut ng mch phi, p sut y ng mch tri v tht tri
(Tin ti). Qu trnh huyt ng tt hn s lm tng kh nng gng sc.
C ch tc ng :
Hytrol l mt liu thuc m bn thn n khng c hot tnh cao. N c hy phn thnh Aciddicarboxylic gc Enalaprilat hot ng. Tc dng cn thit ca Hytrol ln h thng Angiotensin
Renin l c ch s chuyn ha Angiotensin II hot ng. Ngn chn kh nng kch thch tit
Aldosterone ca Angiotensin I.
Enalaprilat lin kt cht vi enzym chuyn v tn ti lu trong huyt tng dn n ko di thi
gian ca thuc nn ch dng mt liu n Hytrol mi ngy.
CH NH
Hytrol ch nh kim sot cc loi cao huyt p v suy tim xung huyt mn tnh khc nhau.
CHNG CH NH
Qu mn vi cc thnh phn ca thuc.
CH PHNG v THN TRNG LC DNG

Ch { phng :
Bnh nhn phi c nhc nh bo li nhng cn nhc u nh, t bit trong nhng ngy
u tr liu. Khng chng ch nh khi c s h huyt p tm thi, c th tip tc iu tr mt
khi p huyt tng sau s gin n th tch.
Bnh nhn phi c nhc nh bo ngay bt kz du hiu vim nhim no (vim hng, st) m
c th l du hiu ca gim bch cu trung tnh. Vi nhng bnh nhn c bnh keo mch hay
bnh thn phi theo di theo chu kz s lng bch cu do chng mt bch cu ht v suy ty
xng c th xy ra, c bit nhng bnh nhn ny.
nhng bnh nhn tri qua phu thut ln hoc ang gy m bng tc nhn gy gim p,
Hytrol ngn chn s hnh thnh Angiotensin II th pht i vi vic gii phng Renin b tr.
Nu xy ra gim huyt p v c xem nh gy bi c ch ny, n c th c hiu chnh nh
s gin n th tch.
Bnh nhn c nhc nh khng s dng nhng dn xut mui c cha Kali nu khng c
kin bc s
Ghi ch :
Tng t nh cc thuc khc, phi bo m nhng iu cn dn r rng i vi cc bnh nhn
c iu tr vi Hytrol. Cc thng tin ny nhm m bo tnh an ton v hiu qu ca thuc.
N khng phi l ngoi { i vi nhng tc ng ngoi c th v bit.
Thn trng lc dng :
Cn thn s dng Hytrol trong trng hp huyt p thp v lon chc nng thn. Ch s dng
Hytrol trong thi gian mang thai v cho con b khi m li ch iu tr ln hn nhng nguy him
tim tng cp.
V mc an ton v hiu qu ca Hytrol ni tr em cha c kim chng.
TNG TC THUC
Tc dng gim p huyt ca Hytrol tng nh nhng tc nhn chng cao huyt p gii phng
Renin nh thuc li tiu. Hytrol c th lm gim s mt Kali do thuc li tiu loi thiazid.
TC DNG NGOI
Hytrol khng phi l mt hp cht Sulfuhydryl, do t l tc dng ngoi l nh hn. Phn
ln nhng trng hp ngoi mong mun l nh v tm thi v bn cht, phn ng ng k
nht ch l au u, hoa mt v mt mi.
gim tn sut, Hytrol thnh thong gy ra nhng tc dng sau :
- Tim mch : nhi mu c tim v tai bin mch mu no, c th th cp i vi gim huyt p
nhiu bnh nhn nguy him cao, ngt, h huyt p ng, nh trng ngc, au ngc.
- D dy - rut : bun nn, tc rut, vim tuyn ty, vim gan hoc vng da mt, au bng, i
ma, lon tiu ha, to bn.
- Thn kinh / Tm thn : cng thng, ln thn, ng g, mt ng, hi hp, d cm.
- Thn : suy chc nng thn, gim niu, lon chc nng thn.

- H hp : co tht ph qun, kh th, chy mi.

- Nhng phn ng khc : ni ban, ph mch (c th ph thanh qun), chut rt, tng tit m
hi, lit dng, nga, suy nhc, mn cm nh nng, rng lng tc, mt, ri lon v gic,
tai, vim li, ri lon to mu.
LIU LNG v CCH DNG
Dng ung.
Ngi ln : 10 - 40 mg/ln/ngy hoc theo hng dn ca bc s. Liu lng ban u cho bnh
nhn ang dng thuc li tiu l 2,5 mg v bnh nhn khng dng thuc li tiu l 5 mg. Liu
lng ny c th iu chnh t t theo phn ng ca huyt p. C th s dng Hytrol km vi
cc c ch th th Beta (b-adernergic), methydopa, nitrat, calci, hydrelazin v prazosin m
khng c phn ng ngoi { c { ngha y t bo.
i vi bnh nhn suy thn : liu lng Hytrol c iu chnh theo gi tr thanh thi
Creatinine.
Thanh thi Creatinine > 30 ml/ pht (S. Creatinine 3 mg/dl) : liu khng thay i.
Thanh thi Creatinine < 30 ml/ pht (S. Creatinine > 3 mg/dl) : khi u dng liu 2,5
mg/ln/ngy, ti a 40 mg/ngy.
i vi cc bnh nhn thm tch, liu lng ban u v liu lng trong nhng ngy thm tch
2,5 mg/ngy. Liu trong cc ngy khng thm tch iu chnh ty theo p ng huyt p.
BO QUN
Ni thong mt, trnh nh sng.

THUC VN I

263.

IDARAC

HOECHST-MARION-ROUSSEL / ROUSSEL VIETNAM

[AVENTIS PHARMA]
Vin nn d b 200 mg : hp 20 vin.
THNH PHN
cho 1 vin

Floctafenine

200 mg

DC LC
Thuc gim au ngoi bin khng c cht gy nghin.
Khng c nguy c nghin floctafenine.
DC NG HC
Floctafenine qua ng ung c nhanh chng hp thu v thy phn thnh cht chuyn ha
chnh tm thy trong mu l acid floctafenic ; cht ny c tc dng gim au. Sau khi ung 400
mg, nng ti a trong huyt tng (Cmax) ca floctafenic acid l 3-4 mg/ml, t c sau 1
gi (Tmax). Thi gian bn hy (T1/2) l khong 6 gi.
Sau acid floctafenic c oxyt ha thnh acid hydroxyfloctafenic v hydroxyfloctafenine. Ba
cht chuyn ha ny ha tan c. Cui cng chng c o thi sau khi kt hp vi acid
glucuronic, 60% qua mt v 40% qua thn.
Acid floctafenic c lc hc tuyn tnh sau khi cho dng cc liu n 200 mg, 400 mg v 600 mg
ngi tr.
Khng thy c tch ly sau khi dng lp i lp li 1200 mg/ngy trong 8 ngy.
ngi gi, chc nng thn c th b suy gim, s gia tng ca nng ti a trong huyt
tng v ca din tch di ng cong khng chng minh cn phi iu chnh liu.
Trong suy thn nng ( thanh thi creatinine di 10 ml/pht), tng ca din tch di
ng cong cho thy c th phi gim liu.
Dng chung vi thc n lm tng kh dng sinh hc ca floctafenine.
Floctafenine dng trong giai on cui ca thai kz qua c thai nhi.
Floctafenine dng cho ph n cho con b qua c sa m.
CH NH
iu tr triu chng cc chng au cp tnh v mn tnh ngi ln.
CHNG CH NH
- C tin s tng cm vi floctafenine, glafenine hay antrafenine, n cht hay phi hp.
- ang iu tr vi thuc c ch bta.
- Suy tim nng.
- Bnh mch vnh.
CH PHNG
Trnh dng thnh thong mt vin lp i lp li (nht l trong cc chng au cp tnh) v c th
gy ra tnh trng nhy cm vi floctafenine.
Cc phn ng d ng ton thn v da nim, c khi a n sc, c th xy ra.
Cc phn ng ny thng theo sau cc phn ng d ng nh nh : cm gic kin b lng bn
tay v lng bn chn, mt v c t ngt, mn , nga thanh qun, cm gic kh chu. Cc
du hiu ny c th xy ra ln dng Idarac trc.

Trc khi k mt n mi, phi lun lun hi xem bnh nhn c cc triu chng trn trong ln
dng Idarac hoc glafenine (n cht hay phi hp) hay antrafenine trc. Nu c, chng ch
nh Idarac cc bnh nhn ny.
THN TRNG LC DNG
- Suy thn : bnh nhn suy thn nng, nng huyt thanh ca floctafenine hi tng, do
nn gim liu.
- Tr em : Khng nn dng floctafenine cho tr em.
Li xe hoc lm cng vic nguy him khc :
Phi cho bnh nhn bit l c th b l khi ung floctafenine.
LC C THAI
cc kho st trn ng vt, floctafenine qua c hng ro nhau thai nhng khng thy c
tc dng gy qui thai hay c thai.
Khng c kinh nghim v tc dng ca floctafenine trn ph n c thai.
LC NUI CON B
Foctafenine qua c sa m. Do khng nn dng floctafenine khi cho con b, hoc nu
dng th phi ngng cho con b.
TNG TC THUC
- Chng ch nh dng chung vi thuc c ch bta, v nu xy ra phn ng kiu phn v, cc
thuc ny lm gim c ch b tr v tim mch v c th dn n hay lm nng thm h huyt
p hay sc.
- Thay i thi gian prothrombine c nhn thy bnh nhn dng di hn thuc khng
vitamin K v floctafenine.
- Khng c tng tc v dc ng hc vi cc thuc khng acid.
TC DNG NGOI
- Phn ng kiu phn v nh cm gic kin b, cm gic nng bng mt v cc chi, ng
ton thn km nga, m ay, ph mch, kh th dng suyn, cm gic kh chu ton thn vi
ngt xu v h huyt p a n try mch, sc.
- Triu chng tiu ha : bun nn, nn, bn v tiu chy.
- Tiu but.
- Suy thn cp phc hi c c hoc khng c thiu niu/v niu.
- L .
- Gim tiu cu, rt him.
LIU LNG v CCH DNG
- au cp tnh : khi u 2 vin, sau ung tip 1 vin, cch qung 6-8 gi, nu cn. Trung
bnh 4 vin/ngy (800 mg).
- au mn tnh : 2-3 vin/ngy (400-600 mg), cch qung 8-12 gi.
- Khng nn dng qu 6 vin/ngy (1200 mg).

- Ung thuc vi mt ly nc.

QU LIU
Qu liu c th gy bun nn, nn, tiu chy, au thng v. Khng c thuc gii. Cn ra d
dy sm.
Sn ng niu, c cha acid floctafenic, hn hu c th xy ra sau khi dng ko di
floctafenine vi liu cao hn liu khuyn co.
BO QUN
Khng cn bo qun c bit.
Hn dng : 4 nm.

264.

IGOL

RAPTAKOS BRETT
Thuc cm : hp 40 gi 6 g.
THNH PHN
cho 1 gi
V ht ca cy Isapgol (Plantago ovata, Plantaginaceae)

3,962 g

DC LC
Ht Plantago c dng trong y hc c truyn n t hn 3.000 nm nay. Thnh phn
hot cht chnh ca Igol l cc acide bo chui ngn v cc polysaccharides nhng tc dng
chnh l do polysaccharides (l cc chui polymer ln, phn nhiu nhnh bao gm D-galactose,
D-glucose, lignin, L-rhamnose, D-xylose, L-arabinose, D-mannose vi nhng chui bn acide
uronique). Arabinoxylans moiety (tng ng vi si x cm) chim gn 90% cu trc.
Thuc thuc loi nhun trng to khi phn hay loi lm mm phn. Do , mt liu ung t 35 g s cho tc dng trong vng 24 gi v kt qu ch tt nht khi dng liu 3-5 g/ln, 2 ln/ngy,
trong 2-3 ngy lin. D vy, vn phi iu chnh liu ty theo phn ng ca bnh nhn.
Tc dng ca thuc ch yu ty thuc vo s tch t nc trong rut non v rut gi. Nh cc
nhm polysaccharides ho nc ht nc rt nhanh mnh to thnh khi nho do lm gia
tng khi lng phn v kch thch nhu ng rut. Vi khun rut gi tiu ha cc thnh phn
ca thuc sn xut cc acide bo d bay hi t polysaccharides lm cng rut gp phn kch
thch nhu ng rut. Cc acide bo chui ngn (acetique, butyrique, propionique) t c hp
th c tc dng to p lc thm thu cng nh kch thch trc tip c trn.

Thuc cn c th lm gim s to thnh ammoniac bi vi khun k kh trong rut gi khong

30% nh ur huyt gim theo v iu ny c th c li cho bnh nhn suy thn mn.
Lignin trong thuc c kh nng kt hp vi cc acide mt lm gim hp th cc acide mt vo
trong mu ng thi bo v chng khi b vi khun ph hy nh lm tng tit chng ra phn.
Hu qu tt nhin l gan phi tng s dng cholesterol tng hp acide mt dn n vic
gim nng cholesterol trong mu (c bit l loi LDL).
liu iu tr, khng c bng chng no cho thy kh nng gy ung th hay qui thai.
c nhng bo co v vic Isapgol lm thay i s pht trin ca bu rut gi. iu ny c
l do s ln men sn phm butyrate m c chng minh l lm ko di s nhn i t bo
v lm gim tc pht trin ca t bo ung th rut gi ngi.
DC NG HC
ng vo : ch dng bng ng ung. 1-6% c thy phn d dy. S cn li xung n
rut gi nguyn dng, khng thay i cu trc ha hc.
Hp thu : thuc khng hp thu vo mu.
Bi tit : hn 70% c thi nguyn dng qua phn.
CH NH
- B sung cht x cho khu phn.
- Phng v tr to bn nht l trong tr, nt hu mn, sau m hu mn, lot trc trng n
thun, khi c thai.
- Phng trnh tnh trng phi rn qu mc khi i tiu.
- Khi cn lm gia tng khi lng phn (nh trong bnh vim ng rut hay trong cc trng
hp t mc tiu).
- Hi chng i trng kch thch.
- Liu php b sung cho ch n king ca bnh nhn c tng cholesterol nh.
CHNG CH NH
- Tr s sinh.
- Tc rut.
- Qu mn cm i vi cc sn phm t Plantago.
THN TRNG LC DNG
Nu pha khuy khng tan u hay khng lng nc, thuc c th vn cc v gy tc rut.
Phi ch { theo di chm sc ngi ln tui khi k n thuc nhun trng loi gi nc to
khi phn v khuynh hng khng thch ung nhiu nc do tui tc.
i vi bnh nhn lit ging c to bn, iu trc tin l phi bo m ch n v lng
nc vo trc khi ngh n thuc nhun trng.
Mi gi Igol c cha 2,16 g ng, do ngi b tiu ng cn c bc s hng dn s
dng.
LC C THAI v LC NUI CON B

Isapgol c th dng iu tr to bn ph n mang thai. Khng c bo co no v vic Isapgol

c nh hng bt kz trn vic cho con b, bi tit qua sa m hoc o thi qua sa m.
TNG TC THUC
Isapgol lm gim thi gian chuyn vn trong rut do c kh nng lm gim s hp thu cc
thuc dng chung nht l loi thuc phn r chm. Dng Igol cng lc vi digoxine, cht st hay
glucose c th lm gim hp thu cc cht ny mc d c mt cng trnh nghin cu cho thy
khng c nh hng ln s hp thu digoxine.
Thuc c th lm sai lc cc xt nghim dung np ng. Khng c bo co v nh hng ca
thuc trn cc xt nghim bnh l lm sng khc.
Thuc c ch hot tnh lipase nhng khng nh hng trn cc enzyme ty tng khc in vitro.
TC DNG NGOI
C th xy ra tc rut nu ung khng nc.
Tc dng ph thng gp nht l y bng.
Vi ngi c c a d ng, c th c phn ng nhy cm ch yu l tnh trng co tht ph qun
v vim mi do ht nhm bt thuc. C l do cc thnh phn si x tc ng nh l mt khng
nguyn ngoi lai v phn ng vi IgE loi gn t bo trong cy ph qun, nim mc mi v m
kt mc mt. Khng c bng chng Igol hay sn phm thoi ha ca n c th hp thu v tc
ng nh l mt hapten lm trung gian cho phn ng d ng.
Qu liu cp tnh : c nguy c cao dn n tc rut, nhng thng gp nht l au bng,
trng bng v y bng. Khng c cht i khng c hiu do rt cn ch ung nhiu
nc ngn nga.
C th xy ra tng bch cu a osine sau khi dng Isapgol.
LIU LNG v CCH DNG
Ngi ln : mi ln 1 gi (6 g), 1-2 ln/ngy. Nn dng t nht 3 ngy lin tip t hiu qu
tt nht.
Tr em di 6 tui : phi do Bc s ch nh dng v dng na liu ngi ln.
Trt 1 gi Igol vo mt na ly nc hay sa (125ml), khuy u v ung ngay. Sau c th
ung thm mt lng nc hay sa tng ng. Hoc c th ch cho thuc n c n.

265.

INTTRIX

BEAUFOUR IPSEN
Vin nang : hp 20 vin v 40 vin.
THNH PHN

cho 1 vin
Tiliquinol
50 mg
Tiliquinol laurylsulfate
50 mg
Tilbroquinol
200 mg
T dc : monohydrated lactose, tinh
bt bp.
Thnh phn ca v nang : gelatine,
titanium dioxide (E71), azorubine (E122),
indigotine (E132).
DC LC
Khng k sinh trng. Dit amp tip xc. Thuc tc ng trn dng thc vt Entamoeba
histolytica minuta v dng nang.
DC NG HC
Khi c ung, do khng b hp thu nhiu bi mng nhy, Intetrix duy tr nng cao ti rut.
CH NH
Intetrix c ngh dng trong iu tr l amp rut ngi ln :
- iu tr ph tr cho amp m ;
- n tr trong trng hp ngi lnh mang amp trong lng rut khng triu chng.
THN TRNG LC DNG
Cc nghin cu mi y xc nhn rng nhng ngi tnh nguyn khe mnh, Intetrix i khi
gy ra mt s tng nng men chuyn transaminase mc va phi, khng c triu chng v
c tnh cht hi qui. Nh vy, trong trng hp nng men transaminase tng, nht l
trng hp b vng da, phi ngng iu tr.
Khng nn iu tr lu di vi Intetrix do c nguy c ca bnh thn kinh ngoi bin (xem phn
Tc dng ngoi ).
LC C THAI v LC NUI CON B
Khng c bt c d liu ng tin cy no v vic gy qui thai th vt.
Hin ti khng c bt c d liu no y cng nh thch ng cho ph p nh gi tc dng
c cho bo thai cng nh gy d dng do s dng thuc ny trong thai kz.
Tuy nhin, khng nn s dng Intetrix trong sut thai kz.
TNG TC THUC
Intetrix khng c k toa phi hp vi nhng thuc khc c cha hydroxyquinoline
TC DNG NGOI
Him khi thy c trng hp nng transminase gan tng cao, a s cc trng hp ny gim
v ht cc triu chng sau khi iu tr.
Him thy cc phn ng da, hoc thuc loi qu nhy cm (chng pht ban, ph Quincke) hoc
loi ni bong bng (ban da sc t thng xuyn).
c bit trong trng hp iu tr lu di, bnh thn kinh ngoi bin v cc ri lon thn kinh

th gic c bo co.
LIU LNG v CCH DNG
Ung : 2 vin vo bui sng v 2 vin vo bui ti.
Thuc ny phi c ung vo u ba n.
Vic iu tr khng nn vt qu 10 ngy.

266.

INTRAZOLINE

TORLAN
c/o KENI - OCA
bt pha tim 1 g : hp 100 l bt.
THNH PHN
cho 1 l
Cfazoline dng mui Na, tnh theo cfazoline

1g

(Na)

(48,3 mg)

DC LC
Cfazoline l khng sinh dit khun thuc h bta-lactamine, nhm cphalosporine.
PH KHNG KHUN
- Cc loi thng nhy cm (CMI <= 8 mg/l) : Staphylococcus nhy vi mticilline, Streptococcus
trong c Streptococcus pneumoniae nhy vi pnicilline, vi khun ng rut (Escherichia
coli, Salmonella ngoi tr cc Salmonella gy st thng hn v ph thng hn, Shigella,
Proteus mirabilis), Haemophilus influenzae, Moraxella catarrhalis, Neisseria gonorrhoeae,
Clostridium perfringens, Peptococcus ;
- Cc loi nhy cm khng thng xuyn : Klebsiella ;
- Cc loi khng (CMI >= 32 mg/l) : Staphylococcus khng mticilline, Streptococcus
pneumoniae khng hoc km nhy cm vi pnicilline, Enterocoques, Listeria monocytogenes,
vi khun ng rut (Enterobacter, Serratia, Citrobacter, Proteus vulgaris, Morganella
morganii, Providencia, Yersinia enterocolitica), Pseudomonas, Acinetobacter, Bordetella, Vibrio,
Campylobacter, Mycobactrie, Chlamydiae, Mycoplasmes, Legionella, Bacteroides, Clostridium
sp.
DC NG HC

Hp thu v phn phi :

Tim bp :
Qua cc kho st dc l hc trn ngi, nng v thi gian lu li trong huyt thanh ca
cfazoline sau khi dng bng ng tim bp c tng kt nh sau :
- Liu 1 g : nng trong huyt thanh sau 1/2 gi l 60,1 mg/ml, sau 1 gi l 63,8 mg/ml, sau 2
gi l 54,3 mg/ml, sau 4 gi l 29,3 mg/ml, sau 6 gi l 13,2 mg/ml, sau 8 gi l 7,1 mg/ml.
Dng tim tnh mch :
Cc nng trung bnh trong huyt thanh sau khi truyn tnh mch liu duy nht 1 g c ghi
nhn nh sau : sau 5 pht l 188,4 mg/ml, sau 15 pht l 135,8 mg/ml, sau 30 pht l 106,8
mg/ml, sau 1 gi l 73,7 mg/ml, sau 2 gi l 45,6 mg/ml, v sau 4 gi l 16,5 mg/ml.
Thi gian bn hy o thi trung bnh l 100 pht. Cc nng iu tr t c trong dch
mng phi, cht dch khp v c trng.
Nu ng dn mt khng b tc, nng ca cfazoline trong m ca ti mt v trong mt
c ghi nhn cao hn nng trong huyt thanh. Ngc li, nu ng dn mt b tc, nng
ca khng sinh trong mt thp hn nhiu so vi nng trong huyt thanh.
C fazoline i qua hng ro nhau thai nhanh v vo thng trong mu ca dy nhau v trong
nc i. Trong sa m, cfazoline c nng rt thp.
T l gn kt vi prot ine l 85 n 90% trong huyt thanh ngi v iu kin sinh l.
Cfazoline phn tn km trong dch no ty.
Bin i sinh hc : cfazoline khng b chuyn ha.
Bi tit :
C fazoline c o thi ch yu qua nc tiu v mt phn qua mt. Sau khi tim 500 mg v
1 g, nh trong nc tiu ca c fazoline vt qu 1000 v 4000 mg/ml ng vi tng liu.
CH NH
Nhim trng do chng nhy cm, ch yu trong cc biu hin nhim trng ming, ng tai
mi hng, ph qun-phi, tit niu-sinh dc, nhim trng huyt, vim mng trong tim, nhim
trng rng ming, ngoi da, thanh mc, xng v khp.
CHNG CH NH
Qu mn vi nhm cphalosporine.
CH PHNG
Ngng tr liu nu xut hin cc biu hin d ng.
Cn phi hi bnh s trc khi k toa nhm cphalosporine do c d ng cho gia nhm
pnicilline v nhm cphalosporine xy ra trong 5-10% trng hp. Tht thn trng khi dng
cphalosporine cho bnh nhn nhy cm vi pnicilline ; cn theo di cht ch.
Cphalosporine b cm dng cho cc i tng c tin s d ng vi cphalosporine kiu phn
ng tc th. Trong trng hp nghi ng, thy thuc cn phi tc trc bn cnh bnh nhn trong
ln dng thuc u tin x l tai bin phn v nu c.

Phn ng qu mn (phn v) c ghi nhn khi dng nhm cphalosporine c th nng v i

khi gy t vong.
THN TRNG LC DNG
- Trng hp bnh nhn b suy thn, liu c iu chnh theo thanh thi cratinine hoc
theo cratinine huyt.
- Cn thn trng theo di chc nng thn trong thi gian iu tr nu c phi hp vi cc khng
sinh c c tnh trn thn (c bit l aminoside) hoc cc thuc li tiu nh furos mide hoc
acide tacrinique (xem Tng tc thuc).
- 1 g cfazoline dng mui Na c cha 48,3 mg Na.
LC C THAI
Tnh v hi ca nhm c phalosporine cha c xc nhn ph n mang thai, tuy nhin cc
nghin cu tin hnh trn nhiu loi ng vt cha cho thy c tc dng sinh qui thai hay c
c tnh trn thai nhi.
LC NUI CON B
Khng nn cho con b trong thi gian iu tr.
TNG TC THUC
Cn thn trng theo di chc nng thn trong thi gian iu tr nu c phi hp vi cc khng
sinh c c tnh trn thn (c bit l aminoside) hoc cc thuc li tiu nh furos mide hoc
acide tacrinique.
Phn ng cn lm sng :
C phalosporine c ghi nhn lm dng tnh test Coombs, iu ny cng c th xy ra i vi
cfazoline.
C fazoline cng c th cho kt qu dng tnh gi trong xt nghim tm glucose trong nc tiu
vi cc cht kh, nhng khng gy tc dng ny khi p dng cc phng php chuyn bit vi
glucose oxydase.
TC DNG NGOI
Biu hin d ng :
- mn ngoi da : ni my ay, pht ban dng si, nga, ni ban.
- phn ng st.
Biu hin ng tiu ha :
- tiu chy, bun nn, i ma, chn n, au bng.
- bnh nm ming do Candida.
- tng men gan tm thi (transaminase, LDH, phosphatase kim).
Biu hin mu :
- tng bch cu a acide.
- gim tiu cu hoc him hn l tng tiu cu.
- gim bch cu, gim bch cu ht, gim bch cu trung tnh.

Vic dng bta-lactamine vi liu rt cao c th gy bnh no do ri lon chuyn ha (ri lon
thc, c ng bt thng, cn co git, hn m), nht l bnh nhn suy thn.
Biu hin khng dung np ti ch :
- tim bp tht : au, vim, kh chu ch tim, c th b cng v st.
- tim truyn tnh mch : vim tnh mch hoc vim tc tnh mch khi tim truyn lin tc do c
t cathter.
LIU LNG v CCH DNG
n ng tim bp : Ha tan cfazoline trong dung mi pha tim bp nh lidocaine
chlorhydrate, hay nc ct pha tim hay dung dch NaCl 0,9%. Lc mnh cho n khi tan hon
ton
n ng tnh mch :
p Tim truyn tnh mch khng lin tc : Ha tan 1 g c fazoline trong 50 n 100 ml nc ct
pha tim hoc mt trong cc dch truyn sau : NaCl 0,9%, glucose 5 hay 10%, Ringer-lactate c
glucose 5%, Ringer, Ringer-lactate, dung dch glucose 5% v NaCl 0,9%.
p Tim tnh mch trc tip : Ha tan 1 g cfazoline trong t nht 5 n 10 ml nc ct pha tim
v tim chm trong 3 n 5 pht.
Ngi ln : 0,50-1 g mi 8-12 gi.
Tr em : 25-50 mg/kg/24 gi.
Cc liu ny c th c tng ln ty theo mc nhim trng.
Ngi suy thn :
n Nhim trng nng :
p H s thanh thi cratinine t 20 n 50 ml/pht :liu tn cng khi u 500 mg, sau l
250 mg/6 gi hay 500 mg/12 gi.
p t 10 n 20 ml/pht : liu tn cng khi u 500 mg, sau l 250 mg/12 gi hay 500
mg/24 gi.
p t 5 n 10 ml/pht : liu tn cng khi u 500 mg, sau l 250 mg/24-36 gi hay 500
mg/48-72 gi.
n Nhim trng nh hoc khng nghim trng lm :
p H s thanh thi cratinine t 20 n 50 ml/pht : liu tn cng khi u 500 mg, sau 125250 mg/12 gi.
p t 10 n 20 ml/pht : liu tn cng khi u 500 mg, sau 125-250 mg/24 gi.
p t 5 n 10 ml/pht : liu tn cng khi u 500 mg, sau 75-125 mg/24 gi.
p di 5 ml/pht : liu tn cng khi u 500 mg, sau 50-75 mg/72 gi.

267.

INTRON A

SCHERING-PLOUGH
Bt pha tim di da, tim bp 3 MIU : hp 1 l bt - Bng A.
Bt pha tim di da, tim bp 5 MIU : hp 1 l bt - Bng A.
THNH PHN
cho 1 l
Interferon alfa-2 b ti t hp

3 MIU

(Albumine ngi)
ng dung mi : Nc ct pha tim

cho 1 l
Interferon alfa-2 b ti t hp

5 MIU

(Albumine ngi)
ng dung mi : Nc ct pha tim
TNH CHT
Interferon alfa-2b ti t hp.
Intron A c to thnh qua qu trnh ng kh, n nh, tit trng t mt cht c tinh
khit cao l Interferon alfa-2b, cht ny c sn xut bng cc k ngh ti t hp DNA.
Interferon alfa-2b ti t hp l 1 prot ine tan c trong nc, c trng lng phn t xp x
19.300 dalton. Cht ny c chit tch t mt dng E. coli, plasmide ca loi ny c lai
ging vi gen Interferon alfa-2 t bch cu ca ngi bng cc cng ngh gen. Bt Intron A
ng kh c mu trng n vng kem.
Hot tnh ca Intron A biu din theo n v quc t (IU), vi 1 mg protine Interferon alfa-2b
ti t hp tng ng vi 2 x 108 IU. n v quc t ny c xc nh bng cch so snh
hot tnh ca Interferon alfa-2b vi hot tnh ca cht chun quc t Interferon bch cu ngi
do T chc y t th gii quy nh.
TC DNG
Interferon alfa-2b ti t hp c cng hiu ngn chn qu trnh tng sinh trong cc nghin cu
tin lm sng trn c t bo nui cy v khi u ca ngi c ghp trn th vt. N cng c

tc ng iu ha min dch trong iu kin in vitro. Interferon alfa-2b ti t hp cn c ch s

nhn i virus in vivo v in vitro.
Interferon tc ng ln hot ng t bo bng cch gn vo cc th th mng t bo c hiu
trn b mt t bo. Kt qu ca nhiu nghin cu cho thy mt khi gn kt vo mng t bo,
Interferon bt u mt chui hot ng rt phc tp bn trong t bo trong c s cm ng
ca mt s enzyme. Ngi ta cho rng qu trnh ny hoc t nht mt phn ca qu trnh ny,
chu trch nhim cho cc p ng khc nhau ca t bo i vi Interferon, bao gm vic c ch
s sao chp ca virus trong cc t bo b nhim virus, ngn chn qu trnh tng sinh t bo v
c tc ng iu ha min dch nh gia tng tnh thc bo ca i thc bo v tng c t t
bo c hiu ca limpho bo i vi t bo ch. Mt phn hoc tt c cc hot tnh ny ca
Interferon ng gp vo hiu lc tr liu ca n.
CH NH
Dng ng ton thn : iu tr bnh vim gan siu vi B mn tnh, vim gan C/khng A, khng B
mn tnh, vim gan delta mn tnh, u nh thanh qun, bnh bch cu th t bo tc, bnh bch
cu mn dng ty, bnh tng tiu cu i km vi bnh bch cu mn dng ty, bnh a u ty, u
bch huyt khng Hodgkin, Sarcome Kaposi nhng bnh nhn b AIDS, carcinome t bo thn,
ung th bung trng, khi u carcinoide di cn (khi u ni tit ty) v u sc t c tnh.
Dng tim trong bng quang : ung th b mt bng quang.
Dng tim trong sang thng : bnh condyloma si mng g, carcinome t bo y, u bch
huyt t bo T da v chng dy sng quang ha.
CHNG CH NH
Tin s tng mn cm i vi Interferon alfa-2b hay bt c thnh phn no ca Intron A.
THN TRNG LC DNG
Cc phn ng qu mn cp tnh trm trng (nh ni m ay, ph mch, co tht ph qun, phn
v) vi Intron A rt him gp trong qu trnh tr liu vi Intron A. Nu c biu hin phn ng
nh th th phi ngng thuc v p dng cc bin php thch hp ngay lp tc. Chng ni ban
thong qua khng cn thit phi ngng tr liu.
Nn cn thn khi dng Intron A cho bnh nhn mc nhng chng bnh lm suy nhc c th
nh c tin s bnh phi (nh bnh phi tc nghn mn tnh) hay tiu ng c khuynh hng
nhim acide-c tone. Cng nn cn thn khi dng cho bnh nhn c ri lon ng mu (nh
chng vim tnh mch huyt khi, nghn mch phi) hay suy ty trm trng.
S dng thuc tim Intron A phi hp vi cc tc nhn ha tr liu khc c th lm gia tng
nguy c ng c (v mc v thi gian), c th gy t vong hay e da tnh mng do tc ng
ca thuc dng ng thi. Cc tc dng ngoi { thng thy nht c kh nng gy t vong hay
e da n tnh mng bao gm vim nim mc, tiu chy, gim bch cu trung tnh, suy thn v
ri lon cht in gii. Do nguy c gia tng c tnh, cn iu chnh liu cn thn i vi Intron
A v c cc tc nhn ha tr liu dng ng thi.

V st c th gp trong hi chng gi cm khi iu tr bng Interferon, ta nn loi tr cc

nguyn nhn gy st dai dng khc.
Khng nn dng Intron A cho bnh nhn vim gan mn c suy gan mt b, cho bnh nhn vim
gan t min hay c tin s bnh t min hay nhng ngi c c ch min dch ghp
cc c quan bi v Intron A c th lm bnh gan trm trng hn trn nhng bnh nhn ny.
Nhim c gan dn n t vong rt him gp. Do , nu bnh nhn c cc bt thng chc
nng gan trong qu trnh iu tr vi Intron A nn c theo di cht ch v ngng thuc nu
cc triu chng tin trin nng.
Khng nn dng Intron A cho bnh nhn suy gan mt b. Bnh nhn vim gan siu vi mn vi
bng chng suy gim chc nng tng hp ca gan (nh gim albumine hay ko di thi gian
prothrombine), nu c iu tr bng Intron A c th tng nguy c mt b lm sng nu c s
dao ng ca aminotransf rase trong qu trnh iu tr vi Intron A (xem phn Xt nghim).
Nn cn nhc gia nguy c v li ch tr liu khi ch nh Intron A cho nhng bnh nhn ny.
Nn duy tr b sung y nc cho bnh nhn iu tr vi Intron A v chng h huyt p do
tnh trng mt nc c quan st thy mt s bnh nhn. Vic b nc c th rt thit
yu.
Bnh nhn c tin s suy tim sung huyt, nhi mu c tim v/hoc c tin s hay ang b lon
nhp tim, nu cn phi iu tr vi Intron A, nn c theo di cht ch. Bnh nhn c cc bt
thng trc v tim v/hoc ang trong giai on ung th tin trin, nn lm in tm
trc khi dng thuc cng nh trong qu trnh iu tr. Chng lon nhp tim (ch yu l lon
nhp trn tht) thng p ng vi cc iu tr thng thng nhng c th i hi phi ngng
dng Intron A.
Cc bnh thm nhim phi, vim phi bao gm c cc bnh c th gy t vong rt him gp
trn bnh nhn c iu tr vi Interferon alfa, trong bao gm c bnh nhn iu tr bng
Intron A. Bnh cn hc vn cha c xc nh. Nu bnh nhn b st, ho, kh th hay cc triu
chng h hp khc, nn kim tra bng X quang. Nu X quang phi cho thy c thm nhim hay
nu c bng chng suy chc nng phi, bnh nhn nn c theo di cn thn v ngng thuc
nu c th. Trong khi nh hng ny c bo co xy ra thng xuyn hn vi bnh nhn
vim gan siu vi mn C/NANB c iu tr vi Interferon alfa, n cng c bo co xy ra
trn nhng bnh nhn mc cc bnh ung th c iu tr vi Interferon. Hn na, cc triu
chng ny c bo co xut hin thng hn khi Interferon alfa c dng ng thi vi
shosaikoto, mt tho dc c ngun gc t Trung quc.
Bnh nhn mc bnh tm thn trc , c bit l chng trm cm hay tin s bnh tm
thn nng khng nn iu tr bng Intron A.
Nu c cc triu chng trm trng trn h thn kinh trung ng, c bit l chng trm cm,
nn ngng iu tr Intron A. Cc tc ng trn h thn kinh trung ng c biu hin vi
chng trm cm, l ln v nhng thay i tnh trng tm thn c quan st thy trn mt

vi bnh nhn dng Intron A v { nh t t cng c th xy ra tuy nhin rt him. Cc tc dng

ngoi ny xy ra trn bnh nhn dng Intron A vi liu khuyn co cng nh vi liu cao
hn. Vi bnh nhn c th hn m, nht l nhng ngi gi v iu tr liu cao. Nhng tc dng
ny ni chung thng l c hi phc, mt vi bnh nhn cn phi c n 3 tun hi phc
hon ton. Rt him khi xut hin cn ng kinh khi s dng liu cao Intron A.
Chng xut huyt vng mc, tc nghn ng mch hay tnh mch vi nhng im nh nt bng
rt him gp trn bnh nhn c iu tr vi Interferon alfa, trong c thuc tim Intron A
(Interferon alfa-2b ti t hp). Cha gii thch c nguyn nhn bnh cn ca nhng hin
tng ny. Cc tc dng ny c v nh xut hin sau vi thng dng thuc, nhng cng c
bo co xy ra trong nhng khong thi gian iu tr ngn hn. Chng tiu ng hay cao
huyt p cng xut hin trn mt vi bnh nhn. Bnh nhn c nhng thay i th lc v th
trng hay nhng triu chng mt trong qu trnh iu tr vi Intron A nn c khm mt.
Cc du hiu trn vng mc gy bi Intron A nn c phn bit vi cc tai bin trn mt trong
cc bnh vng mc do tiu ng hay do cao huyt p, do nn khm mt cho bnh nhn
mc bnh tiu ng hay cao huyt p trc khi iu tr vi Intron A.
Khi bnh nhn c ri lon chc nng gip, ch c th bt u hay tip tc iu tr vi Intron A
khi c th duy tr nng TSH mc bnh thng bng cch dng thuc. Vic ngng iu tr
vi Intron A khng lm hi phc li ri lon chc nng gip xy ra trong qu trnh tr liu.
Do c cc bo co v s gia tng bnh vy nn c sn trc , ch nn dng Intron A cho
bnh nhn b vy nn khi li ch tr liu ln hn nguy c c th gy ra.
Trn bnh nhn b sarcome Kaposi do AIDS, khng nn dng Intron A khi c s hin din ca
cc bnh ni tng ang tin trin nhanh chng. Bnh nhn dng thuc ng thi vi zidovudine
gy ra gim bch cu trung tnh vi t l cao hn so vi khi ch dng zidovudine n thun. Tc
dng ca Intron A khi kt hp vi nhng thuc khc trong iu tr bnh lin quan ti AIDS cha
r rng.
Cc xt nghim tc nhn trung ha Interferon c thc hin trn nhng mu huyt thanh ca
bnh nhn c tim Intron A trong mt vi th nghim lm sng c kim sot. T l trn lm
sng ca hot ng trung ha pht trin trn bnh nhn ung th c iu tr ton thn l vo
khong 3%. Bnh nhn vim gan siu vi NANB/C mn tnh c iu tr vi liu 3 MIU ba ln
mi tun trong 6 thng c t l l 15% m khng c tc ng no ln kt qu lm sng. Tc ng
trung ha ca Interferon trong huyt thanh c tm thy trong khong 1% bnh nhn tim
Intron A vo trong sang thng iu tr bnh mng g. Nng ca yu t trung ha trong
hu ht cc trng hp u thp v biu hin lm sng ca hot ng trung ha ny cng
khng r. S pht trin ca nhng khng th trung ha cha c chng minh trn bnh nhn
c tim Intron A vo trong sang thng trong iu tr carcinome t bo nn hay trn bnh
nhn c tim Intron A trong bng quang trong iu tr ung th bng quang.
Xt nghim : cc xt nghim huyt hc tiu chun v sinh ha ca mu (cng thc mu, s

lng tiu cu, cht in gii, cc men gan, bao gm ALT huyt thanh, bilirubine v albumine
huyt thanh, protine huyt thanh v cratinine huyt thanh) nn c thc hin trn tt c
cc bnh nhn trc khi iu tr v c nh kz trong qu trnh iu tr vi thuc tim Intron A.
Nng TSH phi c gi trong cc gii hn bnh thng trc khi bt u iu tr vi Intron
A. Bnh nhn c nhng triu chng cho thy c ri lon chc nng gip trong qu trnh iu tr
vi Intron A nn c thm khm chc nng gip. Trn bnh nhn c iu tr vim gan, phc
xt nghim khuyn co l vo tun th 1, 2, 4, 8, 12, 16 v mi thng sau , trong sut qu
trnh iu tr. Nu ALT tng (gp hai bnh thng hay nhiu hn) trong qu trnh iu tr vi
Intron A, c th tip tc dng thuc, tr phi quan st c nhng triu chng v du hiu ca
suy gan. Khi ALT tng, nn thc hin cc xt nghim chc nng gan nh thi gian prothombine,
ALT, phosphatase kim, nng albumine v bilirubine cch khong mi 2 tun.
nh hng ln kh nng sinh sn : Interferon c th lm gim kh nng sinh sn. Trong nhng
nghin cu v s dng Interferon trn ng vt linh trng, ngi ta thy c nhng bt thng
trong chu kz kinh nguyt. S suy gim nng estradiol v progest rone c bo co xut
hin ph n c iu tr vi Interferon bch cu ca ngi. Do , ph n trong tui sinh
khng nn dng Intron A tr khi p dng bin php trnh thai hu hiu trong thi gian iu
tr.
Thn trng khi dng Intron A cho nam gii trong tui sinh .
Dng thuc cho tr em : cc liu ln n 10 MIU/m2 c dng mt cch an ton khi dng
cho tr em b vim gan siu vi B mn tnh hot ng. Tuy nhin, hiu lc ca liu php cha
c chng minh. Ni chung, kinh nghim iu tr cho bnh nhn di 18 tui vn cn gii hn
v trong nhng trng hp ny, nn cn nhc gia li ch tr liu vi nguy c c th xy ra.
LC C THAI v LC NUI CON B
Intron A cho thy c tc ng gy sy thai trn Macca mulatta (kh rhesus) vi liu gp 90 v
180 ln so vi liu tim bp hay tim di da l 2 MIU/m2. Mc d s sy thai c quan st
trn tt c cc nhm liu (7,5, 15 hay 30 MIU/kg), tc dng ny ch c { ngha thng k i vi
cc kim sot nhm liu trung bnh v liu cao (tng ng vi gp 90 v 180 ln liu khuyn
co tim bp hay liu tim di da 2 MIU/m2). Khng c nghin cu y v c kim chng
cht ch trn ph n c thai. Ch nn dng Intron A trong lc c thai nu li ch tr liu cao hn
nguy c c th gy ra cho bo thai. Khng nn tim Intron A vo bng quang cho ph n c
thai.
Vic bi tit cc thnh phn ca thuc qua sa m cha c xc nh. Do Intron A c th gy
tc dng ngoi cho tr b sa m, quyt nh ngng cho b hay ngng iu tr ph thuc vo
tm quan trng ca thuc i vi ngi m.
TNG TC THUC
iu tr kt hp : ac taminophne (parac tamol) c dng thnh cng lm gim triu
chng st v nhc u c th xy ra khi iu tr bng thuc tim Intron A. Liu khuyn co

actaminophne l 500 mg-1 g dng 30 pht trc khi tim Intron A. Liu actaminophne ti
a l 1 g, 4 ln/ngy.
Nn dng thuc m, thuc ng hay thuc an thn cn thn khi cho ng thi vi thuc tim
Intron A. Cha nh gi c v tng tc thuc gia thuc tim Intron A vi nhng thuc
khc. Nn cn thn khi dng Intron A kt hp vi cc tc nhn c kh nng lm suy ty. Tc
dng ngoi { ng vn trn s lng bch cu c th xut hin khi dng ng thi Intron A vi
zidovudine. Bnh nhn dng c hai tc nhn ny ng thi c chng gim bch cu trung tnh
xy ra ph thuc liu lng v vi tn sut cao hn vt qu mc ch i so vi khi dng duy
nht mt thuc zidovudine.
TC DNG NGOI
Dng ton thn :
Cc phn ng ph c thy nhiu nht l st, mt mi, nhc u v au c. Cc du hiu st
v mt mi c lin quan n liu dng v c hi phc sau 72 gi tm ngng thuc hoc
ngng tr liu.
Cc phn ng ph thng gp l chut rt, chn n v bun nn.
Cc phn ng ph t gp hn l i ma, tiu chy, au khp, suy nhc, bun ng, chng mt,
rng lng tc, kh ming, cc triu chng ging nh cm (khng c hiu), au lng, trm cm,
kh , au nhc, v m hi , thay i v gic, kch thch, mt ng, ln ln, gim tp trung v h
huyt p.
Cc phn ng ph him gp l au bng, ni ban, lo lng, tai bin ti ni tim, d cm, herps
simplex, nga, au mt, lo lng, chy mu cam, ho, vim hng, thm nhim phi, vim phi,
gim sng sut, st cn, ph mt, kh th, kh tiu, tim p nhanh, cao huyt p, tng cm gic
ngon ming, gim tnh dc, gim cm gic, thay i v gic, phn lng, chy mu li, bnh thn
kinh v bnh a dy thn kinh. Chng cng hay nhc gip cng rt him gp. Nhim c
gan, bao gm kh nng gy t vong rt him gp (xem thm mc Ch { phng).
Cc phn ng ph v tim mch, c bit l lon nhp, thng c lin quan n bnh ca h tim
mch c t trc v tin s ca vic iu tr c tnh trn tim. Bnh c tim thong qua v c
hi phc rt him gp nhng bnh nhn khng c bnh tim trc .
Nhng bt thng v xt nghim thng xy ra khi dng liu trn 10 MIU/ngy bao gm gim
bch cu ht v bch cu ; gim nng hmoglobine v s lng tiu cu ; tng phosphatase
kim, lactate dhydrognase (LDH), cratinine huyt thanh, urea nitrogne huyt thanh v
nng TSH. S gia tng nng ALT/AST (SGOT, SGPT) trong huyt thanh c ghi nhn
nh mt bt thng trn nhng i tng khng vim gan cng nh trn mt vi bnh nhn
vim gan siu vi mn tnh xy ra cng lc vi s thi loi DNAp ca virus.
Tim vo trong sang thng :
Hu ht cc tc dng ngoi l nh cho n trung bnh, thong qua v c th hi phc nhanh
chng. Mc ca cc tc dng ngoi { c bo co xy ra trn nhng bnh nhn c iu

tr bnh mng g, cho thy c gia tng tng ng vi s lng sang thng iu tr v do ,
ph thuc vo liu lng.
Tc dng ngoi { thng gp nht l hi chng ging nh bnh cm, (n lnh, st, nhc u,
au c v mt mi). Cc tc dng ngoi { thng thng khc c bo co bao gm bun nn,
mt mi, chng mt, au khp, au lng v phn ng ti ch (bng rt, nga, au v chy mu
ni tim). Trn bnh nhn c iu tr bnh mng g, phn ng ti ni tim cho thy ph
thuc vo din tin ca sang thng hn l vo vic iu tr vi Intron A.
Cc tc dng ngoi him gp bao gm tiu chy, bun ng, trm cm, au, kh tiu, v m
hi, triu chng dng cm khng c hiu, ln ln, yu t, nn ma, nng bng, vp b chn,
suy nhc, thay i v gic, vim da v nga.
Gim bch cu, gia tng nng men gan trong huyt thanh (AST/SGOT) v gim s lng tiu
cu c bo co xut hin trn mt vi bnh nhn tim Intron A vo trong sang thng.
Hu ht cc thay i cn lm sng ny l thong qua, hi phc nhanh chng v ch trong mc
t nh n trung bnh.
Tc dng ngoi v kt qu xt nghim bt thng quan st c nhng bnh nhn c ti
iu tr bnh mng g bng Intron A th tng t v mt nh tnh cng nh nh lng vi
nhng tc dng ngoi { c bo co trc .
Cc tai bin sau c bo co xy ra rt him sau khi dng Intron A :
Ri lon v huyt hc : thiu mu huyt tn, tng g-globuline, ri lon ng mu.
Tng th : mt nc, tng calci huyt, suy mn, ph ngoi vi, bnh hch bch huyt, ph quanh
hc mt, st cao c tnh, thi loi c quan gh p v toan ha mu.
Tim mch : nh trng ngc, h huyt p t th, au ngc, tim chm, suy tim, rung nh, lon
nhp, ngoi tm thu, au tht ngc, vim tnh mch huyt khi v thiu mu cc b ngoi bin.
H thn kinh trung ng v ngoi bin : mt tr nh, trng thi sng s, co git, tng trng lc
c, tng cm, bng ha, nhc na u, bnh no, run ry, hn m, ri lon ngoi thp, sa st
tr tu lit, ri lon li ni, ngt, tai, chng mt, phi hp bt thng, mt iu ha, tht ng,
ri lon chc nng h thn kinh trung ng, dng i bt thng, tng vn ng, lon trng
lc c, lit.
H ni tit : chng to v nam gii, nam ho, nng thm bnh tiu ng, tng ng huyt.
H tiu ha : hi, vim ming, to bn, tc rut, kht nc, i tin mu en, tng tit nc
bt, vim thc qun, xut huyt trc trng sau khi i tiu, kh nut, xut huyt tiu ha, lot
d dy, vim li, tng sn li, xut huyt trc trng, bch sn ming, nht nht nim mc
ng tiu ha, trng bng, y hi, li nht nht, vim li, mt v gic.
H gan mt : kt qua xt nghim bt thng chc nng gan, tng bilirubine huyt, vng da, gan
lch to, lch to, bnh no do gan.
H c xng : au xng, yu c, vim khp, bnh khp, bnh c.
Ri lon tm thn : bt lc, bn chn, d xc cm, ri lon tnh cch, suy ngh bt thng, c

gng t t, c mng, lnh m, trm cm nng hn, lon thn kinh, phn ng hung d, cm
gic ging say ru, o gic, sa st tr tu.
H sinh dc : kh h, a kinh, xut huyt t cung, xut huyt m o, mt kinh.
Ri lon c ch khng : chp mt, vim kt mc, nhim nm v virus, bnh candida, nhim
khun.
H h hp : gim oxy khng kh th vo, ting th rt, sung huyt mi, vim phi, vim xoang,
vim mi, co tht ph qun, tm ti, th kh kh, au mng phi, ht hi, ho khan, nghn mch
phi, ph phi, vim thanh qun.
Da v phn ph ca da : m ay, trng c, bnh mng, ban xut huyt, thiu mu cc b ngoi
vi, nht, mn l khng herps, hoi t biu b, ri lon tuyn l, nhy cm nh sng, da nht
nht, nm da, bt thng kt cu tc, tng mc tc, mt sc t da, vim da dng liken, nhim
hc sc t v bch bin da.
H niu : ri lon tiu tin, tiu m, a niu, tiu ra mu, tiu nhiu ln, vim bng quang,
thiu niu, hi chng thn h, tiu khng kim ch, tng acide urique huyt.
Ri lon th gic v thnh gic : vim kt mc, s nh sng, nhn m, song th, kh mt, lit dy
thn kinh vn ng mt, bnh vng mc, xut huyt vng mc, qung g, au tai, ic, tng
thnh lc.
LIU LNG v CCH DNG
Intron A c th c s dng bng cch dng dng chai v trng hay ng tim nha.
Nn kim sot thuc bng mt thng v c v tnh khng mu trc khi tim.
i vi phc duy tr dng ng tim di da, bnh nhn c th t tim theo hng dn
ca bc s.
Bnh nhn c s lng tiu cu nh hn 50.000/mm3 khng nn tim bp Intron A m nn
dng theo ng tim di da.
Nu tc dng ph xut hin trong khi tr liu vi thuc tim Intron A trong bt c ch nh no,
nn iu chnh liu dng (gim 50%) hay phi tm thi ngng iu tr cho n khi cc tc dng
ph bt i. Nu biu hin khng dung np xut hin dai dng hoc ti i ti li d iu chnh
liu, hay bnh li tin trin thm, nn ngng tr liu bng thuc tim Intron A.
Vim gan siu vi B mn tnh : liu khuyn co l 30-35 MIU/tun tim di da hay tim bp
hoc 5 MIU/ngy hay 10 MIU, 3 ln/tun, trong vng 16 tun. Ni khc i, liu tc dng thp
nht ca thuc tim Intron A l 3 MIU, 3 ln/tun, tim di da hay tim bp. Nhng bnh
nhn c HBV-DNA trong mu trc khi iu tr thp (ngha l di 100 pcg) c p ng tt nht
vi tr liu Intron A v hu ht cc p ng l gim 50% HBV-DNA trong vng 1 thng. Bnh
nhn c nguy c cao (HBV-DNA > 100 mg) hay nhng bnh nhn khng p ng vi tr liu
trong vng 1 thng, c th c iu tr vi liu lng 5 MIU, 3 ln/tun hoc 5 MIU mi ngy.
Liu lng c th c iu chnh ty theo kh nng dung np thuc ca bnh nhn. Khi c
p ng, ch iu tr c chn la phi duy tr ti a 4 thng, tr khi c s khng dung np

trm trng.
Vim gan siu vi C/NANB mn tnh : liu lng ngh l tim di da 3 MIU, 3 ln/tun, trong
18 thng. Hu ht nhng bnh nhn c p ng cho thy c s ci thin mc ALT trong 12
tun. Mt vi bnh nhn khng p ng vi liu 3 MIU c th p ng vi liu cao hn l 10
MIU, 3 ln/tun. Nhng bnh nhn ti pht sau khi tr liu bng Intron A c th c ti iu tr
vi liu tng t vi ln p ng trc.
Vim gan siu vi delta mn tnh : Intron A c th tim di da vi liu ban u 5 MIU/m2 da, 3
ln/tun, t nht t 3-4 thng d rng iu tr k o di hn c th c ch nh. Liu lng c
th c iu chnh theo kh nng dung np thuc ca bnh nhn.
Bnh u nh thanh qun : liu lng khuyn co ca Intron A l tim di da 3 MIU/m2 da, 3
ln/tun (cch ngy), bt u sau phu thut (bng tia laser) ly i m bu. Liu lng c th
iu chnh theo kh nng dung np thuc ca bnh nhn. C th cn hn 6 tun tr liu mi
thy p ng.
Ung th mu t bo tc : liu lng ngh ca Intron A l tim di da hay tim bp 2
MIU/m2 da, 3 ln/tun (cch ngy). Liu lng c th iu chnh li ty theo kh nng dung np
thuc ca bnh nhn. Nhng bnh nhn khng ct lch cng p ng tng t bnh nhn ct
lch vi nhng nhu cu v truyn mu gim dn ging nhau. S bnh thng ha mt hay nhiu
thng s huyt hc thng bt u trong vng 2 thng iu tr. S ci thin tt c ba thng s
(lng bch cu ht, lng tiu cu v mc hmoglobine) c th cn n 6 thng hay hn na.
Trc khi bt u iu tr, cn lm cc xt nghim nh gi lng hmoglobine, tiu cu,
bch cu ht v cc t bo tc mu ngoi bin v cc t bo tc ty xng. Cc thng s ny
phi c kim tra nh kz trong sut qu trnh iu tr xc nh c hay khng c p ng
vi iu tr. Nu c p ng, nn duy tr iu tr cho n khi khng ci thin hn na v cc
thng s trn c n nh trong khong 3 thng. Nn ngng thuc nu khng c p ng
trong vng 6 thng. Phc iu tr ny phi c duy tr tr khi bnh tin trin nhanh hoc c
s khng dung np trm trng. Nu vic iu tr vi Intron A b gin on, nn lu { rng hn
90% bnh nhn c p ng li vi vic ti iu tr bng Intron A.
Ung th mu dng ty mn tnh : liu lng ngh ca Intron A l tim di da 4-5 MIU/m2
mi ngy. kim sot lng bch cu, c th cn liu duy tr thay i t 0,5-10 MIU/m2. Khi
lng bch cu c kim sot, c th tim 3 ln/tun (cch ngy). Cc nghin cu cho
thy bnh nhn giai on bnh mn tnh c p ng vi Intron A tt hn. iu tr nn bt u
sm ngay sau chn on v duy tr cho n khi c p ng hon ton v huyt hc hay t nht
18 thng.
Ni chung, cc bnh nhn p ng thng c p ng v huyt hc trong vng 2- 3 thng iu
tr. Nhng bnh nhn ny phi c tip tc iu tr cho n khi c p ng hon ton v
huyt hc, nh c nh ngha l c lng bch cu vo khong 3-4 x 109/l.
Tt c cc bnh nhn p ng hon ton v huyt hc phi c iu tr tip tc t c

p ng di truyn t bo hc, m p ng ny mt s bnh nhn ch c th t c sau 2

nm iu tr. Vi bnh nhn lc chn on c lng bch cu cao hn 50 x 109/l, bc s c th
chn la bt u iu tr vi liu chun hydroxyurea v sau thay th bng Intron A khi
bch cu gim di 50 x 109/l. Nhng bnh nhn mi c chn on ung th mu dng ty
mn tnh vi Ph dng tnh cng nn c iu tr phi hp Intron A v hydroxyurea. Intron A
c bt u dng vi liu thay i t 6-10 MIU mi ngy tim di da. Hydroxyurea c
thm vo vi liu 1,0-1,5 g, 2 ln/ngy nu lng bch cu ban u hn 10 x 109/l v c tip
tc cho n khi lng bch cu xung di 10 x 109/l. Sau , ngng hydroxyurea v chnh liu
Intron A ln hay xung duy tr bch cu a nhn trung tnh gia 1- 5 x 10 9/l v tiu cu ln
hn 75 x 10 9/l.
Bnh tng tiu cu i km theo ung th mu dng ty mn tnh : liu khuyn co ging nh vi
liu iu tr bnh ung th mu dng ty mn tnh. Vic iu chnh liu p dng kim sot
lng bch cu cng t ra thch hp kim sot lng tiu cu. Da trn kinh nghim lm
sng tch t cho n nay, khong 1/4 (26%) bnh nhn c chn on bch cu ty mn tnh
ng thi c bnh tng tiu cu vi lng tiu cu trn 500 x 10 9/l. Lng tiu cu c
kim sot trn tt c cc bnh nhn sau 2 thng iu tr. Lng tiu cu c kim tra mi
thng khng c ln no di 80 x 10 9/l.
Bnh a u ty :
iu tr tn cng : thm vo cng vi ha tr liu tn cng, Intron A c th c tim di da
vi liu 3-5 MIU/m2, 3 ln/tun (cch ngy) trong sut giai on tn cng.
iu tr duy tr : nhng bnh nhn trong giai on n nh sau t ha tr liu tn cng, c
th dng duy nht Intron A vi liu 3-5 MIU/m2, 3 ln/tun, tim di da.
iu tr ti pht hay bnh khng tr : bnh nhn c bnh ti pht sau ha tr liu hay khng vi
ha tr, c th ch cn tim Intron A n thun vi liu 3-5 MIU/m2, 3 ln/tun.
U lympho bo khng Hodgkin : b sung thm trong ha tr liu, c th tim Intron A di da vi
liu 5 MIU, 3 ln/tun (cch ngy).
Ung th Kaposi do AIDS : liu thch hp vn cha c xc nh. C hiu qu khi tim di da
hay tim bp Intron A vi liu 30 MIU/m2, 3-5 ln/tun. Liu thp hn (10-12 MIU/m2/ngy)
cng c p dng m khng ghi nhn s gim r rt hiu qu iu tr.
Mt cch khc, Intron A c th dng tim truyn tnh mch vi liu 50 MIU/m2/ngy trong 30
pht trong 5 ngy lin tip, sau ngng t nht 9 ngy ri mi bt u t tr liu 5 ngy k
tip. Khi bnh n nh hoc iu tr c p ng, nn tip tc tr liu cho n khi khng c biu
hin ca bu hoc cho n khi cn thit ngng thuc do c du hiu ca nhim trng c hi
hay tc dng ph trm trng.
Kt hp vi zidovudine (AZT) : trong cc nghin cu lm sng, nhng bnh nhn AIDS cng vi
Sarcome Kaposi c cho dng Intron A kt hp vi AZT. i vi hu ht bnh nhn, phc
iu tr sau c dung np tt : Intron A 5-10 MIU/m2 mi ngy ; AZT 100 mg mi 4 gi. Triu

chng c tnh gii hn liu l gim bch cu trung tnh. Intron A c th c bt u vi

liu 3-5 MIU/m2 mi ngy. Sau 2-4 tun, ty theo s dung np ca bnh nhn, c th tng liu
Intron A t 5 n 15 MIU/m2 mi ngy ; AZT c th tng n 200 mg mi 4 gi. Liu lng phi
c iu chnh trn tng c nhn, da vo s p ng tr liu v s dung np thuc ca mi
ngi bnh.
Ung th t bo thn : trong khi liu thch hp vn cha c xc nh, liu khuyn co trong
giai on tn cng l 10 MIU/m2/ngy (ti a n 18 MIU/ngy), tim bp hoc tim di da.
Liu lng c th c iu chnh ty theo tui tc v tnh trng ca bnh nhn. Liu ny c
th t n bng cch tng t t theo tng nc 3 MIU/m2/ngy trong khong thi gian 3 ngy
(3 MIU/m2/ngy cho 3 ngy, 9 MIU/m2/ngy cho 3 ngy, ri 18 MIU/ngy). Liu ti a c
khuyn co l 36 MIU/ngy, ty vo s dung np ca bnh nhn. Thi gian iu tr tn cng ko
di t nht l 3 thng c th quyt nh tip tc hay ngng tr liu. Nu bnh nhn c bng
chng tin trin bnh, phi ngng ngay iu tr tn cng. i vi tr liu duy tr, c th dng liu
tng t vi ko di khong cch dng thnh 3 ln mi tun trong t nht 6 thng.
Ung th bung trng : liu khuyn co cho bnh nhn mc bnh ung th bung trng dai dng,
di cn gim bt l 50 MIU tim vo phc mc nu ch dng duy nht mt loi thuc. Pha
thuc tim Intron A trong 250 ml dung dch mui, thm vo 1750 ml dung dch thm phn v
tim phc mc qua catheter. Nn thc hin tim truyn nh git trong khong mt gi. C th
lp li cch thc ny mi tun, trong t nht 16 tun trc khi bnh nhn c nh gi li tnh
trng bnh.
Bu di cn dng carcinome (bu tuyn ty ni tit) : hot tnh tr liu ca Intron A c
thy r rng bnh nhn bu di cn dng carcinome v hi chng sau khi dng thuc tim
di da 3-4 MIU/m2 mi ngy hay cch ngy, v tim di da 3 ln mt tun bt u vi liu 2
MIU/m2 v tng dn n 3, 5, 7 v 10 MIU/m2 vi cc khong cch 2 tun ty theo c tnh.
Trong khi s thoi ha bu nguyn pht khng xut hin, 20% bnh nhn gim 50% nc
tiu trong vng 24 gi [mc 5-hydroxyindole acetic acid (5-HIAA)]. Nhng bnh nhn dng
Intron A trong 6 thng (2 MIU/m2/ngy, tim di da trong vng 3 ngy u sau tng n 5
MIU/m2, tim di da 3 ln/tun) cho p ng khch quan khong 50% trong iu tr ko di.
Nhng bnh nhn bu c tnh dng carcinome c th xut hin bnh t min trong thi gian
tr liu Intron A, c bit khi c t khng th. V vy, phi kim sot cht ch bnh nhn v cc
triu chng thc th v triu chng c nng ca bnh t min trong sut qu trnh iu tr.
Bnh u sc t c tnh : c dng nh mt iu tr h tr cho phu thut, Intron A c tim
tnh mch vi liu 20 MIU/m2, 5 ln mi tun trong vng 4 tun, sau l 10 MIU/m2, tim
di da 3 ln mi tun trong vng 48 tun. Khi phi hp vi ha tr liu cho bnh nhn u sc t
di cn, Intron A c dng tim tnh mch vi liu 15 MIU/m2, 5 ln mi tun trong 3 tun, sau
tim di da 10 MIU/m2, 3 ln mi tun cho n khi c du hiu ci thin hay khi bc s cm
thy khng cn cn thit ; bnh nhn c iu tr lu hn 2 nm.

Ung th b mt bng quang : i vi ung th biu m t bo chuyn tip, liu khuyn co l

30-50 MIU mi tun tim nh git vo bng quang trong khong 8-12 tun ; i vi ung th ti
ch, liu khuyn co l 60-100 MIU, tim nh git mi tun trong vng 12 tun.
Cch thc tim truyn nh git Intron A pha vo trong bng quang : bnh nhn nn nhn
ung trong 8 gi trc khi tim truyn gip duy tr nng thuc ti u v trnh s bi tit
qu sm. Bng quang nn trng trc khi tim truyn. Dung dch c tim truyn t bm
tim vo bng quang qua 1 catheter tit trng. Bnh nhn phi gi dung dch trong bng quang
trong 2 gi. Trong qu trnh iu tr, bnh nhn phi thay i t th mi 15 pht bo m
ton b b mt bng quang c tip xc. Sau 2 gi, nn khuyn bnh nhn i tiu bi tit
hon ton.
Condylomata Acuminata (condilom si, bnh mng g) : cc sang thng c tim thuc
trc tin phi c lau sch s bng gc tm cn v trng. Tim vo trung tm sang thng
bng mt kim nh (s 30). Tim 0,1 ml dung dch pha sn cha 1 MIU Intron A vo sang thng
3 ln mt tun v cch ngy trong vng 3 tun. C th cng lc iu tr 5 sang thng. Liu tng
cng ti a cho vic tim thuc mi tun khng c vt qu 15 MIU. Sang thng rng c
th c iu tr bng cch tim nhiu mi (ti a 5 MIU Intron A tng cng trong mt ngy)
hay bng cch tim lin tc ln nhng vng khc nhau ca sang thng.
Ti iu tr : s ci thin thng xut hin 4-8 tun sau khi bt u t iu tr u tin. Nu
kt qu ln tr liu ny cha tha ng, nn tr liu t th nh vi cng phc tng t nu
cc triu chng chc nng v thc th hay cc thay i v cc thng s xt nghim khng ngn
cn vic ti iu tr.
iu tr cc sang thng ph : ngay sau khi kt thc 3 tun iu tr u tin, c th bt u t
iu tr th hai vi phc iu tr tng t iu tr ti a 5 sang thng ph bnh nhn
c t 6-10 condylom. Bnh nhn c hn 10 condylom c th c iu tr lin tip ph thuc
vo s lng condylom. Trong cc nghin cu lm sng, nhng bnh nhn c condylom cng
c iu tr vi Intron A tim vo trong sang thng vi liu 1,5 MIU/sang thng sau bi
ti ch podophylline 25%. Vic iu tr ny c thc hin mi tun mt ln, trong vng 3 tun.
Ung th t bo nn : sang thng trc ht phi c lm sch bng gc tm cn v trng.
Tim vo phn nn v phn cht ca sang thng bng mt kim nh (s 30) v 1 ng tim 1 ml.
Vi nhng sang thng c din tch ban u di 2 cm2, tim 0,15 ml dung dch cha 1,5 MIU
Intron A vo sang thng 3 ln mt tun cch ngy, trong vng 3 tun. Liu tng cng nn t
n 13,5 MIU. Sang thng t bo nn c din tch rng v nt lo t (sang thng rng 2-10
cm2) nn c iu tr 3 ln mt tun trong vng 3 tun vi 0,5 MIU/cm2 din tch ban u ca
sang thng (liu ti thiu l 1,5 MIU). Mi sang thng nn c iu tr mt ln. S ci thin
tnh trng lm sng (hnh dng kch thc, ban ...) ca sang thng c iu tr l ch
nh ng tin cy cho vic iu tr bng sinh thit. Do tnh trng lm sng phi c kim tra
nh kz sau khi kt thc iu tr. S ci thin triu chng thc th ca bnh thng xut hin

khong 8 tun sau khi bt u iu tr. Nu khng thy ci thin lm sng sau 2-3 thng, nn
dng phu thut ct b sang thng.
U bch huyt t bo T da (u si dng nm) : bnh nhn c mng u si dng nm, Intron A
gy thuyn gim lm sng khi tim vo trong vt thng vi liu lng 1-2 MIU/v tr tim 3 ln
mi tun trong vng 4 tun lin tip. Trc ht, sang thng phi c lau sch bng gc tm
cn tit trng ; kim c tim theo mt gc gn nh song song vi da. Tim vo biu m b
mt di mng sang thng vi mt kim nh (s 30) v ng tim 1 ml. Cn ch { khng c
a qu su di sang thng v cn trnh tim di da. Nn lp li liu php ny 3 ln mt
tun, trong vng 4 tun vi tng s 12 mi tim vo mi sang thng. Trong nhng th nghim
lm sng, ci thin ngay ti v tr sang thng c ghi nhn duy tr vi tun sau khi kt thc
iu tr bng cch tim thng vo trong sang thng vi liu tng cng l 2 MIU/ln thc hin.
Dy sng quang ha : sang thng c th c iu tr vi 500 000 (5 x 105 IU) Intron A trong
0,1 ml dung dch, tim vo sang thng vi 1 kim nh (s 25-30). Kim nn m vo phn nn
ca sang thng vi mt gc gn nh song song vi mt phng da. Cn phi ch { khng a
vo di sang thng qu su ; cn nn trnh tim di da v khu vc ny di nn ca sang
thng. Mi tim b mt c th a n ch r r vi s thm nhim ca duy nht lp sng
ho. Nn lp li liu php ny 3 ln mi tun trong vng 3 tun vi tng s 9 mi tim vo mi
ch dy sng quang ha/ln thc hin vi liu tng cng l 1,5 MIU/ln thc hin. Nn ch
khong bn tun t lc kt thc t tr liu trc cho n khi c kt qu lm sng r rt.
Sang thng c hnh thi hc hay triu chng hc lm sng bt thng khng nn iu tr bng
Intron A.
Pha ch bt ng kh Intron A tim hay tim thng vo sang thng : l bt cha liu duy
nht phi c pha vi 1 ml nc ct pha tim. Cng c th dng nc nh khun pha tim
cha 0,9 % ru benzylique. L cha nhiu liu phi c pha vi nc nh khun pha tim
cha 0,9 % ru benzylique (5 ml cho l 25 MIU). tim vo sang thng, pha mt l 10 MIU
Intron A vi 1 ml dung mi s cho mt dung dch ng trng vi nng mong mun l 1
MIU/0,1 ml. Pha thuc vi nhng l c kch c khc nhau t c liu lng khuyn co
cho mt dung dch nhc hay ng trng. Dng bm v kim tim tit trng, tim mt lng
thch hp dung mi vo l Intron A.
Lc nh ha tan bt hon ton. Sau , liu lng thch hp s c rt ra bng bm tim
tit trng v tim di da, bp tht hay vo sang thng nh c ch nh.
Pha ch dung dch Intron A tim truyn tnh mch : (xem Liu lng v cch dng). Khng
c tim truyn ng thi thuc khc cng vi Intron A.
Bnh Sarcoma Kaposi : phc liu lng thay i : nu c th, nn pha dch tim truyn ngay
trc khi dng. Bt ng kh Intron A nn c pha bng cch thm 1 ml nc ct pha tim
vo l. Sau rt ra lng Interferon c tnh ton trc cho 1 liu thch hp v cho vo 50
ml dung dch mui v trng. Trc khi tim mi liu Intron A, bnh nhn cn c sn mt kim

bm s 21 dng tim tnh mch (hay c kim tim tnh mch khc c cung cp). Cn bt u
tim truyn dung dch mui ng trng (tc 200 ml/gi) trc khi cho thuc vo. Nn
ngng tim truyn dung dch mui ng trng ngay trc khi bt u cho Intron A vo. Dung
dch Intron A trong 50 ml dung dch mui tit trng pha sn nn c tim truyn trong
khong thi gian l 30 pht. Sau khi truyn thuc xong phi tip tc truyn dung dch mui bnh
thng trong vng 10 pht vi tc l 200 ml/gi nh ban u.
Bnh u sc t c tnh : Bt ng kh Intron A nn c pha bng cch thm 1 ml nuc ct pha
tim vo l. Lng Interferon c tnh trc cho mt liu thch hp sau c rt ra v
thm vo trong 100 ml dung dch mui ng trng tit trng v tim truyn trong khong 20
pht. Khng c truyn kt hp Intron A vi mt thuc khc.
Pha Intron A tim vo bng quang : cho liu khuyn co l 100 MIU Intron A, mt s thch
hp cc l 5, 10, 25, 30 hay 50 MIU lm 100 MIU c pha vi nc ct pha tim. Khng
pha Intron A vi nc nh khun pha tim tim truyn vo bng quang. Thm vo mi l 1
ml nc ct pha tim. Lc nh ha tan bt hon ton c mt dung dch trong sut.
Gp cc dung dch pha li bng cch ht vo mt ng bm tim 30 ml c liu tng cng
100 MIU Intron A. Thm mt lng va nc ct pha tim vo bm tim c mt th tch
l 30 ml dung dch. tim nh git vo bng quang, bm tim phi c ni vo mt catheter
tit trng. Cn quan st dung dch bng mt thng kim tra cc tiu phn l lng v tnh
khng mu trc khi a vo c th. Dung dch pha phi trong sut v khng mu n vng
nht. Mc d dung dch pha Intron A vi nc ct pha tim c th n nh trong 24 gi nhit
2-30oC, nn dng dung dch tim vo bng quang trong vng 4 gi sau khi pha.
LU KHI S DNG
Khng tim truyn ng thi cc thuc khc vi Intron A.
Tng hp vi cc dung dch tim tnh mch khc : trong dung dch mui ng trng thng
thng, nng Intron A t 50.000-1.000.000 IU/ml c tnh n nh v tng hp vi cc dung
dch c k pha di, khi gi trong t lnh trn 24 gi hoc nhit phng trong chai
thy tinh : dung dch tim Ringer, dung dch tim Lactate Ringer, dung dch tim acide amine,
dung dch tim Natri bicarbonate 5%.
Hn hp ny c duy tr n nh trong tim truyn ko di 6 gi qua b truyn dch.
Tnh tng hp ca Intron A nng ti thiu 105 IU/ml trong dung dch mui ng trng
thng thng c nh gi khi dng qua nhiu b truyn dch khc nhau.
Kt qu tm lc nh sau : tnh tng hp vi cc b tim ng tnh mch.
C th tng hp : 2C001 (Travenol), VI 400 (McGaw), Venoset 78 (Abbott), Ultipor Blood, b
tim thuc v lc dch truyn (Pall), Intrafix Air (B. Braun), b tim STK loi L76 (Aesca), Perfu
Pal (Dubermarid Vitrum), Vacoset V34 (Baxter), Vacoset V2400 (Pharmaseal), Hiplex-Venosteril,
Venoset (Abbott), Vacoset V-736 (McGaw), Vacoset V-717U (McGaw).
Khng tng hp : Versaset V13 (Rivero), Addit IV V1444 (McGaw), Continue Flow (Travenol).

Tnh n nh : sau khi pha vi 1 ml nc pha tim km khun cha 0,9% cn benzyl, dung dch
s c n nh ti thiu 1 thng khi c bo qun 2-8oC hoc trong 2 tun khi bo qun
nhit phng (15-30oC).
Dung dch sau khi pha trong sut v khng mu hoc c mu vng nht.
Khi pha vi nc ct pha tim, Intron A c th c bo qun ng lnh (di - 10oC) trong
ng bm tim polypropylne trong 28 ngy. Dung dch pha n nh trong sut thi gian ny khi
c gii ng v c ng lnh tr li ti a 2 ln.
BO QUN
Bo qun trong khong nhit 2-8 oC.

268.

ISOBAR

JACQUES LOGEAIS
c/o HYPHENS
Vin nn d b : hp 30 vin.
THNH PHN
cho 1 vin
Mthyclothiazide

5 mg

Triamtrne

150 mg

(Lactose)
DC LC
- Mthyclothiazide :
Thuc li tiu thi natri thuc nhm thiazide c tc dng ch yu trn phn v thn. Sau khi
dng liu duy nht, tc ng thi natri thu c ng k sau 2 gi, ti a sau 6 gi v ko di
trong vng 24 gi.
- Triamtrne :
Thuc li tiu tit kim kali, thi natri mc va phi, tc ng bng cch c ch chc nng
trao i ion ng ln xa, lm gim s bi tit kali, tng bi tit natri, chlore v bicarbonate.
Tc ng ny c lp vi s hin din hoc khng ca aldost rone. Nh th, do c tc ng
thi natri, triamtrne c tc dng chng ph n v nu c s dng lu di s c tc dng h
huyt p.

Thi hn tc ng : tc dng li tiu xut hin thng sau 1 gi, ti a t gi th 2 n gi th

4.
K o di tc ng : t 6 n 8 gi, c th ln n 12 gi, i khi n 24 gi.
DC NG HC
- Mthyclothiazide :
Sau khi ung, thuc li tiu thiazide c hp thu nhanh chng. M thyclothiazide c o
thi ch yu thn, di dng khng thay i, do s lc cu thn v bi tit ng thn.
Thuc qua c hng ro nhau thai ; thuc i qua sa m yu.
- Triamtrne :
Sau khi ung, hm lng ti a trong huyt tng t ti thng sau 45 n 60 pht ; nng
ca triamt rne sau c duy tr trong khong 2 gi, sau gim cho n khi xung thp
trong khong 8 gi. Mt lng nh c th c tm thy sau 24 gi v i khi cho n 36 gi
sau.
Triamt rne c chuyn ha thnh parahydroxytriamt rne, sau thnh ester sulfurique
acide ca cht ny.
Triamt rne c o thi thn do s lc cu thn v bi tit ng thn.
Triamtrne v cc cht chuyn ha c tm thy trong nc tiu sau 1 gi. Triamtrne
c o thi ti a sau 2 n 4 gi. Sau 24 gi, c khong 20 n 40% liu ung vo c o
thi, trong 60% c o thi trong 6 gi u. Nu ngng thuc sau mt thi gian iu tr
ko di, s o thi trong nc tiu vn tip tc v gim dn cho n 5 n 7 ngy sau.
C kh nng nhum nc tiu c mu xanh nht do mt cht chuyn ha ca triamtrne.
Triamt rne i ngang yu qua hng ro nhau thai (3% sau 1 gi cu ci).
CH NH
- Huyt p cao.
CHNG CH NH
- Suy thn.
- Mn cm vi sulfamide.
- Bnh no x gan.
- Tng kali huyt.
- Phi hp vi mt thuc li tiu tit kim kali khc.
- Phi hp vi mui kali (ngoi tr bnh nhn b h kali huyt).
CH PHNG
Trong trng hp c tn thng gan, cc thuc li tiu thiazide c th gy ra bnh no x gan.
Trong trng hp xut hin bnh l{ no nh vy, phi ngng iu tr ngay.
Lu { vn ng vin th thao do thuc cho kt qu dng tnh cc test v s dng cht kch
thch (doping).
THN TRNG LC DNG

Triamtrne :
- ngi tiu ng : tnh trng tng ng huyt c th lm nng thm nguy c tng kali
huyt.
- bnh nhn suy gan : c kh nng b toan huyt do tng kali huyt ngi b x gan. Vi
nhng bnh nhn ny, khng nn dng triamtrne nu natri huyt di 125 mEq/l. Ngoi ra,
tuy l nhng ngoi l, mt vi trng hp thiu mu i hng cu hay gim huyt cu ton th
cp tnh cng c quan st thy nhng bnh nhn ny (thiu acide folique).
Thuc li tiu thiazide :
- Theo di natri huyt, kali huyt v chc nng thn, nht l nhng bnh nhn b x gan.
- Kim sot ng huyt v acide urique huyt nhng bnh nhn tiu ng v goutte v
phi cn nhc k vic s dng thuc li tiu nhm thiazide nhng bnh nhn ny.
- Cc thuc li tiu thiazide ch c tc dng y khi chc nng thn bnh thng hay ch gim
nh (nng cratinine trong huyt tng di 25 mg/l, hay 220 mmol/l.
LC C THAI
Khng nn dng thuc li tiu thiazide trong iu tr ph n v cao huyt p lc mang thai, v c
th a n tnh trng thiu mu nhau thai, vi nguy c suy dinh dng bo thai.
LC NUI CON B
Khng nn dng cho ph n nui con b (qua c sa m).
TC DNG NGOI
Ri lon d dy - rut.
Phn ng mn cm ch yu da.
Nguy c b mt nc vi gim th tch mu, h natri huyt, tng acide urique huyt, tng
ng huyt v h huyt p th ng, cn phi ngng thuc hay gim liu.
Ri lon mu him gp : gim tiu cu, gim bch cu, mt bch cu ht, suy ty v thiu mu
tn huyt.
C kh nng gy h kali huyt hoc him hn gy tng kali huyt, nht l bnh nhn suy thn
v tiu ng.
bnh nhn suy gan, c th gy toan huyt do tng kali huyt bnh nhn x gan, c th dn
n bnh no x gan.
Rt him khi b si niu.
Nc tiu c th c mu xanh nht.
LIU LNG v CCH DNG
1 vin/ngy

269.

ISOKET

SCHWARZ PHARMA
c/o RANBAXY
Dung dch tim 0,1% : ng 10 ml, chai 50 ml.
THNH PHN
cho 1 ml
Isosorbide dinitrate

1 mg

T dc (mg/ml) :
Sodium Chloride

9,0 mg

Nc pha tim

994,9 mg

Dung dch Sodium Hydroxide 2N

0-0,00002 mg

Hydrochloride acid 1N

0-0,00002 mg

CH NH
Isoket 0,1% c ch nh iu tr suy tht tri khng p ng th pht sau nhi mu c tim
cp, suy tht tri khng p ng do nhiu nguyn nhn khc nhau v chng au tht ngc nng
hoc khng n nh.
CHNG CH NH
Khng c s dng Isoket 0,1% trong iu tr sc do tim tr khi chun b mt s phng
tin duy tr p lc tm trng , v d ch nh thuc lm co bp c tim ng thi.
Isoket 0,1% c chng ch nh trong try tun hon v tt huyt p nng.
Khng c ch nh Isoket 0,1% cho bnh nhn nhy cm vi nitrates, thiu mu nng, chn
thng u, xut huyt no hoc gim lu lng mu.
THN TRNG LC DNG
Cn ch thn trng n mch v huyt p trong sut thi gian iu tr Isoket 0,1%.
Cn s dng thn trng nhng bnh nhn c glcm gc ng, ang mc chng gim nng
tuyn gip, suy dinh dng, bnh l nng v gan hoc thn, hoc h nhit.
Khng c s dng thuc trong thi kz c thai hoc cho con b tr khi Bc s x t thy cn
thit phi s dng.
TC DNG NGOI
Khi p lc ng mch gim t ngt c th lm tng triu chng thiu mu no v lm gim
ti mu vnh, kinh nghim lm sng vi Isoket 0,1% cho thy y khng phi l mt vn

bnh thng. iu ny ph hp vi tc dng gy gin mch nh bit ca isosorbide dinitrate,

tc dng ny thng ch yu xy ra tnh mch hn l ng mch. Cng ging nh cc nitrates
khc, au u v bun nn c th xy ra trong thi gian iu tr.
LIU LNG v CCH DNG
S tng hp :
Isoket 0,1% c cha Isosorbide dinitrate trong dung dch mui ng trng v tng hp vi
cc dung dch truyn ni chung. Cho n nay khng thy c s bt tng hp no xy ra.
Isoket 0,1% tng hp vi cc chai truyn bng thy tinh v cc ti truyn bng polyethylene.
Isoket 0,1% c th c truyn chm bng cch s dng mt bm tim bng thy tinh hoc
bng nha cng.
Hng dn s dng :
Liu lng :
Liu lng phi c iu chnh ty theo p ng ca bnh nhn. Ni chung, liu t 2 n 7
mg mi gi l thch hp mc d i khi cn n liu cao 10 mg.
Nng yu cu :
5 ng 10 ml hoc 1 chai 50 ml (50 mg) Isoket 0,1% c pha n 500 ml vi cht ti thch hp
nh Sodium chloride tim hoc Dextrose tim. Dung dch thu c s c nng 100 mg/ml.
Khi cn phi gim bt lng dch truyn, c th to dung dch c nng cao hn bng cch s
dng 10 ng 10 ml hoc 2 chai 50 ml Isoket, pha n 500 ml to thnh dung dch c nng
200 mg/ml.
Isoket 0,1% cn c cho vo dung dch truyn ngay sau khi m ra. Phi pha ch hn hp trong
iu kin v khun.
Bng tnh liu :
Nng yu cu :
100 mg/ml : 5
ng hoc 1 chai
50 ml pha thnh
500 ml

200 mg/ml : 10
ng hoc 2 chai
Liu lng 50 ml pha thnh
Isoket
500 ml

Tc chy

Tc chy

m git/pht

m git/pht

ml/gi

git/pht

mg/gi

ml/gi

git/pht

10

3-4

1-2

20

10

30

10

15

40

13

20

50

17

25

60

20

30

10

70

23

35

12

80

27

40

13

90

30

45

15

100

33

10

50

17

1 ml = 60 git nh nhi khoa = 20 git chun

Bng tnh liu :
Bng tnh liu cho bit tc truyn cn thit m bo mt liu lng Isoket tnh bng
mg/gi, nng s dng l 100 mg/ml hoc 200 mg/ml.
V d :
Vic tnh ton liu lng rt n gin. Vi nng 100 mg/ml bnh nhn cn 6 mg Isoket mi
gi v cn tc nh git l 60 git nh nhi khoa mi pht (tng ng 60 ml/gi) hoc 20
git chun/pht. Nu cn phi hn ch lng dch cn truyn, liu tng t (6 mg/gi) c th
ch nh bng cch s dng nng 200 mg/ml vi tc nh git l 30 git nh nhi khoa mi
pht (tng ng 30 ml mi gi) hoc 10 git chun mi pht.
Cch dng :
Isoket l mt dung dch c nng v khng bao gi c tim thuc trc tip. Cn phi ch
nh thuc vi dung dch thch hp nh Sodium Chloride tim hoc Dextrose tim. Dung dch
Isoket pha ch phi lun lun c cho bng ng truyn tnh mch hoc vi s h tr ca
mt bm tim. Trong khi s dng phi theo di cht ch huyt p v mch ca bnh nhn. Pha
ch dung dch bng cch thay i lng Isoket 0,1% yu cu vi th tch dch truyn tng
ng.
Tr em :
Mc an ton v hiu qu ca Isoket 0,1% cha c thit lp tr em.
BO QUN
nhit phng khng qu 30oC.

270.

ISOMIL

ABBOTT
Sa bt dinh dng : hp 400 g, 1000 g
THNH PHN
Tinh bt bp thy phn, du bp, sucrose, du thc vt, protein u nnh tinh ch, khong
cht (canxi phosphat tribasic, kali xitrat, kali chlorid, magi chlorid, canxi carbonat, natri chlorid,
st sulfat, km sulfat, ng sulfat, mangan sulfat, kali iodid), vitamins (ascorbic acid, cholin
chlorid, a-tocopheryl acetat, niacinamid, canxi pantothenat, thiamin hydrochlorid, vitamin A
palmitat, pyridoxin hydrochlorid, riboflavin, folic acid, phylloquinon, biotin, vitamin D3,
cyanocobalamin), amino acid (L-methionin, taurin v L-carnitin).
Thnh phn bt ng trong Isomil c cung cp t sucrose, tinh bt bp thy phn.
Thnh phn protein bao gm cc protein u nnh c tinh ch.
Cht b o, a s l cc acid bo khng no chui di, c cung cp t du hng dng, du
da v du u nnh (linoleic acid, linolenic acid).
Trong thnh phn ca Isomil khng cha lactose.
Phn tch thnh phn
100 g bt
Nng lng
kcal
KJ
Thnh phn dinh dng
Cht m (g)
Cht bo (g)
Linoleic Acid (g)
Bt ng (g)
Khong cht (g)
m (g)
Khong cht
Canxi (mg)
Phospho (mg)
Magi (mg)
Natri (mg)
Kali (mg)
Clo (mg)

517
2163
13,7
28,1
5,1
52,5
3,4
2,4
532
380
41
243
578
449

Km (mg)
6
St (mg)
7,8
ng (mg)
357
Mangan (mg)
304
It (mg)
76
Sinh t
Vitamin A (mg)
600
Vitamin D (mg)
7,6
Vitamin E (mg)
12,9
Vitamin K1 (mg)
42
Vitamin C (mg)
53
Vitamin B1 (mg)
494
Vitamin B2 (mg)
456
Vitamin B6 (mg)
304
Vitamin B12 (mg)
2,3
Niacin (mg)
5,3
Pantothenic Acid (mg)
3,8
Folic Acid (mg)
100
Biotin (mg)
23
Cholin (mg)
60
Taurin (mg)
34
L-carnitin (mg)
9
CH NH
Isomil l cng thc dinh dng dnh cho tr b d ng vi protein sa b ; v cho bnh nhn bt
dung np lactose.
LIU LNG v CCH DNG
Dng mung lng km theo hp sa. Pha 1 mung sa bt vi 60 ml nc un si ngui
n khong 50oC. Khng nn thm nc hoc bt lm thay i nng .
b phn sa tha sau khi dng.
BO QUN
Hp m phi c y v bo qun ni kh mt (nhng khng cho vo t lnh).

THUC VN K

271.

KALEORID LP

LEO PHARMA
c/o ZUELLIG
Vin phng thch ko di 600 mg : hp 30 vin.
THNH PHN
cho 1 vin
Potassium chloride

600 mg

DC LC
B sung kali :
Trn phng din sinh l, kali mu gim di 3,6 mmol/l cho bit rng c th ang thiu kali ;
vic thiu kali c th c ngun gc :
- do tiu ha : tiu chy, nn i, dng thuc nhun trng kch thch.
- do thn : do tng bi tit qua thn, trong trng hp c bnh l ng thn, bm sinh hoc khi
iu tr bng thuc li mui niu, corticoid hay amphotericine B (IV), do dng qu liu cc cht
kim hay cc dn xut ca cam tho.
- do ni tit : tng aldosterone nguyn pht (cn phi iu tr nguyn nhn).
Vic thiu kali, v mt triu chng, c th gy : mi mt cc c, gi lit, vp b v thay i
in tm , ri lon kh cc, tng kch thch tm tht.
Ion Cl- : cung cp ion Cl- cho ph p iu chnh nhim toan chuyn ha thng c lin quan n
gim kali mu.
Hot cht thuc c phng thch ko di lm gim nguy c gy lo t ca KCl.
DC NG HC
KCl c phng thch k o di trong 6 n 8 gi. Nu lm xt nghim quang tuyn vng bng, s
thy c vin thuc do cu to ca vin thuc c mt khun khng tan t phng thch ra
hot cht. Vin thuc sau khi phng thch ht hot cht vn cn nguyn dng v c o
thi qua phn, iu ny l bnh thng v khng c g phi lo lng.
Hot cht thuc c bi tit ch yu qua nc tiu. Trng hp bnh nhn b suy thn, s
o thi s gim v c th gy tng kali mu.
CH NH
Tng kali mu, nht l khi do dng thuc : thuc li mui niu, corticoid, thuc nhun trng.
CHNG CH NH
Tuyt i :

- Tng kali mu hay tt c cc tnh hung c th gy tng kali mu, c bit l : suy thn, hi
chng addison, tiu ng khng kim sot c (do nhim acid chuyn ha), ri lon trng
lc c bm sinh, dng ng thi vi thuc gi kali ring l hay kt hp vi thuc li mui niu
(ngoi tr khi c kim tra cht ch kali mu).
Tng i :
- Tacrolimus, ciclosporine, thuc c ch angiotensine II, thuc cc ch men chuyn (ngoi tr
trng hp gim kali mu).
THN TRNG LC DNG
- Kim tra kali mu trc v trong thi gian iu tr.
- Thn trng khi s dng cho ngi gi.
TNG TC THUC
Chng ch nh phi hp :
- Thuc li tiu tng kali mu (amiloride, canrenone, spironolactone, triamterene, dng mt
mnh hay phi hp) : nguy c tng kali mu, c th gy t vong, nht l bnh nhn b suy thn
(phi hp tc ng tng kali mu). Trong cc trng hp ny phi chng ch nh phi hp,
ngoi tr trng hp bnh nhn ang b gim kali mu.
Khng nn phi hp :
- Tacrolimus, ciclosporine, thuc c ch angiotensine II, thuc c ch men chuyn : nguy c
tng kali mu, c th gy t vong, nht l bnh nhn b suy thn (phi hp tc ng tng kali
mu) : khng phi hp mui kali vi mt trong cc thuc trn, ngoi tr trng hp bnh nhn
ang b gim kali mu.
TC DNG NGOI
- Tng kali mu (vi nguy c t t) : trnh iu ny, nn kim tra kali huyt thng xuyn.
- Dng liu cao c th gy lot d dy t trng. Nguy c gy lo t rut non, ghi nhn mt vi
dng ung, gim do thuc ny c bo ch di dng phng thch ko di.
LIU LNG v CCH DNG
iu tr thiu kali c xc nhn : liu lng c iu chnh theo gi tr kali mu nh
lng trc v trong thi gian iu tr. Trng hp chc chn h kali mu (di 3,6 mmol/l),
bt u vi liu hng ngy tng ng vi 4 g KCl, tng ng vi 52 mmol kali.
Liu hng ngy c chia lm 2 n 3 ln, nn ung thuc vo cui ba n.

272.

KANAMYCIN MEIJI

MEIJI SEIKA
c/o NOMURA
Bt pha tim 1 g : hp 10 l.
Bt pha tim 1 g : hp 10 ng
THNH PHN
cho 1 l
Kanamycine sulfate

1g

cho 1 ng
Kanamycine sulfate

1g

DC LC
Tc ng :
Kanamycin l khng sinh nhm aminoglycoside, sn sinh bi Streptomyces kanamyceticus.
Thuc c tc ng trn vi khun gram dng, gram m v hiu qu trong iu tr nhiu loi
nhim trng v bnh lao.
Vi sinh hc :
Tc ng khng khun : Kanamycin c tc ng khng vi khun gram dng, gram m v
Mycobacterium tuberculosis. Thuc cng c chng minh hiu qu i vi Staphylococcus a
khng thuc, E.coli v Klebsiella sp.
DC NG HC
Hp thu v o thi : Khi tim bp kanamycin ngi ln khe mnh vi liu duy nht 0,5 g
hoc 1 g, nng nh trong mu t c sau 1 gi vi cc ch s ln lt l 28 mg/ml v 43,1
mg/ml, sau nng gim xung dn dn. Khong 77% liu dng c o thi trong nc
tiu trong vng 6 gi.
DC L LM SNG
Cc kt qu cc th nghim lm sng so snh v th nghim m trn lm sng, bao gm 3089
trng hp c tng kt nh sau :
Hiu qu lm sng : Thuc t hiu qu 82-100% trong nhim trng ng h hp, nh vim
ph qun, vim phi v ho g ; 82-91% trong nhim trng ng tit niu nh vim bng
quang, vim thn-b thn, vim niu o v lu ; 75% trong vim phn ph t cung ; 80% trong
nht c, vim ty, chc ; 83-97% trong vim v, vim hch bch huyt, vim xng ty ; 80100% trong vim amian, vim tai gia ; 82-87% trong nhim trng hu phu v cc nhim
trng khc.

Phn ng ph: Trong 11224 trng hp t cc vin nghin cu trn th gii, cc phn ng ph
c biu hin trong 2252 trng hp (20,1%). Cc phn ng ph thng gp l :
Gim thnh lc (8,3%), tn thng thn kinh (0,1%), suy thn (1,4%), suy gan (0,2%), ri lon
tiu ha (2,3%), au v chai ni tim (1,8%), ni mn (0,5%) v tng bch cu i toan (0,7%).
C TNH
c tnh cp :
ng vt th
nghim

ng
s
dng
Tim IV Tim trong phc mc

Tim
IM
1320
1190

Tim
SC
2020
1970

Ung

Chut c
240
1860
18.700
Chut ci
245
1980
17.500
(LitchfieldWilcoxon method)
Nhim c bn cp v mn tnh : Khi tim bp kanamycin vi liu 100 mg/kg ngy 1 ln ch
(tr ngy th by v ch nht) trong vng 6 thng; khng thy bt thng g trong cc xt
nghim mu, nc tiu v chc nng gan thn hoc trong cc m c th nhm dng 100
mg/kg. Tuy nhin, trong nhm dng 200 mg/kg c xut hin tiu m v tiu mu trong vng 23 tun v c gim PSP v tng NPN.
CH NH
Cc vi khun nhy cm : Staphylococcus, Neisseria gonorrhoeae, Escherichia coli,
Mycobacterium tuberculosis, cc dng nhy cm vi kanamycin ca Streptoccocus
pneumoniae, Proteus sp, Pseudomonas aeruginosa, Haemophilus influenzae, Klebsiella sp.
Cc bnh c ch nh : Nht c, vim ty, chc. Vim v, vim hch bch huyt, vim xng
ty. Vim amian, vim ph qun, vim phi, ho g. Vim thn b thn, vim bng quang, vim
niu o, vim t cung v phn ph, lu. Vim tai gia. Nhim trng th pht sau vt thng,
bng v phu thut. Lao phi v lao ngoi phi.
CHNG CH NH
Bnh nhn c tin s qu mn vi khng sinh nhm aminoglycoside nh streptomycin,
kanamycin, gentamycin v fradiomycin hay bacitracin.
THN TRNG LC DNG
Lu { :
Nn trnh dng kanamycin cho cc bnh nhn sau : bnh nhn c tin s bn thn hoc gia
nh b ic do dng streptomycin hoc do nguyn nhn khc. c bit thn trng khi bt buc
phi dng thuc cho cc bnh nhn ny.
Thn trng :

Bnh nhn suy thn. Bnh nhn ln tui. Bnh nhn dinh dng km hoc bnh nhn ang
dinh dng ng tnh mch. Bnh nhn c tng trng suy kit (Nn theo di st do c th xy
ra nguy c thiu vitamin K).
LC C THAI v LC NUI CON B
Tr s sinh c th b tn thng dy thn kinh s 8 ; do thuc ny ch nn s dng cho ph
n c thai hay nghi ng c thai khi hiu qu iu tr mong mun cao hn bt kz nguy c no c
th xy ra.
Nn trnh cho con b trong thi gian iu tr, do kanamycin qua c sa m.
TNG TC THUC
Do kanamycin lm tng kh nng c thn cc dch truyn thay th mu nh dextrans, nn
trnh dng chung vi cc dch trn.
Vic c ch h hp do phong to thn kinh c c th xy ra, do cn c bit thn trng khi
dng vi thuc v cm hoc thuc gin c.
Nn trnh kt hp vi thuc li tiu quai nh ethacrynic acid v furosemide, do kh nng tng
c tnh ln thn v tai.
Nn trnh kt hp vi cc thuc gy c thn v c tai, nh vancomycin, capreomycin v
enviomycin, do kh nng tng c tnh ln thn v tai.
Nn trnh kt hp vi cc thuc gy c thn, nh ciplastin, carboplatin, cyclosporin v
amphotericin B, do kh nng tng c tnh ln thn.
TC DNG NGOI
H thn kinh : tn thng dy thn kinh s 8, gy ra cc triu chng nh tai, gim nghe v
chng mt (do tn thng tin nh) c th xy ra ; do , nn theo di cht ch. Nn ngng
thuc khi c cc triu chng trn xy ra. c bit thn trng khi bt buc phi dng thuc.
Thn : him khi c cc bnh thn nng, suy thn cp c th xy ra, do cn theo di st bao
gm cc xt nghim nh kz. Nu c g bt thng, nn ngng thuc v thay th bng tr liu
thch hp. Him khi : ph, tiu m, tiu mu, ri lon in gii kali c th xy ra.
Sc : nn theo di st, d triu chng sc him khi xy ra. Ngng thuc v thay th bng tr liu
thch hp khi c cc triu chng nh au ngc, kh th, nh trng ngc, h huyt p .v.v. xy
ra.
Qu mn : ngng thuc nu c phn ng qu mn nh ni mn xy ra. Khi cn dng thuc li
(trong bnh lao), cn lm gii cm ng.
Thiu vitamin : him khi gy thiu vitamine K (gim prothrombin mu, d chy mu.v.v.) v
thiu vitamin B (vim li, vim ming, chn n, vim thn kinh v.v.).
Mt s tc dng ngoi khc : nhc u, t mi c th xy ra.
LIU LNG v CCH DNG
Liu dng :
iu tr bnh lao :

Ngi ln : liu thng dng 2 g kanamycin tim bp chia ra ln (sng v ti), 2 ln mi tun.
Hoc dng liu 1 g ngy 1 ln trong 3 ngy/tun. Thuc c th dng ti ch khi cn thit.
Bnh nhn ln tui (> 60 tui), 0,5-0,75 g dng 1 ln.
Nn gim liu tr em v bnh nhn nh k.
Ni chung, thuc ny nn c dng phi hp vi cc thuc khng lao khc.
Cc nhim trng khc :
Liu thng ngy ngi ln 1-2 g kanamycin tim bp, chia ra 1-2 ln. Tr em: 30-50 mg/kg
th trng/ngy tim bp, chia ra 1-2 ln. Thuc c th dng ti ch khi cn thit.
Liu c th c iu chnh ty theo tui bnh nhn v mc triu chng.
Lu { khi s dng :
Khi tim bp, nn tun theo cc thn trng sau trnh tc dng ph cho m v thn kinh :
- Khng tim v tr c dy thn kinh.
- Khng tim lp li cng mt ch tim. Thn trng c bit khi tim cho tr s sinh, tr sinh
non v tr b m, tr nh nhi.
- Khi bnh nhn b au nhiu hoc c chy mu ngc ln ti ni tim, nn rt kim ra ngay v
tim ni khc.
- Khng nn trn vi cc thuc khc khi tim.
- Trnh dng lin tc, dng ko di.
- St trng l thuc bng bng tm cn.
Tc ng c ch thn kinh c v lit h hp c th xut hin, d aminoglycoside c dng
bng ng no, nht l khi bnh nhn ang dng thuc v cm hoc thuc gin c hay bnh
nhn ang c truyn lng nhiu mu chng ng bng citrate.
Dung dch pha kanamycin sulphate phi trong sut v khng mu. Dung dch him khi c mu
nh v thng khng gy hi khi s dng.
BO QUN
Trnh trn chung vi cc thuc khc v kanamycin c th gy nhum mu hay mt hiu lc.
Sau khi pha thuc nn dng ngay, nu khong phi bo qun nhit phng.
Bo qun thuc nhit phng.

273.

KEFADIM

ELI LILLY
Bt pha tim 1 g : hp 1 l.
THNH PHN

cho 1 l
Ceftazidime pentahydrate

1g

TNH CHT
Ceftazidime l khng sinh nhm cephalosporin c tc dng dit khun bng cch c ch s tng
hp protein thnh t bo vi khun v ceftazidime khng li hu ht cc enzym b-lactamase.
Vi liu bnh thng, nng iu tr t c trong cc m ca c th l c s cho cc ch
nh c bit. Sau khi tim bp liu 500 mg v 1 g ceftazidime, nng nh trung bnh trong
huyt tng ln lt l 18 mg v 37 mg/mL.
Sau khi tim tnh mch ceftazidime liu 0,5 g, 1 g v 2 g, nng trung bnh trong huyt tng
ln lt l 46 mg/mL, 87 mg/mL v 170 mg/mL. Nng iu tr trong huyt thanh t c t
8 n 12 gi sau khi tim tnh mch hoc tim bp. Thi gian bn thi khong 1,8 gi. Thuc kt
hp km vi protein trong huyt tng, ch khong 10%. Ceftazidime khng chuyn ha trong
c th v thi tr nguyn vn nc tiu qua lc cu thn. Khong 80-90% liu dng c thi
theo nc tiu trong vng 24 gi.
In vitro, ceftazidime dit c cc vi khun sau y :
- Gram m : Pseudomonas aeruginosa v Pseudomonas spp., Klebsiella pneumoniae v
Klebsiella spp., Proteus sp. (c indole dng tnh v indole m tnh), Providencia sp., Escherichia
coli, Enterobacter spp., Citrobacter spp., Serratia spp., Salmonella spp., Shigella spp., Yersinia
enterocolitica, Pasteurella multocida, Acinetobacter sp., Neisseria gonorrhoeae, Neisseria
meningitidis, Haemophilus influenzae (bao gm cc chng to b-lactamase v Haemophilus
parainfluenzae).
- Gram dng : Staphylococcus aureus, Staphylococcus epidermidis, Micrococcus spp.,
Streptococcus spp. (bao gm Streptococcus pneumoniae v Streptococcus pyogenes).
- Vi khun k kh : Peptococcus spp., Peptostreptococcus spp., Streptococcus spp.,
Propionibacterium spp., Clostridium perfringens, Fusobacterium spp., Bacteroides spp. (nhiu
chng Bacteroides fragilis u khng).
In vitro, ceftazidime khng tc ng ln Staphylococcus khng methicillin, Streptococcus
faecalis, Listeria monocytogenes, Campilobacter spp. hoc Clostridium difficile. Thnh phn
mui sodium tng cng khong 52 mg (2,3 mEq) i vi mi gam Ceftazidime.
CH NH
Ceftazidime c ch nh trong cc nhim khun nng, do nhng chng vi khun nhy cm
n thun hay phi hp nu trn, bao gm cc bnh sau :
Nhim khun ng h hp di, nhim khun ng tit niu, nhim khun trong bng bao
gm vim mng bng v nhim khun ng mt, nhim khun huyt, nhim khun ph khoa,

nhim khun da v m mm, nhim khun xng v khp.

Trc khi khi u iu tr, nn th nghim khng sinh , s b phn lp v nh danh chng
vi khun gy bnh. Nu tnh trng nhim khun trm trng v kiu lm sng cho thy do
nhng vi khun nhy vi ceftazidime, vic iu tr c th bt u ngay trc khi c kt qu
khng sinh . Nu nhim khun nng e da n tnh mng, c th phi hp iu tr ngay
Ceftazidime vi mt loi aminoglycoside v theo di st chc nng thn. Liu dng ca c hai
loi khng sinh trn ty thuc vo mc nng ca bnh l nhim khun v ton trng ca
ngi bnh.
Nu nghi ng c nhim cc vi khun k kh, nn phi hp Ceftazidime vi mt khng sinh thch
hp.
CHNG CH NH
Khng dng Ceftazidime vi ngi bnh qu mn cm vi khng sinh nhm cephalosporin.
CH PHNG
Trc khi dng Ceftazidime, phi kim tra bit ngi bnh trc y c mn cm vi
cephalosporin, penicillin hoc c tin s d ng vi cc thuc khc hay khng.
THN TRNG LC DNG
Ceftazidime nn thn trng khi dng cho ngi bnh c ghi nhn c qu mn cm vi
penicillin hoc c tin s d ng thuc.
Khi c cc du hiu u tin ca s qu mn cm, cn ngng iu tr ngay. Mc du cha c
trng hp no c vi thn c ghi nhn, nhng phi theo di st chc nng thn ngi
ang dng liu cao hoc phi hp vi aminoglycoside. Cn gim liu dng, ty thuc vo s suy
gim ca chc nng thn, trnh nhng din bin do nng thuc cao, v d nhng cn
ng kinh (xin c phn Liu lng v Cch dng cc bnh nhn c chc nng thn gim).
LC C THAI
S khng nguy hi ca Ceftazidime ngi mang thai cha c xc nh, v vy khng nn
dng thuc ny khi c thai. Thuc ch nn dng trong nhng trng hp ngoi l, khi m vic
nh gi gia li v hi c cn nhc k.
LC NUI CON B
Ceftazidime c bi tit qua sa vi nng thp. Nn thn trng khi dng thuc cho cc b
m ang thi kz cho con b.
TNG TC THUC
- Phi hp Ceftazidime vi cc khng sinh nhm aminoglycoside c th gy ra cc du hiu c
cho thn (xin c phn Thn trng lc dng), v khng nn trn chung trong cng mt ng bm
tim, trnh tng k thuc.
Cc sai lch trong kt qu xt nghim : C th gp kt qu dng tnh gi trong th nghim
Coombs hoc xt nghim ng niu bng k thut dng cht kh (Fehling, Clini-Test...), tuy
vy khng nh hng i vi cc phng php dng enzym.

TC DNG NGOI
Nhng tc dng ph sau y c ghi nhn trong cc trng hp ring bit :
- Ti ch : Vim tnh mch hoc vim tc tnh mch do tim tnh mch. au sau khi tim bp.
- Qu mn cm : da, st v nga.
- H tiu ha : Tiu chy, bun nn, nn, au bng v him gp vim i trng.
- Huyt hc : Tng thong qua ur v creatinine mu, him gp hn l gim bch cu, gim bch
cu trung tnh, gim tiu cu thong qua.
- Gan : Tng thong qua cc enzym gan : SGOT, SGPT v phosphatase kim.
- H thn kinh trung ng : Nhc u, chng mt, d cm v ri lon v gic.
Dng thuc di ngy c th bi nhim cc loi vi khun khng nhy cm vi thuc. Trong mt
s him trng hp, c thy cn ng kinh ngi bnh suy thn m liu Ceftazidime gim
khng mc.
LIU LNG v CCH DNG
Liu lng, ng tim v khong cch gia cc ln tim ty thuc vo mc nhim khun,
tnh trng ca ngi bnh v nhy cm ca vi khun i vi Ceftazidime.
Liu dng cho tim tnh mch v tim bp ging nhau, cc liu cao hn nn dng theo ng
tnh mch.
Khi chc nng thn bnh thng :
Ngi ln : Liu dng 1 n 6 g/24 gi, v d 0,5 g, 1 g hoc 2 g dng tim tnh mch hoc tim
bp cho mi 8 hoc 12 gi.
Trong hu ht nhng trng hp nhim khun, dng thuc vi cc liu 1 g cho mi 8 gi hoc 2
g cho mi 12 gi.
Vi nhim khun ng tit niu v nhng nhim khun t trm trng, liu thng dng 0,5 g
hoc 1 g cho mi 12 gi l .
i vi ngi bnh nhim khun rt nng, nht l ngi b suy gim min dch bao gm cc
bnh nhn b gim bch cu trung tnh v nhim Pseudomonas, nn dng 2 - 3 gam cho mi 8
gi.
Tr em : Tr s sinh n 2 thng tui : Mc du cn c gii hn v cc th nghim lm sng,
nhng liu 25 mg n 60 mg/kg/24 gi, chia lm 2 ln dng, chng t c hiu qu.
Tr trn hai thng tui v di mt nm tui : 25 mg n 50 mg/kg hai ln trong 24 gi.
Tr em trn mt nm tui : 30 n 100 mg/kg/24 gi, chia lm 2 n 3 ln dng.
tr em b bnh nng, c th dng n 150 mg/kg/24 gi v ti a l 6 g/24 gi, c th chia
lm 3 ln dng.
Khi chc nng thn km :
Trong trng hp ny, liu dng nn xc nh ty thuc vo mc suy gim chc nng ca
thn.

 ngi ln sau liu khi u 1 g, cc liu duy tr nn dng tip theo v c th xc nh da

theo bng sau :
H s thanh thi
creatinine
(mL/pht)
50 - 31
30 - 16
15 - 16
<5

Nng creatinine
trong huyt tng
mmol/L (mg/100mL)
150 - 200 (1,7 - 2,3)
200 - 350 (2,3 - 4,0)
350 - 500 (4,0 - 5,6)
> 500 (> 5,6)

Liu ceftazidime
ngh dng cho mi
ln (gam)
1,0
1,0
0,5
0,5

Tn s
dng
(gi)
12
24
24
48

Liu dng nn tng ln ngi bnh nhim khun nng, nht l ngi b gim bch cu trung
tnh i km. Liu dng cho mi ln bng trn c th tng thm 50% hoc chn cch tng tn
s dng thuc. Nng Ceftazidime trong huyt tng nhng i tng trn cng phi c
kim sot, khng cho ph p nng ti thiu vt qu 40 mg/mL.
Nu ch bit tr gi nng creatinine trong huyt tng (mg/100mL), ta c th i sang tr gi
thanh thi creatinine tng ng bng cch tnh ton qua cng thc sau :
Nam = Th trng (kg) x (140 - tui) / 72 x creatinine huyt tng
N = 0,85 tr gi ca nam.
Sau khi thm phn lc mu, ngi bnh khng cn phi dng liu b sung. Tuy nhin, phi tnh
liu dng trong khi thm phn lc mu, ngi bnh c th c dng mt liu lc kt thc
tin trnh ny.
Cch dng
Cc l thuc c cung cp dng gim p lc. Khi pha thuc, CO2 c phng thch ra v
to nn p lc dng. d dng, nn tin hnh theo k thut sau :
ng tim bp : Pha l thuc 1 g vi 3 mL dung dch ng pha long thuc. Lc u thuc
tan ht.
ng tim tnh mch : i vi tim tnh mch trc tip, pha thuc vi dung dch ng pha
long thuc. i vi truyn tnh mch trong khong thi gian ngn (v d, di 30 pht), pha 2
g trong 50 mL dung dch nc ct.
Cc dung dch ny c th c tim trc tip vo tnh mch, hoc qua ng dy truyn tnh
mch nu ngi bnh ang c truyn cc dung dch thch ng vi thuc.
L 1 g, tim bp/tim tnh mch :
1. Chc kim xuyn qua np l v bm vo dung dch pha long thuc. Vng chn khng trong l
s gip dch pha long vo d dng. Sau , rt kim bm tim ra.
2. Lc l thuc ha tan thuc hon ton. CO2 c phng thch v sau 1 - 2 pht s c

mt dung dch trong sut.

3. Lt ngc l thuc. Vi bm tim n pt-tng xung ht, hy chch kim qua np l, dung
dch thuc s vo ng bm tim (p lc to nn trong l s gip a thuc vo ng bm tim).
Phi m bo l u kim lun nm trong phn dung dch thuc, m khng nm trong phn kh
bn trn. Dung dch rt ra c th cha mt t bt kh CO2, nn tng kh ra trc khi dng.
Tnh n nh trong hu ht cc cht ha tan thng thng : dung dch tim sau khi ha tan
thuc vi mt lng dch ha tan ch nh nn c dng sau mt thi gian ngn. Nu
khng th thc hin c, cc dung dch pha vi nc hoc vi bt kz mt loi dch ha tan
thuc thng thng no khc s c duy tr tt n 24 gi nu c bo qun nhit
di 25oC. Ceftazidime n nh nng t 1 mg/mL n 40 mg/mL, tr trong dung dch
sodium bicarbonate m ngi ta khuyn khng bao gi nn dng pha thuc.
Ghi ch : gi cho thuc c v khun, cn ch { l kim dng ht kh ra khng c n
vo trc khi ton b thuc c ha tan.
i vi tim bp, c th dng dung dch lidocaine hydrochloride 0,5% hoc 0,1% pha thuc.
Dung dch ny c th bo qun n 6 gi 25oC.
QU LIU
Cc du hiu ng c v cc triu chng xy ra sau khi dng Cefatazidime qu liu bao gm :
au, vim ti ch v vim tnh mch ch tim thuc.
Dng ng tim cephalosporin nhng liu ln khng thch hp c th gy nn nhc u, d
cm v chng mt. ng kinh do dng qu liu i vi mt s loi cephalosporin c th xy ra,
c bit ngi bnh suy thn v d b tch ly thuc.
Nhng thay i bt thng v kt qu xt nghim sau khi dng qu liu bao gm : tng
creatinine, BUN, enzym gan v bilirubin, th nghim Coombs dng tnh, tng tiu cu, gim
tiu cu, tng bch cu a eosin, gim bch cu v ko di thi gian prothrombin.
Liu tim di da trung bnh gy cht chut cng v chut nht trng thay i t 5,8 n 20
g/kg, trong khi liu tim tnh mch gy cht th l trn 2 g/kg.
X tr : Khi iu tr vic dng qu liu, nn quan tm n kh nng dng qu liu vi nhiu loi
thuc v dc ng hc bt thng ca thuc ngi bnh.
Nu ngi bnh phn ng vi thuc, phi ngng ngay vic dng thuc.
Thuc chng co git c th c dng iu tr, nu c ch nh lm sng. Bo m ng
th thng, duy tr thng kh v truyn dch.
Theo di st v duy tr cc chc nng sinh tn trong nhng gii hn cho php : nng cc cht
kh trong mu, cc cht in gii...
Nu qu liu trm trng, nht l trn ngi bnh c suy thn v khi cc phng php tr liu
cn bn tht bi, nn t vn kt hp truyn mu vi thm phn lc mu.

274.

KEFLOR

RANBAXY
hn dch ung 125 mg/5 ml : l 60 ml.
vin nn tan r nhanh 250 mg : v 6 vin, hp 5 v.
vin nn tan r nhanh 125 mg : v 6 vin, hp 5 v.
vin nn bao phim phng thch chm 375 mg : v 6 vin, hp 5 v.
THNH PHN
cho 1 mung caf Keflor hn dch (5 ml)
Cefaclor

125 mg

cho 1 vin Keflor Distab

Cefaclor

125 mg

cho 1 vin Keflor Distab

Cefaclor

250 mg

cho 1 vin Keflor MR

Cefaclor

375 mg

M T
Cefaclor l khng sinh cephalosporin bn tng hp th h th 2. Cu to ha hc ca cefaclor l
3-chloro-7-D-(2-phenylglycinamido)-3-cephem-4-carboxylic acid monohydrate. Cng thc phn
t l C15H14ClN3O4S. H2O v khi lng phn t l 385,8.
DC LC
C ch tc dng :
Cefaclor l mt cephalosporin dit khun v cng nh cc cephalosporin khc, n c ch s
tng hp thnh t bo vi khun. N axyl ha cc enzym transpeptidase gn kt vi mng v vy

ngn nga s lin kt cho ca peptidoglycan cn thit cho s vng chc v bn ca thnh
t bo vi khun.
Ph khng khun :
Ph khng khun ca cefaclor bao gm cc vi khun sau :
Staphylococci (coagulase dng tnh, coagulase m tnh v nhng chng sinh penicillinase),
Streptococcus pyogenes, Streptococcus pneumoniae, Moraxella catarrhalis bao gm nhng
chng sinh b-lactamase, Haemophilus influenzae bao gm nhng chng sinh b-lactamase,
Escherichia coli, Proteus mirabilis, Klebsiella spp., Neisseria gonorrhoea.
Th nghim tnh nhy cm : Th nghim v tnh nhy cm bng phng php dng a khng
sinh theo Hi ng Quc Gia v cc tiu chun xt nghim dng cho lm sng (NCCL), a ra
cc tiu chun v ng knh vng i vi cefaclor nh sau :
<= 14 mm : khng thuc
15-17 mm : nhy cm trung bnh
>= 18 mm : nhy cm
DC NG HC
i vi dng Keflor vin nang, bt pha hn dch v Keflor Distab :
Cefaclor dung np tt qua ng ung. S hin din ca thc n c th lm chm s hp thu
nhng lng hp thu th khng thay i. Nng huyt thanh 6 mg/l v 13 mg/l c ghi nhn
sau khi ung ln lt 250 mg v 500 mg cefaclor. Nng nh huyt thanh c ghi nhn t
0,5 n 1 gi. Khong 25% thuc kt ni vi protein. Cefaclor phn b rng n khp c th.
Thuc thi tr nhanh qua thn, 85% liu qua nc tiu di dng khng i trong 2 gi. Thi
gian bn hy trong huyt tng ca cefaclor khong 30 pht n 1 gi.
i vi dng Keflor MR :
Sau liu ung Keflor MR, thuc c hp thu tt qua ng tiu ha, ch yu nh c ch
khuch tn th ng. Keflor MR c thi gian bn hy huyt thanh khong 0,7 gi. Nng nh
trong huyt tng (Cmax) sau liu ung Keflor MR khi i vo khong 4,75 mg/ml sau khong 2
gi. Nu ung khi no, thi gian t nng nh trong huyt tng b chm n hn 3 gi, v
Cmax cng gim xung (4,36 mg/ml). V vy, nn ung Keflor MR khi i.
i vi cefaclor (phng thch chm) nng trong mu c duy tr lu hn so vi cefaclor
dng phng thch tc th. S tun th ca bnh nhn i vi cefaclor phng thch chm tt hn.
Thi gian lu trung bnh (MRT) ngha l thi gian trung bnh thuc hin din trong c th c
k o di 50% i vi cefaclor (phng thch chm) so vi cefaclor phng thch tc th, gip
cefaclor c th c ung 2 ln trong ngy thay v 3 ln nh dng phng thch tc th.
Khong 25% cefaclor c gn kt vi protein huyt tng. Cefaclor c phn b rng ri
trong c th, vi nng cao dch tai gia, dch xoang v cht tit kh qun. Thuc i qua
nhau thai, v c tit rt t qua sa.
Cefaclor khng b chuyn ha gan, v ngi ta khng pht hin thy cc sn phm chuyn

ha ca cefaclor. Trong 2 gi u sau khi ung thuc, khong 38-54% thuc c pht hin
trong nc tiu, v sau 8 gi t khi ung thuc, khong 85% thuc c bi tit qua nc tiu
dng khng chuyn ha.
CH NH
c ch nh iu tr cc nhim khun sau y gy ra bi cc vi khun nhy cm :
Vim ph qun cp v t cp vim ph qun mn do S. pneumoniae, Haemophilus influenzae,
(bao gm nhng chng sinh b-lactamase), Haemophilus parainfluenzae, Moraxella catarrhalis
(bao gm nhng chng sinh b-lactamase) v S. aureus.
Vim phi do S. pneumoniae, Haemophilus influenzae (bao gm nhng chng sinh b-lactamase)
v Moraxella catarrhalis (bao gm nhng chng sinh b-lactamase).
Vim tai gia cp, vim hng, vim amydan v vim xoang do S. pyogenes, S. pneumoniae,
Haemophilus influenzae, S. aureus (bao gm nhng trng hp khng amoxicillin).
Nhim khun tit niu do E. coli, Klebsiella pneumoniae, Proteus mirabilis v S. saprophyticus.
Nhim khun da v m mm do S. aureus, S. epidermidis v S. pyogenes.
CHNG CH NH
Chng ch nh nhng bnh nhn c tin s d ng vi khng sinh nhm cephalosporin.
CH PHNG
Keflor phi c dng thn trng cc bnh nhn nhy cm penicilline. Cn nghi ng chn
on vim i trng mng gi nhng bnh nhn b tiu chy khi ang dng Keflor.
THN TRNG LC DNG
Tng qut :
Cn thn trng cn nhc gia nguy c v li ch khi ch nh cho cc bnh nhn c tin s ri
lon chy mu, vim lo t i trng, vim rut khu tr hoc vim i trng mng gi.
Phi ngng dng nhng bnh nhn c phn ng d ng vi thuc, v cn c iu tr thch
hp vi cc thuc tng p loi amine, khng histamine hay corticosteroide.
Dng Keflor ko di c th lm cho cc vi khun khng nhy cm pht trin qu mc.
Tnh sinh ung th v t bin :
Cha c bng chng no cho thy cefaclor gy ra ung th v t bin.
Kh nng sinh sn :
Cc nghin cu y v c kim tra ngi cha c tin hnh. Tuy nhin cc nghin cu
trn ng vt cho thy cefaclor khng nh hng ln kh nng sinh sn.
S dng trong nhi khoa :
Chuyn ha v/hoc thanh thi qua thn ca cephalosporin thp hn dn n thi gian bn
hy k o di c ghi nhn tr s sinh.
Cc nghin cu y v mi lin h gia tui v tc dng ca cefaclor cha c tin hnh
tr sinh thiu thng v tr di mt thng tui. Tuy nhin, cc nh hng c hiu trn nhi
khoa cho n nay cha c ghi nhn tr mt thng tui hoc ln hn.

S dng trong lo khoa :

Cho n nay cha ghi nhn c nh hng c hiu no trn lo khoa khi dng cephalosporin
ngi ln tui. Tuy nhin bnh nhn ln tui thng c gim chc nng thn lin quan n
tui nn c th cn iu chnh liu v/hoc khong cch gia liu nu ch nh cephalosporin
cho cc bnh nhn ny.
S dng trong nha khoa :
iu tr cephalosporin ko di c th dn n pht trin Candida albicans qu mc, dn n
nm candida ming.
S dng bnh nhn suy gan/ suy thn :
V cefaclor khng chuyn ha gan, khng cn iu chnh liu bnh nhn suy gan. Tuy nhin,
liu dng phi c gim bnh nhn suy thn.
LC C THAI
Cefaclor thm c qua nhau thai. Tuy nhin nhng nghin cu trn ng vt cho thy cefaclor
khng gy tc dng ph trn bo thai. Nhng nghin cu y v c kim tra ngi cho
n nay cha c tin hnh. Keflor ch c th dng ph n c thai nu c ch nh r rng.
LC NUI CON B
Cefaclor khuch tn vo sa m, thng nng thp. Tuy nhin cc nh hng trn ngi
cho n nay cha c bo co. Keflor ch c th dng ph n nui con b nu c ch nh r
rng.
TNG TC THUC
Thuc khng ng, coumarin hoc cc dn xut indandione hoc Heparin v cht tiu huyt :
Cephalosporin c th c ch s tng hp vitamin K bng cch c ch khun ch trong lng rut.
Cn iu tr d phng bng vitamin K khi dng ko di mt trong cc thuc ny cc bnh
nhn suy dinh dng v bnh nng.
Probenecid : Probenecid lm chm s bi tit cefaclor.
S hp thu ca Keflor MR gim nu dng chung vi cc thuc khng acid c cha aluminium
hydroxide hay magnesium hydroxide trong vng 1 gi.
Thay i cc gi tr xt nghim :
Test Coombs (antiglobulin) : Phn ng Coombs dng tnh thng xy ra cc bnh nhn dng
liu ln cephalosporin ; tn huyt t khi xy ra nhng c ghi nhn ; th nghim cng
dng tnh tr s sinh c m dng cephalosporin trc lc sinh.
Glucose niu : Cefaclor c th lm glucose niu dng tnh gi hoc tng cao gi to khi th
nghim dng sulfate ng (Benedict's, Fehling's, hoc vin Clinitest). Cc xt nghim tm
glucose bng phng php ln men nh Clinistix v Tes-Tape th khng b nh hng.
Thi gian prothrombin (PT) : Cefaclor c th c ch s tng hp vitamin K do c ch khun ch
trong lng rut. Do thi gian prothrombin c th ko di.
TC DNG NGOI

Tiu ha : Bun nn, nn, au bng, vim i trng mng gi, tng nh SGOT, SGPT hay
phosphatase kim.
Huyt hc : Tng thong qua lympho, tng bch cu a acid, gim bch cu, thiu mu tn
huyt v gim bch cu a nhn c hi phc.
Thn : Tng nh creatinine huyt thanh, BUN hay bt thng kt qu phn tch nc tiu, vim
thn k c hi phc.
Thn kinh trung ng : Kch ng, mt ng, l ln, gim trng lc, chng mt, ng g.
Cc phn ng qu mn : Nga, ni m ay, cc phn ng ging nh bnh huyt thanh, hi
chng Stevens-Johnson, hoi t thng b.
LIU LNG v CCH DNG
Keflor vin nang, Kelfor ht pha hn dch, Keflor Distab :
Ngi ln :
250 - 500 mg mi 8 gi. Liu cao nht l 4 g/ngy.
Tr em :
Tr di 1 thng : Liu lng cha c nghin cu.
Tr di 1 tui : 62,5 mg ung 3 ln/ngy.
Tr 1 - 5 tui : 125 mg ung 3 ln/ ngy.
Tr trn 5 tui : 250 mg ung 3 ln/ngy.
Cch dng :
Keflor vin nang : Nut thuc vi mt t nc.
Kelfor ht pha hn dch : Pha thuc theo hng dn trong toa.
Kelfor Distab : Ha tan vin thuc trong 1 tha y nc (5 ml) trc khi ung.
Kelfor MR :
Ngi ln : i vi nhim khun nh v trung bnh : Mt vin Keflor MR 2 ln mi ngy.
i vi nhim khun nng : 2 vin Keflor MR 2 ln mi ngy.
Cn ung thuc khi i v thc n lm gim sinh kh dng ca thuc. Ung nguyn c vin.
Ngi ln tui : Khng cn iu chnh liu nu chc nng thn bnh thng.
Thi gian iu tr tuz thuc vo loi nhim khun, thay i t 7 ti 10 ngy.
QU LIU
Sau khi ung qu liu, bnh nhn c cc triu chng bun nn, i, au thng v v tiu chy.
iu tr triu chng v nng , bao gm duy tr kh o, lm kh mu v in gii huyt
thanh. C th dng than hot, v n gip lm gim hp thu cefaclor. Khng nn dng li tiu
mnh, thm phn phc mc, chy thn nhn to hoc lc mu vi than hot iu tr qu
liu.
BO QUN
Keflor vin nang, Keflor Distab v Kelfor MR : Bo qun nhit khng qu 25oC, trnh m.

Hn dch : Bo qun trong cc bao b kn nhit khng qu 25oC, trnh m. Sau khi pha, hn
dch cn tc dng sau 14 ngy nu c bo qun trong t lnh.

275.

KEFZOL

ELI LILLY
Bt pha tim 1 g : hp 1 l.
THNH PHN
cho 1 l
Cefazolin sodium

1g

(hm lng Natri : 48,3 mg)

DC LC
Cefazolin Sodium v khun l khng sinh nhm cephalosporin bn tng hp dng ng tim
bp hoc tim tnh mch. Tn ha hc 5-Thia-1-azbicyclo[4,2,0]oct-2-ene-2-carboxylic acid, 3[[(5-methyl-1,3,4-thiadiazol-2yl)thio]methyl]-8-oxo-7-[[1H-tetrazol-1-yl)acetyl]amino]-mui
monosodium (6R-trans). Hm lng Natri l 48,3 mg trong 1 g cefazolin sodium. Cng thc
phn t C14H14N8O4S3. Trng lng phn t l 476,5. pH ca dung dch pha t 4,5-6.
Cc th nghim in vitro cho thy cephalosporin c tc ng dit khun do c ch s tng hp
thnh t bo. Cefazolin c hiu qu trn cc vi khun sau c trn in vitro v trn nhim khun
lm sng :
Staphylococcus aureus (k c cc chng tit men penicillinase),
Staphylococcus epidermidis,
Staphylococci khng methicillin (Meti-R) cng khng vi cefazolin,
Streptococcus beta tn huyt nhm A v cc chng streptococci khc (a s cc chng
Enterococci u khng),
Streptococcus pneumoniae,
Klebsiella sp,
Escherichia coli,
Enterobacter aerogenes,
Proteus mirabilis,
Haemophilus influenzae.

Hu ht cc chng Proteus Indole dng tnh (Proteus vulgaris), Enterobacter cloacae,

Morganella morganii, v Providencia rettgeri u khng. Serratia, Pseudomonas, v
Acinetobacter calcoaceticus (trc kia l Mima v Herellea sp) hu nh khng cefazolin.
Khng sinh :
Cc phng php nh lng i hi cn phi o ng knh vng v khun, phng php ny
cho ph p c lng chnh xc nht tnh nhy cm ca vi khun vi cc khng sinh. Phng
php dng a khng sinh c ngh th tnh nhy cm ca vi khun i vi cefazolin.
Vi phng php ny, bo co t phng th nghim cho kt qu "Nhy cm" c { ngha cc vi
khun gy bnh s p ng vi s tr liu. " khng" c ngha vi khun khng p ng vi s
tr liu. "Nhy cm trung gian" c { ngha cc vi khun gy bnh s nhy cm nu dng khng
sinh liu cao hoc nu nhim khun xy ra cc m v dch (nh nc tiu), nhng ni m
nng khng sinh t c mc cao.
i vi cc vi khun gram dng phn lp c, khi c th vi a khng sinh nhm
cephalosporin (30 mg cephalothin) hoc vi a cefazolin (30 mg cefazolin), kt qu vng v
khun ng knh 18 mm cho bit vi khun nhy cm vi cefazolin.
i vi vi khun gram m, nn th vi a cefazolin (dng cc tiu chun nh nu trn) v
qua th nghim in vitro cho thy mt s chng Enterobacteriaceae nhy cm vi cefazolin
nhng li cho kt qu khng khi th vi a khng sinh cephalothin. Khi dng a
cephalothin cc vi khun gram m c ng knh vng v khun >= 18 mm c th coi l nhy
cm vi cefazolin. Tuy nhin, cc vi khun cho ng knh vng v khun nh hn 18 mm a
cephalothin khng nht thit l khng hoc nhy cm trung gian i vi cefazolin.
Khng nn dng a cefazolin th tnh nhy cm ca cc cephalosporin khc.
Cc phng php pha long :
Mu vi khun phn lp c xem nh nhy cm nu nng c ch ti thiu (MIC) cefazolin
nh hn hoc bng 16 mg/mL. Cc vi khun xem nh khng nu MIC ln hn hoc bng 64
mg/mL.
DC NG HC
Dc l hc trn ngi : Bng 1 biu din thi gian v nng cefazolin tng ng t c
trong mu khi tim bp.
Bng 1. Nng trong huyt thanh sau khi tim bp

Nng

Nng
thuc trong
huyt thanh
(mg/mL)

1/2 gi

1 gi

2 gi

4 gi

6 gi

8 gi

250 mg

15,5

17

13

5,1

2,5

500 mg

36,2

36,8

37,9

15,5

6,3

7,1

1 g*

60,1

63,8

54,3

29,3

13,2

* Tr s trung bnh ca 2 nghin cu

Cc nghin cu v dc l hc lm sng cho thy nng nh trung bnh ca cefazolin trong
huyt thanh bnh nhn nhp vin do nhim khun v ngi tnh nguyn bnh thng
tng ng nhau.
Trong mt nghin cu ( ngi bnh thng), tim truyn nh git tnh mch lin tc liu 3,5
mg/kg trong 1 gi (khong 250 mg) v 1,5 mg/kg trong 2 gi tip theo (khong 100mg), nng
cefazolin trong huyt thanh n nh gi th 3 khong 28 mg/ml. Bng 2 biu din nng
trung bnh trong huyt thanh sau khi tim tnh mch mt liu duy nht 1 g ; thi gian bn hy
trung bnh 1,4 gi.
Bng 2. Nng trong huyt thanh sau liu tim tnh mch 1 g
Nng
thuc
trong
huyt
thanh
(mg/mL)
5 pht

15 pht

30 pht

1 gi

2 gi

4 gi

188,4
135,8
106,8
73,7
45,6
16,5
Trong cc nghin cu c kim sot ngi ln bnh thng s dng liu 1 g, 4 ln 1 ngy, trong
10 ngy, khng thy c nhng s thay i r rt v mt lm sng do cefazolin gy ra thng qua
vic gim st cc tr s CBC, SGOT, SGPT, bilirubin, phosphatase kim, BUN, creatinine v phn
tch nc tiu.
Cefazolin c thi tr dng khng i trong nc tiu, phn ln qua s lc cu thn v mt
phn nh do s bi tit ng thn. Tim bp liu 500 mg, khong 56% n 89% liu s dng
c pht hin trong nc tiu trong 6 gi v t 80% n gn 100% trong 24 gi. Vi liu tim
bp 500 mg v 1 g, cefazolin t c nng nh trong nc tiu cao hn 1.000 mg/mL v
4.000 mg/mL.
i vi bnh nhn c thm phn phc mc (2 L/gi), sau 24 gi nng trung bnh trong huyt
thanh khong 10 mg/mL v 30 mg/mL tng ng vi dung dch thm phn cha 50 mg/mL v
150 mg/mL. Nng nh trung bnh trong huyt thanh l 29 mg/mL (t 13 n 44 mg/mL) vi

50 mg/mL (3 bnh nhn) v 72 mg/mL (t 26 n 142 mg/mL) vi 150 mg/mL (6 bnh nhn).
Cefazolin c dung np tt khi s dng bng ng tim qua mng bng.
Khi s dng cefazolin cho nhng bnh nhn khng b tc nghn ng mt, nng Cefazolin
m ti mt v mt cao hn hn nng trong huyt thanh. Tuy nhin khi ng mt b tc
nghn, nng khng sinh trong mt thp hn ng k so vi nng trong huyt thanh.
Cefazolin thm qua mng hot dch b vim v nng khng sinh t c khp c th
tng ng vi nng trong huyt thanh.
Cefazolin d dng qua hng ro nhau thai i vo dy rn v dch i. Cefazolin c nng rt
thp trong sa m.
CH NH
Cefazolin c ch nh trong iu tr cc nhim khun do cc vi khun nhy cm sau :
- Nhim khun ng h hp do S. pneumoniae, Klebsiella sp, H. influenzae, S. aureus (k c
cc chng tit men penicillinase), v cc streptococci beta tn huyt nhm A.
Penicillin G benzathine dng tim c xem l thuc c chn la iu tr v phng nga
nhim khun do Streptococcus bao gm phng nga st thp khp.
Cefazolin c hiu qu dit cc streptococci mi hu, tuy nhin cho n nay cha c cc d
kin cho bit tnh hiu qu ca cefazolin trong ngn nga st thp khp.
- Nhim khun tit niu sinh dc do E. coli, P. mirabilis, Klebsiella sp, v vi chng Enterobacter
v Enterococci.
- Nhim khun da v cu trc da do S. aureus (k c cc chng tit men penicillinase) v
streptococci beta tn huyt nhm A v cc chng streptoccoci khc.
- Nhim khun ng mt do E. coli, cc chng streptococci, P. mirabilis, Klebsiella sp v S.
aureus.
- Nhim khun xng v khp do S. aureus.
- Nhim khun huyt do S. pneumoniae, S. aureus (c chng nhy cm vi penicillin v khng
penicillin), P. mirabilis, E. coli v Klebsiella sp.
- Vim ni tm mc do S. aureus (c chng nhy vi penicillin v khng penicillin), v streptocci
beta tn huyt nhm A.
Nn c cc mi trng nui cy thch hp v thc hin cc th nghim v tnh nhy cm xc
nh tnh nhy cm ca vi khun gy bnh i vi cefazolin.
- D phng trong phu thut : S dng cefazolin trc, trong v sau phu thut c th lm gim
t l nhim khun hu phu nhng bnh nhn phi tri qua nhng phu thut c xp loi
phu thut sch hoc sch nhim c nguy c nhim cao (th d m ct t cung qua ng m
o hoc ct ti mt cc bnh nhn c nguy c cao nh trn 70 tui b vim ti mt cp, vng
da do tc mt hoc si ng mt ch).
Cefazolin c hiu qu khi dng trong cc phu thut m nhim khun ti ni m c th gy ra
cc nguy c trm trng (th d m tim h v lp b phn gi to hnh khp).

S dng cefazolin trong ch nh phng nga nn ngng trong vng 24 gi sau phu thut. i
vi phu thut c bit c nguy c nhim khun (nh m tim h v to hnh khp gi), nn tip
tc s dng cefazolin thm trong 3 n 5 ngy sau khi phu thut hon tt. Trng hp xy ra
nhim khun, ly bnh phm nui cy xc nh vi khun gy bnh v tr liu bng khng sinh
thch hp (xem Liu lng v Cch dng).
CHNG CH NH
Cefazolin chng ch nh i vi bnh nhn c tin s d ng vi khng sinh nhm
cephalosporin.
CH PHNG
Nu c phn d ng vi cefazolin, nn ngng thuc v bnh nhn cn c x tr bng cc
thuc thch hp (nh epinephrine hoc cc amines co mch, khng histamine, hoc
corticosteroid).
S dng cefazolin di ngy c th lm pht trin qu mc cc vi khun khng nhy cm. Cn
theo di trn lm sng cn thn. Nu bi nhim trong khi iu tr, cn c nhng bin php thch
hp.
Khi dng cefazolin cho bnh nhn suy chc nng thn c lng nc tiu t, cn gim liu (xem
Liu lng v Cch dng).
Kefzol khng ch nh dng qua ng tim vo dch no ty. Tht vy, c nhng bo co v
biu hin c tnh nng trn thn kinh trung ng gm co git khi tim cefazolin bng ng
ny.
Tnh gy ung th, t bin gen, nh hng kh nng sinh sn : Cha thc hin cc nghin cu
v tnh t bin gen v cc nghin cu lu di ng vt xc nh kh nng gy ung th ca
cefazolin.
THN TRNG LC DNG
Trc khi tr liu bng cefazolin, cn hi xem trc y bnh nhn c phn ng qu mn i
vi cephalosporin v penicillin cha. Cn thn khi dng thuc cho bnh nhn nhy cm
penicillin. Cc phn ng qu mn cp tnh, nghim trng c th cn dng n epinephrine v
cc bin php cp cu khc.
Vi du hiu trn lm sng v cn lm sng cho thy c d ng cho mt phn gia penicillin v
cephalosporin. c bo co bnh nhn c nhng phn ng trm trng (gm chong phn v)
i vi c hai loi thuc.
Cc khng sinh, bao gm cefazolin, nn c s dng thn trng i vi bnh nhn c biu
hin d ng, c bit l d ng i vi thuc.
Vim kt trng gi mc c bo co xy ra vi hu ht cc khng sinh ph rng (bao gm
cc macrolide, penicillin bn tng hp v cephalosporin). V vy cn lu { n chn on ny
nu bnh nhn b chng tiu chy khi ang s dng khng sinh. Nhng chng vim kt trng
nh vy c th xy ra t nh n nng nguy him n tnh mng, cn x tr bng cc bin php

thch hp.
S dng tr em : S an ton i vi tr thiu thng v tr di 1 thng tui cha c xc
nh.
LC C THAI
Cc nghin cu v kh nng sinh sn c thc hin trn chut vi liu 500 mg hoc 1 g
cefazolin/kg, khng thy du hiu tn thng kh nng sinh sn hoc c hi cho bo thai do
cefazolin. Tuy nhin cha c nhng nghin cu y v kim sot cht ch trn cc ph n c
thai. V cc nghin cu trn sc vt khng phi lun lun tin on p ng ca ngi, nn
thuc ny ch nn dng cho ph n mang thai khi tht cn thit.
Tim cefazolin trc khi phu thut csar (m ly thai qua ng bng), nng thuc trong
mu dy rn o c khong 1/4 n 1/3 so vi nng thuc trong mu ngi m. Thuc
hin hu khng gy phn ng c hi cho thai nhi.
LC NUI CON B
Nng cefazolin rt thp trong sa m nhng cng nn thn trng khi s dng cefazolin cho
cc b m ang cho con b.
TNG TC THUC
Dng chung cefazolin vi probenecid lm gim s bi tit ca cephalosporin qua ng thn, kt
qu gy tng v k o di nng cephalosporin trong mu hn.
Tng tc ca thuc vi cc xt nghim ti phng th nghim : C th c phn ng dng tnh
gi trong xt nghim tm glucose nc tiu i vi dung dch th Benedict, dung dch Fehling
hoc vin Clinitest, nhng s khng c dng tnh gi khi s dng cc phng php dng
enzyme nh Clinistix v Tes-Tape (Th nghim Glucose Enzymatic Strip, USP, Lilly).
Cc th nghim tm antiglobulin (Coombs) trc tip hoc gin tip, dng tnh c th xy ra
tr s sinh nu ngi m dng cefazolin trc khi sanh.
Cn thn trng khi k toa cc khng sinh ph rng cho cc bnh nhn c tin s au d dy,
rut, nht l vim kt trng.
TC DNG NGOI
Cc phn ng ph sau y c ghi nhn :
Phn ng qu mn : St do thuc, ni mn trn da, nga m h, tng bch cu i toan v
chong phn v.
Mu : Gim bch cu trung tnh, gim bch cu, tng tiu cu, phn ng Coombs trc tip hoc
gin tip dng tnh.
Thn : Nng BUN tng tm thi nhng khng thy biu hin lm sng ca suy thn. Vim
thn k v cc ri lon chc nng thn him khi xy ra. Hu ht nhng bnh nhn c phn ng
ny u tnh trng bnh nng trm trng v ang s dng nhiu loi thuc trong iu tr. Vai
tr ca cefazolin trong vic pht sinh cc bnh l trn thn cn cha c xc nh.
Gan : Tng tm thi men SGOT, SGPT v phosphatase kim rt him xy ra. Cng nh penicillin,

v vi cephalosporin khc, vim gan tm thi v vng da mt him khi c ghi nhn.
D dy, rut : Nhng triu chng vim kt trng gi mc c th xy ra trong hoc sau khi tr liu
bng khng sinh. Bun nn v i ma him khi xy ra. Bing n, tiu chy v bnh nm candida
(bnh ta ming) c ghi nhn.
Nhng phn ng ph khc : Him khi gy au ti ni tim bp. Vim tnh mch ni tim c
ghi nhn. Cc phn ng khc bao gm nga vng hu mn, m h, bnh do nm Candida v
vim m o.
LIU LNG v CCH DNG
Cefazolin dng tim bp hoc tnh mch. Tng liu dng hng ngy ging nhau i vi tim bp
hoc tnh mch. Tim Kefzol vo khung nhn cha c chp thun. c nhng bo co v
Kefzol gy c tnh trn h thn kinh trung ng, bao gm co git khi cefazolin s dng theo
cch ny.
Tim bp : Pha thuc theo hng dn Bng 3 vi dung dch tim NaCl 0,9%, hoc cc loi
nc v khun dng pha tim. Lc mnh n khi ha tan. Cefazolin nn c tim su trong
bp tht khi c ln. au ti ni tim thnh thong c th xy ra.
Bng 3. Bng pha long
Quy cch Dung mi
Th tch phng
Nng trung bnh phng
l
thm vo
o|n
o|n
250 mg
2 mL
2 mL
125 mg/mL
500 mg
2 mL
2,2 mL
225 mg/mL
1 g*
2,5 mL
3 mL
330 mg/mL
* Ch nn pha l 1g vi cc loi nc v khun pha tim
Tim tnh mch : Cefazolin c th c tim tnh mch hoc truyn tnh mch lin tc hay ngt
qung.
Truyn tnh mch ngt qung : Cefazolin c th c a vo mt chai dch ang truyn c sn
hoc qua mt chai ring bit. L cefazolin 500 mg hoc 1 g pha vi 50 n 100 ml mt trong
nhng dung dch pha tim sau: NaCl 0,9%, Dextrose 5% hoc 10%, Dextrose 5% trong Ringer
Lactate, Dextrose 5% v NaCl 0,9% (cng c th dng Dextrose 5% v NaCl 0,45% hay 0,2%),
Ringer Lactate, ng chuyn 5% hay 10% trong nc ct pha tim, dung dch Ringer tim,
Normosol-M trong D5-W, Ionosol B vi Dextrose 5% hoc Plasma -Lyte vi Dextrose 5%.
Tim tnh mch (Dung dch c tim trc tip vo tnh mch hoc qua dy truyn dch) :
Cefazolin 500 mg hoc 1 g c pha theo hng dn Bng 3, c pha long tip tc vi
ti thiu 10 ml nc ct pha tim. Tim chm t 3 n 5 pht. Khng tim nhanh hn 3 pht.
Liu dng
Liu thng thng dnh cho ngi ln ghi trong Bng 4.
Bng 4. Liu dng thng thng cho ngi ln

Loi nhim khun

Vim phi do ph cu
Nhim khun nh do cu khun gram dng nhy cm
Nhim khun ng tiu cp tnh, khng bin chng
Nhim khun mc va n nng

Liu
lng
500mg
250 n
500 mg
1g

S ln
tim
12
gi/ln
8
gi/ln
12
gi/ln
6-8
gi/ln
6
gi/ln

500 mg
n 1 g
Nhim khun nng e do n tnh mng (vim ni tm mc, 1 g n
nhim khun mu)*
1,5 g
* Trong trng hp rt him, liu s dng ln n 12 g Cefazolin/1 ngy.
iu chnh liu i vi bnh nhn b suy gim chc nng thn : Cefazolin c th c s dng
cho bnh nhn b suy gim chc nng thn, nhng cn iu chnh liu lng. Nu thanh thi
creatinine ln hn hoc bng 55 ml/pht hoc creatinine huyt thanh nh hn hoc bng 1,5
mg% c th khng cn chnh liu. Bnh nhn c thanh thi creatinine 35 - 54 ml/pht hoc
creatinine huyt thanh 1,6 - 3 mg% cng c th khng cn chnh liu, nhng thi gian gia 2
liu dng phi cch nhau t nht 8 gi. Bnh nhn c mc thanh thi creatinine t 11 ti 34
ml/pht hay creatinine huyt thanh t 3,1 n 4,5mg% nn dng 1/2 liu bnh thng vi
khong cch 12 gi/1 ln. Bnh nhn c thanh thi creatinine nh hn hay bng 10 ml/pht
hoc creatinine huyt thanh ln hay bng 4,6 mg% nn dng 1/2 liu bnh thng vi khong
cch 18 n 24 gi/1 ln. Nhng khuyn co gim liu ny p dng sau liu tn cng u tin
ph hp vi mc trm trng ca nhim khun. Thng tin v thm phn phc mc, xin xem
phn dc l hc.
Phng nga nhim khun sau phu thut : phng nga nhim khun sau phu thut cc
phu thut sch hoc sch nhim c nguy c nhim cao, liu khuyn dng l:
Tim tnh mch hoc tim bp liu 1g, t 1/2 n 1 gi trc khi bt u phu thut.
i vi phu thut ko di (th d 2 gi hoc lu hn), tim tnh mch hoc tim bp 0,5 g - 1 g
trong khi phu thut (liu thoc i ty theo thi gian phu thut).
Tim tnh mch hoc tim bp liu 0,5 - 1g, cch 6 - 8 gi/1 ln trong 24 gi sau phu thut.
iu quan trng l (1) liu trc phu thut cn tim (1/2 gi n 1 gi) trc khi khi u
phu thut c c nng khng sinh y trong huyt thanh v m ti thi im bt
u rch da v (2) nu trong trng hp nghi c nhim, nn tim cefazolin vi khong cch
thch hp ngay trong thi gian phu thut nng khng sinh lun t c mc cn
thit.
Vi loi phu thut m nu nhim khun xy ra th s gy hu qu v cng nghim trng lan
rng (nh m tim h v phu thut chnh hnh khp), khng sinh cefazolin d phng c dng

lin tc trong 3 n 5 ngy sau khi phu thut hon tt.

tr em, i vi cc nhim khun t nh n trung bnh liu dng tng cng hng ngy t 25
n 50mg/kg th trng (khong 10 - 20 mg/lb), chia u 3 hoc 4 liu bng nhau (Bng 5). i
vi nhim khun nng, liu tng cng hng ngy c th ln n 100 mg/kg th trng (45 mg/lb).
Bng 5. Hng dn liu dng trong nhi khoa
Trng
lng
lb
kg

25mg/kg/ngy.
250mg/kg/ngy.
Chia lm 3 liu
Chia lm 4 liu
Liu tim mi ln Th tch (mL) cn Liu tim mi ln
Th tch (mL) cn
(mg, 8 gi/ln)
thit c pha (mg, 6 gi/ln)
thit c pha
long 125 mg/mL
long 125 mg/mL
10
4,5 40 mg
0,35 mL
30 mg
0,25 mL
20
9
75 mg
0,60 mL
55 mg
0,45 mL
30
13,6 115 mg
0,90 mL
85 mg
0,70 mL
40
18,1 150 mg
1,20 mL
115 mg
0,90 mL
50
22,7 190 mg
1,50 mL
140 mg
1,10 mL
Trng
50mg/kg/ngy.
50mg/kg/ngy.
lng
Chia lm 3 liu
Chia lm 4 liu
lb
kg
Liu tim mi ln Th tch (mL) cn Liu tim mi ln
Th tch (mL) cn
(mg, 8 gi/ln)
thit c pha (mg, 6 gi/ln)
thit c pha
long 225 mg/mL
long 225 mg/mL
10
4,5 75 mg
0,35 mL
55 mg
0,25 mL
20
9
150 mg
0,70 mL
110 mg
0,50 mL
30
13,6 225 mg
1,00 mL
170 mg
0,75 mL
40
18,1 300 mg
1,35 mL
225 mg
1,00 mL
50
22,7 375 mg
1,70 mL
285 mg
1,25 mL
Ghi ch : lb = pao (pound) ~ 450 g
tr em suy thn nh n trung bnh ( thanh thi creatinine t 70 n 40 mL/pht), liu
hu hiu bng 60% liu bnh thng hng ngy tim cch nhau 12 gi/ln. Tr em b suy thn
trung bnh ( thanh thi creatinine t 40 n 20 mL/pht), liu hu hiu bng 25% liu bnh
thng hng ngy, tim cch nhau 12 gi/1 ln. Tr em b suy thn nng ( thanh thi
creatinine t 20 n 5 mL/pht), liu hu hiu bng 10% liu dng hng ngy bnh thng,
tim cch nhau 24 gi/ln. Nhng liu khuyn co trn nn p dng sau khi tim liu tn
cng u tin.
Tnh an ton ca thuc i vi tr sinh non v tr di mt thng tui cha c nghin cu
nn khng khuyn co s dng cefazolin trn nhng bnh nhn ny.
Tnh n nh
Trng hp thuc pha nhng cha s dng ngay cho bnh nhn, c th bo qun trong
nhng iu kin sau:

L cefazolin : Cefazolin c pha vo ngay l ng bt thuc trong nc ct pha tim,

Dextrose tim 5%, NaCl tim 0,9%, nc v khun dng pha tim, n nh c trong 24 gi
nhit phng v trong 10 ngy nu bo qun trong t lnh, 2oC - 8oC (36oF ti 46oF).
Nu dung dch cefazolin pha trong nc ct pha tim, Dextrose 5% hoc NaCl 0,9% v c ct
vo t ng ngay sau khi pha, dung dch ny s bn vng trong 12 tun nu bo qun -20oC.
Mt khi c lm tan, dung dch ny n nh trong 24 gi nhit phng hoc trong 10 ngy
nu trong t lnh 2oC - 8oC (36oF ti 46oF). Khi lm m thuc tr li, khng c thuc
ch nng sau khi thuc tan hon ton. Mt khi lm tan, thuc khng nn lm ng tr
li.
Pha long tip vo chai th hai : Cc dung dch cefazolin tim truyn pha trong Dextrose
10%, Dextrose 5% trong Ringer Lactate, Dextrose 5% v NaCl 0,9% (cng c th dng Dextrose
5% v NaCl 0,45% hoc 0,2%), Ringer Lactate, ng chuyn 5% hay 10% trong dung dch nc
ct pha tim, dung dch tim Ringer, Normosol-M trong D5-W, Ionosol-B vi Dextrose 5% hay
Plasma-Lyte vi Dextrose 5%, nn s dng trong 24 gi sau khi pha long nu bo qun nhit
phng hoc trong vng 96 gi nu bo qun trong t lnh, 2oC - 8oC (36oF ti 46oF) (Khng
lm ng lnh cefazolin pha long bng cc dung mi trn).
Trc khi tim, cc ch phm thuc tim nn c kim tra bng mt pht hin xem c
nhng vn g bt thng hoc i mu hay khng.
QU LIU
Cc du hiu v triu chng : Cc du hiu v triu chng ng c khi qu liu cefazolin bao
gm au, sng v vim tnh mch ni tim.
S dng cc liu lng ln khng thch hp cephalosporin tim tnh mch c th gy chng
mt, chng d cm v nhc u. Vi cephalosporin khi dng qu liu c th gy co git, c bit
nhng bnh nhn b suy thn, c th do s tch ly thuc.
Nhng bt thng trong xt nghim cn lm sng lin quan s dng qu liu thuc bao gm
tng creatinine, BUN, cc men gan v bilirubin, th nghim Coombs dng tnh, tng tiu cu,
gim lng tiu cu, tng bch cu i toan, gim bch cu v thi gian prothrombin ko di.
iu tr : X tr qu liu cn cn nhc n kh nng qu liu ca nhiu loi thuc, s tng tc
thuc v dc ng hc bt thng ca bnh nhn.
Trng hp bnh nhn b co git, nn ngng thuc ngay lp tc. iu tr chng co git nu c
ch nh trn lm sng. Bo v ng h hp ca bnh nhn, h tr thng kh v truyn dch.
Theo di cn thn v duy tr trong phm vi cho php cc du hiu sinh tn ca bnh nhn, kh
mu, in gii trong huyt thanh...
Trng hp qu liu trm trng c bit bnh nhn c suy thn, c th phi hp lc mu v
truyn mu nu iu tr bo tn tht bi. Tuy nhin, cha c nhng d kin h tr cho cch
iu tr trn

276.

KENACORT RETARD

BRISTOL-MYERS SQUIBB
hn dch tim 40 mg/1 ml : hp 1 ng thuc 1 ml + cc dng c cn thit tim - Bng B.
hn dch tim 80 mg/2 ml : hp 1 ng thuc 2 ml + cc dng c cn thit tim - Bng B.
THNH PHN
cho 1 ml hn dch tim
Triamcinolone actonide

40 mg

(Alcool benzylique)

DC LC
Glucocorticoid, dng ng ton thn.
Cc glucocorticoid sinh l (cortisone v hydrocortisone) l nhng hormone chuyn ha thun
ty. Cc corticoid tng hp, k c triamcinolone, ch yu c s dng da vo hot tnh
khng vim. liu cao, chng c tc ng lm gim p ng min dch. Tc dng ca chng
trn s chuyn ha v gi mui nc thp hn nhiu so vi hydrocortisone.
DC NG HC
Dng bng ng ton thn (tim bp), Kenacort Retard c hp thu chm v t t (15 n
20 ngy). Thuc c khuch tn tt n m v sau ch yu c o thi qua nc tiu.
Nu s dng bng ng tim ti ch, s hp thu v khuch tn thuc chm hn rt nhiu.
CH NH
Dng ng ton thn :
Vim mi d ng theo ma sau khi p dng cc liu php khc m khng hiu qu (nh
khng histamin ng ton thn, corticoid dng ti ch mi hay corticoid dng ngn hn
ng ung).
Tim ti ch :
Bao gm cc ch nh ca liu php corticoid tim ti ch, khi cn t nng cao ti v tr tim.
Tt c cc ch nh tim ti ch u to thun li cho cc bin chng nhim trng xy ra, nht l
to thun li cho s pht trin ca vi khun.
Thuc ny c ch nh trong cc bnh l :
- Ngoi da : so li.

- Thp khp (tim trong khp) : vim thp khp, cc cn cp tnh sng au ca bnh h khp.
CHNG CH NH
Dng ng ton thn :
Tuyt i :
- Tt c cc tnh trng nhim khun, ngoi tr trong nhng ch nh chuyn bit (xem phn Ch
nh).
- Mt vi trng hp nhim virus ang trong giai on tin trin (nht l vim gan, herpes, thy
u, zona).
- Bnh tm thn cha c tr khi.
- Tim chng bng vaccin sng.
- Qu mn cm vi mt trong cc thnh phn ca thuc.
- Ri lon ng mu, ang iu tr bng thuc chng ng trng hp tim bp hay tim ti
ch.
Khng c chng ch nh tuyt i khi liu php corticoid c ch nh c tnh cht sng cn.
Tng i :
- Cc thuc gy xon nh khng c tc ng chng lon nhp (xem phn Tng tc thuc).
S dng ti ch :
- Nhim trng ti ch hoc ton thn, hoc nghi ng c nhim trng.
- Ri lon ng mu nng, ang iu tr bng thuc chng ng.
- Qu mn cm vi mt trong cc thnh phn ca thuc.
CH PHNG v THN TRNG LC DNG
Ch { phng :
Dng ng ton thn :
- Mt s trng hp him gp b phn ng gi mn cm xy ra nhng bnh nhn c iu
tr bng liu php corticoid ng tim, do cn c bit thn trng trc khi s dng trn
nhng bnh nhn c c a d ng.
- Trng hp bnh nhn b lot d dy t trng, khng chng ch nh dng corticoid nu c
phi hp vi thuc iu tr lot.
Trng hp bnh nhn c tin s b lot, c th k toa corticoid nhng trong qu trnh iu tr
phi tng cng theo di lm sng, v c th cho soi X quang trc nu cn.
Dng corticoid c th to thun li cho cc bin chng nhim trng xy ra, nht l nhim trng
do vi khun, nm men v k sinh trng. Nhim giun ln cp tnh l mt nguy c quan trng.
Tt c nhng ngi n t vng c dch (vng nhit i, cn nhit i, khu vc pha nam chu
u) phi c xt nghim phn tm k{ sinh trng v iu tr tit cn trc khi dng liu php
corticoid.
Cc du hiu nhim trng ang tin trin c th b liu php corticoid che lp.
iu quan trng l cn loi cc nhim trng ni tng, nht l lao, trc khi tin hnh iu

tr, v theo di cc bin chng nhim trng c th xy ra trong thi gian iu tr.
Trng hp c tin s b lao phi, nn phi hp iu tr d phng lao nu c di chng quan
trng trn X quang.
- Dng corticoid cn phi tng cng theo di, nht l ngi gi v trong trng hp bnh
nhn b vim lot kt trng (c nguy c gy thng), mi ni rut gn y, suy thn, suy gan,
long xng, nhc c nng.
Tim ti ch :
- Do thuc c th i vo tun hon mu, cng nn lu { n nhng chng ch nh ca corticoid
khi dng ng ton thn, nht l khi tim nhiu mi ( nhiu v tr khc nhau) hoc lp i lp
li trong mt thi gian ngn :
- Mt vi trng hp nhim virus ang trong giai on tin trin (nht l vim gan, herpes, thy
u, zona).
- Bnh tm thn cha c tr khi.
- Tim chng bng vaccin sng.
- Liu php corticoid c th to thun li cho cc bin chng nhim trng xy ra.
- Tim nhiu ln ( nhiu v tr khc nhau) hoc lp i lp li trong mt thi gian ngn c th gy
cc triu chng lm sng v sinh hc ca bnh l{ tng nng v thng thn.
Thn trng lc dng :
Dng ng ton thn :
- Ngay khi c th, nn chuyn sang corticoid ng ung.
- Ch cn nhc b sung kali khi dng liu cao, trong thi gian di hay trong trng hp c nguy
c b lon nhp hoc khi c phi hp vi thuc c kh nng lm gim kali mu.
- Khi cn thit phi dng liu php corticoid th tiu ng v cao huyt p khng phi l nhng
chng ch nh, nhng vic iu tr bng corticoid c th gy mt cn bng.
- Bnh nhn phi trnh tip xc vi ngi b bnh thy u hay si.
Tim ti ch :
- Tim ti ch corticoid c th lm mt cn bng trong bnh l tiu ng, tm thn, cao huyt
p nng.
- Thn trng khi dng nhng bnh nhn c nguy c nhim trng cao, nht l ngi phi
thm phn lc mu hay mang rng gi.
- Khng tim trong gn.
- Cn lu { cc vn ng vin th thao do thuc c cha hot cht c th cho kt qu dng
tnh khi xt nghim s dng cht kch thch.
LC C THAI v LC NUI CON B
Lc c thai :
Dng ng ton thn :
Th nghim trn ng vt cho thy tc dng gy qui thai ca thuc thay i ty theo loi.

 ngi, thuc qua c nhau thai. Tuy nhin, cc nghin cu dch t hc khng cho thy bt
kz tc ng gy d dng bo thai no c lin quan n vic dng corticoid trong 3 thng u thai
kz.
Trong cc bnh mn tnh cn c iu tr trong sut thi kz mang thai, c th gy chm pht
trin nh bo thai trong t cung. Hn hu c th gy suy thng thn tr s sinh, c quan
st sau khi dng liu php corticoid liu cao.
Do cn theo di lm sng (trng lng, bi niu) v sinh hc mt thi gian tr s sinh c
m dng corticoid trong thi gian mang thai.
Theo trn, corticoid c th c k toa cho ph n c thai nu cn.
Tim ti ch :
Cc nguy c ging nh khi dng corticoid ng ton thn c ngh ti nu tim nhiu ln (
nhiu v tr khc nhau) hay lp i lp li trong thi gian ngn : vi corticoid ng ton thn, c
th gy chm pht trin nh bo thai trong t cung. Hn hu c th gy suy thng thn tr
s sinh, c quan st sau khi dng liu php corticoid liu cao.
Lc nui con b :
Trng hp iu tr di hn v vi liu cao, khng nn cho con b m.
TNG TC THUC
Dng ng ton thn :
Khng nn phi hp :
- Cc thuc gy xon nh (astemizole, bepridil, erythromycin IV, halofantrine, pentamidine,
sparfloxacine, sultopride, terfenadine, vincamine) : nn thay bng nhng thuc khng gy xon
nh trong trng hp h kali mu.
Thn trng khi phi hp :
- Acid salicylic ng ton thn, v c th suy ra cho cc salicylate khc : lm gim salicylate
mu trong thi gian iu tr bng corticoid v tng nguy c qu liu salicylate khi ngng dng
corticoid, do corticoid lm tng o thi cc salicylate.
Chnh liu cc salicylate trong thi gian phi hp v sau khi ngng iu tr bng corticoid.
- Thuc chng lon nhp gy xon nh (amiodarone, bretylium, disopyramide, nhm quinidine,
sotalol) : h kali mu l mt yu t thun li, cng nh chm nhp tim v on QT di t
trc.
D phng h kali mu, iu chnh nu cn ; theo di on QT. Nu b xon nh, khng dng
thuc chng lon nhp.
- Thuc chng ng dng ung : corticoid c th gy cn tr s chuyn ha ca thuc chng
ng dng ung v ca cc yu t ng mu. Nguy c gy xut huyt c th ca liu php
corticoid (trn nim mc ng tiu ha, tnh d v ca mao mch) khi dng liu cao hoc iu
tr ko di trn 10 ngy.
Nu cn thit phi phi hp, nn tng cng theo di : kim tra sinh hc ngy th 8, sau

mi 15 ngy trong thi gian phi hp v sau khi ngng dng corticoid.
- Cc thuc gy h kali mu khc (thuc li tiu gy h kali mu dng mt mnh hay di dng
phi hp, thuc nhun trng kch thch, amphotericine B IV : tng nguy c h kali mu do hip
ng tc dng.
Theo di kali mu, iu chnh nu cn, nht l trong trng hp ang iu tr bng digitalis.
- Digitalis : h kali mu c th to thun li cho nhng tc dng c ca digitalis.
Theo di kali mu, iu chnh nu cn, v ty tnh hnh, c th kim tra in tm .
- Heparine dng tim : lm nng thm nguy c gy xut huyt c th ca liu php corticoid
(trn nim mc ng tiu ha, tnh d v ca mao mch) khi dng liu cao hoc iu tr ko
di trn 10 ngy. Khi phi phi hp, cn tng cng theo di.
- Cc thuc gy cm ng men (carbamazepines, phenobarbital, phenytoine, primidone,
rifabutine, rifampicine) : lm gim nng trong huyt tng v hiu lc ca corticoid do lm
tng chuyn ha gan. Hu qu c th c bit nghim trng bnh nhn b bnh addison v
trong trng hp gh p c quan.
Theo di lm sng v sinh hc, chnh liu corticoid trong thi gian phi hp v sau khi ngng
dng thuc gy cm ng men.
- Insuline, metformine, sulfamide h ng huyt : lm tng ng huyt, i khi gy nhim
ceton (do corticoid lm gim dung np ca cc thuc ny i vi glucid). Thng bo cho bnh
nhn v tng cng t theo di lng ng trong mu v nc tiu, nht l khi bt u iu
tr. C th chnh liu thuc tr tiu ng trong thi gian phi hp v sau khi ngng dng
corticoid.
Lu { khi phi hp :
- Thuc tr tng huyt p : lm gim tc dng h huyt p (do corticoid gy gi mui-nc).
- Interferon a : c kh nng c ch tc ng ca interferon a.
- Vaccin sng gim c : c nguy c gy bnh ton thn, c th dn n t vong. Nguy c ny
tng nhng ngi b suy gim min dch do mt bnh tim n.
Nn thay bng vaccin bt hot nu c loi ny (bnh bi lit).
- Praziquantel : c th lm gim nng ca praziquantel trong huyt tng.
Tim ti ch :
Cc tng tc ca glucocorticoid vi cc thuc khc ch hn hu mi xy ra khi dng ng
tim ti ch liu thng thng. Cc nguy c ny c th c cn nhc ti khi tim nhiu ln
( nhiu v tr khc nhau) hay lp i lp li trong thi gian ngn.
TC DNG NGOI
Dng ng ton thn :
Mt vi trng hp him gp v phn ng phn v c quan st khi dng corticoid ng
tim. Cc ri lon v nhp tim cng c m t, c lin quan n ng dng IV.
Cc tc dng khc :

- Ri lon nc v cht in gii : h kali mu, nhim kim chuyn ha, gi mui-nc, tng
huyt p, suy tim sung huyt.
- Ri lon ni tit v chuyn ha : hi chng Cushing do thuc, teo v thng thn, ngng tit
ACTH, gim dung np glucose, c th phc hi, c th gy tiu ng tim n, ngng tng
trng tr em, c th phc hi, i khi gy kinh nguyt khng u.
- Ri lon h c-xng : teo c, chm hi phc, sau khi b yu c, long xng, i khi vnh
vin, gy xng bnh l{, c bit l ln ct sng, hoi th xng khng nhim trng ca c
xng i.
- Ri lon tiu ha : lot d dy - t trng, thng lot, lot rut non ; vim ty cp c ghi
nhn nht l tr em.
- Ri lon da : mn trng c, ban xut huyt, bm mu, rm lng, chm lnh so.
- Ri lon thn kinh - tm thn :
- Thng gp : sng khoi, mt ng, kch ng.
- Him gp : tnh kh tht thng, ln ln, co git.
- Tnh trng trm cm khi ngng iu tr.
- Ri lon mt : mt vi dng glaucoma v c thy tinh th.
Tim ti ch :
Cc tc dng ngoi ton thn ca glucocorticoid rt him khi xy ra sau khi dng ng tim
ti ch do nng trong mu thp, nhng nguy c tng nng tuyn thng thn (gi muinc, mt cn bng trong bnh tiu ng v tng huyt p...) tng theo liu v tn sut tim :
- nguy c nhim trng ti ch (ty theo v tr tim) : vim khp... ;
- teo m c, di da v da. Nguy c gy t gn nu tim trong gn ;
- vim khp cp do lng ng vi tinh th ;
- vi ha ti ch ;
- phn ng d ng ti ch v ton thn ;
- ng : nhc u v cn bng vn mch c th xy ra, thng bin mt sau 1 hoc 2 ngy.
LIU LNG v CCH DNG
Bit dc ny khng c dng xng ht.
Tng ng v tc ng khng vim ca 5 mg prednisolone : 4 mg triamcinolone.
Lc k trc khi s dng.
Dng ng ton thn :
Tim bp su (trong c mng).
Vim mi d ng theo ma sau khi p dng cc liu php khc m khng hiu qu (nh
khng histamin ng ton thn, corticoid dng ti ch mi hay corticoid dng ngn hn
ng ung) : 1 mi tim, lp li 1 ln trong trng hp vim mi gy au n, sau khi p
dng cc liu php khc m khng hiu qu.
Tim ti ch :

Khoa thp khp : tim trong khp 1/4-2 ml mi 3 tun.

Khoa da : tim trong sang thng (so li) : 1-3 ml (ty theo rng ca sang thng) mi 3
hoc 4 tun. C th tim trong sang thng bng dng c Dermo-jet.
Nn trnh tim qu nng trnh gy teo di da.
Tim lp li trng hp ti li hay triu chng cn dai dng.
QU LIU
Nu xut hin hi chng Cushing trong khi ang iu tr th c th l do qu liu

277.

KETASMA

SUN PHARMA
Vin nn 1 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Ketotifen (fumarate)

1 mg

T dc: Lactose BP, tinh bt BP, dicalci

phosphat BP, cellulose vi tinh th BP, bt
mu brilliant blue IH, methanol BP, natri
propyl paraben BP, bronopol BP, talcum
BP, magnesi stearat BP, silicon dioxid keo
NF, tinh bt natri glycolat NF.
DC LC
Ketotifen l thuc ung c tc dng n nh t bo mast v tc dng khng histamin.Tc dng
khng histamin ca ketotifen l d phng, m v bn cht l gy bi nhng tc ng dc l
sau :
- c ch s p ng thi qu kh o v s co kh o gy bi yu t hot ha tiu cu.
- c ch s tch ly bch cu a acid gy bi yu t hot ha tiu cu.
- c ch s gii phng nhng cht ha hc trung gian nh Histamin v SRS-A. gy co tht kh
qun t t bo Mast.
- Chng co ph qun cm ng SRS-A.
- Duy tr mt ca t bo thuc nhm Beta-2 v o min dch nhanh mt cch thc nghim

i vi Isoprenaline.
- Ko di mnh m hiu qu ca th tip th H1.
DC NG HC
Ketotifen c hp th gn nh hon ton bng cch ung. Kh dng sinh hc t 50% do
chuyn ha bc u (First-pass) m rng gan. Nng cao im trong huyt tng t
c sau 2 n 4 gi. Lin kt Protein xp x khong 75%. S thanh thi Ketotifen khi mu v
c bn qua hai giai on :
- Giai on bn hy ngn ban u ko di trong khong 3 gi (phn b).
- Giai on bn hy o thi ko di khong 22 gi.
Ch khong 1% Ketotifen c bi tit qua nc tiu trong vng 48 gi.
Dng chuyn ha ch yu l N-glucuronide Ketotifen chim khong 60-70% lng o thi.
NorKetotifen l mt dng chuyn ha khc. Do nhng c tnh dc ng hc ca Ketotifen,
tr em trn 3 tui dng theo liu ca ngi ln. Nu cn thit phi dng cho tr em di 3 tui,
liu dng nn gim phn na. iu tr t 6-12 tun vi Ketotifen s lm gim ng k triu
chng hen suyn s dng thuc chng hen suyn.
CH NH
Thuc phng bnh hen kh qun.
D ng ph qun.
D ng bi, phn hoa (hay fever)
Do tc dng khng Histamin, Ketotifen c th c s dng iu tr :
- Vim mi d ng
- Tnh trng d ng trn da
- D ng a h
Ketotifen khng c hiu qu trong vic iu tr cn ca hen cp tnh.
CHNG CH NH
Khng c chng ch nh, ngoi tr trng hp qu mn vi Ketotifen.
THN TRNG LC DNG
Khng hy b (ngng s dng) thuc chng hen suyn khi khi u liu trnh vi Ketotifen.
Thi gian phn ng c th ko di trong sut thi gian u ca liu trnh.
Thn trng vi nhng ngi li xe hoc iu khin my mc vn hnh nhanh.
S lng tiu cu c th gim nh thong qua, i vi bnh nhn ang dng thuc iu tr
bnh tiu ng theo ng ung (him). Nn thng xuyn kim tra s lng tiu cu mu.
Ch dng thuc cho ph n c thai v cho con b trong trng hp tht cn thit.
TNG TC THUC
Ketotifen c th lm tng hiu ng ca thuc gim au, thuc an thn, thuc cha d ng v
ru.
TC DNG NGOI

Kh ming, hoa mt c th xy ra khi bt u dng thuc. Nhng triu chng ny thng bin
mt trong qu trnh iu tr,c th tng trng lng.
LIU LNG v CCH DNG
Dng ung.
Ngi ln: 1 vin, 2 ln/ngy. C th tng liu ti 2 vin, 2 ln/ngy.
Khi xy ra hin tng ngy ngt trong thi gian u ca liu trnh, c th dng 1/2 vin, 2
ln/ngy, sau s tng liu.
Tr em 6 thng-3 tui: dng 1/2 liu ca ngi ln.
QU LIU
c tnh xy ra ngi vi liu s dng t 20-120 mg, c nhng triu chng c ghi nhn
nh trong th nghim trn ng vt : bun ng, ln ln, mt nh hng, mt thc, rung git
nhn cu, co git c ghi nhn, gim nhp tim, th nhanh v thnh thong suy h hp c
th xy ra.
Sc ra d dy loi b Ketotifen cha hp th v nhng iu tr triu chng h tr cn thit
nn tin hnh. C th cn s dng thuc chng co git.
Phc hi tng i nhanh thm ch vi liu lng ln v nng trong mu cao (54 mg/lt).
Mc huyt tng tr liu nm trong vng t 1-4 mg/lt.
BO QUN
ni mt, trnh nh sng (thch hp t 15oC-30oC)

278.

KIM TIN THO

XN DP TW26 - OPC
vin bao ng 120 mg : l 100 vin, 200 vin.
vin bao phim 120 mg : l 100 vin, 200 vin.
thuc nc 120 mg/ml : chai 100 ml, 180 ml km theo ly ong lng.
THNH PHN
cho 1 vin bao ng
Cao kh Kim tin tho (extractum siccum Desmodii styracifolii)

120 mg

cho 1 vin bao phim

Cao kh Kim tin tho (extractum siccum Desmodii styracifolii)

120 mg

cho 1 ml thuc nc
Cao kh Kim Tin Tho (extractum siccum Desmodii styracifolii)

120 mg

M T
Kim tin tho c tn khoa hc l Desmodium styracifolium (Osbeck) Merr, thuc h u
(Fabaceae). C tn khc l Mt tru, ng tin lng, Vy rng, Mt rng. Cy tho l loi leo,
di khong 30-50 cm. Thn cy dt c nhiu lng trng mn. L kp mc so le gm 3 l cht hnh
trn chiu di 1,8-3,4 cm v rng 2-3,5 cm. Mt di ca l c nhiu lng mn mu trng bc,
mt trn c nhiu gn. Hoa mc thnh chm c mu tm. Qu nh c cc ht hnh u.
DC LC
Si tit niu gm nhng loi sau :
- Si c gc canxi, c th l oxalat canxi hay phosphat canxi, sinh ra khi nng canxi trong
nc tiu tng cao.
- Si san h, sinh ra do nhim khun tit niu.
- Si uric, si cystin sinh ra do cc ri lon chuyn ha, khng thy c bng chp X quang.
Si sinh ra cn do phi hp ca mt s yu t khc nh d dng ng tit niu lm cn tr s
thot ra ca dng nc tiu ; hoc ca mt s thuc nh hng ti pH ca nc tiu, nh
ung vitamin C liu cao c th gy si thn...
Cc nghin cu dc l hin i cho bit Kim tin tho c tc dng :
- Li tiu, li mt.
- Khng sinh.
- Khng vim.
- Dn mch, h huyt p.
Nh vy, c ch tr si ca Kim tin tho c gii thch nh sau : trc ht l li tiu, pha
long dng nc tiu, lm ngng s gia tng kch thc ca hn si. Sau nh tc dng
chng vim, khng khun m lm gim s ph n ca niu qun, to iu kin thun li cho si
di chuyn xung di v i ra ngoi. ng y cng quan nim nh vy v gi l tc dng bi
thch lm thng (tng si ra ngoi v thng ng niu).
Theo kt qu nghin cu lm sng cho thy Kim tin tho c hiu lc iu tr tt i vi si
oxalat canxi. Thi gian iu tr ph thuc vo kch thc v v tr ca si trong ng tit niu.
Y hc c truyn s dng lm thuc li thy, thng lm, cha i rt v i but, si thn, si

ng tit niu, si mt, bnh hong n.

CH NH
Thanh thp nhit, li niu, bi si (si ng tit niu, si thn).
Vim b thn, vim ti mt.
THN TRNG LC DNG
Ngi b au d dy nn ung lc no.
LIU LNG v CCH DNG
Thuc vin (bao ng, bao phim) : ung mi ln 5 vin, ngy 3 ln, ung vi nhiu nc.
Thuc nc : mi ngy 3 ln, mi ln 5 ml (c ly ong lng km theo) ha trong mt ly nc
chn.
Ung nhiu nc trong thi gian iu tr.
Vin bao phim v thuc nc u dng c cho bnh nhn tiu ng.
BO QUN
L np kn, ni kh mt.

279.

KLACID

ABBOTT
Vin nn bao phim 250 mg : v 14 vin, hp 1 v ; v 10 vin, hp 1 v.
Vin nn bao phim 500 mg : v 14 vin, hp 1 v.
Nh tng ung 125 mg/5 ml : chai 30 ml, chai 60 ml.
THNH PHN
cho 1 vin
Clarithromycin

250 mg

cho 1 vin
Clarithromycin

cho 5 ml

500 mg

Clarithromycin

125 mg

DC LC
Clarithromycin l mt cht bn tng hp ca erythromycin A. N thc y tc ng chng vi
khun bng cch kt hp vi tiu n v ribosome 50s ca nhng vi khun nhy cm v c ch
tng hp protein. N c hiu lc cao chng li nhng vi sinh vt gram dng v gram m, i kh
v k kh. Nng c ch ti thiu (MICs) ca clarithromycin so vi MICs ca erythromycin ni
chung thp hn hai ln, cht chuyn ha 14-hydroxy ca clarithromycin cng c hot tnh
khng khun. MICs ca cht chuyn ha ny bng hoc hai ln cao hn MICs ca hp cht
nguyn thy, ngoi tr H. influenzae trong cht chuyn ha 14-hydroxy c hot tnh gp hai
ln hp cht nguyn thy.
Trn thc nghim, Klacid thng c hot tnh chng li nhng vi khun sau :
Nhng vi khun gram dng :
Staphylococcus aureus (nhy methicillin) ; Streptococcus pyogenes (lin cu khun tiu huyt
beta nhm A) ; lin cu tiu huyt a (nhm viridans) ; Streptococcus (Dipplococcus)
pneumoniae ; Streptococcus agalactiae ; Listeria monocytogenes.
Nhng vi khun gram m :
Haemophillus influenzae ; Haemophillus parainfluenzae ; Moraxella (Branhamella) catarrhalis ;
Neisseria gonorrheae ; Legionella pneumophila ; Bordetella pertussis ; Helicobacter pylori ;
Campylobacter jejuni.
Mycoplasma : Mycoplasma pneumoniae ; Ureaplasma urealyticum.
Nhng vi sinh vt khc : Chlamydia trachomatis ; Mycobacterium avium ; Mycobacterium
leprae ; Mycobacterium kansasii ; Mycobacterium chelonae ; Mycobacterium fortuitum ;
Mycobacterium intracellulare.
Nhng vi khun k kh : Bacteroides fragilis nhy macrolide ; Clostridium perfringens ;
Peptococcus species ; Propionibacterium acnes.
Clarithromycin cng c hot tnh dit khun chng li nhiu ging vi khun. Nhng vi khun ny
gm Haemophillus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes,
Streptococcus agalactiae, Moraxella (Branhamella) catarrhalis, Neisseria gonorrheae,
Helicobacter pylori v Campylobacter spp.
Hot tnh ca clarithromycin chng Helicobacter pylori trong mi trng trung tnh mnh hn
trong mi trng axit.
DC NG HC
Clarithromycin c hp thu nhanh v tt qua ng tiu ha sau khi ung. Cht chuyn ha
c hot tnh sinh hc 14-hydroxyclarithromycin c hnh thnh t chuyn ha u tin. Klacid
c th c cho m khng cn quan tm n cc ba n v thc n khng nh hng n

kh dng sinh hc ca Klacid. Thc n lm hi chm hp thu clarithromycin v hnh thnh cht
chuyn ha 14-hydroxy.
Dc ng hc ca clarithromycin khng u ; tuy nhin, trng thi n nh t c trong
vng 2 ngy. Vi liu 250 mg hai ln trong ngy, 20% thuc bi tit qua nc tiu dng khng
i. Vi liu 500 mg hai ln trong ngy, liu lng bi tit qua nc tiu mi ngy ln hn
(khong 36%). 14-hydroxy clarithromycin l cht chuyn ha ch yu qua nc tiu v chim
10-15% liu. Hu ht liu cn li c thi tr trong phn. Khi clarithromycin c cho 3 ln
mi ngy, nng clarithromycin trong huyt tng tng hn i vi liu 500 mg hai ln mi
ngy.
Klacid cung cp nng trong m nhiu ln cao hn nng thuc lu hnh trong mu. Nng
cao c ghi nhn trong m phi v hch hnh nhn. liu iu tr, 80% clarithromycin kt
hp vi protein.
Klacid cng thm nhp qua lp nhy ca d dy. Nng clarithromycin trong lp nhy d dy
v trong m d dy khi s dng clarithromycin ng thi vi omeprazole cao hn khi s dng
clarithromycin n thun.
CH NH
Klacid c ch nh trong iu tr nhim trng do mt hoc nhiu vi khun nhy cm.
Nhng ch nh gm :
Nhim trng ng h hp di v d vim ph qun cp tnh v mn tnh, v vim phi.
Nhim trng ng h hp trn v d vim xoang v vim hng.
Klacid thch hp iu tr khi u nhng nhim trng h hp mc phi trong cng ng v
c chng minh l c hot tnh trn thc nghim chng li nhng tc nhn sinh bnh
thng thng v nhng tc nhn gy vim phi khng in hnh nh c lit k trong
phn loi vi sinh hc.
Vi s hin din ca cht c ch axit do omeprazole, Klacid cng c ch nh trong iu tr
tit tr H. pylori nhng bnh nhn lot t trng.
CHNG CH NH
Clarithromycin chng ch nh trn nhng bnh nhn c tin s tng mn cm vi nhng khng
sinh thuc nhm macrolide.
Khng nn cho clarithromycin km vi nhng dn cht ca ergot.
Chng ch nh s dng clarithromycin vi bt kz thuc no sau y : cisaprid, pimozide v
terfenadine. Nng cisapid, pimozide v terfenadine tng c bo co nhng bnh
nhn dng ng thi c hai loi nhng thuc ny v clarithromycin. iu ny c th gy ko di
thi gian QT v nhng ri lon nhp k c nhp nhanh tht, rung tht v xon nh. Nhng tc
dng tng t c ghi nhn khi cho ng thi astemizole v nhng macrolide khc.
THN TRNG LC DNG
Clarithromycin c bi tit ch yu qua gan v thn. Nn thn trng khi s dng khng sinh

ny trn nhng bnh nhn suy chc nng gan hoc thn.
Vic s dng clarithromycin ko di v lp li c th gy nn s pht trin nm hoc vi khun
khng cn nhy vi thuc. Nu xy ra bi nhim, nn ngng clarithromycin v tin hnh tr liu
thch hp.
Trn mt s t ngi, vi khun H. pylori c th tr nn khng clarithromycin.
Ging nh nhng khng sinh macrolide khc, vic s dng clarithromycin nhng bnh nhn
ung ng thi vi nhng thuc c chuyn ha bi h thng sc t t bo P450 c th lm
tng nng nhng thuc trong huyt thanh.
LC C THAI v LC NUI CON B
Tnh an ton ca clarithromycin trong lc mang thai v nui con bng sa m cha c xc
minh. V vy khng nn s dng Klacid trong lc mang thai hoc cho con b tr khi li ch nhiu
hn nguy c. Mt vi cng trnh nghin cu trn sc vt gi tc dng c tnh trn phi
nhng ch nhng liu c c tnh r rng i vi ngi m. Khng tm thy clarithromycin
trong sa ca nhng sc vt ang cho con b v trong sa m.
TNG TC THUC
Clarithromycin c chng minh khng c tc dng tng h vi nhng thuc nga thai ung.
Ging nh nhng khng sinh macrolide khc, vic s dng clarithromycin ng thi vi ung
nhng thuc c ha bi h thng cytochrome P450 (th d warfarin, nhng alkaloid ca
ergot, triazolam, lovastatin, disopyramide, phenytoin v cyclosporin) c th lm tng nng
nhng thuc trong huyt thanh. S dng clarithromycin cho nhng bnh nhn ang dng
theophylline lm tng nng theophylline trong huyt thanh v c tnh tim tng ca
theophylline.
Vic s dng clarithromycin trn nhng bnh nhn ang dng warfarin c th lm tng hiu lc
nhng tc dng ca warfarin. Nn thng xuyn theo di thi gian prothrombin nhng bnh
nhn ny.
Hiu qu ca digoxin c th tng khi dng ng thi vi Klacid. Nn theo di nng digoxin
trong huyt thanh.
Clarithromycin c th lm tng hiu lc ca carbamazepine do lm gim tc bi tit.
Nhng macrolide c ghi nhn l lm thay i chuyn ha ca terfenadine, gy tng nng
ca terfenadine. Tnh trng ny i km vi ri lon nhp tim v do nn trnh ch nh
clarithromycin cho nhng bnh nhn ang dng terfenadine v bt kz nhng khng histamin
khng gy ng c lin quan nh astemizole.
Vic s dng ng thi clarithromycin vi zidovudine cho nhng bnh nhn ngi ln b nhim
HIV c th lm gim nng zidovudine trng thi bn. Phn ln c th trnh tnh trng ny
bng cch b tr nhng liu Klacid v zidovudine cho nhau khong 1-2 gi. Khng ghi nhn
phn ng ging nh vy tr em.
Mc d nng trong huyt tng ca clarithromycin v omeprazole c th tng khi cho cng

mt lc, nhng khng cn phi chnh liu lng. Nng clarithromycin trong huyt tng
tng c th cng xy ra khi c s dng ng thi vi Maalox hoc ranitidine. Khng cn phi
iu chnh liu lng.
TC DNG NGOI
Nhn chung clarithromycin c dung np tt. Nhng tc dng ph c bo co gm bun
nn, kh tiu, tiu chy, nn v au bng. Vim ming, vim thanh mn v ni ht ming
c bo co. Nhng tc dng ph khc gm nhc u, nhng phn ng d ng t m ay v
pht ban nh da cho n phn v v him hn l hi chng Stevens-Johnson. Ri lon v gic
c th xy ra. Mt mu li c hi phc gp trong nhng th nghim lm sng khi cho
clarithromycin v omeprazole km nhau. C nhng bo co v nhng tc dng ph thong qua
trn h thn kinh trung ng gm lo lng, chng mt, mt ng, o gic, lon tm thn, c mng
v l ln, tuy nhin cha xc nh c mi tng quan nhn qu. C nhng bo co v mt
kh nng nghe khi dng clarithromycin thng hi phc khi ngng thuc. Vim i trng gi
mc c ghi nhn him gp khi dng clarithromycin v c th t nh n e da sinh mng.
Ging nh nhng macrolid khc, ri lon chc nng gan c ghi nhn (thng c th hi
phc) gm nhng th nghim chc nng gan b thay i, vim gan v mt c hoc khng c
vng da i km. Ri lon chc nng c th trm trng v suy gan gy t vong c ghi nhn rt
him.
LIU LNG v CCH DNG
Nhim trng ng h hp, da v m mm :
Ngi ln : Liu thng dng l 250 mg mi ngy 2 ln trong 7 ngy mc dng trong nhng
trng hp nhim trng nng c th tng n 500 mg mi ngy 2 ln v k o di n 14 ngy.
Tr em trn 12 tui : s dng nh ngi ln.
Tr em di 12 tui : S dng Klacid dng nh tng dnh cho bnh nhi :
Liu hng ngy i vi tr em l 7,5 mg/kg, mi ngy ung 2 ln cho ti liu ti a 500 mg. Thi
gian iu tr thng l 7-10 ngy ty theo chng gy bnh v bnh nng hay nh. iu tr vim
hng do lin cu khun phi t nht 10 ngy. Huyn dch chun b c th dng km hoc
khng km vi ba n, v ung cng vi sa.
Bng sau y l hng dn gi { cch nh liu dng :
Hng dn liu
dng cho bnh nhi
(da trn trng
lng c th)
Trng lng

kg

Liu dng chun 5 ml

(mung c ph), dng ngy
2 ln
lbs

125 mg/5 ml

8-11
18-25
0,5
12-19
26-43
1
20-29
44-64
1,5
30-40
65-88
2
* Tr em < 8 kg hoc < 18 lb cn tnh liu theo kg hay lb (khong 7,5 mg/kg, ngy 2 ln hoc 3,4
mg/lb ngy 1 ln).
Dit tr H. pylori nhng bnh nhn lot t trng :
Ngi ln : liu clarithromycin thng dng l 500 mg mi ngy 2 ln trong 7 ngy. Klacid nn
c s dng km vi omeprazole 40 mg ung 2 ln mi ngy. Mt cng trnh nghin cu quan
trng c thc hin vi omeprazole 40 mg mt ln mi ngy trong 28 ngy. Nhng nghin
cu h tr c thc hin vi omeprazole 40 mg mt ln mi ngy trong 14 ngy.
Ngi gi : s dng nh ngi ln.
Suy thn : Thng khng cn iu chnh liu tr khi bnh nhn suy thn nng ( thanh thi
creatinine di 30 ml/pht). Nu cn chnh liu nn gim mt na tng liu mi ngy, th d
250 mg mi ngy mt ln hoc 250 mg mi ngy 2 ln trong trng hp nng.
Klacid c th cho m khng cn quan tm n cc ba n v thc n khng nh hng n
kh dng sinh hc.
QU LIU
Nhng bo co cho thy vic tiu ha lng ln clarithromycin c th gy ra nhng triu chng
v tiu ha. Mt bnh nhn c tin s ri lon lng cc tiu ha 8 g clarithromycin v cho
thy tnh trng tm thn b thay i, thi hoang tng, kali mu gim v oxy mu gim. Nn
iu tr nhng phn ng d ng i km qu liu bng cch ra d dy v iu tr nng . Ging
nh nhng macrolide khc, nng clarithromycin trong huyt thanh khng b nh hng bi
lc mu hoc thm phn phc mc.
BO QUN
Gi thuc nhit phng (15-30oC) trong nhng hp ng kn. Bo v trnh nh sng.

280.

KLION

GEDEON RICHTER
vin nn 250 mg : v 10 vin, hp 2 v.
THNH PHN
cho 1 vin

Metronidazole

250 mg

CH NH
Nhim Trichomonas b phn tit niu - sinh dc nam v n.
Nhim Giardia lamblia. L amip v cc dng khc ca bnh l amip. p-xe gan do amip. Phn c
nang amip khng km theo triu chng lm sng.
Vim lot ming.
D phng nhim khun k kh hu phu, hoc sau cc phu thut chn lc rut kt, ng mt,
rut tha v sau phu thut ph khoa. C th dng Klion mt mnh hoc kt hp vi nhng
khng sinh c tc dng chng li vi khun i kh.
iu tr nhim khun k kh khu tr hoc ton thn.
Trng c .
Cha nghin ru, duy tr s khng dung np vi ru.
CHNG CH NH
3 thng u ca thai kz. Thi kz cho con b.
CH PHNG v THN TRNG LC DNG
Trong thi gian iu tr bng Klion (c bit trong 3 ngy sau khi dng liu n cao iu tr
bnh do Trichomonas), khng dng cc loi nc ung cha ru ethylic (khng dung np
ru) v nn trnh quan h tnh dc.
c bit trong trng hp iu tr t 7 n 10 ngy, nn kim tra cng thc mu v trong
nhng trng hp iu tr di ngy (nh cai nghin ru), nn kim tra mu hng thng.
TNG TC THUC
Klion khng nn dng ng thi vi disulfiram (v c th xut hin tc dng hip ng, trng
thi lon thn kinh, lon tm thn), v cng nn thn trng khi dng ng thi vi thuc chng
ng mu dng ung (Klion c th lm tng nhng tc dng c hiu ca thuc chng ng
mu).
TC DNG NGOI
ng mm, ta li, kh ming, bun nn, chn n, tiu chy, nhc u v nc tiu c.
Nhng biu hin trn s t ht, sau khi ngng thuc.
V Klion cha nhm nitr, n c th gy gim bch cu nh.
LIU LNG v CCH DNG
Nn ung nguyn vin, khng nhai, trong hoc sau ba n vi mt t nc.
Nhim Trichomonas :
Bn tnh ca bnh nhn b nhim Trichomonas cng coi nh mc bnh. Ch c kh nng lnh
bnh lu di khi c hai cng c iu tr ng thi.
Phng php cha bnh c 2 phc :
- Phc 1 : Mi bui sng v mi bui ti, c nam v n ung 1 vin nn (250 mg), ung trong

10 ngy. Trong thi gian ny (10 ngy), vo tt c cc bui ti trc khi i ng, ph n nn t
su vo m o mt vin t m o. Khi cn, phc iu tr ny c th c nhc li v liu
thuc hng ngy c th tng n 3-4 vin.
- Phc 2 : Dng 1 ln duy nht, liu cao : Ngi bnh cng nh bn tnh ung mt ln 8 vin
nn (2 g) Klion. Nn dng thuc vo bui ti, trc khi i ng.
Nhim Giardia :
Ngi ln : 2 x 2 vin nn trong 5-7 ngy.
Tr em : di 1 tui ung 1/2 vin nn ; t 2-4 tui ung 1 vin ; t 5-8 tui, ung 11/2 vin ;
trn 8 tui, ung 2 x 1 vin, trong 6 ngy, sau ba n.
Bnh amip :
Ngi ln :
- Phn c nang amip khng km theo triu chng lm sng : 2-3 x 2 vin/24 gi, ung trong 5 7 ngy.
- Bnh amip mn tnh (k c cc trng hp lon chc nng gan) : 3 x 2 vin/24 gi, ung trong
5-10 ngy.
- Trong bnh l amip th lan ta v cp tnh, iu tr cho n khi ht triu chng : 3 x 3 vin/24
gi.
- Nu gp p-xe gan amip, liu thng thng (v ti a) l : dng 2500 mg (10 vin) trong 24
gi, liu ny c dng 1 ln hoc chia lm 2-3 ln trong 24 gi, ung trong 3-5 ngy, dng
song song vi cc bin php iu tr khc (ra rut, khng sinh, trc ht l tetracycline, v.v.)
Tr em :
- T 1-3 tui, dng liu bng 1/4 liu ca ngi ln.
- T 3-7 tui, dng liu bng 1/3 liu ca ngi ln.
- T 7-10 tui, dng na liu ca ngi ln.
- Tr di 1 tui, nn dng liu thch hp, c tnh mt cch va .
Bnh vim lot ming :
Ngi ln : dng 2 x 1 vin/24 gi, trong 3-5 ngy ; nu bnh nng, c th t ngay ln b mt
vt lot khong 20 pht.
Tr em : khng dng Klion iu tr cho tr em b bnh vim lot ming.
Phng nga nhim khun hu phu :
Ngi ln : trc phu thut, ung 3 x 1-2 vin/24 gi, dng trong 3-4 ngy ; cng c th dng
liu khi u l 4 vin (1 g) ; c th tip tc iu tr sau phu thut (khi c th ung c),
ung 3 vin/24 gi, dng trong 7 ngy.
Chng nhim khun k kh :
Liu thuc ty tng c th, cn c vo tui, cn nng ca ngi bnh, v vo vng nhim khun
v mc trm trng ca bnh. Liu ti a ca ngi ln l 6-8 vin/24 gi.

Chng nghin ru :
Ung 2 vin trong 24 gi, trong thi gian khng qu 6 thng.

281.

KOMIX

BINTANG TOEDJOE
Sir : gi 7 ml, hp 30 gi.
Sir : chai 60 ml.
THNH PHN
cho 1 gi
Dextromethorphane HBr

14 mg

Chlorpheniramine maleate

1,4 mg

Phenylpropanolamine HCl

12,5 mg

Ammonium chloride

87,5 mg

cho 1 mung cafe (5 ml)

Dextromethorphane HBr

10 mg

Chlorpheniramine maleate

1 mg

Phenylpropanolamine HCl

10 mg

Ammonium chloride

62,5 mg

DC LC
Dextromethorphane HBr l mt thuc ho mnh khng c tc ng gy ng, tc ng trung tm
lm tng ngng gy ho v c dng gim ho hiu qu m khng gy l thuc thuc.
Chlorpheniramine maleate l thuc khng histamin H1 c tc ng cnh tranh trn th th H1,
gim triu chng d ng.
Phenylpropanolamine HCl l thuc ging giao cm, c tc ng gim sung huyt nim mc,

khoang mi v gim sung huyt mi.

Ammonium chloride l thuc long m.
CH NH
Gip gim ho c xut tit hay khng, cm thng thng, sung huyt mi do d ng hay do
nguyn nhn khc.
CHNG CH NH
Tng huyt p, cng gip hay qu mn vi bt kz thnh phn no ca thuc.
THN TRNG LC DNG
Nu iu tr trn 7 ngy m cc triu chng vn cn hay c st, nn xem xt li vic iu tr.
Khng dng qu liu ch nh.
Khng nn dng trong hen ph qun.
C th nh hng n kh nng tp trung khi li xe hay vn hnh my mc.
Khng dng cho tr em di 2 tui, tr khi c ch nh c bit.
TNG TC THUC
IMAO, thuc chn bta, phenytoin.
TC DNG NGOI
Kh ming, phn ng qu mn, an thn.
LIU LNG v CCH DNG
Dng gi :
Ngi ln : 1-2 gi, ngy 3-4 ln.
Tr em : 1 gi, ngy 3-4 ln.
Dng xir :
Ngi ln : 2 mung cafe, ngy 3-4 ln.
Tr em 6-12 tui : 1 mung cafe, ngy 3-4 ln ; 2-6 tui : na mung, ngy 3-4 ln.

282.

KONAKION

HOFFMANN - LA ROCHE
thuc tim 10 mg/ml : ng 1 ml, hp 5 ng.
thuc tim 2 mg/0,2 ml : ng 0,2 ml, hp 5 ng.
THNH PHN
cho 1 ml Konakion MM

Phytomenadione

10 mg

T dc : acide glycocholique, lecithine,

sodium hydroxyde, nc pha tim.

cho 0,2 ml Konakion MM paediatric

Phytomenadione

2 mg

T dc : acide glycocholique, lecithine,

sodium hydroxyde, acide chlorhydrique,
nc pha tim.

DC LC
Vitamine K1 (phytomenadione), hot cht ca Konakion, l mt yu t gy ng mu. Do l mt
thnh phn ca h thng men carboxylase gan, vitamine K1 can thip vo phn ng carboxyl
ha cc yu t ng mu s II (prothrombine), VII, IX v X v ca cc cht c ch ng mu
protein C v S. Coumarine c ch phn ng kh oxy ca phenomenadione (dng quinone)
thnh phenomenadione hydroquinone v cng phng phytomenadione epoxide pht sinh
sau phn ng carboxyl ha do b kh oxy thnh dng quinone.
Vitamine K1 l cht i khng vi cc cht chng ng mu kiu coumarine nh
phenprocoumone. Ngc li, vitamine K1 trung ha tc ng ca heparine ging nh tc ng
ca protamine i khng vi heparine.
Vitamine K1 khng hiu nghim trong trng hp gim prothrombine mu do di truyn hoc do
suy gan nng.
Konakion c bo ch di dng hn dch trong vitamine K1 c ha tan trong h keo
sinh l ca hn hp acide mt v lecithine, mt cht chuyn vn cng c tm thy trong c
th. H hn dch MM ny c dung np tt hn dng tim kinh in trc kia.
DC NG HC
Hp thu :
Khi dng bng ng ung, phytometadione c hp thu s khi on gia ca rut non.
S hp thu ch t c ti a khi c s hin din ca mt v dch ty. Sau khi dng bng
ng ung, sinh kh dng ca thuc vo khong 50% v thay i rt ln gia ngi ny v
ngi khc. Thuc bt u c tc dng sau khi tim tnh mch khong 1-3 gi v sau khi ung
hay tim bp khong 4-6 gi.
Phn phi :

Khoang phn phi ban u tng ng vi th tch huyt tng. Trong huyt tng,
phytometadione c t l gn kt vi lipoproteine l 90% v ch c d tr trong c th trong
mt thi gian ngn. Nng bnh thng ca vitamine K1 trong huyt tng vo khong 0,4
n 1,2 mg/lt. Mt gi sau khi tim tnh mch 10 mg phytomenadione, nng trong huyt
tng khong 500 ng/lt v sau 12 gi, nng ny khong 50 ng/ml. Phytomenadione ch qua
hng ro nhau thai vi t l rt thp v c bi tit rt t qua sa m.
Chuyn ha :
Phytomenadione c chuyn ha nhanh chng thnh cc cht chuyn ha phn cc hn, nh
l 2,3-epoxyde phytomenadione, cht ny sau li chuyn ha tr li thnh phytomenadione.
o thi :
Sau khi bin cht do chuyn ha, phytomenadione lin hp vi acide glucuronique v acide
sulfurique, sau c o thi qua mt v thn. C di 10% liu thuc s dng c bi tit
di dng khng i trong nc tiu. Thi gian bn hy trong huyt tng ca
phytomenadione vo khong 1,5 n 3 gi.
Dc ng ca thuc trong nhng trng hp c bit :
S hp thu vitamine K1 rut b gim trong mt s tnh hung, bao gm cc hi chng km hp
thu, hi chng ngn rut, hp ng mt v suy ty. bnh nhn cao tui c iu tr bng
thuc chng ng th p ng i vi phytomenadione ng tim s nhy hn so vi ngi
tr tui.
CH NH
Konakion :
Chy mu hoc c nguy c chy mu do gim prothrombine mu trm trng (v d nh suy
gim cc yu t ng mu s II, VII, IX v X) do nhiu nguyn nhn khc nhau bao gm dng
qu liu thuc chng ng mu kiu coumarine, dng kt hp vi phenylbutazone hoc gim
vitamine K1 do nhng nguyn nhn khc (v d nh chng vng da do tc ng mt, ri lon
gan v rut, sau khi iu tr lu di bng khng sinh, sulfamide hay salicylate.
Konakion paediatric :
phng v cha tr cc bnh chy mu tr s sinh.
CHNG CH NH
Qu mn cm vi phytomenadione hay vi cc t dc ca thuc.
THN TRNG LC DNG
Dng Konakion MM (10 mg/ml) khng c dng cho tr s sinh v nh nhi di 1 tui. Dng
Konakion MM paediatric (2 mg/0,2 ml) thch hp cho tui ny.
Khi s dng cn kim tra hn dch thuc phi trong sut. Nu bo qun khng ng cch, thuc
c th b vn c hoc tch lm hai lp. Khng s dng trong trng hp ny.
Khi bnh nhn b suy chc nng gan trm trng m c iu tr bng Konakion, s hnh thnh
prothrombine b nguy hi. Cho nn, sau khi s dng Konakion, iu cn thit l phi cn thn

theo di nhng thng s v ng mu.

Khi bnh nhn c mang van tim nhn to c truyn mu cha chng chy mu trm
trng hoc nguy c t vong, nn s dng huyt tng ti.
Nn trnh s dng Konakion liu cao nu vn c { nh tip tc iu tr bng thuc chng ng
mu sau .
Tr s sinh thiu thng c trng lng di 2,5 kg d c nguy c b vng da khi dng bng
ng tim.
LC C THAI v LC NUI CON B
Khng c cng trnh nghin cu i chng no v Konakion c thc hin ng vt hoc
ph n mang thai. Tuy nhin trn c s nhiu nm kinh nghim lm sng, khi s dng Konakion
liu khuyn co, thuc chc chn an ton v khng c thnh phn no ca thuc (c vitamine
K1 ln cc t dc trong cng thc bo ch) gy ra hiu qu c. D vy, cng ging nh tt c
cc thuc cha bnh, Konakion ch nn s dng ph n mang thai nu xt thy li ch iu tr
cho b m cao hn nhng nguy c c th xy ra cho bo thai.
V vitamine K1 ch qua hng ro nhau thai vi t l rt thp, nn khng nht thit phi khuyn
co dng Konakion cho b m phng cc bnh chy mu cho tr s sinh.
Ch mt phn nh vitamine K1 s dng c bi tit qua sa m. liu iu tr, s dng
Konakion cho b m cho con b khng gy ra mt nguy c no cho tr. Tuy nhin, Konakion
khng c khuyn co cho b m cho con b nh l mt bin php phng bnh chy mu
tr s sinh.
TNG TC THUC
Vitamine K1 i khng vi hiu qu ca cc thuc chng ng mu kiu coumarine. S dng
chung vi vi cc thuc chng co git s lm h tc dng ca vitamine K1.
TC DNG NGOI
C mt vi bo co ring l nhng khng c kim chng cho rng c th xy ra nhng phn
ng ging phn v sau khi tim tnh mch Konakion MM.
Him khi xy ra nhng trng hp nh tnh mch b kch thch hoc vim tnh mch khi tim
tnh mch hn dch Konakion.
LIU LNG v CCH DNG
Konakion MM v Konakion MM paediatric tim dng tim tnh mch. Dung dch trong ng
thuc khng nn pha long hoc pha trn vi cc loi thuc tim khc, nhng c th tim vo
phn di ca b dy ang truyn lin tc dch truyn NaCl 0,9% hoc dextrose 5%.
Konakion MM (10 mg/ml) :
Liu chun :
Phi ngng thuc chng ng mu v tim tnh mch chm (t nht 30 giy) Konakion MM vi
liu 10-20 mg (1-2 ng). Nng prothrombine c xc nh trong 3 gi sau v nu cha thy
p ng thch hp, liu ny c th c lp li nhng khng c qu 50 mg Konakion MM

tim tnh mch trong 24 gi.

Trng hp chy mu trm trng v e da tnh mng : iu tr bng Konakion MM nn c
phi hp vi bin php iu tr cho hiu qu tc th nh l truyn mu (ton phn hoc truyn
cc yu t ng mu).
Trng hp chy mu t trm trng hn : c th s dng dng ung.
Nhng ch nh khc (v d nui n qua ng tim truyn) : nu cn c th dng cc liu 10-20
mg.
Hng dn liu c bit :
- Ngi cao tui : bnh nhn cao tui c xu hng nhy cm hn nn cn chn liu mc thp
hn trong gii hn liu khuyn co.
- Tr em trn 1 tui : theo khuyn co ca bc s, nu tr em phi s dng n Konakion, nn
chn liu 5-10 mg.
- Tr em di 1 tui : i vi nhm bnh nhi ny, nn s dng Konakion MM dnh cho tr em.
Konakion MM paediatric (2 mg/0,2 ml) :
Liu d phng :
- Dnh cho tt c tr s sinh khe mnh : 2 mg lc sanh xong hoc mt thi gian ngn sau khi
sanh, sau 1 liu 2 mg na c cho ung trong thi gian t ngy th 4 n ngy th 7 sau
sanh.
- Dnh cho tr b sa m hon ton : nn thm vo cho tt c tr s sinh khe mnh mt liu 2
mg ung sau tun th 4 n tun th 6.
- Dnh cho tr s sinh c cc yu t nguy c c bit (nh sinh thiu thng, lc sanh b ngp,
vng da do tc ng mt, khng c kh nng b, m s dng thuc chng ng mu hoc
thuc chng ng kinh) :
- 1 mg tim bp hoc tim tnh mch lc sanh xong hoc mt thi gian ngn sau sanh, nu
ng ung khng ph hp.
- Nhng liu tim bp hoc tim tnh mch khng c vt qu 0,4 mg/kg (tng ng 0,04
ml/kg) tr sinh thiu thng c th trng nh hn 2,5 kg (xem phn Thn trng lc dng).
- Liu lng v s ln s dng cc liu thuc v sau ty thuc vo tnh trng chy mu.
Liu iu tr :
Liu khi u : 1 mg tim tnh mch. Nhng liu v sau, nu cn, ph thuc vo bnh cnh lm
sng v tnh trng chy mu.
Trong vi tnh hung, iu tr bng Konakion MM paediatric c th nn c phi hp vi bin
php iu tr cho hiu qu tc th nh l truyn mu ton phn hoc truyn cc yu t ng
mu b li s lng mu mt v ko di thi gian p ng i vi vitamine K1.
QU LIU
Hin cho n nay cha c trng hp tng phytomenadione mu no c bo co.
BO QUN

Bo qun thuc trnh nh sng v nhit nng. Nu bo qun khng ng cch, thuc c th
b vn c hoc tch lm hai lp. Khng s dng trong trng hp ny.
Khng dng thuc qu hn in trn bao b.

283.

KREMIL-S

UNITED LABORATORIES
Vin nn : v 20 vin, hp 5 v.
THNH PHN
cho 1 vin
AHMC loi F-MA 11*

325 mg

Dimethylpolysiloxane

10 mg

Dicyclomine chlorhydrate

2,5 mg

* Gel Aluminium hydroxyde-Magnsium carbonate hot tnh cao c lm kh trong qu trnh

phun.
DC LC
Kremil-S l ch phm chng lot d dy vi tc ng khng acide, chng y hi v gii co tht.
Thuc trung ha nhanh chng v iu chnh pH dch v v mc t 3-5. pH ny, tc dng phn
gii protine ca pepsine c gim n mc dch v mt i tnh bo mn d dy nhng vn gi
c chc nng tiu ha ca n.
Kremil-S lm gim s tch t qu mc ca cht hi trong ng tiu ha bng cch thay i sc
cng lin b mt, ph v mng bao dai bng cht nhy ca bng hi, do gii phng cht hi
sinh ra v a ra ngoi qua s hay x hi.
Dicyclomine chlorhydrate trong thnh phn thuc lm th gin c trn ca ng tiu ha,
kim sot s co tht gy au ca phn d dy t trng.
CH NH
iu tr ngn v di hn cc chng lot ng tiu ha v gim au do tng tit acide, tng vn
ng d dy, rut b kch ng v co tht, y hi kh tiu, vim d dy, v chua, vim t trng,
vim thc qun, thot v khe, ch n khng thch hp, nhim c alcool v au sau phu
thut bng. Cng c tc dng gim au bng tr em.

CHNG CH NH
Bnh nhn mc chng glaucome gc ng hay gc hp v c th lm tng nhn p.
Khng dng cho bnh nhn tt lit rut hay hp mn v v c th dn n s tt rut.
THN TRNG LC DNG
Nn dng cn thn cho bnh nhn suy mch vnh, suy tim hay ph i tuyn tin lit.
Nhp tim nhanh c th l hu qu ca s c ch dy thn kinh ph v hay a n chng au
tht ngc khi gng sc trn nhng bnh nhn mc bnh mch vnh.
TC DNG NGOI
Vi bnh nhn suy thn, mui magnsium c th gy trm cm h thn kinh trung ng.
nhng ngi qu nhy cm, thnh phn c tc dng chng co tht ca thuc (dicyclomine
chlorhydrate) c th gy kh ming, chong vng v m mt. mt s bnh nhn i khi cng
c mt mi, bun nn, nhc u v kh tiu vi dicyclomine.
LIU LNG v CCH DNG
C th nhai hoc nut vin thuc. Vin c mi thm bc h.
n Lo t ng tiu ha v vim d dy : 2-4 vin mi 4 gi hoc theo s ch nh ca bc s.
n iu tr triu chng ca tng tit acide d dy (v chua, kh tiu, , au thng v v au do
y hi) : 1-2 vin sau khi n hay khi cn thit.

THUC VN L

284.

LACTACYD

SANOFI SYNTHELABO VIETNAM

Dung dch si bt, dng sa, dng ngoi da : chai 60 ml v 250 ml ; gi 10 ml.
THNH PHN
cho 100 g
Atomisat ca lactosrum

0,9 g

Acide lactique

1g

T dc t pH 3,5 v

100 ml

DC LC
Thuc ty dng st trng da v nim mc.
Mt dung dch nc cha cht hot ha b mt phi hp vi acide lactique c m bng
lactosrum (pH 3,5)
CH NH
Ty sch da v nim mc.
iu tr ph tr cc bnh ngoi da do vi khun nguyn pht hoc c kh nng bi nhim.
CHNG CH NH
Tin cn d ng vi mt trong cc thnh phn ca thuc (hoc cng nhm).
THN TRNG LC DNG
Cng nh i vi tt c cc loi thuc ty (x bng, cht hot ha b mt), cn ra li tht k
sau khi dng.
Trnh dng nhiu ln trn da kh, chm cp tnh, vng da bng kn.
TNG TC THUC
Trnh dng cng lc hay lin tip vi cc thuc st trng khc v c th c hin tng giao thoa.
TC DNG NGOI
- C th to phn ng kh chu ti ch khi dng nhiu ln.
- Mi trng acide thun li cho s pht trin ca Candida albicans.
LIU LNG v CCH DNG
Dng nh x bng nc pha long 1/3, ra li tht k.
BO QUN
Ni mt.

285.

LACTACYD

SANOFI SYNTHELABO VIETNAM

Thuc nc si bt, dng sa dng cho v sinh ph n : chai 60 ml v 250 ml ; gi 10 ml.
THNH PHN
cho 100 ml
Atomisat ca lactoserum

0,9 g

Acide lactique

1g

T dc t pH 3,5 va

100 ml

DC LC
St trng da v nim mc.
Hot ha b mt phi hp vi acid lactic c m bng lactoserum (pH 3,5), di dng dung
dch nc.
CH NH
- V sinh ph n hng ngy : cn bng sinh l ca nim mc c duy tr bi thnh phn t
nhin (Lactoserum) v pH acide ca Lactacyd.
- Sn sc sau sinh.
- Ph khoa : vim m o, huyt trng, vim m h, nga m h.
CHNG CH NH
Tin cn d ng vi mt trong cc thnh phn (hoc cng nhm).
CH PHNG v THN TRNG LC DNG
- Cng nh i vi tt c cc loi thuc ty (x bng, cht c hot tnh b mt), ra nc li
tht k sau khi dng.
- Trnh dng nhiu ln trn da kh, eczema cp tnh, vng da bng kn.
TNG TC THUC
Trnh dng cng lc hay tip theo cc thuc st trng khc v c th c hin tng giao thoa.
TC DNG NGOI
- C th to phn ng kh chu ti ch khi dng lp i lp li.
- Mi trng acide thun li cho s pht trin ca Candida albicans.
LIU LNG v CCH DNG
- Lc k trc khi dng.
- Dng nh x bng nc. Ra nc li tht k sau khi dng. C th dng ra nhiu ln trong
ngy.
- Bm ra m o : 2-4 mung canh trong 1 lt nc. Hoc dng dng c bm ra m o.
Thng thng c th bm ra 2 ln/tun. Khi c nhim trng m o th bm ra hng ngy.
BO QUN
Ni mt.

286.

LACTOL FORT

LACTOL DU DOCTEUR BOUCARD

c/o KENI - OCA
Bt ung : hp 10 gi, hp100 gi (dng dng cho bnh vin).
Vin nang : hp 20 vin, hp 100 vin.
THNH PHN
cho 1 gi
Cht ng kh

340 mg tng ng vi :

- Lactobacillus acidophilus (vi khun cht ng kh)

10 t

- Mi trng nui cy (trung tnh v ng kh)

160 mg

T dc :

v 800 mg

cho 1 vin
Cht ng kh

170 mg tng ng vi
:

- Lactobacillus acidophilus (xc vi khun cht ng kh)

5 t

- Mi trng cy ln men (trung tnh v ng kh)

80 mg

T dc :

va 235 mg

DC LC
Lactol Fort l thuc chng tiu chy c ngun gc vi khun.
Hot cht chnh l nhng sn phm chuyn ha c ch bin t chng Lactobacillus
acidophilus cht sau khi cy trong mi trng lactoserum.
Trong thc nghim hay trn ng vt cc nghin cu dc l{ nu ra 4 c ch nh sau :
- Hot cht kim khun trc tip do cc cht ha hc c to thnh t L. acidophilus (acid
lactic, cc cht khng sinh c cng thc cha r).
- S kch thch min dch khng chuyn bit ca nim mc (tng s tng hp IgA).
- S kch thch tng sinh h vi khun bo v sinh acid, ch yu do s hin din ca nhiu vitamin
nhm B.
- S kt dnh ca L. acidophilus thuc chng Lact ol b git bi nhit vo t bo rut ngi,
c chc nng hp thu v tit dch, trong mi trng canh cy. Trong mu canh cy t bo, s

hin din ca L. acidophilus cht ca chng Lactol cng s hin din ca mi trng cy ln
men, c ch s kt dnh v xm ln vo t bo rut ca nhng vi sinh gy ra tiu chy. Trn
thc t vic s dng L acidophilus cht ca chng Lactol trn chut, c ch s pht tn khp
c th ca Campylobacter jejuni t ng tiu ha.
CH NH
Thuc c dng iu tr chng tiu chy c ngun gc khng do nguyn nhn thc th
ngi ln, tr em v tr cn b.
- tr cn b (di 2 tui) : nn b sung vic b nc.
- Trn 2 tui : vic iu tr khng loi b b nc nu cn thit.
Mc b nc v ng a nc vo c th (ng ung hoc ng tim truyn) phi
thch hp vi cng tiu chy v c a ca bnh nhn.
LIU LNG v CCH DNG
Liu lng :
Dng gi :
Ung t 1 n 2 gi mi ngy, ty theo mc tiu chy.
Tiu chy cp tnh : ung 3 ln, mi ln 1 gi ngy u tin, sau 2 ln, mi ln 1 gi trong
nhng ngy tip theo.
Dng vin :
Ung t 2 n 4 vin mi ngy, ty theo mc tiu chy.
Tiu chy cp tnh : ung 3 ln, mi ln 2 vin ngy u tin, sau 2 ln, mi ln 2 vin trong
nhng ngy tip theo.
Cch s dng v ng dng :
ng ung. Cho thuc trong gi vo mt ly nc, lc u ri ung. Thuc trong gi hay trong
vin nang c th c ha tan trong bnh nc b.
BO QUN
Khng c dng qu thi hn s dng ghi trn bao hp.
Trnh ni c nh sng v m t.

287.

LAMISIL

NOVARTIS
kem bi ngoi da : tube 5 g.
THNH PHN

cho 100 g
Terbinafine hydrochloride

1g

Cht bo qun : Benzyl alcohol

DC LC
Terbinafine l mt allylamine c tc dng dit nm ph rng i vi nm da, nm mng v nm
lng hnh. Tc dng dit hay l khng nm men ty thuc vo chng loi nm.
Terbinafine can thip chn lc vo giai on u ca qu trnh sinh tng hp ergosterol, dn
n s thiu ht ergosterol v lm tng s tch t nng squalene trong ni t bo v lm
cht t bo nm. Terbinafine pht huy tc dng bng cch c ch squalene epoxidase trong
mng t bo nm. Men squalene epoxidase ny khng gn kt vi h thng cytochrome P450.
Terbinafine khng gy nh hng ti s chuyn ha ca cc hormon hay cc thuc khc.
DC NG HC
c th ngi, di 5% liu dng c hp thu sau khi bi thuc ti ch. V vy, tc dng ton
thn rt nh. Cc cht chuyn ha thng qua qu trnh chuyn ha sinh hc khng c tc dng
khng nm v c o thi ch yu qua phn v nc tiu. Thi gian bn thi l 17 gi. Khng
c bng chng v tch ly thuc.
CH NH
Nhim nm da gy ra bi cc loi nm nh Trichophyton (T. rubum, T. mentagrophytes, T.
vurrucosum, T. violaceum), Microsporum canis v Epidermophyton foccosum.
Nhim nm men da, c bit gy ra bi nm Candida (nh Candida albicans).
Lang ben do Pityrosporum orbiculare (c bit n nh Malassezia furfur).
CHNG CH NH
Mn cm vi terbinafine hay vi bt c thnh phn t dc no ca thuc.
THN TRNG LC DNG
Lamisil dng kem ch dng ngoi. Trnh thuc tip xc vi mt.
LC C THAI v LC NUI CON B
Cc nghin cu v s sinh sn trn ng vt khng ch ra tc dng c hi no ca thuc,
nhng cha c th nghim kim chng no c thc hin trn ph n c thai. V vy, khng
nn dng thuc cho ph n c thai tr khi li ch iu tr vt tri nhng nguy c c th xy ra.
Terbinafine c bi tit qua sa m v mc d vi lng hp thu t vn khng nn dng thuc
trong thi kz cho con b.
TNG TC THUC
Cha c s tng tc thuc no c bit n vi Lamisil dng kem.

TC DNG NGOI
Mn , nga, cm gic kin t i khi xy ra ti ch dng thuc nhng rt t khi phi ngng
iu tr v l do ny. Cc phn ng v hi ny cn phi c phn bit vi cc phn ng d ng
i hi phi ngng iu tr.
LIU LNG v CCH DNG
C th bi kem 1-2 ln mi ngy. Ra sch v lau kh vng da b nhim nm trc khi dng
thuc. Bi mt lp kem mng vo vng da b nhim nm v vng da xung quanh ri thoa nh.
Trong cc trng hp nhim nm c try (hm) da (k v, k ngn chn, ngn tay, k mng,
bn) nn ph lp thuc bi bng mt gc mng, nht l v ban m.
Thi gian iu tr :
Nm da thn, nm da i : 1 tun.
Nm da chn : 1 tun.
(Thng thng ch iu tr 1 tun l nu bi thuc 2 ln mi ngy).
Nm Candida da : 1 tun.
Lang ben : 2 tun.
Cc triu chng lm sng thng thuyn gim sau vi ngy iu tr, vi iu kin khng b ti
nhim. Cn phi iu tr u n v thi gian. Nu khng c du hiu ci thin sau 2 tun
iu tr th cn xem xt li chn on.
Dng thuc ngi gi :
Khng c bng chng cho thy s khc bit v liu dng hay tc dng ph gia ngi gi v tr.
Dng thuc tr em :
Kinh nghim dng Lamisil ti ch i vi tr em cn hn ch, v vy cha th a ra khuyn co
cho i tng ny.
Lu { chung :
Vic gi v sinh tt l cn thit v phi lun lun i km vi vic s dng Lamisil trnh ti
nhim nm (nh t qun o lt, v (tt), giy...).
QU LIU
Cha c trng hp qu liu no c bit n

288.

LARIAM

HOFFMANN - LA ROCHE
Vin nn d b 250 mg : hp 8 vin.
THNH PHN

cho 1 vin
Mefloquine hydrochloride, tnh theo mefloquine base

250 mg

DC LC
Lariam tc dng trn th v tnh ni hng cu ca k sinh trng st rt trn ngi : Plasmodium
falciparum. P. vivax, P. malariae v P. ovale.
Lariam cng c tc dng trn cc k sinh trng st rt khng li cc thuc chng st rt khc
nh cloroquine, proguanil, pyrimethamine v phi hp pyrimethamine-sulfonamide.
S khng li mefloquine ca P. falciparum c bo co, ch yu vng ng Nam . Cng
gp s khng cho gia mefloquine v halofantrinev s khng cho gia mefloquine v
quinine cng c ghi nhn mt s vng.
DC NG HC
Hp thu :
Kh dng sinh hc tuyt i ca mefloquine khng c xc nh v thuc khng c dng tim
tnh mch. Sinh kh dng ca dng vin so vi dng dung dch ung l trn 85%. S c mt ca
thc n lm tng r rt ch s ny v ko di thi gian hp thu, dn ti tng khong 40% sinh
kh dng. nh nng trong huyt tng t c t 6-24 gi (trung bnh khong 17 gi) sau
khi dng mt liu n Lariam. Nng ti a trong huyt tng tnh theo mg/l l tng ng
vi liu tnh theo miligram (v d : mt liu n 1000 mg cho nng ti a trong huyt tng
vo khong 1000 mg/l). Vi liu 250 mg mt ln trong tun, nng ti a trong huyt tng
trng thi n nh l 1000-2000 mg/l t c sau 7-10 tun.
Phn b :
Trn ngi trng thnh khe mnh, th tch phn b r rng l vo khong 20 l/kg cho thy
s phn b rt tt trong t chc. Mefloquine c th tch ly trong hng cu c cha k sinh
trng vi mt t l t hng cuti huyt tng l khong 2 ln. T l gn vi protein l khong
98%. t c hiu qu trong iu tr d phng l 95% th cn nng trong mu ca
mefloquine l 620 ng/ml.
Mefloquine qua c nhau thai. Vic bi tit vo sa m hnh nh rt t (xem phn Lc c thai
v Lc nui con b).
Chuyn ha :
Hai cht chuyn ha c nhn dng trn ngi. Cht chuyn ha chnh l 2,8-bistrifluoromethyl-4-quinoline carboxylic acid khng c hot lc vi P. falciparum. Trong mt
nghin cu trn nhng ngi tnh nguyn khe mnh, cht chuyn ha acid carboxylic xut
hin trong huyt thanh 2 n 4 gi sau khi ung mt liu n. Nng ti a trong huyt
tng, cao hn khong 50% so vi nng mefloquine, t c sau 2 tun. Sau , mc
trong huyt tng ca cht chuyn ha chnh v mefloquine gim dn ti mt mc tng

ng. Din tch di ng cong ca cht chuyn ha chnh rng hn 2 n 3 ln so vi cht

gc.
Cht chuyn ha khc, mt alcohol, ch c mt trong khong vi pht.
o thi :
Trong mt vi nghin cu ngi trng thnh khe mnh, thi gian bn thi trung bnh ca
mefloquine thay i gia 2 v 4 tun, trung bnh khong 3 tun. thanh thi ton b, ch yu
gan, l khong 30 ml/pht. R rng l mefloquine c bi tit ch yu qua mt v phn.
Trn ngi tnh nguyn, vic bi tit qua nc tiu di dng mefloquine nguyn dng v cht
chuyn ha chnh l 9% v 4% ca liu. Nng ca cc cht chuyn ha khc khng c o
trong nc tiu.
Tr em v ngi gi : khng thy s thay i r rt lin quan n tui v mt dc ng hc
ca mefloquine. V vy, liu cho tr em c ngoi suy t liu ch nh cho ngi ln.
Khng c nghin cu no v dc ng hc c tin hnh trn bnh nhn suy thn v ch c
mt t l nh thuc c o thi qua thn. Khng c s khc bit r rt gia mefloquine v
cc cht chuyn ha chnh ca n qua s thm tch mu. Khng cn iu chnh liu ha d
phng i vi bnh nhn c thm tch t c nng tng t nh nhng bnh nhn
khe mnh (ngi tnh nguyn).
Thai nghn khng c nh hng lm sng r rt v dc ng hc ca mefloquine.
Dc ng hc ca mefloquine c th b nh hng trong st rt c tnh.
thy s khc bit v dc ng hc nhng chng tc dn c khc nhau. Tuy nhin, trn
thc t, iu ny c tm quan trng khng ln so vi tnh trng min dch ca c th v tnh
nhy cm ca k sinh trng.
Khi dng thuc phng nga lu di, thi gian bn thi ca mefloquine khng thay i.
CH NH
D phng, iu tr v iu tr ch i st rt.
D phng : Ha d phng vi Lariam c ch nh cho nhng ngi i du lch n vng c st
r t, c bit nhng vng c nguy c nhim bnh cao vi chng P. falciparum khng vi nhng
thuc chng st rt khc.
iu tr : Lariam c ch nh trong iu tr st rt bng ng ung, c bit khi nguyn nhn
gy ra bi chng P. falciparum khng vi nhng thuc chng st rt khc. Thuc cng c th
c s dng iu tr P. vivax v bnh st rt hn hp (xem phn Liu lng v Cch dng).
iu tr ch i : Lariam c ch nh nh mt tr liu ch i cho nhng ngi du lch v t
dng nh mt bin php cp cu khi nghi ng st rt m khng c sn thuc cc c s y t
trong vng 24 gi.
CHNG CH NH
Chng ch nh s dng Lariam nhng bnh nhn bit c tin s qu mn cm vi
mefloquine hoc nhng cht c lin quan (nh quinine v quinidine) hoc bt kz mt t dc

no c trong thnh phn thuc.

Lariam khng nn c ch nh dng d phng nhng bnh nhn trm cm hoc c tin s
tm thn hoc co git.
THN TRNG LC DNG
Cng nh phn ln cc thuc khc, phn ng qu mn thay i t phn ng da nh ti phn v
khng th d on trc c.
Trn nhng bnh nhn c ng kinh, Lariam c th lm tng nguy c co git. Thuc do vy ch
c ch nh iu tr tit bnh nhng bnh nhn ny v ch khi c nhng l do y t bt
buc phi s dng thuc (xem phn Tng tc thuc).
Vi nhng bnh nhn c suy chc nng gan, vic o thi mefloquine c th b ko di, dn ti
tng nng ca thuc trong huyt tng.
V nhng nguy him tim tng ti sinh mng do vic ko di khong QTc, halofantrine khng
c dng cng lc hoc tip sau Lariam. Hin nay khng c ti liu no v vic dng Lariam
tip sau halofantrine.
Nu c cc triu chng lo u cp tnh, trm cm, thao thc hoc ln xut hin trong qu trnh
iu tr d phng, cn dng Lariam v cn mt thuc khc iu tr d phng thay th.
nh hng ln kh nng li xe v vn hnh my mc :
Nu bnh nhn thy chng mt, mt thng bng hoc nhng ri lon khc ca h thn kinh
trung ng v ngoi bin th nn thn trng khi li xe, li may bay, vn hnh my mc, th ln,
hoc cc hot ng cn phi phi hp cc ng tc nhanh nhn, chnh xc.
LC C THAI v LC NUI CON B
Khi dng liu cao hn 5-20 ln so vi liu iu tr ngi, mefloquine gy qui thai chut v
nhim c thai th ; tuy nhin, kinh nghim s dng Lariam trn lm sng khng gy ra qui
thai hoc nhim c thai. Tuy vy Lariam ch s dng 3 thng u ca thai kz khi cc li ch c
th bin h c cho nhng nguy c tim tng i vi thai. Ph n trong tui sinh nn c
khuyn dng bin php trnh thai trong khi iu tr d phng i vi st rt bng Lariam v cho
3 thng tip theo. Tuy nhin, trong trng hp c thai ngoi mun, ha d phng i vi st
rt bng Lariam khng c ch nh cho ti kt thc thai kz.
Mefloquine c bi tit vo trong sa m vi mt lng rt thp, nh hng ca n cn cha
c bit. Do vy cc b m ang dng Lariam khng nn cho con b.
TNG TC THUC
Dng phi hp Lariam v cc thuc c lin quan khc (nh quinine, quinidine v cloroquine) c
th gy ra cc bt thng trn in tm v lm tng nguy c co git (xem phn Liu lng
v Cch dng, mc iu tr). Ngi ta cng thy r rng dng halofantrine sau mefloquine gy
ra ko di r rt khong QTc. Du hiu ca khong QTc ko di khng tm thy trn lm sng khi
dng mefloquine n c. Hnh nh ch c mt hin tng giao thoa thuc dng ny trn lm
sng i vi Lariam mc d trn l thuyt vic dng phi hp vi cc thuc khc bit c gy

nh hng ln s dn truyn (nh thuc chng lon nhp hoc cht chn bta giao cm, thuc
c ch knh canxi, khng histamine hoc cht chn H1, thuc chng trm cm tricyclic v
phenothiazines) cng c th nh hng n vic ko di khong QTc. Khng c d liu kt
lun c hay khng vic ung mefloquine v cc thuc trn c nh hng ln chc nng tim.
Trn nhng bnh nhn ang dng thuc chng co git (nh acid valproic, carbamazepines,
phenobarbital hoc phenytoin), dng phi hp vi Lariam c th lm gim tc dng kim sot
cn ng kinh v lm gim nng trong huyt tng ca cc thuc chng co git. Trong mt
s trng hp c th cn dng thm liu ca thuc chng co git (xem phn Thn trng lc
dng).
Khi dng phi hp Lariam vi vaccin sng chng thng hn, khng loi tr c vic lm gim
min dch. Do vy dng vaccin vi cc vi khun sng gim c cn c kt thc t nht 3 ngy
trc khi dng liu Lariam u tin.
Khng thy nhng tng tc thuc no khc nhng d vy, nhng nh hng ca Lariam trn
nhng ngi du lch c dng cc loi thuc khc, c bit l thuc chng ng hoc chng tiu
ng, nn c kim tra trc khi khi hnh.
TC DNG NGOI
Vi liu dng trong st rt cp tnh, nhng phn ng ph ca Lariam c th khng phn bit
c r vi bn thn cc triu chng ca bnh. Nhng phn ng ph hay gp nht khi dng
Lariam d phng l bun nn, nn v chng mt thng ch mc nh v gim dn khi
dng thuc ko di, mc du hm lng thuc trong huyt tng tng ln.
T l cc phn ng ph c bo co trong s dng iu tr d phng bng mefloquine c th
so snh vi bo co v ch iu tr ha d phng khc. Ti liu v cc phn ng ph c
trng bi s chim u th ca cc phn ng ph v tm thn kinh.
Nhng tc dng ph hay gp nht c bo co l bun nn, nn, phn nho hoc tiu chy
v au bng, chng mt hoc hoa mt, mt thng bng, cc phn ng ph v tm thn kinh
nh au u, bun ng, ri lon gic ng (mt ng, m mng khng bnh thng).
Nhng tc dng ph t gp :
Cc ri lon tm thn kinh : bnh thn kinh v cm gic v vn ng (bao gm c d cm, run,
tht iu), co git, kch ng hoc bn chn, lo u, trm cm, thay i tm trng, hong s, hay
qun, l ln, o gic v cc phn ng tm thn v phn ng paranoid. Him c ghi nhn v
nh t t nhng khng c mi lin h vi vic ung thuc.
Ri lon h tim mch : ri lon tun hon (h huyt p, tng huyt p, bc ha, ngt), au ngc,
nhp tim nhanh, nh trng ngc, nhp tim chm, mch khng u, ngoi tm thu v nhng
thng tn khc v dn truyn tim.
Da : ni mn, ngoi ban, ban , my ay, nga, chm, rng tc.
H c xng : yu c, chut rt, au c, au khp.
Cc triu chng khc : ri lon th lc, ri lon tin nh bao gm tai v suy gim thnh lc,

kh th, suy nhc, kh chu, mt mi, st, ra m hi, n lnh, kh tiu, chn n.
Cc triu chng khc : ri lon th lc, ri lon tin nh bao gm tai v suy gim thnh lc,
kh th, suy nhc, kh chu, mt mi, st, ra mi hi, n lnh, kh tiu, chn n.
Nhng bt thng v xt nghim : tng cc men gan thong qua, gim bch cu hoc tng bch
cu, gim tiu cu.
C bit c trng hp gp hng ban a dng, hi chng Stevens-Johnson, block nh tht v
bnh no.
Do thi gian bn hy ca mefloquine di, cc phn ng ph ca Lariam c th xy ra hoc tn
ti ti vi tun sau khi dng liu thuc cui cng.
Nhng nghin cu trn in vitro v in vivo cho thy khng c hin tng tan mu phi hp vi
vic suy gim G6PD.
LIU LNG v CCH DNG
Mefloquine c v ng v hi bng rt. Nn nut trn vin Lariam vi t nht mt cc nc.
Vin thuc c th c nghin v ha ln vi mt lng nh nc, sa hoc ung khc
dng cho tr nh hoc cho nhng ngi khng th nut c ton b vin thuc.
D phng :
Liu chun :
Liu Lariam d phng khuyn dng l vo khong 5 mg/kg/mt ln trong tun.
Trng lng (kg)
Liu
5-10 kg
1/8 vin*
10-20 kg
1/4 vin
20-30 kg
1/2 vin
30-45 kg
3/4 vin
> 45 kg
1 vin
* C s phn chia vin thuc da trn liu 5 mg/kg trng lng. Liu chnh xc cho tr nh
c trng lng thp hn 10 kg tt nht c chun b v pha ch bi dc s.
Liu hng tun cn c ung u n, lun vo mt ngy ca tng tun, tt nht l sau ba
n chnh.
Liu u tin nn dng t nht mt tun trc khi n vng c dch.
Kinh nghim vi Lariam cho tr nh di 3 thng tui v nng di 5 kg cn hn ch. Liu cho
tr ln c ngoi suy t liu ch nh cho ngi ln (xem phn Dc ng hc).
Ch dn liu c bit :
i vi nhng ngi du lch sp ti vng c nguy c cao, nu vic iu tr d phng mt tun
trc khi ti vng dch l khng th c th phi dng "liu ti" bao gm liu ung hng tun
cho mi ngy trong 3 ngy lin tip, sau , dng liu chun hng tun, c ch nh nh sau :
Ngy th nht

Liu th nht

Ngy th hai
Liu th hai
Ngy th ba
Liu th ba
Sau
liu u n hng tun
Vic s dng liu ti c th phi hp vi vic tng cc phn ng ph.
Trong mt s trng hp, v d nh khi mt ngi i du lch ang dng mt thuc khc, nn
bt u d phng 2-3 tun trc khi khi hnh, vi m bo rng vic phi hp thuc c
dung np tt (xem phn Tng tc thuc).
gim nguy c mc st r t sau khi ri khi vng c dch, nn tip tc dng thuc thm 4
tun na m bo nng thuc trong mu c tc dng khi th hoa hng t trong gan ra
ngoi.
Khi vic d phng vi Lariam tht bi, ngi bc s nn nh gi thn trng nhng thuc chng
st rt no c th s dng iu tr. Nu dng halofantrine, xem phn Thn trng lc dng v
Tng tc thuc.
iu tr :
Liu chun :
Ton b liu iu tr mefloquine khuyn dng l 20-25 mg/kg cn nng.
Trng lng (kg)
Tng liu
Chia liu (*)
5-10 kg
1/2-1 vin
10-20 kg
1-2 vin
20-30 kg
2-3 vin
2+1
30-45 kg
3-4 vin
2+2
45-60 kg
5 vin
3+2
> 60 kg
6 vin
3+2+1
* Vic chia tng liu iu tr ra 2-3 liu ung mi 6-8 gi c th lm gim tn sut v mc
nng ca tc dng ph.<
Kinh nghim dng Lariam tr nh hn 3 thng hoc cn nng di 5 kg cn hn ch.
Khng c nhng thc nghim ring v tng liu iu tr nhiu hn 6 vin nhng bnh nhn c
th trng rt nng.
Ch dn liu c bit :
i vi mt s ngi c min dch, nh dn c vng dch t st rt, cn gim liu thch hp.
Mt liu dng y th hai nn c dng cho nhng bnh nhn b nn trong vng 30 pht
sau khi ung thuc. Nu nn xy ra trong vng 30-60 pht sau khi ung thuc, nn dng thm
mt na liu na.
Sau khi iu tr st rt do P. vivax, nn dng d phng li mt dn cht ca 8-aminoquinoline
(v d primaquine) nhm loi tr th trong gan.
Nu mt t iu tr Lariam y khng gip ci thin bnh trong vng 48-72 gi, khng nn
s dng Lariam iu tr li ln na. Nn chn mt iu tr thay th khc. Khi st rt xy ra

trong thi gian dng d phng bng Lariam, bc s nn nh gi cn thn nn dng thuc no
iu tr. Khi dng halofantrine, cn xem phn Thn trng lc dng v Tng tc thuc.
Lariam c th dng iu tr st rt c tnh nng sau khi dng khi u bng mt t quinine
tim tnh mch trong t nht 2-3 ngy. Hin tng giao thoa gy ra cc tc dng ph c th
c d phng bng cch dng cch qung t nht 12 gi sau khi dng liu quinine cui cng.
nhng vng c st r t a khng thuc, khi u iu tr vi artemisinin hoc mt dn cht,
nu c, tip sau dng Lariam.
iu tr trong lc ch i :
Lariam c th c ch nh nh mt thuc dng cp cu tm thi khi cha n c mt
c s y t trong vng 24 gi sau khi bt u triu chng. T iu tr nn bt u vi liu khong
15 mg/kg ; vi bnh nhn nng 45 kg hoc hn, liu khi u nh vy s l 3 vin Lariam. Nu
khng th ti c c s y t trong vng 24 gi, v khng c tc dng ph nghim trng no
xy ra, ln dng th hai ca tng liu iu tr nn c dng sau 6-8 gi (2 vin bnh nhn
nng 45 kg hoc hn). Nhng bnh nhn nng hn 60 kg nn dng thm 1 vin sau khi ung
liu th hai 6-8 gi (xem phn ch nh liu cho iu tr pha trn).
Bnh nhn nn c khuyn ti khm bc s cng sm cng tt sau khi t iu tr, thm ch
ngay c khi h cm thy hon ton bnh phc hay c khng nh hoc bc b bi s
chn on.
QU LIU
Trong nhng trng hp dng Lariam qu liu, cc triu chng cp trong phn Tc dng
ngoi c th nng hn. Cc qui trnh sau nn c tin hnh trong trng hp qu liu : Gy
nn hoc ra d dy. Theo di chc nng tim (nu c tth th bng in no ) v trng thi
thn kinh trong t nht l 24 gi. iu tr triu chng v hi sc h tr nu cn, c bit i vi
nhng ri lon tim mch.

289.

LGALON

MADAUS
c/o GALIEN
vin bao 70 mg : hp 40 vin.
THNH PHN
cho 1 vin

Qu Silybum marianum, tnh theo Silymarine

70 mg

DC LC
Thuc c tc ng hng gan.
Silymarine c tc dng bo v t bo gan v chc nng ca cc cu trc xung quanh v bn
trong t bo gan, gip gan hot ng hiu qu hn v tng hiu qu thi c ca gan.
Tc dng bo v t bo gan c chng minh khng ch trong cc th nghim dng nhng
tc nhn c in tn cng ln gan nh t trachlorure carbone, thioac tamide, D-galactosamine,
alcool thylique, vv, m cn trn cc tn thng nng gan gy bi phalloidine, a-amanitine v
Frog virus 3 (FV3).
DC NG HC
Sau khi ung 140 mg silymarine, tng ng vi 2 vin Lgalon, nng ca hot cht t c
mt t 10 n 30 mg/ml.
o thi qua mt ko di khong 24 gi.
o thi qua thn thp (khong 3%).
CH NH
iu tr cc ri lon chc nng tiu ha trong cc bnh v gan.
TC DNG NGOI
Rt him khi gy au d dy hay tiu chy.
Hn hu c th gy phn ng d ng.
LIU LNG v CCH DNG
Mi ln ung 2 vin, 2 n 3 ln/ngy.

290.

LNITRAL 2,5 mg dng ung

BESINS-ISCOVESCO
c/o TEDIS
Vin nang (cha cc vi ht c tc dng ko di) 2,5 mg : hp 60 vin.
THNH PHN
cho 1 vin
Trinitrine

2,5 mg

(Lactose)
(Saccharose)
DC LC
Thuc chng au tht ngc thuc dn xut nitrate.
Cc dn xut nitrate ch yu c tc dng gy gin tnh mch, nh vy lm gim lu lng mu
v tim qua ng tnh mch v do lm gim p lc mu dn v tim. liu cao hn, dn xut
nitrate cn gy gin cc tiu ng mch vi gim huyt p ng mch.
Nh th trinitrine gip cho tim gim bt hot ng v gim tiu th oxy c tim. Trinitrine
cng gip ti phn phi lng mu qua mch vnh di lp mng trong tim.
Nh vo nhng c tnh v huyt ng nu trn, Lnitral c dng nh mt iu tr h tr
trong bnh suy tim nng.
Nh vo s phn tn chm v u, L nitral thng khng gy h huyt p ng mch cng nh
khng gy nhp tim nhanh phn x.
DC NG HC
Dng gii phng chm : sau khi ung, nh vo c tnh ca dng bo ch vi nang, trung bnh t
30 pht n 7 gi, ngi ta tm thy trong huyt tng ngi khng ch gm cc sn phm
chuyn ha ca hot cht (dn xut mono v dinitrate ca glycrol), m ch yu l cc phn t
trinitrine dng cha b bin i.
CH NH
D phng cn au tht ngc.
iu tr h tr trong bnh suy tim tri nng bn cp.
Lu { : cc dn xut nitrate thng c s dng trong bnh suy tim mn tnh nng : li ch ca
vic iu tr ny c chng t qua cc iu tr ngn hn v ang c tip tc theo di qua
cc iu tr lu di.
CH PHNG
Liu hu hiu phi c t ti t t, do dng liu cao t ngt c th gy h huyt p ng
mch v nhc u d di mt vi i tng.
Liu dng hng ngy cn chia ra v iu chnh theo hiu qu v s dung np ca ngi bnh.
Trong trng hp ang s dng liu cao, khng nn ngng iu tr t ngt.
THN TRNG LC DNG
nh lng mthmoglobine huyt trong trng hp xut hin tm ti m khng c bnh phi
km theo (mthmoglobine huyt thng xy ra khi iu tr liu cao).
LC C THAI
Do thiu nghin cu trn sc vt v thiu s liu lm sng ngi, nguy c khi dng thuc
cha c xc nh ; v thn trng, khng k toa cho ph n mang thai.

LC NUI CON B
Do thiu s liu v vic thuc c c bi tit qua sa m hay khng, khng nn cho con b
trong thi gian iu tr.
TNG TC THUC
Cc thuc gy gin mch, thuc h huyt p v thuc li tiu c th gia tng tc dng lm h
huyt p ca dn xut nitrate, c bit ngi gi.
TC DNG NGOI
Nhc u thong qua, bun nn, bc ha, h huyt p (c km theo nhp tim nhanh phn x
hoc khng), nht l ngi gi.
LIU LNG v CCH DNG
Liu hu hiu phi t ti t t v do Bc s quyt nh.
D phng cn au tht ngc : ung thuc khng nhai trung bnh mi ngy 2 n 3 vin, chia
u trong ngy.
H tr iu tr trong suy tim tri nng th bn cp : ung thuc khng nhai trung bnh mi ngy
6 n 12 vin, chia u trong ngy.
Khi dng dn xut nitrate, cn phi c giai on ca s gia liu dng cc ngy (khong cch
gia liu cui ca ngy hm trc v liu u ca ngy hm sau) trnh hin tng ln thuc
khi dng mt cch lin tc.
Giai on ca s phi c chn lc tnh trng bnh n nh. Thi kha biu dng cc thuc
chng co tht phi hp (chn bta v/hay c ch calci) cng phi c chn la bo m
bao trm iu tr.
Ung thuc chia lm 2 n 3 ln trong ngy v cch nhau t nht 12 gi.
Th thc dng thuc tng t nhau trong iu tr d phng cn au tht ngc v trong iu tr
suy tim tri.
Trong iu tr d phng cn au tht ngc, hin tng ln thuc c th xy ra do cn nm
r th thc k toa v lu { n giai on ca s m bo hiu qu iu tr ca dn xut
nitrate.
Trong suy tim, hin tng ln thuc cng c th xy ra v cng phi lu { n giai on ca s.
Tuy nhin, c th gii hn hin tng ny bng cch iu chnh liu ca dn xut nitrate v cc
tr liu phi hp.
QU LIU
Trng hp ng c do qu liu, biu hin ng c bao gm hai loi :
- gin ton th cc mch mu km theo try mch,
- tm ti do mthmoglobine huyt.
Kt qu nh lng t 0,8 g/100 ml tr ln, vic iu tr bao gm tim tnh mch xanh
m thylne 1% : 1 n 2 mg/kg, hoc ng ung : 50 mg/kg trong cc trng hp t nghim

trng hn.
Nn cp cu bnh vin.

291.

LNITRAL 3 mg v 15 mg dng tim

BESINS-ISCOVESCO
c/o TEDIS
Dung dch tim 3 mg : ng 2 ml, hp 50 ng.
Dung dch tim 15 mg : ng 10 ml, hp 50 ng.
THNH PHN
cho 1 ng 2 ml
Trinitrine di dng dung dch cn 4%

3 mg

cho 1 ng 10 ml
Trinitrine di dng dung dch cn 4%

15 mg

DC LC
Thuc chng au tht ngc v iu tr suy tim thuc dn xut nitrate.
- Trinitrine tc ng bng cch gy gin mch ngoi bin vi u th trn tnh mch vi gim
lng mu dn v tm tht.
- iu ny cho php :
- duy tr hoc ci thin hiu nng ca tim,
- gim tiu th oxy,
- gim thiu mu cc b c tim,
- phn phi li lng mu qua mch vnh.
Vi liu cao hn, trinitrine gy gin tiu ng mch vi gim huyt p ng mch.
DC NG HC
Thuc c chuyn ha gan v o thi qua thn di dng dn xut mono v dinitrate
glycrol.
Thi gian bn hy trong huyt tng : 30 n 60 giy.
CH NH

- Suy tim, c bit suy tim trong giai on cp tnh ca nhi mu c tim.
- Ph phi cp c ngun gc tim.
- au tht ngc nghim trng.
- Gy h huyt p c kim sot trong khi phu thut ; trong ch nh ny cn phi lu { cc im
sau :
- nu cn h huyt p mc trung bnh c kim sot, dng Lnitral dng tim bng cch
truyn lin tc thng s t c huyt p h n mc mong mun mt cch tuyt i ;
- nu cn h huyt p mc su c kim sot (huyt p ng mch trung bnh thp hn hoc
bng 50 mm Hg), chng hn nh cn phi s dng trong phu thut thn kinh, th kt qu
thng khng n nh (trong 2/3 trng hp khng c dng mt tc nhn khc) ;
- c th hi phc li huyt p bnh thng mt cch nhanh chng ;
- vic gy h huyt p ny c th km theo gim dung lng tim, t l vi mc h huyt p,
thng khong 20 n 25%.
CH PHNG v THN TRNG LC DNG
Nu hn hu bnh nhn b tm ti m khng do mc ng thi mt bnh phi, cn phi nh
lng m th moglobine (do m th moglobine thng d xy ra khi iu tr liu cao).
TNG TC THUC
Cc thuc gy gin mch, thuc h huyt p v thuc li tiu c th gia tng tc dng lm h
huyt p ca dn xut nitrate, c bit ngi gi.
TC DNG NGOI
C th b nhc u thong qua, tuy nhin khng cn thit phi ngng iu tr. C th gy h
huyt p, nht l ngi gi.
KHNG DUNG NP THUC
Dung np vi cc dng c tim truyn : cc nghin cu cho thy rng cht plastic ca cc dng
c tim truyn bng polyvinyle chlorure hp ph mt phn khng ng k dn xut nitrate
dng ng tim.
- dng c ng v bm tim : nn dng loi c cht liu bng thy tinh, polypropylne hoc
bng polythylne.
- ming lp ng, dy truyn : nn dng loi c cht liu bng polypropylne, polythylne hoc
tflon.
LIU LNG v CCH DNG
Truyn tnh mch :
n Suy tim, ph phi cp tnh, au tht ngc nghim trng : S dng bm tim bng in.
B dng c tim truyn : mt cch tng qut, truyn tnh mch sau khi pha long 30 mg
nitroglyc rine (tng ng 2 ng thuc Lnitral 15 mg hoc 10 ng thuc Lnitral 3 mg) trong
500 ml dung dch ng trng, vi lu lng khng i nh vo b truyn dch bng in ;
trng hp khng c b truyn dch bng in :

- lu lng c th c iu chnh bng cch m s git trong mt pht ;

- theo di huyt p mao mch hoc huyt p ng mch phi hoc t nht l huyt p ng
mch v tn s tim ;
- nn kim sot lu lng truyn nhm trnh tnh trng tt huyt p ton thn di 20 n 30
mm Hg, hoc huyt p mao mch di 14 mm Hg.
Liu lng c th thay i ty theo tng ch nh, thng thng trong khong 20 n 50
mg/pht. i khi cn dng liu cao hn t c hiu qu mong mun, c bit khi cn gy
h huyt p c kim sot. Khi dng liu cao, nn tng liu tng nc mi 5 n 10 pht.
- Lu { : dng thn trng trong trng hp huyt p mao mch phi thp hn 14 mmHg. Trnh
gim mnh p lc y do c nguy c gy gim lng mu.
n Gy h huyt p c kim sot : Ch dng ng truyn tnh mch, hoc khng pha long, hoc
sau khi pha long trong dung dch ng trng. S dng bm tim bng in vi lu lng
c th iu chnh c. Liu ca Lnitral dng tim cn thit t c kt qu gy h huyt
p c kim sot th thay i theo tng bnh nhn, cng nh l thi gian h huyt p thu c.
Mt khc, lu lng ca Lnitral dng tim c iu chnh theo kt qu trung bnh ca huyt
p ng mch mong mun so vi mc h huyt p thu c.
ng tnh mch trc tip :Trng hp cp cu ph phi cp tnh nghim trng c ngun gc
tim : trung bnh tim tnh mch trc tip trong 30 giy n 1 pht, t 1/2 ng n 1 ng tim
L nitral 3 mg, i khi c th tim lp li ty theo kt qu thu c trong mi 10 pht sau .
Nn truyn duy tr Lnitral dng tim vi liu t 1 n 2 mg/gi vi cc iu kin tng t nh
khi s dng thuc ny bng ng tim truyn tnh mch.
- Lu { : cn lu { ghi nhn huyt p ng mch lc khi u. nhng bnh nhn c huyt p
ng mch tm thu di 12, cn phi gim liu. Trong thc t, ghi nhn mt s trng hp
tt huyt p quan trng (di 9), thng s hi phc li sau khi ngng iu tr.
- Cc dng dng chuyn tip sau khi truyn tnh mch :
Liu ca cc dng ny c iu chnh theo lu lng truyn ln cui cng, hoc mi 6 n 8
gi theo mg/gi tim, trung bnh :
- trinitrine ng ung : Lnitral 7,5 mg, 1 hoc 2 vin nang ;
- trinitrine ng qua da : Lnitral dng ngm qua da, 15 mg (tng ng vi 1 liu).
QU LIU
Trng hp b gim lng mu : truyn b sung mu.
Nu b mthmoglobuline huyt, cn c tr liu chuyn bit (tim tnh mch xanh mthylne
1%).
BO QUN
Trong chai dch truyn bng thy tinh cha dung dch glucose ng trng, n nh ca
nitroglycrine t nht l 15 ngy nhit v nh sng mi trng.

292.

LNITRAL 7,5 mg dng ung

BESINS-ISCOVESCO
c/o TEDIS
Vin nang (cha cc vi ht c tc dng ko di) 7,5 mg : hp 60 vin.
THNH PHN
cho 1 vin
Trinitrine

7,5 mg

(Lactose)
(Saccharose)
DC LC
Thuc chng au tht ngc thuc dn xut nitrate.
Cc dn xut nitrate ch yu c tc dng gy gin tnh mch, nh vy lm gim lu lng mu
v tim qua ng tnh mch v do lm gim p lc mu dn v tim. liu cao hn, dn xut
nitrate cn gy gin cc tiu ng mch vi gim huyt p ng mch.
Nh th trinitrine gip cho tim gim bt hot ng v gim tiu th oxy c tim. Trinitrine
cng gip ti phn phi lng mu qua mch vnh di lp mng trong tim.
Nh vo nhng c tnh v huyt ng nu trn, L nitral c dng nh mt iu tr h tr
trong bnh suy tim nng.
Nh vo s phn tn chm v u, L nitral thng khng gy h huyt p ng mch cng nh
khng gy nhp tim nhanh phn x.
DC NG HC
Dng gii phng chm : sau khi ung, nh vo c tnh ca dng bo ch vi nang, trung bnh t
30 pht n 7 gi, ngi ta tm thy trong huyt tng ngi khng ch gm cc sn phm
chuyn ha ca hot cht (dn xut mono v dinitrate ca glycrol), m ch yu l cc phn t
trinitrine dng cha b bin i.
CH NH
D phng cn au tht ngc.
iu tr h tr trong bnh suy tim tri nng bn cp.
Lu { : cc dn xut nitrate thng c s dng trong bnh suy tim mn tnh nng : li ch ca

vic iu tr ny c chng t qua cc iu tr ngn hn v ang c tip tc theo di qua

cc iu tr lu di.
CH PHNG
Liu hu hiu phi c t ti t t, do dng liu cao t ngt c th gy h huyt p ng
mch v nhc u d di mt vi i tng.
Liu dng hng ngy cn chia ra v iu chnh theo hiu qu v s dung np ca ngi bnh.
Trong trng hp ang s dng liu cao, khng nn ngng iu tr t ngt.
THN TRNG LC DNG
nh lng mthmoglobine huyt trong trng hp xut hin tm ti m khng c bnh phi
km theo (mthmoglobine huyt thng xy ra khi iu tr liu cao).
LC C THAI
Do thiu nghin cu trn sc vt v thiu s liu lm sng ngi, nguy c khi dng thuc
cha c xc nh ; v thn trng, khng k toa cho ph n mang thai.
LC NUI CON B
Do thiu s liu v vic thuc c c bi tit qua sa m hay khng, khng nn cho con b
trong thi gian iu tr.
TNG TC THUC
Cc thuc gy gin mch, thuc h huyt p v thuc li tiu c th gia tng tc dng lm h
huyt p ca dn xut nitrate, c bit ngi gi.
TC DNG NGOI
Nhc u thong qua, bun nn, bc ha, h huyt p (c km theo nhp tim nhanh phn x
hoc khng), nht l ngi gi.
LIU LNG v CCH DNG
Liu hu hiu phi t ti t t v do Bc s quyt nh.
D phng cn au tht ngc : ung thuc khng nhai trung bnh mi ngy 2 n 3 vin, chia
u trong ngy.
H tr iu tr trong suy tim tri nng th bn cp : ung thuc khng nhai trung bnh mi ngy
2 n 3 vin, chia u trong ngy.
Khi dng dn xut nitrate, cn phi c giai on ca s gia liu dng cc ngy (khong cch
gia liu cui ca ngy hm trc v liu u ca ngy hm sau) trnh hin tng ln thuc
khi dng mt cch lin tc.
Giai on ca s phi c chn lc tnh trng bnh n nh. Thi kha biu dng cc thuc
chng co tht phi hp (chn bta v/hay c ch calci) cng phi c chn la bo m
bao trm iu tr.
Ung thuc chia lm 2 n 3 ln trong ngy v cch nhau t nht 12 gi.
Th thc dng thuc tng t nhau trong iu tr d phng cn au tht ngc v trong iu tr
suy tim tri.

Trong iu tr d phng cn au tht ngc, hin tng ln thuc c th xy ra do cn nm

r th thc k toa v lu { n giai on ca s m bo hiu qu iu tr ca dn xut
nitrate.
Trong suy tim, hin tng ln thuc cng c th xy ra v cng phi lu { n giai on ca s.
Tuy nhin, c th gii hn hin tng ny bng cch iu chnh liu ca dn xut nitrate v cc
tr liu phi hp.
QU LIU
Trng hp ng c do qu liu, biu hin ng c bao gm hai loi :
- gin ton th cc mch mu km theo try mch,
- tm ti do mthmoglobine huyt.
Kt qu nh lng t 0,8 g/100 ml tr ln, vic iu tr bao gm tim tnh mch xanh
m thylne 1% : 1 n 2 mg/kg, hoc ng ung : 50 mg/kg trong cc trng hp t nghim
trng hn.
Nn cp cu bnh vin.

293.

LEUCO-4

PHARMASCIENCE
c/o GALIEN
vin nn 30 mg : hp 30 vin.
THNH PHN
cho 1 vin
Adnine

30 mg

DC LC
Chng suy nhc.
CH NH
iu tr h tr suy nhc chc nng.
CHNG CH NH
Qu mn cm vi mt trong cc thnh phn ca thuc.
LC C THAI v LC NUI CON B
Lc c thai :

Khng c nghin cu v tc dng gy qui thai ca thuc trn ng vt. Trn lm sng, cho n
nay khng c trng hp no gy d dng hay c phi c bo co. Tuy nhin khng th loi
hn mi nguy c c th xy ra khi dng thuc ny trong thi gian mang thai. Do nn thn
trng khng dng thuc ny trong thi gian mang thai.
Lc nui con b :
Do khng c s liu v s bi tit ca thuc qua sa m, trnh s dng thuc ny trong thi
gian cho con b.
LIU LNG v CCH DNG
Dng cho ngi ln.
6 vin/ngy, chia lm 3 ln, hay mi ln 2 vin ngy 3 ln.
Ung thuc vi nhiu nc.
Thi gian iu tr nn gii hn trong 4 tun.
BO QUN
Trnh m.

294.

LEUCODININE B 10%

PROMEDICA
c/o GALIEN
Thuc m 10% : tube 30 g.
THNH PHN
cho 100 g
Mquinol

10 g

DC LC
Tc nhn lm gim sc t.
Mquinol c tn ha hc l monom thyl ther hydroquinone, c tc ng lm gim sc t do
c ch s tng hp mlanine (cn gi l hc t).
CH NH
iu tr ti ch cc trng hp tng sc t mlanine mc phi, c bit trong : chng da i
mi ngi ln tui, nhim hc t sau phu thut hoc do ha cht (nc hoa).
CHNG CH NH
Qu mn cm vi mquinol.

Tr em di 12 tui.
CH PHNG v THN TRNG LC DNG
Trnh phi ra nng nhng ch da b tng sc t, v cn bo v tt vng da ny bng qun o
hoc dng kem chng nng trong thi gian iu tr.
Khng c bi ln nim mc hoc vo mt.
LC C THAI
Trn lm sng, cho n nay khng c trng hp no c ghi nhn b d dng hoc c tnh
trn bo thai do dng thuc. Tuy nhin, cc s liu v s dng mquinol trong sut thi gian
mang thai th cha c th loi tr ht tt c nhng nguy c.
Do , v thn trng, khng nn bi thuc khi c thai.
LC NUI CON B
Do cn thiu s liu, khng nn bi thuc trong thi gian nui con b.
TC DNG NGOI
Cc phn ng kiu gy kch thch hoc qu mn vi mquinol (him gp).
Him gp : tng hc t sau vim, chng da lang trng en khng ng nht vi nhng m
trng ni bi thuc v mt vi trng hp gy gim hc t xa ni bi thuc cng c ghi
nhn.
LIU LNG v CCH DNG
Bi thuc hai ln/ngy.
C th gim s ln bi thuc ty theo cc du hiu ci thin ca bnh. Khi sc t gim nh
mong mun, nn tip tc bi thm t nht mi tun mt ln. Cn bo v ch bi thuc, khng
tip xc vi nh nng mt tri hoc tia t ngoi.
TNG K
Trnh pha trn vi nhng loi kem hoc thuc m khc (c th gy bt tng hp, c bit vi
nhng ch phm c tnh oxy ha hoc cc phc hp kim loi).

295.

LEUNASE

KYOWA HAKKO KOGYO

c/o MITSUI
bt pha tim 10.000 KU : hp 1 l.
THNH PHN

cho 1 l
L-asparaginase

10.000 KU*

* 1 n v KU L-asparaginase tng ng vi lng enzym cho ra 1 mmol amoniac/1 pht khi

phn hy L-asparagine iu kin 37oC
DC LC
M t :
- c tnh chung :

ng 10.000 KU

Cm quan

pH

Gii hn ASTT

trng

6,5-7,5

#1 (dd 2 ml/dd mui)

- bn vng : dng tinh th bn vng vi nhit, pH, nh sng. Khong pH bn vng 6,0-8,5.
- Tnh cht l ha ca hot cht :
L-Asparaginase l mt enzym bao gm 4 tiu phn vi tng cng 321 amino acid.
Tn thng thng : L-asparaginase.
Phn t lng : 141.000.
M t : tinh th hnh kim hay hnh tr. Rt tan trong nc, khng tan trong methanol, acetone,
chloroform.
Tnh cht dc lc :
Nhng nghin cu v tc dng chng tn sn ca L-asparaginase c bt u t bi bo co
ca J.G Kidd vo nm 1953. Bi bo nu rng huyt thanh ly t chut lang c th hin tc dng
chng tn sn. Vn ny c tip tc pht trin thm khi J.D Broome tm ra rng hot cht
gy tc ng chnh l L-asparaginase.
Leunase inj. l mt ch phm tim cha L-asparaginase - mt enzym phn hy protein c sn
xut t chng E. Coli HAP. V mt lm sng, Leunase inj. c tha nhn c tc dng chng
li bnh bch cu cp tnh v bnh u limph c tnh.
Dc l :
- Tc dng chng khi u : L-asparaginase c hiu lc trn bnh bch cu L5178, bnh sarcm
limph 6C3HED chut nht v bnh sarcm 256 chut cng.
- C ch tc ng : L-asparaginase gy tc ng chng khi u do phn hy L-asparagine trong
huyt tng lm cn ngun dinh dng cho vic pht trin t bo u cn asparagine.
DC NG HC
L-asparaginase khuch tn k m n cc m ; thi gian bn hy bao gm 2 pha v dao ng t 8
n 30 gi ty theo ngi ; 24 gi sau khi tim tnh mch 1.000 KU/kg, nng trong huyt
tng c ghi nhn t 8 n 20 KU/ml ; sau khi tim bp, nng trong huyt tng c

ghi nhn thp hn 50%.

TH NGHIM LM SNG
Tc ng lm sng :
Cc th nghim lm sng c tin hnh ch yu trn cc dng ung th t bo mu ti 36 bnh
vin Nht Bn.
Kt qu :
T l t hiu qu tr liu l 57,6% (80/139) i vi trng hp bnh bch cu cp, 75,0%
(51/68) i vi trng hp u limph v 40,8% (29/71) i vi trng hp bnh bch cu ty.
T l t hiu qu tr liu i vi trng hp u limph c l 55,8% (7/13) i vi dng sarcm t
bo li v 68,9% (13/190) i vi dng sarcm limph.
Nhng phn ng bt li v hu qu c nh gi trn 302 trng hp :
- Phn ng nhy cm : sc 6 trng hp (2,0%), m ay 17 trng hp (5,6%).
- Huyt hc : gim tiu cu 20 trng hp (6,6%), thiu mu 10 trng hp (3,3%), d chy
mu 4/115 trng hp (3,5%), gim bch cu 14 trng hp (4,6%).
- Gan : tng amoniac huyt 12/96 (12,5%), h protein huyt 43/112 (38,4%), tng nng
albumin huyt 20/96 (20,8%), tng nng fibrinogen huyt 23/124 (18,5%).
- Thn : ph 10 trng hp (3,3%), tng BUN 3 trng hp (1,0%).
- Ty : hoi t o Langerhands 1/103 (0,91%), tng amylase huyt tng 1 trng hp (0,3%).
- Thn kinh no : ri lon chc nng no (k c ri lon chc nng c quan) 5 trng hp
(1,7%), co git 6 trng hp (2%).
- Tiu ha : bun nn 103 trng hp (34,1%), i ma 89 trng hp (29,5%), bing n 63
trng hp (20,9%).
- Tc ng khc : st 43 trng hp (14,2%), kh chu 28 trng hp (9,3%).
TH NGHIM PHI LM SNG
c tnh cp : LD50 (x104 KU/kg)
I.V.

I.P.

S.C.

Chut nht

95,7

240,0

210,0

Chut cng

33,3

36,1

36,1

c tnh mn :
Tim phc mc cho chut vi liu 500-91.000 KU/kg trong 6 thng, chn n v chm tng
trng c nhn thy giai on u ca th nghim ; sung huyt v ph l lch, thoi ha
m v sung huyt gan, sung huyt v h thn, h thn v thoi ha tinh trng tinh hon
c quan st thy khng ph thuc liu.
Gy d dng :

Tim tnh mch chut nht v tim phc mc chut cng liu 1.000 KU/kg hoc hn, chm
tng trng, d t vong, thot v no, bt thng t sng ngc v xng sn, chm to
xng c quan st thy.
CH NH
Bnh bch cu cp tnh (gm c trng hp mn tnh chuyn th cp tnh), u limph c tnh.
CHNG CH NH
Trnh s dng cho nhng bnh nhn c tin s d ng vi L-asparaginase.
CH PHNG v THN TRNG LC DNG
Ch { phng :
- Vim ty cp c th xy ra. Cn theo di bnh nhn cn thn. Nu c nhng triu chng nh
au bng, nn, tng enzym ty nh amylase, phi ngng thuc v x tr thch hp.
Tiu ng nng c th xy ra. Cn theo di bnh nhn cn thn trong qu trnh tr liu. Nu c
nhng triu chng nh kh ming kht nc, a niu, phi ngng tr liu v x tr thch hp.
- Leunase inj. c th gy nhng phn ng bt li nh suy ty xng, v vy, cn theo di thng
xuyn nhng xt nghim v huyt hc, xt nghim chc nng gan thn..., nu c hin tng
bt thng, phi gim liu hoc ngng thuc. Vic tr liu trong thi gian di cn phi c
thc hin vi s theo di k lng do nhng phn ng bt li trn c th rt nghim trng v
ko di.
- Cn ch { c bit n s xut hin hay s trm trng thm ca cc kh nng nhim khun v
xut huyt.
- Thn trng khi tr liu cho tr em, theo di nhng biu hin ban u c th dn n nhng
phn ng bt li.
- Vic tr liu cho tr em v nhng bnh nhn cn kh nng sinh sn cn phi thn trng v c s
nh hng ln c quan sinh dc.
Thn trng lc dng :
Cn thn trng trong nhng trng hp sau :
- Vim ty hay c tin s vim ty (lm trm trng thm hoc gy ti pht).
- Ri lon chc nng gan (tng amoniac huyt c th d dng xy ra).
- Ri lon chc nng thn (tng nit huyt c th xy ra).
- Suy ty (lm trm trng thm).
- ang mc nhng bnh nhim khun (s nhim khun c th trm trng hn v suy ty).
- ang mc bnh thy u (c th gy ri lon ton thn, nguy c t vong).
Lu { khi s dng :
- Trc khi s dng : 0,1 ml nc mui sinh l cha 1-10 KU Leunase tim di da v theo di
bnh nhn trong 30 pht n 1 gi pht hin nhng phn ng bt thng nu c.
S dng ngay sau khi pha.
- ng s dng : Leunase inj. ch c s dng bng cch truyn tnh mch nh git.

LC C THAI v LC NUI CON B

L-asparaginase c bo co l c th gy qui thai ng vt th nghim. Do , khng
nn s dng cho ph n c thai hay nghi ng c thai.
Cha c kt lun v s an ton trong thi kz cho con b. Tt hn c, nn ngng cho con b nu
bnh nhn cn tr liu.
TNG TC THUC
Trong nhiu trng hp, thuc c s dng kt hp vi nhng thuc ung th khc v gy nn
tc dng hp lc. Tuy nhin, cn c nhng lu { c bit n kh nng xy ra nhng phn ng
ph v phi nghim ngt tun theo liu ch nh.
TC DNG NGOI
Dng nng :
- Sc : triu chng sc c th xy ra. Khi gp bt c du hiu no nh l m, co git, h huyt
p, n lnh, st, nn ma, phi ngng thuc lp tc v x tr thch hp.
- Nhng ri lon nghim trng v ng mu (tng Fibrinogen, Plasminogen, AT-III, Protein C....)
nh xut huyt no, nhi mu no, xut huyt phi c th xy ra. Cn theo di thng xuyn
bng cc xt nghim cn lm sng trong qu trnh tr liu. Nu c nhng bt thng xy ra, phi
ngng thuc v x tr thch hp.
- Vim ty cp : do c th xy ra vim ty cp, cn theo di bnh nhn cn thn. Nu c bt c
triu chng no nh au bng, nn ma, tng enzym ty nh amylase, cn ngng thuc v x
tr thch hp.
Vim ty cp c th lm ri lon chc nng bi tit ca tuyn ty (hoi t o Langerhans) gy
tiu ng. Cn theo di bnh nhn cn thn. Nu c bt c triu chng no nh kh ming,
kht nc, a niu, cn ngng thuc v x tr thch hp.
- Tng amoniac huyt : gy ri lon kh nng { thc. Cn theo di bnh nhn cn thn bng
nhng xt nghim nh kz. Nu c nhng bt thng no xy ra, cn ngng thuc v x tr
thch hp.
- Hn m : c th xy ra hn m, ri lon thc, mt nh hng. Cn theo di bnh nhn cn
thn. Nu c nhng triu chng bt thng xy ra, cn ngng thuc v x tr thch hp.
- Ri lon t chc no : t vong tng c ghi nhn v c s ri lon t chc no din
rng.
Nhng phn ng bt li khc :
- Mn cm : cc phn ng mn cm nh ni ban.
- Huyt hc : gim tiu cu, thiu mu...
- Gan : ri lon chc nng gan, gan m...
- Thn : protein niu, thiu niu, nit huyt, ph.
- Tiu ha : bing n, bun nn, i ma, tiu chy.
- Tm thn : kh chu, au u, ng g, lo lng.

- Triu chng khc : st, au mch, gy bt thng trong s dung np ng, tng lipid huyt.
LIU LNG v CCH DNG
Liu lng :
Thng thng, truyn tnh mch 50-200 KU/1 kg/1 ngy, iu tr mi ngy hay cch ngy.
Liu ny c th iu chnh ty theo tui tc v th trng lm sng.
Cch dng :
Leunase inj. c ha tan bng 2-5 ml nc ct pha tim.
Sau , pha long bng 200-500 ml dch truyn v s dng.
QU LIU
S qu liu c th gy ra nhng phn ng ph nghim trng nh suy gim chc nng ty xng
m c th phng trnh c. Trong trng hp thiu cht gii c chuyn bit, dng mt
lng ln thuc c nhm SH nh vitamine B2, B6, C v glutation s c tc dng bt hot thuc
nh tng tc qu trnh chuyn ha phn hy.
BO QUN
Hn dng : 2 nm (s dng trc hn ghi trn nhn).
Bo qun nhit mt (di 15oC).

296.

LEXOMIL

HOFFMANN - LA ROCHE
Vin nn d b lm bn 6 mg : hp 30 vin.
THNH PHN
cho 1 vin
Bromazpam

6 mg

DC LC
Dng liu thp, Lexomil c tc dng chn lc trn chng lo u, p lc tm l v thn kinh cng
thng. Dng liu cao, Lexomil c tc dng an thn v gin c.
DC NG HC
Sau khi ung thuc, nng ti a trong huyt tng t c sau 1 n 2 gi. Sinh kh dng
ca hot cht khng b bin i trung bnh l 84%. Bromazpam c thi gian bn thi t 10 n
20 gi ; ngi cao tui, thi gian ny c th k o di hn. Bromaz pam c chuyn ha
gan. V mt s lng, c hai cht chuyn ha chim t l cao l 3-hydroxy-bromazpam v 2-(2-

amino-5-bromo-3-hydroxybenzoyl)-pyridine. Hai cht chuyn ha ny c o thi ch yu

qua nc tiu di dng lin hp.
Bromazpam gn kt vi protine huyt tng vi t l trung bnh l 70%.
CH NH
Cc ri lon v cm xc : tnh trng lo u, cng thng, lon tnh kh km lo u trong chng trm
cm, d b kch ng, mt ng.
Cc biu hin do lo u v cng thng thn kinh nh :
- ri lon chc nng ca h tim mch v h hp (ri lon gi au tht ngc, hi hp nh trng
ngc, nhp tim nhanh, tng huyt p, kh th, th gp... do nguyn nhn tm thn) ;
- ri lon chc nng ca h tiu ha (hi chng kt trng d b kch thch, vim lot kt trng,
au thng v, co tht, trng bng, tiu chy...) ;
- ri lon chc nng ca h tit niu (bng quang d b kch thch, i dt, au bng kinh...).
- cc ri lon tm thn thc th khc (nhc u do nguyn nhn tm thn, bnh ngoi da do
nguyn nhn tm thn...).
Lexomil cng c ch nh iu tr tnh trng lo u v cng thng c lin quan n n mt
bnh l{ mn tnh v cng c s dng nh mt tm l liu php h tr trong bnh thn kinh
tm l.
CHNG CH NH
Khng ch nh Lexomil cho bnh nhn qu mn cm vi benzodiazpines.
Nhng bnh nhn b nghin ru hay nghi ng b nghin ru hay b mt tnh trng l thuc
thuc gy nghin th khng c dng Lexomil, ngoi tr dng thuc di s gim st cht
ch.
THN TRNG LC DNG
Thn trng khi dng Lexomil cho bnh nhn b nhc c nng do thuc c th lm nng thm
tnh trng ny.
Trong cc thng u ca thai kz, ch dng thuc trong trng hp c bit cn thit.
Hot cht ca thuc c bi tit qua sa m, do khng c dng thuc khi cho con b.
Cn thng bo cho bnh nhn khng c li xe hay iu khin my mc trong vng 4 n 6
gi sau khi ung thuc, v Lexomil c th lm gim tp trung v phn x ty thuc vo liu
dng v mc nhy cm ca tng bnh nhn.
L thuc thuc :
Dng benzodiazpines c th gy ra tnh trng l thuc thuc. Nguy c ny tng ln khi dng
thuc ko di, dng liu cao hay nhng bnh nhn c yu t m ng. Triu chng nghin
thuc thng xy ra khi ngng thuc t ngt v bao gm - trong nhng trng hp nng nht
c ghi nhn - run ry, vt v, ri lon gic ng, hi hp, nhc u v ri lon s tp trung.
Ngoi ra, mt s triu chng khc nh tot m hi, co tht c bp v bng, ri lon tri gic,
v trong mt s trng hp him, c th gy m sng v cn ng kinh.

Ty theo thi gian tc ng ca thuc, cc triu chng nghin thuc c th xy ra sau khi ngng
thuc t vi gi n mt tun hoc lu hn.
Nhm gim ti a nguy c b l thuc thuc, cc benzodiazpines ch c k toa sau khi
chn on k bnh v ch k toa trong mt giai on ngn nht c th (chng hn trong ch nh
l thuc ng, khng c dng qu 4 tun). Nu cn dng thuc tip tc, phi ti khm nh kz.
Ch cho dng thuc di hn nhng bnh nhn c tnh trng bnh tht xu v sau khi cn
nhc gia li ch iu tr vi nguy c l thuc thuc.
trnh nhng triu chng cai nghin, nn ngng thuc t t, trong thi gian ny liu phi
c gim t t. Khi xut hin cc triu chng cai nghin, cn phi theo di st v chm sc
cho bnh nhn.
TNG TC THUC
Nu ang dng thuc m ung ru s lm tng tc dng ca thuc, tng t nh i vi cc
thuc hng tm thn khc.
Nu dng phi hp vi cc thuc tc ng ln thn kinh trung ng nh cc thuc an thn,
thuc chng trm cm, thuc ng, thuc gim au v gy v cm... tc dng c ch thn kinh
trung ng c th tng ln.
TC DNG NGOI
liu iu tr, Lexomil c dung np tt. C th xy ra mt mi, bun ng v yu c (him)
khi dng liu cao. Cc triu chng trn khi khi gim liu.
Mc du kinh nghim lm sng khng cho thy thuc c c tnh no mu cng nh trn chc
nng gan v thn, vn nn theo di cc thng s ny nu dng thuc di hn.
Trng hp dng thuc ko di v liu cao, c th xy ra tnh trng l thuc thuc nhng
bnh nhn c yu t m ng, nh i vi tt c cc thuc ng hay thuc an thn khc.
Trng hp c phn ng nghch li nh lo u nng hn, o gic, ri lon gic ng hay kch ng,
cn phi ngng thuc.
Cc tc dng ngoi { c lin quan n liu ung v mc nhy cm ca tng c a :
LIU LNG v CCH DNG
Liu thng thng :
iu tr ngoi tr : 1,5-3 mg, ti a 3 ln/ngy.
Trng hp nng, iu tr bnh vin : 6-12 mg, 2 n 3 ln/ngy.
Liu nu trn ch c tnh tng qut, cn iu chnh thch hp cho tng bnh nhn. Nu iu tr
ngoi tr th liu khi u nn thp v tng t t cho n khi t c liu ti u. Khi cc triu
chng bnh ci thin, sau vi tun nn th ngng dng thuc. Nu dng thuc ng theo
thi hn ny th vic ngng thuc khng gy vn g c. Nu dng thuc di hn th khi
ngng thuc phi t t.
Liu lng trong nhng trng hp c bit :
Nu dng trong nhi khoa, phi chnh liu theo th trng ca tr.

 bnh nhn cao tui v yu, phi dng liu thp hn.
QU LIU
Dng qu liu mt mnh Lexomil do v tnh hay c rt him khi nh hng n tnh mng. Cc
triu chng ch yu l tc ng iu tr c tng mnh ln (an thn, yu c, ng su) hoc
kch ng. Trong a s trng hp ch cn theo di v sn sc bnh nhn.
Nu qu liu rt cao km nht l khi phi hp vi cc thuc tc ng ln thn kinh trung ng
khc, c th dn n hn m, mt phn x, suy tim v h hp, kh th. Bin php cp cu gm
ra d dy v theo di y khoa, dng Anexate (flumaz nil) gii ng c.

297.

LIPANTHYL

FOURNIER
[FOURNIER GROUP VIETNAM]
Vin nang 100 mg : hp 48 vin.
Vin nang 300 mg : hp 30 vin.
THNH PHN
cho 1 vin
Fnofibrate

100 mg

(Lactose)

cho 1 vin
Fnofibrate

300 mg

(Lactose)
DC LC
Thuc h lipide mu.
Fnofibrate c th lm gim cholestrol mu t 20 n 25% v gim triglycride mu t 40 n
50%.
- Tc dng gim cholestrol mu l do lm gim cc phn on gy x va ng mch c t
trng thp (VLDL v LDL), ci thin s phn b cholestrol trong huyt tng bng cch lm

gim t l :
cholestrol ton phn / HDL cholestrol
(t l ny tng cao trong bnh tng lipide mu gy x va ng mch)
- C s lin quan gia bnh tng lipide mu vi x va ng mch, v gia x va ng mch
vi cc nguy c tim mch. Do gim lipide mu s cho tc ng c li, ngn nga xut hin
cc bnh tim mch.
- iu tr di hn s lm gim ng k vic tch tr cholestrol ngoi mch mu, thm ch s
ht hn.
- Thuc c chng minh c tc ng bi acide urique niu nhng bnh nhn tng lipide
mu v lm gim acide urique mu trung bnh khong 25%.
- F nofibrate lm tng cc apoprot ine A1 v gim cc apoprotine B, ci thin t l :
Apoprotine A1 / Apoprotine B
(t l ny c xem nh l mt du hiu ca chng x va ng mch)
- Tc dng chng kt tp tiu cu ca f nofibrate c chng minh ng vt v ngi
qua cc nghin cu lm sng, c biu hin qua gim kt tp ADP, acide arachidonique v
pinphrine.
chut cng : c iu tr bng f nofibrate, ngi ta quan st c gim 80% tc ng ca
HMG Co-A rductase ca cc microsome gan. Hin tng ny c th tham gia vo c ch tc
ng ca Lipanthyl.
DC NG HC
- Hp thu : cht chuyn ha chnh trong huyt tng l acide f nofibrique.
Nng ti a trong huyt tng t c sau khi ung thuc 5 gi.
Acide fnofibrique lin kt mnh vi albumine huyt tng v c th ko cc thuc khng
vitamine K ra khi lin kt vi prot ine v lm tng tc dng chng ng mu ca cc thuc
ny.
- Thi gian bn hy trong huyt tng : thi gian bn hy o thi trong huyt tng ca acide
fnofibrique vo khong 20 gi.
- Chuyn ha v bi tit : ch yu c o thi qua nc tiu : 70% trong 24 gi, 88% trong 6
ngy v mc o thi ti a l 93% (qua nc tiu v qua phn). Fnofibrate ch yu c
bi tit di dng acide fnofibrique v dn xut lin hp glucuronic.
Cc nghin cu dc ng hc sau khi cho dng liu duy nht v iu tr lin tc, kt lun
rng khng c hin tng tch ly thuc. Acide f nofibrique khng c o thi khi lm thm
phn.
CH NH
Chng tng cholest rol mu (type IIa) v tng triglyc ride mu ni sinh n l (type IV) hoc
phi hp (type IIb v III) ngi ln, sau khi p dng ch n king thch hp v kin tr
nhng khng hiu qu (nht l sau khi p dng ch n king m cholest rol mu vn cn cao

hay khi c nhng yu t nguy c phi hp).

Duy tr ch n king lun lun cn thit.
CHNG CH NH
- Suy gan.
- Suy thn.
CH PHNG
- Dng fibrate c th gy mt s tn thng c. Cc tn thng ny c th xy ra thng hn
trong trng hp c h albumine mu.
- Tn thng c thng hay xy ra nhng bnh nhn b au c lan ta v gy cm gic au c
v/hoc tng ng k cratine-kinase c ngun gc c (hm lng cao hn bnh thng
khong 5 ln) ; trong nhng trng hp ny cn phi ngng iu tr.
- Ngoi ra, nguy c b tn thng c c th tng ln trong trng hp dng phi hp vi mt
fibrate khc hoc vi cht c ch HMG Co-A r ductase (xem Tng tc thuc).
THN TRNG LC DNG
- Nu sau 3 n 6 thng iu tr m nng lipide huyt thanh vn khng gim mt cch kh
quan, phi x t n cc phng php iu tr b sung hay thay bng cc phng php iu tr
khc.
- Tng lng transaminase, thng l tm thi. Do , cn kim tra mt cch c h thng cc
men transaminase mi 3 thng, trong 12 thng u iu tr ; ngng iu tr nu ASAT v ALAT
tng trn 3 ln gii hn thng thng.
- Nu c phi hp vi thuc ung chng ng mu, nn tng cng theo di hm lng
prothrombine th hin qua ch s INR (xem Tng tc thuc).
LC C THAI
Cc kt qu nghin cu trn ng vt khng cho thy thuc c tc ng gy qui thai.
Trong lm sng, khng thy thuc gy d dng hoc c tnh cho thai. Tuy nhin, khng loi tr
c cc nguy c khi dng cho ph n c thai.
Khng ch nh dng fibrate trong lc mang thai, tr khi triglyc ride mu tng rt cao (> 10 g/l)
sau khi dng ch n king vn khng iu chnh c v c nguy c vim ty cp.
LC NUI CON B
V thiu thng tin v s bi tit ca fnofibrate qua sa m, khng nn ch nh fnofibrate cho
b m nui con b.
TNG TC THUC
Chng ch nh phi hp :
- Perhexiline : c th gy vim gan cp tnh, c kh nng t vong.
Khng nn phi hp :
- Cc fibrate khc, cc cht c ch HMG Co-A r ductase : c nguy c phi hp cc tc dng
ngoi { trn c.

Thn trng khi phi hp :

- Thuc ung chng ng mu : tng tc dng ca thuc ung chng ng mu v tng nguy c
xut huyt (do cnh tranh lin kt vi protine huyt tng).
Kim tra thng hn ch s INR v iu chnh liu ca thuc ung chng ng mu trong thi
gian iu tr bng f nofibrate v 8 ngy sau khi ngng iu tr bng thuc ny.
TC DNG NGOI
- Nh vi tt c fibrate, i khi c ghi nhn gy tn thng c (au c lan ta, c cm gic au,
yu t), ngoi l c th gy tiu c, i khi trm trng. a s thng t hi phc khi ngng
thuc (xem Ch { phng).
- Mt s tc dng ngoi khc t xy ra v thng l nh, gm :
- ri lon tiu ha d dy hoc rut, kiu gy kh tiu,
- tng transaminase (xem Thn trng lc dng),
- d ng da.
- Tng ch s sinh si mt khi iu tr ko di vi clofibrate. Tng t, khng th loi tr nguy
c ny i vi cc loi fibrate khc. Tuy nhin, nghin cu trn 100 i tng, khng thy tng
si mt sau 6 nm iu tr vi Lipanthyl.
LIU LNG v CCH DNG
Phi hp vi ch n king. Ung thuc trong ba n chnh.
Ngi ln : 300 mg/ngy (1 vin 300 mg hoc 3 vin 100 mg).
Tr em trn 10 tui : ti a 5 mg/kg/ngy, tng ng vi 1 vin 100 mg/20 kg cn nng.
Dng thuc di s theo di ca bc s chuyn khoa.

298.

LIPICARD

USV
c/o CT TNHH DP MINH HIN
Vin nang 200 mg : v 7 vin, hp 4 v.
THNH PHN
cho 1 vin
Fenofibrate (dng vi ht)
T dc: cremophore RH 40, starch 1500,

200 mg

talc, colloidal silicon dioxide.

DC LC
Fenofibrate l thuc h lipid c tc dng ni bt trn triglyceride huyt thanh. C ch tc dng
ca fenofibrate cha c xc nh r. Acid fenofibric, cht chuyn ho c hot tnh ca
fenofibrate, h triglyceride huyt tng r rng bng cch c ch tng hp triglyceride, dn
n gim phng thch VLDL vo tun hon. Acid fenofibric cng kch thch d ha lipoprotein
giu triglyceride, tc VLDL. Fenofibrate cng gim mc acid uric huyt thanh ngi b tng
acid uric huyt v ngi bnh thng bng cch tng bi tit acid uric trong nc tiu.
DC NG HC
Hp thu : Fenofibrate c hp thu tt t ng d dy rut sau khi ung. Trong mt nghin
cu ngi tnh nguyn kho mnh, khong 80% liu duy nht fenofibrate nh du bng
ng v phng x xut hin trong nc tiu ch yu di dng acid fenofibric v cc phc hp
glucuronide ca n v 25% bi tit trong phn. Nng nh trong huyt tng ca acid
fenofibric xy ra trong vng 6 n 8 gi sau khi ung. Hp thu fenofibrate tng khi dng chung
vi thc n. Hp thu ca fenofibrate dng vi ht tng khong 35% so vi ung thuc lc i.
Phn phi : ngi tnh nguyn kho mnh nng trong huyt tng t n trng thi bnh
n trong vng 5 ngy ung thuc. Khng c ghi nhn v tch ly thuc sau nhng liu lp li.
Chuyn ha : Sau khi ung, fenofibrate c thy phn nhanh chng bi esterase thnh cht
chuyn ho c hot tnh acid fenofibric. Khng tm thy fenofibrate nguyn dng trong huyt
tng. Dng chuyn ha c hot tnh, acid fenofibrate, kt hp vi acid glucuronide v sau
c bi tit trong nc tiu.
Thi tr : Khi ung, fenofibrate c bi tit ch yu trong nc tiu hu ht di dng cht
chuyn ha c hot tnh acid fenofibric v acid fenofibric glucuronide. Khong 60% thuc bi
tit trong nc tiu v khong 25% trong phn.
thanh thi ca acid fenofibric gim rt nhiu bnh nhn suy thn ( thanh thi creatinine
< 50 ml/pht). Tuy nhin, bnh nhn suy thn va ( thanh thi creatinine 50 n 90
ml/pht), thanh thi v dung lng phn phi khi ung ca acid fenofibric tng so vi ngi
khe mnh. Do , nn gim liu bnh nhn suy thn nng, nhng khng cn phi iu chnh
liu ung fenofibrate bnh nhn suy thn va. Khng c d liu v tc dng ca thiu nang
gan trn dc ng hc ca fenofibrate.
CH NH
Fenofibrate c ch nh iu tr tng lipid huyt loi IIa, IIb, III, IV v V khi liu php n king
khng hiu qu.
CHNG CH NH
Ri lon chc nng gan bao gm x gan do mt tin pht v bnh nhn bt thng chc nng
gan dai dng khng r nguyn nhn, v ri lon chc nng thn.

Bnh ti mt trc .
Mn cm vi fenofibrate.
THN TRNG LC DNG
Do tng t v ha hc, dc l v lm sng gia fenofibrate v gembibrozil, clofibrate, kt
qu th nghim lm sng bt li ca nhng thuc ny cng c th p dng cho fenofibrate.
Tng mc transaminase AST (SGOT) hoc ALT (SGPT) trong huyt thanh c ghi nhn khi
iu tr vi fenofibrate. Mc tng cao ca nhng enzyme ny s tr li nh trc khi iu tr
sau khi ngng thuc hoc trong khi tip tc iu tr. Nn thng xuyn theo di nh kz mc
transaminase trong khi iu tr.
Bnh si mt : nu nghi ng bnh si mt, nn kim tra ti mt. Nn ngng fenofibrate nu tm
thy si mt.
Bnh nhn ang dng fenofibrate than phin v au c, mm v yu c nn c nh gi y
khoa ngay v bnh c k c mc CK huyt thanh. Nu nghi ng hoc chn on bnh c, nn
ngng fenofibrate.
Tnh an ton tr em : Tnh an ton v hiu qu tr em cha c chng minh.
LC C THAI
Fenofibrate cho thy c c tnh i vi phi v gy qui thai chut ln khi cho liu ln gp 7
n 10 ln liu ti a ngh v c c tnh i vi phi th khi cho liu ln gp 9 ln liu ti
a ngh. Khng c nghin cu c i chng v tha ng ph n mang thai. Ch dng
fenofibrate khi mang thai nu li ch iu tr c th bin minh nguy c cho thai nhi.
LC NUI CON B
Khng nn dng fenofibrate ph n ang cho con b. Do kh nng sinh u ung th nghin
cu ng vt, nn quyt nh ngng cho con b hoc ngng thuc.
TNG TC THUC
Thuc ung chng ng dng cng lc : nn thn trng khi k toa cng lc thuc ung chng
ng do kh nng chng ng ging coumarin trong ko di thi gian prothrombin. Nn gim
liu thuc chng ng nhm gi thi gian prothrombin mc mong mun.
Dng cng lc vi thuc c ch men kh HMG-Co : khng c d liu v iu tr kt hp nhng
thuc ny. Kt hp nhng cht tng t v ha hc v dc l{ nh gemfibroxil v simvastatin
c nguy c kt hp chng myoglobin-niu, tng ng k mc creatinine kinase (CK) v
myoglobin-niu dn n suy thn vi t l cao.
TC DNG NGOI
Cc nghin cu c cng b ghi nhn v tc dng khng mong mun khong 1% bnh
nhn iu tr vi fenofibrate. Tc dng khng mong mun dn n ngng thuc 6% bnh
nhn. Trong a s trng hp ngoi ban da l tc dng khng mong mun gy ngng thuc.
Nhng tc dng khng mong mun c th do fenofibrate :
Tiu ha : vim gan, si mt, vim ti mt, gan to

Xng c : au c, nhc c, myoglobin-niu

Da v phn ph : nhy cm vi nh sng, chm
H hp : vim ph nang d ng.
LIU LNG v CCH DNG
Bnh nhn nn theo ch n king thch hp lm h triglyceride/lipid trc khi dng
fenofibrate v nn tip tc n king trong khi iu tr vi fenofibrate. Nn dng 1 vin 200 mg
mi ngy cng vi thc n.
QU LIU
Fenofibrate gn kt mnh vi protein huyt tng, nn x t n thm tch mu khi iu tr qu
liu. Cho n nay cha c ghi nhn v qu liu, nn x t n iu tr triu chng.

299.

LIPITOR

PFIZER
c/o ZUELLIG
Vin nn 10 mg : v 10 vin, hp 3 v v 10 v.
Vin nn 20 mg : v 10 vin, hp 3 v v 10 v.
THNH PHN
cho 1 vin
Atorvastatin calcium

10 mg

cho 1 vin
Atorvastatin calcium
T dc : calcium carbonate,
microcrystalline cellulose, lactose
monohydrate, croscarmellose sodium,
polysorbate 80, hydroxypropyl cellulose,
magnesium stearate, Opadry White YS - 1
- 7040, Antifoam AF Emulsion Medical,

20 mg

candelilla Wax.
DC LC
Lipitor (Atorvastatin calcium), thuc h lipid mu tng hp, l cht c ch men kh 3-hydroxy3-methylglutaryl-coenzyme A (HMG-CoA reductase). Men ny xc tc phn ng chuyn HMGCoA thnh mevalonate trong qu trnh tng hp cholesterol.
C ch tc dng :
Atorvastatin l cht c ch cnh tranh v chn lc men kh HMG-CoA, c ch qu trnh chuyn
3-hydroxy-3- methylglutaryl- coenzyme A thnh mevalonate, mt tin cht ca sterol, bao gm
cholesterol. Triglycerides v cholesterol trong gan c kt hp li thnh VLDL v phng thch
vo huyt tng a n m ngoi bin. Lipoprotein t trng thp (LDL) c to thnh t
VLDL v c thoi bin mt cch nguyn pht qua th th LDL i lc cao.
Atorvastatin lm gim lipoprotein v cholesterol huyt tng bng cch c ch men kh HMGCoA, c ch s tng hp cholesterol gan v bng cch tng s lng nhng th th LDL gan
trn b mt t bo t tng s ly i v thoi bin LDL.
Atorvastatin lm gim sn xut LDL v gim s lng cc ht LDL. Atorvastatin lm gia tng
ng k hot tnh ca th th LDL cng vi s thay i c li trn tnh cht ca cc ht LDL tun
hon. Atorvastatin c hiu qu trn vic lm gim LDL nhng bnh nhn tng cholesterol gia
nh ng hp t, mt qun th khng c p ng bnh thng vi thuc h lipid.
Trong mt nghin cu p ng iu tr theo liu, atorvastatin (10-80 mg) lm gim cholesterol
ton phn (30-46%), gim LDL-C (41-61%), gim apolipoprotein B (34-50%), v gim
triglycerides (14-33%), lm gia tng HDL v apolipoprotein A vi mt t l thay i. Nhng kt
qu ny khng i nhng bnh nhn tng cholesterol mu gia nh d hp t, nhng th tng
cholesterol mu khng c tnh gia nh, tng lipid mu phi hp, bao gm nhng bnh nhn
tiu ng khng ph thuc insulin.
DC NG HC
Hp thu: Atorvastatin c hp thu nhanh chng sau khi ung, nng thuc trong huyt
tng ti a t c trong vng 1-2 gi. Mc hp thu v nng atorvastatin tng t l vi
liu lng atorvastatin. Atorvastatin dng vin n n c kh dng sinh hc 95-99% so vi dng
dung dch. kh dng sinh hc tuyt i ca atorvastatin khong 14% v kh dng ton
thn ca hot ng c ch men kh HMG-CoA khong 30%. Tnh kh dng ton thn thp l do
s thanh lc nim mc ng tiu ha v/hoc chuyn ha ln u gan. Mc d thc n
lm gim tc v mc ca s hp thu khong 25% khi c nh gi bi Cmax v khong
9% khi c nh gi bi AUC, nhng s gim LDL-C th khng i khi atorvastatin c ung
cng lc vi thc n hay khng. Nng atorvastatin huyt tng sau khi dng thuc bui
chiu ti thp hn khi dng bui sng (khong 30% i vi Cmax v AUC). Tuy nhin, hiu qu
gim LDL-C th nh nhau bt k thi im dng thuc trong ngy (xem Liu lng v Cch

dng).
Phn phi: Th tch phn phi trung bnh ca atorvastatin khong 381 lt. Trn 98% atorvastatin
c gn kt vi protein huyt tng. T l hng cu huyt tng xp x 0,25 cho thy s thm
thuc vo t bo hng cu thp.
Chuyn ha: Atorvastatin c chuyn ha ch yu thnh dn xut hydroxy ha ti v tr ortho
v para v cc sn phm oxide ha ti v tr beta. In vitro, s c ch men kh HMG-CoA ca cc
cht chuyn ha qua con ng hydroxyl ha v tr ortho v para tng ng vi s c ch
ca atorvastatin. Khong 70% hot ng c ch trong huyt tng ca men kh HMG-CoA l
do cc cht chuyn ha c hot tnh. In vitro, cc nghin cu cho thy tm quan trng ca s
chuyn ha atorvastatin bi cytochrome P450 3A4 gan, ph hp vi nng atorvastatin
trong huyt tng tng ln ngi sau khi dng ng thi vi erythromycin, mt cht c ch
c bit n ca isozyme ny (xem Ch { phng v Tng tc thuc). sc vt, cht
chuyn ha ortho-hydroxy s tri qua thm qu trnh glucuronide ha.
Bi tit: Atorvastatin v cc chuyn ha ca n c thi tr ch yu qua mt sau qu trnh
chuyn ha ti gan v/hoc ngoi gan. Tuy nhin, thuc khng i qua chu trnh gan rut. Thi
gian bn hy trong huyt tng trung bnh ca atorvastatin ngi khong 14 gi, nhng mt
na thi gian ca hot ng c ch men kh HMG-CoA l 10-20 gi do c s ng gp ca cc
cht chuyn ha c hot tnh. Di 2% lng atorvastatin ung vo c tm thy trong nc
tiu.
Tc ng : Atorvastatin v mt s cht chuyn ha ca n c hot tnh dc l ngi. Ni tc
ng u tin ca atorvastatin l gan, y l ni ch yu tng hp cholesterol v thanh thi
LDL. S gim LDL-C tng ng vi liu lng thuc nhiu hn l vi nng thuc ton thn.
Liu dng thuc tng ngi nn da vo p ng tr liu (xem Liu lng v Cch dng).
Nhng nhm bnh nhn c bit:
Ngi ln tui: Nng atorvastatin trong huyt tng nhng ngi ln tui, khe mnh (<
65 tui) th cao hn so vi ngi tr (khong 40% i vi Cmax v 30% i vi AUC). Hiu qu
iu tr c th so snh vi hiu qu nhng bnh nhn tr hn c dng vi cng mt liu
atorvastatin.
Tr em: Nhng nghin cu v dc ng hc cha c thc hin tr em.
Gii tnh: Nng atorvastatin trong huyt tng ph n khc vi nam gii (cao hn
khong 20% i vi Cmax v thp hn khong 10% i vi AUC). Tuy nhin, khng c s khc
bit r rt trn lm sng v hiu qu iu tr trn lipid mu gia nam v n.
Suy thn: Bnh l thn khng nh hng ln nng thuc trong huyt tng hay hiu qu
iu tr ca atorvastatin. V vy, khng cn thit iu chnh liu lng bnh nhn suy thn
(xem Liu lng v Cch dng).
Thm tch mu: Trong khi cc nghin cu cha c thc hin bnh nhn suy thn giai on
cui, thm tch mu khng c hy vng l s lm tng ng k thanh thi ca atorvastatin do

thuc c gn kt mnh vi protein huyt tng.

Suy gan: Nng atorvastatin trong huyt tng tng ng k bnh nhn c bnh gan mn
tnh do ru, khong 16 ln i vi Cmax v 11 ln i vi AUC (xem Chng ch nh).
CH NH
Atorvastatin c ch nh nh thuc h tr cho ch n lm gim cholesterol ton phn,
LDL-C, apolipoprotein B v triglyceride bnh nhn c tng lipid mu nguyn pht, tng lipid
mu hn hp v tng cholesterol mu c tnh gia nh d hp t. Atorvastatin cng c ch
nh lm gim cholesterol ton phn v gim LDL-C bnh nhn tng lipid mu gia nh
ng hp t nh mt thuc h tr cho cc bin php iu tr khc (th d: LDL-apheresis,
cholestyramine) hoc l khi cc bin php iu tr khc khng thc hin c.
CHNG CH NH
Atorvastatin b chng ch nh bnh nhn nhy cm vi bt kz thnh phn no ca thuc ny,
nhng ngi c bnh l gan th ang tin trin hay c s tng dai dng khng gii thch c
ca transaminases huyt thanh vt qu 3 ln gii hn trn ca mc bnh thng, nhng bnh
nhn mang thai, cho con b, nhng bnh nhn nghi ng c thai. Atorvastatin nn dng cho ph
n tui sinh ch khi nhng bnh nhn ny khng c thai v c cung cp thng tin v nguy
c i vi bo thai.
CH PHNG v THN TRNG LC DNG
Ch { phng :
Trc khi dng atorvastatin, nn c gng kim sot tng cholesterol mu bng ch n thch
hp, tp th dc, gim cn bnh nhn b o ph v iu tr nhng bnh l{ cn bn khc.
Atorvastatin c th gy ra tng creatine phosphokinase v transaminases (xem Thn trng lc
dng v Tc dng ngoi ).
Thn trng lc dng :
nh hng ln gan :
Cng nh nhng thuc lm h lipid mu cng nhm, s tng va phi (> 3 ln gii hn trn ca
mc bnh thng) ca transaminases huyt thanh c ghi nhn sau khi iu tr vi
atorvastatin.
Tng dai dng transaminases huyt thanh (> 3 ln gii hn trn ca mc bnh thng trong t
nht 2 ln xt nghim) xy ra 0,7% bnh nhn dng atorvastatin trong cc th nghim lm
sng. Tn sut ca nhng bt thng ny l 0,2%, 0,2%, 0,6% v 2,3% tng ng vi liu 10, 20,
40 v 80 mg. Ni chung, s gia tng ny khng lin quan n vng da hay nhng triu chng c
nng v thc th khc. Khi gim liu atorvastatin hoc iu tr ngt qung hoc ngng thuc,
transaminases s tr v mc trc khi iu tr. Hu ht cc bnh nhn c gim liu
atorvastatin u khng b cc di chng. Cc xt nghim chc nng gan nn c thc hin
trc khi iu tr v nh kz sau . Nhng bnh nhn c bt kz triu chng c nng hay thc
th no gi { n tn thng gan nn c kim tra chc nng gan. Cn theo di nhng

bnh nhn c nng d transaminases tng cho n khi cc bt thng c gii quyt. Nu ALT
hoc AST tng ln gp trn 3 ln gii hn trn ca mc bnh thng mt cch dai dng th
nn gim liu hoc ngng dng atorvastatin. Nn dng thn trng bnh nhn ung ru
v/hoc c tin s bnh l gan. Bnh gan ang tin trin hoc tng transaminases dai dng
khng gii thch c l nhng chng ch nh i vi vic s dng atorvastatin (xem Chng ch
nh).
nh hng ln c xng :
au c c ghi nhn nhng bnh nhn iu tr vi atorvastatin (xem Tc dng ngoi ).
Bnh c, l tnh trng au c hay yu c cng lc vi tng creatine phosphokinase (CPK) > 10
ln gii hn trn ca mc bnh thng, nn c ngh n bt kz bnh nhn c au c lan
ta, nhy cm au c hay yu c, v /hoc tng ng k CPK. Cn nhc nh bnh nhn l phi
bo ngay cho bc s khi c au c, nhy cm au hay yu c khng gii thch c, c bit nu
i km vi tnh trng kh chu hay st. Nn ngng iu tr bng atorvastatin nu CPK tng r
rt, nu xc nh hoc nghi ng c bnh c.
Nguy c ca bnh c trong qu trnh iu tr vi nhng thuc khc trong nhm statin s tng
ln khi dng ng thi vi cyclosporine, dn xut ca fibric acid, erythromycin, niacin, hay cc
thuc khng nm nhm azole. Khi iu tr kt hp atorvastatin vi cc dn xut fibric acid ,
erythromycin, cc thuc c ch min dch, cc thuc khng nm nhm azole hay niacin, cn cn
nhc k cng gia li ch v nguy c, v theo di cn thn pht hin bt kz triu chng c
nng hay thc th no ca au c, nhy cm au, hay yu c, c bit l trong nhng thng
u iu tr v trong thi gian iu chnh liu sau . Cn kim tra CPK nh kz trong nhng
tnh hung ny, nhng khng chc chn l vic theo di nh th s ngn cn c bnh c
nng xy ra (xem Ch { phng v Tng tc thuc).
iu tr atorvastatin nn tm thi gim liu hoc ngng iu tr nhng bnh nhn c bnh
cnh nng v cp tnh gi { n vim c hoc nhng bnh nhn c cc yu t nguy c d pht
trin thnh suy thn th pht sau tiu myoglobin kch pht (nh nhim trng cp nng, h
huyt p, i phu, chn thng, ri lon chuyn ha nng, ri lon nc in gii, ri lon ni
tit, ng kinh khng kim sot).
S dng tr em :
Kinh nghim iu tr bnh nhn nh tui c gii hn liu n 80 mg/ngy 8 bnh nhn c
tng cholesterol mu c tnh gia nh ng hp t. Khng ghi nhn bt thng v mt lm sng
hay sinh ha no nhng bnh nhn ny.
Vn gy ung th, gy t bin, gim kh nng sinh sn :
Atorvastatin khng gy ung th chut ng. Liu ti a dng chut gp 63 ln liu ti a
dng ngi (80 mg/ngy) tnh theo mg/kg th trng.
Trong 1 nghin cu tin hnh trong 2 nm chut nh, tn sut ca adenoma t bo gan
chut c v carcinoma t bo gan chut ci tng ln khi s dng atorvastatin liu ti a, l

liu gp 250 ln liu ti a ngi tnh theo mg/kg th trng.

Cc thuc khc trong nhm statin tng t v mt ha hc, u gy ra ung th chut khi
dng liu gp 12-125 ln so vi liu ngh trn lm sng, tnh theo mg/kg th trng.
Atorvastatin khng biu hin kh nng gy t bin gen 4 th nghim in vitro c km hoc
khng km s hot ha chuyn ha hoc 1 xt nghim trn c th sng. Cho kt qu m tnh
test Ames vi Salmonella typhimurium v Escherichia coli, kt qu m tnh xt nghim cn
lm sng HGPRT v s t bin gen trn t bo phi ca chut ti m Trung Quc. Atorvastatin
khng lm tng ng k s t bin nhim sc th xt nghim trn t bo phi ca chut ti
m Trung Quc v cho kt qu m tnh xt nghim v nhn sinh sn trn chut nh.
Quan st khi cho dng liu ln n 175 mg/kg/ngy chut ng c hay 225 mg/kg/ngy
chut ng ci th khng thy c nh hng bt li no n kh nng sinh sn ca chng. Liu
ny gp 100-140 ln liu ngh ti a ngi tnh theo mg/kg th trng.
Atorvastatin khng gy nh hng bt li ln tinh trng v tinh dch, hoc ln m bnh hc ca
c quan sinh sn ch vi liu dng 10, 40 hay 120 mg/kg trong 2 nm.
LC C THAI v LC NUI CON B
Chng ch nh s dng atorvastatin trong thai kz v lc ang nui con bng sa m. Ph n c
kh nng mang thai nn dng cc bin php nga thai hu hiu. Khng dng atorvastatin nu
nghi ng mang thai. Hin nay cha r thuc ny c bi tit qua sa m hay khng. Do c kh
nng gy phn ng bt li cho tr b m, cho nn ph n ang s dng atorvastatin khng nn
cho con b (xem Chng ch nh).
TNG TC THUC
Xc sut ca bnh c trong qu trnh iu tr vi nhng thuc khc trong nhm statin tng ln
khi dng ng thi vi cyclosporine, dn xut fibric acid, erythromycin, khng nm nhm azole
hay niacin (xem Thn trng lc dng).
Antacid : dng ng thi atorvastatin vi huyn dch antacid ng ung c cha magnesium
v aluminum hydroxide, s lm gim nng atorvastatin trong huyt tng khong 35%, tuy
nhin, tc dng ca thuc ln hiu qu gim LDL-C khng b thay i.
Antipyrine : Atorvastatin khng c nh hng ln dc ng hc ca antipyrine, do s
tng tc nhng thuc c chuyn ha qua cng cytochrome isozymes khng c ngh n.
Cholestyramine : Nng atorvastatin trong huyt tng gim (khong 25%) khi dng
cholestyramine cng vi atorvastatin. Tuy nhin, hiu qu iu tr trn lipid mu khi dng ng
thi 2 thuc th cao hn khi ch dng 1 trong 2 thuc.
Digoxin : Dng ng thi atorvastatin v digoxin lm tng nng digoxin huyt tng ang
trong tnh trng n nh gn 20%. Cn theo di mt cch thch hp nhng bnh nhn ang
dng digoxin.
Erythromycin : nhng ngi khe mnh, khi dng ng thi atorvastatin vi erythromycin
vn l 1 cht c ch cytochrome P450 3A4 c bit (liu 500 mg 4 ln mi ngy), s lm

tng nng atorvastatin trong huyt tng (xem Thn trng lc dng, mc nh hng ln c
xng).
Thuc vin nga thai ung : Dng ng thi vi thuc vin nga thai ung c cha
norethindrone v ethinyl estradiol lm tng AUC ca norethindrone v ca ethinyl estradiol gn
20%. Khi chn lc 1 loi thuc vin nga thai cho ph n ang dng atorvastatin nn cn nhc
n iu ny.
Nhng nghin cu v s tng tc ca atorvastatin vi warfarin v vi cimetidine c thc
hin, v khng thy c s tng tc c { ngha no v mt lm sng.
Cc thuc khc : trong cc nghin cu lm sng, khi dng ng thi atorvastatin vi cc thuc
h p v liu php thay th estrogen th khng thy bng chng tng tc thuc bt li c
ngha trn lm sng.
TC DNG NGOI
Atorvastatin ni chung c dung np tt. Nhng phn ng ph thng nh v thong qua.
Di 2% bnh nhn phi ngng dng thuc do tc dng ph trong th nghim lm sng ca
atorvastatin . Nhng tc dng bt li thng gp nht (>=1%) trong cc nghin cu lm sng c
nhm chng l to bn, y hi, kh tiu, au bng, nhc u, bun nn, au c, mt mi,
tiu chy v mt ng.
Nhng tc dng ph km theo sau y c bo co : ph thn kinh mch, chut rt, vim
c, au c, d cm, bnh l thn kinh ngoi bin, vim ty, vim gan, vng da mt, chn n, i
ma, rng tc, nga, pht ban, bt lc, tng ng huyt v h ng huyt. Khng phi tt c
cc tc dng ph k trn u c mi quan h nhn qu vi vic iu tr bng atorvastatin.
LIU LNG v CCH DNG
Nn hng dn cho bnh nhn ch n lm gim cholesterol mu theo tiu chun trc khi
dng atorvastatin v duy tr ch n ny trong sut thi gian iu tr. Liu khi u thng l
10 mg 1 ln mi ngy.
Liu iu tr c th t 10-80 mg 1 ln mi ngy. C th ung thuc vo bt c thi im no
trong ngy lc i hoc no. Liu dng ty thuc tng c nhn da theo nng LDL-C cn bn,
mc tiu iu tr, v p ng ca bnh nhn (xem Hng dn iu tr).
Sau liu khi u v/hoc xc nh liu atorvastatin, nn kim tra cc ch s lipid mu trong
vng 2-4 tun, v chnh liu theo kt qu xt nghim.
Tng cholesterol mu nguyn pht v tng lipid mu hn hp :
a s bnh nhn c kim sot bng liu 10 mg atorvastatin mt ln mi ngy. p ng iu
tr r rt c c trong vng 2 tun, v p ng ti a thng t c trong 4 tun. p ng
ny c duy tr trong tr liu lu di.
Cc hng dn di y c th c dng thit lp mc tiu iu tr :
A. Hng dn NCEP i vi vic iu chnh lipid mu

C bnh XVM c
x|c nha

>= 2 yu t
nguy cb

LDL-C
LDL-C
mg/dl (mmol/l)
mg/dl (mmol/l)
Nng lc khi Mc tiu iu
u
tr
khng
khng
>= 190 (>= 4,9)
< 160 (< 4,1)
khng
c
>= 160 (>= 4,1)
< 130 (< 3,4)
c
c
c hoc khng
> 130 (> 3,4)
<= 100 (<= 2,6)
a. Bnh mch vnh hoc bnh mch mu ngoi bin (bao gm bnh ng mch cnh c triu
chng).
b. Cc yu t nguy c khc i vi bnh mch vnh bao gm : tui (nam : >= 45 tui, n >= 55
tui hoc mn kinh sm m khng dng liu php thay th estrogen); tin s gia nh c bnh
mch vnh sm; ang ht thuc l; tng huyt p; HDL-C < 35 mg/dl (< 0,91 mmol/dl) v tiu
ng. Gim i 1 yu t nguy c nu HDL-C >= 60mg/dl (>= 1,6mmol/l)
c. nhng bnh nhn c bnh mch vnh vi LDL-C 100-129mg/dl, th thy thuc nn nh gi
lm sng quyt nh xem c bt u iu tr bng thuc hay khng.
B. Hi x va ng mch Chu u (EAS)/ Mc tiu iu tr i vi iu chnh lipid mu
Dn s bnh nhn

Khng c yu t nguy c v khng c bnh mch vnh

Mt yu t nguy c v khng c bnh mch vnh
Mt yu t nguy c nghim trng, >= 2 yu t nguy c, c bnh mch
vnh, hay bnh mch mu ngoi bin

Mc tiu
iu tr
LDL-C
mg/dl
(mmol/l)
155-175
(4,0-4,5)
135-155
(3,5-4,0)
115-135
(3,0-3,5)

Nhng yu t nguy c nh hng n kt qu iu tr :

Theo hi x va ng mch chu u, nhng yu t nguy c c th iu chnh c : tng huyt
p, ht thuc l, tiu ng, bo ph, HDL-C thp, fibrinogen cao.
C. Cc yu t khc : Tin s gia nh c bnh mch vnh hay bnh mch mu ngoi bin, tin s
c nhn c bnh mch vnh, c bit cc bnh nhn cn phu thut ti to mch mu, n ng,
ph n tui mn kinh.
Tng Cholesterol mu ng hp t c tnh gia nh :
Ngi ln : Trong mt nghin cu nhng bnh nhn tng cholesterol mu ng hp t c
tnh gia nh th hu ht cc bnh nhn u c p ng vi liu 80 mg atorvastatin. Hiu qu
t c l gim LDL-C > 15% (18-45%).

Tr con : Kinh nghim iu tr bnh nhi (vi liu atorvastatin ln n 80 mg/ngy) cn gii
hn.
Liu lng bnh nhn suy thn : Bnh thn khng nh hng n liu lng thuc trong
huyt tng cng nh khng nh hng n tc dng lm gim LDL-C ca atorvastatin. V vy,
khng cn chnh liu nhng bnh nhn ny.
Ngi ln tui : Hiu qu v tnh an ton khng c s khc bit bnh nhn ln tui (> 70
tui) so vi nhng bnh nhn khc khi s dng liu ngh.
QU LIU
Khng c iu tr c hiu no khi dng atorvastatin qu liu. Nu c qu liu, tin hnh iu tr
triu chng v cc bin php h tr cn thit. Do thuc gn kt mnh vi protein huyt tng,
khng hy vng l s lm tng thanh thi atorvastatin ng k bng cch thm tch mu.
BO QUN
Di 25oC.

300.

LIPOBAY

BAYER PHARMA
Vin bao phim 0,2 mg : hp 28 vin - Bng B.
Vin bao phim 0,3 mg : hp 28 vin - Bng B.
THNH PHN
cho 1 vin
Cerivastatin sodium

0,2 mg

cho 1 vin
Cerivastatin sodium

0,3 mg

DC LC
Thuc c ch tng hp cholesterol.
Cerivastatin l mt cht ng phn lp th (enantiomer) tng hp tinh khit, c tc dng c
ch cnh tranh s tng hp cholesterol, c bit c ch men HMG-CoA (hydroxy-methylglutaryl coenzyme A) reductase. Men ny c tc dng xc tc cho "bc xc nh tc " trong

qu trnh tng hp cholesterol, chuyn i HMG-CoA thnh acid mevalonic.

V tr tc dng ch yu ca cerivastatin l gan. Nh lm gim lng cholesterol ni bo, cc
cht c ch men HMG-CoA reductase to nn tc dng iu ha ngc trn cc th th LDL
(lipoprotein t trng thp) gan, lm tng thanh thi LDL cholesterol v lm gim
cholesterol ton phn ln LDL cholesterol trong huyt thanh.
CH NH
Tng cholesterol huyt tin pht (th II a v II b).
iu tr tng cholesterol huyt nhng bnh nhn khng p ng tt vi ch n king thch
hp.
CHNG CH NH
B mn cm vi mt trong cc thnh phn ca thuc Lipobay.
Bnh gan ang tin trin hoc men transaminase huyt thanh tng cao lin tc khng r
nguyn nhn.
Tr em : Khng dng cho tr em v cha c kinh nghim lm sng.
CH PHNG v THN TRNG LC DNG
Chc nng gan :
- Nh cc thuc h lipid khc, hin tng tng men gan xy ra trong qu trnh iu tr vi
Lipobay. Trong a s cc trng hp, hin tng gia tng ny nh v khng c triu chng. V
cng ging nh i vi cc thuc h lipid khc, nn lm xt nghim chc nng gan trc khi bt
u iu tr, v sau phi xt nghim nh kz. Cn ch { n nhng bnh nhn c nng
men transaminase gia tng, v phi ngng iu tr nu nh men ALT (GPT) v AST (GOT) vt
gp 3 ln tr s cao nht ca gii hn bnh thng.
- Cn thn trng khi dng Lipobay cho nhng bnh nhn c tin s ung ru nhiu hoc c
tin s b bnh gan (bnh gan ang tin trin hay men transaminase tng khng r nguyn
nhn u l nhng chng ch nh dng Lipobay).
C :
- Ging nh vi cc cht c ch men HMG-CoA reductase, thnh thong c hin tng tng
men creatinine-phosphokinase (CPK) trn nhng bnh nhn dng Lipobay. iu ny thng
khng c { ngha lm sng. Bnh c, i km vi nng CPK tng r rt (bng hoc ln hn 10
ln tr s gii hn trn ca mc bnh thng) v/hoc au c lan ta, c nhy cm au hay yu
c, him gp nhng ngi dng thuc c ch men HMG-CoA reductase. Nn yu cu bnh
nhn thng bo cho thy thuc nu b au c, c nhy cm au hoc yu c nht l khi c km
theo mt mi hay st. Phi ngng dng thuc Lipobay nu c chn on hoc nghi ng b
bnh c, hoc khi nng men CPK tng cao r rt v c khng nh qua vi ln xt nghim.
Nguy c mc bnh c s tng ln nhng bnh nhn va s dng thuc c ch men HMG-CoA
reductase va c iu tr bng cyclosporin, dn xut ca acid fibric, acid nicotinic,
erythromycin hoc azole. V vy nn thn trng vi cc phi hp ni trn.

- Nhng ri lon chc nng thn th pht do tiu c vn xy ra trong nhng trng hp him.
V vy nn tm thi ngng s dng Lipobay nhng bnh nhn ang c nguy c suy thn th
pht do tiu c vn.
LC C THAI v LC NUI CON B
Lc c thai :
Cha c d liu v vic s dng thuc Lipobay ph n c thai. Cholesterol v c cc sn phm
ca qu trnh sinh tng hp cholesterol u l nhng thnh phn thit yu cho s pht trin
ca thai nhi. V vy, cc cht c ch men HMG-CoA reductase u b chng ch nh khi mang
thai v vi ph n ang cn kh nng sinh n, tr khi c bo v thch ng. Trong cc
nghin cu trn ng vt, khng thy c tc dng gy qui thai.
Lc nui con b :
Nhng nghin cu tin lm sng trn chut cho thy rng Lipobay c bi tit vo sa m.
Ph n ang nui con b khng nn dng Lipobay.
TNG TC THUC
Thuc tch acid mt : Lipobay nn s dng t nht mt gi sau khi dng resin (th d nh
cholestyramine) trnh s tng tc do thuc gn kt vi resin.
Khng c nh hng ng k v lm sng trong nhng nghin cu khc nhau v tng tc
thuc vi cc thuc thng dng cho bnh nhn tng cholesterol huyt (th d nh warfarin,
digoxin, cc thuc khng acid, cimetidine).
Nh c bo co v cc thuc c ch men HMG-CoA reductase khc, kh nng b bnh c
c th xy ra nu s dng ng thi vi acid nicotinic, fibrate (dn xut ca acid fibric), hay
cyclosporin. Nhng cho n nay vn cha c bo co no i vi Lipobay.
TC DNG NGOI
Ni chung Lipobay c dung np tt. Cc phn ng ph do thuc trn lm sng ln xt nghim
u nh v thong qua.
Trong nhng nghin cu c i chng vi gi dc, cc phn ng ph sau y c ghi
nhn (Lipobay : n = 2.522, gi dc : n = 570).
T l mc < 1%-0,1% :
- Ton thn : suy nhc (mt).
- Tiu ha : y hi, to bn, bun nn.
T l mc < 0,1% :
- Ton thn : au u, au bng, au lng.
- Tiu ha : kh tiu, au d dy-rut, chy mu li rng, x t nghim chc nng gan bt thng,
phn mt mu.
- Ri lon v chuyn ha v dinh dng : tng creatine phosphokinase.
- H c-xng : au khp.
- H thn kinh : gic m bt thng, mt ng, v m hi nhiu.

- Da v phn ph : ni ban, ri lon da.

- Gic quan c bit : ri lon v mt
Cng nh cc loi statin khc, hin tng c nhn mt v di bao nhn mt c thng
bo, mc d cha xc nh c mi lin h v cn nguyn vi Lipobay.
Nhng phn ng ph trm trng sau y ca cc thuc cng loi c thng bo nhng cho
n nay vn cha thy Lipobay : phn ng qu mn (hi chng qu mn bao gm phn v,
ph mch, hi chng ging lupt ban , vim mch mu, gim tiu cu, gim bch cu, thiu
mu tn huyt, hoi t biu m do nhim c, hng ban a dng), vng da mt, c nhn
mt, trm cm, vim ty, bnh thn kinh ngoi vi.
LIU LNG v CCH DNG
Trc khi bt u iu tr bng Lipobay, cn loi tr nhng nguyn nhn th pht gy tng
cholesterol huyt. Bnh nhn nn tip tc ch n king ng n nhm lm gim cholesterol
huyt trong sut qu trnh iu tr.
Ngi ln :
Dng Lipobay mi ngy mt ln vo bui ti (vo ba n chiu hoc khi i ng). Liu khi u l
0,1 mg mt ln, mi ngy. Sau t nht 4 tun, c th tng liu thm 0,1 mg na ty theo p
ng ca tng ngi. Liu ti a c khuyn dng l 0,3 mg mt ln, mi ngy.
Dng thuc cng vi thc n khng nh hng n tc dng ca cerivastatin. p ng ng k
vi Lipobay t c trong vng 2 tun v p ng ti a xut hin trong vng 4 tun. p ng
s c duy tr trong sut qu trnh iu tr lin tc.
Ngi cao tui :
Khng c nhng chng c lm sng gi rng cn phi dng liu lng khc cho nhng ngi
cao tui. Cng ging nh cc iu tr khc, cn khi u vi liu lng thp nht.
Ri lon chc nng thn :
Da vo nhng d liu dc ng hc, khng cn phi chnh liu cho nhng bnh nhn b ri
lon chc nng thn. Tuy vy, v kinh nghim lm sng vi nhm bnh nhn ny cn hn ch,
do nn bt u iu tr bng liu thp nht cho bnh nhn mc bnh thn va v nng, v
phi theo di cht ch.
Tr em :
V cha c kinh nghim lm sng, nn khng dng cho tr em.
Dng thuc phi hp :
Lipobay trong n tr liu c hiu lc lm gim cholesterol ton phn v LDL choleterol. Hiu
lc ny c th gia tng nu phi hp vi thuc tch acid mt (th d nh cholestyramine, xem
mc Tng tc thuc).
QU LIU
Cha c thuc i khng vi Lipobay. Nu dng qu liu, hy iu tr triu chng v tin hnh
nhng bin php h tr thch hp.

301.

LIPOFUNDIN MCT/LCT 10% - 20%

B. BRAUN
dch truyn 10% : chai 100 ml, 250 ml, 500 ml.
dch truyn 20% : chai 100 ml, 250 ml, 500 ml.
THNH PHN
Lipofundin MCT/LCT 10% :
cho 1000 ml dch truyn
Du u nnh

50 g

Triglyceride chui trung bnh

50 g

Phospholipide lng trng

12 g

Glycerol

25 g

Nc tim truyn va

1000 ml

Phosphate (mmol/l)

14,5

Gi tr nng lng :
(kJ/l)

4430

(kcal/l)

1058

p sut thm thu

345 mOsmol/l

Lipofundin MCT/LCT 20% :

cho 1000 ml dch truyn
Du u nnh

100 g

Triglyceride chui trung bnh

100 g

Phospholipide lng trng

12 g

Glycerol

25 g

Nc tim truyn va

1000 ml

Phosphate (mmol/l)

14,5

Gi tr nng lng :
(kJ/l)

7900

(kcal/l)

1908

p sut thm thu

380 mOsmol/l

TNH CHT
Lipofundin MCT/LCT l mt nh dch bo v trng, cha triglycerid chui di (LCT) v chui
trung bnh (MCT) vi t l 1:1, khng c ch nhit t, dng tim truyn. Nh dch c pH dao
ng trong khong 6,5-8,5.
Nh dch cha du u nnh l sn phm t nhin c tinh ch cha triglyceride trung tnh
trong phn ln l nhng acid bo khng no.
Triglyceride chui trung bnh (MCT) l hn hp nhng triglyceride trung tnh gm khong 60%
caprylic acid v 40% capric acid.
DC L LM SNG
- Lipofundin MCT/LCT cung cp nng lng v acid bo khng no thit yu cho nhng bnh
nhn cn nui dng bng ng tnh mch.
- Triglyceride chui trung bnh (MCT) c thanh thi nhanh hn v oxy ha to nng lng
hon ton hn triglyceride chui di (LCT). Do , MCT c xem nh mt ngun cung cp
nng lng l{ tng cho c th c bit trong nhng trng hp s oxy ha ca LCT b suy
gim nh do thiu ht carnitin hay do gim hot ng ca enzym carnitin palmitoyl transferase.
- Triglyceride chui di (LCT) cung cp nhng acid b o khng no ngn nga v iu chnh v
mt lm sng nhng ri lon sinh ha do thiu acid bo thit yu.
- Phosphatid cha phospholipid ca lng trng lin quan n s thnh lp cu trc mng t
bo v nhng chc nng sinh hc khc.
- Glycerol chuyn ha to nng lng hay c d tr di dng glycogen v cht bo.
CH NH
Cung cp nng lng cho bnh nhn nui n qua ng tnh mch. Khi s dinh dng qua
ng tnh mch k o di trn 5 ngy, Lipofundin MCT/LCT ngn nga cc biu hin lm sng

ca s thiu ht cc acid bo thit yu.

CHNG CH NH
bnh nhn c nhng biu hin ri lon chuyn ha lipid nh tng lipid mu bnh l, thn h
nhim m, vim ty cp km tng lipid mu.
Cc chng ch nh khc : tnh trng nhim toan mu do nhim ceton, tnh trng thiu oxy mu,
thuyn tc, sc cp.
CH PHNG
Thn trng bnh nhn trong tnh trng nhim toan, bnh gan trm trng, bnh phi, nhim
trng, bnh l{ lin quan n h vng ni m, thiu mu, nhng ri lon trong s ng mu hay
khi c s e da tc nghn do m.
Truyn qu nhanh nh dch bo c th gy ra s tng th tch v cht bo qu mc do pha
long t ngt vi huyt tng ca c th, s thng d nc, tnh trng sung huyt, ph phi,
suy gim chc nng trao i kh ca phi.
THN TRNG LC DNG
Khi truyn Lipofundin MCT/LCT, phi ch theo di cht ch s thanh thi cht bo ra khi
huyt tng - Lipid mu phi tr v bnh thng mt ngy sau khi truyn dch.
- Nu truyn nh dch cht bo trong thi gian di phi c bit ch { n huyt , thi gian
ng mu, chc nng gan v s lng tiu cu.
- Bnh nhi : Lipofundin MCT/LCT 20% s dng an ton v hiu qu trn bnh nhi (tr s sinh v
tr em) trong dinh dng ton phn ngoi ng rut.
LC C THAI
Khng nn dng cho ph n mang thai nht l trong 3 thng u thai kz.
TC DNG NGOI
Tc dng ngoi { c biu hin di 2 dng :
- Tc th : kh th, tm ti, phn ng d ng, gia tng lipid mu, tng ng mu, nn ma, nhc
u, gia tng thn nhit, run, m hi, au lng.
- Phn ng mun : gan to, vng da do thuyn tc trung tm tiu thy, lch to, gim tiu cu,
gim bch cu, thay i chc nng gan v hi chng qu ti.
LIU LNG v CCH DNG
Liu lng :
Ngi ln :
Lipofundin MCT/LCT c th cung cp ti 60% nhu cu nng lng (khng do protein) hng ngy,
liu trung bnh 1-2 g/kg/ngy.
- Lipofundin MCT/LCT 10% : Trong 15 pht u : tc khng qu 0,5-1,0 ml/kg/gi.
Nu khng c phn ng ph, c th tng n 2 ml/kg/gi sau .
- Lipofundin MCT/LCT 20% : Trong 15 pht u : tc khng qu 0,25-0,5 ml/kg/gi. Nu
khng c phn ng ph, c th tng n 1 ml/kg/gi sau .

Trong ngy u tin ch truyn 500 ml Lipofundin MCT/LCT 10% hay 250 ml Lipofundin
MCT/LCT 20%. Nu bnh nhn khng c phn ng ph, liu dng c th tng ln trong nhng
ngy k tip.
Tr s sinh :
Ti a 3 g/kg/ngy.
Tc truyn ti a : 0,15 g/kg/gi (tng ng vi dch truyn 10% l 1,5 ml/kg/gi ; v dch
truyn 20% l 0,75 ml/kg/gi).
Cch dng :
- Lipofundin MCT/LCT c dng nh mt phn trong dinh dng ton phn ngoi ng rut
qua tnh mch ngoi bin hay tnh mch trung tm.
- Lipofundin MCT/LCT c th truyn cng lc vi carbonhydrate, amino acid (bng cch t
kha 3 ng gn v tr truyn dch). N cho php trn ln cc loi dch ny tc thi trc khi i
vo tnh mch.
- Khng nn trn ln nh dch bo vi cht in gii, thuc...
Lu { :
- Lipofundin MCT/LCT c cha trong chai thy tinh dng mt ln. Nu s dng khng ht,
phn cn li phi hy b.
- Khng c tim truyn nu nh dch b tch lp.
QU LIU
Khi qu ti cht bo hoc c xut hin nhng phn ng ph trong iu tr, ngng ngay truyn
dch Lipofundin MCT/LCT n khi nng triglycerid trong huyt tng (c kim tra bng
phng php o c) t mc cho php.
BO QUN
Bo qun nhit < 25 oC (77oF).

302.

LIPOVENOES 10% PLR

FRESENIUS
c/o CT TNHH DP HONG KHANG
nh dch tim truyn : chai 100 ml, thng 10 chai ; chai 250 ml, thng 10 chai ; chai 500 ml,
thng 10 chai.
THNH PHN

cho 1000 ml
Du u nnh

100 g

Glycerin (glycerol)

25,0 g

Phospholipid chit t trng

6,0 g

Nng thm thu

272 mosm/l

pH

6,5-8,7

Nng lng cung cp

4522 kj/l (hay 1080 kcal/l)

CH NH
p ng nhu cu ng thi v nng lng v acid bo cn thit trong nui dng bng ng
tnh mch.
CHNG CH NH
- Chuyn ha lipid b suy yu.
- Tng xut huyt nng.
- Chuyn ha khng n nh bnh nhn tiu ng.
- 3 thng u thai kz.
- D ng vi protein g.
- Tt c nhng bnh l cp tnh v e da mng sng nh : shock v try mch, nhi mu c tim
mi, t qu, nghn mch, hn m cha r nguyn nhn.
- Nhng chng ch nh chung i vi nui dng ng tnh mch nh : h kali mu, tnh
trng tha nc, mt nc nhc trng.
- Vic s dng Lipovenoes bnh nhn tr em b bilirubin mu cao phi c theo di cn
thn. Bilirubin phi c kim tra thng xuyn khi dng cht bo dng nh dch. N c nguy
c gy bnh vng nhn no.
THN TRNG LC DNG
Triglycerid mu phi c kim tra hng ngy. Hm lng ng trong mu, chuyn ha acidbase, cn bng nc in gii phi c kim tra thng xuyn. Nng triglycerid trong mu
khi truyn dch khng c vt qu 3 mmol/l ngi ln v 1,7 mmol/l tr em.
TC DNG NGOI
Phn ng sm c th xy ra khi dng cht bo dng nh dch nh : st nh, cm gic nng, cm

gic lnh run, cm gic bt thng v s m v s tm ti, n mt ngon, bun nn, nn, th ht
hi, au u, lng, xng, ngc, tht lng v chng cng au dng vt (rt him khi xy ra).
Nu nhng tc dng ph ny xy ra hoc nng triglycerid gia tng khi truyn dch trn tr s
3 mmol/l ngi ln v 1,7 mmol/l tr em th phi ngng truyn hoc nu cn thit th dng
tip nhng gim liu. Mt hi chng qu ti phi c theo di. Hi chng ny c th xy ra do
di truyn, liu chuyn ha khc nhau tng c nhn, v nhng bnh mc trc y dng
nhng liu khc nhau v thay i lin tc. Hi chng qu ti gm cc triu chng sau : gan ln
c hoc khng c vng da, thay i hoc gim cc yu t ng mu (thi gian mu chy, thi
gian mu ng, thi gian prothrombin, tiu cu...), lch ln, thiu mu, gim bch cu ht,
khuynh hng chy mu, th nghim chc nng gan bt thng.
TNG TC THUC
Tng tc gia Lipovenoes vi cc thuc khc hin khng c bit. S khng tng hp c
th xy ra qua nhng ion+ a ha tr (v d Ca), c bit khi dng chung vi heparin. Ch nn
dng chung dung dch Lipovenoes vi nhng dch truyn khc, cht in gii v thuc khc khi
s tng hp c chng minh.
LIU LNG v CCH DNG
Dch truyn Lipovenoes c th c dng chung vi cc dung dch acid amin khc v/hoc dung
dch carbohydrate, nhng phi qua cc ng truyn khc nhau. Vic dng ng thi 2 dung
dch phi c quan st k trn lm sng, s tng hp ca 2 dung dch phi c khng nh.
- Tr em : nu khng dng chung thuc khc : 1-2 g cht b o/kg/ngy, tng ng 10-20 ml
Lipovenoes 10%/kg/ngy. Nu nhu cu nng lng gia tng : dng n 3 g cht bo/kg/ngy,
tng ng vi 30 ml lipovenoes 10%/kg/ngy.
- Ngi ln : nu khng dng chung vi cc thuc khc : 1-2 g cht b o/kg/ngy, tng ng
10-20 ml lipovenoes 10%/kg/ngy.
- Tc truyn : ti a 0,125 g cht bo/kg/gi (tng ng vi 1,25 ml). Tuy nhin, lc u
truyn phi dng liu thp, ti a 0,05 g cht bo/kg/gi. ngi nng 70 kg, bt u truyn
vi tc 10 git/pht v gia tng sau mi 30 pht n ti a 26 git/pht.
- Thi gian iu tr : dng trong sut thi gian nui dng bng ng tnh mch.
BO QUN
Khng dng thuc qu hn dng ghi trn nhn.
Lc k trc khi s dng.
Bo qun di 25oC, khng ng bng.
Ch s dng khi dung dch ng nht v l khng b h.
thuc xa tm tay vi ca tr con.

303.

LOCABIOTAL 1%

LES LABORATOIRES SERVIER

dung dch xt ming hoc mi : bnh 5 ml (100 liu) + bm nh liu + 2 ng tra.
THNH PHN
cho bnh 5 ml
Fusafungine

50 mg

DC LC
Khng sinh ti ch (ng h hp).
Fusafungine l mt khng sinh ti ch c tc ng khng khun in vitro v in vivo trn :
streptocoque nhm A, pneumocoque, staphylocoque, mt s chng ca Neisseria, mt s mm
bnh ym kh, Candida albicans v Mycoplasma pneumoniae.
DC NG HC
ngi, sau khi dng thuc bng ng ht, khng pht hin thy fusafungine trong huyt
tng do hot cht chnh bm vo nim mc ng h hp.
CH NH
iu tr h tr ti ch c tnh khng khun trong cc nhim trng ng h hp trn : vim
mi, vim xoang, s mi, vim hng-mi, vim hng, vim amidan, sau ct amidan, vim thanh
qun, vim kh qun.
Lu { : nu c cc du hiu lm sng ca mt bnh nhim trng tng qut, cn s dng liu
php khng sinh ng ton thn.
CHNG CH NH
C tin s d ng vi thuc.
Tr s sinh (di 30 thng tui) : nguy c gy co tht thanh qun.
CH PHNG v THN TRNG LC DNG
Khng ch nh iu tr di hn do c kh nng gy mt cn bng h tp khun bnh thng vi
nguy c gy khuch tn vi khun.
LC C THAI v LC NUI CON B
ng vt, thuc khng c tc dng gy qui thai.
Fusafungine khng c c tnh trn phi thai hoc pht hin thy trong huyt tng khi dng

ngi.
TC DNG NGOI
C th gy phn ng ti ch tm thi kiu gy kch thch vng ming-hu, thng khng cn
phi ngng iu tr.
Ht hi.
LIU LNG v CCH DNG
Ngi ln : xt vo ming hoc vo mi l mi mi 4 gi.
Tr em : xt vo ming hoc vo mi l mi mi 6 gi.
Thng iu tr khng qu 10 ngy ; nu trn thi hn ny, cn xem xt li vic iu tr.
Cch thao tc :
Trc khi s dng ln u, nhn 5 ln ln nt n khi ng bm nh liu.
Bnh xt phi c gi thng ng gia ngn ci v ngn tr, ng tra pha trn.
Khi s dng, t ng tra ming (mu trng) trong ming v ngm mi li, sau nhn mnh v
lu ln nt n ng thi ht su.
Thc hin cng cng mt thao tc khi dng xt vo mi sau khi gn ng tra tng ng
(ng mu vng).

304.

LOMEXIN

RECORDATI
c/o GROWENA-IMPEX
kem bi ngoi da 2% : tup 5 g v 30 g.
vin t m o (thuc trng) 200 mg : hp 6 vin thuc trng.
vin t m o (thuc trng) 1000 mg : hp 2 vin thuc trng.
THNH PHN
cho 100 g
Fenticonazole nitrate

2g

cho 1 trng
Fenticonazole nitrate

200 mg

cho 1 trng
Fenticonazole nitrate

1000 mg

DC LC
Lomexin c hot cht chnh l fenticonazole nitrate, y l mt dn xut mi ca imidazole do
hng bo ch Recordati ca tng hp, c hot tnh khng nm v khng khun rt tt.
- Lomexin l mt cht khng nm ph rng, cho tc ng km s pht trin v dit nm trn cc
dermatophytes (l tc nhn gy hu ht cc bnh nhim vi nm trn da v nim mc), cc loi
nm men gy bnh, nm mc v nm lng hnh.
Th nghim in vitro v in vivo cho thy Lomexin c tc ng chng li cc loi vi nm sau :
Trichophyton mentagrophytes, T. verrucosum, T. rubrum, T. tonsurans, T. terrestre ;
Microsporum canis, M. gypserum, M. audouinii, M. fulvum, M. cookei ; Epidermophyton
floccosum ; Candida albicans ; Cryptococcus neoformans ; Geotrichum candidum ; Torulopsis
glabrala, Sporotricum schenckli, Aspergillus niger, A. fumigatus, A. flavus, Penicillium
crysogenum.
- Ngoi ra, Lomexin cn c tc ng chng li cc vi khun Gram dng (Staphylococcus,
Streptococcus). V vy c ch nh trong trng hp nhim nm c km bi nhim.
Khc vi c ch tc ng ca cc khng sinh, c ch tc ng khng khun ca Lomexin c
th hin trn nhiu mc khc nhau : trn mng t bo vi khun (lm tng tnh thm), trn cc
plasmide (c ch tin trnh oxy ha ti lp th), trn nhn (c ch s tng hp ARN).
- Lomexin cng c hot tnh chng Trichomonas vaginalis, c in vitro v in vivo.
DC NG HC
Cc nghin cu dc ng hc trn ph n v trn ng vt chng t rng hp thu qua da
rt thp.
AN TON TIN LM SNG
DL50 chut :
- ng ung > 3000 mg/kg.
- tim trong phc mc = 1276 mg/kg (chut c) v 1265 mg/kg (chut ci).
DL50 chut cng :
- ng ung > 3000 mg/kg,
- tim di da > 750 mg/kg,
- tim trong phc mc = 440 mg/kg (chut c) v 309 mg/kg (chut ci).
c tnh trng din : sau khi cho dng cc liu 40, 80 v 160 mg/kg/ngy trong 6 thng,
chut cng v ch, fenticonazole nitrate c dung np tt. Tuy nhin c pht hin c mt c
tnh nh l gy tng trng lng ca gan i vi liu 160 mg/kg chut cng, nhng khng gy

nh hng g v m bnh hc. ch, hin tng ny cng c pht hin i vi liu 80 v
160 mg/kg, ng thi cng c tng thong qua SGPT huyt thanh.
Fenticonazole nitrate khng nh hng n chc nng sinh dc ca c hai gii tnh, v khng
iu chnh kh nng sinh sn ng vt th nghim. Fenticonazole nitrate khng gy qui thai
chut cng v th, v khng gy t bin trn 6 th nghim v kh nng gy t bin.
Cc kt qu tt c ghi nhn khi lm cc th nghim v kh nng dung np ca thuc trn
b, th v heo con (da ca cc ng vt ny tng t da ngi v mt hnh thi, chc nng v
mc nhy cm vi nhng tc nhn gy kch ng). Khng c phn ng no v nhy cm, c
tnh trn da hay d ng vi nh sng... c ghi nhn i vi fenticonazole nitrate.
CH NH
Lomexin kem bi ngoi da :
- Bnh nm ngoi da do Dermatophytes (Trichophyton, Epidermophyton, Microsporum) cc v
tr khc nhau nh : nm da u, nm da thn, nm da i, nm da chn (bnh chn lc s), nm
bn tay, nm mt, nm ru, nm mng.
- Bnh vi nm Candida ngoi da (hm da, chc mp, nhim nm Candida mt, nhim vi nm
Candida vng t lt, tng sinh mn v vng bu), vim quy u, vim bao quy u, vim mng
v vim quanh mng.
- Lang ben (do Pytirosporum orbiculare v P. ovale).
- Bnh nm tai (do Candida hay cc loi nm mc) ch dng khi c tn thng mng nh.
- Bnh nm do Corynebacterium minutissimum.
- Bnh nm c bi nhim vi khun (gy bi vi khun Gram dng).
Lomexin thuc trng 200 mg :
- Bnh vi nm Candida sinh dc (vim m h - m o, vim c t cung, fluor nhim khun).
Lomexin T thuc trng 1000 mg :
- Nhim Trichomonas m o.
- Nhim trng m o dng hn hp do Trichomonas v vi nm Candida albicans.
- Bnh vi nm Candida nim mc m o (vim m h - m o, vim c t cung, fluor nhim
khun).
CHNG CH NH
Qu mn cm vi thuc.
CH PHNG
Bnh do vi nm Candida : khi lm v sinh nn s dng loi x phng c pH trung tnh hoc kim
(do pH acid to thun li cho vi nm Candida pht trin).
LC C THAI
Mc du s hp thu qua da v qua m o rt k m nhng khng nn s dng ch phm ny
trong thai kz.
TC DNG NGOI

- Do fenticonazole hp thu rt thp qua da nn khng gy tc dng ton thn. Tuy nhin, nu
bi thuc ln vng da b chy mu, ln din tch rng, tr s sinh nht l nhng vng da c
np gp, cng nn lu { n kh nng ny.
- Rt him khi xy ra cc biu hin khng dung np ti ch, nh cm gic nng rt nh, nga,
ban .
LIU LNG v CCH DNG
Lomexin kem bi ngoi da :
Bi thuc sau khi ra sch v lau kh sang thng. Khi bi thuc, nn thoa nh v u.
Thng c th bi thuc mi ngy 1 ln l . Trng hp nhim trng nng, c th bi thuc
2 ln/ngy.
Thi gian iu tr thay i theo mm bnh v v tr ca sang thng :
- Bnh vi nm Candida :
- hm k : 2 n 3 tun,
- vim mng v vim quanh mng : 2 thng.
- Bnh do vi nm dermatophytes :
- herpes loang vng v hm cc vng da c np gp : 2 n 4 tun,
- bnh chn lc s : 3 n 6 tun.
- Lang ben : 2 n 4 tun.
Lomexin thuc trng 200 mg :
t 1 vin Lomexin 200 mg trc khi i ng trong 3 ngy lin tip ty theo mc nhim vi
nm.
Nn t thuc su trong m o v y su n vm m o.
Lomexin T thuc trng 1000 mg :
- Nhim Trichomonas m o v nhim trng m o dng hn hp (Trichomonas + Candida) :
t 1 vin Lomexin T 1000 mg, nu cn c th t thm 1 vin sau 24 gi.
- Bnh vi nm Candida nim mc m o : liu duy nht 1 vin Lomexin T 1000 mg, t vo
bui ti. Nu cc triu chng vn cn, c th dng tip thm mt liu na cch sau 3 ngy.
Nn t thuc su trong m o v y su n vm m o.

305.

LOPID

PFIZER
c/o ZUELLIG
Vin nang 300 mg : v 10 vin, hp 10 v.

Vin nn 600 mg : v 10 vin, hp 6 v - Bng B.

THNH PHN
cho 1 vin
Gemfibrozil

300 mg

cho 1 vin
Gemfibrozil

600 mg

DC LC
Thuc iu tr ri lon lipide mu thuc nhm fibrate.
C ch tc ng :
- Gim tng hp VLDL (triglycride) gan do c ch s tiu m ngoi bin (gim cc acide
bo c sn) v gim s st nhp cc acide bo c chui di. Vic gim s tng hp cc VLDL s
lm gim s hnh thnh cc LDL (cholest rol gy x va ng mch) trong c cht nh du
l apoprot ine B c ghi nhn gim nhiu trong huyt tng ;
- Tng cc HDL c lin quan n vic tng s thoi bin cc VLDL v tng s tng hp cc
apoprotine AI v AII. S thanh lc cholestrol gan v s o thi qua mt c tng ln.
ngi, gemfibrozil c cho thy c hiu qu khi dng liu duy nht mi ngy.
Thuc c tc ng ln s kt dnh v kt tp tiu cu, c chng minh trn th vt cng nh
qua cc kho st lm sng trn ngi.
ngi, cc nghin cu lm sng cho thy rng dng Lopid vi liu duy nht mi ngy 900 mg
s c hiu qu :
- Gim rt nhanh hm lng ca cc triglycride ;
- Gim cholestrol ton phn ;
- Gim cholestrol LDL ;
- Tng cholest rol HDL ;
- Ci thin s phn b ca cholestrol trong huyt tng bng cch lm gim s tng quan
VLDL + LDL / HDL (tng quan ny tng trong bnh l{ tng lipide huyt gy x va ng mch).
DC NG HC
Hp thu :
- Lopid c hp thu nhanh qua ng tiu ha sau khi ung thuc.

- t nng ti a trong mu t 1 n 2 gi sau khi ung thuc.

Thi gian bn hy trong huyt tng :
- Hm lng trong huyt tng c lin quan tuyn tnh vi liu dng. Thi gian bn hy trong
huyt tng khong 1 gi 30. Khng pht hin c s tch ly thuc khi iu tr di hn bng
Lopid.
Chuyn ha v bi tit :
- Gemfibrozil c chuyn ha ch yu qua gan.
- Bi tit di dng lin hp v hot cht khng b bin i. Thuc c bi tit ch yu qua
nc tiu (70%). Gn kt vi protine trong khong 97%.
CH NH
1. Lopid c ch nh ngn nga nguyn pht bnh mch vnh v nhi mu c tim bnh
nhn tng cholest rol mu, ri lon lipide mu hn hp, tng triglyc ride mu tng ng type
IIa, IIb v IV theo xp loi ca Fredrickson.
2. iu tr nhng ri lon lipide mu khc :
- Type III v V.
- Km vi tiu ng.
- Km vi u vng.
Lopid c ch nh nh mt iu tr b sung vo ch n nhm lm gim nguy c mc bnh
mch vnh bnh nhn nhm IIb c 3 ri lon : HDL cholestrol thp, LDL cholestrol v
triglycride cao, v khng c tin cn hoc triu chng bnh mch vnh, khi cc bnh nhn ny
c p ng khng y vi vic gim cn, vi iu tr bng ch n, vn ng v cc dc
cht khc c tc dng lm gim LDL cholest rol v tng HDL cholest rol.
CHNG CH NH
Ri lon chc nng gan thn nng.
Tng mn cm vi Lopid.
CH PHNG
Tnh an ton v hiu qu ca Lopid i vi tr em cha c cng nhn.
THN TRNG LC DNG
Lopid c th lm tng bi tit cholestrol vo trong mt, d to si ti mt. Nu nghi ng c si
ng mt, cn lm cc xt nghim v ti mt. Nn ngng dng Lopid nu tm thy si mt.
Phi hp s dng cng lc Lopid v Lovastatin c th gy vim c nng vi s gia tng
cratinine kinase v tiu myoglobine.
LC C THAI
Khng dng cho ph n c thai hoc nghi c thai.
LC NUI CON B
Khng dng cho ph n nui con bng sa m.
TNG TC THUC

Lu { khi s dng thuc khng ng v Lopid cng lc, nn gim liu thuc khng ng v duy
tr thi gian prothrombine mc mong mun trnh bin chng xut huyt.
Khi s dng Lopid v Lovastatin cng lc, mt s him trng hp c th gy vim c nng.
TC DNG NGOI
t xy ra, khng vt qu 1,3% s bnh nhn (trong cc th nghim lm sng).
Ri lon tiu ha : bun nn, nn, kh tiu.
Phn ng d ng da.
Tng transaminase v bilirubine. Nn theo di chc nng gan khi s dng Lopid. Nhng ri lon
ny s ht dn khi ngng dng Lopid.
Gim nh hmoglobine, hmatocrite v bch cu vo giai on u khi s dng Lopid, rt him
xy ra thiu mu nng, gim bch cu, gim tiu cu nng v suy ty. Nn kim tra cng thc
mu nh kz trong 12 thng u iu tr vi Lopid.
LIU LNG v CCH DNG
900 - 1200 mg, chia lm 2 ln trong ngy ; ung thuc na gi trc ba n sng v ti.

306.

LOPRIL

BRISTOL-MYERS SQUIBB
vin nn d b 25 mg : hp 30 vin.
vin nn d b 50 mg : hp 30 vin - Bng B.
THNH PHN
cho 1 vin
Captopril

25 mg

(Lactose)

cho 1 vin
Captopril
(Lactose)

50 mg

DC LC
Thuc c ch men chuyn angiotensine.
Captopril l thuc c ch men chuyn angiotensine I thnh angiotensine II, cht gy co mch
ng thi kch thch s bi tit aldostrone v thng thn.
Kt qu l :
- gim bi tit aldostrone,
- tng hot ng ca rnine trong huyt tng, aldost rone khng cn ng vai tr kim tra
ngc m tnh,
- gim s khng ngoi vi ton phn vi tc ng chn lc trn c v trn thn, do khng
gy gi mui nc hoc nhp tim nhanh phn x trong iu tr lu di.
Tc ng h huyt p ca captopril cng c th hin nhng bnh nhn c nng rnine
thp hoc bnh thng.
c tnh ca tc ng h huyt p :
Captopril c hiu lc mi giai on ca cao huyt p : nh, va v nng ; Captopril c ghi
nhn lm gim huyt p tm thu v tm trng, t th nm v t th ng.
Tc ng h huyt p c c sau khi ung thuc 15 pht v c hiu lc ti a sau khi ung
thuc t 1 n 1 gi 30 pht. Thi gian tc ng ty thuc vo liu, thng t 6 n 12 gi.
nhng bnh nhn c p ng, huyt p c tr li bnh thng sau 15 ngy iu tr, v duy
tr mc n nh khng ti li.
Khi ngng thuc khng xy ra hin tng huyt p tng vt tr li.
iu tr cao huyt p ng mch bng captopril s ci thin s gin ng mch cng nh l
gim ph i tm tht tri.
Trong trng hp cn thit, c th phi hp vi thuc li tiu nhm thiazide s c tc dng
hip ng. Ngoi ra, phi hp thuc c ch men chuyn v thuc li tiu nhm thiazide s gim
nguy c h kali huyt so vi khi ch dng mt mnh thuc li tiu.
C ch tc ng trn huyt ng bnh nhn suy tim :
Captopril gim cng sut ca tim :
- do tc ng lm gin tnh mch, do iu chnh s chuyn ha ca prostaglandine : gim tin
gnh ;
- do gim s khng ngoi vi ton phn : gim hu gnh.
Cc nghin cu c thc hin bnh nhn suy tim cho thy rng :
- gim p lc y tht tri v phi,
- gim s khng ngoi vi ton phn,
- tng lu lng tim v ci thin ch s tim,
- tng lu lng mu n c.
Cc nghim php gng sc cng c ci thin.
Cc c tnh trong iu tr sau nhi mu c tim :

 bnh nhn b nhi mu c tim vi ri lon chc nng tht tri (phn sut phun di 40%),
iu tr bng captopril trn mt s ln bnh nhn chng minh :
- gim t vong ni chung,
- gim t vong do ngun gc tim mch,
- gim ti pht nhi mu c tim,
- gim tin trin bnh sang suy tim,
- gim kh nng phi nhp vin do suy tim (nghin cu SAVE).
Captopril c tc dng hip ng vi cc tr liu nhi mu c tim khc, ci thin t l t vong v
gim ti pht nhi mu.
Captopril c tc dng mi tui, gii tnh, v tr b nhi mu, v c th phi hp thm vi
mt tr liu sau nhi mu c tim khc (tan cc huyt khi, chn bta, aspirine).
Cc c tnh trong iu tr bnh thn do tiu ng :
Mt s th nghim so snh vi placebo cho thy rng iu tr bng captopril cho bnh nhn tiu
ng l thuc insuline, c protine niu, c cao huyt p hoc khng, c cratinine huyt
di 25 mg/l s lm gim 51% nguy c tng gp i cr atinine huyt v gim 51% t l t vong
v lc thn nhn to - thay thn.
Tc dng trn thn khng ch c lin quan n tc dng h huyt p, m cn do mt tc dng
bo v thn hon ton c lp vi vic h huyt p ng mch.
DC NG HC
Captopril c hp thu nhanh qua ng ung (nh hp thu trong mu t c trong gi
u tin).
T l hp thu chim 75% liu dng v gim t 30 n 35% khi dng chung vi thc n, tuy nhin
khng nh hng g n tc dng iu tr.
C 30% gn vi albumine huyt tng. Thi gian bn hy o thi ca phn captopril khng b
bin i khong 2 gi.
C 95% captopril b o thi qua nc tiu (trong 40 n 50 di dng khng b bin i).
bnh nhn suy thn, nng captopril trong huyt tng tng ng k bnh nhn c
thanh thi cratinine <= 40 ml/pht ; thi gian bn hy c th tng n 30 gi.
Captopril qua c nhau thai.
Mt lng rt nh captopril c bi tit qua sa m (xem Lc c thai).
CH NH
- Huyt p cao.
- Suy tim sung huyt.
- Trong giai on sau nhi mu nhng bnh nhn b ri lon chc nng tht tri v khng c
du hiu lm sng suy tim. iu tr lu di bng captopril gip bnh nhn ci thin s sng cn,
gim nguy c ti pht nhi mu c tim cng nh gim nguy c tin n suy tim.
- Bnh thn do tiu ng ph thuc insuline c tng prot ine niu. iu tr di hn s gim

tn thng thn.
CHNG CH NH
Tuyt i :
- Qu mn cm vi captopril.
- Tin s b ph mch (ph Quincke) do dng thuc c ch men chuyn.
Tng i :
- Phi hp vi thuc li tiu tng kali huyt, mui kali v lithium : xem Tng tc thuc.
- Hp ng mch thn hai bn hoc ch cn duy nht mt qu thn lm vic.
- Tng kali huyt.
CH PHNG
C a b suy gim min dch : nguy c b gim bch cu trung tnh/mt bch cu ht.
Cc thuc c ch men chuyn trong c captopril i khi ngoi l c th gy mt bch cu ht
v/hoc gy suy ty khi chng c s dng :
- liu cao (> 150 mg/ngy),
- bnh nhn suy thn phi hp vi cc bnh h thng (bnh collagne nh lupus ban ri
rc hoc bnh x cng b), c iu tr bng thuc lm gim min dch v/hoc nhng thuc
c kh nng gy gim bch cu. Trng hp phi hp nhiu loi thuc, cn theo di st mc
dung np mu v thn.
Vic chp hnh tt cc ch liu lng khuyn co c th ngn nga xy ra cc tai bin trn
(khng vt qu liu captopril 150 mg/ngy). Tuy nhin, nu s dng thuc c ch men chuyn
trn nhm bnh nhn ny, cn cn nhc k gia hiu qu iu tr v cc nguy c.
Ph mch (ph Quincke) :
Ph mch mt, u chi, mi, li, thanh mn v/hoc thanh qun i khi cng c ghi nhn
trong mt s him trng hp iu tr bng thuc c ch men chuyn, k c captopril. Trong
nhng trng hp ny, phi ngng ngay captopril v theo di bnh nhn cho n khi ht hn
ph. Nu ch b ph mt v li, c th t khi khng cn phi iu tr, c th dng cc thuc
khng histamine lm du cc triu chng.
Nu ph mch phi hp vi ph thanh qun c th gy t vong. Nu ph sang n li, thanh
mn hoc thanh qun, c th gy nght th, cn phi c x l ngay lp tc bng cch tim
di da dung dch adrnaline 1o/oo (0,3 ml n 0,5 ml) v p dng cc bin php cp cu thch
hp.
Khng c tip tc k toa thuc c ch men chuyn nhng bnh nhn ny (xem Chng ch
nh).
Bnh nhn c tin s b ph Quincke khng lin quan n vic dng thuc c ch men
chuyn cng c nguy c cao khi dng loi thuc ny.
Lc mu :
Cc phn ng ging phn v (ph li v mi vi kh th v gim huyt p) cng c ghi nhn

khi lm thm phn c dng mng c tnh thm cao (polyacrylonitrile) nhng bnh c iu
tr bng thuc c ch men chuyn. Nn trnh phi hp ny.
THN TRNG LC DNG
- Ho khan c ghi nhn khi s dng thuc c ch men chuyn, c c tnh dai dng v khi khi
ngng thuc. Nguyn nhn do thuc c th c ngh n, tuy nhin nu vic iu tr bng
thuc c ch men chuyn l cn thit, c th duy tr iu tr.
- Tr em : hiu lc v mc dung np ca captopril tr em cha c thit lp bng cc
nghin cu c kim sot. Tuy nhin, captopril vn c s dng iu tr bnh tim mch
tr em. Nn bt u iu tr bnh vin.
- Trng hp suy tim, mt mui-nc, v.v. : nguy c b h huyt p v/hoc suy thn.
C s kch thch h thng rnine-angiotensine-aldost rone c ghi nhn, c bit bnh
nhn b mt mui-nc quan trng (n king theo ch khng c mui hoc iu tr ko di
bng thuc li tiu), bnh nhn c huyt p ng mch ban u thp, trng hp b hp
ng mch thn, suy tim sung huyt hoc x gan c trng ph bng.
Thuc c ch men chuyn c th phong b h thng ny, nht l trong ln s dng u tin v
trong hai tun l u iu tr, c th gy ra tt huyt p t ngt v/hoc, mc d rt him v
thi hn thay i, tng cr atinine huyt tng gy suy thn chc nng i khi cp tnh.
Trong nhng trng hp nu trn, cn bt u iu tr vi liu thp v tng t t.
- Ngi gi : cn nh gi chc nng thn v kali huyt trc khi bt u iu tr (xem Liu
lng v Cch dng). Liu ban u c iu chnh li sau ty theo p ng v huyt p,
nht l trong trng hp mt mui-nc, nhm trnh tt huyt p c th xy ra t ngt.
- Trng hp suy thn (thanh thi cr atinine di 40 ml/pht) : gim liu. nhng bnh nhn
ny v nhng bnh nhn b bnh cu thn, nn theo di nh kz kali v cratinine (xem Liu
lng v Cch dng).
- Bnh nhn b x va ng mch : do nguy c b h huyt p c th xy ra trn tt c bnh
nhn, cn phi c bit thn trng nhng bnh nhn c bnh tim thiu mu cc b hoc suy
tun hon no, bng cch bt u iu tr liu thp.
- Bnh nhn b cao huyt p do thn : nguyn tc iu tr cao huyt p do thn l vn ti
ti mu thn (ti to mch mu thn). Tuy nhin, dng Lopril c th c ch cho nhng bnh
nhn ny trong thi gian ch i phu thut iu chnh hoc trng hp khng th phu thut
c. Khi iu tr phi dng liu ban u thp v theo di chc nng thn cng nh kali huyt,
mt vi bnh nhn c th b suy thn chc nng, tuy nhin s hi phc li khi ngng iu tr.
- Bnh nhn suy tim nng (giai on IV) hoc i tho ng l thuc insuline (c khuynh
hng tng kali huyt) : khi iu tr phi c theo di cht ch trn lm sng v liu ban u
phi thp.
- Bnh nhn cao huyt p vi suy mch vnh : khng ngng thuc chn bta ; phi hp thuc
c ch men chuyn vi thuc chn bta.

- Ghp thn hoc thm phn mu :

Thiu mu vi gim hm lng h moglobine c ghi nhn. Tc dng ny dng nh khng
ph thuc vo liu lng nhng c lin quan n c ch tc ng ca cc thuc c ch men
chuyn.
Vic gim ny mc trung bnh, xy ra trong thi hn khong 1 n 6 thng, sau mc
n nh. S khi sau khi ngng iu tr. Vic iu tr c th c p dng nhng cn phi kim
tra mu thng xuyn.
- Can thip phu thut : trng hp c dng thuc gy v cm, v thng xy ra hn khi s
dng cc loi thuc gy v cm c tim nng h huyt p, thuc c ch men chuyn s lm tt
huyt p. Nn ngng iu tr mt ngy trc khi phu thut nu c th.
LC C THAI
Cc nghin cu trn th vt cho thy khng c tc dng gy qui thai, nhng c c tnh trn
phi thai ca nhiu loi.
ph n c thai c iu tr bng thuc c ch men chuyn :
- cha c nghin cu dch t hc rng ri ;
- mt vi quan st ring r ph n c thai trong ba thng u cho thy rng ni chung c th
bo m v phng din khng gy qui thai ngoi tr mt vi trng hp d dng vm s c
lin quan n vic dng lu di thuc c ch men chuyn trong thi gian mang thai.
- dng thuc trong 3 thng gia v 3 thng cui, v nht l nu tip tc cho n khi sinh, d c
nguy c gy tn thng thn c th gy gim chc nng thn ca bo thai vi i khi b thiu
i, suy thn tr s sinh, vi h huyt p v tng kali huyt, thm ch v niu (c hi phc hoc
khng).
T kt lun rng :
Nguy c gy d dng, nu c, rt thp. Khng cn thit phi ph thai khi tnh c pht hin c
thai trong khi ang iu tr. Tuy nhin cn siu m kim tra vm s.
Ngc li, nu pht hin c thai khi ang iu tr bng Lopril, cn ngng ngay thuc ny v
trong sut thai kz.
LC NUI CON B
Mt lng nh captopril (khong 1% so vi nng trong mu ca ngi m) c bi tit qua
sa m. Do nn ngng cho con b trong thi gian iu tr.
TNG TC THUC
Khng nn phi hp :
- Thuc li tiu tng kali huyt (spironolactone, triamtrne, mt mnh hoc phi hp...) : tng
kali huyt (c th gy t vong), nht l bnh nhn suy thn (phi hp tc ng lm tng kali
huyt). Khng phi hp thuc li tiu tng kali huyt vi thuc c ch men chuyn, tr trng
hp bnh nhn b h kali huyt.
- Lithium : tng lithium huyt c th n ngng gy c (do gim bi tit lithium thn). Nu

bt buc phi dng thuc c ch men chuyn, cn theo di st lithium huyt v iu chnh liu.
Thn trng khi phi hp :
- Thuc tr i tho ng (insuline, sulfamide h ng huyt) :
Tng tc dng h ng huyt bnh nhn i tho ng c iu tr bng insuline hoc
sulfamide h ng huyt. Him khi xy ra cc biu hin kh chu do h ng huyt (ci thin
s dung np glucose do gim nhu cu insuline).
Tng cng t theo di ng huyt.
- Baclofne : tng tc dng h huyt p.
Theo di huyt p ng mch v iu chnh liu thuc h huyt p nu thy cn.
- Thuc li tiu : nguy c h huyt p t ngt v/hoc suy thn cp tnh khi dng thuc c ch
men chuyn trng hp bnh nhn trc b mt mui-nc.
Trong cao huyt p ng mch, nu vic iu tr bng thuc li tiu trc gy mt muinc (c bit bnh nhn hoc ang c iu tr bng thuc li tiu, hoc theo ch
n king khng c mui, hoc bnh nhn lc thn nhn to), cn phi :
- hoc ngng thuc li tiu trc khi bt u dng thuc c ch men chuyn, v sau c th
dng tr li thuc li tiu h kali huyt nu cn thit,
- hoc dng liu ban u thp thuc c ch men chuyn v tng liu t t.
bnh nhn suy tim sung huyt c iu tr bng thuc li tiu, bt u bng liu rt thp
thuc c ch men chuyn, c th sau gim liu li tiu h kali huyt dng phi hp.
Trong mi trng hp, cn theo di chc nng thn (cratinine huyt) trong cc tun l u
iu tr bng thuc c ch men chuyn.
Lu { khi phi hp :
- Thuc khng vim khng stroide (do suy lun t indomtacine) : gim tc dng h huyt p
(do thuc khng vim khng stroide gy c ch cc prostaglandine c tc dng gin mch v
phnylbutazone gy gi mui-nc).
- Thuc chng trm cm nhm imipramine (ba vng), thuc an thn kinh : tng tc dng h
huyt p v nguy c h huyt p th ng (hip ng tc dng).
- Corticoide, ttracosactide : gim tc dng h huyt p (do corticoide gy gi mui-nc).
TC DNG NGOI
V phng din lm sng :
- Nhc u, suy nhc, cm gic chng mt, ri lon tnh kh v/hoc ri lon gic ng, vp b.
- H huyt p theo t th hoc khng (xem Ch { phng v Thn trng lc dng).
- Pht ban ngoi da.
- au bao t, chn n, bun nn, au bng, thay. i v gic.
- Ho khan c ghi nhn khi s dng thuc c ch men chuyn. Ho c tnh cht dai dng v s
khi khi ngng iu tr. Nguyn nhn do thuc phi c x t n khi c nhng triu chng
trn.

- Ngoi l : ph mch (ph Quincke) : xem Ch { phng v Thn trng lc dng.

V phng din sinh hc :
- Tng va phi ur v cratinine huyt tng, hi phc khi ngng iu tr. Vic tng ny
thng gp hn bnh nhn b hp ng mch thn, cao huyt p c iu tr bng thuc li
tiu, bnh nhn suy thn. Trng hp b bnh cu thn, dng thuc c ch men chuyn c th
gy protine niu.
- Tng kali huyt, thng l thong qua.
- Thiu mu (xem Ch { phng v Thn trng lc dng) c ghi nhn khi dng thuc c ch
men chuyn trn nhng c a c bit (nh ghp thn, lc mu).
LIU LNG v CCH DNG
Cao huyt p v cn :
Bnh nhn c th tch mu bnh thng :
Liu thng thng : 50 mg/ngy, ung hai ln cch nhau 12 gi.
Trong mt vi trng hp nng : 150 mg/ngy, chia lm 2 hoc 3 ln, sau gim t t liu ny
xung.
Bnh nhn iu tr bng thuc li tiu : hoc ngng thuc li tiu trc 3 ngy v dng tr
li sau nu cn thit, hoc bt u bng liu 12,5 mg/ngy.
Ngi gi/Suy thn :
Thanh thi cratinine > 41 ml/pht :
- Liu khi u : 25 n 50 mg/ngy.
- Liu tip theo : ti a 150 mg/ngy (theo nguyn tc).
Thanh thi cratinine t 21 n 40 ml/pht :
- Liu khi u : 25 mg/ngy.
- Liu tip theo : ti a 100 mg/ngy.
Thanh thi cratinine t 11 n 20 ml/pht :
- Liu khi u : 12,5 mg/ngy.
- Liu tip theo : ti a 75 mg/ngy.
Thanh thi cratinine < 10 ml/pht :
- Liu khi u : 6,25 mg/ngy.
- Liu tip theo : ti a 37,5 mg/ngy.
Cao huyt p do thn : khi u bng liu 6,25 mg/ngy.
Suy tim sung huyt :
Liu khi u : khi u bng liu 6,25 mg/ngy. Sau tng dn liu hng ngy tng nc 12,5
mg, sau 25 mg.
Liu hiu qu : 50 n 100 mg/ngy, chia lm 2 hoc 3 ln. Theo di liu lng sao cho HA tm
thu khng < 90 mm. i vi bnh nhn suy tim ang iu tr bng li tiu, nn gim liu cn
phn na bng cch cho 6,25 mg mi 2 ngy.

Nhi mu c tim cn cp :
iu tr cng sm cng tt trn nhng bnh nhn c iu kin huyt ng hc n nh : cho 1
liu test u tin 6,25 mg. Sau 2 gi cho 12,5 mg v 12 gi sau cho tip 25 mg.
Ngy sau : 100 mg chia lm 2 ln trong 4 tun nu tnh trng huyt ng hc cho ph p. Sau
nh gi li tip tc iu tr.
iu tr sau nhi mu c tim : Nu khng iu kin th iu tr t ngy th 3 n ngy th
16 sau cn nhi mu.
Liu khi u ( bnh vin) : 6,25 mg/ngy, sau l 12,5 mg x 3 ln/ngy trong vng 2 ngy,
sau l 25 mg x 3 ln/ngy nu iu kin huyt ng hc bnh nhn (huyt p) cho php.
Liu thng thng (iu tr nh) : 75 n 150 mg/ngy, chia 2 n 3 ln.
Nu b tt huyt p, ta nn gim liu thuc li tiu hoc cc thuc dn mch khc.
C th dng captopril chung vi cc thuc tan huyt khi, aspirine, c ch bta.
Bnh thn do tiu ng : 50 n 100 mg/ngy, chia lm 2 n 3 ln.
QU LIU
Thng xy ra nht khi b qu liu l tt huyt p.
Khi huyt p tt nhiu, cn t bnh nhn t th nm, u thp, v truyn tnh mch dung
dch ng trng NaCl hay bng bt c phng tin no khc lm tng th tch mu lu
chuyn.
Captopril c th thm tch c.

307.

LORADIL 10

HIKMA
c/o O.P.V. (OVERSEAS)
Vin nn 10 mg : v 10 vin, hp 1 v.
THNH PHN
cho 1 vin
Loratadine

10 mg

TNH CHT
Loradil c hot cht loratadine l mt thuc khng histamin mnh c tc dng di, khng lm
bun ng v c hiu ng khng cholinergic khng ng k.

Loratadine l cht i khng ca th th histamin H1 chn lc, c i lc cao vi th th histamin

ngoi bin hn l trung ng.
Loratadine khi pht tc dng nhanh v c hiu lc khng histamin k o di hn 24 gi, do
ch cn dng thuc mt ln mi ngy.
CH NH
Loradil c dng iu chnh cc ri lon do histamin gy ra nh lm du cc triu chng
ca vim mi d ng (ht hi, s mi, nga), cng nh vim kt mc d ng.
Loradil cn c dng lm gim cc du hiu v triu chng ca m ay v cc ri lon d
ng da.
CHNG CH NH
Loradil chng ch nh trong nhng trng hp c biu hin qu mn vi thuc.
CH PHNG v THN TRNG LC DNG
Cha xc nh c tnh an ton v nh hng tr em di 2 tui v ph n c thai, ph
n cho con b. Trong nhng trng hp ny, ch nn dng thuc khi tht cn thit.
TC DNG NGOI
Khng ng k, c th so snh nh placebo, c bit liu di 40 mg mi ngy.
LIU LNG v CCH DNG
Liu thng dng cho tr ln v ngi ln :
1 vin nn (10 mg) mi ngy.
QU LIU
Trong trng hp qu liu, nn iu tr triu chng v nng . C th ra d dy v dng cht
gy nn.

308.

LORATIN

TENAMYD
c/o MEDIPLANTEX
c/o MEDIPHARCO
c/o CT DL TW2 - PHYTOPHARCO
vin nn 10 mg : v 10 vin, hp 1 v.
THNH PHN
cho 1 vin

Loratadine vi th

10 mg

DC LC
Loratadine l cht khng histamine 3 vng (tricyclic) mnh, c tc dng di v hot tnh i
khng chn lc trn cc th th histamine H1 ngoi vi.
CH NH
Loratadine vin c ch nh lm gim cc triu chng thng kt hp vi vim mi d ng
theo ma, nh ht hi, chy nc mi, nga, k c nga mt v nng mt.
Cc triu chng v du hiu ca my ay t pht mn tnh v nhng ri lon khc thuc d ng
da.
CHNG CH NH
Nhng bnh nhn c tng cm hoc d ng vi loratadine hay cc thnh phn t dc khc ca
thuc.
THN TRNG LC DNG
i vi bnh nhn suy gan hoc suy thn, liu dng lc khi u phi thp hn bnh thng (5
mg loratadine, mi ngy mt ln hoc 10 mg, hai ngy mt ln.
LC C THAI v LC NUI CON B
Lc c thai :
Tnh an ton ca thuc s dng trong thi kz thai ngh n khng c xc nhn. Do ,
loratadine ch c dng cho ph n ang mang thai nu tht s cn thit.
Lc nui con b :
Thuc c bi tit d dng vo sa m. Do c tng nguy c ca thuc khng histamine i vi
nh nhi, cn phi quyt nh hoc ngng cho con b hoc ngng dng thuc sau khi cn
nhc k tm quan trng ca thuc i vi ngi m.
TNG TC THUC
- Khi dng loratadine vi ketoconazole s lm tng nng loratadine trong huyt tng
nhng khng c cc ri lon ng k v lm sng v sinh ha (k c in tm ).
- Dng ng thi vi ru, loratadine khng c tc dng mnh nh o c cc nghin cu
tm thn vn ng.
TC DNG NGOI
Vi liu dng thng thng hng ngy 10 mg, loratadine khng c tc dng an thn hoc khng
cholinergic ng k. Tc dng ph c th gp l mt, nhc u, bun ng, kh ming, ri lon
tiu ha.
Trong thi gian tip th loratadine vin, him khi c bo cc vim gan hay rng tc.
LIU LNG v CCH DNG
Ngi ln v tr em trn 12 tui : 10 mg loratadine (1 vin), mi ngy mt ln.
Tr em t 6 n 12 tui : 5-10 mg loratadine, mi ngy mt ln.

i vi bnh nhn b suy gan hay suy thn, liu dng lc khi u phi thp : 5 mg (na vin),
mi ngy mt ln, hoc 10 mg (1 vin), hai ngy mt ln.
QU LIU
Khi ung mt ln 160 mg loratadine vn khng c tc dng ngoi no xy ra.
BO QUN
Bo qun nhit t 2oC n 30oC, ni mt v kh.
thuc xa tm tay tr em.

THUC VN M

309.

MAALOX

XNLD RHNE POULENC RORER

[AVENTIS PHARMA]
Vin n n nhai : hp 40 vin.
THNH PHN
cho 1 vin
Aluminium hydroxyde

400 mg

Magnsium hydroxyde

400 mg

(Saccharose)

(150 mg)

(Hng liu bc h dng bt)

DC LC
Khng acide :
- Bo v nim mc thc qun - d dy - t trng.
- Khng cn quang i vi tia X.
Nghin cu in vitro vi n v liu theo phng php Vatier :
- kh nng khng acide ti a trn l{ thuyt l 82,05 mmol/vin
CH NH
iu tr triu chng nhng cn au do bnh thc qun - d dy - t trng.

CHNG CH NH
Lin quan magnsium : suy thn nng.
THN TRNG LC DNG
ngi suy thn v thm phn mn tnh, cn cn nhc hm lng nhm (nguy c bnh no).
LC C THAI v LC NUI CON B
Khng c d liu tin cy v tc dng gy qui thai sc vt.
Trn lm sng, hin khng c d liu y c lin quan nh gi tc dng gy d dng hoc
c hi i vi thai nhi ca aluminium hay magnsium hydroxyde khi dng cho ph n trong
thai kz.
Bit rng thuc c hp thu yu, ch nn xem xt vic s dng thuc ny cho ph n mang
thai nu cn thit.
S c mt ca cc ion nhm v magnsium c th c tc ng trn nhu ng rut :
- cc mui nhm gy to bn nn c th lm tng thm tnh trng to bn thng thy ph
n mang thai, ng thi, vi liu cao, c th gy mt phosphore (tr aluminium phosphate). S
hp thu ion nhm c xem l ti thiu v khng c nguy c qu ti khi gii hn liu dng theo
tng ngy v theo thi gian, nhng s c nguy c tht s khi s dng khng thn trng, nht l
trong trng hp m b suy thn : nguy c nhim c nhm cho thai nhi v tr s sinh.
- cc mui magnsium c th gy tiu chy : c nguy c tng magne mu nu dng thuc vi
liu cao v di hn.
TNG TC THUC
Cc thuc khng acide tng tc vi mt s thuc khc c hp thu bng ng ung :
Thn trng khi phi hp :
- Thuc chng lao (ethambutol, isoniazide), cycline, fluoroquinolone, lincosanide, khng
histamine H2, atnolol, mtoprolol, propranolol, chloroquine, diflunisal, digoxine,
diphosphonate, fluorure sodium, glucocorticoide (c th l prednisolone v dexamethasone),
indomtacine, ktoconazole, lanzoprazole, thuc an thn kinh nhm phnothiazine,
pnicillamine, phosphore, mui st, sparfloxacine : gim s hp thu qua ng tiu ha ca cc
thuc trn.
- Kayexalate : gim kh nng gn kt ca nha vo kali, vi nguy c nhim kim chuyn ha
ngi suy thn.
Nn s dng cc thuc khng acide cch xa cc thuc trn (trn 2 gi v, trn 4 gi i vi
fluoroquinolone).
Lu { khi phi hp :
- Dn xut salicylate : tng bi tit cc salicylate thn do kim ha nc tiu.
TC DNG NGOI
Lin quan n aluminium : mt phosphore khi iu tr lu di hay vi liu cao.
LIU LNG v CCH DNG

1 n 2 vin vo lc au hoc 1 gi sau ba n v trc khi ng, ti a 6 ln mi ngy, ngi

ln.
BO QUN
Trnh m.

310.

MADECASSOL

ROCHE NICHOLAS (SERDEX DIVISION)

c/o MARKETING SANPROMEX
Kem bi ngoi da 1% : tup 10 g, 25 g, 40 g.
Bt dng ngoi da 2% : l 10 g, 20 g.
Vin nn 10 mg : hp 25 vin.
Gc tit trng c tm thuc 1% : ming 10 cm x 10 cm, hp 5 ming.
THNH PHN
cho 100 g kem
Chit xut chun Centella asiatica

1g

cho 1 l bt 2 g
Chit xut chun Centella asiatica

40 mg

cho 1 l bt 10 g
Chit xut chun Centella asiatica

200 mg

cho 1 vin
Chit xut chun Centella asiatica

10 mg

cho 100 g Madecassol Tulgras

Chit xut chun Centella asiatica

1g

DC LC
Madecassol c tc ng kch thch sinh tng hp collagen t cc nguyn bo si ca thnh tnh
mch v da ngi, do gp phn lm cho s dinh dng ca m lin kt c tt nht.
DC NG HC
Dng kem, thuc bt, bng p : Khi dng ti ch, thnh phn hot cht trong Madecassol s
thm nhanh v rng ri (1-3 gi).
CH NH
Dng kem, thuc bt :
iu tr b sung trong iu chnh cc yu t gy bnh hay cc yu t lm nng thm, trong iu
tr ti ch sau khi ty ra v st trng cc vt lot chn c ngun gc tnh mch. iu tr b
sung vic xoa nn cc vt so si v so tng sinh. iu tr h tr cc vt m hoc vt bng nh
c din tch hp.
Bng p :
H tr cho iu tr ti ch cc vt lot chn, vt m, vt chn thng v vt bng nng, lan
rng.
Vin nn :
Ci thin cc hin tng lin quan n suy tnh mch bch huyt (chn nng, au, kh chu khi
nm). Dng trong cc trng hp ri lon lin so do khim khuyt (vt thng lu lnh) hoc
qu pht (so tng sinh, so li).
CHNG CH NH
Nhy cm vi cc thnh phn ca thuc. Khng dng nh mt hay p mt.
Dng kem : Trnh dng cho vt thng r nc.
Dng thuc bt : Trnh dng cho vt thng su.
TC DNG NGOI
- Dng kem, thuc bt, bng p : nga, cm gic nng rt, chm.
- Thuc vin : ri lon tiu ha nh v thong qua nh bun nn, au thng v ; him gp :
phn ng d ng.
LIU LNG v CCH DNG
Dng kem, thuc bt :
Ra sch v kh trng vt thng trc khi dng, thoa 1-2 ln/ngy.
Bng p :
Thay bng mi ngy.

Vin nn :
Ngi ln : Liu tn cng : 6 vin/ngy ; Liu duy tr : 3 vin/ngy.
Tr em trn 30 thng tui : na liu ngi ln.

311.

MADIPLOT

TAKEDA
c/o MEGA PRODUCTS
vin nn 10 mg : v 10 vin, hp 30 vin.
vin nn 20 mg : v 10 vin, hp 30 vin.
THNH PHN
cho 1 vin
Manidipine chlorhydrate

10 mg

cho 1 vin
Manidipine chlorhydrate

20 mg

TNH CHT
Manidipine chlorhydrate l mt tc nhn lm h huyt p i khng calci c tc dng ko di.
L dn xut ca 4-aryl-1,4-dihydropyridine vi mt chui piperazinalkyl nhnh bn.
Manidipine cho mt tc dng h huyt p ko di hu hiu bng cch lm gin mch mu, ch
yu do c ch knh calci.
Trong lm sng, Madiplot gip kim sot tt huyt p vi liu duy nht trong ngy. Thuc hu
hiu trong iu tr cao huyt p v cn (mc nh v trung bnh), cao huyt p vi suy thn
v cao huyt p nng.
DC LC
- Tc dng h huyt p ca manidipine chlorhydrate l do tc ng ln knh calci ph thuc
in th mng ca c trn mch mu, c ch dng calci i vo t bo v lm gin c trn mch
mu, do lm gin mch.
- Manidipine chlorhydrate c i lc cao vi th th ca knh calci ph thuc in th mng.

- Manidipine chlorhydrate c tnh c hiu cao i vi tiu ng mch ngoi bin, lm gim
khng lc mch mu ngoi bin bnh nhn cao huyt p, rt t gy tc dng c ch ln chc
nng tim.
- Manidipine chlorhydrate cn c tc ng lm gim s co mch gy ra bi ion K+.
- Manidipine chlorhydrate c i lc cao i vi mch mu thn, lm gin c hai tiu ng mch
vo v ra ca tiu cu thn.
DC NG HC
Vi liu duy nht 20 mg manidipine ung sau mi bui n sng cho bnh nhn cao huyt p v
cn, sau 4 gi nng ti a trong mu l 7,1 +/- 3,5 ng/ml. Nng v thi gian ny cng gn
tng t bnh nhn cao huyt p v cn b suy thn.
gan, manidipine c chuyn ha ln lt thnh hp cht pyridine v diphenylmethane
khng c hot tnh. Thuc c o thi qua nc tiu trong vng 24 gi v khng c s tch t
bnh nhn c chc nng thn bnh thng hay suy thn.
CH NH
Cao huyt p.
THN TRNG LC DNG
Ngng t ngt thuc i khng calci s lm tng cc triu chng. Do nu cn thit phi
ngng manidipine, phi gim liu dn dn v phi theo di k cng v tun theo s ch dn ca
bc s.
Madiplot him khi gy gim huyt p qu . Trong trng hp , cn thc hin gim liu,
ngng thuc hay nhng bin php khc.
Do nhng triu chng nh chng mt c th xy ra do h huyt p, bnh nhn cn phi c
lu { khi ung thuc c bit khi lm vic trn nhng ni cao hay khi thao tc my, li xe.
Cn thn trng khi s dng thuc cho bnh nhn suy gim chc nng gan.
Ngi ln tui : trnh tnh trng h huyt p qu mc thng thy ngi ln tui, nn s
dng vi liu khi u thp v theo di cht ch huyt p trong thi gian iu tr.
tr em : Cha c nghin cu lm sng v tnh an ton ca thuc trn tr em.
LC C THAI
Madiplot c bo co rng lm ko di thi kz thai nghn v thi gian sanh th vt th
nghim. Do cn trnh dng thuc cho ph n c thai hay nghi ng l c thai.
LC NUI CON B
Thuc c bo co l c th qua c sa m th vt th nghim. Trnh dng thuc cho
ph n nui con b. Nu bt buc phi dng thuc, cn khuyn ngng cho con b.
TNG TC THUC
V Madiplot c th tng cng tc ng ca nhng thuc h huyt p khc nn cn phi thn
trng khi phi hp.
Ging nh nhng cht i khng calci khc (nifdipine), manidipine c th lm tng nng

digoxine trong mu.

Tc ng ca cc thuc c ch dng calci c bo co l s c gia tng khi dng chung vi
cimtidine.
TC DNG NGOI
Trn gan : Do thuc c th lm tng SGOT, SGPT, g-GTP, LDH v ALP, bnh nhn nn c theo
di cn thn v kim tra cc ch s ni trn. Nu c nhng du hiu bt thng, cn ngng
thuc hay p dng nhng bin php thch hp.
Trn thn : Him khi gy tng BUN hay cr atinine huyt thanh. Nu c nhng du hiu bt
thng, cn ngng thuc hay p dng nhng bin php thch hp.
Trn mu : Him khi gy gim bch cu. Nu c nhng du hiu bt thng, cn ngng thuc
hay p dng nhng bin php thch hp.
Tim mch : Him khi gy nhng cn nng bng mt, nng ngi, nh trng ngc, nhp tim
nhanh, sung huyt kt mc.
Tm thn kinh : i khi c th b chng mt, chng mt khi ng ln, nhc u, nhc u m ,
bun ng hay c cm gic b t ngi.
Tiu ha : i khi c th b bun nn, i ma, kh chu d dy, au bng lan ta, to bn, hay
kh ming.
Cc tc dng ph khc : i khi c th b tnh trng bt n, yu t, ph n, tiu gt hay tng
ton b cholestrol huyt thanh, acide urique hay triglycride.
LIU LNG v CCH DNG
Thng thng dng cho ngi ln mt liu duy nht 10 - 20 mg manidipine chlorhydrate, ung
thuc mi ngy sau ba n sng, ngi ln tui c th khi u vi liu 5 mg.
Liu thng thng dng cho ngi ln c th tng dn nu cn thit, liu trung bnh nh sau :
- Madiplot 10 : 1 - 2 vin/ngy, ung sau ba n sng.
- Madiplot 20 : 1/2 - 1 vin/ngy, ung sau ba n sng

312.

MADOPAR MODOPAR

HOFFMANN - LA ROCHE
vin nn 250 mg : hp 100 vin.
vin nang phng thch chm 125 mg : hp 100 vin.
vin nang 250 mg : hp 60 vin.
THNH PHN

cho 1 vin nn (Madopar)

Levodopa

100 mg

Benserazide chlorhydrate tnh theo benserazide

25 mg

cho 1 vin nang phng thch chm (Madopar HBS)

Levodopa

100 mg

Benserazide chlorhydrate tnh theo benserazide

25 mg

cho 1 vin nang (Modopar)

Levodopa

200 mg

Benserazide chlorhydrate tnh theo benserazide

50 mg

DC LC
nhng hch y thn kinh ca bnh nhn Parkinson, dopamine, cht dn truyn thn kinh
no, khng hin din y s lng. Liu php thay th dopamine da trn vic s dng cht
levodopa ; y l mt tin cht ca dopamine v cht dopamine c kh nng xuyn qua hng
ro mu-no rt hn ch.
Sau khi ung, levodopa, nhanh chng b kh carboxyl (mt i mt phn t CO2) thnh
dopamine, ngoi no cng nh cc vng ca no. Kt qu l hu ht levodopa ung vo
khng n c cc hch y thn kinh v dopamine sn xut ngoi bin thng gy ra cc
hiu qu khng mong mun. Do , iu mong mi l ngn cn c phn ng kh carboxyl
ngoi no ca levodopa. iu ny p ng c nh vo vic s dng ng thi hai cht
levodopa v benserazide, mt cht c ch men gy nn phn ng kh carboxyl ngoi bin.
Modopar l s kt hp ca hai cht ny theo t l 4:1. Kt hp t l ny, trn cc th nghim
lm sng chng t kt qu thch hp nht trong iu tr v kt qu ny bng nh s dng
levodopa n c, liu cao.
Dng thuc Madopar HBS l mt cng thc c bit phng thch hot cht lu di d dy, ni
m vin nang cn li lu chng 3-6 gi v do , Madopar HBS c s dng nh l ngun
d tr ca thuc.

DC NG HC
Hp thu :
Levodopa c hp thu phn ln phn trn ca rut non. Nng huyt tng ti a ca
levodopa t vo khong mt gi sau khi ung liu Madopar v Modopar dng chun. kh
dng sinh hc tuyt i ca levodopa t liu Madopar v Modopar dng chun l 98%, bin
ng t 74% n 112%. Dng vin nang v vin nn ca Madopar v Modopar dng chun u
tng ng vi nhau. Thc n lm gim nng v thi gian hp thu levodopa. Nng nh
levodopa huyt tng l 30% thp hn v xy ra chm hn khi s dng Modopar dng chun
sau ba n tiu chun. Phm vi hp thu ca levodopa b gim 15% do bi s gia tng thi gian
lm trng d dy.
Tnh cht dc ng hc ca Madopar HBS khc vi tnh cht dc ng hc ca Madopar v
Modopar dng chun (vin nang v vin nn). Cc hot cht ca Madopar HBS c phng
thch chm trong d dy. Nng ti a trong huyt tng t c 2-3 gi sau khi ung v
ch bng 20-30% so vi dng liu chun. ng biu din nng huyt tng theo thi gian
chng t thi lng bn gi tr ca Madopar HBS di hn thi lng bn gi tr ca Madopar v
Modopar dng chun (thi lng bn gi tr l khong thi gian m cc nng huyt tng
bng hoc cao hn phn na nng ti a). iu ny ch r tnh cht tc dng chm c kim
sot ca Madopar HBS. kh dng sinh hc ca Madopar HBS bng 50-70% ca Madopar v
Modopar dng chun v khng b nh hng bi thc n. Nng huyt tng ti a ca
levodopa khng b nh hng bi thc n, nhng xy ra chm hn khong 5 gi sau khi ung
Madopar HBS.
Phn phi :
Levodopa xuyn qua hng ro mu-no nh vo h vn chuyn c th trung ha. Levodopa
khng gn kt vi protein huyt tng v c th tch phn phi l 57 lt.
Ngc li levodopa, benserazide khng xuyn qua hng ro mu-no liu iu tr. N tp
trung phn ln thn, phi, rut non v gan.
Chuyn ha :
Levodopa c chuyn ha theo hai con ng chnh l kh carboxyl (decarboxylation) v
methyl-ha (O-methylation) v hai ng ph l chuyn amin (transamination) v oxy-ha
(oxidation).
Men Aromatic amino acid decarboxylase chuyn levodopa thnh dopamine. Nhng sn phm
cui cng ca ng chuyn ha ny l homovanillic acid v dihydroxy phenylacetic acid.
Men catechol-O-methyltransferase chuyn levodopa thnh 3-O-methyldopa. Cht chuyn ha
trong huyt tng chnh c thi gian bn hy giai on thi tr l 15-17 gi v n c tch
ly trong bnh nhn s dng Modopar cc liu iu tr.
Khi levolopa c ung chung vi benserazide, phn ng kh carboxyl ngoi bin ca levolopa
suy gim c phn nh bng nng trong huyt tng ca levodopa v ca 3-O-

methyldopa cao hn v nng trong huyt tng ca catecholamine (dopamine v

noradrenaline) v ca phenolcarboxylic acid (homovanillic acid, dihydrophenylacetic acid) thp
hn.
Benserazide b hydroxy ha tr thnh trihydroxy benzylhydrazine trong nim mc rut v
gan.
o thi :
Vi s hin din ca men decarboxylase ngoi bin c ch levodopa, thi gian bn hy ca
levodopa giai on thi tr khong 1.5 gi. Thi gian bn hy ny di hn mt t (25%)
bnh nhn gi mc bnh Parkinson. thanh thi ca levodopa t huyt tng khong 430
ml/pht. Levodopa tm c trong nc tiu khong 7% liu s dng. Levodopa b thi tr
nh vo s chuyn ha v cc cht chuyn ha ca levodopa u b bi tit trong nc tiu.
Benserazide hu nh hon ton b thi tr nh chuyn ha. Nhng cht chuyn ha ca
benserazide phn ln u b bi tit trong nc tiu v mt phn nh trong phn.
CH NH
iu tr tt c cc dng Parkinson ngoi tr nguyn nhn do thuc.
CHNG CH NH
Khng c s dng bnh nhn bit mn cm vi levodopar, benserazide hoc cc t
dc trong cng thc bo ch.
Khng c s dng kt hp vi cc cht IMAO, ngoi tr selegiline
Khng c s dng cho bnh nhn ri lon chc nng mt b tr ni tit, thn gan v tim,
bnh tm thn vi mt phn ri lon thn kinh hoc bnh thin u thng (glaucoma) gc ng
Khng nn s dng bnh nhn di 25 tui (h xng phi pht trin hon ton).
Khng c s dng ph n mang thai, hay c kh nng th thai m khng s dng bin
php trnh thai thch hp. Nu bit c thai khi ang s dng Modopar, phi ngng thuc tc
th.
THN TRNG LC DNG
Phn ng mn cm c th xy ra ngi c c a nhy cm.
Nn thng xuyn o nhn p bnh nhn glaucoma gc m bi v trn l thuyt levodopa
lm tng nhn p.
Trong thi gian iu tr ( liu n nh), cn nn kim tra chc nng gan v cng thc mu.
Bnh nhn b tiu ng phi xt nghim ng huyt thng xuyn v liu lng ca thuc
tr bnh tiu ng phi c iu chnh cho ph hp vi nng ca ng huyt.
Modopar phi c ngng t 12 n 24 gi trc phu thut c s dng thuc gy m ton
thn. Sau phu thut c th dng tr li Modopar, liu c tng dn cho n bng vi liu
trc phu thut.
Khng c ngng Modopar t ngt. Ngng t ngt s a n hi chng ging nh an
thn kinh c tnh (st cao, cng c, c th thay i trng thi tm l{ v tng creatinine

phosphokinase trong huyt tng). Hi chng ny e da sinh mng ca bnh nhn. Nu xy ra

cc du hiu v triu chng nh th, bnh nhn phi c bc s theo di cn thn v c
iu tr triu chng thch nghi. Nu cn, bnh nhn phi c iu tr ti bnh vin. Bnh nhn
c th c s dng li Modopar sau khi c nh gi chnh xc.
LC C THAI v LC NUI CON B
Tuyt i chng ch nh ph n c thai, hay c kh nng th thai m khng s dng bin
php trnh thai thch hp v Modopar c th gy tn thng trn s pht trin b xng ca
bo thai.
V ngi ta cha bit benserazide c bi tit qua sa m hay khng, cc b m ang iu tr
bng Modopar khng nn cho con b.
TNG TC THUC
Cc thuc an thn kinh v thuc h huyt p c cha reserpine gy c ch tc dng ca
Modopar.
Khi mun s dng Modopar bnh nhn ang iu tr bng IMAO khng chn lc, khng thun
nghch, cn phi c mt khong cch t nht hai tun t khi ngng IMAO n khi bt u iu
tr bng Modopar (xem thm phn Chng ch nh). Tuy nhin, IMAO-B chn lc (nh l
moclobemide) c th iu tr chung vi Modopar v, theo nh khuyn co, cn phi chnh liu
levodopa ty thuc vo nhu cu ca c nhn mi ngi bnh v c hai phng din hiu qu v
dung np.
S phi hp gia IMAO-A v IMAO-B s tng ng vi IMAO khng chn lc v do cc
cht ny khng nn s dng cng mt lc vi Modopar.
Modopar khng c s dng ng thi vi cc thuc ging thn kinh giao cm (nh l
epinephrine, norepinephrine, isoproterenol hoc amphetamine, nhng cht ny gy kch thch
h thn kinh giao cm) v levodopa c th lm tng hiu qu ca cc thuc ny. Nu bt buc
phi dng cng lc vi cc thuc ny, cn phi theo di cht ch h tim mch v gim liu cc
thuc ging thn kinh giao cm (sympathicomimetic).
Dng chung cc thuc khng cholinergic (trihexyphenidyl) vi Modopar (dng chun hoc HBS),
tnh cht dc ng hc ca levodopa khng b nh hng.
Dng chung cc thuc chng toan (antacid) vi Madopar HBS, vn tc hp thu levodopa b gim
32%.
Hiu qu ca Modopar khng b nh hng bi cc thuc a sinh t c cha vitamin B6.
S dng kt hp Modopar v cc loi thuc khc chng Parkinson (nh cht ch vn/khng
cholinergic, amantadine, dopamine) c th chp nhn c, tuy nhin, s kt hp nh th c
th lm tng c hiu qu iu tr v tc dng ph. iu cn thit l phi gim liu Modopar
hoc cc cht khc. Cc thuc khng cholinergic khng nn ngng t ngt nu iu tr bng
Modopar c tin hnh, bi v levodopa khng bt u tc dng trong mt thi gian.
Levodopa c th gy nh hng ln cc kt qu ca cc xt nghim v catecholamine,

creatinine, urea acid v glucose. Xt nghim coombs c th cho kt qu dng tnh gi bnh
nhn ang s dng Modopar.
Ung Modopar ng thi vi thc n nhiu protein c th lm thay i hp thu levodopa
qua ng d dy rut.
TC DNG NGOI
Khi s dng Modopar, c th gp cc triu chng n mt ngon, bun nn, i ma v tiu chy.
Trong trng hp c bit c th thy s thay i hoc mt v gic. Nhng hiu qu ngoi { nh
vy c th xy ra giai on u iu tr v c th kim sot c bng cch s dng Modopar
trong khi n vi lng thc n, thc ung y hoc bng cch tng liu chm chm.
Trong nhng trng hp him, ngi ta c th gp cc phn ng da nh nga, ni da,
chng lon nhp tim hoc gim huyt p t th c th xy ra chng gim huyt p th ng ni
chung s gim sau khi gim liu Modopar.
Chng thiu mu tan huyt cng nh chng gim bch cu nh v thong qua v chng gim
tiu cu cng c th xy ra trong mt s t trng hp him hoi. Do , trong bt c trng
hp s dng levodopa lu di no cng u phi theo di nh kz : cng thc mu, xt nghim
chc nng gan v thn.
giai on iu tr sau, cc c ng khng thc (nh dng ma git-ma vn) c th xy ra.
Thng thng chng ny c th khi hoc lm cho c th dung np c bng cch gim liu.
Nn tng liu tng bc tng hiu qu iu tr bi v nhng hiu qu ngoi khng nht
thit phi iu tr.
Modopar c th lm tng cc men transaminase gan, tng nng alkaline phosphatase,
nhng thng thng tng nh v khng vt qu gii hn trn ca mc bnh thng.
Bnh nhn cao tui iu tr bng Modopar c th xy ra tnh trng lo u, kch ng, mt ng, o
gic, hoang tng v mt nh hng nu bnh nhn c tin s ri lon nh th. Chng
trm cm cng c th xy ra bnh nhn iu tr bng Modopar, nhng y cng c th l hiu
qu ca chnh chng bnh ang tin trin.
Nng urea nitrogen trong mu (BUN) c th gia tng bnh nhn iu tr bng Modopar
(levodopa). Mu nc tiu c th i, thng c mu lt sang mu m.
LIU LNG v CCH DNG
Phi bt u bng liu thp. Liu lng phi c nh gi theo tng ngi bnh v chnh liu
cho n khi t hiu qu tt nht.
Nhng ch dn v liu lng sau y cn c xem nh l hng dn :
Dng vin nang khi ung phi nut nguyn vin nang khng c nhai. Cn dng vin nn c
th b ra thnh nhiu phn nh d nut.
Do thc n khng nh hng n s hp thu thuc, c th ung thuc vo bt kz lc no c th
c, t nht 30 pht trc hoc mt gi sau khi n. Tuy nhin, cng c mt s bnh nhn nhn
thy Modopar c dung np tt khi ung vi thc n.

iu tr khi u :
thi kz u ca bnh Parkinson, nn bt u iu tr bng Modopar liu thp 62,5 mg, 3-4
ln/ngy, sau nh gi s dung np ca thuc v tng liu ln t t ty thuc vo s p
ng ca bnh nhn.
Thng thng hiu qu tt nht s t liu Modopar hng ngy l 500-1000 mg, nn chia lm
3 hoc nhiu ln ung. T 4 n 6 tun l s hon chnh liu hiu qu tt nht. Nu cn phi
tng liu hng ngy cao hn na, ch nn tng mi thng mt ln.
Liu duy tr :
Liu duy tr trung bnh ca Modopar l 500-700 mg/ngy chia ra lm 3-6 ln ung. i vi tng
bnh nhn, s ln ung (khng t hn 3 ln) v cch phn chia liu trong ngy phi c iu
chnh t hiu qu tt nht.
Hng dn s dng trong cc trng hp c bit :
Bnh nhn ang s dng cc thuc khc chng Parkinson c th s dng Modopar. Tuy nhin,
khi iu tr bng Modopar trc v hiu qu iu tr tr nn r rng, liu ca thuc khc,
nu cn, phi gim xung hoc gim t t ri chm dt.
Nhng bnh nhn c nhng dao ng v hiu qu ca thuc iu tr trong ngy (hin tng tt
m) nn tng s ln ung thuc trong ngy bng cch chia liu nh ra hoc tt hn l s dng
Madopar HBS.
Vic chuyn t Modopar dng chun sang Madopar HBS nn thc hin theo tng ngy mt, bt
u bng liu bui sng, liu hng ngy v s ln ung thuc trong ngy phi c duy tr nh
l Modopar dng chun. Sau 2-3 ngy, liu phi c tng dn n khong 50%, bnh nhn
phi c thng bo rng tnh hung ca h c th tm thi tr nn xu hn. Do c tnh dc
ng ca Madopar HBS, thi gian bt u tc dng ca thuc b chm li. C th tng hiu qu
lm sng bng cch kt hp Madopar HBS v Modopar dng chun. S kt hp ny c hiu qu
c bit liu bui sng u tin (liu ny cao hn cc liu bui sng trong ngy). S chnh liu
Madopar HBS cho ph hp vi tng c nhn phi c thc hin chm v thn trng, cch
qung t nht 2-3 ngy gia mi ln chnh liu. Trong trng hp s p ng ca Madopar HBS
cha t hiu qu y ngay c khi s dng cc liu hng ngy n 1500 mg levodopa, tt
hn nn tip tc tr li iu tr trc kia vi Madopar hay Modopar dng chun.
Hin tng p ng thi qu (ri lon vn ng) sau khi s dng Madopar HBS c th kim sot
c nh vo vic ko di thi gian gia hai ln dng thuc, tt hn l gim liu n thun.
cc bnh nhn b bt ng sut m, hiu qu tt (dng tnh) c ghi nhn sau khi t t
tng liu Madopar HBS ln n 250 mg vo bui ti trc khi ln ging ng. Bnh nhn phi
c theo di cn thn xem cc triu chng tm thn ngoi xy ra hay khng.
QU LIU
Cc triu chng qu liu thng thng nht l cc c ng bt thng khng t , l ln tm
thn, mt ng v cng him thy l bun nn, i ma, ri lon nhp tim.

iu tr qu liu lm trng d dy tc khc, theo di cht ch chc nng h hp, tim. Nu cn

thit c th s dng thuc kch thch h hp v/hoc thuc chng ri lon nhp tim hoc thuc
an thn kinh thch hp.

313.

MAGN-B6

SANOFI SYNTHELABO VIETNAM

Vin bao : v bm 10 vin, hp 5 v.
Dung dch ung : ng 10 ml, hp 10 ng, 4 ng, 3 ng.
THNH PHN
cho 1 vin
Lactate de magnsium dihydrate

470 mg

(tng ng vi 1,97 mmol hay 48 mg Mg2+)

Pyridoxine chlorhydrate (vitamine B6)

5 mg

cho 1 ng thuc
Lactate de magnsium dihydrate

186 mg

Pidolate de magnsium

936 mg

(tng ng vi 4,12 mmol hay 100 mg Mg2+)

Pyridoxine chlorhydrate (vitamine B6)

10 mg

DC LC
V phng din sinh l, magnsium l mt cation c nhiu trong ni bo. Magnsium lm gim
tnh kch thch ca neurone v s dn truyn neurone-c. Magn sium tham gia vo nhiu phn
ng men.
Pyridoxine, l mt coenzyme (ng diu t), tham gia vo nhiu qu trnh chuyn ha.
CH NH

- iu tr cc trng hp thiu magnsium nng, ring bit hay kt hp.

Khi c thiu calcium i km th trong a s trng hp phi b magn sium trc khi b
calcium.
- iu tr cc ri lon chc nng ca nhng cn lo u i km vi tng thng kh (cn c gi l
tng co git) khi cha c iu tr c hiu.
CHNG CH NH
Suy thn nng vi thanh thi ca cr atinine di 30 ml/pht.
TNG TC THUC
Trnh dng magnsium kt hp vi cc ch phm c cha phosphate v mui calcium l cc
cht c ch qu trnh hp thu magnsium ti rut non.
Trong trng hp phi iu tr kt hp vi t tracycline ng ung, th phi ung hai loi
thuc cch khong nhau t nht 3 gi.
Khng phi hp vi lvodopa v lvodopa b vitamine B6 c ch.
TC DNG NGOI
Tiu chy, au bng.
LIU LNG v CCH DNG
Ngi ln :
Thiu magnsium nng : 6 vin/24 gi hay 3 ng ung/ngy, hoc 12 mmol hay 300 mg
Mg2+/24 gi.
Tng co git : 4 vin/24 gi hay 2 ng ung/ngy, hoc 8 mmol hay 200 mg Mg2+/24 gi.
Tr em : 1 n 3 ng/ngy ty theo tui (4,12 n 12,4 mmol hay 100-300 mg Mg2+).
Nn chia liu dng mi ngy ra lm 2 hoc 3 ln : sng, tra v chiu ; mi ln nn ung vi
nhiu nc.
BO QUN
nhit < 25oC, trnh nh sng.

314.

MAGNEVIST

SCHERING AG
c/o ZUELLIG
dung dch tim : l 10 ml, hp 1 l.
THNH PHN

cho 1 ml
Acide gadopentetique dng mui dimeglumine

469 mg

CH NH
Chp hnh nh cng hng t (MRI) ca s v ty sng.
Chp hnh nh cng hng t ton c th.
Ch nh gii hn "chp hnh nh cng hng t" ton c th tr em di 2 tui.
CHNG CH NH
Cha c chng ch nh.
THN TRNG LC DNG
Thn trng khi s dng trong mt s trng hp :
- Bnh nhn c tng d ng v cc bnh nhn ny d b phn ng qu mn hn.
- Suy thn nng v gim thi tr thuc cn quang. Cho n nay, khng thy c tnh trng suy
thn nng thm hoc cc phn ng ph khc do dng thuc cn quang. Tuy nhin, trong trng
hp c bit trm trng, cn loi Magnevist ra khi c th bng th thut lc mu.
- Ph n c thai.
TC DNG NGOI
Thnh thong : bun nn, nn, phn ng da v nim mc dng d ng. Bnh nhn tng d ng
thng d b phn ng qu mn hn cc bnh nhn khc.
Him : phn ng phn v c th dn n sc (cn cp cu), nn phng bng cch chun b
sn dng c cp cu khi lm th thut.
Rt him : cm gic nng nh hoc au ti ni tim c th xy ra khi tim tnh mch hoc chch
thuc cn quang.
Him : tnh trng co git xy ra sau khi tim thuc. Nhc u thong qua, gin mch, chng
mch, n lnh v ngt xu.
LIU LNG v CCH DNG
0,2 ml Magnevist / kg cn nng. Trn lm sng, nu nghi ng c tn thng, d rng chp cng
hng t cho hnh nh cn quang bnh thng, cn tim thm 0,2 ml hoc thm ch 0,4 ml
Magnevist / kg trong vng 30 pht sau khi chp c th gip gia tng chn on.

315.

MANINIL 5

BERLIN CHEMIE
c/o CT TNHH DP THNH - SAIGON PHARMA

Vin nn 5 mg : l 120 vin.

THNH PHN
cho 1 vin
Glibenclamide

5 mg

CH NH
Bnh tiu ng ngi ln tui (bnh tiu ng loi II khng ph thuc insulin) khi iu
tr bng ch n king m khng .
CHNG CH NH
Vi nhng bnh nhn tiu ng loi I ph thuc insulin (bnh tiu ng ngi tr) ; c ri
lon nng s chuyn ha ng vi s toan chuyn ha mu ; suy gim nng chc nng ca
gan v thn ; ph n c thai v cho con b ; qu mn cm vi glibenclamide.
CH PHNG v THN TRNG LC DNG
Ch { phng :
Maninil 5 lm h ng mu.
H ng mu c th xy ra khi ung thuc qu liu, n king qu mc (khng n, n b ba),
ung ru v tp luyn qu sc. i, ra m hi, chn tay bn chn, au u, mt tp trung v
hung hng l nhng du hiu ca h ng mu. Khi lng ng trong mu xung qu thp
dn n mt thc v b co git. Nu c du hiu ca lng ng trong mu thp, nn ung
ngay khong 20 g ng. Nu lng ng trong mu h xung qu thp gy mt thc, nn
cho nhp vin khn cp.
Thn trng lc dng :
Trc khi lng ng trong mu c iu chnh mt cch tt nht, hay khi ung thuc
khng u n, thi gian phn ng thuc c th b thay i dn n nh hng khi li xe hay
vn hnh my mc.
TNG TC THUC
- Cc thuc sau y lm tng tc dng h ng huyt ca glibenclamide, do c th gy h
ng huyt : insulin, cc thuc tiu ng dng ung, c ch men chuyn, cc steroid ng
ha v ni tit t sinh dc nam, chloramphenicol, dn xut coumarin, cyclophosphamide,
disopyramide, fenfluramine, fenyramidol, fibrate, fluoxetin, ifosfamide, c ch MAO,
miconazole, para-aminosalicylic acid, pentoxifylline (liu cao dng tim), phenylbutazone,
azapropazone, oxyphenbutazone, probenecid, quinolones, salicylates, sulfinpyrazone,
sulfonamide, cc thuc c ch giao cm v d nh c ch bta v guanethidine, tetracycline,
tritoqualine, trofosfamide.
- Cc thuc sau y lm gim tc dng h ng huyt ca glibenclamide, do c th gy

tng ng huyt : acetazolamide, barbiturates, corticosteroids, diazoxide, li tiu,

epinephrine (adrenaline) v cc thuc tc dng ging thn kinh giao cm khc, glucagon, nhun
trng (sau khi iu tr di hn), acid nicotinic (liu cao), estrogen v progesterone,
phenothiazine, phenytoin, ni tit t tuyn gip, rifampicin.
- Cc thuc i khng th th H2, clonidine, v reserpine c th lm tng hay gim tc dng h
ng huyt ca glibenclamide.
- Di nh hng ca cc thuc c ch giao cm nh c ch bta, clonidine, guanethidine v
reserpine, cc du hiu iu ha ngc ca h giao cm i vi h ng huyt c th gim
hoc bin mt.
- Ung mt lc nhiu ru hoc ung ru lu ngy c th lm tng hay gim tc dng h
ng huyt ca glibenclamide.
- Glibenclamide c th lm gim hay tng tc dng ca cc dn xut ca coumarin.
TC DNG NGOI
Maninil 5 thng thng khng c tc dng ph. i khi gy ri lon tiu ha hay c nhng phn
ng qu mn, c bit vi da, v trong mt vi trng hp c bit c th gy nn thay i h
thng to mu.
LIU LNG v CCH DNG
Liu dng Maninil 5 c quyt nh cho mi bnh nhn ty thuc vo lng ng trong
mu. Liu dng tng ln dn k t khi bt u iu tr, bt u dng na vin Maninil 5 v tng
n liu cn thit trong vng vi ngy. Liu hng ngy ln ti 10 mg glibenclamide (2 vin
Maninil 5) thng c ung mt ln vo bui sng trc khi n sng, liu cao hn c chia
ra ung vo bui sng v bui ti.
Ni chung hiu qu ti a khi ung 3 vin Maninil 5 mi ngy.
BO QUN
Bo qun nhit khng qu 25oC

316.

MEDIATOR

LES LABORATOIRES SERVIER

vin bao 150 mg : hp 30 vin.
THNH PHN
cho 1 vin

Benfluorex chlorhydrate

150 mg

DC LC
Thuc tc ng ln mt s yu t nguy c gy x va ng mch.
+ Tc ng ca Mediator ln chuyn ha glucide :
- Trong bnh i tho ng khng c triu chng bnh nhn bo ph, Mediator lm gim
ng huyt sau khi n v ci thin vng HPO (vng di ng cong gy bi phng php
lm tng ng huyt) mc cao hn so vi ng cong ghi nhn c so vi cng mt ch
bnh nhn c cho dng placebo.
- Mediator khng c tc ng trn s bi tit insuline, do khng gy tt ng huyt.
+ Tc ng ca Mediator ln chuyn ha lipide :
- Lm gim hp thu triglycride rut. Tc ng ny c xc nhn trn ngi qua cc kho
st dc l lm sng, da trn c tnh lm gim hot ng ca men lipase ca tuyn ty.
- Lm gim s tng hp triglycride v cholestrol gan in vitro v in vivo (chut cng).
- Lm gim s nhim m gan do n nhiu lipide, glucide trong cc kho st chut cng b
b o ph cng nh kho st trn chut cng c th nghim gy i tho ng.
- Gii hn s gn cholest rol vo thnh ng mch (th).
C ch tc ng ny c th c dng gii thch s gim cholestrol v triglycride ngi.
+ Tc ng b sung ca Mediator :
bnh nhn b o ph tng acide urique huyt c iu tr bng Mediator phi hp vi ch
n king, acide urique huyt c ghi nhn gim khong 14%.
+ Khng c trng hp tng tc bt li no c ghi nhn khi dng phi hp Mediator vi cc
tr liu khc.
Mediator :
- khng lm tng tc ng chng ng mu,
- khng gy tt ng huyt,
- khng nh hng n chc nng ca tuyn gip.
DC NG HC
- Hp thu nhanh v hon ton qua ng tiu ha vi nh hp thu t c t 1 n 2 gi sau
khi ung thuc.
- o thi nhanh v hon ton qua nc tiu : sau 8 gi, trung bnh c khong 74% liu ung
vo c o thi.
S o thi c thc hin theo 2 pha :
- pha u tin nhanh (60% trong 3 hoc 4 gi),
- pha th hai chm, chm dt sau khong 36 gi.
CH NH
- Phi hp vi n king trong bnh tng triglyc ride huyt. Vic duy tr ch n king lun

lun cn thit.
- Phi hp vi n king trong bnh i tho ng khng c triu chng km theo bo ph. Vic
duy tr ch n king lun lun cn thit.
CHNG CH NH
Vim ty mn tnh c xc nhn.
CH PHNG
Cc ri lon chuyn ha c lin quan n vic iu tr bng Mediator ch yu c quan st
ngi ln. Do khng nn k toa Mediator cho tr em.
THN TRNG LC DNG
Nu sau mt giai on iu tr khong vi thng (3 n 6 thng) m khng ghi nhn c gim
lipide huyt mt cch tha ng, nn s dng thm cc bin php khc h tr.
Cc vn ng vin th thao cn c thng bo rng dng thuc c th cho kt qu dng tnh
khi xt nghim s dng cht kch thch.
LC C THAI
Cc kt qu nghin cu c thc hin trn th vt cho thy thuc khng c tc dng gy qui
thai. Do thiu s liu ngi, cc kt qu nghin cu trn th vt khng th cho php kt lun
rng thuc c gy d dng hay khng. Do thn trng, khng k toa cho ph n mang thai.
LC NUI CON B
Khng c s liu v s bi tit ca thuc qua sa m, khuyn khng nn cho con b m trong
thi gian iu tr.
TC DNG NGOI
Mt s tc dng ph sau c ghi nhn : tiu ha (bun nn, nn, au bao t, tiu chy), suy
nhc, ng g, chng mt. Tuy nhin, cc tc dng ny ch xy ra khi dng liu trn 3 vin/ngy
v thay i ty theo mc nhy cm ca tng ngi.
LIU LNG v CCH DNG
3 vin/ngy.
C th dng liu ny ngay t u hoc tng dn :
- Tun u : 1 vin vo ba n ti,
- Tun th hai : 1 vin vo ba n tra, 1 vin vo ba n ti.
- Tun th ba : 1 vin vo ba n sng, 1 vin vo ba n tra, 1 vin vo ba n ti.
Sau , ty kt qu xt nghim sinh hc, c th gim liu cn 2 vin, i khi 1 vin mi ngy.
Kt hp vi ch n king, Mediator l mt iu tr triu chng phi dng ko di v phi
c theo di thng xuyn.
QU LIU
Trong trng hp qu liu, vic cp cu ch yu l iu tr triu chng : ra d dy, bi niu
thm thu, iu chnh cc ri lon in gii, theo di huyt p, thc, cc chc nng h hp v
tim mch.

317.

MLADININE

PROMEDICA
c/o GALIEN
vin nn 10 mg : tube 30 vin.
Dung dch dng bi ngoi da 0,1% (tc ng nh) v 0,75% (tc ng mnh) : l 24 ml.
THNH PHN
cho 1 vin
Mthoxsalne

10 mg

(lactose, saccharose)

cho 100 ml dung dch 0,1% (tc ng nh)

Mthoxsalne

100 mg

(Alcool)

cho 100 ml dung dch 0,75% (tc ng

mnh)
Mthoxsalne

0,75 g

(Alcool)
DC LC
Thuc gy cm quang.
Mthoxsalne (hoc 8-m thoxypsoralne) lm tng s nhy cm ca da i vi tc ng ca tia
cc tm ca nh nng mt tri hoc nhn to. Ph tc ng ca tia cc tm l t 320 n 380
nm, hiu lc ti a thu c vi 365 nm.
DC NG HC
Dng vin :

Dng m thoxsalne ng ung s gy cm quang da ti a trong thi gian gia 2 n 4 gi

v ht tc dng sau 6 n 8 gi.
90% sn phm c o thi trong 12 gi, qua nc tiu, di dng dn xut hydroxyl ha
hoc lin hp glucuronic.
ng hc ca thuc thay i nhiu ty theo c nhn.
CH NH
Trong khun kh quang ha tr liu : vy nn, bch bin, nm da dng si, u lympho bo T
ngoi da, liken phng, tri tc, bnh da do nh sng, bnh t bo bn da (mastocytose
cutane), vim da do tng d ng.
Dung dch 0,75% (tc dng mnh) ch c k toa sau khi s dng trc dung dch 0,1%
(tc dng yu).
CHNG CH NH
Dng Mladinine :
Vin nn :
- Cao huyt p, suy tim.
- Suy gan v suy thn.
Vin nn v dung dch dng ngoi da :
- S dng nh m phm lm da rm nng.
- Cc bnh da b nng hn khi ra nng (lupus , ri lon chuyn ha porphyrine).
Dng liu php PUVA (phi hp iu tr bng psoralne v tia cc tm sng A) :
- c thy tinh th.
- Tin s b ung th da.
- Trc iu tr bng cc tc nhn c cha arsen v cc tia bc x gy ion ha.
- Tr em.
CH PHNG
Khng bao gi c s dng M ladinine nh l m phm, c bit l lm cho mu da tr
nn rm nng, v c nguy c gy phng.
THN TRNG LC DNG
- Phi nng sau khi ung hoc bi Mladinine ngoi da s c nguy c cao gy phng.
- Nn nghim tc tn trng vic tng t t thi gian chiu tia cc tm (mt tri hoc dng n)
v sau mi t chiu, trnh phi nng thm bng cch che kn da v bi kem chng nng ln
phn da h, nhm mc ch trnh nguy c gy phng (im lu { ny cn phi cng nghim
ngt hn trong trng hp dng ng bi ngoi da).
- Khuyn eo knh en sm c tc dng hu hiu chng tia cc tm trong thi gian chiu tia cc
tm sng A (UVA), k o di 8 n 10 gi sau , i khi n 24 gi.
- ph n tr, nn chn cc bin php nga thai khc hn l vin ung trong thi gian iu tr.
- Nn lu { cc nguy c tim tng v lu v di ca quang ha liu php v do cn phi theo

di bnh nhn tht st : lo ha da, bin i sc t, c th gy ung th biu m t bo gai, c

thy tinh th.
LC C THAI
ng vt, mthoxsalne khng gy qui thai. ngi, cc s liu lm sng trn cc dn s
nh khng cho thy c tc dng gy d dng no c bit. Tuy nhin, cc s liu ny khng y
v do nn trnh iu tr trong thi kz mang thai.
TNG TC THUC
Trnh dng ng thi vi cc thuc c th c c tnh gy cm quang (sulfamide,
phenothiazine, tetracyclines).
TC DNG NGOI
Vin nn v dung dch bi ngoi da :
- Cc trng hp hp phng nng c ghi nhn.
- Tc dng c lin quan n qu liu ca tia cc tm sng A : nga, ban xy ra sau khi dng
liu php PUVA, cc phn ng d ng vi nh sng, hin tng Koebner, bnh ngoi da dng
pemphigus c bng nc, lupus ban .
Vin nn :
Tc dng c trng ca m thoxsalne : au d dy, kh chu bng, bun nn (c th trnh
bng cch ung thuc vi thc n, hoc tt nht l ung thuc vi sa).
LIU LNG v CCH DNG
Vin nn :
Bnh nhn :
- cho n 30 kg : 1 vin/bui iu tr ;
- 31 n 50 kg : 2 vin/bui iu tr ;
- 51 n 65 kg : 3 vin/bui iu tr ;
- 66 n 80 kg : 4 vin/bui iu tr ;
- 81 n 90 kg : 5 vin/bui iu tr ;
- trn 90 kg : 6 vin/bui iu tr ;
2 n 3 gi sau khi ung thuc, cho bnh nhn phi nng hoc chiu x UVA.
- Phi nng (thng c khuyn co trong iu tr bnh bch bin) : phi tng t t, u tin
l t 10 n 15 pht.
Ch : cc phn ng pht ban thng c quan st sau khi phi nng khong 48 gi. Do
nu cn tng thi gian phi nng th nn tng mi 2 ngy c th ghi nhn cc phn ng ph
ny nu c xy ra.
- Chiu x UVA (quang ha liu php, liu php PUVA) : cn c nhng trang thit b c bit vi
cc n pht tia cc tm sng A (UVA) t 320 n 380 nm, vi nh l 365 nm, v trong thc t
khng pht ra tia cc tm sng B (UVB).

Th thc iu tr (thi gian, khong cch gia cc bui iu tr) ty thuc vo cng ca n
v c tnh ca da (mu da, mc nhy cm ca da i vi nh nng mt tri).

c tnh ca da

Liu UVA
(joule/cm2)
iu tr ban u

tng t t

I. Lun lun b phng, khng rm nng bao gi

0,5

0,5

II. Lun lun b phng, hi rm nng nh

0,5

III. i khi b phng, lun rm nng

1,5

0,5/1

IV. Khng phng bao gi, lun rm nng

V. Ngi c nhiu sc t (chu , bc Phi)

2,5

VI. Ngi da en

1/1,5

Thi gian chiu x cng c th c xc nh bng liu ti thiu gy c tnh (DPM). Khong
cch gia cc bui chiu l t 2 n 4 tun, ty theo tng ch nh.
Thi gian chiu x c xc nh ty theo c tnh ca da v kt qu DPM v tng ln trong
tng bui ty theo mc dung np ca bnh nhn v tin trin ca bnh.
Khng c qu liu ti a UVA cho mi bui chiu x, liu ny thay i t 10 joule/cm2 i vi
nhm da loi I cho n 20 joule/cm2 i vi nhm da loi VI.
Thng thng, iu tr bnh vy nn phi cn n khong 15 n 25 bui chiu x. i vi
bnh nm da dng si cn phi c s bui chiu x nhiu hn.
iu tr duy tr (t 1 ln/tun n 1 ln/thng) vi liu bng vi liu ca bui iu tr cui cng.
Th thc iu tr c th khc i vi cc bnh nhn c p ng yu vi phng php iu tr c
in.
Th thc iu tr ny c th c iu chnh ty theo mc chuyn ha thuc ca tng bnh
nhn.
Dung dch bi ngoi da :
Lu { : Ch dng n dung dch M ladinine c tc ng mnh 0,75% sau khi s dng trc
dung dch c tc ng yu 0,1%.
iu tr bng cch bi ti ch dung dch M ladinine i vi cc sang thng ti ch v c gii
hn, v phi c d dng bo v khi cn ra nng. Lun lun bt u bng dung dch c tc
ng yu 0,1% (nu cn c th pha long hn na thnh 1/2 hoc 1/4 bng dung dch cn
60deg). Cn tht thn trng khi iu tr trnh mi nguy c gy phng c th xy ra. Chm

thuc bng mt que gn v thoa bn trong ca mng sang thng, khng thoa thuc n st
b ca mng trnh tng sc t chu bin.
- Phi nng :
Phi nng vo cui bui chiu. Do nguy c b pht ban ch xy ra sau 48 gi nn lc u, cc
bui phi nng phi cch nhau 48 gi.
Thi gian phi nng phi c tun th nghim ngt v tng tht t t :
- tun l u : 1/4 pht,
- tun th nh : na pht,
- tun th ba : 1 pht,
- tun th t : 1,5 n 2 pht.
Ch tng thi gian phi nng nu khng da nhiu 48 gi sau bui phi cui.
Trng hp bnh nhn c dung np tt (da rt sm mu), c th chuyn sang dung dch
0,75% sau 3 n 4 tun v bt u li bng thi gian 1/4 pht. Thi gian phi cng phi c
tng t t.
- Chiu x UVA (liu php PUVA) :
Chiu UVA 1 gi sau khi bi thuc, phi c tng t t vi liu t 0,25 n 0,50 joule/cm2
trong bui chiu u tin. Gia hai bui chiu, c th tng ti a l 0,25 joule/cm2.
Trng hp b pht ban nng hoc b nga, phi gin on iu tr mt thi gian v sau bt
u li vi liu ti a khng qu phn na ca liu trc .
- Liu php PUVA phi hp vi ngm trong nc c pha mthoxsalne :
bn ngm c chun b bng cch pha long 1 l dung dch M ladinine 0,75% trong 80 n
100 lt nc t nng t 1,8 n 2,2 mg mthoxsalne/lt (ng vi 2 l trong 1 bn tm
ngi ln 150 n 160 lt).
Ngm bnh nhn trong vng 15 pht, sau cho chiu xa ngay sau khi lau kh (khng ch
mnh m ch dng gc lau nh).
Liu UVA c khuyn co trong liu php ny th thp. Trong bui chiu x u tin, dng liu
0,20 joule/cm2, sau tng chm t 0,02 n 0,05 joule/cm2 trong mi bui v t n ti a
l 1 joule/cm2.
Sau mi bui chiu x (mt tri hoc UVA) : ra tht sch vng da iu tr v bo v khng
tip xc thm na vi nh nng mt tri trong vng t nht 24 gi, bng cch mc qun o,
mang gng, qun khn chong, vv v i vi nhng phn da khng th che ch c, phi bi
mt lp kem chng nng ton phn.

318.

MENINGOCOCCAL A + C VACCINE

AVENTIS PASTEUR
Bt pha dung dch tim bp, di da : hp 1 l bt ng kh cha 1 liu vaccin + ng tim
cha 0,5 ml dung mi (s dng cho c nhn).
THNH PHN
cho 1 liu vaccin
Polysaccharide tinh khit ng kh ca vi khun Neisseria meningitidis nhm
50 mg
A
Polysaccharide tinh khit ng kh ca vi khun Neisseria meningitidis nhm
50 mg
C
(Lactose)
ng dung mi : Dung dch m ng trng

0,5 ml

DC LC
Vaccin c iu ch t khng nguyn Meningocoque c tinh khit.
Min dch xut hin 2 tun sau khi tim v ko di khong 3 nm.
CH NH
Phng nga vim mng no do Meningocoque nhm A v C.
Vic chng nga cn c khuyn co vng c ni dch cao hoc c dch do Meningocoque
nhm A v C.
CH PHNG
Vaccin ny gip c th chng li nguy c nhim Meningocoque A v C nhng khng c tc dng
i vi Meningocoque B (l tc nhn thng gy vim mng no Php) cng nh i vi cc
vi khun gy vim mng no t m khc (Haemophilus influenzae, Streptococcus
pneumoniae...).
THN TRNG LC DNG
Khng nn tim cho tr di 18 thng tui.
Nu tr c tip xc vi ngi bnh b nhim Meningocoque A + C th c th tim nga nu tr
trn 6 thng tui.
TC DNG NGOI
Trong vng 24 gi sau khi tim, c th st nh v hi ch chch.
LIU LNG v CCH DNG
Tim bp hay tim di da.

Ngi ln v tr em trn 18 thng tui u tim mt liu nh nhau.

Vaccin c trnh by di dng bt v khi ha tan trong dung mi s tr thnh mt dung dch
khng mu trong sut hoc hi trng c.
THI GIAN BO HNH
Ba nm.
BO QUN
nhit +2oC n +8oC trong t lnh, trnh nh sng, khng c lm ng c li.

319.

MEPRASAC

HIKMA
c/o O.P.V. (OVERSEAS)
Vin nn 20 mg : chai 10 vin.
THNH PHN
cho 1 vin
Omeprazole

20 mg

TNH CHT
Meprasac thuc nhm hp cht chng bi tit d dy mi thuc nhm benzimidazole, khng c
tc dng khng cholinergic hay khng H2 . Omeprazole gim s bi tit acid d dy qua mt c
ch tc dng chn lc cao. Thuc to ra s c ch c hiu ty thuc vo liu lng i vi
men H+K+ATPase (bm proton). Hot ng ny c ch giai on cui s to thnh acid d dy,
v vy c ch s bi tit acid c bn v bi tit do kch thch ngay c khi ang c xung kch thch
khng ng lc. Meprasac c hp thu nhanh, do khi pht tc dng nhanh v hu nh
c chuyn ha hon ton v thi nhanh qua nc tiu.
CH NH
Meprasac c ch nh trong :
1. iu tr ngn hn lot t trng
2. iu tr ngn hn lot d dy
3. iu tr ngn hn vim thc qun tro ngc
4. iu tr di hn tng tit dch v bnh l trong hi chng Zollinger-Ellison.
CHNG CH NH

Mn cm vi omeprazole.
CH PHNG v THN TRNG LC DNG
Trong trng hp nghi ng lot d dy, cn loi tr kh nng bnh l{ c tnh do iu tr c th
lm nh triu chng v tr hon chn on.
Omeprazole c th ko di thi gian o thi diazepam, warfarin, v phenytoin, do khi dng
chung vi nhng thuc ny cn theo di cn thn hoc gim liu. Khng c tng tc thuc vi
propanolol hay theophylline nhng khng loi tr kh nng tng tc thuc vi nhng thuc
cng c chuyn ha qua h thng men Cytochrome P450.
LC C THAI v LC NUI CON B
Khng nn s dng omeprazole trong thi gian mang thai v cho con b tr phi cn nhc
mt cch k lng.
TC DNG NGOI
Ni chung, omeprazole c dung np tt, tc dng ngoi { thng nh v thong qua, khng
cn phi gim liu.
Cc tc dng ngoi ca thuc bao gm : bun nn, nn, tiu chy. Him khi gp to bn, y
hi.
LIU LNG v CCH DNG
- Lot t trng : 20 mg mt ln/ngy, trong 2 n 4 tun.
- Lot d dy v vim thc qun tro ngc : 20 mg mt ln/ngy trong 4 n 8 tun.
- i vi bnh nhn khng vi cc phc iu tr khc, liu dng c th tng ln 40 mg
ngy mt ln.
- i vi nhng bnh l{ tng tit dch v : liu ban u 60 mg ngy mt ln, c th iu chnh khi
cn thit v iu tr lin tc ty theo ch nh lm sng. Liu trn 80 mg c th chia thnh 2 ln
trong ngy.
Khng cn iu chnh liu ngi ln tui hoc nhng bnh nhn c thng tn chc nng
gan hoc thn.
Cha c kt lun v an ton v hiu qu tr em.
QU LIU
Khng c cht i khng c hiu khi dng omeprazole qu liu, iu tr ch l iu tr triu
chng v nng . Liu duy nht ti 160 mg omeprazole vn c dung np tt.

320.

MERISLON

EISAI
c/o DIETHELM
vin nn 6 mg : v 10 vin, hp 50 v.
THNH PHN
cho 1 vin
Btahistine msilate

6 mg

DC LC
Merislon lm gin c vng tin mao mch v vy c tc dng gia tng tun hon ca tai trong.
N kim sot tnh thm ca mao mch tai trong do lm gim tch t ni dch bch huyt tai
trong. ng thi n cng ci thin tun hon no, gia tng lu lng mu qua ng mch cnh
trong v ng mch t sng. V vy, trn lm sng Merislon rt hiu qu trong iu tr chng
mt v chong vng.
DC L LM SNG
Ci thin ri lon tun hon tai trong
Nghin cu trn chut lang : u tin ngi ta gy ri lon tun hon tai trong ca chut, sau
cho tim b tahistine m silate vo mng bng. Sau 30 pht thy lu lng mu tng ln n
148% so vi trc khi dng thuc. Tc dng ny c hiu trong tnh trng bnh l.
Gim tch t ni dch bch huyt tai trong
Nghin cu ch cho thy dng lympho di chuyn trong ng ngc tng t 2-3,5 ln sau khi
tim tnh mch b tahistine m silate. iu ny cho thy rng cc dch lympho gy ph n ti t
chc c thu tr li mch lympho v dn i.
Tng ng vi hin tng tng cng tun hon tai trong ca chut sau khi dng btahistine
m silate, ngi ta thy rng p lc tnh tai trong gim xung v cc xung ng dng sng
tng ln. iu ny chng t rng b tahistine m silate lm tng cng tun hon tai trong v
kch thch s bi tit v thu dch tai trong vo mch lympho dn i.
Ci thin tun hon ni s
Nghin cu ch cho thy btahistine msilate lm gia tng hn 50% lu lng mu ng
mch cnh trong. Ngay c vic trc dng khng histamine th tc dng ny khng nhng
khng b gim i m cn c tng cng ln.
DC NG HC
Nghin cu trn ch c cn nng khong 10 kg vi liu 240 mg btahistine msilate. Nng
huyt tng cao nht t c sau khi ung 60-90 pht, sau b tahistine m silate nhanh
chng bin mt khi huyt tng.
chut cho dng liu 5-6 mg/kg b tahistine m silate nh du bng hydro phng x 3H cho

thy nng phng x tp trung cao nht gan, sau l m m, lch v thn. Sau 24 gi,
khong 10-30% c thi tr qua nc tiu v khong 50-70% qua phn.
CH NH
iu tr chng mt v chong vng lin quan n nhng bnh sau :
- Bnh Menire.
- Hi chng Menire.
- Chng mt ngoi bin.
THN TRNG LC DNG
Thn trng khi s dng trong nhng trng hp sau :
- Bnh nhn c tin s lot d dy hoc ang c vt lo t ng tiu ha do thuc c tc ng
ging histamine c th lm tng tit acide dch v do can thip ln th th H2.
- Bnh nhn hen ph qun do thuc c tc ng ging histamine c th gy co tht ng h
hp do can thip ln th th H1.
- Bnh nhn b u ty thng thn do thuc c tc ng ging histamine c th lm gia tng
huyt p do tng tit adrnaline.
Ngi gi : do tui ny, nhng hot ng chc nng sinh l{ thng gim, nn p dng
nhng bin php nh gim liu v tng cng theo di kim tra.
Tr em : cha xc nh c tnh an ton khi s dng thuc cho tr em.
LC C THAI
Tnh an ton ca Merislon cha c kim chng. Thuc ny ch nn dng cho ph n c thai
hoc nghi ng c thai ch trong trng hp xt thy ch li mang li ln hn so vi nhng tai
bin c th gp.
TNG TC THUC
Vin Merislon cha tng c pht hin l c tng tc vi bt kz loi thuc no khc.
TC DNG NGOI
- Tiu ha : him khi gp bun nn hoc nn.
- Tnh mn cm : him khi gp phn ng mn cm nh ni mn ngoi da.
LIU LNG v CCH DNG
Liu thng thng cho ngi ln l ung mi ln t 1 n 2 vin, ngy dng 3 ln sau mi ba
n.
Liu nn c iu chnh ty theo tui v mc nng nh ca bnh.
BO QUN
Vin Merislon nn c bo qun nhit phng v trong l chng m khi m np.

321.

MESULID

SCHERING-PLOUGH
Vin nn : hp 10 vin, 100 vin.
THNH PHN
cho 1 vin
Nimesulide

100 mg

DC LC
Mesulid l mt thuc khng vim khng steroid, l mt phn t mi c cc tnh cht gim au,
h st v khng vim. Nimesulide c ch tng hp prostaglandine in vitro v tc dng ca n c
v l bi nhiu c ch khc nhau. Mesulid c ch chn lc enzym cyclooxygenase-2, do lm
gim s tng hp prostaglandine lin quan n vim. Mesulid c ch vic to thnh cc gc oxy
t do m khng nh hng n ha hng ng v s thc bo. N cng c ch gii phng
enzym myeloperoxidase.
CH NH
Mesulid l mt thuc khng vim khng steroid, c ch nh trong nhiu bnh cnh khc
nhau cn h st, gim au v khng vim, nh bnh vim khp xng mn tnh, bnh thp
ngoi khp, au v vim sau khi can thip phu thut v sau chn thng cp, lm gim st v
au lin quan vi vim ng h hp cp tnh v au bng kinh.
CHNG CH NH
Mesulid khng c dng cho cc bnh nhn trc y b qu mn cm vi thuc ; nhng
bnh nhn b lo t ng tiu ha ang tin trin, suy gan nng hoc trung bnh, suy thn nng
(thanh thi creatinin < 30 ml/pht).
THN TRNG LC DNG
Vic dng thuc phi c kim tra cht ch nhng bnh nhn qu mn cm vi cc thuc
khng vim khng steroid khc v vi acid acetylsalicylic (aspirin). C th xy ra mn cm cho
vi aspirin v cc thuc khng vim khng steroid khc.
LC C THAI v LC NUI CON B
Nh cc thuc khng vim khng steroid khc, khng nn dng Mesulid trong thi kz mang
thai. Khng c dng trong 3 thng cui ca thai kz v cc thuc khng vim khng steroid
c bit l gy ng kn ng ng mch tr em v c th c nguy c mt trng lc t
cung. n nay cha c cc thng tin v s bi tit ca nimesulide qua sa m v v vy khng
c dng cho ph n cho con b.
TNG TC THUC
Nimesulide lin kt nhiu vi protein v c th s th ch cc thuc lin kt vi protein khc.

Tuy nhin, khng c tng tc ng k v lm sng khi dng ng thi Mesulid vi furosemid,
warfarin, digoxin, theophyllin, glibenclamid, cimetidin v thuc khng acid.
TC DNG NGOI
Mesulid ni chung c dung np tt. nng, bun nn, au d dy, ban da d ng, au u,
chng mt i khi c bo co vi Mesulid (0,1-5%). Cc tc dng ph ny ni chung l nh,
thong qua v him khi cn ngng iu tr.
LIU LNG v CCH DNG
Liu khuyn co cho ngi ln l mi ln 1 vin, ngy 2 ln. Nu cn, c th tng ln mi ln 2
vin, ngy 2 ln. Phi nut c vin vi nc sau ba n.
QU LIU
Khng c trng hp dng qu liu Mesulid no c bo co. Khng c thuc gii c c
hiu. Trong trng hp dng qu liu, phi ngay lp tc iu tr triu chng v iu tr nng .
BO QUN
Bo qun di 25oC.

322.

MTOSPASMYL

MAYOLY-SPINDLER
c/o TEDIS
vin nang mm : hp 20 vin.
THNH PHN
cho 1 vin
Alvrine citrate

60 mg

Simthicone

300 mg

DC LC
- Alvrine : chng co tht hng c thuc nhm papavrine, khng c tc dng atropinique.
- Simthicone : to mt lp mng bo v v c tc dng chng y hi.
CH NH

- iu tr triu chng bnh kt trng chc nng km theo trng bng.

LC C THAI
Cc nghin cu trn ng vt cho thy thuc khng gy c tnh trn phi thai cng nh khng
gy qui thai. Tuy nhin, s liu trn ngi cn hn ch, do thn trng khi ghi toa cho ph
n c thai.
LC NUI CON B
Do thiu s liu nghin cu, nn thn trng khi ghi toa cho ph n nui con b.
LIU LNG v CCH DNG
Mi ln 1 vin, 2-3 ln/ngy, vo u cc ba n.

323.

METHYCOBAL

EISAI
c/o DIETHELM
vin nn 500 mg : v 10 vin, hp 50 v.
dung dch tim 500 mg : ng tim 1 ml, hp 10 ng.
THNH PHN
cho 1 vin
Mecobalamin

500 mg

cho 1 ml thuc tim

Mecobalamin

500 mg

DC LC
Methycobal l mt ch phm c gc mecobalamin, mt loi co-enzym ca vitamin B12 c trong
mu v dch no ty. Mecobalamin c vn chuyn vo m thn kinh tt hn cc ng ng
ca vitamin B12 khc, n thc y qu trnh chuyn ha ca acid nucleic, protein v lipid thng
qua hot ng chuyn nhm methyl. Do Methycobal rt hiu qu trong iu tr cc bnh l
thn kinh ngoi bin.
DC L LM SNG
Tng cng s chuyn ha acid nucleic, protein v lipid :

Thc nghim vi cc dng t bo no chut cho thy mecobalamin, bng cch hot ng
nh l mt coenzyme cho qu trnh to methionine t homocysteine, tham gia vo qu trnh
tng hp thymidine t deoxyuridine, v tng cng tng hp ADN v ARN. Cc thc nghim
trn t bo thn kinh chut cng cho thy mecobalamin cng tng cng tng hp lecithin,
mt thnh phn ch yu ca bao myelin.
c vn chuyn hiu qu vo m ca t bo thn kinh v ci thin cc ri lon chuyn ha :
Thc nghim trn chut cho thy mecobalamin, mt ng ng ca vitamin B12 c cha nhm
methyl, c nng cao trong mu v dch no ty v c vn chuyn vo trong cc tiu th
ca t bo thn kinh mnh hn v nhiu hn so vi CN-B12 (cyano-cobalamin).
Thc nghim trn cc t bo thn kinh ta chut c gy bnh tiu ng cho thy
mecobalamin gip duy tr chc nng si trc bng cch tng cng tng hp cc protein l
thnh phn cu trc chnh ca si trc v bnh thng ha tc dn truyn ca cc protein
ny trong si trc.
Phc hi cc tn thng dy thn kinh trn m hnh bnh thn kinh ngoi bin thc nghim :
Cc thc nghim bnh l hc thn kinh v in sinh l cho thy mecobalamin ngn chn s
thoi ha si thn kinh chut v th c gy bnh thn kinh ngoi bin thc nghim bng
cc thuc nh Adriamicin v Vincristine, hoc gy tiu ng thc nghim bng Streptozotocin.
Hiu qu ca mecobalamin ng thi c nghin cu trn m hnh chut bch c gy lit
mt do chn p dy thn kinh. Qu trnh phc hi c nh gi thng qua phn x chp mt,
xung in c v kho st m hc. Hiu qu iu tr ca nhm dng mecobalamin cng t hiu
qu tng t nh nhm dng steroid trong vic y nhanh qu trnh hi phc ca m thn kinh
b tn thng.
c cc xung thn kinh bt thng do kch thch ca m thn kinh :
R trc v r sau ca dy thn kinh ty sng c ct ri khi ty sng ch v c ni vi
dy thn kinh ta. Kch thch in vo u di ca dy thn kinh c ngm trong dung
dch Ringers v ghi li hiu in th hot ng r trc v r sau ca ty sng. Sau ha tan
DBCC, OH-B12, CH3-B12 ln lt vo dung dch Ringers trn nng 500 mg/ml v so snh tc
dng c ch ca cc cht ny i vi cc xung dn truyn bt thng. Kt qu cho thy tc
dng c ch cc xung kch thch thn kinh ca mecobalamin (CH3-B12) l mnh nht.
Ci thin tnh trng thiu mu nh qu trnh thc y trng thnh v phn chia ca nguyn
hng cu :
Mecobalamin tng cng tng hp acid nucleic trong ty xng, cng nh s trng thnh v
phn chia ca nguyn hng cu, kt qu l gia tng s lng hng cu. iu tr bng
mecobalamin cho thy c tc dng hi phc nhanh cc ch s nh : s lng hng cu,
hemoglobin v hematocrit chut thiu mu do thiu vitamin B12.
DC NG HC
Khi cho chut ung 57Co-CH3B12, tnh phng x sau 72 gi c tm thy theo th t nng

gim dn thn, tuyn thng thn, ty, gan v d dy. Hot tnh phng x tng i thp
c, tinh hon, no v t bo thn kinh.
CH NH
- Cc bnh l thn kinh ngoi bin.
- Thiu mu hng cu to do thiu vitamin B12.
THN TRNG LC DNG
Khng nn s dng thuc lin tc trong nhiu thng nu khng thy c tc dng sau mt thi
gian dng thuc.
TC DNG NGOI
n khng ngon, bun nn, tiu chy hoc nhng triu chng ri lon tiu ha khc c th xy
ra sau khi dng thuc.
LIU LNG v CCH DNG
Vin nn : ung 1 vin, 3 ln/ngy sau ba n.
ng tim :
Bnh l thn kinh ngoi bin : liu thng thng i vi ngi ln l 1 ng (500 mg
mecobalamin), tim bp hoc tim tnh mch, ba ln mt tun. Liu nn c iu chnh ty
theo tui ca bnh nhn v mc nng nh ca cc triu chng.
Thiu mu hng cu to : liu thng thng i vi ngi ln l 1 ng (500 mg mecobalamin),
tim bp hoc tim tnh mch, ba ln mt tun. Sau khong 2 thng iu tr, liu nn gim
xung thnh liu duy tr mc t 1 n 3 thng tim nhc li mt ng.
BO QUN
Dc phm ny khng bn i vi nh sng, v vy nn c tn tr v bo qun trnh nh
sng.

324.

MIACALCIC

NOVARTIS
Dung dch tim di da, tim bp v tim truyn tnh mch 50 UI/ml : ng 1 ml, hp 5 ng.
Dng phun qua ng mi 200 UI/liu : chai phun phn phi 14 liu.
THNH PHN
cho 1 ng
Calcitonin tng hp (t c hi)

50 UI

cho 1 liu thuc phun

Calcitonin tng hp (t c hi)

200 UI

DC LC
Calcitonin l mt trong nhng ni tit t iu ha s chuyn ha canxi, c ch hot ng ca
hormone ph gip trng. Calcitonin gim mnh m s thu hi canxi t xng trong trng hp
c s gia tng vn tc hy xng nh trong bnh long xng, bnh Paget, bnh lon dng
thn kinh (bnh Sudeck) v hy xng do ung th. Tc dng ca thuc trong chng long
xng ph n mn kinh th hin r rng trn ct sng hn l cc chi v cc chng
bnh c gia tng vn tc hy v to xng hn l cc bnh chm hy v to xng. Thuc c
ch hot ng ca hy ct bo trong khi dng nh n kch thch s hnh thnh v hot ng
ca to ct bo. Calcitonin cn ngn chn s tiu xng, do lm gim s gia tng bt
thng nng canxi trong huyt thanh cng nh tng bi tit canxi, phosphor v natri trong
nc tiu bng cch gim s ti hp thu cc ng thn. Tuy nhin nng canxi trong huyt
thanh khng b gim di mc bnh thng.
Calcitonin c ch tit dch d dy v ty nhng khng lm nh hng n nhu ng rut.
C nhng bng chng v tc dng gim au ca Miacalcic mt vi bnh nhn c ri lon v
xng gy au.
Trong khi tt c cc calcitonin u tng t nhau v mt cu trc cng c 32 acid amin trong
chui n vi cc th t khc nhau ty theo loi, calcitonin c hi c i lc mnh hn vi cc
th th bm gn ca chng (nhng im bm ny cng c tm thy mt vng ca h
thn kinh trung ng), nn hu hiu hn v mt lm sng v c tc dng k o di hn cc
calcitonin tng hp t cc loi c v (k c ngi).
DC NG HC
Dung dch tim :
sinh kh ng tuyt i ca Miacalcic l khong 70% sau tim bp hay tim di da. Nng
nh trong huyt tng t c trong vng 1 gi v thi gian bn hy l 70-90 pht. Khong
95% liu dng c bi tit qua thn vi t l thuc dng khng i l 2%. Th tch phn phi
o c l 0,15-0,31/kg v lin kt vi protein l 30-40%.
Dung dch xt mi :
Nhng d liu v kh dng sinh hc ca Miacalcic dng xt mi thu c t cc cuc thm
d khc nhau s dng cc phng php khc nhau cho thy tnh bin thin rt ln. Cng tng
t nh cc ni tit t a peptide khc, nng calcitonin c hi trong huyt tng khng cho
bit trc c p ng lm sng. Ngc li, s o lng cc cht nh du thch hp ca s
chuyn ha xng nh phosphatase kim v s bi tit hydroxyproline trong nc tiu, cho

thy c s tng quan vi liu dng, kt qu ng tin cy vi kh dng sinh hc v do

nn c dng nh gi hiu qu lm sng. Trong gii hn ca hot tnh sinh hc, hiu lc
ca Miacalcic dng xt mi bng mt na dng tim bp hay tim di da.
CH NH
Long xng :
- Long xng giai on sm hoc long xng tin trin ph n mn kinh khi cc tr liu phi
hp estrogen/canxi thng thng l chng ch nh hay khng th thc hin c do mt vi l
do khc.
- Long xng do lo suy.
- Long xng th pht, v d long xng do dng corticosteroid hay do bt ng.
- ngn nga hy xng tin trin, bnh nhn s dng Miacalcic phi c cung cp b sung
canxi v vitamin D thch hp theo nhu cu ca tng ngi.
au xng kt hp vi hy xng v /hoc gim xng.
Bnh Paget xng (vim xng bin dng), c bit i vi nhng bnh nhn c km theo :
- au xng.
- Cc bin chng thn kinh.
- Tng s tiu hy v to xng phn nh qua vic gia tng nng ca phosphatase kim
trong huyt thanh v s bi tit hydroxyproline trong nc tiu.
- S lan rng dn dn ca tn thng xng.
- Gy xng khng hon ton hoc ti i ti li.
Tng canxi huyt v cn tng canxi huyt do :
- Hy xng qu mc trong bnh c tnh c di cn xng nh ung th v, phi, thn, u ty v
cc bnh c tnh khc.
- Cng tuyn cn gip, tnh trng nm bt ng hay ng c vitamin D c trng hp cp v
mn tnh.
Bnh lon dng thn kinh (bnh Sudeck) do cc nguyn nhn v yu t thun li khc nhau
nh long xng au nhc sau chn thng, lon dng phn x thn kinh giao cm, hi
chng vai - cnh tay, chng ha thng, cc ri lon dinh dng thn kinh do s dng thuc.
CHNG CH NH
Qu mn cm vi Miacalcic.
THN TRNG LC DNG
Do l mt polypeptide, calcitonin thng gy nhng phn ng qu mn ti ch hay ton thn.
Do , nn thn trng thc hin phn ng da trc khi p dng tr liu vi thuc bnh nhn
c tin s phn ng qu mn. Nn ngng thuc nu c du hiu qu mn lin quan r rng n
thuc.
Tr em : do thiu kinh nghim v vic s dng Miacalcic ko di tr em, khng nn iu tr
nhiu hn vi tun tr khi cn nhc rng cn phi iu tr ko di.

LC C THAI v LC NUI CON B

Cc nghin cu v kh nng sinh sn trn sc vt khng cho thy c nguy c tn hi no n
thai nhi, tuy nhin iu ny cha c khng nh qua cc th nghim kim chng ph n c
thai. Bn thn thuc khng i qua hng ro nhau thai ng vt. Khng nn cho con b trong
qu trnh iu tr vi Miacalcic do c bng chng rng thuc c tit ra qua sa m.
TC DNG NGOI
Thng gp : bun nn, nn, i khi chng mt v nng bng mt. Cc phn ng ph ny ty
thuc liu v thng xy ra sau khi tim tnh mch hn l sau khi tim bp hoc di da.
Thng chng t khi, ch mt vi trng hp cn gim liu tm thi. C rt t bo co v a
niu v n lnh.
Trong nhng trng hp him, tim calcitonin c th gy phn ng qu mn, gm phn ng ti
ni tim, hoc phn ng da ton thn, tuy nhin cc phn ng dng phn v a n nhp tim
nhanh, h huyt p v ngt cng c bo co trong mt s t trng hp.
LIU LNG v CCH DNG
Liu lng :
Miacalcic c th dng di dng xt mi, tim di da, tim bp hoc tim tnh mch. ng
s dng c khuyn co cho cc ch nh khc nhau c tm tt trong bng sau :

Ch nh

ng
dng
Xt mi Tim SC Tim IM Tim IV Truyn IV

Long xng

Bnh Paget

Tng canxi
- cp

- mn

Ri lon dinh dng thn kinh

Thuc c dung np ton thn v ti ch tt khi dng ng liu khuyn co vi cc ng

dng trn.
Long xng sau mn kinh :
Hin cha xc nh c liu hu hiu thp nht v liu khuyn co c s dng hin nay
nh sau :

Dng tim : 50-100 UI mi ngy hoc 100 UI mi 2 ngy, tim di da hoc tim bp, ty mc
trm trng ca bnh.
Dng xt mi : 100-200 UI mi ngy hoc 200 UI mi 2 ngy, 1 liu hay chia nhiu liu ty theo
p ng ca mi bnh nhn.
au xng kt hp vi hy xng v/hoc gim xng :
Liu lng c iu chnh ty theo nhu cu ca tng bnh nhn. T 200 n 400 UI mi ngy.
Liu = 200 UI c th dng n liu ; khi cn dng liu cao hn nn chia thnh nhiu liu. C th
phi tr liu nhiu ngy cho n khi tc dng gim au t c hiu qu hon ton. Trong giai
on iu tr duy tr liu dng ban u thng c gim v/hoc c th ko di khong cch
gia 2 liu.
Bnh Paget :
Dng tim : 100 UI mi ngy hoc mi 2 ngy, tim di da hoc tim bp. ng tim di da
c dung np rt tt v bnh nhn c th t tim c di s hng dn ca bc s hay y t.
Trong mt vi trng hp ch cn tim cch hai ngy khi iu tr duy tr ch cn dng 50 UI mi
ngy, c bit khi cc du hiu v triu chng lm sng c ci thin. Mt khc c th tng
liu mi ngy ln n 200 UI nu cn thit.
Dng xt mi : liu 200 UI mi ngy, dng n liu hay chia lm nhiu liu. Trong mt s trng
hp c th cn phi dng liu 400 UI chia lm 2 ln mi ngy lc bt u iu tr. C th gim
liu sau mt thi gian bnh nhn dng dng xt mi.
Tng canxi huyt :
iu tr cp cu tng canxi huyt :
Trong iu tr cp cu v cc tnh trng nng khc, ng s dng hiu qu nht l truyn nh
git tnh mch.
Dng tim : 5-10 UI cho mi kg th trng mi ngy, ha trong 500 ml dung dch mui ng
trng, truyn nh git tnh mch trong t nht 6 gi, hoc tim tnh mch chm chia lm 2-4
liu trong ngy. Bnh nhn phi c bi ph nc. Khi cn thit nn cp cu bng phng
php iu tr c hiu i vi bnh cn.
iu tr lu di tnh trng tng canxi huyt mn :
Dng tim: 5-10 UI/kg th trng mi ngy ty theo p ng lm sng v sinh ha, dng tim
di da hay tim bp liu duy nht hay chia lm 2 liu. Nu th tch thuc tim ln hn 2 ml th
nn dng theo ng tim bp. Nn tim cc mi nhng v tr khc nhau.
Dng xt mi : 200-400 UI chia vi ln mi ngy.
Bnh lon dng thn kinh :
Cn chn on sm v phi bt u iu tr ngay sau khi chn on chnh xc.
Dng tim : 100 UI mi ngy, tim bp hoc tim di da trong 2-4 tun. C th cho tip 100 UI
3 ln mi tun trong 6 tun, ty vo tin trin lm sng.
Dng xt mi : 200 UI chia vi ln mi ngy trong 2-4 tun, sau dng liu 200 UI 3 ln mt

tun trong vng 6 tun.

Ghi ch :
Trong bnh Paget v nhng bnh mn tnh c lin quan n s tiu hy v to xng khc, cn
iu tr t nht vi thng n vi nm. S iu tr lm gim ng k lng phosphatase kim
trong huyt thanh v s bi tit hydroxyproline trong nc tiu, i khi tr v mc bnh
thng. Tuy nhin, i khi lng phosphatase kim v hydroxyproline bi tit c th tng sau
khi gim xung lc u ; khi y bc s phi da vo bnh cnh lm sng x t on xem c nn
ngng iu tr khng, v bao gi th c th tip tc iu tr li.
Cc ri lon v chuyn ha xng c th ti xut hin mt hoc vi thng sau khi ngng thuc,
i hi mt t iu tr khc bng Miacalcic. Mc d khng th c th xut hin trn mt vi
bnh nhn tr liu lu ngy vi calcitonin, hiu lc trn lm sng ca thuc thng khng b nh
hng. i khi thuc c th mt hiu lc khi dng lu di, c th do bo ha cc im gn
dng nh khng c lin quan g n s pht sinh khng th. Sau mt thi gian ngng iu tr
p ng vi calcitonin li c tr li.
S dng lu di dng xt mi khng gy ra cc thay i bnh hc nim mc mi.
Hng dn s dng :
Dng xt mi :
- G np bo v.
- Ch p dng cho s dng ln u tin: gi cht thit b, mnh pittng cho n khi nghe
ting cch mi b ra. Lm nh th 3 ln. Ca s ti y ca nt khi ng by gi s c mu
xanh v bnh bm sn sng s dng.
- Hi ci u v pha trc v n nh ming vi chai thuc vo mt trong hai l mi. m bo
rng n trn mt ng thng vi ng mi cho bi sng ca thuc lan ta u. n
pittng mt ln v bung ra. Trong ca s m, bn s thy s 1.
- Sau khi bm thuc, ht vo mnh nhiu ln nga thuc thot ra khi mi. ng th ra
ng mi ngay sau khi bm thuc.
- Nu cn dng n liu 2 ln bm Miacalcic cng mt lc, nn bm ln 2 vo l mi bn kia.
- Lun lun y np bo v li sau khi dng nga vi phun b tc.
- Khi mu xut hin trn ca s m v c mt khng lc ng k chng li pittng chuyn
ng vo su hn (cnh bo dng li), 16 liu c phng ra. Mt lng nh cn thuc (do
k thut ng chai) vn cn st li trong chai thuc.
D trong tnh hung no cng khng bao gi c th m rng vi phun bng kim hay vt sc
nhn. iu ny ph hy hon ton hot ng ca chai thuc. ng tho g pittng. m
bo cc liu u bng nhau, hy gi chai thuc lun v tr ng thng. Trnh lc mnh chai
thuc hay ni qu nng.
- T khi m np, chai thuc xt mi phi c nhit phng v s dng ti a khng qu
4 tun l.

BO QUN
ng tim v l xt cha m phi c bo qun trong t lnh (2-8oC). Khi m l xt mi c
gi nhit phng, v tr thng ng v dng trong thi gian ti a l 4 tun.
Nh tt c cc thuc khc, Miacalcic phi xa tm tay tr em.

325.

MICOSTAT 7

AMERIPHARM
c/o O.P.V. (OVERSEAS)
Vin t m o 100 mg : hp 7 vin.
THNH PHN
cho 1 vin
Miconazole nitrate

100 mg

CH NH
iu tr hiu qu hu ht cc nhim trng do nm m o gy ra, c bit i vi Candida sp.
Nu ln u tin thy nga hay kh chu m o, nn hi kin bc s ; nu trc y c
chn on nhim nm, v by gi li c nhng triu chng nh th, c th dng vin t m
o miconazole theo nh hng dn trong 7 ngy lin tip.
CH PHNG
Sn phm ny ch hiu qu trong iu tr nhim nm m o, khng c dng trong cc bnh
l v mt v khng c ung.
Khng c s dng vin t m o miconazole nu c nhng du hiu v triu chng nh
di y, v nu cc triu chng xy ra trong khi iu tr bng vin t miconazole, hy
ngng s dng thuc ny v lin h vi bc s ngay, do bnh nhn c th mc nhng bnh l
nghim trng hn :
- st trn 38oC
- au bng di, au lng hoc vai
- kh h m o hi.
Nu cc triu chng khng ci thin, hoc xu hn trong vng 3 ngy, triu chng khng gim
hon ton trong vng 7 ngy, c th bnh nhn b mt bnh khc hn l nhim nm, nn hi
kin bc s.

Nu triu chng ti pht trong vng 2 thng hoc nu bnh nhn b cc nhim trng m khng
th cha khi bng nhng liu php thch hp, nn hi kin bc s.
Du thc vt ca vin thuc c kh nng lm suy yu thnh phn latex ca bao cao su cng nh
mng trnh thai. Do khng nn qu tin cy vo kh nng ngn nga cc bnh l truyn qua
ng sinh dc hoc nga thai ca bao cao su v mng trnh thai khi ang s dng vin t m
o miconazole.
Khng s dng nt chn tampon khi ang dng thuc ny.
Khng dng cho tr em di 12 tui.
Nu bnh nhn ang mang thai hoc nghi ng c thai, khng nn dng thuc ny tr phi c
kin bc s.
Gi thuc xa tm vi ca tr em.
Trong trng hp ung nhm thuc ny, phi tm s gip chuyn mn ngay, lin h vi
trung tm kim sot ng c.
THN TRNG LC DNG
t kt qu tt nht :
1. Nn s dng liu trnh (7 ngy), mc d gim cc triu chng.
2. S dng mi vin hng m lin tc mc d ang giai oi c kinh.
3. Mc qun lt dt bng si bng.
4. Nu ngi bn i c cc triu chng nga, , kh chu dng vt, nn khuyn anh ta i
gp bc s ngay v cng nn bo rng bn ang iu tr nhim trng nm.
5. Lau kh m h k lng sau khi tm, bi. Thay tm t, o qun lm vic m t cng
sm cng tt, v m h kh s khng to iu kin cho nm pht trin.
6. Sau khi i tiu tin, lau m h t trc ra sau.
7. Khng tht ra tr phi c ch nh ca bc s, do tht ra s lm ri lon thng bng vi khun
m o.
8. Khuyn bnh nhn khng gi trong trng hp cn chu ng c, v khi gi s gy kch
thch hn v c th lan rng s nhim trng.
9. Bc s nn hi k v bt kz mi thuc bnh nhn ang s dng, do mt vi loi thuc c th
lm cho m o d nhim trng hn.
Nu bnh nhn c thc mc, nn trnh by vi bc s.
Mi vin t u c v bc, khng nn s dng nu c du hiu v b rch v tr li cho quy
thuc.
TC DNG NGOI
- Gia tng tm thi cm gic nga, nng rt, c/hoc khng km theo kch thch khi vin thuc
c t vo trong.
- au qun bng, nhc u, vim rut, pht ban.
Nu c bt kz cc triu chng trn xy ra, ngng t thuc v n gp bc s ngay.

LIU LNG v CCH DNG

t vin m o mi ngy 1 vin trong 7 ngy lin tip.
HNG DN S DNG
Lu { : bo qun thuc nhit phng 15-30oC, tt nht l gi thuc ngn thng trong t
lnh trnh thuc b nho, trong trng hp thuc b nho do ngoi, c th ngm vin
thuc vo trong nc vin thuc cng li ri thc hin theo cc bc di y :
t vin m o vo lc i ng trong 7 ngy lin tip.
1. X vin t m o, tch ri lp v plastic bng ngn ci, dng ngn tr v ngn ci gi 2 lp
v plastic v ko tch ri ra.
2. t vin thuc vo dng c t thuc.
3. a nh nhng phn u cha thuc vo m o, ri dng pt tng y vin thuc t t vo
cng su cng tt.
Bn c th lm t th ng vi 2 chn hi giang ra v hi cong u gi hoc nm nga vi
u gi gp li. Khi sn sng, bn y pt tng t vin thuc vo su bn trong m o,
sau rt dng c t thuc ra khi m o. Nn i ng cng sm cng tt sau khi t trnh
chy thuc ra ngoi.
Bn c th s dng bng v sinh hay qun lt trong khi dng vin thuc t, nhng khng nn
s dng nt chn tampon.
4. Ra sch dng c sau mi ln dng, rt 2 phn ca dng c ri ra, ra sch bng x phng v
nc m ri rp chng li 1 cch nh nhng.
5. Lp li cc bc t 1 n 4 trc khi i ng trong 6 m tip theo.
BO QUN
Nn thuc nhit phng 15-30oC.
Trnh ni nng trn 30oC.

326.

MICROGYNON 30

SCHERING AG
c/o ZUELLIG
Vin nn : v 21 vin c ghi ngy nh.
THNH PHN
cho 1 vin
Levonorgestrel

0,15 mg

Ethinylestradiol

0,03 mg

DC LC
Kt hp progesteron-estrogen nga thai, dng ng ung
Bnh thng khi ung Microgynon 30 theo ch dn, trng s c d phng khng chn vo
lc trng c th tinh. Hn na dch nhy c t cung vn c lm cho tinh trng ca nam gii
kh di ng. Mng t cung cng cn khng c chun b cho s lm t ca trng th tinh.
Nh vy Microgynon 30 c hiu qu bo v trnh th thai.
V thuc c ghi ngy nh, cha 21 vin nn. Mi ngy ung 1 vin, dng trong 21 ngy lin,
tip theo sau l mt khong thi gian 7 ngy khng ung thuc trc khi li tip tc ung v
thuc tip theo. Trn v c hng dn rt r cn phi ung mi vin nn vo ngy no trong chu
kz.
CH NH
Thuc nga thai, dng ng ung.
CHNG CH NH
C thai, cho con b, ri lon chc nng gan, vng da hoc nga ko di trong ln c thai trc,
hi chng Dubin-Johnson, hi chng Rotor, tin s hay hin ti ang b u gan,, tin s hay hin
ti ang c qu trnh huyt khi tc mch ng mch hay tnh mch v cc tnh trng thun
li cho s pht trin cc bnh ny (v d cc ri lon ca h thng ng mu vi khuynh hng
hay to huyt khi, cc bnh tim r rt), thiu mu hng cu hnh lim, iu tr hay ang c
ung th v hoc ung th ni mc t cung, tiu ng nng vi cc thay i mch mu, cc ri
lon chuyn ha lipid, tin s nhim herpes lc mang thai, x cng tai vi tnh trng nng hn
lc mang thai.
THN TRNG LC DNG
Thn trng khi s dng trong nhng trng hp : tiu ng, tng huyt p, dn tnh mch, x
cng tai, bnh x cng ri rc, ng kinh, ri lon chuyn ha porphyrin, co cng c, ma git
loi thng thng. Trong nhng trng hp ny, cng nh khi c tin s vim tnh mch, hay
khuynh hng tiu ng, ch dng Microgynon 30 di s gim st y khoa cht ch.
L{ do ngng dng Microgynon 30 tc th :
Cc cn au na u xut hin ln u, cc cn nhc u d di bt thng xy ra thng
xuyn hn, cc ri lon t ngt v nhn thc (v d ri lon th gic v thnh gic), du hiu
u tin ca vim tc tnh mch hoc huyt khi nghn mch (v d au bt thng hay sng
cng chn, au nh m khi ht th hay khi ho m khng c l do r rng), cm gic au hoc
tc ngc ; trong khi ch phu thut (6 tun chun b trc ), tnh trng bt ng (v d sau
tai nn). Trong tt c cc trng hp trn c s gia tng nguy c to huyt khi. Cc l do khc
ngng thuc l : xut hin vng da, vim gan khi pht, nga ton thn, cc cn ng kinh
gia tng, huyt p tng ng k, thai kz.

Ghi ch c bit :
Theo cc hiu bit hin nay, c s kt hp gia vic dng cc ch phm phi hp progesteronestrogen vi nguy c gia tng bnh l huyt khi tc tnh mch v ng mch l khng th loi
tr.
Nguy c tng i ca huyt khi ng mch (v d : t qu, nhi mu c tim) s cng tng
thm khi c ht thuc l nhiu, tui cao v dng ng thi thuc nga thai ung.
nhng trng hp him u lnh ca gan v ngay c nhng trng hp rt him u c tnh ca
gan, mt s ca l t, dn n xut huyt trong bng nguy him n tnh mng, c th xy ra
sau khi dng cc cht ni tit t. Thy thuc phi c thng bo v vic xy ra ca nhng cn
au bng trn bt thng m khng gim ngay trong thi gian ngn.
LC C THAI v LC NUI CON B
Lc c thai :
Chng ch nh.
Lc nui con b :
Cn nhc gia li ch ca vic dng thuc vi nguy c tim tng cho bo thai.
TNG TC THUC
Barbiturates, phenylbutazone, hydantoins, rifampicin, ampicillin lm gim tc dng ca nga
thai ca Microgynon 30. Nhu cu dng thuc tr tiu ng dng ung hay insulin c th thay
i khi dng phi hp vi Microgynon 30.
TC DNG NGOI
Trng hp him, c th xy ra nhc u, au d dy, bun nn, cm gic cng v, thay i th
trng v tnh dc, hoc trm cm.
Dng di hn i khi c th gy ra nhng mng mu hi nu trn mt v nhng mng ny s r
hn nu tip xc lu vi nh nng mt tri. Do nhng ph n c khuynh hng ny nn
trnh ngoi nng qu lu.
Trng hp ring l c bo co c nh hng n th gic khi dng thuc.
LIU LNG v CCH DNG
Trc khi bt u dng Microgynon 30, cn phi thc hin khm k v ni khoa tng qut, v
ph khoa (k c khm v v lm pht t bo c t cung) v cn phi ghi nhn cn thn tin s
gia nh.
Ngoi ra, tnh trng ri lon h thng ng mu phi c loi tr nu c bt kz ngi no
trong gia nh c bnh l huyt khi tc mch (v d huyt khi tnh mch su, t qu, nhi
mu c tim) t lc tui tr. C thai cng phi loi tr. thn trng, nn thc hin khm kim
tra khong mi 6 thng khi iu tr lu di vi Microgynon 30. Trong 14 ngy u ca t dng
thuc u tin, phi dng thm mt phng php nga thai khng hormon (tr phng php
v nhp v nhit ) m bo nga thai tuyt i t ngy u tin ung thuc ny.
t ung thuc u tin :

Hy i chu kz kinh nguyt tip theo. Ung vin n n u tin vo ngy th 5 ca chu kz (ngy
u chy mu tc l ngy u tin ca chu kz), khng k n chy mu kinh nguyt ngng
hay cha ngng.
Ly vin thuc u tin ra khi v phn c nh du vi ngy tng ng trong tun (v d :
"Mon" tng ng vi ngy th 2 trong tun), n vin thuc ra ngoi qua lp giy nhm, v nut
nguyn vin thuc vi mt t nc. Ung thuc vo gi no trong ngy khng quan trng,
nhng mt khi chn mt thi im c bit, thng l sau n sng hay n ti, th nn dng
thuc ng vo thi im ca mi ngy.
Mi ngy 1 vin trong 21 ngy :
T ngy th nh, mi ngy phi ung 1 vin thuc theo hng mi tn trn v thuc cho n
ht v. Nu qun khng chc l ung hay cha vin thuc ca ngy , ch cn nhn trn v
thuc s bit ngay.
7 ngy khng ung thuc :
Sau khi ung tt c 21 vin nn, c mt khong thi gian 7 ngy khng ung thuc tip theo
sau. Trong thi gian ny (khong 2 n 4 ngy sau khi ung vin nn cui cng) s gp chy
mu.
Nhng t tip theo :
Sau thi gian ngh 7 ngy, s dng thuc tr li vi v thuc k tip, bt k kinh ht hay vn
cn (thng ht kinh).
Tm li, vic dng thuc theo mt qui trnh n gin l 3 tun ung thuc, 1 tun khng ung
thuc, v mi v thuc mi s bt u vo ngy trong tun ging nh i vi v thuc c.
Ch :
- Ung thuc khng u, i ma hay ri lon tiu ha vi tiu chy, ri lon chuyn ha rt
him khi xy ra hoc dng k o di ng thi vi mt s thuc khc (xem Tng tc thuc) c
th nh hng n tc dng nga thai (triu chng u tin l xut huyt gia chu kz). Thuc
nhun trng nh khng c nh hng ti tc dng ca Mycrogynon. Nhng nu gp ri lon
tiu ha nh nn v tiu chy, s khng m bo l vin thuc hng ngy c th lu trong c
th pht huy tc dng, khng c g chc chn l c tc dng nga thai. Nu gp trng
hp ny nn dng thm phng php nga thai khng hormon (tr phng php nhp v nhit
) cho chu kz c bit ny, nhng khng c ngng dng Microgynon 30 nh ch dn.
Nu dng mt thuc trnh th thai hormon khc, hoc mun bt u ung Microgynon 30
rt sm sau khi hoc khi xy thai, hay khi cho con b, cn phi cn nhc v c kin ca bc
s chuyn khoa.
- Nu xy ra xut huyt gia chu kz : Nu xy ra xut huyt "khng theo lch" trong thi gian
ung Microgynon 30 th khng c ngng ung thuc. Xut huyt nh thng s t ngng.
Tuy nhin, nu xut huyt nng ging nh hnh kinh th nn hi kin bc s.
- Nu khng thy c mt kz kinh nguyt : Nu gp trng hp khc thng, khng thy chy

mu trong khong thi gian khng ung thuc, hy tm ngng ung thuc Microgynon 30 v
phi hi kin ca bc s chuyn khoa.
- Nu qun ung thuc vo gi thng l, phi ung vin thuc ny trong vng 12 gi. Nu qu
12 gi k t thi im vn thng ung vin nn trong ngy th s bo v trnh th thai trong
chu kz ny c th b gim st. Tuy nhin vn phi tip tc ung nhng vin nn khc trong v
thuc vo thi im nh thng l, b qua nhng vin n n qun ung. Tuy vy phi dng
ng thi mt phng php nga thai khng hormon (tr nhng phng php v nhp v
nhit ) b sung thm cho ti khi ht v thuc . Khng ung vin nn hoc nhng vin nn
qun ung. Trong khong thi gian 7 ngy khng ung thuc tip theo sau nh qui nh,
s c chy mu mt cch bnh thng. Nu khng xy ra xut huyt, cn chc chn phi khng
c thai mi tip tc dng thuc.
- Ngng thuc : Sau khi ngng ung Microgynon 30 cc c quan sinh sn thng ly li chc
nng y n mc li c kh nng th thai bnh thng. iu duy nht c th nhn thy l
chu kz u s c th khong mt tun di hn bnh thng. Tuy nhin, nu chu kz khng tr li
bnh thng trong vng 2-3 thng u, hy tham kho kin ca bc s chuyn khoa.

327.

MICROLAX - MICROLAX BB

SANOFI SYNTHELABO VIETNAM

Gel bm vo trc trng : ng canule 5 ml, hp 6 ng.
Gel bm vo trc trng : ng canule 3 ml, hp 6 ng.
THNH PHN
cho 1 ng Microlax
Sorbitol 70%, dng tinh th

4,465 g

Sodium di dng citrate

450 mg

Sodium di dng laurylsulfoactate

45 mg

cho 1 ng Microlax Bb
Sorbitol 70%, dng tinh th

2,679 g

Sodium di dng citrate

270 mg

Sodium di dng laurylsulfoactate

27 mg

DC LC
Thuc x kch thch.
DC NG HC
Thi gian bt u c tc dng : 5-20 pht.
CH NH
- iu tr triu chng to bn do cc nguyn nhn vng trc trng v hu mn.
- Chun b ni soi trc trng.
CH PHNG
Khng nn iu tr ko di.
iu tr to bn bng thuc ch l mt iu tr h tr cho mt iu tr gm ch n v v sinh.
THN TRNG LC DNG
Trnh dng Microlax v Microlax b b trong t cp ca tr, d hu mn hay vim i trng
xut huyt.
TC DNG NGOI
Dng ko di c th gy cm gic rt bng ti ch v hn hu gy vim i trc trng sung
huyt.
LIU LNG v CCH DNG
Liu lng :
Mt ng / ngy, dng trc thi im d nh i cu 5-20 pht.
Cch dng :
M np ng canule. a ton b canule vo trc trng, bp y ht thuc trong ng vo trc
trng, trong khi rt canule ra vn bp gi ng.

328.

MIKROFOLLIN FORTE

GEDEON RICHTER
vin nn 0,05 mg : v 10 vin.
THNH PHN

cho 1 vin
Ethinylestradiol

0,05 mg

CH NH
iu tr v kinh v thiu kinh do suy chc nng bung trng, bng huyt v a kinh, au kinh,
cai sa, mn trng c v ung th tin lit tuyn.
CHNG CH NH
Mang thai, suy gan, cc tnh trng sau vim gan, c tin s vng da mang thai v cn v nga.
Hi chng Dubin-Johnson v Rotor, c tin s huyt khi tnh mch, bnh nghn mch, cc
bu v v t cung mc hay nghi ng, lc ni mc t cung, xut huyt m o khng r
nguyn nhn, ri lon chuyn ha lipid, tng mc chng x cng tai trong cc kz mang thai
trc.
CH PHNG v THN TRNG LC DNG
Vic ngng thuc ngay ch c xem x t trong trng hp tn sut nhc na u v nhc u
trm trng cao cha tng c trc y, ri lon th gic cp, cc du hiu nghn tnh mch hay
nghn mch, cao huyt p, vng da mt, nm lit ging thng xuyn. Estrogen c th lm
gi mui v nc, v th thn trng c bit trong trng hp suy tim hay thn, cao huyt p,
ng kinh v hen ph qun, trong trng hp glaucome gc ng hay phng, p sut nhn cu
c th tng. Trong trng hp i tho, dung np glucose c th gim.
Trc khi bt u iu tr, cn khm chi tit c bit khm k tuyn v v c quan chu, huyt
p. Trong trng hp iu tr lu di, nn ti khm sau 6 thng u, sau ti thiu l hng
nm. V nguy c xut huyt bt ng, nn dng cch qung khi iu tr lu di.
V liu cao estrogen trong giai on u mang thai c th hi thai nhi, loi tr mang thai khi bt
u iu tr.
Cc test chc nng gan v ni tit ch cho kt qu ng tin cy sau 2-4 thng ngng iu tr.
TNG TC THUC
Thuc to enzyme c th lm tng chuyn ha ch phm.
TC DNG NGOI
Bun nn, nn, nhc u, nhc na u, thay i th trng, v v hot ng tnh dc, gi mui
v nc, vi liu cao hn tng nguy c nghn mch, rm da, vng da mt, xut huyt nhiu
v bt ng, xut huyt lm tm, bt lc nam, gim sinh tinh, d ng da.
LIU LNG v CCH DNG
Ty c nhn.
Trong trng hp v kinh v thiu kinh ung 1-2 vin/ngy trong 20 ngy, sau tim bp 5
mg progestin/ngy trong 5 ngy.

Trong trng hp au kinh ung 1 vin/ngy trong 20 ngy, mi 2 hoc 3 thng. Vic dng
thuc nn bt u t ngy th 4-5 ca chu kz kinh.
cai sa ung 1 vin/ngy trong 3 ngy sau khi sinh, 3 ngy tip theo ung 3 x 1/2 vin/ngy,
3 ngy tip theo na ung 1/4 vin/ngy.
Trong bnh mn trng c ung 1 vin/ngy.
Trong trng hp ung th tin lit tuyn 3 x 1-2 vin/ngy, liu ny c th gim dn cho n
liu duy tr 1 vin/ngy.

329.

MITOMYCIN-C KYOWA

KYOWA HAKKO KOGYO

c/o MITSUI
Bt pha tim 2 mg : hp 10 l - Bng A.
Bt pha tim 10 mg : hp 1 l - Bng A.
THNH PHN
cho 1 l
Mitomycin C J.P.

2 mg

cho 1 l
Mitomycin C J.P.

10 mg

DC LC
M t :
- c tnh chung :
Cm quan pH

ASTT nng /dd mui

ng 2 mg

tm xanh

5,5-7,0

#1

0,96% (pha trong 5 ml nc ct)

ng 10 mg

tm xanh

5,5-7,0

#1

0,96% (pha trong 25 ml nc ct)

- Tn thng thng : Mitomycin C.

- Tn ha hc : Azirizino[2', 3' : 3, 4]pyrrolo[1, 2-a]indole-4, 7-dione-6-amino-1, 1a, 2, 8, 8a, 8bhexahydro-8(hydroxymethyl)8a-methoxy-5-methyl-carbamate.
- Cng thc phn t : C15H18N4O5 = 334,33
- M t : bt kt tinh hay tinh th kt tinh mu xanh tm. Tan nh trong nc, methanol v
aceton ; rt tan trong ethyl acetat hay chloroform ; khng tan trong tetrachlorua carbon.
- bn vng : dng kt tinh bn vng nhit thng. Trong dung dch, bn vng pH 8,
bn vng s gim khi pH gim xung 7.
Tnh cht dc lc :
Nhm Mitomycin bao gm mt s cc cht chng tn sn c tm thy trong dch nui cy
Streptomyces caespitosus bi Hata v cng s ti Vin nghin cu Kitasato nm 1955.
Trong s nhng khng sinh ny, Mitomycin C c tc dng tt nht v c chit tch, tinh khit
ha vo nm 1956.
Mitomycin C Kyowa l ch phm tim cha Mitomycin C c hot ph rng khng ung th v tc
ng chng khi u. Cht ny c xc nh c tc dng ln cc dng ung th ng rut,
ung th phi, ung th v, ung th t cung, ung th u v c, ung th bng quang v bnh
bch cu mn tnh.
Dc l :
- Tc ng chng khi u :
Mitomycin th hin ph khng khi u rng v c hot tnh hu hiu trn nhng t bo u c
nui cy : carcinm Ehrlich, sarcm 180, bnh bch cu P388, sarcm Yoshida.
- C ch tc ng :
Mitomycin kt hp vi DNA ca t bo ung th v c ch s nhn i ca DNA qua s lin kt
cho ca xon i DNA ny nh ngn chn c khi u. Bng chng cho thy rng nhng t
bo giai on sau ca qu trnh tin sinh tng hp (G) v na giai on u ca qu trnh sinh
tng hp th rt nhy cm vi thuc.
DC NG HC
Mt phn ca liu tim vo c o thi qua nc tiu (khong 4,3-4,8% trong vng 4 gi sau
khi tim) : t 30 n 120 pht sau khi tim tnh mch, ngi ta pht hin thy lng thuc
c o thi qua nc tiu l nhiu nht v gim dn sau .
Phn cn li ca liu tim vo c phn phi rng ri n cc m gy tc ng : trong 15
n 30 pht cc m lnh v nhanh hn cc m ung bu.
Nng ca thuc trong mu gim tng i nhanh. Mitomycin c chuyn ha gan.
Tuy nhin, sau 24 gi, ngi ta vn cn tm thy trong nc tiu khong 10% liu tim vo.
TH NGHIM LM SNG
Tc ng lm sng :
Kt qu th nghim lm sng tin hnh ti 49 bnh vin Nht nh sau :

T l t hiu qu tr liu trn 2.680 trng hp l 39,1% (1.049/2.680) (nhng trng hp ny

c nh gi theo tiu chun 1-A ca Karnofsky cng nh tiu chun ca Hi Tr liu Ung th
Nht).
T l t hiu qu tr liu n l Mitomycin C l 39,4% (488/1.239), trong 29,7% trng hp
(131/441) ung th bao t ; 34,4% trng hp (11/32) ung th rut gi ; 36,7% trng hp
(87/237) ung th phi ; 29,4% trng hp (5/17) ung th gan ; 67,2% trng hp (90/134) ung
th t cung ; 50,0% trng hp (18/36) ung th v ; 40,0% trng hp (8/20) ung th u v
c ; 76,9% trng hp (40/52) ung th bng quang v 95,0% trng hp (19/20) bnh bch cu
mn.
T l t hiu qu ca tr liu kt hp l 38,3% (572/1.493). Trong khi t l t hiu qu ca tr
liu bng ng tim tnh mch l 35,8% (867/2.419), bng ng ng mch l 66,5%
(129/194), th hiu qu khi tr liu cc b nh liu php ni bng quang l 79,1% (53/67).
Phn ng bt li :
Nhng phn ng bt li c kho st trn 329 trng hp tr liu bng ng tnh mch, kt
qu nh sau :
(Tng s trng hp kho st cho mi dng khng phi lun lun l 329)
- Gim bch cu : 130 trng hp (40,2%).
- Gim tiu cu : 75 trng hp (24,6%).
- Bing n : 58 trng hp (21,85).
- Bun nn-i ma : 41 trng hp (15,4%).
- Kh chu : 15 trng hp (5,6%).
- St cn : 18 trng hp (5,5%).
- Hay chy mu : 12 trng hp (3,6%).
- Thiu mu : 10 trng hp (3,0%).
TH NGHIM PHI LM SNG
c tnh cp : LD50 mg/kg
I.V.

I.P.

P.O.

chut nht ICR

4,3

8,4

53,5

chut nht ddy

8,2

8,4

26,8

chut cng

3,1

5,0

67,4

th

3,4

ch

0,72

c tnh mn :
Vi liu 0,4 ; 1,2 ; 3,6 ; 11 ; 33 ; 100 mg/kg tim phc m cho chut cng lin tc trong 6 tun,
s c ch tng trng nhn thy th th nghim vi liu trn 11 mg/kg, gim vn ng, co
cng c nhn thy nhm liu 100 mg/kg, t vong c nhn thy sau 130 ngy.
Nhng xt nghim sinh ha mu (150 ngy sau khi tim) liu 100 mg/kg cho thy c hin
tng gim bch cu, tng K+, tng BUN v NPN c v ci. nhm c, gim hng cu, gim
th tch lng hng cu, gim nng hemoglobin, bt thng cc t bo li v gim protein
huyt tng.
Ngoi ra, xt nghim (150 ngy sau khi tim) nhm liu 100 mg/kg cho thy c hin tng teo
l lch v teo tuyn c, teo tinh hon, tuyn tin lit nhm c v teo bung trng nhm
ci.
Gy d dng :
chut ang mang thai, vi liu duy nht 2-10 mg/kg vo ngy th 10-14 ca thi kz c thai,
thy c hin tng chm pht trin bo thai. Vi liu 7,5 mg/kg, gy d dng nh h mi, cm
ngn, dnh ngn.
Gy ung th :
Tim di da cho chut nht vi liu 2 mg x 2 ln 1 tun, tng cng 35 ln, sarcm c quan
st thy trong tun th 39 n 54.
CH NH
Lm thuyn gim nhng triu chng ch quan hay khch quan ca nhng bnh sau :
Bnh bch cu limph mn, bnh bch cu ty mn, ung th bao t, ung th rut gi, ung th
phi, ung th ty, ung th gan, ung th c t cung, ung th ni mc t cung, ung th v, ung
th u c v ung th bng quang.
CHNG CH NH
Tuyt i :
- Bnh nhn c tin s d ng vi Mitomycin C.
Tng i :
iu tr rt cn thn vi nhng bnh nhn sau :
- C ri lon chc nng gan (cc phn ng bt li c th xy ra rt nghim trng).
- C ri lon chc nng thn (cc phn ng bt li c th xy ra rt nghim trng).
- Suy ty (tnh trng suy ty c th tr nn nghim trng hn).
- ang b nhim khun (tnh trng nhim khun c th nghim trng hn do suy ty).
- ang mc bnh thy u (c th gy ri lon ton thn, nguy c t vong).
CH PHNG v THN TRNG LC DNG
Tng qut :
- C th xy ra nhng phn ng bt li nghim trng nh suy ty xng. Cn phi theo di
bnh nhn thng xuyn bng cc xt nghim cn lm sng (xt nghim v huyt hc, chc

nng gan thn...). Nu c nhng bt thng xy ra, x tr thch hp nh gim liu hoc ngng
thuc. Tr liu trong thi gian di cn phi theo di bnh nhn cn thn v nhng phn ng bt
li ny c th gy hiu qu nghim trng v ko di.
- Cn c nhng ch { c bit n nhng du hiu ban u hay s trm trng thm ca cc
triu chng nhim khun v xut huyt.
- Thn trng khi tr liu cho tr em, theo di nhng biu hin ban u c th dn n nhng
phn ng bt li.
- Vic tr liu cho tr em v nhng bnh nhn cn kh nng sinh sn cn phi thn trng v c s
nh hng ln c quan sinh dc.
Tr liu cho ngi gi :
nhng bnh nhn ln tui cc chc nng sinh l{ suy yu, c bit s suy ty c th ko di
cng nh ri lon chc nng thn, Mitomycin C Kyowa cn c dng tr liu di s theo di
nghim ngt v liu v phn liu.
Nhng lu { khi s dng :
Khi s dng :
- trnh au mch, vim tnh mch v chng huyt khi, nn tim tnh mch cng chm cng
tt. Phi ht sc ch { n v tr v phng php tim.
- Khi tim tnh mch cn ch trnh thuc trn ra ngoi gy x cng v hoi t ni tim.
Chun b dung dch tim : Mitomycin C c ha tan trong dung dch acid v cn c s dng
cng sm cng tt trnh gim hiu lc thuc. Khng kt hp vi ch phm tim c pH thp.
phng khc :
c nhng bo co cho thy rng c nhng khi u khc xy ra chut nht c s dng
Mitomycin qua ng tim di da v chut cng c s dng Mitomycin qua ng phc mc
hay tim tnh mch.
LC C THAI v LC NUI CON B
Mitomycin c bo co rng c th gy qui thai ng vt th nghim. Do , khng nn
s dng cho ph n c thai hay nghi ng c thai.
Cha c kt lun v s an ton trong thi kz cho con b. Tt hn c, ngng cho con b nu
bnh nhn cn tr liu.
TNG TC THUC
Cn phi phng khi s dng cng lc vi nhng thuc nh cc cht chng ung th khc,
hoc ang x tr (cc phn ng bt li nh suy ty xng c th trm trng hn).
TC DNG NGOI
Dng nng :
- Hi chng hng cu niu : cn phi theo di bnh nhn bng nhng xt nghim nh kz. Nu
c bt c triu chng no nh thiu mu hng cu v, gim tiu cu, suy thn, phi ngng
thuc v x tr kp thi.

- Suy ty xng : gim bch cu, gim tiu cu, xut huyt, thiu mu... c th xy ra. Cn theo
di bnh nhn cn thn. Nu c nhng hin tng bt thng, gim liu hoc ngng thuc v
x tr kp thi.
- Vim phi k v x ha phi : vim phi k vi cc triu chng st, ho, kh th, X-quang bt
thng, i eosin, x ha phi. Nu nhng phn ng ny xy ra, cn ngng thuc v x tr kp
thi nh dng corticoid thng thn.
Cc dng khc :
- Thn : i khi xy ra protein niu, huyt niu, ph, tng huyt p. Cn theo di bnh nhn cn
thn. Nu c triu chng bt thng, cn ngng thuc v x tr thch hp.
- Gan : i khi gy ri lon chc nng gan.
- Tiu ha : chn n, bun nn i ma, vim ming, tiu chy c th xy ra.
- Phn ng nhy cm : cc phn ng d ng nh ni ban c th xy ra.
- H tit niu : vim bng quang, huyt niu, teo bng quang c th xy ra khi s dng liu php
nh git ni bng quang.
- Phn ng khc : kh chu, rng tc.
LIU LNG v CCH DNG
Tr liu tng t :
p dng cho ngi ln, tim tnh mch 4-6 mg Mitomycin C mt hay hai ln mt tun.
Tr liu lin tc :
p dng cho ngi ln, tim tnh mch 2 mg Mitomycin C mi ngy mt ln.
Tr liu tng t vi liu cao :
p dng cho ngi ln, tim tnh mch 10-30 mg Mitomycin C mi t cch nhau 1 n 3 tun
hoc lu hn.
Tr liu phi hp vi cc thuc chng ung th khc :
p dng cho ngi ln, liu 2-4 mg mt hoc hai ln mt tun v kt hp vi cc thuc khng
ung th khc. Nu cn thit c th dng ng ng mch, ng tim vo ty, ng tim
mng phi, ng phc mc vi liu 2-10 mg/ngy. Liu ny c th c iu chnh ty theo
tui tc ca bnh nhn v tnh trng bnh l.
Trong 1 ng, ha tan bng 5 ml nc ct pha tim cho mi 2 mg hot cht.
Ung th bng quang :
Thng thng c dng phng ti pht, bm bng quang 4-10 mg Mitomycin C mi
ngy hay mi hai ngy. tr liu, bm bng quang 10-40 mg mi ngy. Liu ny c th c
iu chnh ty theo tui tc ca bnh nhn v tnh trng bnh l.
QU LIU
S qu liu c th gy ra nhng phn ng ph nghim trng nh suy gim chc nng ty xng
m c th phng trnh c. Trong trng hp thiu cht gii c chuyn bit, dng mt
lng ln thuc c nhm SH nh vitamine B2, B6, C v glutation s c tc dng bt hot thuc

nh tng tc qu trnh chuyn ha phn hy.

BO QUN
Hn dng 4 nm.
Bo qun nhit phng (1-30oC).

330.

MIZOLLEN

SANOFI SYNTHELABO VIETNAM

vin nn 10 mg : hp 15 vin - Bng B.
THNH PHN
cho 1 vin
Mizolastine

10 mg

DC LC
Mizolastine c tnh cht khng histamine v chng d ng nh tnh i khng chuyn bit v
chn lc trn cc th th histamine H1 ngoi vi.
Cc nghin cu ngi cho thy mizolastine 10 mg c tc dng khng histamine nhanh (sau 4
gi) v ko di (24 gi). Khng c hin tng min dch nhanh c ghi nhn.
Trong cc th nghim tin lm sng v lm sng, khng ghi nhn c tc dng khng cholinergic.
DC NG HC
Mizolastine c hp thu nhanh bng ng ung. Nng nh trong huyt tng t c
trung bnh sau 1,5 gi.
Sinh kh dng vo khong 65%.
Thi gian bn hy trung bnh l 13 gi vi t l gn kt vi protein l 98,4%.
bnh nhn suy gan, s hp thu mizolastine thp v thi kz phn phi k o di hn.
CH NH
iu tr triu chng cc trng hp vim kt mc mi d ng theo ma (st rm), vim kt mc
mi d ng quanh nm v ni m ay.
CHNG CH NH
- D ng vi mt trong cc thnh phn ca thuc.
- iu tr ng thi vi cc thuc khng sinh thuc h macrolide hoc cc thuc chng nm
thuc h imidazole.
- iu tr ng thi vi thuc c bit c tc dng k o di QT, nh cc thuc chng lon nhp

thuc nhm I v II.

- Bnh nhn c tin s ngt.
- Suy gan nng .
- Bnh l tim mch vi biu hin lm sng r hoc tin s ri lon tim mch.
- Bnh nhn c hoc nghi ng c QT ko di hoc mt cn bng v in gii, c bit l h kali
mu.
- Nhp tim chm ng k.
THN TRNG LC DNG
Mizolastine c tc dng nh trn vic ko di QT : ch gp mt vi trng hp.
Bnh nhn gi c bit nhy cm vi tc ng an thn ca mizolastine v tc dng ca thuc
trn s ti phn cc tim.
Li xe v vn hnh my mc :
Hu ht bnh nhn dng mizolastine u c th li xe hoc vn hnh my mc. Tuy nhin,
pht hin nhng bnh nhn nhy cm vi thuc, nn kim tra s p ng vi thuc ca tng c
nhn trc khi bnh nhn li xe hoc vn hnh my mc.
LC C THAI v LC NUI CON B
S an ton ca vic dng mizolastine ph n c thai cha c chng minh. Do khng
nn dng mizolastine khi mang thai, nht l 3 thng u ca thai kz.
Sau khi dng mizolastine, thuc c th hin din trong sa m, do khng nn dng
mizolastine khi ang cho con b.
TNG TC THUC
Khng nn phi hp vi :
- Cc thuc chng nm thuc h imidazole c gc ketoconazole hoc cc khng sinh thuc h
macrolide c gc erythromycine, troleandomycine, clarithromycine, josamycine : v s lm tng
nng mizolastine trong huyt tng.
Cn thn trng khi phi hp vi :
- Cimetidine, cyclosporine v nifedipine.
- Alcool : trong nhiu nghin cu khng thy c s gia tng tc dng an thn kinh v gim tc
dng ca thuc khi phi hp mizolastine vi alcool.
TC DNG NGOI
- Ng gt v suy nhc.
- Tng s ngon ming v tng cn.
Him hn :
- Kh ming.
- Ri lon tiu ha.
- au u.
- H huyt p, lo u, trm cm.

- Bt thng trong cng thc mu (bch cu, ng v cht in gii)

LIU LNG v CCH DNG
Ngi ln v tr em trn 12 tui : 1 vin/ngy.
QU LIU
Cn theo di, nht l QT v nhp tim t nht l 24 gi. Nghin cu bnh nhn suy thn cho
thy vn lm thm phn khng lm tng mc thanh thi ca thuc.

331.

MODALIME 100 mg

SANOFI SYNTHELABO VIETNAM

Vin nn 100 mg : v 14 vin, hp 2 v.
THNH PHN
cho 1 vin
Ciprofibrate

100 mg

CH NH
iu tr tng lipid mu nguyn pht bao gm tng cholesterol mu, tng triglycerid mu v tng
lipid mu hn hp sau khi tht bi bng ch n t m. Theo phn loi Fredrickson l
cc tp IIa, IIb, III v IV.
CHNG CH NH
Suy gan nng, suy thn nng, c thai v cho con b. Khng dng Modalim cho tr em di 12
tui.
THN TRNG LC DNG
Liu dng hng ngy khng nn vt qu 100 mg, liu dng t 200 mg tr ln thng i km
vi nguy c cao cc tc dng ph lin quan n c. S dng thn trng trn bnh nhn c suy
gan, suy thn. Nu sau nhiu thng iu tr, nng lipid mu vn khng c kim sot tt,
cn cn nhc n cc bin php iu tr khc hoc iu tr b sung.
LC C THAI v LC NUI CON B
Khng nn dng.
TNG TC THUC
V thuc gn kt cao vi protein huyt tng nn c th tranh chp vi cc thuc khc ti cc v
tr gn kt nn cn gim liu cc thuc khng ng ung nh warfarin v iu chnh liu da
trn thi gian prothrombin. D cha c cc d liu chuyn bit nhng dng nh ciprofibrate

lm tng tc dng cc thuc h ng huyt ung v tc dng ca n c l cng b nh hng

bi cc thuc nga thai ung. Cng nh cc fibrate khc, vic s dng chung Modalim vi cc
thuc nhm c ch men HMG-CoA reductase hay vi cc fibrate khc c th gy ra cc bnh l
v c.
TC DNG NGOI
Cc tc dng ph c th gp gm au u, chng mt, ni ban ngoi da, bun nn, nn, tiu
chy v kh tiu. Rng tc, bt lc, hoa mt, ng g, cm gic mt mi him gp. Cc tc dng
ph ny thng t va n nh v xy ra sm khi iu tr v gim dn khi tip tc dng thuc.
Nn kim tra chc nng gan nh kz khi dng thuc. Nn ngng dng Modalim khi cc bt
thng v men gan ko di.
LIU LNG v CCH DNG
Liu thng thng 1 vin mi ngy. Nn gim liu bnh nhn b suy thn (ung 1 vin mi 2
ngy) v phi theo di cn thn

332.

MONOTRATE

SUN PHARMA
Vin nn 20 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Isosorbide mononitrate

20 mg

T dc: Lactose BP, tinh bt BP, cellulose

vi tinh th BP, silicon dioxid keo NF, natri
propyl paraben BP , bronopol BP, talcum,
magnesi stearat BP, tinh bt natri glycolat
NF.
DC LC
Hot cht ca monotrate, isosorbid mononitrat BP pha long, l mt cht gin mch c s

dng rng ri trong iu tr bnh thiu mu cc b tim (au tht ngc). Monotrate ngn nga
c hiu qu cc giai on thiu mu cc b nh au/kh chu ngc, tng s dung np tp luyn
v iu chnh li nhng thay i ECG gy ra bi thiu mu cc b.
Tc ng ch yu ca monotrate l lm gin c trn ca mch to ra tc ng gin mch trn
c ng mch ngoi vi ln tnh mch vi tc ng chnh l trn tnh mch. S gin mch hu
mao qun, bao gm c tnh mch ln, lm tng cng s gp mu ngoi vi v lm gim mu
tnh mch tr v tim v do lm gim p sut tm tht tri cui kz tm trng (Tin gnh). S
gin ng mch lm gim sc cn mch ton thn v p sut ng mch (Hu gnh). Nhng tc
ng ny ca monotrate dn ti lm gim nhu cu oxy ca c tim.
Liu iu tr ca monotrate c th lm gim p sut tm thu, tm trng v p sut trung bnh
ng mch c bit v tr ng. Tuy nhin hiu qu trn ti mu mch vnh thng c
gi nguyn. Monotrate lm gim s tng bt thng ca p sut tm tht tri cui kz tm
trng v p sut mao qun phi xut hin trong nhng cn au tht ngc giai on cp.
Ngi ta cho rng monotrate lm gim thiu mu cc b c tim trong nhng cn au tht ngc
l do lm gim tiu th hay nhu cu oxy ca c tim (c o bng tch s t l p sut (pressurerate product), ch s trng lc - thi gian, ch s lm vic - t qu) v bng s nh hng c
li ln phng trnh cung cp - nhu cu.
Hot cht ca monotrate, isosorbid mononitrat, khng b chuyn ho s cp gan v do vy
gim s khc bit trong dc ng hc gia cc c th.
CH NH
Monotrate c dng ngn nga s xut hin ca nhng giai on thiu mu cc b trong
cn au tht ngc.
CHNG CH NH
Khng nn dng monotrate nhng bnh nhn c tin s qu mn cm hay c nhng p ng
c ng vi nitrit hay nitrat. S hin din ca thiu mu nng, tn thng u, xut huyt no,
h huyt p nng hay gim th tch mu cng l nhng chng ch nh cho vic s dng
monotrate. Khng nn s dng trong trng hp nhi mu c tim cp c p sut np mu
thp, thiu nng tun hon cp (sc, suy mch) hay huyt p rt thp.
CH PHNG v THN TRNG LC DNG
Ch { phng :
rt him bnh nhn, tnh nhy cm ng k i vi tc ng h huyt p ca nitrat biu l
s bun nn, i ma, mt mi, bn chn, xanh xao, ra m hi v suy nhc c th xut hin
liu iu tr thng thng ca monotrate.
u im ca iu tr bng nitrat (monotrate) trong giai on ngay sau cn nhi mu c tim
cha c xc nh. Nu mt ngi c chn s dng monotrate trong giai on sm sau
cn nhi mu c tim, cn tin hnh vic theo di huyt ng v thng xuyn nh gi lm
sng v hu qu tim tng ca h huyt p.

Alcol c th lm tng tc ng h huyt p ca monotrate. Triu chng suy tun hon c th

xut hin sau khi s dng liu u tin, c bit nhng bnh nhn c tun hon mu khng
n nh.
Thn trng lc dng :
Nn thn trng s dng monotrate khi c s gim th tch mu do iu tr bng thuc li tiu
v nhng ngi ang s dng mt thuc chng cao huyt p khc.
Nn thn trng mt cch thch ng khi s dng monotrate nhng bnh nhn b tng nhn p
cn th, thiu nng tuyn gip, thn nhit thp, suy dinh dng v bnh gan v thn nng.
Ch nn dng monotrate trong thi gian mang thai hay cho con b sau khi cn nhc gia li ch
thu c v nhng nguy c c th c. Tnh an ton v hiu qu ca isosorbid mononitrat
(monotrate) tr em th cha c xc nh.
TNG TC THUC
Tc ng gin mch ca isosorbid mononitrat - monotrate c th lm tng tc ng ca cc
thuc gin mch khc. Alcol cng lm tng thm tc ng loi ny. c nhng bo co v
triu chng h huyt p th ng r rt khi cc thuc chn knh calci v cc nitrat hu c c
dng kt hp. C th cn phi c s iu chnh liu ca cc loi thuc ny.
TC DNG NGOI
Monotrate c dung np tt hu ht bnh nhn. Tc dng ph nh nhc u v bng
mt, xut hin nh l mt tc ng qu mc ca s gin mch ca isosorbid mononitrat
thng c bn cht nh v thong qua v c khuynh hng bin mt sau khong mt tun iu
tr. Phn ng qu mn v nhng giai on chng mt hay mt mi thong qua c th i khi
xut hin mt vi bnh nhn. Bun nn v i ma c l khng thng gp khi dng isosorbid
mononitrat.
LIU LNG v CCH DNG
Dng ung.
C th bt u iu tr vi 10 mg mi ngy trong 2 ngy, sau l 3 ln mi ln 10 mg mi ngy
trong 3 ngy trnh cc tc dng ph c bn cht thong qua ph thuc vo liu. Ri sau ,
liu c th tng ln 20 mg hai n ba ln mi ngy. Hu ht cc bnh nhn p ng tt vi liu
trnh ny. Mt t bnh nhn cn liu cao hn, c th dng ti 40 mg hai n ba ln mi ngy.
Liu dng ti a khng nn vt qu 120 mg.
BO QUN
ni mt, trnh nh sng.

333.

MORIAMIN FORTE

HOECHST-MARION-ROUSSEL / ROUSSEL VIETNAM

[AVENTIS PHARMA]
Vin nang : hp 100 vin.
THNH PHN
cho 1 vin
L-Leucine
18,3 mg
L-Isoleucine
5,9 mg
L-Lysine
25 mg
L-Phenylalanine
5 mg
L-Threonine
4,2 mg
L-Valine
6,7 mg
L-Tryptophan
5 mg
DL-Methionine
18,4 mg
5-hydroxyanthranilic acid HCl
0,2 mg
Vitamin A
2000 UI
Vitamin D2
200 UI
Vitamin B1 nitrate
5 mg
Vitamin B2
3 mg
Nicotinamide
20 mg
Vitamin B6
2,5 mg
Folic acid
0,2 mg
Ca pantothenate
5 mg
Vitamin B12
1 mg
Vitamin C
20 mg
Vitamin E
1 mg
DC LC
Thuc kt hp 8 acid amin thit yu v 11 vitamin cn thit cho nhu cu hng ngy ca c th..
Ngoi ra, thuc cn cha 5-hydroxyanthranilic acid c tc dng kt hp cc acid amin thit yu
vi cc sinh t sao cho chng phi hp thnh mt cht dinh dng hiu qu cao.
CH NH
- Duy tr sc khe v phc hi sc khe khi b mt nhc.
- Duy tr sc lc trong cc iu kin nh nhit cao, m cao v lnh.
- Bi dng cho tr em, ph n c thai v m cho con b.
- Bnh beri-beri, bnh scorbut, bnh qung g, bnh ci xng, vim dy thn kinh.
LIU LNG v CCH DNG
1-2 vin/ngy. i vi tr em, c th ha tan phn bn trong ca vin thuc trong nc hoc
sa.

BO QUN
Gi thuc ni mt, kh ro v trnh nh sng.

334.

MORIAMIN S-2

HOECHST-MARION-ROUSSEL
[AVENTIS PHARMA]
Dung dch tim truyn tnh mch : chai thy tinh 500 ml, thng 10 chai.
Dung dch tim truyn tnh mch : ng thuc 20 ml, hp 50 ng.
THNH PHN
chai 500 ml
L-Leucine
L-Isoleucine
L-Lysine HCl
L-Mthionine
L-Phnylalanine
L-Thronine
L-Valine
L-Tryptophane
L-Arginine HCl
L-Histidine HCl.H2O
Glycine
D-Sorbitol
ng vi : Tng lng acide amine
ng vi : Nng acide amine
(Na+)
(Cl-)

6,150 g
2,750 g
11,150 g
3,550 g
4,350 g
2,70 g
3,050 g
0,90 g
4g
2g
5g
25 g
45,6 g
9,12%
(18 mEq/l)
(182 mEq/l)

ng thuc 20 ml
L-Leucine
L-Isoleucine
L-Lysine HCl
L-Mthionine
L-Phnylalanine
L-Thronine

0,246 g
0,110 g
0,446 g
0,142 g
0,174 g
0,108 g

L-Valine
L-Tryptophane
L-Arginine HCl
L-Histidine HCl.H2O
Glycine
D-Sorbitol
ng vi : Tng lng acide amine
ng vi : Nng acide amine
(Na+)
(Cl-)

0,122 g
0,036 g
0,160 g
0,080 g
0,20 g
1g
1,824 g
9,12%
(18 mEq/l)
(182 mEq/l)

DC LC
Dung dch m nng cao.
CH NH
Gim protide mu. Dinh dng km. Tin v hu phu.
THN TRNG LC DNG
Khng c dng trong cc trng hp:
- Hn m gan hoc c nguy c hn m gan.
- Suy thn nng hoc c ur huyt cao.
- Ri lon chuyn ha acide amine.
- Khng dung np fructose do di truyn.
Dng cn thn trong trng hp:
- Toan huyt nng.
- Suy tim sung huyt.
- ngi gi, chc nng sinh l{ thng gim, nn c bit cn thn bng cc bin php nh
gim liu lng, gim vn tc truyn...
TC DNG NGOI
Triu chng tng cm nh ni mn him khi xy ra, v nu c ngng dng thuc.
ng tiu ha : i khi c bun nn, i ma...
Tim mch : i khi c nng ngc, hi hp.
Truyn nhanh mt lng ln c th gy toan huyt.
Cc tc dng ph khc : c th c cm gic n lnh hoc nng bng, st, nhc u hoc au
dc tnh mch.
LIU LNG v CCH DNG
Ngi ln : thng dng 20-500 ml mi ln, bng cch tim tnh mch chm hoc truyn nh
git tnh mch. Nn truyn vi vn tc khong 10 g acide amine trong 60 pht thuc t
c hiu qu cao.
Thng vn tc chun l 200 ml trong 80-100 pht (khong 30-40 git/pht) i vi ngi ln.

 tr em, ngi gi hoc bnh nng, vn tc truyn phi chm hn.

Liu lng c th thay i ty theo tui, triu chng bnh v cn nng, nhng lng D-Sorbitol
khng c vt qu 100 g/ngy.
Lu { khi dng :
- Dung dch c cha Na+ (~ 18 mEq/l) v Cl- (~ 182 mEq/l), nn thn trng v cn bng in gii
trong trng hp truyn mt lng ln hoc dng phi hp vi mt dung dch in gii.
- Truyn tnh mch vi vn tc chm.
- Dung dch c th kt tinh, cn lm nng n 50-60oC, sau ngui li bng thn nhit
trc khi dng.
- Ch dng khi thy dung dch hon ton trong sut.
- Khng s dng chai thuc, ng thuc dng d dang.
- Chai 500 ml khng c ng dn kh. Ch ghim kim dn kh tc th ngay trc khi tim truyn cho
bnh nhn trnh b r r.
- ng 20 ml c mt im ct v c m bng cch bng vo c ng thuc theo ng hng
nghch vi im nh du mu xanh dng.

335.

MORIHEPAMIN

HOECHST-MARION-ROUSSEL
[AVENTIS PHARMA]
Dung dch tim truyn : ti nha 200 ml, thng 30 ti.
Dung dch tim truyn : ti nha 300 ml, thng 30 ti.
Dung dch tim truyn : ti nha 500 ml, thng 20 ti.
THNH PHN
cho 1 ti 200 ml
L-Isoleucine

1,840 g

L-Leucine

1,890 g

L-Lysine actate

0,790 g

L-Mthionine

0,088 g

L-Phnylalanine

0,060 g

L-Thronine

0,428 g

L-Tryptophane

0,140 g

L-Valine

1,780 g

L-Alanine

1,680 g

L-Arginine

3,074 g

Acide L-Aspartique

0,040 g

L-Histidine

0,620 g

L-Proline

1,060 g

L-Serine

0,520 g

L-Tyrosine

0,080 g

Acide amino actique

1,080 g

Tng lng acide amine

15,170 g

Nng acide amine

7,585 % (trng lng/th tch)

Cc cht khc
L-Cystine

0,050 g

Sodium bisulfite

0,050 g

cho 1 ti 300 ml
L-Isoleucine

2,760 g

L-Leucine

2,835 g

L-Lysine actate

1,185 g

L-Mthionine

0,132 g

L-Phnylalanine

0,090 g

L-Thronine

0,642 g

L-Tryptophane

0,210 g

L-Valine

2,670 g

L-Alanine

2,520 g

L-Arginine

4,611 g

Acide L-Aspartique

0,060 g

L-Histidine

0,930 g

L-Proline

1,590 g

L-Serine

0,780 g

L-Tyrosine

0,120 g

Acide amino actique

1,620 g

Tng lng acide amine

22,755 g

Nng acide amine

7,585 % (trng lng/th tch)

Cc cht khc
L-Cystine

0,750 g

Sodium bisulfite

0,750 g

cho 1 ti 500 ml
L-Isoleucine

4,600 g

L-Leucine

4,725 g

L-Lysine actate

1,975 g

L-Mthionine

0,220 g

L-Phnylalanine

0,150 g

L-Thronine

1,070 g

L-Tryptophane

0,350 g

L-Valine

4,450 g

L-Alanine

4,200 g

L-Arginine

7,685 g

Acide L-Aspartique

0,100 g

L-Histidine

1,550 g

L-Proline

2,650 g

L-Serine

1,300 g

L-Tyrosine

0,200 g

Acide amino actique

2,700 g

Tng lng acide amine

37,925 g

Nng acide amine

7,585 % (trng lng/th tch)

Cc cht khc
L-Cystine

0,125 g

Sodium bisulfite

0,125 g

DC LC
Morihepamin c cc c im nh sau :
Lng ln Arginine : arginine kch hot chu trnh ur gan chuyn ha ammoniac v lm
gim lng ammoniac trong mu.
T l Fischer (acide amine phn nhnh/acide amine thm) c nng cao do lng acide amine

phn nhnh tng :

- acide amine phn nhnh c chuyn ha thnh acide glutamique no v c, do lm
gim lng ammoniac.
- acide amine phn nhnh ngn chn s vn chuyn cc acide amine thm vo no, do vy, ci
thin c tnh trng ri lon acide amine no.
Lng thp cc acide amine sinh ammoniac : cc acide amine sinh amoniac nh glycine, serine,
threonine v lysine u c gim nng .
CH NH
Ci thin bnh no do gan trong suy gan mn.
THN TRNG LC DNG
Vic s dng cn ngng mt thi gian hay chuyn sang iu tr bng nhng phng cch khc
nu cng lc xut hin cc triu chng tm thn v thn kinh nng hn v tng nng
ammoniac trong mu.
Khng truyn cho nhng bnh nhn sau :
- bnh nhn suy thn nng ;
- bnh nhn c ri lon chuyn ha acide amine do nguyn nhn ngoi gan.
Dng cn thn cho nhng bnh nhn sau :
- bnh nhn toan huyt nng ;
- bnh nhn b suy tim sung huyt.
Dng cho ngi ln tui :
Cc chc nng sinh l{ ngi ln tui thng gim, do phi thn trng khi dng ; th d nh
gim liu.
Dng cho tr em :
Tnh an ton khi dng khi dng cho tr em cha c xc nhn (v cha c th nghim lm
sng).
Lu { khi s dng :
Dung dch cha khong 100 mEq/l ion acetate, khi truyn vi lng ln hoc kt hp vi cc
loi dung dch in gii khc cn lu { tnh trng ri lon in gii.
Cn truyn tnh mch chm.
TC DNG NGOI
- Mn cm : ni mn hoc cc triu chng tng t him khi xut hin, nu c cn phi ngng
truyn.
- H tiu ha : i khi c bun nn, i ma.
- H tun hon : i khi c nng ngc, hi hp hoc cc triu chng tng t.
- Chuyn ha ng : him khi c h ng huyt.
- Truyn nhanh hoc truyn s lng ln : truyn lng ln hoc tc nhanh c th gy toan
huyt, hoc i khi gia tng nng ammoniac thong qua do qu ti lng nitrogene.

- Cc triu chng khc : him khi c lnh run, st, nhc u, au dc mch mu hay tot m
hi.
LIU LNG v CCH DNG
Thng thng, 500 ml truyn tnh mch mt ln mi ngy ngi ln. Thi gian truyn 500 ml
thng khng di 180 pht.
Khi truyn tnh mch trung ng c th pha 500 ml vo dung dch glucose truyn trong 24
gi. Liu c th tng gim ty theo tui, triu chng bnh v cn nng.
Lu { khi truyn :
- y l mt dung dch c ch.
- Khng cn dng kim dn kh.
- Khng s dng khi dung dch, bnh thng trong sut, tr nn c mu, r r hoc c nc
ng trong bao.
- Khng s dng nu tm phim nim nt cao su ming bao b bc.
- Cht chng oxy ha c t trong bao nhm gi tnh n nh ca dung dch. Khng m bao
nu cha dng ngay. Khi m bao phi dng ngay.
- Khi pha thm cc thuc khc, chc kim thng gc vi nt cao su.
- Khi tri lnh cn si m n nhit c th trc khi dng.
- Dung dch c th kt tinh, cn lm m n 50-60oC, sau ngui bng nhit c th
trc khi dng.
- Khng dng nu dung dch khng hon ton trong sut.
- Khng dng dung dch truyn d dang.
MOTILIUM hn dch - MOTILIUM-M
JANSSEN PHARMACEUTICA
c/o JANSSEN-CILAG
c/o MEGA PRODUCTS
Hn dch ung 1 mg/ml : l 30 ml.
Vin nn 10 mg : v 10 vin, hp 100 vin.
THNH PHN
cho 1 mung lng
Domperidone

cho 1 ml

5 mg

Domperidone

1 mg

cho 1 vin
Domperidone maleate

10 mg

DC LC
Domperidone khng th th dopamine vi c tnh chng nn i tng t metoclopramide v
mt s thuc hng thn kinh khc. Tuy nhin, khc vi cc thuc ny domperidone khng d
dng qua c hng ro mu no. ngi s dng domperidone, c bit l ngi ln, tc
dng ph nh hi chng ngoi thp rt him gp, nhng domperidone thc y s tit
prolactin ti tuyn yn. Tc ng chng nn c th do s phi hp ca tc ng ngoi bin (vn
ng d dy) v vic khng th th dopamine ti vng cm ng ha CTZ (chemoreceptor trigger
zone) nm ngoi hng ro mu no. Nghin cu trn sc vt cho thy nng thp trong
no, ch r tc dng ca domperidone ch yu trn cc th th dopamine ngoi bin.
Nghin cu ngi cho thy ung domperidone lm gia tng thi kz co ca hang v-t trng,
gia tng qu trnh lm rng d dy vi thc n lng v c-lng ngi khe mnh v vi thc
n c bnh nhn c s chm lm rng d dy, v tng trng lc c tht thc qun di
ngi khe mnh. Thuc khng nh hng ln s tit ca d dy.
DC NG HC
nhng ngi i, domperidone hp thu nhanh sau khi ung, vi nng nh trong mu t
c khong 1 gi sau. Kh nng sinh hc thp ca domperidone ng ung (xp x 15%) l
do thuc c chuyn ha mnh qua giai on 1, thnh rut v gan. Mc d kh nng sinh
hc ca domperidone tng ln ngi bnh thng khi c dng sau ba n, bnh nhn c
than phin v tiu ha nn ung domperidone trc khi n 15-30 pht. Nng axit trong d
dy gim s lm gim s hp th domperidone. Kh dng sinh hc ng ung s gim nu
trc bnh nhn ung cimetidine hay sodium bicarbonate. Thi gian t nng nh s
hi chm v AUC s hi tng khi thuc c ung sau khi n.
Domperidone c v khng tch ly hay to ra chuyn ha ring, nng nh trong huyt
tng t c sau 90 pht l 21 ng/ml sau khi ung 30 mg/ngy trong 2 tun th hu nh
tng ng vi nng nh 18 ng/ml t c sau liu ung u tin. T l domperidone
gn kt protein huyt tng l 91-93%.
Nghin cu s phn phi thuc bng cch nh du phng x trn sc vt cho thy thuc c
phn b rng ri trong m c th nhng nng thp trong no. chut, mt s lng nh
thuc i qua nhau thai.Nng domperidone trong sa m bng 1/4 nng domperidone

trong mu.
Domperidone tri qua qu trnh chuyn ha nhanh v nhiu ti gan bng s hydroxyl ha v
kh N-alkyl. In vitro, th nghim v chuyn ha vi cht c ch bit trc cho thy CYP3A4 l
dng chnh ca cytochrome P-450 lin quan n s kh N-alkyl ca domperidone, trong khi
CYP3A4, CYP1A2 v CYP2E1 lin quan n s hydroxyl ha nhn thm ca domperidone. Thi
tr qua nc tiu v phn khong 31 v 66% liu ung. Mt phn nh thuc c thi ra ngoi
dng nguyn vn (10% qua phn v 1% qua nc tiu). Thi gian bn hy trong mu sau khi
ung liu n l 7-9 gi ngi khe mnh nhng k o di bnh nhn suy chc nng thn
trm trng.
CH NH
Cc triu chng n khng tiu m thng lin quan n s chm lm rng d dy, tro ngc
d dy thc qun v vim thc qun :
- Cm gic y bng, mau no, cng tc bng, au bng trn.
- y bng, y hi, hi.
- Bun nn, nn.
- Nng bng sau xng c c hoc khng km theo cht cha trong d dy ln ming.
Bun nn v nn do c nng, thc th, nhim trng hoc thc ch hoc nn do thuc hoc do
x tr. Ch nh c bit cho bun nn v nn gy ra do thuc ng vn dopamin dng bnh
nhn bnh Parkinson (nh L-dopa v bromocriptine).
CHNG CH NH
Khng c dng bnh nhn c bit l khng dung np vi thuc.
Khng c dng khi vic kch thch vn ng d dy c th nguy him nh ang xut huyt
tiu ha, tc rut c hc hoc thng tiu ha.
Motilium cng khng c dng bnh nhn c khi u tuyn yn tit prolactin (prolactinoma).
THN TRNG LC DNG
Khi dng cng lc vi cc thuc khng axit v thuc gim tit axit, cc thuc ny phi dng sau
ba n, ngha l chng khng c dng kt hp cng lc vi Motilium hn dch.
Tr nh nhi :
V chc nng chuyn ha v chc nng hng ro mu no cha pht trin hon chnh trong
nhng thng u i, mi thuc ch c dng tr nh nhi vi s cn trng cao v s gim
st y khoa cht ch.
V c th khng gy tc dng ph ln thn kinh trung ng ca domperidone phn ln do vic
km xm nhp qua hng ro mu no, nn nhng tc dng ph ny khng hon ton loi tr
tr nh hn 1 tui.
Ri lon chc nng gan :
Bi v domperidone c chuyn ha mnh gan nn thn trng khi dng bnh nhn ri
lon chc nng gan.

Ri lon chc nng thn :

bnh nhn suy thn nng (creatinin mu ln hn 6 mg/100 ml, ngha l ln hn 0,6 mmol/l),
thi gian bn hy domperidone trong huyt tng tng t 7,4 ln 20,8 gi, nhng nng
thuc trong huyt tng ngi tnh nguyn thp hn ngi khe mnh. Bi v mt lng
rt nh thuc di dng khng chuyn ha c thi tr qua thn, khng cn phi iu chnh
liu bnh nhn suy thn khi ch iu tr cp mt liu dng duy nht. Tuy nhin, vi vic s
dng lp i lp li, liu dng thng xuyn phi gim mc 1-2 ln/ngy, ty thuc vo mc
suy thn trm trng nh th no m cn phi gim liu. Ni chung bnh nhn m iu tr di
ngy phi c xem xt li u n.
nh hng ln kh nng li xe v vn hnh my mc :
Motilium khng nh hng ln s tnh to.
LC C THAI v LC NUI CON B
sc vt th nghim dng domperidone liu cao n 160 mg/kg/ngy khng gy tc dng sinh
qui thai. Tuy nhin, ging nh phn ln cc thuc khc, Motilium ch c dng cho ph n c
thai trong 3 thng u thai kz nu chng minh c li ch ca iu tr khi tin lng.
Cho n nay, khng c bng chng no ca s gia tng bt kz nguy c gy qui thai ngi.
Thuc c bi tit trong sa m chut (hu ht di dng cht chuyn ha : nng nh l
40 v 800 mg/ml sau liu ung v liu tnh mch 2,5 mg/kg, tng ng). ph n cho con b
nng thuc trong sa nh hn 4 ln nng trong huyt tng. Cha r l n c gy hi
cho tr s sinh hay khng v th ph n ang cho con b khng c khuyn khch dng
Motilium tr phi li ch mong i ca iu tr l nhiu hn nguy c tim tng.
TNG TC THUC
Dng cng lc thuc khng cholinergic c th lm mt tc dng iu tr n khng tiu ca
Motilium hn dch v Motilium-M.
Thuc khng axit v khng tit axit khng c dng kt hp vi Motilium hn dch v chng
lm cho kh dng sinh hc ng ung thp hn (xem Thn trng lc dng).
Con ng chuyn ha chnh ca domperidone qua CYP3A4. Cc d liu in vitro cp n cc
thuc s dng phi hp m gy c ch mnh men ny c th dn n kt qu l tng nng
domperidone trong mu.
V d cht c ch CYP3A4 nh :
- thuc khng nm azole,
- khng sinh h macrolid,
- thuc c ch HIV protease,
- nefazodone.
Theo l thuyt, v domperidone c tc ng ln vn ng d dy, n c th nh hng s hp
thu cc thuc ung ng thi, c bit l cc thuc gii phng hot cht ko di hoc thuc tan
ti rut. Tuy nhin, nhng bnh nhn ang dng digoxin hoc paracetamol, vic dng ng

thi vi domperidone khng nh hng nng ca nhng thuc ny trong mu.

Motilium hn dch v Motilium-M c th kt hp vi thuc :
- hng thn kinh, m khng lm gia tng tc dng ca cc thuc ny,
- thuc ng vn dopamin (bromocriptine L-dopa) nhm gim nh cc tc dng ph ngoi bin
ca chng nh ri lon tiu ha, bun nn, nn i.
TC DNG NGOI
Tc dng ph rt him, vi trng hp co tht rut thong qua c ghi nhn. Hin tng
ngoi thp him thy tr nh v khng gp ngi ln. Nu c, hin tng ny s phc hi
hon ton v nhanh chng ngay sau khi ngng thuc.
Bi v tuyn yn nm ngoi hng ro mu no, Motilium c th lm tng nng prolactine
trong mu. Trong nhng trng hp him gp ny, s tng prolactine trong mu c th gy ra
hin tng lin quan ni tit - thn kinh nh chng v to, s tng tit sa bt thng. Khi hng
ro mu no cha trng thnh (nh tr nh nhi) hoc bt thng, tc dng ph thn kinh
trung ng khng hon ton c loi tr. Him gp cc trng hp d ng, nh l pht ban v
ni m ay.
LIU LNG v CCH DNG
n khng tiu mn :
Ngi ln : mi ln 1 vin hoc 10 ml hn dch x 3 ln/ngy, 15-30 pht trc ba n v nu
cn thm 1 ln trc khi i ng.
Tr em : mi ln 1/2 vin hoc 2,5 ml hn dch/10 kg cn nng, 3 ln/ngy trc ba n v nu
cn thm 1 ln trc khi i ng.
Nu kt qu cha hi lng, liu trn c th tng gp i ngi ln v tr em trn 1 tui.
Trong cc trng hp cp v bn cp (c bit l bun nn v nn) :
Ngi ln : mi ln 2 vin hoc 20 ml hn dch, 3-4 ln trc ba n v trc khi i ng.
Tr em t 5-12 tui : mi ln 1 vin hoc 2 x 2,5 ml/10 kg cn nng, 3-4 ln trc ba n v
trc khi i ng.
Tr em di 5 tui : khng nn dng dng vin m ch nn dng Motilium hn dch.
Lu { :
- Nn ung thuc trc ba n. Nu ung sau khi n, s hp thu thuc c th b chm li.
- Bnh nhn suy thn, liu thng dng nn gim (xem Thn trng lc dng).
QU LIU
Triu chng :
Triu chng qu liu bao gm ng g, mt nh hng v phn ng ngoi thp, c bit tr
em.
iu tr :
Trong trng hp qu liu, cn iu tr vi than hot v theo di st bnh nhn.
Cc thuc khng tit cholin, thuc iu tr parkinson, hay thuc khng histamin vi c tnh

khng tit cholin c th gip ch trong vic kim sot cc phn ng ngoi thp.
BO QUN
Bo qun nhit 15-30oC

336.

MUCINUM l'extrait de cascara

INNOTECH
c/o ZUELLIG
vin bao : hp 20 vin.
THNH PHN
cho 1 vin
Sene, l, cao kh

30 mg

(lng tng ng vi heterosides

anthracenique c trnh by di dng
sennoside B vi lng ti thiu trong mt
vin : 2,1 mg)
Cascara, v, cao kh

40 mg

(lng tng ng vi heterosides

anthracenique c trnh by di dng
cascaroside A vi lng ti thiu trong
mt vin : 6,4 mg)
Boldo, bt l

50 mg

Anis vert, bt tri cy

30 mg

DC LC
Thuc nhun trng loi kch thch.
Thuc lm thay i s trao i nc-cht in gii rut v kch thch nhu ng i trng.
CH NH
iu tr ngn hn triu chng to bn ngi ln.
CHNG CH NH

Tuyt i :
- Bnh l{ vim i trng thc th (vim lot trc trng, bnh Crohn...).
- Hi chng tc nghn hoc bn tc.
- Hi chng au bng khng r nguyn nhn.
- Tnh trng mt nc nng c km mt cht in gii.
- Tr em di 10 tui.
Tng i :
- Cc thuc gy xon nh : xem Tng tc thuc.
- Tr em t 10 n 15 tui.
CH PHNG
Dng thuc ch l mt h tr trong iu tr bng ch v sinh v n ung :
- thm vo ch n cc loi thc n di dng thc vt c nhiu cht x v nc,
- nn hot ng th lc v tp thi quen i tiu hng ngy.
tr em, ch k toa thuc kch thch nhun trng trng hp tht c bit : do c nguy c lm
tr ngi hot ng bnh thng ca phn x i tiu.
Khng nn dng lu di thuc nhun trng (khng dng qu 8 n 10 ngy).
Dng lu di cc dn xut ca anthracenique c th dn n nhng ri lon sau :
- bnh do thuc nhun trng (rt him) vi bnh i trng chc nng nng, bnh nhim hc t
trc i trng, ri lon nc in gii km theo h kali trong mu,
- tnh trng l thuc vi nhu cu cn thuc nhun trng thng xuyn, i hi tng liu v gy
to bn nghim trng khi ngng thuc : s l thuc ny thay i khc nhau ty theo bnh
nhn, v c th xy ra m bc s khng bit.
LC C THAI
Khng nn dng cho ph n c thai.
LC NUI CON B
Khng nn dng cho ph n trong thi gian cho con b.
TNG TC THUC
Khng nn phi hp :
- Cc thuc gy xon nh :
- thuc chng lon nhp : amiodarone, bretylium, disopyramide, thuc nhm quinidine, sotalol.
- thuc khng chng lon nhp : ast mizole, b pridil, rythromycine tim tnh mch,
halofantrine, pentamidine, sparfloxacine, sultopride, terfnadine, vincamine.
C nguy c gy xon nh : h kali trong mu l mt yu t thun li ging nh trng hp nhp
chm v khong QT ko di. Dng thuc nhun trng khng gy kch thch.
Thn trng khi phi hp :
- Dn xut digitaline : h kali trong mu gy thun li cho cc tc dng c ca dn xut
digitaline. Theo di st kali mu v lm in tm nu c th ; dng thuc nhun trng loi

khng kch thch.

- Cc thuc h kali khc : cc thuc li tiu h kali mu (n c hay phi hp), amphotricine
B (ng tnh mch), corticoides (gluco, min ralo ng ton thn), t tracosactide : nguy c
cao gy h kali mu (phi hp tc dng). Theo di st kali mu v iu chnh liu nu cn ; dng
thuc nhun trng loi khng kch thch.
TC DNG NGOI
- C th gy tiu chy v au bng, c bit ngi c bnh i trng d b kch thch.
- C th gy h kali huyt.
- Thnh thong lm cho nc tiu c mu sc bt thng khng c { ngha lm sng.
LIU LNG v CCH DNG
Ch dng cho ngi ln.
1 n 2 vin, bui ti lc i ng.
Khng dng qu 8 n 10 ngy.

337.

MUCOLATOR

ABBOTT
Bt pha dung dch ung 200 mg : gi 3 g, hp 30 gi.
THNH PHN
cho 1 gi
Acetylcysteine

200 mg

T dc : Saccharose, natri saccharin, keo

dioxyd silic, mu vng cam S (E 110), mi
qut (dextrine, tinh du qut)
Hm lng saccharose : 2,74 g/gi.
DC LC
Tan long cht nhy.
CH NH
Thuc ny c tc dng bin i cht tit ca ph qun, lm cho s dn lu cht tit d dng khi
ho. Thuc ny dng thch hp khi c s ng trong ph qun i km vi cc trng thi nhim
trng b my h hp (cc bnh cp tnh ca ph qun v phi).

CHNG CH NH
bit c d ng vi mt trong cc thnh phn ca ch phm.
THN TRNG LC DNG
Khng dng thuc chng ho hoc thuc lm kh cht tit ca ph qun trong lc iu tr bng
Mucolator.
Dng Mucolator phi cn thn khi c lot d dy t trng.
Khi ang b tiu ng hoc ang theo ch hn ch ng, nn ch { n hm lng ng
ca thuc (mi gi c cha 2,74 g ng saccharose).
LC C THAI v LC NUI CON B
Cn thn trng khng dng thuc ny khi mang thai v trong thi kz cho con b.
TC DNG NGOI
C th c ri lon tiu ha (bun nn, tiu chy, au d dy). Trong trng hp ny cn phi
gim liu.
LIU LNG v CCH DNG
Dng ung.
Tr em 2 n 7 tui : 1 ln ung 1 gi, dng 2 ln/ngy.
Ngi ln v tr em trn 7 tui : 1 ln ung 1 gi, dng 3 ln/ngy.
Bt trong gi cn pha long trong mt na cc nc (nn ung trc cc ba n chnh).
Thi gian iu tr : Khng dng qu 8 n 10 ngy nu khng c nhng ch nh c bit.

338.

MUCOMYST oral

BRISTOL-MYERS SQUIBB
bt pha hn dch ung 200 mg : hp 30 gi.
THNH PHN
cho 1 gi
Actylcystine

200 mg

(Saccharose)

(1,28 g)

(Sodium)

(55 mg)

DC LC
Actylcystine l mt cht iu ha cht nhy bng cch lm tan m. Thuc tc ng trn giai

on gel ca cht nhy bng cch ct t cu ni disulfure ca cc glycoprot ine v do to

thun li cho s khc m.
DC NG HC
Ac tylcyst ine c hp thu nhanh : nng nh trong huyt tng t c sau 1 gi, sau
khi ung liu t 200 n 600 mg.
kh dng sinh hc t 4 n 10% liu s dng, phn ln do chu s bin i khi qua gan ln
u.
Ac tylcyst ine c chuyn ha thnh rt nhiu dn xut oxy ha.
Thi gian bn hy l 2 gi. Thanh thi thn chim khong 30% thanh thi ton phn.
CH NH
iu tr cc ri lon ca s tit ph qun, ch yu trong cc bnh ph qun cp tnh nh vim
ph qun cp tnh v giai on cp tnh ca cc bnh phi-ph qun mn tnh.
CH PHNG
Ho l yu t c bn bo v ph qun-phi nn cn phi c tn trng.
Vic kt hp thuc lm tan m v thuc chng ho v/hoc lm kh s tit m (tc dng
ging atropine) l khng hp l.
THN TRNG LC DNG
Cn thn trng nhng bnh nhn b lot d dy t trng.
Trng hp bnh nhn b tiu ng hoc ang theo ch n c ng, nn lu { n lng
ng c trong mi gi l 1,28 g.
LC C THAI
Cc kt qu ca cc nghin cu thc hin trn vt th nghim cho thy r thuc khng gy qui
thai. Do cn thiu s liu lm sng ngi, nn thn trng trnh dng thuc ny trong thi
gian mang thai.
LC NUI CON B
Khng nn dng thuc khi cho con b.
TC DNG NGOI
Vi liu cao, c th thy nhng hin tng ri lon v tiu ha (au d dy, bun nn, tiu
chy). Trong trng hp ny, cn gim liu.
LIU LNG v CCH DNG
Liu lng :
Ngi ln v tr em trn 7 tui : 600 mg/ngy, chia lm 3 ln, hay mi ln ung 1 gi, ngy 3
ln.
Tr em t 2 n 7 tui : 400 mg/ngy, chia lm 2 ln, hay mi ln ung 1 gi, ngy 2 ln.
Tr cn b di 2 tui : 200 mg/ngy, chia lm 2 ln, hay mi ln ung na gi, ngy 2 ln.
Cch dng :
Pha thuc trong mt t nc.

339.

MUCOTHIOL

LAPHAL
c/o HYPHENS
Bt ung 150 mg : hp 20 gi.
Vin nn 200 mg : hp 30 vin.
THNH PHN
cho 1 gi
N,S-Diacetylcysteinate de methyl

150 mg

cho 1 vin
N,S-Diacetylcysteinate de methyl

200 mg

DC LC
Thuc tan m.
N,S-Diacetylcysteinate de methyl l mt cht iu ha cht nhy bng cch lm tan m. Thuc
tc ng trn giai on gel ca cht nhy bng cch ct t cu ni disulfure ca cc
glycoprotein v do to thun li cho s khc m.
CH NH
iu tr cc ri lon ca s tit ph qun, ch yu trong cc bnh ph qun cp tnh nh vim
ph qun cp tnh v giai on cp tnh ca cc bnh phi-ph qun mn tnh.
CH PHNG v THN TRNG LC DNG
Ch { phng :
Trng hp ho m m, st hoc trong cc bnh phi v ph qun mn tnh, nn nh gi li
vic iu tr.
Ho l yu t c bn bo v ph qun-phi nn cn phi c tn trng.
Vic kt hp thuc lm tan m v thuc chng ho v/hoc lm kh s tit m (tc dng
ging atropine) l khng hp l.
Thn trng lc dng :
Cn thn trng nhng bnh nhn b lot d dy t trng.
Trng hp bnh nhn b tiu ng hoc ang theo ch n c ng, nn lu { rng dng

thuc bt c cha ng
LC C THAI v LC NUI CON B
Lc c thai :
Cc kt qu ca cc nghin cu thc hin trn vt th nghim cho thy r thuc khng gy qui
thai. Do cn thiu s liu lm sng ngi, nn thn trng trnh dng thuc ny trong thi
gian mang thai. Tuy nhin, cho n nay, cha c trng hp d tt no c ghi nhn khi dng
cho ph n c thai.
Lc nui con b :
Khng nn dng thuc khi cho con b.
LIU LNG v CCH DNG
Dng vin :
Ngi ln v tr em trn 7 tui : 600 mg/ngy, chia lm 3 ln, hay mi ln ung 1 vin, ngy 3
ln.
Ung thuc vi mt ly nc.
Dng bt :
Tr em t 2 n 7 tui : 600 mg/ngy, chia lm 4 ln, hay mi ln ung 1 gi, ngy 4 ln.
Ha tan thuc cha trong gi vo mt ly nc.
Hm lng ny khng ph hp cho tr di 2 tui.

340.

MUCUSAN suspension

UNITED LABORATORIES
Hn dch ung dng cho tr em 100 mg/5 ml : chai 30 ml.
Hn dch ung dng cho tr em 100 mg/5 ml : chai 60 ml.
THNH PHN
cho 5 ml
Carbocystine

100 mg

DC LC
Mucusan c hot cht chnh carbocystine l mt cht phn gii cht nhy hu hiu trong vic
gim ho i km theo s tit qu cht nhy dnh. Mucusan lm long cht tit ph qun bng
cch b gy cu ni disulfure lin kt cho cc chui peptide ca mucine m nhn cho vic gia

tng nht ca cht tit ph qun. Tnh cht ny lm gim qunh ca cht nhy, lm thay
i c ca m v do gip khc ra d dng hn cht nhy c lm long. Do ,
thuc lm gim mc trm trng v khong cch ca cc ln ho cng nh chng kh th.
Hot cht cng gip bnh thng ha chc nng tit cht nhy ca nim mc ph qun bng
cch ngn nga vim v gim bt tnh nht v n hi ca cht tit ph qun.
Mucusan vi dng bo ch thch hp, mi v d chu, d hp thu, rt thch hp cho vic s dng
tr em.
CH NH
Ri lon cp hay mn tnh ng h hp trn v di i km theo tit nhiu m nh vim
mi, vim xoang, vim ph qun cp v mn, kh ph thng v gin ph qun.
CHNG CH NH
Lot d dy t trng tin trin.
THN TRNG LC DNG
Cn thn trng vi nhng bnh nhn c tin s tng toan v nn trnh dng cho bnh nhn b
lo t ng tiu ha.
TC DNG NGOI
Bun nn, au u, kh chu d dy, tiu chy. i khi c xut huyt tiu ha, ni mn da.
LIU LNG v CCH DNG
Hn dch c mi du d ung.
Ung 3 ln mt ngy.
Di 2 tui : theo hng dn Bc s.
T 2 n 3 tui : mi ln 1 mung caf.
T 4 n 7 tui : mi ln 1,5 mung caf.
T 8 n 12 tui : mi ln 2-3 mung caf.

341.

MUXOL

LEURQUIN MEDIOLANUM
c/o KENI - OCA
vin nn 30 mg : hp 30 vin.
dung dch ung : chai 180 ml.
THNH PHN

cho 1 vin
Ambroxol

30 mg

cho 100 ml
Ambroxol

300 mg

DC LC
Thuc tan m.
Ambroxol l thuc iu ha s bi tit cht nhy loi lm tan m, c tc ng trn pha gel ca
cht nhy bng cch ct t cu ni disulfure ca cc glycoprotein v nh th lm cho s long
m c d dng.
DC NG HC
Ambroxol c hp thu tt qua ng tiu ha v t nng ti a trong huyt tng
khong 2 gi sau khi ung thuc.
Sinh kh dng ca thuc vo khong 70%.
Thuc c th tch phn phi cao chng t rng c s khuch tn ngoi mch ng k.
Thi gian bn hy khong 7,5 gi.
Thuc ch yu c o thi qua nc tiu vi 2 cht chuyn ha chnh di dng kt hp
glucuronic.
S o thi ca hot cht v cc cht chuyn ha ch yu din ra thn.
CH NH
iu tr cc ri lon v s bi tit ph qun, ch yu trong cc bnh ph qun cp tnh : vim
ph qun cp tnh, gii on cp tnh ca cc bnh ph qun - phi mn tnh.
CH PHNG v THN TRNG LC DNG
- Trng hp ho c m cn phi t nhin v l yu t c bn bo v phi - ph qun.
- Phi hp thuc long m hoc thuc tan m vi thuc ho l khng hp l.
- Nn thn trng bnh nhn b lot d dy - t trng.
LC C THAI v LC NUI CON B
Lc c thai :
Cc nghin cu trn ng vt cho thy thuc khng gy qui thai. Do cn thiu d liu ngi,
nn thn trng trnh dng thuc ny trong thi gian c thai.
Lc nui con b :
Khng nn s dng thuc ny trong thi gian cho con b.
TC DNG NGOI

C th xy ra hin tng khng dung np thuc (au d dy, bun nn, tiu chy). Trong
trng hp ny nn gim liu.
LIU LNG v CCH DNG
Ngi ln :
Dng vin : 2 n 4 vin mi ngy, chia lm 2 ln.
Dng dung dch ung : 2 mung canh mi ngy, chia lm 2 ln.

342.

MYCOSTATINE

BRISTOL-MYERS SQUIBB
vin bao 500.000 UI : hp 16 vin.
bt pha hn dch ung : chai 24 liu (mi liu 1 ml).
vin n n t m o 100.000 UI : hp 12 vin.
THNH PHN
cho 1 vin bao
Nystatine

500.000 UI

cho 1 liu hn dch ung

Nystatine

100.000 UI

cho 1 vin n n t m o
Nystatine

100.000 UI

DC LC
Thuc khng nm : tr vi nm candida.
Hot cht chnh ca Mycostatine l nystatine, y l mt khng sinh khng nm do tip xc
thuc h polyne, chit t nm Streptomyces noursei.
Ph tc ng khng nm : Trong th nghim, Mycostatine c tc dng trn rt nhiu loi vi
nm dng men hoc si. Trn thc t lm sng, Mycostatine c tc dng ch yu trn candida

v geotricum.
Thuc khng c tc dng khng khun hoc khng virus.
Thuc ch yu gy tc dng ti ch (do tip xc) : chng hn nh khi dng ng ung s iu
tr ti ch nhim trng do vi nm candida trn ng tiu ha.
DC NG HC
Tc ng tr vi nm candida ch yu l ti ch.
Dng bng ng ung, nystatine hu nh khng c hp thu qua nim mc ng tiu ha ;
nystatine c tm thy trong phn di dng khng b bin i.
CH NH
iu tr hoc h tr iu tr :
- nhim candida vng ming-hu v rut,
- nhim candida m o.
Ty theo c quan b nhim candida m chn thuc thch hp :
Vin bao :
- Nhim candida ming (nht l sau khi iu tr di hn bng khng sinh) : ta li, vim
ming, mt nh li, li b en, au hng do nhim candida, nhim candida vng thc qun
v bao t.
- Nhim candida rut v tt c cc bnh do vi nm candida m u tin c nhim trng
rut.
Hn dch ung :
- Dng ng ung cho tr nh nhi, tr cn nh tui v cc trng hp nhim candida nng
ming v hu.
- Dng ti ch : iu tr ngoi da (thm vo gc).
- Thoa ln nim mc (sang thng ming), nh vo m o (vim m o do vi nm candida,
vv).
Vin n n t m o :
- Nhim candida m h hoc m h-m o,
- H tr iu tr nhim candida ming.
CHNG CH NH
Qu mn cm vi nystatine.
CH PHNG
- Nu thiu cc triu chng lm sng gi m ch pht hin c candida da hoc nim mc th
khng th da vo ch nh thuc.
- Khi xc nh nhim vi nm candida, phi tm k cc yu t sinh thi cho php hoc to iu
kin thun li cho vi nm pht trin. Cn thanh ton hoc cha cc yu t thun li trnh ti
pht.
- Nn iu tr ng thi mi nhim candida gy bnh.

THN TRNG LC DNG

Trong thi gian iu tr bng Mycostatine ng ung, trnh dng ng thi bng ng ung
cc thuc iu chnh s chuyn vn rut, thuc bng nim mc ng tiu ha v ni chung
l tt c cc tc nhn c th cch ly hot cht thuc tip xc vi nim mc ng tiu ha, v
chng c th lm gim hiu lc ca nystatine.
TC DNG NGOI
- C th c d ng.
- Dng t m o trong mt vi trng hp ngoi l c th gy kch nim mc.
- Ngoi l c th gy mt s ri lon nh tiu ha : bun nn, tiu chy...
LIU LNG v CCH DNG
Ung thuc chia lm 3 hoc 4 ln trong ngy v xa ba n.
Vin bao :
- Tr em : 2 n 8 vin/ngy.
- Ngi ln : 8 n 12 vin/ngy.
Trng hp nhim candida ming-hu, nn nghin vin thuc ra trc khi s dng thuc
c th tip xc trc tip vi sang thng.
Thi gian iu tr t nht 3 tun l.
Bt pha hn dch ung :
- Nh nhi : 5 n 30 mung lng/ngy.
- Tr em : 10 n 40 mung lng/ngy.
Liu lng (vin bao v hn dch) c th tng v k o di trong nhng trng hp kh tr.
Vin n n t m o :
- Nhim candida m o : iu tr trong 20 ngy lin tip vi 1 n 2 vin/ngy. Nn lm m
vin thuc trc v t su trong m o.
BO QUN
Bt pha hn dch ung : nhit di 30oC.
Sau khi pha : gi c 7 ngy di 30oC v 10 ngy 5oC.

343.

MYDOCALM

GEDEON RICHTER
dung dch tim 100 mg/ml : ng 1 ml, hp 5 ng - Bng B.
vin bao 50 mg : v 10 vin, hp 3 v - Bng B.

vin bao 150 mg : v 10 vin, hp 3 v - Bng B.

THNH PHN
cho 1 ml thuc tim
Tolperisone chlorhydrate

100 mg

cho 1 vin
Tolperisone chlorhydrate

50 mg

cho 1 vin
Tolperisone chlorhydrate

150 mg

DC LC
Mydocalm l mt thuc gin c tc dng trung ng, c tc ng phc tp.
Nh lm bn vng mng v gy t cc b, Mydocalm c ch s dn truyn trong cc si thn
kinh nguyn pht v cc nron vn ng, qua c ch c cc phn x a synap v n
synap. Mt khc, theo mt c ch th hai, qua s c ch dng Ca2+ nhp vo synap, ngi ta
cho rng cht ny c ch gii phng cht vn chuyn. Trong thn no, Mydocalm c ch ng
phn x li - ty sng. Trn cc m hnh ng vt khc nhau, ch phm ny c th lm gim
trng lc c tng v s co cng sau khi mt no.
Mydocalm ci thin tun hon ngoi bin. Tc dng lm d dng tun hon khng ph thuc
vo nhng tc dng gp trong h thn kinh trung ng ; tc dng ny c th lin quan n tc
dng chng co tht nh v tc dng khng adrenergic ca tolperisone.
DC NG HC
Khi ung, tolperisone c hp thu tt qua rut non. Nng nh trong huyt tng xut
hin trong vng 0,5-1 gi sau khi dng thuc. Do c chuyn ha u tin mnh, nn sinh kh
dng ca ch phm ny khong 20%.
Tolperisone c chuyn ha mnh qua gan v thn. Hp cht ny c thi tr ch yu qua
thn (hn 99%) di dng cht chuyn ha.
Hot tnh dc l ca cht chuyn ha cha c bit. Sau khi tim tnh mch, thi gian bn
thi khong 1,5 gi.
CH NH
iu tr s tng trng lc c xng mt cch bnh l trong cc ri lon thn kinh thc th

(tn thng b thp, x va nhiu ch, tai bin mch no, bnh ty sng, vim no ty...).
Tng trng lc c, co tht c v cc co tht km theo cc bnh vn ng (v d : thoi ha t
sng, thp khp sng, cc hi chng tht lng v c, bnh khp ca cc khp ln).
Phc hi chc nng sau cc phu thut chn thng - chnh hnh.
iu tr cc bnh nghn mch (va x ng mch nghn, bnh mch mu do tiu ng, vim
mch to huyt khi nghn, bnh Raynaud, x cng b lan ta) cng nh nhng hi chng xut
hin trn c s suy gim s phn b thn kinh-mch (xanh tm u chi, chng kh i do lon
thn kinh - mch tng cn).
Bnh Little v nhng bnh no khc km theo lon trng lc c l nhng ch nh nhi khoa
c bit ca thuc ny.
CHNG CH NH
Nhy cm vi bt kz thnh phn no ca thuc.
Nhc c nng.
V thiu nhng kt qu nghin cu thch hp, nn chng ch nh dng thuc tim Mydocalm
cho tr em.
Chng ch nh tng i :
Mang thai, c bit trong 3 thng u ca thai kz. Khng nn dng Mydocalm trong thi kz cho
con b.
CH PHNG v THN TRNG LC DNG
Vi cc liu thp hng ngy, nn dng Mydocalm vin n n bao phim 50 mg iu tr cho tr
em.
LC C THAI v LC NUI CON B
Trn ng vt, tolperisone khng gy qui thai.
chut cng v th, c tnh vi phi xut hin sau liu ung 500 mg/kg th trng v 250
mg/kg th trng theo th t tng ng. Tuy nhin, nhng liu ny cao hn liu iu tr gp
nhiu ln.
V khng c nhng d kin lm sng thch hp, khng nn dng Mydocalm cho ngi mang thai
(c bit trong 3 thng u), tr khi tc dng c li cho m vt hn bt kz c tnh vi phi c
th c.
Tng t, cng v khng bit tolperisone c c bi tit qua sa m hay khng, nn khng
dng Mydocalm trong thi kz cho con b.
TNG TC THUC
Cha bit r tng tc thuc lm hn ch s dng Mydocalm. Mc d tolperisone l mt hp
cht tc dng trung ng, nhng khng gy ng, v vy c th c dng kt hp vi thuc
ng, thuc an thn, thuc an thn kinh.
Tolperisone khng nh hng ti tc dng ln h thn kinh trung ng ca ru.
Mydocalm lm tng mnh tc dng ca acid nifluminic, v vy, khi dng ng thi nn gim liu

acid nifluminic.
TC DNG NGOI
Nhc c, nhc u, h huyt p, bun nn, nn, au bng. Nhng tc dng ngoi ny
thng bin mt khi gim liu.
Him khi xy ra phn ng qu mn (nga, hng ban, m ay, ph thn kinh mch, sc phn v,
kh th).
LIU LNG v CCH DNG
Ngi ln :
Dng ng ung, liu hng ngy l 150-450 mg, c chia thnh 3 phn bng nhau ty theo
nhu cu v dung np ca tng ngi bnh. Dng ng tim, Mydocalm tim bp vi liu 100
mg x 2 ln/ngy; hay liu n 100 mg/ngy, nu tim tnh mch chm.
Tr em :
Thuc tim ny khng dng cho tr em. Nu dng cc vin nn bao phim, tr em di 6 tui c
th ung vi liu 5 mg/kg th trng/ngy, nhng liu ny c chia thnh 3 phn bng nhau.
Trong nhm 6-14 tui, liu hng ngy l 2-4 mg/kg th trng, nhng liu ny c chia thnh 3
phn bng nhau.
QU LIU
Nhng d kin v qu liu Mydocalm rt him. Mydocalm c ranh gii iu tr rng v trong y
vn, ngay c dng liu ung 600 mg cho tr em cng khng gy nhng triu chng nhim c
trm trng no.
C gp hin tng kch ng sau khi iu tr tr em vi liu ung 600 mg. Trong nhng nghin
cu c tnh cp tin lm sng, th liu cao Mydocalm c th gy tht iu, co git cng - run,
kh th, lit h hp.
Mydocalm khng c thuc gii c c hiu. Nu gp qu liu, nn iu tr h tr v iu tr
triu chng.
BO QUN
Vin nn bao phim : bo qun 15-30oC.
Thuc tim : bo qun ni mt (8-15oC), trnh nh sng.

344.

MYONAL

EISAI
c/o DIETHELM
vin nn 50 mg : v 10 vin, hp 3 v.
THNH PHN
cho 1 vin
Eperisone hydrochloride

50 mg

DC LC
Myonal lm tng c s gin c vn v tnh gin mch, do s tc ng ca thuc ln h thn kinh
trung ng v trn c trn mch mu. Myonal c hiu qu iu tr n nh trong vic ci thin
cc triu chng khc nhau c lin quan n s tng trng lc c, nh ct t cc vng xon
bnh l ca s co tht c vn.
Myonal tc ng ch yu trn ty sng lm gim cc phn x ty v to ra s gin c vn nh
lm gim s nhy cm ca thoi c thng qua h thng ly tm gamma. Thm vo , tc dng
gin mch ca thuc lm tng s tun hon. Do , Myonal bng mt phng php a dng,
ct t vng xon bnh l, m trong s co c khi pht s ri lon ca dng mu, sau
gy au v dn ti trng lc c gia tng hn na.
Myonal c chng minh l mt thuc c hiu qu v mt lm sng trong vic ci thin cc
triu chng tng trng lc c, nh s co cng ca vai, au t sng c, s co c kiu nhc
u, hoa mt, au tht lng v s co cng cc u chi - c th i km vi bnh l no ty, hi
chng t sng c, vim quanh khp vai v tht lng.
DC L LM SNG
Gin c vn
c ch s co cng c to ra do thc nghim :
Eperisone hydrochloride cho thy mt hiu qu c ch ph thuc vo liu trn s co cng mt
no do ct ngang phn c no (co cng gamma) v s co cng mt no do thiu mu cc b (co
cng a) mo v chut.
Lm gim phn x ty :
Eperisone hydrochloride lm gim in th n v a synap, c to ra do kch thch r thn
kinh ly tm ty sng mo. Tc dng ny ph thuc vo liu.
Gim s nhy cm ca thoi c :
Eperisone hydrochloride c ch hot ng ca si thn kinh hng tm (si Ia) t thoi c ca
ngi sau khi ung thuc 20 pht. Eperisone hydrochloride c ch s phng thch in t ca
cc nron vn ng gamma, nhng khng tc ng trc tip ln thoi c ca ng vt. V vy,
Eperisone hydrochloride lm gim s nhy cm ca thoi c thng qua cc nron vn ng

gamma.
Lm tng lu lng mu
Tc ng gin mch :
Eperisone hydrochloride lm tng cc tc dng hy giao cm c v i khng Ca2+ trn c trn
mch mu trong gin mch.
Lm tng lu lng mu :
Eperisone hydrochloride lm tng th tch dng mu da, c, ng mch cnh ngoi, ng
mch cnh trong v ng mch t sng.
Tc dng gim au v c ch phn x au
chut, Eperisone hydrochloride c tc dng c ch phn x au - khi kp vo ui chut - v
trung ha cht P, c l l mt trong nhng cht trung gian thn kinh lin quan n s truyn
cm gic au trong thn ty sng.
To s d dng trong vn ng t
Myonal c dng iu tr lit cng nhng bnh nhn lt no, lm ci thin nhng ng
cong lc quay Cybex v nhng biu c. Myonal lm cc vn ng ch ng c d dng,
nh s dui v gp cc chi, m khng lm gim sc c.
DC NG HC
Eperisone hydrochloride c s dng bng ng ung nhng ngi ln khe mnh vi
liu 150 mg/ngy, trong 14 ngy lin tc. Vo ngy th 1, 8 v 14, thi gian trung bnh dn ti
nng ti a nm trong khong t 1,6 n 1,9 gi. Nng ti a trung bnh l 7,5 n 7,9
ng/ml ; thi gian bn hy trung bnh l 1,6 n 1,8 gi v AUC (din tch di ng cong nng
huyt tng) l 19,7 n 21,1 ng.gi/ml. Nhng thng s nng trong huyt tng ca
Eperisone hydrochloride c o vo ngy th 8 v 14 th khng c s thay i ng k so vi
ngy u tin.
Hp thu, phn phi, chuyn ha v thi tr :
Khi 14C-Eperisone hydrochloride (Eperisone hydrochloride c nh du phng x 14C) c
s dng bng ng ung cho chut vi liu 50 mg/kg, hu ht lng thuc c hp thu qua
ng tiu ha v nng Eperisone hydrochloride di dng khng i trong huyt tng
thp. iu ny gi rng hiu qu hp thu u tin (first-pass) tng i cao. Sau khi ung 30
pht, nng phng x trong no, ty sng, thn kinh i v cc c khong bng vi nng
trong mu. Trong vng 5 ngy u tin sau khi dng thuc, 98% phng x ung c thu
hi, 77% t nc tiu, 21% t phn. Vo thi im 24 gi sau khi ung, 43% phng x c
bi tit theo mt. Pht hin ny cho thy Eperisone hydrochloride tham gia vo chu trnh rut gan. iu c thy chut, chut lang v ch sn. Eperisone hydrochloride c
chuyn ha thng qua s hydrate ha cc carboxylate, mt cht chuyn ha khng hot ng.
CH NH
Ci thin cc triu chng tng trng lc c lin quan n nhng bnh sau : hi chng t

sng c, vim quanh khp vai v tht lng.

Lit cng lin quan n nhng bnh sau : bnh mch mu no, lit cng do ty, thoi ha t
sng c, di chng sau phu thut (bao gm c u no ty), di chng sau chn thng (chn
thng ty, tn thng u), x cng ct bn teo c, bi no, thoi ha ty, bnh mch mu
ty v cc bnh l no ty khc.
THN TRNG LC DNG
Yu sc, chng mt hay bun ng c th xy ra khi dng thuc. Ngng dng hay gim liu khi
c du hiu u tin ca cc triu chng . Bnh nhn dng thuc khng nn li xe hay iu
khin my mc.
Nhng bnh nhn sau y yu cu cn thn khi dng thuc : bnh nhn c ri lon chc nng
gan.
LC C THAI v LC NUI CON B
Lc c thai :
S an ton ca Myonal trong sut thai kz cha c bit r. Thuc ny ch nn s dng cho
nhng bnh nhn mang thai hoc ph n nghi ng c thai, nu kt qu iu tr mong i c gi
tr hn bt kz mt nguy c no c th c.
Lc nui con b :
Myonal khng c khuyn co s dng nhng ph n ang cho con b. Nu cn thit phi
dng thuc, bnh nhn nn ngng cho con b.
TNG TC THUC
Mt bo co c cp n tnh trng ri lon iu tit mt xy ra sau khi dng ng thi
methocarbamol vi tolperisone hydrochloride (mt hp cht c cu trc tng t Myonal).
TC DNG NGOI
Tc dng ngoi t khi xy ra :
- Ri lon chc nng gan, thn, s lng hng cu hay gi tr hemoglobine bt thng. Nn
theo di cc chc nng trn hoc thc hin cc xt nghim huyt hc. Ngng thuc khi c du
hiu bt thng.
- Cc tc dng ngoi khc : pht ban, triu chng tm thn kinh nh mt ng, nhc u, bun
ng, cm gic co cng hay t cng, run u chi. Cc triu chng d dy-rut nh bun nn,
nn, chn n, kh ming, to bn, tiu chy, au bng hoc cc triu chng ri lon tiu ha
khc, cc triu chng ri lon tit niu.
LIU LNG v CCH DNG
Thng thng i vi ngi ln, ung 3 vin/ngy, chia lm 3 ln sau mi ba n. Liu lng
nn c iu chnh theo tui ca bnh nhn v mc trm trng ca triu chng.
BO QUN
Vin n n Myonal nn c lu tr nhit phng v trnh m t sau khi m bao b
ng gi

THUC VN N

345.

NACLOF

NOVARTIS OPHTHALMICS
Thuc nh mt : l nh git 5 ml.
THNH PHN
cho 1 ml
Diclofenac sodium

1,0 mg

(Thiomersal)

(0,04 mg)

DC LC
Naclof cha diclofenac sodium, cht non-steroid c tc dng khng vim v gim au.
C ch tc dng ca diclofenac c chng minh qua thc nghim l c ch s tng hp
prostaglandin. Prostaglandin ng mt vai tr quan trng trong sinh bnh hc ca phn ng
vim v au.
Khi c dng trc phu thut ly thy tinh th c, Naclof ngn chn s co ng t xy ra
trong lc phu thut. Naclof cng c tc dng khng vim khi c dng sau phu thut hoc
chn thng mt hoc cc tnh trng vim khng do nhim trng khc ca mt. Khi dng vi
mc ch d phng cho bnh nhn m ly thy tinh th c v t knh ni nhn, Naclof lm
gim tn sut v nng (nu c xy ra) ca ph hong im dng nang.
Khi nh mt, liu dng hiu qu mi ngy ch vo khong 0,25-0,5 mg (1 git x 3-5 ln/ngy) v
liu ny bng 1% liu Voltaren dng cho bnh nhn thp khp.
DC NG HC
Thc nghim trn th khe mnh cho thy diclofenac (nh du bng 14C) t nng ti a
trong gic mc v kt mc vo thi im 30 pht sau khi nh. Thuc c thi tr nhanh v
hon ton ra khi c th sau 6 gi.
ngi, kh nng ngm vo tin phng ca diclofenac c xc nhn.
Khng pht hin thy diclofenac trong huyt thanh ngi sau khi nh diclofenac sodium 0,1%
vo mt.

CH NH
Ngn chn s co ng t trong phu thut ly thy tinh th c.
Tnh trng vim sau phu thut ly thy tinh th c v cc can thip phu thut khc.
Dng trc v sau phu thut phng nga ph hong im dng nang trong phu thut ly
thy tinh th c v t thy tinh th nhn to.
Cc tnh trng vim khng do nhim trng ca phn trc mt (v d : vim kt mc mn tnh
khng do nhim trng).
Tnh trng vim sau chn thng xuyn thng v khng xuyn thng (kt hp vi iu tr khng
sinh ti ch).
CHNG CH NH
Bnh nhn c qu mn cm vi diclofenac hoc thiomersal.
Ging nh cc thuc khng vim khng corticoid khc, Naclof cng c chng ch nh i vi
bnh nhn suyn, ni m ay, hoc vim mi cp c cn nguyn do acetylsalicylic acid hoc cc
thuc c ch s tng hp prostaglandin khc.
THN TRNG LC DNG
Bnh nhn mang knh tip xc ch nn nh Naclof vo nhng lc khng mang knh. Trong
trng hp nhim trng hoc c nguy c nhim trng cao, cn kt hp cng lc vi cc iu tr
khc nh khng sinh.
Nu p ng iu tr khng tha mn, cn nh gi li chn on (nhim trng, qu mn cm
vi thuc).
Nu bnh nhn b m mt sau khi nh thuc th khng nn li xe hay vn hnh my.
LC C THAI v LC NUI CON B
Th nghim v c tnh trn s sinh sn ng vt cho thy khng c nguy c i vi thai
nhng cha c kim chng trn ph n mang thai.
Do cha c ti liu xc nhn tnh an ton ca Naclof trn ph n c thai hay cho con b, khng
nn dng thuc cho i tng ny tr trng hp bt buc.
Thai kz loi B.
TNG TC THUC
Cho n nay cha r.
C th kt hp Naclof vi cc thuc nh mt c cha corticoid nu cn thit.
ngn nga thuc chy ra ngoi, nn nh cc thuc cch nhau ti thiu 5 pht.
TC DNG NGOI
Cc th nghim trn lm sng ghi nhn nhng phn ng ph sau :
Thnh thong xt nh hoc va thong qua v/hoc m mt ngay sau khi nh thuc.
Him : phn ng qu mn cm di dng nga, v nhy cm nh sng.
LIU LNG v CCH DNG
Ngi ln :

- Trc phu thut : nh mt 5 ln, mi ln 1 git trong vng 3 gi trc phu thut.
- Sau phu thut : ngay sau phu thut, nh 1 git, lp li 3 ln ; sau , nh 3-5 ln mi ngy
cho n khi t hiu qu iu tr.
- Cc ch nh khc : nh 1 git, 4-5 ln mi ngy, ty thuc nng nh ca bnh.
Ch cn nhc vic iu tr lu di khi nh gi k ch nh v khm mt cn thn. Ni chung,
khng nn dng thuc lu hn vi tun. Cha c kinh nghim nhiu trong vic dng thuc lu
di.
Tr em :
Cha c nghin cu c th v vic dng Naclof tr em nhng ti liu ghi nhn c th dng
Voltaren dng ung v dng ta dc cho tr trn 12 thng tui.
QU LIU
Vic ung lm Naclof khng gy tc dng ph g v mt l thuc nh mt 5 ml ch cha 5 mg
diclofenac sodium, lng ny tng ng khong 3% liu ung ti a dng cho ngi ln.
BO QUN
ng np li sau mi khi dng. Khng nn dng mt chai thuc lu hn mt thng sau khi
m np.

346.

NASONEX

SCHERING-PLOUGH
Dung dch xt mi 50 mg/ln xt : bnh xt 40 liu, 120 liu - Bng B.
THNH PHN
cho 1 ln xt
Mometasone furoate monohydrate, tnh theo mometasone furoate

50 mg

M T
Thuc nc xt mi Nasonex l mt bnh xt c bm phn liu bng tay, cha mt hn dch
ca mometasone furoate. Mi ln n bm phn liu cung cp khong 100 mg hn dch
mometasone furoate, cha mt lng mometasone furoate monohydrate tng ng vi 50
mg mometasone furoate.
T dc : cellulose, glycerol, citric acid monohydrate, natri citrate dihydrate, polysorbate 80,
benzalkonium chloride, phenylethyl alcohol v nc tinh ch.
Cht bo qun : benzalkonium chloride 0,2 mg/g v phenylethyl alcohol 2,5 mg/g.

DC LC
Mometasone furoate l mt corticosteroid dng ngoi vi tnh cht chng vim ti ch cc
liu khng c cc tc dng ton thn.
DC L LM SNG
Mometasone furoate dng dng xt mi c sinh kh dng ton thn khng ng k (<= 0,1%) v
ni chung khng pht hin c trong huyt tng, mc d s dng mt ph p nh lng nhy
vi gii hn xc nh thp 50 pg/ml ; do , khng c d liu dc ng hc tng ng cho
dng dng ny. Hn dch mometasone furoate hp th rt km bi ng tiu ha v mt
lng nh c th c nut v hp th tri qua mt qu trnh chuyn ha bc u rng ri
trc khi thi tr theo nc tiu v mt.
Trong cc nghin cu dng cc khng nguyn ng mi, Nasonex cho thy c tc dng khng
vim c cc p ng d ng pha sm v mun. N c chng t bi s gim (so vi
placebo) ca histamin v cc bch cu a eosin, bch cu trung tnh v cc protein kt dnh t
bo biu m.
CH NH
Nasonex c ch nh cho ngi ln v tr em trn 12 tui iu tr cc triu chng vim
mi theo ma v vim mi d ng quanh nm.
cc bnh nhn c tin s cc triu chng trung bnh n nng ca vim mi d ng theo ma,
iu tr d phng bng Nasonex c khuyn dng 2 n 4 tun trc thi gian d kin bt
u ca ma phn hoa.
CHNG CH NH
Mn cm vi bt c thnh phn no ca thuc.
THN TRNG LC DNG
Nasonex khng c dng khi c cc nhim trng khu tr khng c iu tr nim mc mi.
V tc dng c ch s lnh vt thng ca cc corticosteroid, cc bnh nhn va qua phu
thut mi hay chn thng mi khng c dng corticosteroid ng mi cho ti khi lnh.
Sau 12 thng iu tr vi Nasonex, khng c bng chng v s teo nim mc mi ; cng nh
vy, mometasone furoate c khuynh hng lm phc hi nim mc mi gn vi kiu hnh m
hc bnh thng. Cng nh vi bt kz iu tr di hn no, cc bnh nhn dng Nasonex trong
vi thng hoc di hn phi c kim tra nh kz v cc thay i c th c nim mc mi.
Nu xut hin nhim nm khu tr mi hoc hng, ngng dng Nasonex hoc c th yu cu
iu tr thch hp. Kch ng mi hng dai dng c th l mt ch nh ngng dng Nasonex.
Thn trng khi dng Nasonex cho bnh nhn b nhim trng lao ng h hp khng hot ng
hoc hot ng, hoc cc nhim trng virus ton thn, vi khun, nm cha c iu tr hoc
herpes simplex mt.
Khng c bng chng suy trc tuyn di i-tuyn yn-thng thn (HPA) sau khi iu tr ko
di vi Nasonex. Tuy nhin cc bnh nhn chuyn t s dng di hn cc corticosteroid ng

ton thn sang dng Nasonex cn c theo di cn thn. Ngng dng corticosteroid ng
ton thn cc bnh nhn ny c th dn n suy thng thn trong mt s thng cho ti khi
chc nng ca trc HPA hi phc. Nu cc bnh nhn ny c du hiu v triu chng ca suy
thng thn, phi dng li corticosteroid ng ton thn, ng thi cc phng php iu tr
v nh gi phi c tin hnh.
Trong khi chuyn t dng corticosteroid ng ton thn sang dng Nasonex, vi bnh nhn c
th b cc triu chng ca vic ngng dng cc corticosteroid tc dng ton thn (v d au
khp v/hoc c, mt mi v bt u suy nhc), tuy nhin cc triu chng mi s thuyn gim
v vn c tip tc vic tr liu vi Nasonex. S chuyn thuc nh vy cng c th lm bc l cc
tnh trng d ng tn ti t trc nh vim kt mc d ng v eczema, b c ch trc bi
tr liu vi corticosteroid ng ton thn.
Cc bnh nhn dng corticosteroid m b c ch min dch phi c cnh bo v nguy c
ca vic tip xc vi cc nhim trng (v d thy u, si) v tm quan trng ca vic xin kin
ca thy thuc nu c cc tip xc nh vy.
Sau khi dng cc corticosteroid phun m vo mi, cc trng hp c bit thng vch ngn mi
hoc tng p sut ni nhn c bo co l rt him.
LC C THAI v LC NUI CON B
Khng c cc nghin cu c kim sot tt hoc y trn ph n c thai. Sau khi xt mi
liu khuyn co lm sng ti a cho bnh nhn, nng mometasone trong huyt tng l
khng o c, nh vy s tip xc ca thai nhi vi thuc c xem l khng ng k v kh
nng c tnh trn s sinh sn l rt thp.
Cng nh cc ch phm corticosteroid dng cho mi khc, Nasonex ch nn dng cho ph n c
thai, cho con b hoc ph n tui sinh sn khi li ch c th c ln hn nguy c tim tng cho
ngi m, thai nhi v tr nh. Tr em c m dng corticosteroid trong khi mang thai phi c
theo di k v chng suy thng thn.
TNG TC THUC
Thuc nc xt mi Nasonex c dng ng thi vi loratadine m khng c tc ng
r rng no v nng ca loratadine hoc cc cht chuyn ha chnh ca n trong huyt
tng. Nng mometasone furoate trong huyt tng l khng pht hin c. iu tr phi
hp c dung np tt.
TC DNG NGOI
Cc phn ng bt li ti ch lin quan n iu tr c bo co trong cc nghin cu lm sng
bao gm chy mu cam (bao gm chy mu, nim mc nhum mu mu v vt mu lm m
(8%), vim hng (4%), rt mi (2%) v kch ng mi (2%), chng l cc c trng c thy khi
dng thuc xt mi corticosteroid. Chy mu cam ni chung c t kim sot v nh v mc
, v xy ra t l cao hn so vi placebo (5%) nhng t l tng ng hoc thp hn so
vi cc corticosteroid dng iu tr mi c nghin cu (ti 15%). T l b cc tc dng khc l

tng ng vi placebo.
LIU LNG v CCH DNG
Sau ln u mi bm Thuc nc xt mi Nasonex (thng n 6 n 7 ln cho ti khi thy
thuc xt ra l ng u), mi ln n cung cp khong 100 mg hn dch mometasone furoate,
cha mt lng mometasone furoate monohydrate tng ng vi 50 mg mometasone
furoate. Nu khng dng bm xt trong 14 ngy hoc hn, phi mi li bm trc khi dng ln
tip theo.
Lc k l trc mi ln dng.
Ngi ln (bao gm c bnh nhn gi) v tr em t 12 tui tr ln : Liu khuyn co thng
thng phng bnh v iu tr l 2 ln xt (50 mg mi ln xt) vo mi bn mi (tng liu 200
mg). Ch khi cc triu chng c kim sot, liu gim xung 1 ln xt cho mi bn mi (tng
liu 100 mg). Nn gim liu sau khi kim sot c cc triu chng.
Thi gian bt u tc dng ng k v lm sng xy ra 12 gi sau liu u tin.
QU LIU
V sinh kh dng h thng khng ng k (<= 0,1%) ca Nasonex, khi dng qu liu khng cn
bt kz iu tr no ngoi tr vic theo di, sau bt u dng liu c k thch hp.
BO QUN
Bo qun ni mt, di 25oC.

347.

NATALVIT

AMERIPHARM
c/o O.P.V. (OVERSEAS)
Vin nn : hp 30 vin, 100 vin.
THNH PHN
cho 1 vin
Vitamin A

4000 UI

Vitamin C

100 mg

Vitamin D

400 UI

Vitamin E

11 UI

Thiamin

1,5 mg

Riboflavin

1,7 mg

Niacin

18 mg

Vitamin B6

2,6 mg

Folate

800 mg

Vitamin B12

4 mg

Calcium

200 mg

St

60 mg

Km

25 mg

CH NH
B sung y ngun vitamin v khong cht cn thit cho ph n trong giai on trc, trong
thai kz v trong thi gian cho con b, gp phn gim thiu cc ri lon thng gp trong khi
mang thai nh nn i, thiu mu, chut rt v gim cc ri lon ca tr do khng cung cp
vitamin v khong cht cho ngi m trong thi kz mang thai.
CH PHNG v THN TRNG LC DNG
Nn gi thuc trnh xa tr em. Trong trng hp ung qu liu, phi bo ngay cho bc s.
LIU LNG v CCH DNG
Mi ngy 1 vin hoc ty theo s hng dn ca bc s.
BO QUN
Bo qun ni kh ro nhit phng 15-30oC.

348.

NATRILIX SR

LES LABORATOIRES SERVIER

vin bao phim phng thch chm 1,5 mg : hp 30 vin - Bng B.
THNH PHN

cho 1 vin
Indapamide hemihydrate

1,5 mg

DC LC
Thuc li tiu on pha long v thn.
Indapamide l mt dn xut sulfonamide c 1 vng indole, lin quan v mt dc l hc vi cc
thuc li tiu thiazide, tc dng bng cch c ch s hp thu natri on pha long ca v
thn.
Thuc lm tng bi tit natri v chlor ra nc tiu v tng bi tit kali v magne mc t
hn, bng cch gia tng li tiu v thc hin mt hot ng chng cao huyt p. Cc nghin
cu giai on II v giai on III trong n tr liu chng t mt hiu qu chng cao huyt p
ko di 24 gi. Hiu qu ny t c nhng liu lng ch hi gy ra li tiu. Hot ng
chng cao huyt p ca n lin quan n s ci thin sc n hi ca ng mch v gim khng
lc tiu ng mch v khng lc mch mu ngoi bin ton th. N lm gim ph i tht tri.
Tc dng iu tr t n mt mc n nh khi vt qu mt liu no , trong khi cc tc dng
ngoi { gia tng : khng gia tng liu khi khng t hiu qu iu tr.
Ngi ta cng chng t bnh nhn cao huyt p, qua mt thi gian ngn, trung bnh v
di, rng :
- indapamide khng can thip vo chuyn ha lipide : triglycerides, LDL v HDL.
- indapamide khng can thip vo chuyn ha carbonhydrate, ngay c bnh nhn tiu ng
cao huyt p.
DC NG HC
Natrilix SR c cung cp dng phng thch ko di, bao gm mt h thng cht cn bn vi
s phn b bn trong mt gi , iu ny cho php s phng thch ko di ca indapamide.
- Hp thu : phn indapamide phng thch c hp thu nhanh chng v hon ton bi ng
tiu ha. Thc n lm tng tc hp thu nhng khng nh hng n lng lng thuc
c hp thu. Cc nng nh trong huyt tng xy ra khong 12 gi sau liu duy nht. Cho
thuc lp li hn ch cc bin i v nhng nng huyt tng gia 2 liu. C s thay i
ng k tng ngi.
- Phn b : 79% thuc gn vi protein huyt tng. Thi gian bn thi trong khong 14-24 gi
(trung bnh 18 gi). Tnh trng n nh t n sau 7 ngy.
Cho thuc lp li khng gy tch t thuc.
- Chuyn ha : indapamide c thi tr ch yu qua nc tiu (70% liu lng) v phn (22%)
dng cc cht chuyn ha khng hot ng.
- Dn s c nguy c : cc thng s dc ng hc khng b thay i nhng bnh nhn suy
thn.

CH NH
Cao huyt p.
CHNG CH NH
- Tng cm vi cc sulfonamide.
- Suy thn nng.
- Bnh l gan no hoc suy thn nng.
- H kali mu.
CH PHNG v THN TRNG LC DNG
Ch { phng :
Thiazide v cc thuc li tiu lin quan c th gy ra bnh l gan no cc bnh nhn suy chc
nng gan. Phi ngng ngay iu tr bng thuc li tiu trong trng hp ny.
Thn trng lc dng :
Cn bng nc v in gii :
- Natri huyt thanh :
Natri huyt thanh phi c nh gi trc khi bt u iu tr, v sau cc khong cch
u n. Tt c cc iu tr bng thuc li tiu c th gy ra h natri mu, i khi c cc hu
qu nghim trng. V h natri mu lc u khng c triu chng nn theo di u n l iu
thit yu v phi thc hin thng xuyn hn cc dn s c nguy c cao, nh bnh nhn
ln tui v x gan (xem phn Tc dng ngoi v Qu liu).
- Kali huyt thanh :
Mt kali v h kali mu l nguy c chnh ca thiazide v cc thuc li tiu lin quan. Nguy c
pht trin h kali mu (< 3,4 mmol/l) phi c ngn nga mt s dn s nguy c cao, nh
cc bnh nhn ln tui v/hoc dinh dng km v/hoc cc bnh nhn ang ch iu tr
nhiu thuc, bnh nhn x gan c ph v c chng, v cc bnh nhn c bnh l tim do mch
vnh hoc suy tim. Trong cc tnh hung ny h kali mu lm tng thm c tnh trn tim ca
digitalis alkaloid v nguy c lon nhp. Cc bnh nhn c khong QT ko di do bm sinh hoc
do dng thuc cng c nguy c b h kali mu. H kali mu (ging nhp tim chm) l mt yu t
dn a n s pht trin ca lon nhp nng, c bit l xon nh, c kh nng gy t vong.
Kali huyt thanh phi c theo di thng xuyn hn trong mi trng hp ny. nh gi kali
huyt thanh u tin phi c thc hin trong tun l u iu tr. Khi pht hin h kali th
phi iu chnh.
- Calcium huyt thanh :
Cc thuc li tiu thiazide c th lm gim s bi tit calcium qua nc tiu v gy mt s gia
tng calcium mu nh thong qua. Tng calcium mu r rt c th lin quan vi cng tuyn
cn gip khng c chn on. Ngng iu tr trc khi kim tra chc nng tuyn cn gip.
ng mu :
ng mu phi c theo di cc bnh nhn tiu ng, c bit khi c h kali mu.

Acid uric :
Nguy c cc t thng phong b tng ln bnh nhn tng acid uric trong mu.
- Chc nng thn v cc thuc li tiu :
Thiazide v cc thuc li tiu lin quan ch c tc dng y khi chc nng thn cn y
hoc ch thay i nh (creatinine huyt thanh < 25 mg/l, ngha l 220 mmol/L ngi ln).
ngi ln tui, mc creatinine huyt thanh phi c iu chnh theo tui, cn nng v gii
tnh. Gim th tch mu, th pht sau mt nc v natri gy bi thuc li tiu vo lc bt u
iu tr, gy ra gim tc lc cu thn, c kh nng a n tng urea mu v creatinine
huyt thanh. Suy thn chc nng thong qua khng c hu qu lm sng cc bnh nhn c
chc nng thn bnh thng, nhng c th lm nng suy thn c sn.
- Vn ng vin :
Cc vn ng vin phi c thng bo cho bit rng thuc ny c cha mt hot cht c th
gy ra phn ng dng tnh trn cc x t nghim tm sot thuc doping.
Cc tc dng trn kh nng li xe v s dng my mc :
Natrilix SR khng lm thay i s tnh to, nhng vi phn ng c nhn, trong mi tng quan
vi s gim p lc ng mch, c th thay i, c bit vo lc bt u iu tr hoc khi kt
hp vi mt thuc chng cao huyt p khc. Do , kh nng li xe hoc s dng my mc c
th b gim.
LC C THAI v LC NUI CON B
Lc c thai :
Nh l mt nguyn tc, trnh k toa thiazide v cc thuc li tiu lin quan cho ph n c thai
v khng bao gi dng iu tr chng ph sinh l ph n c thai, vi nguy c thiu dng
thai.
Lc nui con b :
V thuc c khuch tn vo trong sa m, khuyn khng nn cho con b trong lc iu tr.
TNG TC THUC
Khng nn phi hp :
- Lithium : tng mc lithium huyt thanh vi cc du hiu qu liu, nh vi mt ch n king
t mui (bi tit lithium qua nc tiu gim). Tuy nhin, khi Natrilix c v cn thit, th cn theo
di st lithium huyt thanh v liu lng phi c iu chnh theo .
- Cc thuc khng chng lon nhp gy ra xon nh (astemizole, bepridil, erythromycin (IV),
halofantrine, pentamidine, sultopride, terfenadine, vincamine) : xon nh (h kali mu, chm
nhp tim, v khong QT di c sn l cc yu t thun li). S dng cc thuc khng gy xon
nh cc bnh nhn c h kali mu.
Thn trng khi phi hp :
- Thuc khng vim non-steroid (ton thn), salicylates liu cao : c th lm gim tc dng
chng cao huyt p ca indapamide. Suy thn cp bnh nhn mt nc (gim tc lc cu

thn). Bi ph nc cho bnh nhn v theo di chc nng thn vo lc bt u iu tr.

- Cc cht h kali mu khc : amphotericin B (IV), glucocorticoids (ton thn),
mineralocorticoids, cosyntropin, cc thuc nhun trng kch thch : gia tng nguy c h kali
mu (tc dng ph thm). Theo di v nu cn thit th iu chnh kali huyt thanh, thn trng
c bit trong trng hp iu tr digitalis. S dng cc thuc nhun trng khng kch thch.
- Baclofen : lm mnh thm tc dng h huyt p.
Bi ph nc cho bnh nhn, theo di chc nng thn lc bt u iu tr.
- Digitalis alkaloids : h kali mu lm r thm nhng tc dng c ca digitalis alkaloids. Theo
di kali huyt thanh v ECG v xem xt li iu tr khi thch hp.
Cn nhc khi phi hp :
- Cc thuc li tiu gi kali (amiloride, spironolactone, triamterene) :
S kt hp hp l ny, hu ch vi bnh nhn, khng loi tr c kh nng h kali mu hoc,
c bit cc bnh nhn suy thn v tiu ng, l tng kali mu. Theo di kali huyt thanh v
ECG v xem xt li iu tr khi thch hp.
- Cc thuc c ch men chuyn : nguy c h huyt p t ngt v/hoc suy thn cp trong lc
a vo iu tr mt thuc c ch men chuyn trng hp c sn mt natri (c bit
nhng bnh nhn b hp ng mch thn).
Trong cao huyt p, khi iu tr li tiu trc c th gy ra mt natri :
- thuc li tiu phi c ngng 3 ngy trc khi bt u iu tr bng mt thuc c ch men
chuyn, v mt thuc li tiu h kali mu nn c dng tr li khi cn thit ;
- hoc bt u vi thuc c ch men chuyn liu lng thp, v gia tng liu t t.
Trong suy tim huyt, bt u bng liu rt thp thuc c ch men chuyn, sau khi gim liu
ca thuc li tiu h kali mu kt hp.
Trong mi trng hp, theo di chc nng thn (o cr atinine huyt thanh) trong tun l u
iu tr bng thuc c ch men chuyn.
- Cc thuc chng lon nhp gy xon nh : loi Ia (quinidine, hydroquinidine, disopyramide),
amiodarone, bretylium, sotalol : xon nh (h kali mu, chm nhp tim, v khong QT ko di
c trc l cc yu t thun li).
Phng nga v, nu cn, iu chnh kali mu : theo di khong QT. Trong trng hp xon
nh, khng cho dng thuc chng lon nhp [my to nhp (pacemaker)].
- Metformin : toan ha acid lactic do metformin c khi pht bi suy thn chc nng lin
quan n cc thuc li tiu, c bit cc thuc li tiu quai. Khng c s dng metformin khi
creatinine huyt thanh vt qu 1,5 mg/dL (135 mmol/L) nam gii v 1,2 mg/dL (110
mmol/L) n gii.
- Cc thuc cn quang c iode : trong trng hp mt nc do li tiu, nguy c gia tng suy
thn cp, c bit sau khi dng liu cao cc thuc cn quang c iode.
Bi ph nc trc khi dng thuc cn quang c iode.

- Cc thuc chng trm cm imipramine (ba vng), cc neuroleptic : gia tng hiu qu chng
cao huyt p v gia tng nguy c h huyt p t th (tc dng cng thm).
- Mui calcium : nguy c tng calcium mu do bi gim bi tit calcium qua nc tiu.
- Cyclosporine : nguy c tng creatinine huyt thanh m khng c thay i mc cyclosporine
lu thng, ngay c khi khng c mt nc v mui.
- Corticosteroids, cosyntropine (ton thn) : lm gim tc dng chng cao huyt p (gi nc v
mui bi corticosteroids).
TC DNG NGOI
a s cc tc dng ngoi trn lm sng v th nghim l ph thuc liu lng. Thiazide v cc
thuc li tiu lin quan, bao gm indapamide, c th gy ra :
V cc thng s xt nghim :
- Mt kali v h kali mu, c th c bit trm trng mt s dn s nguy c cao (xem Thn
trng lc dng). Trong cc thc nghim lm sng thc hin vi indapamide 1,5 mg, h kali
huyt thanh c thy trong vi trng hp sau 4-6 tun iu tr. Kali huyt thanh < 3,4
mmol/l trong khong 10% bnh nhn v kali huyt thanh < 3,2 mmol/l trong 4% bnh nhn. Sau
12 tun iu tr, gim trung bnh ca kali huyt thanh l 0,23 mmol/L.
- H natri mu vi gim th tch mu, gy ra mt nc v h huyt p t th. S mt ng thi
ion chlor c th sau gy toan chuyn ha b, mc d tn sut xut hin v ln ca tc
dng ny thp.
- Tng acid uric huyt thanh v glucose mu trong lc iu tr : s dng cc thuc li tiu ny
phi c xem xt cn thn cc bnh nhn thng phong hoc tiu ng.
- Cc ri lon v huyt hc (him hn nhiu) : gim tiu cu, gim bch cu, mt bch cu ht,
gim sn ty xng, thiu mu tn huyt.
- Tng calcium mu rt him.
V mt lm sng :
- Kh nng xy ra bnh l gan no cc bnh nhn suy gan (xem Chng ch nh v Ch {
phng).
- Cc phn ng tng cm, c bit l da, cc i tng d b d ng v cc biu hin suyn.
- Hng ban dt sn (maculopapular rashes), t ban, kh nng suy thoi thm lupus ban h
thng c trc.
- Bun nn, bn, chng mt, suy nhc, d cm, nhc u v kh ming, him khi gp v
thng hi phc sau khi gim liu.
- Ngoi l : vim ty.
LIU LNG v CCH DNG
ng ung : 1 vin/ngy, thng vo bui sng.
QU LIU
Khng c tc dng c no c thy khi dng n 40 mg indapamide, tng ng vi 27 ln

liu thuc cn cho iu tr. Cc du hiu ca qu liu ch yu bao gm cc ri lon v nc v

in gii (h natri mu, h kali mu). V lm sng, c th bun nn, i, h huyt p, vp b,
chng mt, bun ng, l ln, a niu hoc thiu niu, hoc trong trng hp rt nng : v niu
(do h th tch mu). Cc phng php gip ban u bao gm nhanh chng loi tr thuc
(hoc cc thuc) bng ra d dy v/hoc dng than hot tnh, sau iu chnh li cn bng
nc-in gii trong bnh vin chuyn khoa.
BO QUN
Thi gian lu gi : 2 nm.
Bo qun ni kh, nhit phng (15oC-25oC).

349.

NAUTAMINE

SANOFI SYNTHELABO VIETNAM

vin nn d b 90 mg : hp 20 vin.
THNH PHN
cho 1 vin
Diphnhydramine diacfylline

90 mg

DC LC
Thuc chng nn.
CH NH
Nga v iu tr say tu xe.
Nga v iu tr bun nn v nn.
CHNG CH NH
Qu mn cm vi cc thuc khng histamine.
Tr em di 2 tui.
Nguy c glaucome gc ng.
Nguy c b tiu do ri lon niu o - tuyn tin lit.
CH PHNG v THN TRNG LC DNG
Lu { ngi li xe v ngi s dng my mc v kh nng b bun ng. Hin tng bun ng s
tng nhiu nu nh c ung ru hay cc thc ung hay thuc c cha ru trong thi gian
dng Nautamine.
LC C THAI

Nu cn, c th ung Nautamine c trong 3 thng cui ca thai kz, nhng khng nn ung
nhiu ln. Nu c ung thuc vo cui thai kz, nn theo di cc chc nng thn kinh v tiu ha
ca tr s sinh.
LC NUI CON B
Do thuc c bi tit mt lng nh qua sa m, khng nn ung thuc khi cho con b.
TNG TC THUC
Khng nn phi hp :
- Alcool : ru lm tng tc dng an thn ca thuc, c th dn ti hu qu nguy him, nht l
khi li xe hay iu khin my mc.
Trnh ung ru v cc thc ung hay thuc c cha ru.
Lu { khi phi hp :
- Atropine v cc thuc c tc ng atropinic (thuc chng trm cm nhm imipramine, thuc
chng lit rung c tc ng khng cholinergic, thuc chng co tht c tc ng atropinic,
disopyramide, thuc an thn kinh nhm phenothiazine) : phi hp cc tc dng ngoi nh gy
b tiu, to bn, kh ming.
- Cc thuc gy c ch thn kinh trung ng khc (thuc chng trm cm c tc dng an thn,
nhm barbiturate, clonidine v cc cht cng h, thuc ng, cc dn xut ca morphine gim
au v chng ho, methadone, thuc an thn kinh, thuc an thn gii lo u) : tng c ch thn
kinh trung ng, c th dn ti hu qu nguy him, nht l khi li xe hay iu khin my mc.
TC DNG NGOI
Ng gt.
Tc dng atropinic : kh dch tit ph qun, kh ming, ri lon iu tit, bn, b tiu, gim tr
nh hay gim s tp trung, nht l ngi ln tui.
LIU LNG v CCH DNG
Dng cho ngi ln v tr em trn 2 tui.
Liu thng thng nh sau :
Ngi ln v tr em trn 12 tui : ung 1 vin hoc 1 vin ri, na gi trc khi khi hnh.
Nu cc triu chng bun nn vn cn, c th ung thm 1 liu nhng phi cch ln ung u
trn 6 gi. Khng ung qu 6 vin/ngy.
Tr em t 6 n 12 tui : ung 1 vin, na gi trc khi khi hnh. Nu cc triu chng bun
nn vn cn, c th ung thm 1 liu nhng phi cch trn 6 gi. Khng ung qu 4 vin/ngy.
Tr em t 2 n 6 tui : ung na vin sau khi nghin nt, na gi trc khi khi hnh. Nu
cc triu chng bun nn vn cn, c th ung thm 1 liu nhng phi cch ln ung u trn
6 gi. Khng ung qu 4 ln na vin nghin nt/ngy.
QU LIU
- Triu chng : co git (nht l nh nhi v tr em), ri lon nhn thc, hn m.
- X tr : nhp vin v iu tr triu chng.

350.

NEBCIN

ELI LILLY
Dung dch tim 80 mg/2 mL : hp 1 ng 2 mL.
THNH PHN
cho 1 ng
Tobramycin sulfate

80 mg

DC LC
Tobramycin l khng sinh h aminoglycoside, tan trong nc, trch t nm Streptomyces
tenebrarius. Nebcin dng tim, l mt dung dch nc v trng, trong sut, khng mu, dng
ng tim.
Tobramycin c cng thc ha hc (C18H37N5O9)2.5H2SO4. Trng lng phn t: 1425,39.
Tobramycin tc ng bng cch c ch qu trnh tng hp protein trong t bo vi khun. Cc
th nghim in vitro chng t tobramycin l khng sinh dit khun.
Tobramycin c hiu qu trn a s cc chng vi khun sau y, c trn nhim trng lm sng v
in vitro (xem Ch nh)
Vi khun hiu kh gram dng
Staphylococcus aureus
Vi khun hiu kh gram m
Citrobacter sp.
Enterobacter sp.
Escherichia coli
Klebsiella sp.
Morganella morganii
Pseudomonas aeruginosa
Proteus mirabilis
Proteus vulgaris
Providencia sp.
Serratia sp.
Aminoglycoside c tc ng yu trn hu ht vi khun gram dng, gm Streptococcus
pyogenes, Streptococcus pneumoniae, v enterococci.
Mc d phn ln cc chng enterococci khng in vitro, tuy nhin vi chng trong nhm ny

cn nhy cm. Cc nghin cu in vitro cho thy mt aminoglycoside kt hp vi mt khng sinh

c tc ng ln s tng hp thnh t bo s c tc dng hip ng trn mt s chng
enterococci. In vitro, kt hp penicillin G v tobramycin c tc dng hip ng dit khun trn
mt s chng Enterococcus faecalis. Tuy nhin, s kt hp ny khng c tc dng hip ng
trn cc vi khun tng t, th d Enterococcus faecium. c im trn khng th dng
on trc tnh nhy cm. Khng sinh v cc th nghim v tnh hip ng khng sinh cn
c ch trng.
C th c khng cho gia cc aminoglycoside.
Khng sinh
K thut khuch tn : Cc phng php nh lng cn o ng knh vng vi khun cho php
c lng chnh xc nht tnh nhy cm ca vi khun vi khng sinh. Phng php ny c
y Ban Quc Gia v cc Chun Mc Phng Th Nghim Lm Sng (NCCLS) chp thun. Phng
php s dng a c ngh nh gi tnh nhy cm tobramycin. Bin lun kt qu
da trn mi tng quan gia ng knh vng v khun v nng c ch ti thiu (MIC) ca
tobramycin.
Kt qu ca phng th nghim, s dng a tm 10 mg tobramycin c bin lun theo nhng
tiu chun sau :
ng knh vng v khun (mm)

Bin lun kt qu

>= 15

(S) Nhy cm

13 - 14

(I) Trung gian

<= 12

(R) khng

Kt qu "nhy cm" cho thy vi khun c th b c ch vi nng bnh thng t c trong

mu. Kt qu "trung gian" cho thy vi khun s nhy cm nu dng khng sinh liu cao hoc
nu nhim trng cc m v dch c nng khng sinh cao. Kt qu " khng" cho thy
nng thuc t c khng th c ch vi khun v nn chn cch iu tr khc.
Phng php chun mc i hi phi s dng cc vi khun chng trong phng th nghim. a
tm 10 mg tobramycin phi to ra ng knh vng v khun nh sau :
Vi khun

ng knh vng v khun (mm)

E. coli ATCC 25922

18 - 26

P. aeruginosa ATCC 27853

19 - 25

S. aureus ATCC 25923

19 - 29

K thut pha long : phng php pha long trong canh v thch, nh l phng php c
NCCLS ngh, c th dng xc nh MIC ca tobramycin. Kt qu th MIC nn c bin
lun theo cc tiu chun sau :
MIC (mg/mL)

Bin lun kt qu

<= 4

(S) Nhy cm

(I) Trung gian

>= 16

(R) khng

Ging nh vi phng php khuch tn chun mc, phng php pha long cn cc vi khun
chng trong phng th nghim. Bt tobramycin chun mc phi to ra cc gi tr MIC sau :
Vi khun

Gii hn MIC (mg/mL)

E. faecalis ATCC 29212

8,0 - 32,0

E. coli ATCC 25922

0,25 - 1

P. aeruginosa ATCC 27853

0,12 - 2

S. aureus ATCC 29213

0,12 - 1

DC NG HC
Tobramycin c hp thu nhanh sau khi tim bp. Tobramycin t c nng nh trong
huyt thanh sau khi tim bp khong 30-90 pht. Sau mt liu tim bp 1 mg/kg, nng ti
a trong huyt thanh ln n 4 mg/mL, nng c th o c k o di n 8 gi. Ni chung,
nng iu tr trong huyt thanh khong t 4 n 6 mg/mL. Khi truyn tnh mch trong vng
1 gi, nng trong huyt thanh tng t nh tim bp. Nebcin hp thu qua ng tiu ha
rt km.
bnh nhn c chc nng thn bnh thng, tr tr s sinh, Nebcin khng b tch t trong
huyt thanh khi c dng 8 gi mt ln. Tuy nhin, bnh nhn suy thn v tr s sinh, nng
khng sinh trong huyt thanh thng cao hn v duy tr trong thi gian di hn. V vy, liu
dng cho cc bnh nhn ny nn c iu chnh cho ph hp (xem Liu lng).
Sau khi dng qua ng tim, ch mt phn nh thuc c chuyn ha m thi, phn ln
tobramycin c thi tr qua s lc cu thn. thanh thi thn tng t nh thanh thi
ca creatinine ni sinh. Cc nghin cu v siu lc cho thy gn nh khng c gn kt vi

protein huyt thanh. bnh nhn c chc nng thn bnh thng, 84% liu dng xut hin
trong nc tiu trong 8 gi, v ln n 93% trong 24 gi.
Nng nh trong nc tiu t 75 n 100 mg/mL sau khi tim bp mt liu duy nht 1
mg/kg. Sau mt vi ngy iu tr, lng tobramycin c bi tit trong nc tiu tng gn n
liu dng hng ngy. Khi chc nng thn suy gim, s bi tit Nebcin b chm li, v s tch t
thuc c th to ra nng c trong mu.
Thi gian bn hy trong huyt thanh ngi bnh thng l 2 gi. Thi gian bn hy t l
nghch vi thanh thi creatinine, v nn iu chnh thi biu liu dng theo mc suy thn
(xem Liu lng). bnh nhn c thm phn, c th 25-70% liu dng c th c thi tr,
ty thuc vo thi gian v cch thm phn.
Tobramycin c th c tm thy trong m, dch c th sau khi tim thuc. Nng thuc
trong mt v phn thng thp, iu ny cho thy thuc bi tit qua mt rt t. Sau khi tim,
nng tobramycin trong dch no ty thp. Nng ny ph thuc liu dng, tc thm
nhp thuc, mc vim mng no. Thuc cng c tm thy trong m, dch mng bng,
hot dch, dch p-xe. Thuc c th i qua mng nhau. Nng thuc ti v thn cao gp
nhiu ln so vi nng bnh thng trong huyt thanh.
Probenecid khng nh hng n s vn chuyn ca tobramycin ng thn.
CH NH
Nebcin c ch nh cho cc nhim trng nghim trng do cc chng vi khun nhy cm trong
cc bnh l{ sau y :
- Nhim trng huyt tr s sinh, tr em, ngi ln do P. aeruginosa, E. coli, v Klebsiella sp.
- Nhim trng ng h hp di do P. aeruginosa, Klebsiella sp, Enterobacter sp, Serratia sp,
E. coli v S. aureus (cc chng to v khng to penicillinase).
- Nhim trng h thn kinh trung ng nng (vim mng no) do cc vi khun nhy cm.
- Nhim trng trong bng, gm vim phc mc, do E. coli, Klebsiella sp, v Enterobacter sp.
- Nhim trng da, xng v cu trc da do P. aeruginosa, Proteus sp, E. coli, Klebsiella sp,
Enterobacter sp, v S. aureus.
- Nhim trng ng tit niu c bin chng v ti pht do P. aeruginosa, Proteus sp (indole
dng v m tnh) E. coli, Klebsiella sp, Serratia sp, S. aureus, Providencia sp, v Citrobater sp.
Cc aminoglycoside, bao gm Nebcin, khng c ch nh s dng trong nhim trng ng
tit niu giai on u khng bin chng, tr khi vi khun gy bnh khng cn nhy cm vi
cc khng sinh t c tnh hn. Nebcin c th c ch nh trong nhim trng t cu nng, khi
c chng ch nh ca penicillin hoc cc thuc t c hn, v khi kt qu khng sinh v chn
on lm sng cho thy nn dng Nebcin.
Nn nui cy vi khun trc v trong khi iu tr phn lp v nh danh vi khun gy bnh,
v nh gi tnh nhy cm vi tobramycin. Nu kt qu khng sinh cho thy vi khun gy
bnh khng vi tobramycin, nn chn cch iu tr khc. C th bt u s dng Nebcin

trc khi c kt qu khng sinh bnh nhn nghi ng nhim trng gram m nng e da
tnh mng, gm c nhng bnh nhn c ch nh dng kt hp penicillin hoc cephalosporin vi
aminoglycoside. Sau , da vo kt qu khng sinh , mc trm trng ca nhim trng, v
cc yu t b sung quan trng khc c bn trong phn Thn trng lc dng quyt nh
c tip tc s dng Nebcin hay khng.
CHNG CH NH
Mn cm vi bt kz mt aminoglycoside no l mt chng ch nh ca tobramycin. Tin s
mn cm hoc c nhng phn ng c nng i vi cc aminoglycoside c th cng l chng
ch nh vi bt kz aminoglycoside no, v c nhy cm cho gia cc thuc trong nhm.
CH PHNG
Nn xt nghim mu v nc tiu trong qu trnh iu tr, nh c khuyn co trong phn
Thn trng khi x dng. Theo di calcium, magnesium v sodium trong huyt thanh.
Trong khi iu tr nn o nh kz nng nh v nng cn trong huyt thanh, khng nn
nng nh vt qu 12 mg/mL trong thi gian di. Nng cn tng cao (trn 2 mg/mL)
chng t thuc tch t trong m. S tch ly thuc, tui cao, v liu tng dn l nhng yu t
gp phn gy c tnh trn tai v thn. Rt cn thit theo di st nng trong huyt thanh
bnh nhn c chc nng thn suy gim.
Cn xc nh nng thuc trong huyt thanh sau 2 hoc 3 liu dng, iu chnh liu khi cn
thit, v nn nh gi tip cch 3-4 ngy 1 ln trong thi gian iu tr. Trong trng hp c biu
hin thay i chc nng thn, nn o nng thuc trong huyt thanh thng xuyn hn, v
iu chnh liu hoc thi biu dng thuc da theo hng dn trong phn Liu lng.
o nng nh, nn ly mu khong 30 pht sau khi truyn tnh mch hoc 1 gi sau khi
tim bp. o nng cn, nn ly mu sau khi tim 8 gi hoc ngay trc khi dng liu tip
theo. Thi im ly mu ny ch l khuyn co, v c th thay i ty theo kinh nghim thc
hnh. Tuy nhin iu quan trng l nn nht qun trong sut qu trnh iu tr i vi tng
bnh nhn, tr phi chng trnh liu lng dc ng hc c vi tnh ha c sn c s iu
tr. o nng trong huyt thanh rt c ch, gip theo di iu tr bnh nhn nng c thay i
chc nng thn, bnh nhn b nhim vi khun t nhy cm hn, hoc bnh nhn dng liu
ti a.
Dng liu cao tobramycin (40 mg/kg) gy c ch thn kinh c v lit h hp mo c bo
co. Lu { n kh nng ngng th ko di hay th pht khi dng tobramycin cho bnh nhn
gy m, ang dng cc thuc c ch thn kinh c nh succinylcholine, tubocurarine,
decamethonium, hay khi dng cho bnh nhn c truyn mt lng mu ln c citrat. Nu
nghn thn kinh c xy ra, c th iu tr bng mui calcium.
c bo co c d ng cho gia cc aminoglycoside.
Dc ng hc thay i bnh nhn bng din rng c th lm gim nng aminoglycoside
huyt thanh, v vy khi iu tr bng Nebcin cho nhng bnh nhn nh vy cn phi o nng

huyt thanh xc nh liu dng thch hp.

bnh nhn cao tui chc nng thn c th gim, nhng khng biu hin r nhng kt qu
xt nghim thng qui nh BUN hay creatinine huyt thanh. Nn xc nh thanh thi
creatinine v s chnh xc hn. Cn theo di tht cht ch chc nng thn khi iu tr vi
aminoglycoside cc bnh nhn ny.
T l c trn thn gia tng khi dng ng thi aminoglycoside v cephalosporin c bo
co.
Cn thn khi dng aminoglycoside bnh nhn b bnh h c, nh bnh nhc c, bnh
Parkinson, v c th lm tnh trng yu c nng thm, do thuc tc dng tng t curare ni
tip gip thn kinh c.
Aminoglycoside c th c hp thu vi s lng ng k khi dng dng ti hay bi ti ch,
do c th gy c vi thn, v thn kinh.
Aminoglycoside dng di kt mc v/hoc trong mt cha c chp thun. c bo co
aminoglycoside, bao gm tobramycin, gy hoi t im vng khi dng bng ng ny.
Xem phn Thn trng lc dng v vn dng ng thi vi thuc li tiu mnh, v dng kt
hp hay k tip vi cc thuc c vi thn hay c vi thn kinh khc.
Cc khng sinh loi b-lactam gy mt hot tnh ca tobramycin v cc aminoglycoside khc
c bo co in vitro v cc bnh nhn suy thn nng. Khng thy c c tnh ny nhng
bnh nhn c chc nng thn bnh thng khi tim bng hai ng ring bit.
iu tr vi tobramycin c th lm pht trin qu mc cc chng vi khun khng nhy cm. Nu
c xy ra, nn p dng phng php iu tr thch hp.
THN TRNG LC DNG
Nn theo di bnh nhn cht ch khi k n Nebcin v cc aminoglycoside khc, v cc thuc
ny c kh nng gy c trn tai v thn.
c tnh thn kinh, c th biu hin bi triu chng c tnh trn thnh gic v trn tin nh.
Tn thng v thnh gic thng khng hi phc, c hai bn, c th mt phn hay ton phn.
Tn thng dy thn kinh s 8 v c tnh trn thn xy ra phn ln do dng aminoglycoside
bnh nhn c sn tn thng thn, hoc c chc nng thn bnh thng nhng dng thuc
trong thi gian di hn hoc liu cao hn ch nh. Nhng biu hin khc ca c tnh trn thn
kinh c th gm : t, cm gic da b chm chch, c co rt, chng co git. Nguy c ic do
aminoglycoside cng tng khi nng nh v nng cn trong huyt thanh cng cao. Tn
thng c tai c th khng c cc triu chng bo trc c tnh trn dy thn kinh s 8, v
trng hp ic hai bn, mt phn hay ton phn, c th tip tc tin trin sau khi ngng
thuc.
Nhng biu hin r rng ca c tnh trn thn, xut hin sau khi ngng iu tr mt vi ngy
him khi xy ra. c vi thn do aminoglycoside thng c th hi phc.
Nn theo di st chc nng thn v dy thn kinh s 8 nhng bnh nhn bit hay nghi ng

suy thn, v nhng bnh nhn lc u chc nng thn bnh thng, nhng trong khi iu tr
li c du hiu suy thn. Trong qu trnh iu tr, nn theo di nh kz nng nh v nng
cn ca aminoglycoside trong huyt thanh m bo nng thuc va nhm trnh nng
gy c. Nng thuc trong huyt thanh khng nn vt qu 12 mg/mL trong thi gian
di. Nng cn tng cao (trn 2 mg/mL) c th l du hiu tch ly thuc ti m. S tch ly
thuc, nng nh qu cao, ln tui, liu dng tng dn l nhng yu t gp phn gy c
tnh trn tai v thn (xem phn Ch { phng). Nn xt nghim nc tiu pht hin gim
t trng, tng protein niu, t bo v tr niu. Nn o nh kz BUN, creatinine huyt thanh,
thanh thi creatinine. Nu c th, nn o thnh lc nhiu ln bnh nhn cao tui, c bit
l cc bnh nhn c nguy c cao. Khi c du hiu tn thng chc nng thn, tin nh hoc c
tai, cn ngng thuc hoc iu chnh li liu.
S dng cho tr em : Xem phn Ch nh v Liu lng.
Cn thn khi dng Nebcin cho tr s sinh, tr non v thn ca tr cha hon chnh, khin cho
thi gian bn hy thuc ko di.
Trnh dng ng thi hay k tip vi cc khng sinh gy c thn kinh v/hoc c vi thn
khc, c bit l cc aminoglycoside khc (th d amikacin, streptomycin, neomycin, kanamycin,
gentamicin v paromomycin), cephaloridine, viomycin, polymyxin B, colistin, cisplatin,
vancomycin. Nhng yu t khc lm tng nguy c bao gm tui cao, mt nc.
Khng nn dng ng thi aminoglycoside vi thuc li tiu mnh, nh acid ethacrynic,
furosemide. Bn thn mt s thuc li tiu cng gy c cho tai, v vic s dng thuc li tiu
ng tnh mch lm tng c tnh ca aminoglycoside do thay i nng khng sinh trong
huyt thanh v m.
Cc aminoglycoside c th gy c cho bo thai khi dng cho ph n c thai (xem phn Ch
phng).
Nebcin cha sodium bisulfite, c th gy phn ng dng d ng mt s ngi nhy cm, gm
cc triu chng chong phn v v cc cn hen t nh n e da tnh mng bnh nhn. T l
nhy cm vi sulfite trong cng ng cn cha bit v c l thp. Nhng ngi c bnh hen
nhy cm vi sulfite nhiu hn ngi khng b hen.
LC C THAI
Aminoglycoside c th gy hi bo thai khi dng cho ph n c thai. Thuc i qua nhau thai.
c bo co v ic bm sinh c hai tai khng hi phc cc tr em c m dng streptomycin
trong thai kz. Tc dng ph nghim trng trn b m, bo thai, tr s sinh khi iu tr cho ph
n c thai bng cc aminoglycoside khc cha c bo co. Nu tobramycin c dng trong
thai kz hay bnh nhn th thai trong thi gian dng tobramycin, nn bo trc cho bnh nhn
v kh nng gy c cho bo thai.
TC DNG NGOI
c tnh trn thn kinh : Tc dng ph trn nhnh tin nh v nhnh thnh gic ca dy thn

kinh s 8 c ghi nhn, c bit cc bnh nhn dng liu cao hoc dng ko di, cc
bnh nhn trc dng thuc gy c trn tai, v cc bnh nhn mt nc. Cc triu
chng bao gm : chng mt, chong vng, tai, ting gm trong tai, mt thnh lc. Lng tai
thng khng hi phc, biu hin ban u l gim kh nng nghe m sc cao. Tobramycin v
gentamicin sulfat tng t nhau v c tnh trn tai.
c tnh trn thn : Thay i chc nng thn, biu hin bng gia tng BUN, NPN, creatinin
huyt thanh, thiu niu, tr niu, tng protein niu c bo co, c bit bnh nhn c
tin s suy thn m thi gian iu tr k o di hn hoc dng vi liu cao hn ch nh. Tc dng
ph trn thn c th xy ra c cc bnh nhn lc u c chc nng thn bnh thng.
Cc nghin cu lm sng v nghin cu trn sc vt th nghim c tin hnh so snh
c tnh trn thn ca tobramycin v gentamicin. Trong mt vi nghin cu lm sng v nghin
cu trn sc vt, tobramycin t gy c vi thn hn nhiu so vi gentamicin. Trong mt vi
nghin cu lm sng khc li khng thy s khc bit ng k v t l gy c trn thn gia
tobramycin v gentamicin. Cc tc dng ph c th lin quan n Nebcin c bo co, gm
: thiu mu, gim bch cu ht, gim tiu cu, st pht ban, vim da trc vy, nga, my ay,
bun nn, nn, tiu chy, nhc u, ng lm, au ni tim, l ln, mt nh hng.
Cc bt thng trn xt nghim c th lin quan n Nebcin bao gm : tng transaminase
huyt thanh (AST *SGOT+, ALT *SGPT+), tng LDH v bilirubin huyt thanh, gim calcium,
magnesium, natri, kali trong huyt thanh, gim bch cu, tng bch cu v tng bch cu i
toan.
LIU LNG v CCH DNG
Nebcin c th dng tim bp hay tim tnh mch. Liu ging nhau cho c tim bp hoc tim
tnh mch. Nn xc nh th trng bnh nhn trc khi iu tr tnh liu chnh xc. Nn o c
nng nh v nng tn lu (xem Thn trng lc dng, v Ch { phng)
Bnh nhn c chc nng thn bnh thng :
- Ngi ln nhim trng nng : 3 mg/kg/ngy, chia lm 3 liu bng nhau, dng mi 8 gi (xem
Bng 1).
- Ngi ln nhim trng e da tnh mng : c th dng n 5 mg/kg/ngy, chia lm 3 hoc 4
liu bng nhau (xem Bng 1). Nn gim xung cn 3 mg/kg/ngy ngay khi lm sng cho php.
trnh nng trong mu qu cao gy tng c tnh, liu dng khng nn vt qu 5 mg/kg/
ngy, tr khi c theo di nng trong huyt thanh (xem Thn trng lc dng, v Ch {
phng).
Bng 1. Bng hng dn liu dng cho ngi ln c chc nng thn bnh thng (liu dng
mi 8 gi)
Trng
lng

Liu thng
thng cho cc

Liu ti a cho cc
nhim trng e do

bnh
nhn

nhim trng
nng 1 mg/kg
mi 8 gi (Tng
liu : 3
mg/kg/ngy)
mg/liu

kg

tnh mng (gim liu

cng sm cng tt)
1,66 mg/kg mi 8 gi
(Tng liu : 5
mg/kg/ngy)
mL/liu*

mg/liu

mL/liu

lb
mi 8 gi

mi 8 gi

120

264 120

200

115

253 115

2,9

191

4,75

110

242 110

2,75

183

4,5

105

231 105

2,6

175

4,4

100

220 100

2,5

166

4,2

95

209 95

2,4

158

90

198 90

2,25

150

3,75

85

187 85

2,1

141

3,5

80

176 80

133

3,3

75

165 75

1,9

125

3,1

70

154 70

1,75

116

2,9

65

143 65

1,6

108

2,7

60

132 60

1,5

110

2,5

55

121 55

1,4

91

2,25

50

110 50

1,25

83

2,1

45

99 45

1,1

75

1,9

40

88 40

66

1,6

* p dng cho tt c dng trnh by ca Nebcin, tr dng tim cho tr em.

- Tr em : 6-7,5 mg/kg/ngy, chia 3-4 liu bng nhau (2-2,5 mg/kg/ mi 8 gi hoc 1,5 - 1,89
mg/kg/mi 6 gi).
- Tr s sinh di 1 tun tui, non hay thng : c th dng n 4 mg/kg/ngy, chia lm 2
liu bng nhau, mi 12 gi.
Ch nn iu tr trong thi gian ngn, thng thng l 7-10 ngy. Thi gian c th lu hn trong
cc nhim trng c bin chng, kh iu tr. Trong trng hp ny, nn theo di chc nng
thn, thnh gic v tin nh, v c tnh trn thn kinh d xy ra khi iu tr lu hn 10 ngy.
Bnh nhn c tn thng chc nng thn
Nu c th nn theo di nng tobramycin trong huyt thanh trong thi gian iu tr.
Sau liu ti 1 mg/kg, cc liu k tip phi c iu chnh, gim liu vi khong cch dng mi
8 gi, hoc vi liu bnh thng nhng khong cch di hn. C hai bin php ny c ngh
khi khng th o trc tip nng tobramycin trong huyt thanh, m da trn thanh thi
creatinine hay nng creatinine huyt thanh, v cc gi tr ny c lin quan vi thi gian bn
hy ca tobramycin. Khi p dng thi biu liu dng da theo mt trong hai phng php trn,
nn kt hp vi theo di trn lm sng tht cn thn, v nn c iu chnh khi cn thit.
Khng p dng hai phng php ny khi ang tin hnh thm phn cho bnh nhn.
Gim liu vi khong cch 8 gi : Khi thanh thi creatinine khng qu 70 mL mi pht, hoc
khi bit tr s creatinine huyt thanh, c th xc nh liu dng bng cch nhn liu bnh thng
trong Bng 1 vi s phn trm ca liu bnh thng biu km theo y.
Mt cch hng dn khc s b c lng liu dng mi 8 gi ( bnh nhn c tr s
creatinine mu n nh) l chia liu bnh thng cho tr s creatinine huyt thanh ca bnh
nhn.
Liu bnh thng vi khong cch dng ko di : Nu khng tnh c thanh thi creatinine,
v tnh trng bnh nhn n nh, c th tnh c thi gian cch nhau gia cc liu dng thuc
(tnh bng gi) theo liu trong Bng 1 bng cch nhn nng creatinine huyt thanh cho 6.
Liu dng cho bnh nhn bo ph : C th tnh bng php cng trng lng c on bnh
thng ca bnh nhn, vi trng lng tha 40% so vi trng lng bnh thng tnh liu
dng mg/kg.
Tim bp : C th tim Nebcin bng cch rt mt lng thuc va trc tip t l thuc,
hoc dng loi ng tim c sn thuc.
Tim tnh mch : i vi ngi ln lng dch pha thng l 50-100 mL (sodium chloride 0,9%,
dextrose 5%). i vi tr em, lng dch pha gim tng ng. Thng thng, thi gian truyn
t 20-60 pht. Khng nn truyn nhanh hn 20 pht v nng nh trong huyt thanh vt
qu 12 mg/mL (xem Thn trng lc dng).

Khng nn trn Nebcin vi cc thuc khc, nn dng ring r da theo liu lng v ng
dng c khuyn co.
Trc khi dng, nn quan st k l thuc pht hin cc tnh cht bt thng hay thay i
mu sc, khi dung dch v l cho php.
QU LIU
Du hiu v triu chng : Du hiu v triu chng khi dng qu liu tobramycin ph thuc vo
liu dng, chc nng thn, tnh trng dch th, tui tc, v c dng ng thi cc thuc c
c tnh tng t hay khng. c tnh c th xy ra trn cc bnh nhn dng trn 10 ngy,
ngi ln dng trn 5 mg/kg/ngy, tr em dng liu trn 7,5 mg/kg/ngy, bnh nhn b gim
chc nng thn nhng khng c iu chnh liu dng ph hp.
c trn thn do aminoglycoside tng ng cht ch vi din tch vng nm di ng cong
ca biu biu din nng huyt thanh so vi thi gian. c vi thn d xy ra hn nu
nng tn lu trong mu khng thp hn 2 mg/mL. c tnh trn thn t l thun vi nng
trung bnh trong mu. Nhng bnh nhn d c nguy c b hoi t cp ng thn bao gm: bnh
nhn cao tui c chc nng thn bt thng, ang dng nhng thuc c tc dng ph gy c
vi thn khc, hoc gim th tch tun hon. Qu liu aminoglycoside gy ra c tnh trn thnh
gic v tin nh. c tnh ny xy ra khi iu tr trn 10 ngy, bnh nhn c chc nng thn
bt thng, bnh nhn mt nc, bnh nhn c dng ng thi thm cc thuc khc gy c
trn thnh gic. Bnh nhn c th khng c du hiu hoc triu chng, hoc c th b chong
vng, chng mt, tai, mt kh nng nghe cc m sc cao. Cc du hiu, triu chng c trn
tai c th ch bt u xut hin sau khi ngng thuc mt thi gian di.
Nghn thn kinh c hoc lit h hp c th xy ra sau khi dng cc aminoglycoside. Nghn thn
kinh c, suy h hp, lit h hp ko di xy ra ph bin hn bnh nhn c km bnh nhc
c nng hay bnh Parkinson. Lit h hp k o di cng c th xy ra bnh nhn dng
decamethonium, tubocurarine, hoc succinylcholine. Nu xy ra nghn thn kinh c, c th
iu tr bng mui calcium, nhng cng c th cn n s h tr ca my th.
Nu bnh nhn ung tobramycin, c tnh s t xy ra hn do aminoglycoside hp thu km qua
ng tiu ha.
iu tr : Khi nghi ng b qu liu, hy gi n Trung tm kim sot c cht trong vng bit
c nhng thng tin mi nht v iu tr qu liu. S d c khuyn co ny l v, ni chung,
thng tin v iu tr trng hp qu liu c th thng hay thay i v nh th thng tin s
mi hn trong toa thuc. Khi iu tr qu liu, lu { n kh nng b qu liu nhiu loi thuc,
tng tc gia cc thuc, dc ng hc bt thng ca bnh nhn. Khi u iu tr qu liu
tobramycin gm bo m thng ng th, cung cp oxy v thng kh tt. Bt u ngay cc
bin php hi sc nu lit h hp xy ra.
Cc bnh nhn dng qu liu tobramycin, c chc nng thn bnh thng, nn c b dch
y duy tr lng nc tiu 3-5 mL/kg/gi. Theo di cn thn tnh trng cn bng dch

th, thanh thi creatinine, nng tobramycin huyt tng cho n khi nng
tobramycin huyt thanh xung di 2 mg/mL.
Nhng bnh nhn c thi gian bn hy thuc di hn 2 gi hoc c chc nng thn bt thng
c th cn n bin php iu tr tch cc hn. nhng bnh nhn ny, c th c ch nh lc
mu.
BO QUN
Bo qun nhit trong phng t 59o ti 86oF (15o ti 30oC).

351.

NEO ENTROSTOP

KALBE FARMA
Vin nn : hp 12 vin.
THNH PHN
cho 1 vin
Attapulgite hot ha

650 mg

Pectin

50 mg

DC LC
Attapulgite hot ha l magnesium aluminium silicate ngm nc c tnh khit ha v
hot ha bng nhit lm tng kh nng hp ph. dng bt rt mn th huyn ph trong
nc (5%) c pH 7-9,5, attapulgite hot ha l mt cht hp ph mnh c s dng trong
iu tr tiu chy.
Pectin l mt carbohydrate tinh khit thu c t dch chit acid qu cam hay to, c s
dng phi hp vi cc cht hp ph trong iu tr tiu chy. Attapulgite v pectin hp ph c
cht, hi, vi khun v virus rut.
CH NH
NEO-CODION
BOUCHARA
c/o TEDIS
Vin bao dng cho ngi ln : hp 20 vin.
THNH PHN

cho 1 vin
Codeine camphosulfonate

25 mg

tng ng : Codeine

14,93 mg

Sulfogaiacol

100 mg

Grind lia, cao nc cn

20 mg

DC LC
- Codeine : alcaloide ca opium, thuc chng ho c tc ng trung ng ; c ch trung tm h
hp.
- Sulfogaiacol : lm lng cc cht tit nim mc ng h hp v c tc dng long m.
- Cao nc cn Grind lia : dc liu c tc dng chng ho.
DC NG HC
Codeine :
Thi gian t c nng ti a trong huyt tng khong 1 gi.
Chuyn ha gan.
Khong 10% codeine b loi gc methyl v chuyn thnh morphine trong c th.
Thi gian bn hy khong 3 gi ( ngi ln).
Qua c nhau thai v c bi tit qua sa m.
CH NH
iu tr triu chng ho khan gy kh chu.
CHNG CH NH
Tuyt i :
- Qu mn cm vi mt trong cc thnh phn ca thuc.
- Suy h hp.
- Ho suyn.
- Ph n cho con b (xem Lc nui con b).
Tng i :
- Alcool (xem Tng tc thuc).
CH PHNG
- iu tr ko di liu cao c th gy l thuc thuc.
- Trng hp ho c m cn phi t nhin v l c ch c bn bo v phi-ph qun.
- Phi hp thuc long m hoc thuc tan m vi thuc chng ho l khng hp l.
- Trc khi k toa thuc chng ho, cn tm nguyn nhn gy ho c iu tr c hiu, nht l
hen ph qun, vim ph qun mn tnh, gin ph qun, cc cht gy cn tr trong ph qun,

ung th, nhim trng ph qun-phi, suy tht tri, tc nghn phi, trn dch mng phi. Nu
cn ho khng c ci thin vi mt loi thuc ho dng theo liu thng thng, khng nn
tng liu m cn nh gi li tnh trng lm sng ca bnh nhn.
THN TRNG LC DNG
- Cn thn trong trng hp tng p lc ni s.
- Tuyt i khng c ung ru trong khi dng thuc.
- Cn lu { cc vn ng vin th thao do thuc c th cho kt qu xt nghim s dng cht
kch thch dng tnh.
- Ngi li xe v vn hnh my mc cn phi lu { v c nguy c b bun ng khi dng thuc.
LC C THAI
Cc nghin cu thc hin trn ng vt cho thy codeine c tc ng gy qui thai.
Tuy nhin trn lm sng, cc s liu dch t hc trn mt s lng gii hn ph n khng cho
thy codeine c tc dng gy d dng no c bit.
Trong 3 thng cui ca thai kz, nu ngi m dng di hn codeine d vi liu lng nh th
no cng c th l nguyn nhn gy hi chng cai nghin tr s sinh.
Dng liu cao codeine vo cui thai kz ngay c ngn hn cng c th gy c ch h hp tr s
sinh.
Do , ch nn dng codeine trong thi gian mang thai khi tht cn thit.
LC NUI CON B
Codeine c bi tit qua sa m ; mt vi trng hp gim huyt p v ngng th c
ghi nhn nh nhi sau khi m dng qu liu codeine. Do thn trng, trnh dng thuc c
codeine trong thi gian cho con b.
TNG TC THUC
Khng nn phi hp :
- Alcool : ru lm tng tc dng an thn ca benzodiazpine. Trnh ung ru v cc thuc c
cha alcool. Vic gim tp trung v thc cnh gic c th gy nguy him cho ngi li xe v
ang iu khin my mc.
Lu { khi phi hp :
- Cc thuc gy c ch thn kinh trung ng khc (thuc gim au morphine, mt vi thuc
chng trm cm, thuc khng histamine H1 c tc dng an thn, barbiturate, benzodiazpine,
clonidine v cc thuc cng h, thuc ng, thuc gii lo, thuc an thn kinh) : tng c ch thn
kinh trung ng c th gy nguy him cho ngi li xe v ang iu khin my mc.
TC DNG NGOI
Lin quan n codeine :
- liu iu tr, cc tc dng ngoi { tng t nh ca nhm opium, tuy nhin him hn v
nh hn. C th gy to bn, bun ng, chng mt, bun nn, i ma ; him hn, c th gy co
tht ph qun, d ng da, c ch h hp.

- Qu liu iu tr, c th gy l thuc thuc v hi chng ngng thuc t ngt ngi dng
thuc v tr s sinh c m b nghin codeine.
LIU LNG v CCH DNG
Dng cho ngi ln.
Nu khng phi hp vi thuc khc c cha codeine hoc vi thuc chng ho tc ng trung
ng, liu codeine hng ngy khng c vt qu 120 mg ngi ln.
Liu thng thng :
Mi ln ung 1 vin, lp li sau 6 gi nu cn, khng vt qu 4 ln/ngy.
Ngi gi hoc trng hp bnh nhn b suy gan : liu ban u gim cn phn na, sau c
th tng ln ty mc dung np v nhu cu.
QU LIU
Triu chng ngi ln : suy h hp (tm ti, th chm), ng gt, pht ban, bun nn, nga,
tht iu, ph phi (him).
Triu chng tr em (ngng ng c khong 2 mg codeine/kg, liu duy nht) : th chm,
ngng th, hp ng t, co git, triu chng gii phng histamine, b tiu.
iu tr : tr h hp, dng naloxone.

352.

NEO-PYRAZON

UNITED LABORATORIES
vin bao phim tan rut 50 mg : v 4 vin, hp 25 v.
THNH PHN
cho 1 vin
Diclofnac mui Na

50 mg

DC LC
Diclofnac sodium l mt dn xut acide phnylactique ca acide carboxylique, l mt khng
vim khng st roide c tc ng nh mt cht c ch hiu qu, cnh tranh, v khng o
ngc vi men sinh tng hp prostaglandine (cyclooxyg nase) in vitro v in vivo v do c
ch s hnh thnh cc sn phm sau ca s sinh tng hp prostaglandine. Vi liu iu tr
thng thng, nhiu tc ng khng vim v gim au c th xem nh l da trn c s ca
tnh cht ny.
Neo-pyrazon cn l cht c ch bradykinine : nhiu bo co cho bit mt vi tc ng ca

kinine (cht gy vim), cht trung gian ha hc ca prostaglandine lm d dng cho vic hnh
thnh prostaglandine. V vy, diclofnac sodium (Neo-pyrazon) c ch sinh tng hp
prostaglandine cng c { ngha l c ch hot ng ca kinine.
Neo-pyrazon ngn cn hot ng ca men lysosome : iu ny rt c gi tr v men lysosome
c xem nh gi vai tr quan trng trong bnh cn ca cc bnh khp v trong s thoi ha
ca m lin kt v khp.
Neo-pyrazon m thnh phn hot cht l diclofnac, gn kt 99,7% vi protine huyt thanh,
ch yu vi albumine. Do cc mch mu ca vng b vim cho php cc protine c trng lng
phn t ln i qua, cc thuc c gn vo nhng protine ny c th t n nng cao ti
v tr vim. Khi hin din vng vim c tnh acide, cc phn t thuc di dng t do c
gii phng v mt s i xuyn qua mng lipide ca t bo.
Neo-pyrazon cn c i lc cao vi vim v cc dn xut acide ch khng phi l dn xut base
ca thuc khng vim khng st roide nh v v tr vim.
Neo-pyrazon ha tan tt trong dch rut lm cho thuc c nng ti a trong huyt tng v
kh dng sinh hc cao. Tnh cht ny gip lm gim cc chng vim nhanh chng.
Qua cc th nghim khc nhau cho thy Neo-pyrazon tng i an ton v dung np tt
hn mt s thuc khng vim khng st roide khc nh aspirine, indom tacine, naproxne v
ibuprofne.
CH NH
iu tr di hn cc triu chng trong :
- vim thp khp mn tnh, nht l vim a khp dng thp v vim cng khp ct sng hay
trong nhng hi chng lin kt nh hi chng Fiessiger-Leroy-Reiter v thp khp trong bnh
vy nn.
- bnh cng khp gy au v mt kh nng lm vic.
iu tr triu chng ngn hn cc cn cp tnh ca :
- bnh thp khp v tn thng cp tnh sau chn thng ca h vn ng nh vim quanh
khp vai cng tay, vim gn, vim bao hot dch, vim mng hot dch, vim gn bao hot dch.
- vim khp vi tinh th (arthrite microcristalline).
- bnh khp.
- au tht lng, au r thn kinh nng.
Thuc cn c ch nh dng gim au do phu thut nh, phu thut ming, ct amyan,
phu thut hu mn-trc trng, sanh n, chn thng do tai nn hay trong th thao, au bng
do kinh nguyt.
CHNG CH NH
- Qu mn vi khng vim khng stroide.
- Lot d dy t trng tin trin.
- Suy gan hay suy thn nng.

CH PHNG
Cn thn khi dng khng vim khng stroide trong cc bnh nhim trng hay c nguy c
nhim trng cho d c kim sot tt do thuc c kh nng lm gim sc khng t nhin
ca c th chng li nhim trng v/hay che khut cc du hiu thng thng ca s nhim
trng.
Theo di triu chng ng tiu ha, ngng iu tr trong trng hp c xut huyt d dy
rut.
Nu iu tr lu di, nn kim tra chc nng gan, thn v mu.
Ngng iu tr khi c ban mn nc.
THN TRNG LC DNG
Cn thn khi dng v phi theo di c bit cc bnh nhn c tin s bnh ng tiu ha (lot
t trng, thot v honh, vim lo t i trng, bnh Crohn), tin s ri lon mu hay ng mu.
Khi bt u iu tr, phi theo di k vic bi niu v chc nng thn nhng bnh nhn suy
tim, x gan, thn h mn tnh, bnh nhn c dng thuc li tiu, nhng bnh nhn mt mu
nhiu sau mt cuc i phu, v c bit l ngi c tui.
Ngi iu khin phng tin giao thng v s dng my mc cn lu { v nguy c b chong
vng khi dng thuc.
LC C THAI
Do thn trng, chng ch nh trong 3 thng u ca thai kz.
Chng ch nh trong 3 thng cui ca thai kz (nguy c nhim c tim, phi v thn trn thai
nhi, nguy c k o di thi gian mu chy m v con).
LC NUI CON B
Chng ch nh cho ph n nui con b.
TNG TC THUC
Khng nn phi hp :
- Cc thuc khng vim khng stroide khc bao gm c cc dn xut ca salicylate liu cao :
tng nguy c gy lo t v xut huyt tiu ha.
- Khng ng ng ung, h parine dng ng tim v ticlopidine : tng nguy c xut huyt.
- Vng trnh thai : c kh nng lm gim hiu qu nga thai.
- Lithium : tng lithium trong mu c th t n liu c do lm gim bi tit lithium qua thn.
- Mthotrexate vi liu > 15 mg/tun : lm tng c tnh huyt hc ca mthotrexate.
Thn trng khi phi hp :
- Thuc li tiu : nguy c suy thn cp nhng bnh nhn b mt nc do gim lc cu thn.
- Mthotrexate vi liu thp < 15 mg/tun : kim tra hng tun trong sut nhng tun u kt
hp thuc.
- Pentoxifylline : tng nguy c xut huyt.
Lu { khi phi hp :

- Thuc h huyt p : diclofnac c th lm gim tc dng ca thuc li tiu, thuc chn bta,
thuc c ch men chuyn.
- Interf ron a : nguy c c ch hot ng ca interfron.
- Thuc iu tr huyt khi : tng nguy c xut huyt.
TC DNG NGOI
Ri lon ng tiu ha : thng gp : bun nn, i ma, tiu chy, to bn, au thng v (khi
bt u iu tr) ; him khi gy : lot, xut huyt v thng ng tiu ha (sau khi iu tr ko
di).
Ri lon mu : him khi gy gim bch cu, gim tiu cu, thiu mu, suy ty.
Phn ng qu mn :
- da : pht ban, ni my ay, nga, chm. Him khi gy ban a dng.
- h hp : ph Quincke, suyn, him khi c phn ng phn v, nht l nhng ngi c d
ng vi aspirine.
Ri lon h thn kinh trung ng : nhc u, bun ng, chng mt, chong vng.
Ri lon thnh gic : tai, him khi gy gim thnh lc.
Ri lon th gic : nhn m, nhn thnh hai.
Phn ng ngoi da : him khi gy cc bnh da mn nc (Stevens Johnson v hi chng Lyell).
Him khi gy phn ng nhy cm vi nh sng.
Ri lon tit niu :
- thn : suy thn cp tnh, vim thn k, him khi b hi chng thn nhim m.
- tit niu : tiu ra mu, protine niu.
Ri lon chc nng gan :
- tng lng transaminase.
- him khi gy vim gan c hay khng c vng da.
Ri lon thn kinh : mt ng, co git.
Ri lon tm thn : d b kch thch, thc u m.
Cc tc dng ngoi { khc : vim i trng, him khi gy ph ngoi bin, h huyt p, tng kali
huyt, ngoi ban, rng tc.
LIU LNG v CCH DNG
Dng thuc trong cc ba n.
Dng cho Ngi ln :
n Bnh thp khp :
p Liu tn cng :150 mg/ngy, chia lm 3 ln.
p Liu duy tr :75-100 mg/ngy, chia lm 1-3 ln.
n au bng do kinh nguyt : 100 mg/ngy, chia lm 2 ln.

353.

NEOAMIYU

HOECHST-MARION-ROUSSEL
[AVENTIS PHARMA]
Dung dch tim truyn : ti nha 200 ml, thng 30 ti.
THNH PHN
cho 1 ti (200 ml)
L-Isoleucine

1,500 g

L-Leucine

2,000 g

L-Lysine acetate

1,400 g

L-Methionine

1,000 g

L-Phenylalanine

1,000 g

L-Threonine

0,500 g

L-Tryptophane

0,500 g

L-Valine

1,500 g

L-Alanine

0,600 g

L-Arginine

0,600 g

Acid L-Aspartic

0,050 g

Acid L-Glutamic

0,050 g

L-Histidine

0,500 g

L-Proline

0,400 g

L-Serine

0,200 g

L-Tyrosine

0,100 g

Acid amino acetic

0,300 g

Tng lng acid amin

12,200 g

Nng acid amin

6,100% kl/tt

Hm lng nit ton phn

8,1 mg/ml

Nng acid amin t do ton phn

5,90% kl/tt

Acid amin thit yu / Acid amin khng thit yu

3,21

Na+

# 2 mEq/l

CH3COO-

# 47 mEq/l

Cht thm vo :
L-Cysteine

0,050 g

Natri bisulfite

0,050 g

TNH CHT
Neoamiyu l mt dung dch nc khng mu v trong sut dng tim truyn.
pH

T s p sut thm thu

6,6-7,6

#2

DC LC
Liu php acid amin thit yu cho bnh nhn suy thn c dng qua ng truyn tnh mch
ngoi vi trn cc bnh nhn lc mu v bnh nhn suy thn mn giai on bo tn. Liu php
ny cng c dng cung cp dinh dng ton phn qua ng tim truyn (TPN - Total
Parenteral Nutrition) cho bnh nhn suy thn cp. Ngi ta ghi nhn liu php c ci thin
chuyn ha protein v acid amin v cng lm gim cc triu chng do ur huyt tng cng nh
lm chm qu trnh suy yu th trng ngi suy thn
Tuy nhin, c nhng bo co l khi dng ch phm acid amin thit yu cho bnh nhn suy thn,
cc phn ng ph nh bun nn v nn c th xy ra, v khi dng mt ch phm acid amin
thit yu trong iu kin t s calo/nit thp trong TPN c th xy ra ri lon thc km vi

tng ammoniac huyt.

Neoamiyu l mt ch phm mi, vn c cc tc dng ca mt ch phm acid amin thit yu cho
suy thn, l cc tc dng duy tr chc nng thn v gim cc triu chng do ur huyt tng.
Bn cnh , thuc ny b sung thm cc acid amin mt cch tch cc hn, an ton v d s
dng, v c mt hiu qu dinh dng y . l mt dung dch tim truyn acid amin ton
phn dng cho suy thn, giu cc acid amin thit yu v c cha cc acid amin khng thit yu.
DC NG HC
Hp thu, phn b, chuyn ha, thi tr :
Neoamiyu nh du bi 14C c tim cho chut cng bnh thng v chut cng suy thn
mn nhn TPN. Mc phng x cao cc m c tng hp protein hoc tng trng t bo
cao, nh ty tng, tuyn nc bt, rut non v gan. Khng c khc bit v mc phng x
trong m gia hai nhm nghin cu. Bi tit 14CO2 trong hi th khong 44% trong vng 72 gi
sau khi tim. Bi tit vo nc tiu thp khong 5%. Nh vy, cc acid amin tim vo c c
th s dng nhiu.
CH NH
Cung cp cc acid amin cho suy thn cp v mn trong cc trng hp sau :
- Thiu protein mu
- Suy dinh dng
- Trc v/hoc sau khi phu thut.
CHNG CH NH
- Hn m gan hoc c th hn m gan (ri lon cn bng acid amin c th b thc y lm nng
thm hoc dn n hn m gan).
- Tng ammoniac huyt (qu ti nit c th lm nng thm chng tng ammoniac huyt).
- Bt thng bm sinh trong chuyn ha acid amin (cc acid amin a vo c th khng c
chuyn ha lm cc triu chng nng thm).
CH PHNG v THN TRNG LC DNG
Thn trng chung :
- Dng Neoamiyu khi cht dinh dng khng th hoc khng c cung cp qua ng
ming cn phi nui bng ng tim truyn.
- Dng mt ch phm acid amin thit yu cho suy thn l ngun nit duy nht c ghi nhn
gy ra tng ammoniac huyt hoc ri lon thc. V l , ngng dng Neoamiyu ngay nu
thy c mt bt thng nh gim cc c ng t ch hoc ni nhm.
Cn thn khi truyn cho nhng bnh nhn sau :
- Ri lon chc nng tim hoc tim mch (lu lng tun hon tng gy gnh nng cho tim v
lm nng thm cc triu chng).
- Tn thng gan hoc xut huyt d dy rut (gy tch ly qu mc acid amin hoc tng
ammoniac mu).

- Ri lon in gii nng hoc mt thng bng acid-baz (cc triu chng c th nng thm).
ngi gi :
Ni chung cc chc nng sinh l{ u gim ngi gi. Nn thn trng bng cch truyn chm
hoc gim liu.
tr em :
S an ton khi s dng tr em cha c xc nh (cha c kinh nghim lm sng).
Cn ch khi s dng :
Trc khi dng :
Tinh th c th kt ta. Trong trng hp ny hm nng dung dch ln 50-60oC lm tan tinh
th. Sau lm ngui dung dch n nhit ca c th v s dng.
Khng c s dng dung dch khng hon ton trong sut.
Mt khi m np, thuc phi c s dng ngay v thuc tha khng c s dng li.
Trong khi dng :
Bnh nhn suy thn mn nm vin m khng phi lc mu, gim 5 n 10 g protid t s lng
m c trong thc n cho mi 200 ml trc khi s dng thuc.
Thuc cha khong 2 mEq/l Natri v 47 mEq/l acetate. Trong trng hp dng mt lng ln
hoc c phi hp vi mt dch truyn c cht in gii cn phi kim tra s thng bng in gii
trong c th.
Tc tim : truyn tnh mch chm.
LC C THAI v LC NUI CON B
S an ton ca thuc trong khi c thai cha c xc nh. S dng thuc ph n c thai
hoc c th c thai i hi li ch d tnh phi hn hn cc nguy c c th xy ra.
TC DNG NGOI
Tng cm : nga ton thn c th xy ra khng thung xuyn. Pht ban hoc ni m ay ton
thn him xy ra. Nu nh c cc triu chng ny th ngng iu tr.
D dy rut : bun nn, nn hoc chn n c th xy ra khng thng xuyn.
Tim mch : kh chu ngc hoc nh trng ngc c th xy ra khng thng xuyn.
Liu cao, truyn nhanh : truyn nhanh vi liu cao c th gy nhim toan.
Cc du hiu khc : au u, tc mi / chy mi, toan chuyn ha, tng creatinin, hoc tng
GOT v GPT c th xy ra khng thng xuyn. Qu ti acid amin do thuc c th gy tng BUN
khng thng xuyn. Him khi c st, rt run, cm gic nng, nng bng u, hoc au dc
mch mu.
LIU LNG v CCH DNG
Liu lng :
Suy thn mn :
- Liu thng dng cho ngi ln l 200 ml mt ln mi ngy, truyn tnh mch ngoi vi nh
git chm. Tc truyn c bn l 200 ml trong 120 pht n 180 pht (khong 25 n 15

git/pht), chm hn i vi tr em, ngi gi hay ngi b bnh nng. Liu c th tng hay
gim ty giai on, triu chng hay th trng bnh nhn. i vi bnh nhn lc mu, thuc
c truyn vo bn tnh mch ca tun hon thm tch, bt u t 90 n 60 pht trc khi
hon thnh vic chy thn. cc acid amin c s dng c hiu qu trong c th, nng
lng cung cp t nht phi l 1500 Kcal/ngy.
Trong trng hp TPN, liu thng dng cho ngi ln l 400 ml/ngy, truyn nh git vo
tnh mch trung tm. Liu c th thay i ty tui, triu chng hay th trng bnh nhn. cc
acid amin c s dng c hiu qu trong c th, phi cung cp t nht 500 Kcal nng lng phi
protein cho mi 1,6 g nit a vo (200 ml Neoamiyu).
Suy thn cp :
Liu thng dng cho ngi ln l 400 ml/ngy, truyn nh git qua ng tnh mch trung
tm theo TPN. Liu c th thay i ty tui, triu chng v th trng bnh nhn. cc acid
amin c s dng c hiu qu trong c th, phi cung cp t nht 500 Kcal nng lng phi
protein cho mi 1,6 g nit a vo (200 ml Neoamiyu).
Thn trng khi dng :
- Khng cn dng kim dn kh.
- gi cho dung dch khng tr nn c mu, khng m bao ngoi cho n khi no sn sng
dng. (C cht hp th oxy t bn trong bao ngoi gi cho sn phm n nh).
- Khng c dng nu dung dch, bnh thng trong sut, tr nn c mu, hoc nu b r r
hoc c git nc ng bn trong bao ngoi.
- Khng c dng nu ming phim nim nt cao su b bc.
- m kim tim thng qua im c du O trn nt cao su. Nu m nghing c th lm thng
bao ngoi v gy r r.
- Cn thn nh tay vi bao ngoi v dung dch s tr nn c mu nu bao ngoi b hng.
- Thc o trn ti plastic c dng tham kho.
BO QUN
Bo qun nhit phng

354.

NEOPEPTINE

RAPTAKOS BRETT CO., LTD.

Dung dch ung : chai thy tinh 15 ml + ng m git.

Vin nang : v 10 vin, hp 10 v.

Dung dch ung : chai thy tinh 60 ml, 100 ml.
THNH PHN
cho 1 ml thuc git
Alpha-amylase (t vi khun, 1 : 800)

20 mg

Papaine

10 mg

Tinh du Dill

2 mg

Tinh du Anise

2 mg

Tinh du Caraway

2 mg

cho 1 vin
Alpha-amylase (t vi khun, 1 : 800)

100 mg

Papaine

100 mg

Simethicone

30 mg

cho 5 ml thuc nc
Alpha-amylase (t vi khun, 1 : 800)

100 mg

Papaine

50 mg

DC LC
- Alpha-amylase l mt men ni sinh c th thy phn tinh bt v cc polysaccharide (hot tnh
amylotic) bng cch tn cng vo mi ni a-1,4 glucosidic cho ra cc dextrine, oligosaccharide
v monosaccharide. Alpha-amylase dng trong Neopeptine vin nang c ly t ngun vi
khun Bacillus subtilis. Amylase ca vi khun cho n nay c u im l bn hn trong mi
trng acide ca d dy so vi diastase (amylase) ly t ng vt v vi nm. Mt ml
Neopeptine git c kh nng tiu ha 15 mg tinh bt chn. Mi vin nang Neopeptine tiu ha
khng di 80 g tinh bt chn phng thch 320 kcal.

- Papaine l men tiu ha m ch t nha qu u cha chn bao gm papaine v

chymopapaine c th thy phn amide v ester polypeptide cho ra peptide c trng lng
phn t thp. C hai loi men trn u bn trong mi trng acide v kim v gip tiu ha
nhanh thc n.
- Simethicone : l cht khng thm nc v c sc cng b mt rt thp. Simethicone lm thay
i sc cng b mt ca cc bt kh lm chng nhp li vi nhau. Cht ny c dng iu tr
y hi. Sim thicone c tc dng ti ch trong ng tiu ha m khng hp thu v v th khng
c nh hng ton thn.
- Cc tinh du Dill, Anise v Caraway c tc dng iu ha nhu ng c trn tiu ha. Khi nhu
ng c trn suy gim, chng kch thch nh to cm gic i hoc gy trung tin gip chng
y hi trng bng khi thc n khng tiu ln men trong rut. Khi c trn tng co tht, chng
lm du, nh chng c nn tr, nn ma c bit tr b m v tr em tui n dm v
giai on cai sa. Do tnh cht ca tinh du v nng thuc kh m c, tc dng ca thuc
rt nhanh v mnh.
DC NG HC
Khng c ti liu i vi cc ch phm enzyme.
CH NH
Git : Tr nh n khng tiu ; ri lon tiu ha ; y hi trng bng sau khi n hay b ; tnh
trng bing n tr em v tr nh ; c sa.
Vin nang : Ngi ln : chn n, n khng tiu, y hi, trng bng si rut do men, tiu phn
sng.
Thuc nc : Ngi ln v tr em lon tiu ha y hi v ln men, chn n, kh tiu, tiu ha
k m, trng hi.
CHNG CH NH
C tin s tng cm vi bt kz thnh phn no ca thuc.
Tng cm vi cc loi enzyme ; vim ty cp, tnh trng nng ca cc bnh ty tng mn tnh.
THN TRNG LC DNG
Git : Khng c.
Vin nang :
Ph n mang thai : ch dng nu tht s cn v phi theo di cn thn v c th xy ra tnh trng
thuc gy hi bo thai hoc c th nh hng n kh nng sinh sn.
M cho con b : ngi ta khng r thuc c c bi tit qua sa m hay khng.
Liu qu cao c th gy bun nn, au bng qun hay tiu chy. Liu cc cao thng i km
vi tng ur niu v tng ur huyt.
Thuc nc : Thng dung np tt. Cc tc dng ph thng c bo co nht ch yu l
h tiu ha khi dng liu qu cao hoc khi dng ko di. Cc loi phn ng d ng cng c
quan st thy t hn.

TNG TC THUC
Khng c tng tc lm sng r rt no c ghi nhn. Tuy nhin, cc thuc khng acide nh
carbonate calci hay hydroxyde magnesium c th v hiu ha tc dng ca cc enzyme.
TC DNG NGOI
Tc dng ph thng thng nht c bo co l v tiu ha. Do c papain, c th gy tiu
chy.
c ghi nhn phn ng d ng xy ra cng nhn ht phi bt a-amylase chit t vi nm
Aspergillus oryzae. Cc phn ng ny khng xy ra i vi a-amylase t vi khun.
i vi nhng bnh nhn c tin s nhy cm vi trypsine, pancreatine hay pancrelipase c th
b phn ng d ng. nhng bnh nhn tng cm vi tht heo cn thn trng khi dng thuc
chung vi cc sn phm t tht heo. Ngng dng thuc nu triu chng tng cm xut hin,
tin hnh iu tr triu chng v iu tr h tr nu cn thit.
Kch ng da v nim mc : khng c lm dnh bt thuc ra tay v c th gy kch ng da. Bi
bt mn ca thuc c th kch ng nim mc mi v nim mc h hp. Ht nhm bt phn tn
trong khng kh c th kch hot mt cn hen suyn. Suyn cng c th xut hin cc bnh
nhn nhy cm vi cc nng men pancreatine.
LIU LNG v CCH DNG
Git : Tr nh di 1 tui : 0,5 ml (khong 12 git) mi ngy, ung 1 ln hay chia lm 2 ln, c
th pha vo sa, thc n hoc nh trc tip vo ming.
Vin nang : Mi ln 1 vin, ngy 2 ln ung sau ba n.
Thuc nc : Ngi ln : 5 ml (1 mung c ph), hai ln mi ngy, ung sau mi ba n. Tr em
trn 1 tui : mi ngy 5 ml (1 mung c ph), chia lm hai liu ung sau ba n.
NEOXIDIL
GALDERMA
dung dch 2% : chai xt 60 ml vi bm nh liu khng c kh y.
THNH PHN
cho 1 ml
Minoxidil

20 mg

T dc : cn 60%, propylene glycol, nc

ct.
DC L LM SNG
Neoxidil kch thch s pht trin tc trn nh u ngi nam v n b hi u kiu nam gii
(alopecia androgenetica). Khng bit c c ch tc dng ca minoxidil kch thch s pht
trin tc nhng mt vi thuc lm gin ng mch khc ging nh minoxidil cng c tc ng

kch thch mc tc khi dng theo ng ton thn.

Tnh sinh ung th :
Khng c bng chng v tnh sinh ung th th v chut ln khi s dng Neoxidil trn da trong
khong thi gian 1 nm. Ch n c minoxidil cho chut nht trong vng 24 thng gy gia
tng t l lymphm c tnh trn chut ci v gia tng t l u gan chut c. Tuy nhin, t l b
lymphm khng c lin quan n liu lng v tng t nh cc nhm chng trong cc
nghin cu s dng chut nht trong cng mt qun th. T l u gan li ph thuc vo liu
lng vi mt s gia tng quan st c vi liu 63 mg/kg/ngy nhng khng thy xut hin
vi liu 25 hay 10 mg/kg/ngy. Thuc khng gy nh hng no trn t l u c tnh gan.
Ging nh trng hp lymphm, t l b u gan cng trong gii hn kim chng c c trc
y trn i tng l qun th chut nht. Khng thu c bng chng v kh nng gy ung
th trong nghin cu dng ch n c minoxidil chut ln. Tuy nhin, nghin cu trn
chut ln ch kho st vi mt s lng th bng 1/3 s lng trong th nghim vi chut nht
v liu lng ch bng mt na liu ti a ; v thuc c dng trong mt thi lng ngn hn
(n 15 thng chut ln c v 22 thng chut nht ci). Minoxidil khng gy t bin
trong test salmonella (test Ames), th nghim lm h hi DNA/dung ly bng cht kim hay test
vi nhn chut ln. Trong mt nghin cu s dng chut ln c v ci dng liu ung
minoxidil ti a khuyn co cho ngi trong iu tr cao huyt p hoc gp 5 ln cao hn (nhn
ln theo liu cho mt bnh nhn 50 kg), c s gim t l th thai ph thuc vo liu lng.
CH NH
Neoxidil c ch nh trong iu tr hi u kiu nam gii (alopecia androgenetica) ti nh
u. Thuc khng c tc dng no trn chng hi u trn. Ni chung, cn t nht 4 thng
iu tr lin tc trc khi tc bt u mc v tip tc mc thm khi iu tr n 1 nm.
CHNG CH NH
Neoxidil chng ch nh nhng bnh nhn c tin s qu mn vi bt kz thnh phn no ca
thuc.
THN TRNG LC DNG
Tng qut :
Bnh nhn c iu tr vi Neoxidil nn c khm hng thng sau khi bt u dng Neoxidil
v t nht mi su thng sau . Nu hn hu c xut hin tc dng ton thn, nn ngng
thuc.
Neoxidil cha cn c th gy bng v kch ng mt. Khi v tip xc thuc vi vng nhy cm
(mt, da b try v nim mc), nn ra vng ny vi tht nhiu nc lnh.
Nn trnh ht phi hi phun m ca thuc.
Khng nn dng Neoxidil kt hp vi cc thuc dng ti ch khc bao gm cc corticoid bi da,
retinoid v petrolatum hay nhng tc nhn c bit lm tng s hp thu thuc qua da.
Neoxidil ch dng ngoi da. Mi ml Neoxidil cha 20 mg minoxidil. Ung nhm dung dch ny c

th dn ti nhng tc dng ngoi ton thn (xem Qu Liu).

Cng nh cc thuc dng ngoi da khc, s ton vn ca lp biu m gim do tin trnh vim
hay bnh ca da (nh st da u, vy nn da u hay bng nng nng) c th lm tng s hp
thu qua da ca minoxidil.
S dng cho tr em : Tnh an ton v hiu qu trn bnh nhn di 18 tui cha c xc nh.
LC C THAI
Cha c nghin cu y v c kim chng c thc hin trn ph n c thai c iu tr
vi dung dch bi ti ch Neoxidil cng nh trn ph n c thai ung minoxidil iu tr cao
huyt p. Minoxidil khi dng theo ng ung i km vi s gia tng t l tiu thai th, tuy
nhin tc dng ny khng xy ra chut ln, khi dng gp 5 ln liu ung iu tr cao huyt p
dng cho ngi. Khng c bng chng sinh qui thai khi cho chut ln hay th ung minoxidil.
Tim di da minoxidil cho chut ln ang c thai vi liu 80 mg/kg/ngy (khong 2000 ln liu
hp thu ton thn ti a ngi khi dng ti ch mi ngy) gy c cho chut m nhng
khng gy qui thai. Liu tim di da cao hn cho bng chng gy c tnh trn s pht trin.
Do thn trng, Neoxidil khng nn dng cho ph n c thai.
LC NUI CON B
c mt bo co v s tit minoxidil trong sa m mt ph n c iu tr cao huyt p
bng 5 mg minoxidil ung mi ngy hai ln. Do kh nng tc dng ngoi ln tr c nui
bng sa m do s hp thu minoxidil, khng nn dng Neoxidil cho b m nui con b.
TNG TC THUC
Hin nay, khng c tng tc thuc no c bit l c lin quan n s s dng Neoxidil. Mc
d cha c chng minh trn lm sng, vn c gi thuyt v kh nng minoxidil c hp thu
c tc dng gy h huyt p th ng bnh nhn ang dng ng thi guanethidine.
TC DNG NGOI
Minoxidil c s dng trn 3510 bnh nhn tham gia trong cc th nghim c kim chng
gi dc. Ngoi tr trng hp tc dng ph trn da l tc dng ngoi { thng xy ra vi
nhm minoxidil, khng c phn ng ring l hay phn loi theo h c quan no c cho l c
gia tng trong nhm dng minoxidil. Cc bnh nhn tham gia nghin cu 5 nm v khng c
thay i no v t l hay mc trm trng ca cc phn ng c bo co. Cc tc dng ph
c bo co t kinh nghim lm sng trong qu trnh lu hnh thuc bao gm : eczema,
chng rm lng, ni ban ti ch, nga ngy, kh da/trc vy da u, ri lon tnh dc, ri
lon th gic bao gm gim th lc, tng rng tc, rng lng.
LIU LNG v CCH DNG
Nn lm kh tc v da u trc khi xt dung dch Neoxidil. Nn dng liu 1 ml Neoxidil cho
ton b vng da u b bnh mi ngy hai ln. Liu hng ngy khng nn vt qu 2 ml. Nu
dng u ngn tay bi thuc, nn ra tay sau . Cn 4 thng iu tr vi hai ln dng thuc
mi ngy hay c th lu hn mi bt u c bng chng ca s mc tc tr li. S bt u v

mc ca mc tc tr li thay i ty theo bnh nhn. Nu tc mc tr li, cn dng Neoxidil

hai ln mi ngy cho tc mc thm tip. Mt vi bo co c tnh cht giai thoi v tin trnh
mc tc cng nh hi u s tr li tnh trng trc khi iu tr khi ngng thuc 3 n 4 thng.
Ghi ch : 10 nht xt tng ng vi 1 ml.
QU LIU
S gia tng hp thu ton thn ca minoxidil c th xy ra nu dng Neoxidil thng hn hay vi
liu lng cao hn (so vi ch nh) hoc nu Neoxidil c dng trn vng da rng hay nhng
vng khc ngoi da u. Cho n nay khng thy c trng hp qu liu minoxidil do s dng
Neoxidil ti ch. Do Dung Dch Bi Ti Ch Neoxidil cha mt nng cao minoxidil, v ung
nhm s gy tc dng ngoi { ton thn do tc ng dc l ca thuc (5 ml dung dch bi ti
ch Neoxidil cha 100 mg minoxidil l liu ung ti a iu tr cao huyt p cho ngi ln).
Cc du hiu v triu chng qu liu minoxidil hu nh l nh hng trn tim mch lin quan
n s nc v nhp tim nhanh. nc c th c kim sot bng thuc li tiu thch hp.
Chng nhp tim nhanh c { ngha trn lm sng c th c kim sot bng cch dng tc nhn
c ch bta-adrenergic. Nu c tt huyt p, nn iu tr bng cch truyn tnh mch dung dch
nc mui sinh l. Cc thuc ging giao cm, nh norepinephrine v epinephrine, nn trnh
dng do tc ng kch ng tim qu . Minoxidil v cc cht chuyn ha ca n c th thm
phn c.
BO QUN
Bo qun nhit phng (15-30oC). Trnh tm tay ca tr em.
iu tr triu chng tiu chy khng in hnh.
THN TRNG LC DNG
Ngng thuc nu khng c ci thin sau 48 gi hay nu c st cao.
Tr em 3-6 tui : phi c s gim st ca ngi ln.
TNG TC THUC
Neo Entrostop c th nh hng n s hp thu ca cc thuc khc; nn dng cc thuc khc t
nht 2-3 gi trc hoc sau khi dng Neo Entrostop.
LIU LNG v CCH DNG
Ngi ln v tr em >= 12 tui : ung 2 vin sau mi ln i phn lng (ti a 12 vin/ngy).
Tr em 6-12 tui : ung 1 vin sau mi ln i phn lng (ti a 6 vin/ngy).
BO QUN
Bo qun nhit thng.

355.

NETROMYCIN IM/IV

SCHERING-PLOUGH
dung dch tim bp v tim truyn tnh mch 50 mg/2 ml : l 2 ml, hp 1 l.
dung dch tim bp v tim truyn tnh mch 100 mg/2 ml : l 2 ml, hp 1 l.
dung dch tim bp v tim truyn tnh mch 200 mg/2 ml : l 2 ml, hp 1 l.
THNH PHN
cho 1 l
Netilmicin sulfate

50 mg

cho 1 l
Netilmicin sulfate

100 mg

cho 1 l
Netilmicin sulfate

200 mg

TNH CHT
Netilmicin sulfate l 1 khng sinh bn tng hp, tan trong nc, thuc nhm aminoglycoside.
DC LC
Netilmicin l mt khng sinh dit khun.
Vi khun hc : Netilmicin l mt khng sinh c tc dng dit khun nhanh, tc ng bng cch
c ch s tng hp bnh thng ca protine cc vi khun nhy cm. Netilmicin tc ng
nng thp chng li nhiu loi vi khun gy bnh bao gm Escherichia coli, cc vi khun
nhm Klebsiella-Enterobacter-Serratia, Citrobacter sp, Proteus sp (indole dng tnh v indole
m tnh), bao gm Proteus mirabilis, P. morganii, P. rettgeri, P. vulgaris, Pseudomonas
aeruginosa v Neisseria gonorrhoeae. Netilmicin cng c tc ng in vitro trn cc vi khun
phn lp Hemophilus influenzae, Salmonella sp, Shigella sp v trn Staphylococcus to
pnicillinase v khng to pnicillinase k c cc chng khng methicilin. Mt s chng thuc
Providencia sp, Acinetobacter sp v Aeromonas sp cng nhy cm vi netilmicin.
Nhiu dng vi khun khng vi cc aminoglycoside khc, th d nh kanamycine,
gentamicine, tobramycine v sisomicine th nhy cm vi netilmicin trong iu kin in vitro. i
khi cc dng c xc nh khng vi amikacine nhng li nhy cm vi netilmicin.

S phi hp netilmicin v pnicilline G to mt tc ng dit khun hip ng chng li phn

ln cc chng Streptococcus faecalis (Enterococcus). Tc ng phi hp ca netilmicin v
carbenicilline hoc ticarcilline c tnh hip ng trn nhiu chng Pseudomonas aeruginosa.
Hn na, nhiu chng c lp Serratia khng vi nhiu khng sinh b c ch bi tc dng hip
ng ca netilmicin v carbenicilline, azlocilline, mezlocilline, cefamandole, cefotaxime hay
moxalactam. Cc xt nghim v tnh ng vn ca khng sinh l rt cn thit.
Xt nghim v tnh nhy cm : Nu dng phng php a th nghim tnh nhy cm nh
Bauer v cng s m t, mt a cha 30 mg netilmicin s to mt vng c ch c ng knh
17 mm hoc ln hn cho thy tnh nhy cm ca netilmicin trn cc vi khun phn lp t cc
loi khng phi Pseudomonas aeruginosa. Vi Pseudomonas aeruginosa, tnh nhy cm ca
netilmicin c biu hin bi mt vng c ch c ng knh 12 mm hoc ln hn. Vng c
ch nh hn 12 mm Pseudomonas aeruginosa v nh hn 17 mm trn cc loi khc chng t
vi khun rt c th c kh nng khng.
Do Pseudomonas p ng khc hn vi phn tn ca mtilmicine trn xt nghim nhy cm
bng a thch so vi Enterobacteriaceae v Staphylococcus, ngi ta s dng kch thc vng
v khun khc phn bit vi khun nhy cm v khng. Trn lm sng, s khc bit ny
khng c ngha l tc ng k m hn. Nu vng c ch nm gia gi tr 12 v 17 mm, xt nghim
oxidase dng tnh cng nh cc phng php nhn din khc s chng minh c kh nng
hin din ca pseudomonas nhy cm.
Trong mt vi trng hp nht nh, c bit vi cc chng Pseudomonas aeruginosa, c th
cn phi lm thm xt nghim nhy cm bng phng php ng nghim hay phng php pha
long thch ; nn dng dung dch chun netilmicin lm xt nghim ny.
c tnh :
Trn th vt : cc nghin cu c tnh bn cp v mn trn chut cng, cobaye, ch, mo, th
v kh sc chng t netilmicin t c trn thn v t c trn tai hn cc aminoglycoside khc.
CH NH
Nhim khun gy ra bi cc chng nhy cm ca cc vi khun sau : Escherichia coli, Klebsiella,
Enterobacter, Serratia sp, Citrobacter sp, Proteus sp (indole dng tnh v indole m tnh),
Pseudomonas aeruginosa, Staphylococcus sp (coagulase dng tnh v coagulase m tnh, k c
cc chng khng pnicilline v mticilline) v Neisseria gonorrhoeae.
Cc nghin cu lm sng cho thy netilmicin c hiu qu trong : nhim trng mu (k c nhim
trng tr s sinh), nhim trng nng ng h hp ; nhim trng thn, tit niu-sinh dc ;
nhim trng da, m mm ; nhim trng xng khp ; nhim trng khi gii phu ; vt thng,
bng ; nhim trng trong bng (bao gm vim phc mc) ; nhim trng ng tiu ha.
Netilmicin IM/IV c khuyn dng iu tr khi u trong cc bnh nhim trng nghi ng hay
xc nh c l do vi khun gram m. Trong trng hp nghi ng nhim trng do vi khun
gram m, vic quyt nh tr liu tip tc vi netilmicin IM/IV phi da trn kt qu th nghim

tnh nhy cm, p ng lm sng v s dung np thuc ca bnh nhn.

Trong cc bnh nhim trng nng khi cha xc nh c vi khun gy bnh, netilmicin IM/IV
c dng iu tr khi u kt hp vi mt khng sinh thuc nhm pnicilline hoc
c phalosporine trc khi c kt qu th nghim tnh nhy cm. Nu nghi ng c vi khun k
kh, nn phi hp Netromycin IM/IV vi mt cht khng khun thch hp. Sau khi nhn nh
c vi khun v tnh nhy cm, Netromycin hay khng sinh khc thch hp c ch nh tip
theo.
Netromycin IM/IV c dng c hiu qu khi kt hp vi carbenicilline hay ticarcilline trong
iu tr cc bnh nhim trng rt nng gy ra bi Pseudomonas aeruginosa. Thuc cng cng
hiu khi dng kt hp vi mt thuc loi p nicilline trong iu tr vim ni tm mc gy ra bi
Streptococcus.
tr s sinh nghi ng b nhim trng hoc vim phi do staphylocoque, thng ch nh ng
thi netilmicin vi mt thuc loi pnicilline.
V Netromycin IM/IV c chng minh cng c hiu lc trong iu tr cc bnh nhim trng
nng do staphylocoque, nn n c th c x t n trong iu tr cc bnh ny khi pnicilline
hoc cc dc phm t c hn khng c php s dng v khi cc th nghim tnh nhy cm
ca vi khun cng vi cc chn on lm sng cho ph p. Netromycin cng c x t n trong
cc trng hp nhim nhiu loi vi khun do cc chng nhy cm ca staphylocoque v vi
khun gram m.
Netromycin IM/IV c ch nh vi mt liu duy nht trong iu tr nhim trng lu cu cp
tnh khng bin chng phi nam (niu o, trc trng) v phi n (niu o, c t cung,
trc trng) trong trng hp khng suy thn.
Trong phu thut, Netromycin IM/IV c th c dng trong tin phu v tip tc khi hu phu
tr liu cc bnh nghi ng hoc gy ra do cc vi khun nhy cm.
Netromycin IM/IV c hiu qu trong iu tr cc bnh nhim gy ra bi cc vi khun khng
vi cc aminoglycoside khc nh kanamycine, gentamicine, tobramycine, sisomicine v
amikacine.
CHNG CH NH
Qu mn cm hoc cc phn ng c hi nghim trng vi netilmicin hay vi cc
aminoglycoside khc.
THN TRNG LC DNG
Bnh nhn iu tr vi cc aminoglycoside phi c theo di cn thn v lm sng v c tnh
lin quan n vic s dng chng. Netilmicin gy c tnh thp trn thn. Tuy vy, nh vi tt
c thuc h aminoglycoside khc, nn kim tra chc nng thn trong sut thi gian tr liu.
bnh nhn suy thn, bnh nhn c ch nh dng thuc vi liu cao hoc iu tr ko di v
nhng ngi ln tui, nguy c thuc gy c tnh trn thn cao hn so vi ngi bnh
thng.

Mc d c tnh trn tai ca netilmicin khng thng xuyn v biu hin nh hn so vi cc

aminoglycoside khc, cng c th xy ra gim thnh lc v ri lon chc nng tin nh, ch yu
nhng bnh nhn c tn thng thn t trc v nhng bnh nhn c chc nng thn bnh
thng c iu tr vi liu cao hn v/hoc thi gian iu tr lu hn mc thng thng
khuyn dng.
Nn kho st chc nng thn v dy thn kinh s s 8 trong khi iu tr, c bit cc bnh
nhn c hoc nghi ng b gim chc nng thn th nn kho st thm lc bt u iu tr.
Nn kho st nc tiu xc nh s gim t trng c hiu, tng bi tit protine v c s
hin din ca t bo hoc cc tr niu.
Nn kim tra nh kz BUN, cratinine huyt thanh hay thanh thi cratinine. Khi c th, khuyn
nn lm thnh lc nh kz, c bit nhng bnh nhn c nguy c tai bin cao. Cn chnh
liu hoc ngng dng thuc nu c cc bng chng c tnh trn tai v trn thn. Nh vi cc
aminoglycoside khc hoc nhng trng hp him gp, s thay i chc nng thn v dy thn
kinh s 8 c th khng xut hin cho n sau khi iu tr hon ton.
Nn xc nh nng aminoglycoside trong huyt thanh bo m rng thuc t c nng
thch ng v trnh ngng c hi. Khi kho st nng ti a netilmicin, nn trnh dng
ko di cc nng trn 16 mg/ml. Nng ti a v/hoc ti thiu trong huyt thanh ca
aminoglycoside qu ln c th lm tng c tnh trn thn v dy thn kinh s s 8. Nng ti
thiu (ngay trc khi dng liu k tip) thng s trong khong 0,5-2 mg/ml vi liu khuyn
co s dng. Nn trnh cc nng ti thiu trn 4 mg/ml.
bnh nhn b phng din rng, dc ng ca thuc b bin i c th dn n s gim cc
nng aminoglycoside trong huyt thanh. Vic o nng netilmicin trong huyt thanh c
bit quan trng nhng bnh nhn ny lm c s iu chnh liu.
Cc khng sinh c c tnh trn thn kinh hay thn c th c hp thu ng k t b mt c
th sau khi thoa hoc p ti ch. Nn lu { kh nng c hi ca cc khng sinh ny khi iu
tr bng cch ny.
Gia tng c tnh trn thn c ghi nhn sau khi dng ng thi cc khng sinh
aminoglycoside v cphalosporine.
Mc d s c ch thn kinh-c v lit h hp cha l vn c t ra qua cc th nghim
lm sng, hin tng ny c ghi nhn th c cho dng netilmicin vi liu cao hn
ng k so vi liu dng trn lm sng, do , nn xem x t kh nng ny xy ra ngi, nht l
khi s dng aminoglycoside bnh nhn dng thuc gy m, cc cht gy c ch thn kinh-c
(nh succinyl choline, tubocurarine hay decamethonium) hoc tim truyn lng ln citrate
chng ng mu. Nu c hin tng nghn thn kinh c, c th dng mui calcium phc
hi.
Nn s dng thn trng cc aminoglycoside bnh nhn b ri lon thn kinh-c, nh chng
nhc c nng hay ng c Clostridium botulinum tr em hoc bnh Parkinson, v cc thuc

ny trn l thuyt lm nng thm s nhc c do tc dng ging curare ch ni thn kinh-c.
bnh nhn ln tui, chc nng thn c th suy gim m khng pht hin c r rng qua
cc xt nghim thng quy nh BUN hoc cratinine huyt thanh. S xc nh h s thanh thi
cratinine c th hu ch hn. Cng nh cc aminoglycoside khc, kim sot chc nng thn khi
iu tr vi netilmicin c bit quan trng cc bnh nhn ny.
Hi chng ging Fanconi, vi nhim toan chuyn ha v c acide amine niu c bo co
mt s trng hp ngi ln v tr em c iu tr vi netilmicin sulfate.
chng minh c tnh d ng cho gia cc aminoglycoside.
Bnh nhn phi c cung cp nc y trong qu trnh iu tr.
In vitro, trn ln mt khng sinh h aminoglycoside vi cc loi bta-lactam (pnicilline hoc
cphalosporine) gy mt hot tnh ln nhau mt cch ng k. Ngay c khi 1 aminoglycoside v
1 khng sinh loi p nicilline c s dng ring r bng cc con ng khc nhau, cng c bo
co v gim thi gian bn hy trong huyt thanh ca aminoglycoside hoc nng
aminoglycoside trong huyt thanh cc bnh nhn b gim chc nng thn v mt s bnh
nhn c chc nng thn bnh thng. Thng thng, tc dng mt hot tnh nh th ca
aminoglycoside ch c { ngha v lm sng trn nhng bnh nhn suy thn trm trng.
Vic tr liu bng netilmicin c th dn n s pht trin qu mc ca cc vi khun khng nhy
cm. Nu xy ra trng hp ny, phi dng cc tr liu thch hp.
Thuc tim Ntromycine c cha mtabisulfite Na v sulfite Na ; cc cht ny c th gy ra cc
phn ng d ng bao gm cc triu chng phn v v nguy him n tnh mng hoc cc cn
suyn khng trm trng mt vi i tng nhy cm. Tnh nhy cm vi sulfite thng xuyn
c nhn thy ngi b suyn hn l ngi khng b suyn.
LC C THAI v LC NUI CON B
Vic an ton khi s dng thuc thai ph cha c lm r. Cc nghin cu trn ph n cho
con b cho thy c 1 lng nh netilmicin c bi tit qua sa m. Do kh nng ca cc tc
dng ngoi { ny nn ngng cho con b hoc ngng thuc.
TNG TC THUC
Nn trnh s dng ti ch hay s dng ton thn cng lc v/hoc lin tip vi cc dc phm
c kh nng gy c tnh trn thn v/hoc trn thn kinh nh cisplatine, bacitracine,
polymyxine B, colistine, cephaloridine, amphotricine B, kanamycine, acyclovir, gentamicine,
amikacine, sisomicine, tobramycine, neomycine, streptomycine, paromomycine, viomycine v
vancomycine. Nguy c th hin c tnh c th cao hn bnh nhn ln tui v c th b mt
nc.
Nn trnh s dng ng thi netilmicin vi cc thuc c tc dng li tiu mnh, nh acide
thacrynique hoc furosmide, v bn thn cc thuc li tiu ny c th gy c tnh trn tai.
Hn na, khi dng ng tnh mch, cc thuc li tiu c th lm tng c tnh ca cc
aminoglycoside do lm bin i nng khng sinh trong huyt thanh v trong m.

TC DNG NGOI
c tnh trn thn : him v thng l nh c bo co xut hin sau khi dng netilmicin.
ngi ln tui, bnh nhn c tin s suy thn hoc c iu tr vi lng ln hn yu cu,
c tnh xy ra thng hn v hu ht l c th phc hi.
c tnh trn thn kinh : khng ging cc aminoglycoside khc, dung dch tim Netromycin c
c tnh trn tin nh v trn c tai rt thp. C th c thiu nng tin nh thong qua do c
ch b tr. Thiu nng c tai him gp th thng l khng th phc hi. Tc dng ngoi ln
c tin nh v cc nhnh nghe ca dy thn kinh s s 8 xy ra ch yu bnh nhn suy thn
v dng liu cao v/hoc iu tr ko di. Mt s triu chng xy ra gm : chong vng, chng
mt, tai, mt thnh lc. Mt thnh lc thng biu hin bng s gim nghe m c m sc cao.
Cc yu t khc cng c th tng nguy c gy c tnh trn tai ca aminoglycoside. Nguy c c
tnh thp trn bnh nhn c chc nng thn bnh thng. Khng c ch nh dng dung dch
tim Netromycin vi liu cao hn hoc thi gian di hn liu khuyn dng.
Mt s bnh nhn c tin s b c tnh trn thn kinh vi cc aminoglycoside khc c
iu tr mt cch an ton vi dung dch tim Netromycin IM/IV.
Cc tc dng ngoi khc him xy ra c ghi nhn vi netilmicin bao gm : nhc u, kh
chu, ri lon th gic, mt kh nng nh hng, tim p nhanh, h huyt p, nh trng ngc,
d cm, pht ban, n lnh, st, gi nc, nn ma v tiu chy. Rt him khi c bo co xut
hin phn v.
Cc bt thng trong nhng nghin cu cn lm sng lin quan n netilmicin bao gm : tng
ng huyt ; tng phosphatase kim ; tng SGOT hay SGPT ; bilirubine ; tng kali ; cc nghin
cu chc nng gan bt thng khc ; gim hmoglobine, bch cu v tiu cu ; tng bch cu
a acide, thiu mu v tng thi gian prothrombine.
Ni chung, dung np ti ch ca Netromycin thng l tt, tuy nhin i khi c hin tng au
ni chch hay phn ng ti ch. So snh s chn lc lm sng ngu nhin gia netilmicin v
amikacine th khi tim bp netilmicin gy au t hn mt cch ng k so vi amikacine.
LIU LNG v CCH DNG
Liu khuyn co dng l nh nhau ng tim bp v tim tnh mch.
Nn theo di trng lng c th ca bnh nhn trc khi iu tr tnh ton liu lng cho
ng. ngi bo ph nn tnh ton liu aminoglycoside theo c lng trng lng khng c
m.
Khng nn trn ln Netromycin IM/IV vi cc thuc khc m phi dng ring r theo ng
dng v phc c khuyn co.
Cn o nng ti a v ti thiu ca netilmicin trong huyt thanh chc rng thuc c
dng khng vt qu nng cn thit. Khi dng Netromycin IM/IV mi ngy trong 2 hay 3
ngy, nng ti a c o trong 30 pht n 1 gi sau khi ung cn trong khong 4-12
mg/ml ; nn iu chnh liu trnh nng ti a trong huyt thanh ko di trn 16 mg/ml.

Nn trnh nng ti thiu o trc khi ung liu k tip cao hn 4 mg/ml. Khi dng
Netromycin IM/IV mt liu duy nht ni ngy, c th d on nng nh trong khong 20-30
mg/ml.
Thi gian tr liu thng thng cho mi bnh nhn l t 7-14 ngy. Trong cc trng hp nhim
trng c bin chng, cn iu tr lu di hn. Mc d cc t iu tr ko di ca netilmicin
c dung np tt, vic kim tra chc nng thn, thnh gic, th gic v tin nh cho bnh nhn
c iu tr qu khong thi gian thng thng l rt quan trng. Liu nn c gim khi biu
hin lm sng cho php.
ng tim bp :
Bnh nhn c chc nng thn bnh thng :
Ngi ln : trng hp nhim trng ng tiu hoc nhim trng ton thn khng trm trng
cc bnh nhn c chc nng thn bnh thng, liu dng l 4-6 mg/kg/ngy chia lm 3 ln
bng nhau cch mi 8 gi, hoc chia lm 2 ln bng nhau cch mi 12 gi hoc dng mi ngy 1
ln. Ni chung, vi khong liu lng ny, dng liu thp hn trong trng hp nhim trng
ng tiu v cao hn trong cc bnh nhim ton thn. Vi c hai cng dng, liu dng nn
c iu chnh ty theo mc trm trng ca bnh v tnh trng ca bnh nhn. ngi
ln cn nng t 40-60 kg : c th dng 100 mg mi 12 gi. ngi ln vi th trng nng hn
hay nh hn khong trng lng nu trn, liu dng nn c tnh bng mg/kg ca trng
lng c th khng tnh m.
bnh nhn nhim trng nng : dng 7,5 mg/kg/ngy chia lm 3 liu bng nhau cch mi 8
gi. Liu ny nn gim cn 6 mg/kg/ngy hoc t hn ngay khi biu hin lm sng cho php,
thng trong khong 48 gi.
Tr em : 6-7,5 mg/kg/ngy (dng 2-2,5 mg/kg cch mi 8 gi)
Tr s sinh v mi sinh trn 1 tun : 7,5-9 mg/kg/ngy (dng 2,5-3 mg/kg cch mi 8 gi)
Tr sinh thiu thng hoc mi sinh 1 tun hay di 1 tun : 6 mg/kg/ngy (3 mg/kg dng cch
mi 12 gi)
Bnh nhn suy thn :
Liu phi c iu chnh cc bnh nhn b suy thn. Khi c th, nn kim tra nng
netilmicin trong huyt thanh. Lch dng thuc khng nht thit theo ch nh cng nhc nhng
c nu ra nh mt hng dn v liu lng khi s o lng netilmicin trong huyt thanh
khng th thc hin c. Nu khng c nh lng huyt thanh v chc nng thn n nh,
h s thanh thi cratinine v cratinine huyt thanh l cc ch dn c gi tr nht v mc
thiu nng thn hng dn vic iu chnh liu lng.
Ch iu tr thay i v khong cch dng liu : c th iu chnh bng cch gia tng khong
thi gian gia cc liu c dng thng thng. V nng cratinine trong huyt thanh c
tng quan ln vi thi gian bn hy ca netilmicin trong huyt thanh, xt nghim ny c th
hng dn cho vic iu chnh khong cch thi gian gia cc liu. Khong cch thi gian gia

cc ln dng thuc (tnh bng gi) c th c c lng bng cch nhn mc cratinine trong
huyt thanh (tnh bng mg/100ml) vi 8. Th d : mt bnh nhn cn nng 60 kg vi mc
cratinine trong huyt thanh l 3 mg/100 ml c th dng 120 mg (2 mg/kg) cch 24 gi (3 x 8).
Ch iu tr thay i v liu lng : cc bnh nhn nhim trng ton thn nng hoc suy
thn, khng sinh c th dng vi khong cch thi gian ngn hn nhng liu gim i. cc
bnh nhn ny, nn o nng netilmicin trong huyt thanh.
Cc phng php xut :
Sau liu khi u hoc liu tn cng thng thng, mt hng dn s b xc nh vic gim
liu cch khong 8 gi l chia liu yu cu thng thng vi mc cratinine trong huyt
thanh. Th d : sau liu khi u 120 mg (2 mg/kg), 1 bnh nhn cn nng 60 kg vi mc
cratinine trong huyt thanh l 3 mg/100 ml s c cho dng 40 mg mi 8 gi (120 / 3).
Nu bit h s thanh thi cratinine, liu duy tr c dng mi 8 gi c th tnh bng cng
thc sau :
Liu duy tr mi 8 gi = Liu duy tr thng thng x Ccr ghi nhn / Ccr bnh thng
Ccr = H s thanh thi cratinine (ml/pht/1,73 m2)
Liu khi u hay tip theo ging nhau bnh nhn c chc nng thn bnh thng (xem bng)
Hng dn chnh liu lng bnh nhn thiu nng thn (liu cch 8 gi sau liu khi u bnh
thng).
Cratinine huyt thanh
(mg/100 ml)

H s thanh thi cratinine phng nh

(ml/pht/1,73 m2)

% ca liu thng
thng

<= 1.0

100

100

1,1-1,3

70-100

80

1,4-1,6

55-70

65

1,7-1,9

45-55

55

2,0-2,2

40-45

50

2,3-2,5

35-40

40

2,6-3,0

30-35

35

3,1-3,5

25-30

30

3,6-4,0

20-25

25

4,1-5,1

15-20

20

5,2-6,6

10-15

15

6,7-8,0

10

10

Phc c nu nh mt hng dn liu lng khi vic o mc cratinine trong huyt thanh
khng thc hin c. S suy gim hot ng chc nng thn c th i hi gim liu nhiu
hn so vi liu c nu ra cho bnh nhn c tnh trng suy thn n nh.
ng tim tnh mch : Netilmicin hu hiu trong iu tr bnh nhn b nhim trng mu hoc
b sc. Vic s dng thuc bng ng tim tnh mch cng c a chung cc bnh nhn
suy tim sung huyt, ri lon v mu, bng nng hoc b gim trng lng c.
Dng ng tim tnh mch ngi ln, 1 liu duy nht c th c pha long trong 50-200
ml dung dch mui ng trng hay dung dch v trng Dextrose 5% ; tr s sinh v tr em,
th tch cht pha long nn ty thuc nhu cu nc ca bnh nhn. Dung dch c th c tim
truyn trn khong thi gian t na gi n 2 gi. Trong mt s trng hp, c th tim trc
tip vo tnh mch hoc bm chm vo ng truyn tnh mch trong khong 3-5 pht.
V l{ tnh, Netromycin IM/IV tng hp vi cc dung dch pha tim c k di y v khng
mt tc dng nng 3 mg/ml (v c bn) khi gi nhit phng hay nhit lnh trn 7
ngy :
Nc pha tim tit khun ; dung dch mui tiu chun ; dung dch tim NaCl ; Dextrose 5%
trong nc ; Dextrose 5% vi dung dch in gii s 48 ; Dextrose 5% vi dung dch in gii s
75 ; Dextrose 5% v dung dch tim NaCl 0,9% ; dung dch tim Dextrose 50% ; dung dch tim
sodium bicarbonate 5% ; 6% Dextran 75 trong Dextrose 5% ; 10% Dextran 40 ; Dextrose 10%
trong nc ; dung dch tim Ringer ; dung dch tim Lactated Ringer ; dung dch tim Lactate
Ringer vi Dextrose 5% ; Isolyte P* vi Dextrose 5% ; Isolyte M* vi Dextrose 5% ; Isolyte E* vi
Dextrose 5% ; dung dch tim Osmitrol 10 v 20% ; dung dch tim Plasma-lyte M Dextrose 5% ;
dung dch tim Plasma-lyte 148 ; Plasma-lyte 56 vi Dextrose 5% ; Plasma - Lyte 148 vi
Dextrose 5%; Ionosol B trong D5-W ; Ionosol T trong Dextrose 5% ; 10% Travert+ vi dung dch
in gii s 2 ; 10% Travert+ vi dung dch in gii s 3 ; 10% Gentran* 40 v Dextrose 5% ;
Dextrose 5% trong Polysal++ ; 5% dung dch tim Amigen hoc dung dch tim Amigen 5% vi
Dextrose 5% ; Normosol-R ; Polysal ; dung dch tim Aminosol 5% ; dung dch tim Fre-amine II
8,5% ; dung dch tim Fructose 10% ; v Rheomacrodex 10% trong Dextrose 5%.
(*) : Nhn hiu thng mi ca Vin bo ch McGaw.
(+) : Nhn hiu thng mi ca Vin bo ch Baxter-Travenol, Inc.
(++) : Nhn hiu thng mi ca Vin bo ch Cutter, Inc.
iu tr theo cc ch liu lng c bit : bnh lu phi nam v phi n: Tim bp mt

liu duy nht 300 mg Netromycin. Nn tim su vo phn t trn ngoi ca mng (100 mg/ml)
vi na liu mi bn mng. Khuyn co iu chnh liu da trn th trng khng tnh m i
vi bnh nhn nh ngi hay to bo.
Cc nhim trng ng tit niu : nhim trng tit niu khng bin chng, c bit trong
trng hp mn tnh v ti pht v khng c thiu nng thn, bnh nhn c iu tr vi liu
3 mg/kg, tng ng vi 150-200 mg, tim bp mi ngy mt liu trong 7-10 ngy.
Thm phn lc mu : ngi ln suy thn chu s thm phn lc mu, lng netilmicin rt ra
t mu c th thay i ty thuc nhiu yu t, bao gm phng php thm phn c s
dng. Mt s thm phn lc mu trong 8 gi c th lm gim nng netilmicin trong huyt
thanh khong 63%. Thm phn ngn hn s loi tr c t thuc hn. Liu khuyn co dng
sau mi ln thm phn l 2 mg/kg.
Tr em : dng 2-2,5 mg/kg/ngy, ty thuc vo tnh trm trng ca nhim trng.
iu tr phi hp : khng nn gim liu netilmicin khi phi hp vi cc khng sinh khc bnh
nhn c chc nng thn bnh thng hoc suy yu.
QU LIU
Trong trng hp qu liu hay phn ng c hi, s thm phn lc mu hay phc mc s gip
loi netilmicin ra khi mu. Tuy nhin, t l loi netilmicin bng ng thm phn phc mc th
thp hn. Cc bin php ny c bit quan trng i vi trng hp bnh nhn b suy thn.

356.

NEUPOGEN

HOFFMANN - LA ROCHE
dung dch tim di da v tim truyn tnh mch 30 MUI/ml : hp 5 l 1 ml.
dung dch tim di da v tim truyn tnh mch 48 MUI/1,6 ml : hp 5 l 1,6 ml.
THNH PHN
cho 1 l
Filgrastime

30 MUI

cho 1 l
Filgrastime

48 MUI

TNH CHT
- M t :
Filgrastime l mt protine tinh ch khng glycosyl ha, cha 175 acide amine. Filgrastime
c sn xut t vi khun E. coli c gn thm gne sn xut G-CSF. T dc : m actate
natri (pH 4,0), Mannitol, Polysorbate 80 v nc pha tim.
Tc dng : Yu t kch thch tng trng qu trnh to mu.
- Tc ng dc hc :
G-CSF ngi l mt glycoprot ine iu ha s sn xut v phng thch cc bch cu a nhn
trung tnh c chc nng t ty xng. Neupogen c cha G-CSF ti t hp lm gia tng r rt s
bch cu a nhn trung tnh trong mu ngoi vi trong vng 24 gi, km theo lm tng nh bch
cu n nhn.
liu iu tr, vic tng s lng bch cu a nhn trung tnh ph thuc vo liu lng. Bch
cu a nhn trung tnh c to ra trong c th ngi khi p ng vi Neupogen c chc nng
bnh thng hoc tng chc nng, c chng minh bng cc xt nghim chc nng thc bo
v ha ng ng. Sau khi ngng iu tr Neupogen, s lng bch cu a nhn trung tnh trong
mu gim i 50% trong vng 1-2 ngy v tr v mc bnh thng trong vng 1-7 ngy.
iu tr bng Neupogen lm gim ng k tn sut, mc nng v thi gian ca gim bch
cu v gim bch cu c st, thng thy nhng bnh nhn sau ha tr liu c t bo. Bnh
nhn iu tr bng Neupogen v ha tr liu c t bo c thi gian nm vin t hn v t s
dng khng sinh hn so vi nhng bnh nhn ch s dng n thun ha tr c t bo.
- Tc ng dc ng hc :
C s tng quan tuyn tnh t l thun gia liu lng v nng trong huyt thanh ca GCSF d tim di da hay truyn tnh mch. Sau mt liu duy nht Filgrastim khong 1,769mg/kg (truyn tnh mch ngn trong vng 30 pht) nng nh ca G-CSF dao ng t 51840 ng/ml. Sau khi tim di da liu ngh, nng nh trong huyt thanh ln n 118
ng/ml v c duy tr trn 10 ng/ml trong 8-16 gi. Th tch phn phi trong mu vo khong
150 ml/kg.
Thi gian bn hy trung bnh trong huyt thanh ca G-CSF vo khong 3,5 gi, vi thanh thi
vo khong 0,6 ml/pht/kg.
nhng bnh nhn hi phc sau ghp ty t thn, truyn lin tc Neupogen trong thi gian 28
ngy khng gy ra tch t thuc.
G-CSF l ch rt gn ca Non-glycosylated Recombinant Human Methionyl Granulocyte-Colony
Stimulating Factor.
CH NH
Neupogen c ch nh rt ngn thi gian b gim bch cu nng v cc bin chng ca n
cc bnh nhn :

c dng ha tr liu c t bo, l nhng loi thng gy ra gim bch cu a nhn trung
tnh c st.
c iu tr c ch ty chun b cho ghp ty.
Dng lu di Neupogen lm tng s bch cu a nhn trung tnh, lm gim tn sut cng nh
thi gian cc giai on nhim trng trn cc bnh nhn b :
- Gim bch cu a nhn trung tnh bm sinh.
- Gim bch cu chu kz.
- Gim bch cu v cn, c s bch cu a nhn trung tnh <= 0,5 x 109/l v c tin s nhim
trng nng hoc ti pht.
CHNG CH NH
Neupogen khng nn dng nhng bnh nhn b d ng vi sn phm hoc nhng thnh phn
ca thuc.
THN TRNG LC DNG
Tng sinh t bo c tnh : G-CSF c th thc y s tng trng cc t bo ty in vitro v tc
dng tng t trn mt s t bo ngoi ty in vitro.
Tnh an ton v hiu qu ca Neupogen nhng bnh nhn lon sn ty, bnh bch cu cp
dng ty hoc bnh bch cu mn dng ty cha c xc nh. Do , v kh nng tng
trng cc khi u, cn thn trng khi dng Neupogen trn bt kz bnh l c tnh no c lin
quan n t bo ty.
Th nghim lm sng v kh nng Neupogen nh hng ln s pht trin ca hi chng lon
sn ty thnh bnh bch cu cp dng ty cn cha c thc hin. Do , cn thn trng khi
dng Neupogen trong bt kz tnh hung no ca bnh l tin c tnh ca ty xng.
Tng bch cu : s bch cu > 100 x 109 c ghi nhn khng qu 5% s bnh nhn iu tr
bng Neupogen liu trn 0,3 MUI/kg/ngy (3mg/kg/ngy). Khng ghi nhn c tc dng ph
no lin quan trc tip n mc tng bch cu ny. Tuy nhin trn quan im nguy c do tng
bch cu nng c th xy ra, nn theo di m bch cu u n trong qu trnh iu tr
Neupogen. Nu bch cu trn 50 x 109/l sau giai on gim bch cu a nhn trung tnh ti a,
th nn ngng ngay Neupogen.
Cc nguy c i km vi vic tng liu ha tr : cn thn trng c bit khi iu tr ha cht liu
cao, bi v cha chc bu c ci thin trong khi liu mnh thuc ha tr c th lm tng c
tnh gm tc ng ln tim, phi, thn kinh v da (xin tham kho thng tin hng dn s dng
cc thuc ha tr c dng).
iu tr Neupogen khng loi tr gim tiu cu v thiu mu do ha tr liu c ch ty. Bi v
khi cho ha tr liu cao (chng hn dng liu trong phc tr liu), bnh nhn c th c
nguy c cao gim tiu cu v thiu mu. Nn theo di m tiu cu v o dung tch hng cu
u n. Cn chm sc c bit khi dng n ha tr hay ha tr phi hp nhng tc nhn c
th gy gim tiu cu nng.

Theo di mt ca xng nn thc hin nhng bnh nhn c bnh l{ xng gy long
xng v c iu tr Neupogen lin tc trn 6 thng. Cha c cc nghin cu v Neupogen
trn nhng bnh nhn c gim nng chc nng gan, thn, v do khng nn ch nh
Neupogen cho nhng bnh nhn ny.
Tc dng ca Neupogen nhng bnh nhn b gim ng k cc t bo u dng ty xng
cha c nghin cu.
Neupogen u tin s tc ng ln cc t bo u dng ca bch cu a nhn trung tnh, qua
lm tng s bch cu a nhn trung tnh. Do nhng bnh nhn b gim cc t bo u
dng (chng hn nhng ngi c iu tr bng x tr hay ha tr din rng) p ng tng
bch cu a nhn trung tnh c th b gim.
LC C THAI v LC NUI CON B
Tnh an ton ca Neupogen cha c xc nh ph n c thai. Cha c bng chng v
Neupogen gy qui thai chut v th. Tng tn sut mt phi c quan st thy th,
nhng khng c d dng thai no c bo co.
ph n c thai kh nng nguy c ln thai khi dng Neupogen phi c cn nhc ty theo li
ch ca vic iu tr.
Cha r Neupogen c c bi tit qua sa ngi hay khng. Neupogen khng c khuyn
co nhng ph n cho con b.
TNG TC THUC
Tnh an ton v hiu qu ca Neupogen cho cng mt ngy vi ha tr c t bo c ch ty
cha c xc nh. V tnh nhy cm ca cc t bo ty phn chia nhanh vi thuc ha tr c
t bo c ch ty, khng nn s dng Neupogen trong giai on t 24 gi trc n 24 gi sau
khi ha tr. Cha c cc th nghim lm sng thm d tng tc c th c gia Neupogen vi
cc yu t tng trng to mu v cc cytokine khc.
Bt tng hp ch yu : Neupogen khng nn ha long vi dung dch nc mui. V tnh
tng hp ca Neupogen vi cc cht liu plastic sau khi pha long truyn, xin xem phng
php dng thuc trong phn liu lng v cch dng.
TC DNG NGOI
Dng Neupogen liu ngh thng gy ra au c xng. Triu chng ny thng t nh
n trung bnh nhng i khi nng, v thng c kim sot bng cc thuc gim au tiu
chun.
Cc tc dng ph t gp hn gm bt thng bi niu (ch yu l kh tiu nh n trung bnh).
i khi c gim huyt p thong qua, khng cn iu tr lm sng.
Tng lactate dehydrogenase, phosphatase kim, acide urique mu v gamma glutamyl
transpeptidase c th xy ra nhng thng t nh n trung bnh, ph thuc liu lng v c
th phc hi.
S bch cu trn 100 x 109 xy ra khong 5% s bnh nhn iu tr Neupogen liu > 0,3

MUI/kg/ngy (3mg/kg/ngy). Tuy nhin khng ghi nhn tc dng bt li no lin quan trc tip
n mc tng bch cu ny.
Trn cc th nghim lm sng, Neupogen khng lm tng t l cc tc dng ph ca ha tr liu
c t bo. Cc tc dng ph xy ra nhm bnh nhn iu tr bng Neupogen kt hp ha tr
v nhm bnh nhn iu tr bng gi dc (placebo) kt hp ha tr c sut bng nhau, bao
gm bun nn v nn, rng tc, tiu chy, mt mi, chn n, vim nim mc, nhc u, ho,
da, au ngc, yu c ton thn, au hng, to bn v au khng c hiu. Cc ri lon mch
mu (chng hn bnh tc tnh mch v nhng ri lon th tch dch) i khi xut hin nhng
bnh nhn c iu tr ha cht liu cao sau c ghp ty t thn. Mi lin h nhn qu
vi Neupogen cha c xc nh.
Trong cc nghin cu c tnh hc ng vt, xut huyt ni s bt phc hi c th thy kh.
LIU LNG v CCH DNG
nhng bnh nhn ha tr liu v mt bnh c tnh khng do ty, liu khuyn co ca
Neupogen l 0,5 MUI (5mg/kg tng ng vi 16,6 ml dung dch tim) tim mt ln trong ngy.
Vi mt bnh nhn 60 kg cn dng 1 l Neupogen 30 MUI. nhng bnh nhn c iu tr
bng ha tr c t bo v ghp ty t thn, liu khi u ca Neupogen c ngh l 1 MUI
(10 mg/kg/ngy) truyn di da lin tc trong 24 gi hoc 1 MUI (10 mg/kg/ngy) truyn tnh
mch lin tc trong 30 pht hoc trong 24 gi. Neupogen phi c pha long trong 20 ml dch
truyn glucose 5% (xem phn hng dn pha long).
Khi qua ngng gim bch cu thp nht, liu lng hng ngy ca Neupogen nn c
iu chnh theo p ng ca bch cu a nhn trung tnh nh bng sau :
S bch cu a nhn trung tnh

iu chnh liu Neupogen

> 1,0 x 109/l trong 3 ngy lin tip

Gim n 0,5 MUI (5

mg)/kg/ngy (tng ng
vi 16,6 ml dung dch
tim/kg)

Sau nu s lng tuyt i ca bch cu a nhn trung

Ngng Neupogen
tnh vn gi > 1,0 x 109/l trong 3 ngy lin tip na
Nu s lng tuyt i ca bch cu a nhn trung tnh
gim < 1,0 x 109/l trong qu trnh iu tr, liu Neupogen
nn tng ln tr li theo tng bc nh trn.
Neupogen c chng minh c hiu qu v dung np tt khi iu tr nh trn vi liu ln
n 7,0 MUI (70 mg)/kg/ngy.

Cc th nghim lm sng vi Neupogen bao gm c mt s lng nh nhng bnh nhn ln

tui, nhng do cc nghin cu c bit khng c lm trn nhm bnh nhn ny nn liu
lng ngh cho nhm ngi ln tui ny cha c xc nh.
nhng bnh nhn b gim bch cu nng mn tnh :
Liu khi u :
Gim bch cu bm sinh : I,2 MUI (12 mg)/ngy, chia lm mt hoc nhiu ln.
Gim bch cu t pht hoc c chu kz : 0,5 MUI (5 mg)/kg/ngy, chia lm mt hoc nhiu ln.
iu chnh liu :
Liu phi c xc nh cho tng bnh nhn v m bo duy tr s lng bch cu a nhn
trung tnh ti thiu l 1,5 x 10 9/l.
Dng liu hng ngy trong thi gian di c ch nh t c s lng bch cu a nhn
trung tnh mc cn thit. C th tng liu gp i nu sau 2 tun iu tr m s lng bch cu
a nhn trung tnh vn khng t n 1,5 x 10 9, v phi gim na liu nu s lng bch cu
ht tng qu 10 x 10 9/l. Cn phi tng nhanh liu nhng bnh nhn c nhng nhim trng
nng. Ch dng nhng liu vt qu 14,5 MUI (145 mg/kg/ngy) khi bit chc chn rng
bnh nhn c th dung np c.
Cch dng : Neupogen c th a vo c th bng ng truyn di da hoc truyn tnh
mch trong thi gian ngn, pha long trong Glucose 5% truyn trn 30 pht (xem hng dn
pha thuc). Liu u tin ca Neupogen khng nn cho sm hn 24 gi sau khi kt thc ha tr
c t bo.
Liu hng ngy ca Neupogen nn c tip tc cho n khi qua c giai on gim bch cu
a nhn trung tnh thp nht, v s bch cu a nhn trung tnh t c mc bnh thng.
Thi gian cn thit cho iu tr c th ln n 14 ngy ty theo loi, liu lng v phc ha
tr c t bo c dng.
nhng bnh nhn c iu tr ha tr c t bo, s gia tng tm thi s bch cu a nhn
trung tnh thng xy ra 1-2 ngy sau khi bt u dng Neupogen. Tuy nhin, c p ng
vi tr liu k o di hn, nn tip tc iu tr bng Neupogen cho n khi qua c giai on
bch cu gim ti a hoc n khi s bch cu a nhn trung tnh v mc bnh thng.
bnh nhn c ha tr c t bo v ghp ty t thn : Neupogen c th c tim di da
hoc truyn tnh mch, pha long trong 20-50 ml dung dch Glucose 5% (xem hng dn pha
long). Liu u ca Neupogen khng nn cho trc 24 gi sau khi ha tr c t bo. Tnh hiu
qu v an ton ca Neupogen c dng hn 28 ngy cha c xc nh.
Hng dn pha long : Khi cn, Neupogen c th c pha long trong dung dch Glucose 5%.
Neupogen pha long c th b hp thu bi cc cht liu thy tinh hay nha. Tuy nhin, khi pha
long ng t l th Neupogen s tng hp vi thy tinh v mt s loi plastique gm PVC,
Polyolefin, (1 cht ng trng hp ca polypropylne v polythylne) v Polypropylne. Nu
Neupogen c ha long n nng < 1,5 MUI (15mg)/ml, albumine huyt thanh ngi nn

c cho thm vo t nng cui cng l 2 mg/ml.

Chng hn : trong th tch dung dch tim sau cng 20 ml, tng liu Neupogen khng qu 30
MUI (300 mg) nn cho km thm 0,2 ml dung dch albumine ngi HSA 20%. Khng bao gi
c pha long Neupogen nng cui cng t hn 0,2 MUI (2mg)/ml.
QU LIU
Tc dng ca vic qu liu Neupogen cha c xc nh. Ngng Neupogen s bch cu a
nhn trung tnh s gim xung 50% trong 1-2 ngy v tr v mc bnh thng trong 1-7 ngy.
BO QUN
Dung dch tim nn c bo qun trong t lnh t 2-8oC, nhng khng ng lnh. Mt thi
gian ngn (ln n 7 ngy) tip xc vi nhit cao (ln n 37oC) khng nh hng n tnh
n nh ca Neupogen. Thuc c ng gi km theo ch th nhit chng ng lnh. Cc
l thuc b ng lnh (ch th bn phi cui hp thuc c mu ) th khng nn s dng.
Cc l Neupogen ch nn dng mt ln duy nht.
Thi gian thuc cn tc dng : 2 nm sau khi xut xng.
Dung dch pha long ca Neupogen khng nn chun b qu 24 gi trc khi dng cho bnh
nhn, v nn c d tr trong t lnh 2-8oC.

357.

NEVRAMIN

TAKEDA
c/o MEGA PRODUCTS
vin nn : v 10 vin, hp 300 vin.
thuc tim : ng 2 ml, hp 5 ng.
THNH PHN
cho 1 vin
Thiamine tetrahydrofurfuryl disulfide

54,58 mg

tng ng : Fursultiamine

50 mg

Pyridoxine chlorhydrate

250 mg

Cyanocobalamine

250 mg

cho 1 ng
Thiamine tetrahydrofurfuryl disulfide

21,832 mg

tng ng : Fursultiamine

20 mg

Pyridoxine chlorhydrate

20 mg

Hydroxocobalamine

1000 mg

Mepivacaine chlorhydrate (Carbocaine)

20 mg

DC LC
Fursultiamine (TTFD) : l mt dn xut ca thiamine, c nhng u im hn thiamine
chlorhydrate thng thng :
- C i lc cao vi m.
- Chuyn i nhanh sang dng hot ng ca thiamine l cocarboxylase.
- Ngoi ra, hot cht ny cng c kh nng hp thu tt hn qua ng tiu ha, c nng cao
trong mu v tc ng ko di, khng b phn hy do Aneurinase, c tnh rt thp v tc dng
ph him.
- V mt dc l hc, TTFD cn c tc dng gim au, hip lc vi cc thuc gim au khc, tc
ng chng lit rut v ri lon bng quang do nguyn nhn thn kinh. Vi thiamine, nhng tc
ng ny khng c hay rt yu.
Pyridoxine chlorhydrate : tham gia vo qu trnh bin dng prot ine v lipide, tng hot cc t
bo thn kinh b tn thng.
Cyanocobalamine hay hydroxocobalamine :
- Ngn chn v iu tr chng thiu mu.
- Tc dng phc hi ri lon chc nng dy thn kinh.
CH NH
Vin nn :
- Vim a dy thn kinh.
- Cc chng thiu mu : thiu mu c tnh, thiu mu do k sinh trng.
Thuc tim :
- Vim a dy thn kinh, ri lon chc nng dy thn kinh do bin chng tiu ng.
- Cc chng thiu mu : thiu mu c tnh, thiu mu do k sinh trng, thiu mu do dinh
dng, thiu mu do gii phu hay nhng chng thiu mu khc.

CHNG CH NH
Tin s nhy cm vi cobalamine (vitamine B12 v cc cht cng h).
Khng dung np vitamine B1.
Bu c tnh : do vitamine B12 c tc ng cao trn s tng trng ca m, do c nguy c
y mnh tc sinh sn ca t bo.
CH PHNG
Mt vi trng hp c phn ng min dch, i khi trm trng, thm ch c th gy t vong,
c ghi nhn sau khi tim ch phm c cha cobalamine ; do , nn trnh dng thuc ny
nhng bnh nhn c c a d ng (suyn, eczma).
THN TRNG LC DNG
Ch c dng ng tim bp.
Khng c dng thuc khi c hin tng khng dung np mt trong cc thnh phn ca
thuc qua cc ng dng thuc khc.
Khi tim, cn cn nhc nhng iu kin sau trnh nhng tc dng khng mong mun ln m
v t bo thn kinh :
- Khng nn tim lp i lp li cng mt v tr. Cn ch { c bit khi dng cho tr s sinh, tr
sinh non v tr em.
- Trnh nhng vng c dy thn kinh i qua.
- Kim tim phi c rt ra ngay lp tc v phi i ni tim khi cm thy au nhc hay nhn
thy c mu chy ngc vo ng bm tim.
TNG TC THUC
+ Lvodopa : Chng ch nh phi hp (do lm gim tc ng ca l vodopa khi khng c s
dng km theo cht c ch dopadcarboxylase ngoi bin).
TC DNG NGOI
Phn ng phn v : nga, ni m ay, pht ban, sc.
C th b mn trng c.
Nc tiu c mu .
Nu hn hu c b sc, vic tr liu bao gm : adrnaline, corticoide dng tim, acide epsilon
aminocaproique.
LIU LNG v CCH DNG
Vin nn :
Ung mi ngy 1 n 2 vin sau khi n.
Thuc tim :
Tim bp mi ngy 1 ng, sau 1 ng cch 2 n 3 ngy khi cc triu chng thuyn gim.

358.

NIBIOL

TAKEDA
c/o MEGA PRODUCTS
vin nn : v 10 vin, hp 300 vin.
thuc tim : ng 2 ml, hp 5 ng.
THNH PHN
cho 1 vin
Thiamine tetrahydrofurfuryl disulfide

54,58 mg

tng ng : Fursultiamine

50 mg

Pyridoxine chlorhydrate

250 mg

Cyanocobalamine

250 mg

cho 1 ng
Thiamine tetrahydrofurfuryl disulfide

21,832 mg

tng ng : Fursultiamine

20 mg

Pyridoxine chlorhydrate

20 mg

Hydroxocobalamine

1000 mg

Mepivacaine chlorhydrate (Carbocaine)

20 mg

DC LC
Fursultiamine (TTFD) : l mt dn xut ca thiamine, c nhng u im hn thiamine
chlorhydrate thng thng :
- C i lc cao vi m.
- Chuyn i nhanh sang dng hot ng ca thiamine l cocarboxylase.

- Ngoi ra, hot cht ny cng c kh nng hp thu tt hn qua ng tiu ha, c nng cao
trong mu v tc ng ko di, khng b phn hy do Aneurinase, c tnh rt thp v tc dng
ph him.
- V mt dc l hc, TTFD cn c tc dng gim au, hip lc vi cc thuc gim au khc, tc
ng chng lit rut v ri lon bng quang do nguyn nhn thn kinh. Vi thiamine, nhng tc
ng ny khng c hay rt yu.
Pyridoxine chlorhydrate : tham gia vo qu trnh bin dng prot ine v lipide, tng hot cc t
bo thn kinh b tn thng.
Cyanocobalamine hay hydroxocobalamine :
- Ngn chn v iu tr chng thiu mu.
- Tc dng phc hi ri lon chc nng dy thn kinh.
CH NH
Vin nn :
- Vim a dy thn kinh.
- Cc chng thiu mu : thiu mu c tnh, thiu mu do k sinh trng.
Thuc tim :
- Vim a dy thn kinh, ri lon chc nng dy thn kinh do bin chng tiu ng.
- Cc chng thiu mu : thiu mu c tnh, thiu mu do k sinh trng, thiu mu do dinh
dng, thiu mu do gii phu hay nhng chng thiu mu khc.
CHNG CH NH
Tin s nhy cm vi cobalamine (vitamine B12 v cc cht cng h).
Khng dung np vitamine B1.
Bu c tnh : do vitamine B12 c tc ng cao trn s tng trng ca m, do c nguy c
y mnh tc sinh sn ca t bo.
CH PHNG
Mt vi trng hp c phn ng min dch, i khi trm trng, thm ch c th gy t vong,
c ghi nhn sau khi tim ch phm c cha cobalamine ; do , nn trnh dng thuc ny
nhng bnh nhn c c a d ng (suyn, eczma).
THN TRNG LC DNG
Ch c dng ng tim bp.
Khng c dng thuc khi c hin tng khng dung np mt trong cc thnh phn ca
thuc qua cc ng dng thuc khc.
Khi tim, cn cn nhc nhng iu kin sau trnh nhng tc dng khng mong mun ln m
v t bo thn kinh :
- Khng nn tim lp i lp li cng mt v tr. Cn ch { c bit khi dng cho tr s sinh, tr
sinh non v tr em.
- Trnh nhng vng c dy thn kinh i qua.

- Kim tim phi c rt ra ngay lp tc v phi i ni tim khi cm thy au nhc hay nhn
thy c mu chy ngc vo ng bm tim.
TNG TC THUC
+ Lvodopa : Chng ch nh phi hp (do lm gim tc ng ca l vodopa khi khng c s
dng km theo cht c ch dopadcarboxylase ngoi bin).
TC DNG NGOI
Phn ng phn v : nga, ni m ay, pht ban, sc.
C th b mn trng c.
Nc tiu c mu .
Nu hn hu c b sc, vic tr liu bao gm : adrnaline, corticoide dng tim, acide epsilon
aminocaproique.
LIU LNG v CCH DNG
Vin nn :
Ung mi ngy 1 n 2 vin sau khi n.
Thuc tim :
Tim bp mi ngy 1 ng, sau 1 ng cch 2 n 3 ngy khi cc triu chng thuyn gim.

359.

NIMOTOP

BAYER PHARMA
vin bao 30 mg : hp 30 vin.
dung dch tim truyn tnh mch 10 mg/50 ml : chai 50 ml - Bng B.
THNH PHN
cho 1 vin
Nimodipine

30 mg

cho 50 ml
Nimodipine
Thnh phn khng hot tnh : ethanol
95%, macrogol 400, sodium citrate

10 mg

dihydrate, acid citric khan, nc pha tim.

DC LC
Thnh phn hot tnh ca Nimotop l nimodipine l mt cht c tc ng c bit khng co
mch mu v chng thiu mu cc b no. Nimodipine c th ngn nga hay loi tr s co
mch gy ra in vitro do nhiu cht tc ng trn mch mu (nh serotonin, cc prostaglandin,
v histamine) hay do mu v nhng sn phm thoi ha ca mu. Nimodipine cn c c tnh
dc l thn kinh v tm thn.
Kho st trn nhng bnh nhn c ri lon ti mu no cp cho thy rng nimodipine lm
gin mch mu no v kch thch ti mu no. Do , s gia tng ti mu ln hn trn vng
no b tn thng hay k m ti mu so vi vng no bnh thng. Tn thng thn kinh do
thiu mu cc b bnh nhn xut huyt di mng nhn v t l t vong gim ng k khi
dng nimodipine.
CH NH
Nimotop dng ung :
- iu tr suy gim chc nng no do tui gi vi cc biu hin triu chng nh mt tr nh,
gim tp trung v tm tnh tht thng.
Trc khi bt u iu tr vi Nimotop, nn xc nh r rng rng cc triu chng khng phi l
biu hin ca mt cn bnh tim n cn c iu tr c hiu.
- Dng chuyn tip sau khi tim truyn dch truyn Nimotop, d phng v iu tr khuyt tt
thn kinh do thiu mu cc b l nguyn nhn ca co tht mch mu no sau xut huyt di
nhn.
Nimotop dng truyn tnh mch :
- D phng v iu tr khuyt tt thn kinh do thiu mu cc b do co tht mch mu no sau
xut huyt di mng nhn do phnh mch.
- D phng khuyt tt thn kinh do thiu mu cc b sau khi xut huyt di mng nhn do
chn thng.
CH PHNG v THN TRNG LC DNG
iu tr suy gim chc nng no lc tui gi :
Nimotop khng c dng cho bnh nhn suy gan trm trng (nh x gan).
nhng bnh nhn ln tui c nhiu bnh, bnh nhn suy thn nng (tc lc cu thn < 20
ml/pht) v nhng ngi suy tim mch, nhu cu iu tr vi Nimotop nn c thn trng
cn nhc v nn khm kim tra u n.
Cn cn thn bnh nhn c huyt p thp trm trng (huyt p tm thu < 90 mmHg i vi
dng ung v < 100 mmHg i vi dng truyn tnh mch).
S s dng mn tnh cc thuc chng ng kinh nh phenobarbital, phenytoin hay
carbamazepine lm gim ng k sinh kh dng ca nimodipine dng theo ng ung. Do ,

khng nn s dng ng thi nimodipine dng ng ung v cc thuc chng ng kinh ny.
D phng v iu tr khim khuyt thn kinh do thiu mu cc b sau khi xut huyt di nhn
:
Phi cn thn khi s dng Nimotop nu thnh phn nc ca m no cao (ph no lan ta) hay
nu c p lc ni s tng ng k.
ph hp theo hng dn s dng thuc v do tnh an ton, ch nn s dng Nimotop trong
thai kz nu c ch nh nghim ngt ca bc s.
LC C THAI v LC NUI CON B
Khng c nghin cu v c tnh trn sinh sn sau khi dng dch truyn Nimotop. Khi cn phi
s dng dch truyn Nimotop trong thai kz, phi cn nhc thn trng gia ch li v nguy c c
th xy ra ty theo mc trm trng ca tnh trng lm sng.
TNG TC THUC
Dng ng thi vi cht i khng trn th th H2 cimetidine hay thuc chng co git acid
valproic c th lm tng nng nimodipine trong huyt tng (i vi cc tng tc c th
xy ra vi cc thuc chng ng kinh phenobarbital, phenytoin v carbamazepine, xem phn
Ch { phng v Thn trng lc dng). Cha c kinh nghim v vic s dng Nimotop cng
vi cc thuc an thn hay chng trm cm.
bnh nhn ang dng thuc iu tr cao huyt p, Nimotop c th lm tng tc dng h p
ca thuc ny.
Nu c th c, phi trnh kt hp vi cc thuc i khng calcium khc (nh nifedipine,
diltiazem, hay verapamil) hay vi a-methyldopa. Tuy nhin, nu cn phi phi hp, cn c bit
theo di bnh nhn tht cn thn. Chc nng thn c th suy yu nu dng thuc ng thi vi
cc thuc c kh nng gy c tnh trn thn (nh aminoglycoside, cephalosporin, frusemide)
v c trn bnh nhn suy thn sn. Phi kim tra chc nng thn cn thn trong nhng
trng hp ny, v nu c du hiu suy thn, nn xem xt n vic ngng thuc. Tim tnh
mch ng thi thuc c ch bta c th dn n gim huyt p nhiu hn v kh nng h
tng tc ng inotrop m tnh dn n suy tim mt b.
Do dch truyn Nimotop c cha 23,7% th tch cn, nn lu { n tng tc vi nhng thuc
tng k vi cn.
TC DNG NGOI
- Tc dng trn ng tiu ha : bun nn, vim lot d dy t trng, i khi b lit rut (ri
lon vn ng rut do lit rut).
- Tc dng trn h thn kinh : chng mt, nhc u.
- Tc dng trn h tim mch : huyt p gim ng k, c bit khi cc tr s ban u tng cao,
bng mt, m hi, cm gic m hay nng, gim nhp tim (tim chm) hay him hn l gia tng
nhp tim (tim nhanh).
- Tc dng trn mu v cc thnh phn ca mu : rt him khi c gim tiu cu.

- nh hng ln cc thng s xt nghim.

- Tng transaminase, phosphatase kim, v g-glutamyl-transferase (g-GT), suy thn cng vi gia
tng urea huyt thanh v/hoc creatinine v ngoi tm thu. Nn lu { trong sut qu trnh iu
tr vi Nimotop dng truyn tnh mch rng thuc cha 23,7% th tch cn (200 mg cn trong 1
ml dung dch) v 17% polyethylene glycole 400.
- Phn ng ti ch : vim tnh mch (do tim truyn dung dch truyn Nimotop khng pha long
vo tnh mch ngoi vi).
nh hng ln kh nng li xe :
Ni chung, kh nng li xe v thao tc my mc b suy gim do c th b chng mt. Trong
trng hp dng dch truyn Nimotop, nh hng ny ni chung l khng quan trng.
LIU LNG v CCH DNG
Nimotop dng ung :
Liu lng :
iu tr suy gim chc nng no lc tui gi :
Liu hng ngy khuyn co l 3 x 1 vin bao Nimotop (3 x 30 mg nimodipine).
Trong ri lon chc nng thn trm trng, tc dng chnh ca thuc v tc dng ngoi { nh
gim huyt p c th biu hin r rt hn : Trong nhng trng hp nh vy, nu cn thit,
nn gim liu theo tnh trng huyt p v kt qu in tm .
D phng v iu tr khuyt tt thn kinh do thiu mu cc b sau khi xut huyt di nhn :
Phc khuyn co l truyn dch truyn Nimotop trong 5-14 ngy, sau ung mi ngy 6 x 2
vin bao Nimotop (6 x 60 mg nimodipine).
Trong ri lon chc nng thn hay gan trm trng, c bit khi c x gan, tc dng chnh ca
thuc v tc dng ngoi { nh gim huyt p c th biu hin r rt hn ; trong nhng trng
hp nh vy, nu cn thit, nn gim liu theo tnh trng huyt p v kt qu in tm .
Cch dng :
Ni chung, nn nut trn vin bao Nimotop vi nc, khng cn phi lu { n vic cch xa
ba n.
Thi gian gia hai ln dng thuc khng nn di 4 gi.
Nimotop dng truyn tnh mch :
Liu lng :
Truyn tnh mch :
Khi u tr liu truyn 1 mg nimodipine (= 5 ml dch truyn Nimotop/gi) trong vng 2 gi
(khong 15 mg/kg th trng/gi). Nu liu ny c dung np tt, v c bit nu huyt p
khng gim ng k, sau 2 gi gia tng liu n 2 mg nimodipine (= 10 ml dch truyn
Nimotop/gi) (khong 30 mg/kg th trng/gi). Bnh nhn c th trng thp hn nhiu so vi
70 kg hay c huyt p khng n nh nn bt u vi liu 0,5 mg nimodipine (= 2,5 ml dch
truyn Nimotop/gi).

Nh git vo khoang di nhn :

20 ml dch truyn Nimotop pha long : 1 ml dch truyn Nimotop v 19 ml dung dch Ringer.
Phi s dng ngay sau khi pha.
Trn bnh nhn b tc dng ngoi , khi cn thit nn gim liu hay ngng thuc. Suy gan nng,
c bit l x gan, c th dn n s gia tng sinh kh dng ca nimodipine do gim kh nng
chuyn ha u tin ti gan v gim thanh thi chuyn ha. Tc dng chnh ca thuc v tc
dng ngoi { nh gim huyt p c th biu hin r rt hn. Trong nhng trng hp nh vy,
nu c th c nn gim liu theo tnh trng huyt p ; nu cn thit, nn xem x t n vic
ngng thuc.
Cch s dng :
Dch truyn Nimotop c s dng bng cch tim truyn tnh mch nh git qua mt catheter
trung tm bng mt bm tim. Nn cho thuc qua mt kha vi ba chiu cng lc vi hoc
dung dch glucose 5%, sodium chloride 0,9%, dung dch lactate Ringer, dung dch lactate Ringer
vi magnesium, dung dch Dextran 40 hay HAES [poly(O-2-hydroxyethyl] tinh bt 6% trong t l
khong 1:4 ca Nimotop : dch truyn pha chung). Mannitol, albumin ngi hay mu cng thch
hp truyn chung.
Khng c cho dch truyn Nimotop vo mt bao hay chai dch truyn v khng c trn ln
vi cc thuc khc. Nn tip tc truyn Nimotop trong khi gy m, phu thut v chp X quang
mch mu.
Nn s dng mt kha vi ba chiu gn kt ng polyethylene Nimotop vi ng dch
truyn s dng ng thi v catheter trung tm.
Thi gian truyn dch :
D phng :
Xut huyt di nhn do phnh mch :
Nn bt u truyn tnh mch trong vng 4 ngy sau khi xut huyt v tip tc trong sut giai
on nguy c co tht mch ln nht, ngha l cho n 10-14 ngy sau khi xut huyt di nhn.
Nu trong qu trnh s dng Nimotop d phng, nguyn nhn xut huyt c iu tr bng
phu thut, nn tip tc truyn Nimotop sau phu thut t nht 5 ngy.
Sau khi kt thc tim tuyn, nn tip tc ung 6 x 60 mg nimodipine mi ngy vi khong cch
4 gi trong khong 7 ngy sau .
Xut huyt di nhn do chn thng :
Nn bt u truyn trong vng 24 gi sau khi xut huyt, cng sm cng tt sau khi chn on
thy c mu di nhn, v tip tc truyn trong 7-10 ngy.
Sau khi kt thc truyn tnh mch, nn tip tc ung 6 x 60 mg nimodipine mi ngy vi khong
cch 4 gi trong 11-14 ngy sau lm k o di tng s thi lng iu tr (tim truyn + ung
thuc) n 21 ngy.
iu tr :

Xut huyt di nhn ch do phnh mch :

- Nu cc ri lon thn kinh do thiu mu cc b do co tht mch sau khi c sn xut huyt
di nhn, nn bt u cng sm cng tt v tip tc t nht 5 ngy cho n ti a l 14 ngy.
- Sau , nn ung 6 x 60 mg nimodipine mi ngy vi khong cch 4 gi trong 7 ngy.
Nu trong qu trnh dng Nimotop d phng hay iu tr, nguyn nhn xut huyt c
iu tr bng phu thut, nn tip tc truyn Nimotop sau phu thut t nht 5 ngy.
Nh git vo khong di nhn :
Xut huyt di nhn ch do phnh mch :
Trong qu trnh phu thut, c th truyn nh git vo khong di nhn dung dch Nimotop
va mi pha long (1 ml dch truyn Nimotop v 19 ml dung dch Ringer) lm m n nhit
mu. Phi s dng dung dch pha long Nimotop ngay sau khi pha ch.
Tnh tng k :
Do hot cht ca dch truyn Nimotop b hp thu bi polyvinyl-chloride (PVC), ch c th s
dng ng dch truyn polyethylene (PE).
Hot cht ca dch truyn Nimotop hi nhy cm vi nh sng do nn trnh s dng thuc
di sng mt tri trc tip. Nu khng trnh c s tip xc ny, nn s dng ng bm thy
tinh, v dy truyn dch mu en, nu, vng hay hoc bo v bm truyn v ng bng bao
giy bng m. Tuy nhin, khng cn bin php bo v c bit no trong vng 10 gi nu
truyn Nimotop di nh sng gin tip hay nh sng nhn to.
QU LIU
Triu chng qu liu cp tnh l tt mnh huyt p, tim nhanh hay tim chm, v (sau khi dng
theo ng ung) vim lot d dy t trng v bun nn.
Khi qu liu cp, phi ngng dng Nimotop ngay lp tc. Nn p dng cc bin php cp cu
theo cc triu chng. Nu thuc c dng theo ng ung, nn xem x t n vic ra d dy
cng vi dng than hot. Nu huyt p gim mnh, c th dng dopamine hay adrenaline theo
ng tnh mch. Do khng bit c cht gii c, sau nn iu tr cc triu chng ni bt
nht.
BO QUN
Trnh nh mt tri trc tip nu chai thuc tho khi hp ba cng.
Khng c s dng thuc qu hn dng.
Trnh xa tm vi ca tr em.

360.

NISSEL

TAE RIM
c/o UNICO ALLIANCE
vin nn 25 mg : v 20 vin, hp 50 v ; l 100 vin.
THNH PHN
cho 1 vin
Diphenyl dimethyl dicarboxylate

25 mg

TNH CHT
Nissel c thnh phn hot cht chnh l dimethyl-4,4'-dimethoxy-5,6,5',6'-dimethylene
dioxybiphenyl-2,2'-dicarboxylate.
Cht ny c s dng rng ri trong vic iu tr vim gan siu vi mn v vim gan do
thuc.
Tc dng dc l :
C ch l do s c ch s peroxyd ha lipid v vic gn cng ha tr cc cht chuyn ha ca
CCl4 vi lipid ca tiu th.
Hiu qu lm sng :
Sau iu tr, 80% bnh nhn c SGPT tng cao tr v gii hn bnh thng.
Nissel ci thin ng k tnh trng chc nng gan b suy yu th hin qua vic bilirubin v afetoprotein huyt tng cao.
Sau khi iu tr, cc tn thng m gan nh thoi ha i toan, th i toan, hoi t khu tr v ri
rc u bin mt.
Nissel cng c cng hiu tt trong vic iu tr vim gan do thuc (thuc tr ung th, thuc
khng sinh v khng lao...).
Nissel cn lm gim cc triu chng ca bnh nhn nh au gan, mt v cm gic trng
bng...
Tc dng iu tr ca Nissel trn vim gan mn tin trin v vim gan mn tn ti t ra tt hn
so vi glycyrrhizin v silymarin.
Th nghim lm sng ti Vit Nam :
Mt nghin cu c thc hin ti Trung Tm Bnh Nhit i thnh ph H Ch Minh vi 20
bnh nhn c cho dng Nissel 3-4 vin/ngy cho thy thuc lm gim SGPT trong 1 - 3 thng
u, thng 4 - 6 lun tr s bnh thng. Tuy nhin nghin cu ny cn gii hn cha tm hiu
nh hng ca Nissel ln virus VGB.
Mt nghin cu tin cu c i chng m cng va c thc hin mi y ti Phng Khm
a Khoa trng i hc Y Dc thnh ph H Ch Minh vi bnh nhn c nam ln n c HBsAg
(+) hay/v antiHCV (+), ng thi men ALT cao gp hai ln mc gii hn bnh thng ko di
trn 6 thng. Tng s bnh nhn l 45 ngi c chia lm hai l c c im la chn tng

ng c lch s nhim vim gan siu vi B hoc C trong nhm iu tr lu hn so vi nhm

chng : l chng (19 ngi) c cho dng BAR 2 vin x 3 ln/ngy v nhm iu tr Nissel
0,025 g, 2 vin x 3 ln/ngy. Cc bnh nhn c lm xt nghim sinh ha gm men ALT
(SGPT), AST (SGOT), gammaglutamyl transpeptidase, bilirubin, albumin, globulin, protein huyt
thanh, hematocrit, bch cu, hng cu, tiu cu vo cc thi im trc khi iu tr, thng iu
tr th 1, th 3 v th 6, ng thi theo di cn nng, triu chng lm sng v tc dng ph khi
ung thuc. Sau thi gian iu tr 1, 3 thng vi BAR, men ALT, AST trong nhm chng thay i
khng c { ngha thng k trong khi ALT nhm iu tr Nissel gim r rt mc d men AST
gim t hn so vi mc ban u sau 1, 3, 6 thng iu tr. Nissel khng lm thay i gi tr cc
xt nghim huyt hc v sinh ha khc. Trong s 9 bnh nhn nhm iu tr c HBeAg (+) c 2
trng hp xy ra o ngc huyt thanh vi s hnh thnh antiHBe. Nissel khng nh hng
ln cn nng ca bnh nhn. Cc tc dng ph him gp v khng nghim trng.
CH NH
- Vim gan siu vi B.
- Vim gan do thuc vi SGPT tng cao.
- Gan nhim m (do dng thuc hay ru).
- X gan, mt mi do suy gim chc nng gan, tng SGPT, SGOT do gii phu v ha tr liu.
TC DNG NGOI
Thnh thong c xut hin ngoi ban, tuy nhin triu chng c th mt i khi dng thuc chng
d ng.
C th xut hin chng vng da thong qua, tuy nhin triu chng c th mt i nu ngng
thuc hay dng ng thi vi thuc tr vng da.
Him khi gy bun nn.
LIU LNG v CCH DNG
Ngi ln : mi ln 1 - 2 vin, 3 ln mi ngy sau ba n.
Tr em :
6 - 12 tui : mi ln 1 vin, 3 ln mi ngy sau ba n.
2 - 6 tui : mi ln 1/2 vin, 3 ln mi ngy sau ba n.
Tr em di 2 tui : ty theo ch nh ca bc s.

361.

NIZORAL cream

JANSSEN PHARMACEUTICA
c/o JANSSEN-CILAG

c/o MEGA PRODUCTS

Kem bi ngoi da 2 % : ng 5 g, 10 g v 20 g.
THNH PHN
cho 100 g
Ktoconazole

2g

TNH CHT
Nizoral cream c hot tnh khng nm mnh i vi cc vi nm ngoi da nh chng
Trichophyton, Epidermophyton floccosum v chng Microsporum v i vi cc nm men. c
bit Nizoral c tc dng ni bt trn chng nm Pityrosporum.
Nizoral cream thng tc dng rt nhanh trn triu chng nga, l triu chng thng thy
cc nhim nm ngoi da v nm men cng nh trong nhng bnh da c lin quan n s hin
din ca chung nm Pityrosporum. Triu chng nga gim trc khi thy cc du hiu lnh
bnh u tin.
Nizoral cream c tc dng khng vim v gim nga c th so snh vi hydrocortisone 1%.
Nizoral cream khng gy kch ng nguyn pht hoc d ng hay nhy cm nh sng khi bi
ngoi da.
Sau khi thoa ti ch Nizoral cream khng to ra c mt nng c th pht hin mu.
CH NH
iu tr cc nhim vi nm ngoi da nh : nhim nm thn (lc, hc lo) ; nhim nm bn ;
nhim nm bn tay, bn chn do Trichophyton rubrum, Trichophyton mentaprophytes,
Microsporum canis v Epidermophyton floccosum. iu tr nhim vi nm Candida da v lang
ben.
Nizoral cream cn c ch nh trong iu tr vim da tit b - mt bnh l{ da lin quan n s
hin din ca vi nm Pityrosporum ovale.
CHNG CH NH
Khng dng Nizoral cream nhng ngi c bit l qu mn vi bt kz thnh phn no ca
thuc.
THN TRNG LC DNG
Khng dng Nizoral cream mt.
V Nizoral cream thoa ti ch khng hp thu vo mu nn c th dng Nizoral cream ph n
c thai hoc cho con b. Nizoral cream khng gy pht sinh ung th, hay t bin.
TC DNG NGOI
Trong mt t trng hp khi iu tr bng Nizoral cream thy c cm gic nng rt hoc kch
ng da.

LIU LNG v CCH DNG

Thoa thuc ngy 1 ln ti cc vng b nhim nm cc bnh nhn nhim nm thn, nhim
nm bn, nhim nm bn tay, bn chn, nhim vi nm Candida da v lang ben.
Thoa thuc ngy 1 hoc 2 ln cc bnh nhn vim da tit b, ty vo nng ca tn thng.
Tr liu nn c tip tc thi gian, t nht l mt vi ngy sau khi tt c cc triu chng bin
mt. Nn xem li chn on nu nh khng thy ci thin v lm sng sau bn tun iu tr.
Cc bin php v sinh chung nn c gim st kim tra cc ngun gy nhim hay ti nhim.
Thi gian iu tr thng thng :
- Lang ben : 2-3 tun.
- Nhim nm men : 2-3 tun.
- Nhim nm bn : 2-4 tun.
- Nhim nm thn : 3-4 tun.
- Nhim nm bn chn : 4-6 tun.
- Vim da tit b : 2-4 tun.
BO QUN
Bo qun nhit 15-30oC.

362.

NIZORAL Du gi

JANSSEN PHARMACEUTICA
c/o JANSSEN-CILAG
c/o MEGA PRODUCTS
Du gi 2 % : gi 6 ml, hp 50 gi, chai 50 ml, chai 100 ml.
THNH PHN
cho 100 g
Ktoconazole

2g

TC DNG
Du gi Nizoral c hot tnh khng nm mnh i vi cc vi nm ngoi da dermatophyte v vi
nm men k c chng vi nm Pityrosporum. Du gi Nizoral nhanh chng lm gim triu chng
bong vy v nga trong bnh l vim da tit b (seborrheic dermatitis), gu (pityriasis capitis),
v lang ben (pityriasis versicolor).

CH NH
Du gi Nizoral c ch nh iu tr v d phng vim da tit b da u v ng chn
tc, gu v lang ben trong c lin quan n chng vi nm men Pityrosporum.
CHNG CH NH
Qu mn vi cc thnh phn ca du gi.
THN TRNG LC DNG
Kch ng da c th xy ra khi dng du gi Nizoral ngay sau mt t iu tr ti ch ko di
bng corticosteroid ti cng v tr. V vy cn ch 2 tun k t khi ngng s dng corticosteroid
ti ch ri mi bt u dng du gi Nizoral.
TC DNG NGOI
Kch ng c bo co nhng rt him gp.
LIU LNG v CCH DNG
Gi tc v vng da nhim bnh bng du gi Nizoral. cho du gi tip xc vi tc v da u
3-5 pht trc khi x nc.
Vim da tit b v gu : Dng du gi Nizoral mi tun hai ln trong 2-4 tun.
Lang ben : Dng du gi Nizoral mi ngy mt ln trong ti a 5 ngy.

363.

NIZORAL vin nn

JANSSEN PHARMACEUTICA
c/o JANSSEN-CILAG
c/o MEGA PRODUCTS
Vin nn 200 mg : hp 10 vin (v nhm bo qun trnh m).
THNH PHN
cho 1 vin
Ktoconazole

200 mg

DC LC
Nizoral vin l mt dn xut dioxolane imidazol tng hp c hot tnh dit nm hoc km nm
i vi vi nm ngoi da nm men (Candida, pityrosporum, Torulopsis, Cryptococcus), cc nm
nh v cc eumycetes. Km nhy cm hn l cc chng Aspergillus, Sporothrix schenckii, mt
s Dematiaceae, cc chng Mucor v cc phycomycetes khc ngoi tr Entomophthorales.

Nizoral c ch s sinh tng hp ergosterol nm v lm thay i cc thnh phn lipid khc

mng t bo vi nm. Cho n nay ngi ta cha thy c s pht sinh khng thuc trong lc
iu tr bng Nizoral.
DC NG HC
Trung bnh nng d nh trong huyt tng xp x 3,5 mg/ml t c trong vong 1-2 gi sau
khi ung mt liu 200 mg trong ba n. S thi tr trong huyt tng sau c 2 pha vi thi
gian bn hy l 2 gi trong 10 gi u v 8 gi sau . Sau khi hp thu t ng tiu ha,
ketoconazol c chuyn i thnh mt s cht chuyn ha khng c hot tnh. ng chuyn
ha chnh c bit l oxy ha thoi ging cc vng imidazole v piperazine, s kh alkyl oxy
ha v hydroxy ha vng nhn thm. Khong 13% liu dng c bi xut qua nc tiu, trong
2-4% dng khng chuyn ha. ng bi xut chnh l qua ng mt vo ng tiu ha. In
vitro, s gn protein huyt tng khong 99%, ch yu l albumin. Ch c mt t l khng ng
k ketoconazole vo dch no ty. Ketoconazole l thuc c tnh kim yu v nh vy cn mi
trng acid ha tan v hp thu.
CH NH
- Nhim nm da, tc v mng do vi nm ngoi da v/hoc nm men (nm da cn, nm mng,
nhim Candida quanh mng, lang ben, nm da u, vim nang lng do Pityrosporum, nhim vi
nm Candida nim mc v da mn tnh) m cc trng hp nhim ny khng th iu tr ti
ch c do v tr hoc s lan rng ca thng tn, hoc do nhim vi nm su da, hay khng
p ng vi iu tr ti ch.
- Nhim nm men ng tiu ha.
- Nhim candida m o ti pht, mn tnh m khng p ng vi iu tr ti ch.
- Nhim nm ni tng nh nhim Candida ni tng, nhim Paracoccidioides, Histoplasma,
Coccidioides, Blastomyces.
- iu tr d phng cho nhng bnh nhn gim st c ch khng (do di truyn, do bnh l,
hoc do thuc) vi nguy c gia tng cc nhim vi nm.
Ketoconazole khng thm nhp tt vo h thn kinh trung ng, v vy khng nn iu tr vim
mng no do nm bng ketoconazole ng ung.
CHNG CH NH
Khng nn dng Nizoral cho nhng bnh nhn c bnh l gan cp hay mn tnh hoc bnh nhn
qu mn vi thuc.
Chng ch nh dng nhng thuc sau vi Nizoral : terfenadine, astemizole, cisapride, triazolam,
midazolam ung, quinidine, pimozide, thuc c ch HMG-CoA reductase c chuyn ho bi
CYP3A4 nh l : simvastatine v lovastatine.
THN TRNG LC DNG
Nizoral c tim nng tng tc thuc quan trng trn lm sng (xem phn tng tc thuc vi
nhng thuc khc v cc dng khc nhau ca s tng tc).

- Gim axit d dy : s hp thu gim khi axit d dy gim. bnh nhn ang dng thuc trung
ha acit (v d : aluminium hydroxide) nn dng nhng thuc ny t nht l 2 gi sau khi ung
Nizoral. nhng bnh nhn v toan nh mt s bnh nhn AIDS v bnh nhn dng thuc
khng tit axit (nh cht i khng H2, cht c ch bm proton) c khuyn co nn ung
thuc Nizoral cng vi nc gii kht cola.
- S gia tng nh, tm thi khng triu chng ca transaminases hay phosphatase kim i khi
xy ra. Phn ng khng triu chng ny v hi v khng nht thit phi ngng thuc nhng cn
phi theo di st nhng bnh nhn ny.
- Cn lm th nghim chc nng gan khi iu tr Nizoral k o di hn 2 tun.
- iu quan trng l phi nhc nh nhng bnh nhn iu tr di ngy bng Nizoral cnh gic
cc triu chng ca bnh gan nh mt mi bt thng km theo st, nc tiu vng, phn
nht mu hoc vng da. Cc yu t gia tng nguy c vim gan l ph n trn 50 tui, c tin s
bnh gan, khng dung np thuc, v s dng ng thi cc thuc khc c tc hi cho gan. Cc
th nghim chc nng gan nn c thc hin bnh nhn iu tr bng Nizoral k o di hn 2
tun (trc khi iu tr, sau hai tun v tip tc sau mi thng mt ln). Nu cc th nghim
ny xc nhn bnh gan, cn ngng iu tr bng Nizoral.
- Trong nhng trng hp bnh khng e da n tnh mng i hi thi gian iu tr di, cn
cn nhc gia li ch v yu t nguy c trc khi s dng ketoconazole.
- nhng ngi tnh nguyn vi liu dng mi ngy l 400 mg hay cao hn, cho thy Nizoral
lm gim p ng cortisol i vi s kch thch ACTH. Do , nn theo di st chc nng
thng thn bnh nhn suy thng thn v bnh nhn b stress ko di (phu thut ln,
sn sc c bit v.v.).
nh hng trn kh nng li xe v iu khin my mc :
Khng nh hng.
LC C THAI v LC NUI CON B
liu 80 mg/kg, Nizoral gy ra tt dnh ngn chut nht. Cha c nhng nghin cu v vic
s dng thuc ph n c thai. Do , Nizoral khng c dng trong thai kz, tr khi li ch
tim tng ln hn nguy c c hi cho bo thai.
V Nizoral c tit trong sa m nn nhng ngi m ang dng thuc khng c cho con
b.
TNG TC THUC
Thuc nh hng trn s chuyn ha ketoconazole :
- Thuc cm ng enzym nh l rifampicin, rifabutin, carbamazepine, isoniazid v phenytoin lm
gim ng k kh dng sinh hc ca ketoconazole.
- Thuc nh hng trn axit d dy : xem Thn trng lc dng.
- Ritonavir lm tng kh dng sinh hc ca ketoconazole. Do , khi thuc c dng chung,
cm xem xt vic gim liu ketoconazole.

Tc dng ca ketoconazole trn chuyn ha ca nhng thuc khc :

- Ketoconazole c th c ch s chuyn ha ca nhng thuc c chuyn ha bi mt s
enzym P450 gan, c bit l nhm CYP3A. iu ny c th dn n s gia tng v/hoc ko
di tc dng ca chng, bao gm tc dng ph.
V d : nhng thuc sau khng c s dng chung vi ketoconazole : terfenadine, astemizole,
cisapride, triazolam, midazolam ung, quinidine, pimozide, thuc c ch HMG-CoA reductase
c chuyn ha bi CYP3A4 nh l simvastatin v lovastatin.
Nhng thuc sau cn theo di st nng trong mu, tc dng v tc dng ph. Nu dng
chung vi ketoconazole, nhng thuc ny nn c gim liu nu cn thit :
- Thuc chng ng ng ung.
- Thuc c ch protease HIV nh l ritonavir, indinavir, saquinavir.
- Mt s thuc iu tr ung th nh l vinca alkaloids, busulphan, docetaxel v trimetrexate.
- Thuc c ch canxi chuyn ha bi CYP3A4 nh l dihydropyridines v verapamil.
- Mt s thuc c ch min dch : cyclosporine, tacrolimus, rapamycin.
- Cc thuc khc : digoxine, carbamazepine, buspirone, alfentanil, alprazolam, midazolam tim
mch, rifabutin, methylprednisolone v trimetrexate.
Ngoi l c mt vi trng hp c phn ng khi ung ru, ging nh ung disulfiram vi c
im : bng mt, pht ban, ph ngoi bin, bun nn v nhc u. Tt c cc triu chng
ny s hon ton bin mt trong vng vi gi.
TC DNG NGOI
Nhng phn ng ph thng gp nht c ghi nhn c lin quan n vic s dng Nizoral l
nhng phn ng ph trn ng tiu ha, nh l : ri lon tiu ha, bun nn, au bng v
tiu chy. Nhng phn ng ph t gp hn c ghi nhn bao gm nhc u, s tng c hi
phc cc men gan, ri lon kinh nguyt, chong vng, s nh sng, d cm v phn ng d ng.
Nhng tc dng ph c ghi nhn vi tn sut thp l gim tiu cu, hi u (rng tc), bt
lc v tng p lc ni s c hi phc (v d : ph gai th, thp phng tr nh nhi).
Trong mt s rt t cc trng hp, vi liu lng cao hn liu iu tr 200 mg v 400 mg mi
ngy, ngi ta quan st thy chng v to v thiu sn tinh trng c hi phc.
liu iu tr 200 mg mi ngy, ngi ta c th thy s gim tm thi nng testosterone
trong huyt tng. Nng testosterone tr v bnh thng trong vng 24 gi sau iu tr
Nizoral. Trong thi gian iu tr lu di liu iu tr, nng testosterone trong mu thng
khng khc bit so vi nhm chng.
Trong thi gian dng Nizoral, vim gan (a s do c ng) c th xy ra. Tnh trng ny thng
hi phc nu ngng ngay vic dng thuc.
LIU LNG v CCH DNG
Nizoral nn c ung trong ba n c hp thu ti a.
iu tr :

Ngi ln :
- Nhim nm da, nhim nm ng tiu ha v nm ni tng: Mt vin (200 mg) mi ngy mt
ln trong ba n. Khi khng t c p ng y liu ny, liu dng nn c tng ln
thnh hai vin (400 mg), mi ngy mt ln trong ba n.
- Nhim candida m o : hai vin (400 mg), mi ngy mt ln trong ba n.
Tr em :
- Tr em cn nng t 15-30 kg : 100 mg mi ngy mt ln trong ba n.
- Tr em cn nng trn 30 kg : liu ging nh ngi ln.
Ni chung, vic iu tr nn c tip tc, khng gin on n khi t nht 1 tun sau khi tt c
cc triu chng bin mt v n khi tt c cc mu cy u chuyn sang m tnh.
iu tr phng nga nhng bnh nhn suy gim min dch :
- Ngi ln : 2 vin (400 mg) mi ngy.
- Tr em: 4-8 mg/kg mi ngy mt ln.
Thi gian iu tr thng thng l :
- Nhim Candida m o : 5 ngy k tip nhau.
- Nhim nm da do vi nm ngoi da : khong 4 tun.
- Lang ben : 10 ngy.
- Nhim nm ming v da do Candida : 2-3 tun.
- Nhim nm tc : 1-2 thng.
Nhim nm mng : 6-12 thng, c xc nh bi tc pht trin ca mng, i hi phi t
c s pht trin ra ngoi mt cch y ca mng b nhim nm.
- Nhim nm Candida ni tng : 1-2 thng.
- Nhim nm Paracoccidioides, Histoplasma, Coccidioides: thi gian iu tr ti u l 3-6 thng.
QU LIU
Trong trng hp tai bin qu liu, nn p dng cc bin php h tr. Trong vng mt gi u
sau khi ung, c th ra d dy. C th s dng than hot khi thch hp.
BO QUN
Bo qun nhit 15-30oC

364.

NO-SPA

SANOFI SYNTHELABO VIETNAM

Vin nn 40 mg : v bm 10 vin, hp 2 v ; chai 100 vin.

Dung dch tim 40 mg/2 ml : ng 2 ml, hp 25 ng.

THNH PHN
cho 1 vin
Drotaverine chlorhydrate

40 mg

cho 1 ng
Drotaverine chlorhydrate

40 mg

DC LC
Chng co tht c trn khng thuc nhm khng choline.
DC NG HC
Hp thu qua ng ung tng ng vi ng tim. Hp thu hon ton sau 12 pht. Thi
gian bt u tc dng sau khi tim l 2-4 pht, ti a sau 30 pht.
Chuyn ha ti gan bng hin tng glucurono kt hp. Gn kt rt t vi protine huyt
tng. Thi gian bn hy : 18-22 gi.
CH NH
- Co tht d dy-rut. Hi chng rut b kch thch.
- Cn au qun mt v cc co tht ng mt : sn ng mt v ti mt, vim ng mt.
- Cn au qun thn v cc co tht ng niu-sinh dc : si thn, si niu qun, vim b thn,
vim bng quang.
- Cc co tht t cung : au bng kinh, da sy thai, co cng t cung.
LC C THAI v LC NUI CON B
Cc nghin cu trn vt th nghim khng thy thuc gy qui thai. Tuy vy, cng nh a s cc
thuc khc, thn trng, nn trnh dng No-spa ko di trong thi kz mang thai v cho con
b.
TNG TC THUC
Lvodopa : gim tc dng chng parkinson ca lvodopa.
TC DNG NGOI
Him gp, c th thy bun nn, chng mt.
Huyt p c th tt nu tim tnh mch nhanh.
LIU LNG v CCH DNG
Dng vin :
Ngi ln : 3-6 vin/ngy, mi ln 1-2 vin.
Tr trn 6 tui : 2-5 vin/ngy, mi ln 1 vin.

T 1-6 tui : 2-3 vin/ngy, mi ln 1/2-1 vin.

Dng tim :
Ngi ln : 1-3 ng tim di da hoc 1-2 ng tim bp/ngy.
kim sot cn au qun cp tnh do si : 1-2 ng tim tnh mch chm.

365.

NOOTROPYL

UCB PHARMA
vin nang 400 mg : hp 60 vin.
vin bao 800 mg : hp 45 vin.
dung dch ung 200 mg/ml : chai 125 ml + pipette c khc vch.
dung dch ung 1,2 g/6 ml : ng 6 ml, hp 30 ng.
dung dch tim 1 g/5 ml : ng 5 ml, hp 12 ng.
dung dch tim 3 g/15 ml : ng 15 ml, hp 4 ng.
dch truyn tnh mch 12 g/60 ml : chai 60 ml.
THNH PHN
cho 1 vin
Piractam

400 mg

(Lactose)

cho 1 vin
Piractam

800 mg

(Lactose)

cho 1 ml thuc ung

Piractam

200 mg

cho 1 ng thuc ung

Piractam

1200 mg

cho 1 ng thuc tim 5 ml

Piractam

1g

cho 1 ng thuc tim 15 ml

Piractam

3g

cho 1 chai truyn tnh mch 60 ml

Piractam

12 g

DC LC
Thuc c hot tnh trn s chuyn ha.
Gim oxy huyt do thiu mu cc b v thiu oxy :
- theo kinh nghim kho st trn ng vt, pirac tam lm tng cng s chu ng ca no i
vi s thiu oxy huyt, chng li cc ri lon chuyn ha do thiu mu cc b ;
- pirac tam lm tng s khai thc v tiu th glucose mt cch c lp vi ngun cung cp
oxygne, thun li cho ng chuyn ha pentose v duy tr s tng hp nng lng no
(ATP) ;
- pirac tam lm tng tc hi phc sau chng gim oxy huyt bng cch lm tng nhanh tc
quay ca cc phosphate v c v bng cch lm gim s tch t glucose v acide lactique ;
- Trn in no , pirac tam lm tng nhanh s bnh thng ha sau chng gim oxy huyt
thiu oxy.
Gim oxy huyt do ng c, do thuc :
- kinh nghim cho thy rng piractam lm gim cc ri lon trn in no , tng kh nng
sng st trn ng vt c cho dng barbiturate vi liu gy ng c ;
- do c tc ng chuyn bit trn s chuyn ha no, bng cch lm gim s tiu th
oxygne, piractam cho php duy tr s to thnh ATP, hot ng ca G6PD, m khng lm
tng s hnh thnh cc lactate.

Ngoi ra, pirac tam c tc ng trn rt nhiu cht dn truyn thn kinh (actylcholine,
noradrnaline, dopamine...), nh ci thin cc hot ng c lin quan n tr nh.
Pirac tam cn c tc ng trn cc hot ng vi tun hon v lm gim s kt tp tiu cu.
DC NG HC
- Sau khi ung, thuc c hp nhu nhanh v hon ton. Nng ti a t c trong mu
sau 45 pht v t 2 n 8 gi trong dch no ty. S hp thu thuc vn n nh sau khi ung
thuc nhiu ngy.
- Thi gian bn hy t 4 n 5 gi trong mu v t 6 n 8 gi trong dch no ty (k o di hn
trong trng hp b suy thn).
- ng hc ca s phn phi thuc no v tiu no cho thy rng nu s hp thu ti nhng
ni ny chm li th pirac tam lu li lu hn so vi trong mu.
- Thi gian bn hy lu hn ngi suy thn, do cn gim liu nhng bnh nhn ny.
Pirac tam qua c cc mng lc ca cc my thm tch thn. bnh nhn b suy thn hon
ton v khng hi phc, thi gian bn hy t 48 n 50 gi.
- Thuc qua c hng ro nhau thai.
- o thi : hu ht thuc c o thi qua thn, trong vng 30 gi. Thanh thi thn ca
ngi ln l 86 ml/pht.
CH NH
Dng ung :
- Ci thin triu chng chng mt.
- c ngh ci thin mt vi triu chng suy gim tr tu bnh l ngi gi (ri lon s
tp trung, tr nh...).
- c ngh trong iu tr sau cn nhi mu no hay chn thng s no.
- tr em : iu tr h tr chng kh c.
Dng tim :
- c ngh trong iu tr cn nhi mu no, chn thng s no, rung git c.
CHNG CH NH
Suy thn nng.
Nu khng lm thm tch, khng nn dng cc liu cao gn nhau.
CH PHNG v THN TRNG LC DNG
bnh nhn suy thn, c lm thm tch hay khng :
- liu dng c iu chnh do thuc c o thi hon ton qua thn v do c tnh thm
qua c cc dng c thm tch ;
- cn thn trng dng cc liu cch xa v gim liu khi s thanh thi cratinine thp hn 60
ml/pht (thi gian bn hy ca Nootropyl tng gp i) v c bit nu s thanh thi ny thp
hn 30 ml/pht (thi gian bn hy : 25-42 gi) ;
- do khng kim tra c nng ca piractam trong huyt tng, nn thn trng dng cc

liu cch xa hoc gim liu da trn cc gi tr thanh thi cratinine.

LC C THAI
ng vt, cc nghin cu khng cho thy thuc c tc ng gy qui thai.
ngi, do cn thiu s liu, nguy c ny khng c bit.
TC DNG NGOI
Cc tc dng ph nh cau c, d kch ng, ri lon gic ng c th xy ra sau khi dng liu cao
vi t l khng di 5%.
Cc tc dng ph khc trn h tiu ha nh bun nn, i, tiu chy v au bao t cng c
ghi nhn vi t l di 2%.
LIU LNG v CCH DNG
Dng thuc nc khi ung c th c pha long vi mt t nc.
Ngi ln :
n Ri lon kh nng nhn thc v chng mt :
p Vin 800 mg : liu thng thng mi ln 1 vin, 3 ln/ngy.
p Vin 400 mg : liu thng thng mi ln 2 vin, 3 ln/ngy.
p Dung dch ung vi pipette c khc vch : liu thng thng mi ln 800 mg, 3 ln/ngy, khi
ung c th pha long vi mt t nc.
p Dung dch ung 1,2 g cha trong ng thuc : liu thng thng mi ln 1 ng, 2 ln/ngy, khi
ung c th pha long vi mt t nc.
Cc liu ny c th tng ln trong vi trng hp.
n iu tr cn nhi mu no, chn thng s no :
p Dung dch ung vi pipette c khc vch : liu thng thng mi ln 1 g,3 ln/ngy, khi ung
c th pha long vi mt t nc.
p Dng tim 1 g, 3 g : liu thng thng 3-6 g/ngy, tim tnh mch, tim truyn hoc tim bp.
Liu c th tng n 12 g/ngy trong trng hp nng.
Tr em :
n Chng kh c : dng dng dung dch ung cha trong chai.
Liu trung bnh l 50 mg/kg/ngy (chng hn tr nng 30 kg, mi ln ung 500 mg, 3
ln/ngy), khi ung c th pha long vi mt t nc.
QU LIU
Thuc khng gy c tnh, do khng cn dng n cc bin php chuyn bit khi b qu liu

366.

NORASH

RAPTAKOS BRETT CO., LTD.

Kem bi ngoi da : tup 20 g.
THNH PHN
Oxyde km

7,5% (tt/tt)

Calamine

1,5% (tt/tt)

Cetrimide

1,125% (tt/tt)

Dimethicone 20

20% (tt/tt)

DC LC
Oxyde km l mt cht lm se da nh v c dng nh l mt thuc bi ti ch lm du v
bo v da khi b try xt.
Calamine c tc dng lm se da, chng nga v st trng nh. Thuc c dng trong nhiu
trng hp bnh da khc nhau nh chy nng, chm v my ay vi tc dng nh l mt thuc
lm du v bo v da.
Cetrimide c xem l mt cht c "hot tnh b mt". Phn t cation c thu ht vo t bo
vi khun xm nhp v c hp th qua mng t bo. y hnh nh l ni tc dng ch yu ca
thuc. Cetrimide c ch nh dng lm sch v st trng vt thng, phng v ngoi da.
Cc dimethicone l cc cht khng thm nc v c sc cng b mt thp. Cc cht ny c
dng trong cc ch phm bi lm lp bo v ngoi da chng li cc cht kch thch da c tnh
tan trong nc. Cc loi kem c cha dimethicone c dng phng nga lot do cn (mn
mc) v hm l da. Dimethicone cng c dng bi ti ch nh l cht bng cc vt thng.
Kem Norash l mt phi hp hp l gia oxyde km, calamine, cetrimide v dimethicone. V
Norash c tt c cc thnh phn nu trn nn thuc c tc dng lm se da, chng nga, st
trng v bo v da.
CH NH
Vim da tip xc v kch ng. Lot do cn (mn mc). Lot chn bnh nhn tiu ng.
Phng nh. t da, vt thng, vt cn trng chch t, nt n chn tay. Nga khng c hiu.
Bo v vt thng sau khi m thng hi trng. Chy nng. Lm gim triu chng nga quanh
hu mn bnh nhn tr.
CHNG CH NH
Tng nhy cm vi oxyde km, cetrimide, calamine hay dimethicone.
THN TRNG LC DNG
Ch dng bi ngoi.
TNG TC THUC

Khng c bo co.
TC DNG NGOI
Khng c bo co.
LIU LNG v CCH DNG
Bi nh nhng ln vng b tn thng t nht ba ln mi ngy hoc theo ch dn ca bc s. Nn
dng nc ra sch vng b tn thng trc khi bi. Tham kho kin ca bc s nu bnh
vn ko di.

367.

NORMOGASTRYL

UPSA
vin nn si bt d b : ng 20 vin, hp 2 ng.
THNH PHN
cho 1 vin
Sodium bicarbonate

170 mg

Sodium sulfate khan

285 mg

Sodium hydrognophosphate khan

195 mg

tng ng : Na : 17,9 mEq hoc

411 mg

DC LC
Khng acide.
Trung ha acide d dy : mt vin Normogastryl c kh nng trung ha khong 9,7 mEq ion H+
(97 ml HCl N/10).
CH NH
iu tr triu chng cc biu hin au trong bnh thc qun, d dy, t trng.
CH PHNG v THN TRNG LC DNG
Trng hp bnh nhn theo ch n king mui, cn lu { rng mi vin Normogastryl c
cha khong 17,9 mEq (411 mg) sodium tnh vo khu phn n hng ngy.
TNG TC THUC
Thuc khng acide c th tng tc vi mt vi loi thuc c hp thu qua ng ung v c
th lm gim hp thu qua ng tiu ha cc thuc ny nu dng ng thi.

Do thn trng, nn ung cc thuc cch nhau khong 2 gi nu c th.

TC DNG NGOI
C th gy tiu chy khi dng liu qu cao.
LIU LNG v CCH DNG
Dng sau cc ba n sng, tra, chiu hoc lc b kh chu v tiu ha, sau khi ha tan thuc
trong 1 ly nc.
Liu lng mi ln dng cho ngi ln l 1-2 vin, 2-4 ln/ngy.

368.

NOVALGINE

HOECHST-MARION-ROUSSEL / ROUSSEL VIETNAM

[AVENTIS PHARMA]
Vin nn : hp 20 vin, p v.
THNH PHN
cho 1 vin
Mtamizole sodique (noramidopyrine msilate sodique)

500 mg

DC LC
Thuc gim au, h st.
DC NG HC
Sau khi ung, noramidopyrine c thy phn nhanh trong ng tiu ha. Cht chuyn ha
chnh, 4-methyl-amino antipyrine (4-MAA) c hp thu nhanh v hu nh hon ton. S hp
thu thuc khng b nh hng bi thc n.
t c nng ti a trong mu trong vng 1-2 gi.
Tt c cc sn phm chuyn ha u gn vo protine huyt tng. T l gn ca 4-MAA l 58%.
Tnh trng gn ny khng dn n s tng tc no vi thuc nh thuc chng ng.
Noramidopyrine c chuyn ha hon ton : 90% ca liu ung vo c tm thy trong nc
tiu v 6% c thi qua mt.
Thi gian bn hy (4-MAA) l 2,7 gi, chuyn sang 4,5 gi ngi ln tui.
Trong suy thn cp thanh thi tng cng ca 4-MAA gim v c th dn n s tch t ca
cht chuyn ha hot tnh nu dng thuc nhiu ln.
Sn phm chuyn ha ca noramidopyrine i qua sa m. Noramidopyrine v nhng sn phm
chuyn ha thi nhanh chng bng thm tch.

CH NH
au nhc nhiu cp tnh hay mn tnh nh au trong bnh thp, nhc u, nhc rng, au do u
bu, au sau chn thng hay phu thut.
au do co tht c trn nh au co tht vng d dy-rut, ng mt, thn v ng niu
di.
h cn st cao khng thuyn gim vi cc bin php khc.
Ch s dng noramidopyrine nu thc s n chng t c hiu qu hn so vi thuc gim au
khc.
CHNG CH NH
- Suy chc nng ty xng hoc bnh ca h to mu.
- Tin cn ln cn suyn hoc phn ng phn v do thuc gim au nh salicylate, paracetamol
v cc thuc gim au khng gy nghin khc nh diclofenac, ibuprofen, indomethacin,
naproxen.
- D ng hay khng dung np thuc cha pyrazole (c bit l noramidopyrine hay
amidopyrine).
- Cm dng thuc vi bt kz liu lng no ngi b chng mt bch cu ht d c phi do
amidopyrine hoc noramidopyrine hay khng.
- Thiu glucose-6 phosphate d shydrog nase (nguy c tn huyt).
- Ri lon chuyn ha porphyrine gan (nguy c kch pht).
- Ph n c thai v cho con b : xem Lc c thai v Lc nui con b.
CH PHNG
Cn thn, v thuc ny cha noramidopyrine nn c th gy ra chng mt bch cu ht hay sc
dn n t vong.
Mt bch cu ht :
iu kin xut hin :
Tt c cc thuc cha noramidopyrine u c th gy ra chng mt bch cu ht. l tai bin
min dch - d ng vi chng mt bch cu ht hon ton trong thi gian ti thiu l mt tun.
Nhng tai bin ny him gp nhng vn gy t vong trong hn 10% trng hp mc d c
nhng k thut hi sc huyt hc hin nay. Chng mt bch cu ht khng lin quan n liu
lng v c th xy ra d vi liu rt thp-th d na vin. Khng lng trc c cc tai bin
ny.
Thn trng :
ngi khng c tin cn bnh v mu phi cn nhc tht k trc khi ghi toa. Thc vy, hin
nay khng c cch no pht hin nhng ngi nhy cm ; mt khc khi ang iu tr, khng
c cch no tin lng c chng mt bch cu ht v n c th xut hin sau ln ung thuc
u tin (thy r) hay sau nhiu tun iu tr hoc khi dng thuc tr li. Do , khng th da
vo vic theo di cng thc bch cu. Ngc li mi bnh nhn dng thuc ny phi bit l khi

st xut hin v (hay) au hng v (hay) l ming th phi :

- ngng thuc ngay ;
- kim tra huyt tc khc.
Thc vy, dng thuc tip tc s lm tng nguy c t vong. Khi thy chng mt bch cu ht
phi chuyn ngay bnh nhn vo bnh vin.
Sc :
iu kin xut hin :
l phn ng ton thn, xy ra ch yu nhng ngi c khuynh hng t trc.
Thn trng :
Phi hi bnh nhn v tin cn d ng vi thuc cha pyrazole (xem Chng ch nh).
THN TRNG LC DNG
Thn trng i vi bnh nhn suyn v nhim trng h hp mn tnh, bnh nhn c tin cn ln
cn suyn khi dng thuc gim au hoc khng dung np thuc gim au v bnh nhn c
nguy c cao khng dung np thuc gim au. Bnh nhn suy h to mu.
LC C THAI v LC NUI CON B
Lc c thai : cha c d liu lm sng v vic dng noramidopyrine cho ph n c thai, do
chng ch nh dng Novalgine trong thi kz mang thai.
Lc nui con b : chng ch nh dng v noramidopyrine i qua sa m.
TC DNG NGOI
- Tai bin huyt hc :
Chng mt bch cu ht : xem Chng ch nh, Ch { phng v Thn trng lc dng.
Him gp thiu mu hay gim tiu cu, gim bch cu.
- Ging nh tt c cc thuc cha pyrazole c th c phn ng d ng da kiu m ay hay pht
ban dng dt sn. Him khi nng di dng hoi t biu b (hi chng Lyell v StevensJohnson).
- Mt s trng hp ring l b suy thn cp hay bnh thn m k.
- Cn suyn xy ra ngi a nhy cm, c bit khng dung np aspirine.
- Nc tiu acide c th c mu : c th do mt sn phm chuyn ha hin din vi lng
rt t (3% ca liu ung vo) : acide rubazonique.
LIU LNG v CCH DNG
Ngi ln : 1-2 vin, 1-3 ln/ngy.
Khng dng dng bo ch ny cho tr em.
QU LIU
Gii hn iu tr c bit rng, liu lng hng ngy 15 g tng c dng bnh vin

369.

NOVOBDOUZE DIX MILLE

BOUCHARA
c/o TEDIS
Dung dch tim bp 10 mg/2 ml : hp 4 ng thuc 2 ml.
THNH PHN
cho 1 ng thuc
Hydroxocobalamine actate tnh theo dng base khan

10 mg

DC LC
Vitamine B12 ng vai tr ch yu trong s tng hp ADN, do n rt cn thit cho tt c cc
m c qu trnh ti to m xy ra nhanh chng (cc m to mu, rut non, t cung, v.v...). Tuy
nhin, s d tr gan bnh thng duy tr nng trong mu hu hiu trong vi nm.
Vitamine B12 liu cao c s dng vi mc ch gim au.
DC NG HC
Cc nghin cu dc l trn sc vt cho thy, hydroxocobalamine c nhiu u im so vi
cyanocobalamine : nng trong mu cao hn gp 10-15 ln, gn ln huyt thanh v m cao
hn, o thi qua nc tiu gim trn phn na.
CH NH
iu tr h tr trong mt s bnh l{ au r thn kinh (au dy thn kinh hng, au dy thn
kinh c cnh tay), trong cc bnh thn kinh gy au v mt s bnh vim dy thn kinh mt
pha sau nhn cu do thuc v c cht.
CHNG CH NH
Tin s d ng vi cobalamine (vitamine B12 v cc hp cht cng h).
Bu c tnh : do vitamine B12 c tc ng trn s tng trng ca m, lm tng mc sinh
sn ca t bo, do c nguy c lm cho bu tin trin nhanh.
TC DNG NGOI
Gy phn ng qu mn (ni m ay, sc).
LIU LNG v CCH DNG
Tim bp chm v su, 1 ng thuc mi 2 ngy.
Thuc khng c tc ng ngay m ch xut hin sau khi tim n mi th 2 hoc mi th 3.
Nc tiu c th b nhim mu hng hoc trong thi gian iu tr.

370.

NURIL 5 mg - 10 mg

USV
c/o CT TNHH DP MINH HIN
Vin nn 5 mg : v 10 vin, hp 10 v.
Vin nn 10 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Enalapril maleate

5 mg

T dc: colloidal silicone dioxide, starch,

talc, dimethicone, microcrystalline
cellulose, lactose granule, sodium starch
glycollate.

cho 1 vin
Enalapril maleate

10 mg

T dc: colloidal silicone dioxide, starch,

talc, dimethicone, microcrystalline
cellulose, lactose granule, sodium starch
glycollate.
DC LC
Nuril (Enalapril maleate) l mui maleate ca enalapril, ethyl ester ca enalaprilat, cht c ch
ACE (men chuyn angiotensin) c tc dng ko di. Enalapril maleate l mt tin cht, sau khi
ung s c hot ha bng cch thy phn ethyl ester to thnh enalaprilat c hot tnh c
ch ACE.
C ch tc ng : Enalapril maleate sau khi c thy phn thnh enalaprilat s c ch ACE
(men chuyn angiotensin) trong c th ngi v ng vt. ACE l cht xc tc s bin i
angiotensin I thnh cht gy co mch angiotensin II. Angiotensin II cn c tc dng kch thch v
thng thn tit aldosterone. Hiu qu tr liu ca enalapril trong cao huyt p v suy tim ch
yu do s km hm h thng renin-angiotensin-aldosterone. c ch ACE s lm gim

angiotensin II trong huyt tng v do gim co mch v gim tit aldosterone.

ACE l kininase, mt enzym gy thoi bin bradykinin. S gia tng bradykinin, mt peptide gy
gin mch rt mnh cng ng mt vai tr trong hiu qu tr liu ca Nuril.
DC NG HC
Khong 60% liu ung ca enalapril maleate c hp thu v nng nh t c sau
khong 1 gi. Enalapril c kh ester ch yu gan thnh enalaprilat, cht ny t nng
nh trong huyt tng khong t 3 n 4 gi sau khi ung enalapril. t hn 50% enalaprilat gn
kt vo protein.
Nng ti a trong huyt thanh ca enalapril t l thun vi liu lng, sinh kh dng ca
enalapril di dng enalaprilat vo khong 40%. Enalaprilat khng chuyn ha thm trong c
th ngi, enalapril v enalaprilat c o thi di dng khng i trong nc tiu v phn.
Thuc b loi khi thm tch mu.
Enalapril thi tr qua nhiu pha, s tn ti ca thuc trong pha cui cng cho thy s gn kt
mnh m vo ACE huyt thanh. Thi gian bn thi t 30 n 35 gi. Trng thi n nh t
c sau 3 n 4 liu ung enalapril 10 mg mi 24 gi. C th xy ra tch ly thuc bnh nhn
suy thn nng v va. S bin i enalapril thnh enalaprilat c th chm li bnh nhn ri
lon chc nng gan.
CH NH
Cao huyt p nh v va. Ph tr trong suy tim, bnh nhn khng p ng y vi thuc
li tiu v digitalis.
CHNG CH NH
Bnh nhn qu mn vi thuc. Bnh nhn c tin s ph mch do dng thuc c ch men
chuyn angiotensin.
THN TRNG LC DNG
Tng qut : Suy chc nng thn : Trong nghin cu lm sng bnh nhn cao huyt p c hp
ng mch thn mt bn hay hai bn, tng ur huyt v creatinine huyt thanh c ghi nhn
20% bnh nhn. Gia tng ny hu nh bin mt khi ngng enelapril v/hoc thuc li tiu.
nhng bnh nhn nh vy nn theo di chc nng thn trong vi tun l u iu tr. Mt vi
bnh nhn cao huyt p khng c bnh mch mu thn trc c th c tng ur huyt v
creatinine huyt thanh, thng nh v thong qua, nht l khi enalapril c dng vi thuc
li tiu. iu ny d xy ra hn bnh nhn c suy thn trc . C th cn phi gim liu
enalapril v/hoc ngng thuc li tiu.
Tng kali huyt : Tng kali huyt thanh (hn 5,7 mEq/L) thy khong 1% bnh nhn cao
huyt p trong th nghim lm sng. Trong hu ht trng hp, s gia tng ny c gi tr tch
bit v chm dt cho d iu tr vn tip tc. Tng kali huyt l l do phi ngng iu tr
0,28% bnh nhn cao huyt p. Cc yu t nguy c xy ra tng kali huyt c th gm c thiu
nng thn, tiu ng hay s dng phi hp cc thuc iu tr gim kali huyt.

Phu thut/gy m : bnh nhn tri qua phu thut hoc trong khi gy m vi cc tc nhn
gy h p, enalapril c th ngn chn hnh thnh angiotensin II ln th hai bi hon phng
thch renin. Nu h huyt p xy ra v c cho l do c ch ny, c th iu chnh c bng
cch lm tng khi lng tun hon.
Tr em : S an ton v hiu qu ca thuc tr em cha c chng minh.
LC C THAI
Cha c nghin cu y ph n mang thai. Ch dng enalapril cho ph n mang thai khi
li ch iu tr cao hn nhiu so vi nguy c tim tng cho thai nhi.
LC NUI CON B
Cha c bit thuc c bi tit trong sa m hay khng. V nhiu loi thuc bi tit trong sa
m, nn thn trng khi dng enalapril ph n ang cho con b.
TNG TC THUC
- Thuc h huyt p : Bnh nhn c dng thuc li tiu nht l nhng bnh nhn mi bt u
dng thuc li tiu, c khi b h huyt p qu mc khi bt u iu tr vi enalapril. C th gim
ti thiu kh nng h huyt p bng cch ngng thuc li tiu hoc gia tng lng mui n vo
trc khi bt u iu tr vi enalapril.
- Tc nhn gy phng thch renin : Cc tc nhn chng cao huyt p gy phng thch renin
(thuc li tiu) lm tng tc dng chng cao huyt p ca enalapril.
- Cc tc nhn tim mch khc : Enalapril c th lm gim s mt kali gy bi cc thuc li tiu
loi thiazide. Cc thuc li tiu tit kim kali (spironolactone, triamterene hoc amiloride), cc
dng mui b sung kali c th dn n tng ng k kali huyt thanh. Do khi ch nh phi
hp cc tc nhn ny, nn thn trng v theo di thng xuyn kali huyt thanh.
TC DNG NGOI
Tc dng ngoi { lm sng thng gp nht trong cc th nghim c kim sot l nhc u
(4,8%), chng mt (4,6%), mt mi (2,8%). Trong a s trng hp tc dng ngoi c bn cht
nh v thong qua. Phi ngng iu tr 6,0% bnh nhn. Trong cc th nghim lm sng, tn
sut ca tc dng ngoi { khng lin quan n tng liu dng mi ngy trong phm vi t 10 n
40 mg. T l bnh nhn iu tr vi enalapril c biu hin tc dng khng mong mun tng
ng vi gi dc.
Nhng tc dng ngoi khc xy ra hn 1% bnh nhn iu tr vi enalapril trong cc th
nghim c i chng l : tiu chy (1,6%), ngoi ban (1,5%), h huyt p (1,4%), ho (1,3%) v h
huyt p t th ng (1,3%).
LIU LNG v CCH DNG
Tc dng chng cao huyt p ca enalapril c gia tng bi cc tc nhn chng cao huyt p
gy phng thch renin (thuc li tiu). Do bnh nhn ang iu tr vi thuc li tiu, ha
huyt p triu chng c th xy ra sau liu khi u enalapril. Nu c, nn ngng thuc li
tiu 2 n 3 ngy trc khi bt u iu tr vi enalapril gim kh nng h huyt p. Nu

khng th kim sot huyt p ch vi enalapril n thun, c th dng thuc li tiu tr li. Nu
khng th ngng thuc li tiu, nn dng liu khi u 2,5 mg trong ngy u tin nhm xc
nh h huyt p qu mc c xy ra hay khng. Nu khng xy ra h huyt p qu mc, nn
tng liu n 5 mg ngy mt ln. Sau nn iu chnh liu theo s p ng huyt p. Liu
dng thng thng bin thin t 10 n 40 mg mi ngy, dng mt ln duy nht hoc chia lm
2 ln.

371.

NUTRISOL-S (5%)

GREEN CROSS GUANGZHOU

c/o DIETHELM
dung dch tim truyn 5% : chai 250 ml v 500 ml.
THNH PHNcho 100 ml
L-Isoleucine

352 mg

L-Leucine

490 mg

L-Lysine chlorhydrate

430 mg

L-Mthionine

225 mg

L-Phenylalanine

533 mg

L-Threonine

250 mg

L-Tryptophane

90 mg

L-Valine

360 mg

L-Arginine chlorhydrate

500 mg

L-Histidine chlorhydrate

250 mg

Acide aminoacetique

760 mg

L-Alanine

200 mg

Acide L-Glutamique

75 mg

Acide L-Aspartique

250 mg

L-Proline

100 mg

L-Serine

100 mg

L-Tyrosine

25 mg

L-Cystine

10 mg

ng vi : Tng s acide amine

5000 mg

D-Sorbitol

5000 mg

(pH)

(5,0 - 7,0)

(T l p sut thm thu vi dd mui sinh l)

(tng ng 3)

(Cc acide amine t do)

(4.760 mg/dl)

(Nit ton phn)

(725 mg/dl)

(Na+)

(37 mEq/l)

(Cl-)

(59 mEq/l)

(Calorie)

(40 kcal/dl)

CH NH
Cung cp acide amine trong nhng trng hp :
- Gim proteine huyt.
- Suy dinh dng.
- Tin v hu phu.
CHNG CH NH
Khng c dng trong cc trng hp :
- Bnh nhn hn m gan hoc c nguy c cao.
- Bnh nhn suy thn nng hoc tng natri huyt.
- Bnh nhn c ri lon bin dng acide amine v khng dung np fructose di truyn (suy gan
v thn nng c th xy ra).

THN TRNG LC DNG

Dng thn trng trong cc trng hp :
- Toan mu tin trin.
- Suy tim sung huyt.
TC DNG NGOI
D ng : Ni mn i khi c xy ra. Khi ngng dng thuc.
H tiu ha : Bun nn v i i khi xy ra.
H tun hon : Nng ngc, tim p nhanh i khi xy ra.
Dng nhanh liu cao : C th dn n toan huyt.
Cc du hiu khc : Run, st, nng, nhc u i khi xy ra.
LIU LNG v CCH DNG
Liu lng :
Ngi ln : 20 ml (tng ng 1 g acide amine)/kg/ngy, ti a 30 ml (tng ng 1,5 g acide
amine)/kg/ngy.
Tr em v tr s sinh : 40 ml (tng ng 2 g acide amine)/kg/ngy, ti a 50 ml (tng ng 2,5
g acide amine)/kg/ngy.
Liu trn c th iu chnh ty theo tui, tnh trng v trng lng c th. Liu ti a mi ngy
: 4 chai 500 ml (tng ng 100 g D-Sorbitol).
Nutrisol-S (5 %) cha khong 37 mEq/L Na+ v 59 mEq/L Cl-. Khi s dng liu cao hoc kt hp
vi cc dung dch in gii khc, cn lu { thng bng in gii.
Nn s dng Nutrisol-S (5 %) bng ng truyn tnh mch chm.
Cch dng :
Ngi ln : 20-500 ml/ln, truyn tnh mch chm hoc nh git tnh mch. Tc truyn vo
khong 10 g acide amine trong vng 60 pht (60-100 pht/500 ml tng ng 80-60 git/pht).

372.

NUTROPLEX

UNITED LABORATORIES
Sir : chai 60 ml.
Sir : chai 120 ml
THNH PHN
cho 5 ml (1 mung caf)

Rtinol (vitamine A)

2500 n v USP

Calcifrol (vitamine D)

200 n v USP

Thiamine chlorhydrate

10 mg

Riboflavine

1,25 mg

Nicotinamide

12,5 mg

Pyridoxine chlorhydrate

5 mg

Cyanocobalamine

50 mg

Fe nguyn t

15 mg

Calcium glycrophosphate

12,5 mg

Magnsium gluconate

4 mg

Lysine chlorhydrate

12,5 mg

Phi hp cc vitamine A, B1, B2, B6, B12, D, PP, Ca, Mg v c bit l Fe v Lysine.
DC LC
Nutroplex l mt ch phm kch thch s ngon ming c bit dnh cho tr em trong thi kz
pht trin.
Nutroplex c nhng vitamine v khong cht cn thit cho nhu cu dinh dng hng ngy cng
nh gip b p nhng thiu ht do dinh dng, c bit l cung cp lysine l acide amine
thng thiu ht trong mt ch n ung bnh thng. Lysine c chng minh v mt y
hc l yu t chu trch nhim cho s tng trng v pht trin bnh thng.
Nutroplex cn cung cp Fe, mt nguyn t vi lng ng vai tr quan trng trong qu trnh to
mu, gip da d hng ho.
CH NH
Nutroplex l mt phi hp c ch nh trong cc nhu cu khc nhau v vitamine v cht
khong.
Nutroplex cn c ch nh trong cc bnh thiu mu do thiu st.
ngi khe mnh, Nutroplex cung cp lng cht dinh dng cn thit hng ngy, cung cp
lysine l acide amine cn thit cho s tng trng.
LC C THAI
Lin quan n vitamine A :

Khng vt qu 8.000 UI vitamine A/ngy (k c trong ngun thc n).

LC NUI CON B
Lin quan n vitamine A :
Khng vt qu 8.000 UI vitamine A/ngy (k c trong ngun thc n).
LIU LNG v CCH DNG
Lc chai trc khi dng.
Ngi ln : 2 mung caf/ngy.
Tr em : 1 mung caf/ngy.

373.

NYOLOL 0,25% - 0,50%

NOVARTIS OPHTHALMICS
Thuc nh mt 0,25% : l nh git 5 ml.
Thuc nh mt 0,5% : l nh git 5 ml.
THNH PHN
cho 1 ml dung dch 0,25%
Timolol maleate

3,4 mg

ng vi : Timolol

2,5 mg

(Benzalkonium chlorure)

(0,1 mg)

cho 1 ml dung dch 0,5%

Timolol maleate

6,8 mg

ng vi : Timolol

5,0 mg

(Benzalkonium chlorure)

(0,1 mg)

DC LC
Nyolol c tc dng nhanh, thng bt u 20 pht sau khi nh. Tc dng ti a vo khong 1
n 2 gi v hiu qu h nhn p ng k ko di trong 24 gi i vi Nyolol 0,25% hay 0,50%.

Nyolol c tc dng h nhn p trong bnh glaucome hay cc tnh trng tng nhn p khc.
c tnh dc l ca hot cht chnh timolol maleate bao gm :
- c ch th th beta khng chn lc.
- Khng c hot tnh giao cm ni ti.
- Khng c tc ng v cm ti ch (n nh mng).
Khng ging cc thuc co ng t, Nyolol khng nh hng n kch thc ng t hay s
iu tit. Khng c co qup iu tit v th lc khng thay i.
Ging nh cc thuc iu tr glaucome khc, p ng vi timolol s gim khi iu tr lu di
mt s bnh nhn.
DC NG HC
Hp thu ton thn : nng thuc trong huyt tng sau khi nh mt cha c ghi nhn.
CH NH
- Tng nhn p
- Glaucome gc m mn tnh
- Glaucome ngi ly thy tinh th
CHNG CH NH
Tuyt i :
- Hen ph qun, co tht ph qun, c tin s hen ph qun hoc bnh phi tc nghn mn tnh
nng.
- Suy tim sung huyt khng kim sot c, sc do tim.
- Tc nghn dn truyn nh tht cao (cha t my to nhp).
- Hin tng Raynaud.
- Nhp tim chm < 40-45 nhp/pht.
- D ng vi mt trong cc thnh phn ca thuc.
Tng i :
- Phi hp vi Amiodaron.
CH PHNG
Vn ng vin th thao cn lu { rng thuc c cha cht c th gy phn ng th doping
dng tnh.
THN TRNG LC DNG
Ging nh cc thuc nh mt khc, Nyolol c th hp thu vo tun hon chung v tc ng
ging nh mt thuc c ch beta ng ton thn.
Cn phi iu tr suy tim trc khi dng Nyolol.
i vi bnh nhn c bnh tim nng trc hay bnh nhn ln tui, cn theo di nhp tim v
du hiu suy tim.
Sau khi nh timolol maleate, xy ra trng hp phn ng tim v h hp nng nh t vong
do co tht ph qun bnh nhn hen ph qun v mt s trng hp him t vong do suy tim.

Bnh nhn ang dng thuc c ch beta ng ung khi dng Nyolol cn theo di tc dng
cng thm i vi nhn p cng nh i vi cc tc dng ton thn ca thuc c ch beta.
Bnh nhn tiu ng
Cn thn trng khi dng thuc c ch beta bnh nhn h ng huyt v cn, hoc bnh
nhn tiu ng (c bit tiu ng khng n nh) ang dng insulin hoc thuc h ng
huyt ung. Thuc c ch beta c th che lp triu chng v du hiu ca cn h ng huyt
cp tnh.
Mc d Nyolol c dung np tt bnh nhn glaucome mang knh tip xc cng nh bnh
nhn ly thy tinh th, khng nn mang knh tip xc do nhng nguy c sau y :
- Gim tit nc mt do thuc c ch beta.
- Hp thu vo knh tip xc mt s thnh phn ca thuc (benzalkonium chlorure).
- Vim gic mc trong khi mang knh tip xc do benzalkonium chlorure.
i vi tr em :
Cha c th nghim trn tr em.
Khng nn dng thuc cho tr thiu thng v tr s sinh.
LC C THAI
Cha c th nghim dng thuc cho ph n mang thai.
LC NUI CON B
Thuc c ch beta c tit vo sa m. Nguy c h ng huyt v chm nhp tim tr b
m cha c thng k nh gi. Khng nn cho tr b m khi m ang iu tr.
TNG TC THUC
Cc thuc c ch beta. Cc thuc c ch canxi, thuc gim catecholamine, thuc c ch beta c
th gy h huyt p v/hoc chm nhp tim, v khi dng phi hp vi Nyolol s cho ra tc dng
cng thm.
Cn theo di mt khi iu tr ng thi vi thuc nh mt c cha adrenaline (c th gy dn
ng t).
TC DNG NGOI
Dung dch nh mt Nyolol ni chung dung np rt tt. Th nghim lm sng vi timolol maleate
cho thy ch yu c cc phn ng ph sau :
mt : c th gy kch ng mt, vim kt mc, vim m mt, vim gic mc, gim cm gic gic
mc, thay i khc x (do ngng iu tr vi thuc co ng t mt s trng hp), song th,
v sp mi.
h tun hon : nhp tim chm, lon nhp tim, h huyt p, ngt, bloc tim, tai bin mch mu
no, thiu mu no, suy tim sung huyt, trng ngc, ngng tim.
h h hp : co tht ph qun (xy ra ch yu ngi c bnh co tht ph qun trc ), suy
h hp, kh th.
Ton thn : nhc u, suy nhc, bun nn, chng mt, trm cm, mt mi.

Da : phn ng d ng, bao gm ni mng hay m ay khu tr hay ton thn c ghi
nhn.
LIU LNG v CCH DNG
Khi bt u, nn dng Nyolol 0,25% nh mt 1 git x 2 ln mi ngy.
Nu cha t c hiu qu lm sng mong mun, th chuyn sang dng Nyolol 0,50% nh mt
1 git x 2 ln mi ngy.
Nu cn thit, c th iu tr ng thi vi :
Thuc nh mt iu tr glaucome loi ging giao cm (sympathomimetic) hay loi ging ph
giao cm (parasympathomimetic),
Hay thuc c ch men carbonic anhydrase dng ng ton thn, t c hiu qu tt
hn.
mt s bnh nhn, v hiu qu h nhn p ca Nyolol ch n nh sau vi tun iu tr, nn
cn nh gi nhn p vo khong tun th 4.
Nu nhn p c duy tr mc chp nhn c, c th gim liu xung v nh mt mi ngy
mt ln.
Thay th mt phng php iu tr trc :
- Khi Nyolol c dng thay th mt thuc nh mt loi c ch beta khc, ngng thuc c
vo cui ngy iu tr. Ngy tip theo dng Nyolol 0,25% nh mt 1 git x 2 ln/ngy. Nu cn
dng liu cao hn th thay bng Nyolol 0,50% nh mt 1 git x 2 ln/ngy.
- Khi Nyolol c dng thay th mt thuc nh mt iu tr glaucome khng phi loi c ch
beta, tip tc dng thuc c thm mt ngy trong khi dng thm Nyolol 0,25% 1 git x 2
ln/ngy. Vo ngy tip theo ngng thuc c v ch dng Nyolol 0,25%. Nu cn dng liu cao
hn th thay bng Nyolol 0,50% nh mt 1 git x 2 ln/ngy.
Khi Nyolol c dng thay th nhiu thuc iu tr glaucome ang dng ng thi, cn cn
nhc tng trng hp c th.
Thy thuc s quyt nh ngng mt hay tt c cc loi thuc dng iu tr glaucome trc
.
Khi bnh nhn ang dng thuc co ng t chuyn sang dng Nyolol, cn khm li khc x cho
bnh nhn khi thuc co ng t ht tc dng.
Bnh nhn cn tun th cht ch cc hng dn iu tr v nhn p cn c kim sot c
bit vo giai on u ca iu tr.
Cch dng :
Mi dng l thuc ln u : vn mnh np theo chiu kim ng h lm thng mt l nh
u l thuc.
Sau mi ln nh mt : vn cht np v l thuc tr li vo hp giy trnh nh sng.
BO QUN
Ch nn dng thuc trong vng 30 ngy sau khi m np.

Gi thuc nhit phng (15-25oC).

Nu cha m np, l thuc nh mt Nyolol c th c dng cho n ngy ht hn ghi trn
hp thuc.

THUC VN O

374.

OBIMIN

UNITED LABORATORIES
Vin bao phim : chai 30 vin, 100 vin.
THNH PHN
cho 1 vin
Vitamine A

3 000 n v USP

Vitamine D

400 n v USP

Vitamine C

100 mg

Vitamine B1

10 mg

Vitamine B2

2,5 mg

Vitamine B6

15 mg

Vitamine B12

4 mg

Nicotinamide

20 mg

Calcium panthothnate

7,5 mg

Calcium lactate

250 mg

Acide folique

1 mg

Ferrous fumarate

90 mg

ng (di dng sulfate ng)

100 mg

Iode (dng iodure kali)

100 mg

DC LC
Obimin p ng nhu cu v vitamine v cht khong trong sut thi kz mang thai v cho con
b, thi kz m ngi ph n thng b thiu dinh dng do phi tha mn thm nhng nhu
cu ca thai nhi, do phi chng li nhng tc nhn gy stress trong thi kz mang thai, nhng
kh khn khi sinh n v cho con b.
Vitamine B1 : ngn nga hay iu tr bnh b rib ri thng gp trong lc c thai v thi kz v
thnh nin.
Vitamine B6 : ngn nga co git do thiu ht pyridoxine trong thi kz v thnh nin, kim sot
chng bun nn, nn ma, vim dy thn kinh v nhim c huyt trong thi kz mang thai.
Cc vitamine nhm B gip phng nga v hiu chnh s thiu ht vitamine thng gp trong
thi kz mang thai v cho con b.
Cc tc nhn chng thiu mu : gip ngn chn chng thiu mu trong thi kz mang thai ;
phng nga chng thiu mu do thiu cht st v thiu mu nguyn hng cu khng l th
pht do thiu folate. St dng ferrous fumarate c hp thu tt nht.
CH NH
B sung y ngun vitamine v mt s ion ti cn cho sn ph trong thi kz trc v sau khi
sanh, v gp phn hiu chnh nhng tnh trng ri lon thng gp trong thi kz mang thai nh
bun nn v nn ma, thiu mu, chng t ph (bribri), chng vim dy thn kinh v chut
rt.
LIU LNG v CCH DNG
Mi ngy mt vin hoc theo s ch nh ca bc s

375.

OCUFEN

ALLERGAN
thuc nh mt 0,03% : l 5 ml, l 10 ml.
THNH PHN
cho 1 ml

Natri flurbiprofene

0,3 mg

T dc khng c hot tnh : cn

polyvinyl, thimerosal, dinatri edetate, kali
chloride, natri citrate, acid citric v nc
tinh khit.
DC LC
Natri flurbiprofene thuc nhm acid phenylalkanoic c tc dng h st, gim au, chng vim
trn cc bnh vim ng vt. C ch tc dng thng qua s c ch enzyme cyclo-oxygenase
l enzyme thit yu cho sinh tng hp prostaglandine.
Trn m hnh ng vt, prostaglandine l cht trung gian ha hc ca mt s loi vim trong
mt. Nghin cu trn mt ng vt, thy prostaglandine ph v c hng ro mu - thy dch,
gy gin mch, tng thm thu mao mch, tng bch cu, tng nhn p.
Prostaglandine cn ng vai tr trong p ng co ng t khi phu thut mt do lm co c
vng mng mt khng ph thuc c ch cholinergic. Nghin cu trn lm sng, thy Ocufen c
ch s co ng t trong khi phu thut cha c th thy tinh.
Kt qu v nghin cu lm sng cho thy natri flurbiprofene khng c tc dng r rt trn nhn
p.
CH NH
Ocufen c dng c ch s co ng t trong khi phu thut mt. Ngoi ra, Ocufen cn
c dng chng vim bn phn trc ca mt sau khi phu thut hoc sau khi chiu laser
cho phu thut ct b cng mc.
CHNG CH NH
Khng dng Ocufen nu ngi bnh b vim gic mc biu m do Herpes simplex v ngi
qu mn cm vi cc thnh phn ca thuc ny.
CH PHNG v THN TRNG LC DNG
C mn cm cho gia flurbiprofene v cc thuc chng vim khng steroid, k c acid
acetylsalicylic. V vy, cn thn trng khi dng ngi c mn cm vi cc thuc trn.
Nhim khun cp tnh mt c th b che lp khi dng thuc chng vim ti ch.
Ocufen t n khng c tc dng khng khun. Cn theo di cht khi dng Ocufen cng mt
thuc chng nhim khun khi c nhim khun mt. Cng cn theo di cht ngi c tin s
vim gic mc do Herpes simplex.
Vt thng c th chm lnh khi dng Ocufen.
TNG TC THUC
Mc du trong lm sng v trn thc nghim, cha thy c c s dc l hc chng minh c
tng tc gia acetylcholine chloride (hoc carbachol) vi flurbiprofene, nhng trong thc t,

 thy bnh nhn phu thut mt m nh Ocufen th acetylcholine chloride v carbachol s

mt tc dng.
TC DNG NGOI
Nhng tc dng ngoi d gp nht khi dng Ocufen nh mt l cm gic nng rt v nga mt
tm thi v nhng triu chng nh khc do kch ng mt.
Tuy dng ti ch mt, nhng thuc chng vim khng steroid c th gy tc dng ton thn,
nh lm tng thi gian chy mu do tng tc vi s kt tp tiu cu. ghi nhn trng hp
nh mt bng Ocufen lm tng khuynh hng chy mu m mt khi phu thut mt. V vy
cn thn trng khi dng Ocufen khi phu thut mt ngi bnh d b chy mu hoc ngi
ang dng cc loi thuc c th ko di thi gian chy mu.
LIU LNG v CCH DNG
c ch s co ng t khi phu thut mt, nh vo mt tng liu 4 git Ocufen, c tng 30
pht li nh mt git, bt u t 2 gi trc phu thut.
C 4 gi nh 1 git vo ti kt mc, dng nh vy trong 1 tun sau khi chiu laser cho phu
thut ct b cng mc hoc trong 2-3 tun sau cc quy trnh phu thut khc.
QU LIU
Qu liu thng khng gy ra s c cp tnh. Nu ung nhm th cn ung ung thm nhiu
nc pha long thuc.
BO QUN
Bo qun nhit 15oC-25oC.

376.

OCULOTECT FLUID - OCULOTECT SINE

NOVARTIS OPHTHALMICS
Oculotect Fluid : thuc nh mt (nc mt nhn to) : l 10 ml.
Oculotect Sine : thuc nh mt (nc mt nhn to) : hp cha 20 liu th tch 0,4 ml.
THNH PHN
cho 1 ml Oculotect Fluid
Polyvidone (trng lng phn t trung bnh 29000)

50 mg

Acid boric

2,0 mg

Sodium chlorure

5,4 mg

Sodium lactate

0,2mg

Potassium chlorure

1,5 mg

Calcium chlorure

0,15 mg

Magnesium chlorure

0,2 mg

Nc ct va

1 ml

Cht bo qun : Benzalkonium chlorure

0,05 mg

cho 1 ml Oculotect Sine

Polyvidone (trng lng phn t trung bnh 29000)

50 mg

Acid boric

2,0 mg

Sodium chlorure

5,4 mg

Sodium lactate

0,2mg

Potassium chlorure

1,5 mg

Calcium chlorure

0,15 mg

Magnesium chlorure

0,2 mg

Nc ct va

1 ml

DC LC
Thuc nh mt Oculotect Fluid v Oculotect Sine l dung dch trong sut, khng mu, c
dng di dng git. Sau khi nh vo mt, thuc nhanh chng lan ra trn b mt kt mc v
gic mc to thnh mt lp phim bi trn c tc dng bo v.
Thnh phn ca Oculotect Fluid v Oculotect Sine rt ging nc mt nhn to v bao gm hot
cht chnh polyvidone v cc cht in gii magi, kali v natri.
DC NG HC
Do kch thc ln, polyvidone khng ngm qua gic mc.
Sau khi ung, vi trng lng phn t 12600, polyvidone nhanh chng c o thi qua nc
tiu sau 11 gi. Sau khi tim tnh mch, c th trnh s ng lu trong c th bng cch gim

thnh phn polyvidone c trng lng phn t ln hn 250000.

CH NH
iu tr triu chng cc tnh trng kh mt bao gm c vim kt gic mc kh mt (dng thay
th nc mt khi phim nc mt khng bn vng hoc thiu nc mt).
c bit dng Oculotect Sine khng cha cht bo qun c dng cho nhng bnh nhn eo
knh st trng (tc dng bi trn) hay d ng vi cht bo qun.
CHNG CH NH
Bnh nhn qu mn cm vi mt trong nhng thnh phn ca thuc (v d : cht bo qun).
THN TRNG LC DNG
Nu bnh nhn cm thy m mt sau khi nh thuc th phi i n khi ht m mi c li xe
v iu khin my mc.
Vi Oculotect Fluid : Bnh nhn khng c eo knh tip xc khi nh thuc. C th eo li sau
30 pht.
LC C THAI v LC NUI CON B
Ch dng thuc trong trng hp bt buc.
TNG TC THUC
Trng hp iu tr ng thi vi mt thuc nh mt khc (nh iu tr glaucoma), nn nh
cc thuc cch nhau ti thiu 5 pht v nn nh Oculotect sau cng.
TC DNG NGOI
Thnh thong : cay mt nh thong qua hoc cm gic dnh.
LIU LNG v CCH DNG
Cch dng chung cho c hai dng thuc :
Dng 1 git x 4 ln/ngy, nh vo ti kt mc. S ln dng mi ngy thay i ty theo nng
nh ca bnh.
Vi Oculotect Sine :
- Th tch trong mi liu c th dng mt ln cho c hai mt.
- Nu dng bi trn v lm t knh st trng th nh mt git vo knh trc khi t knh
vo mt.
- B phn thuc cn tha ngay sau khi dng, khng dnh dng cho ln sau.
BO QUN
Oculotect Fluid : y np li ngay sau khi dng. Khi m np chai thuc, ch nn dng chai
thuc ny trong vng 1 thng. Cc chai thuc cha m np c th c dng cho n ngy ht
hn ghi trn hp thuc.
Oculotect Sine : B phn thuc cn tha ngay sau khi dng, khng dnh dng cho ln sau.
Nn thuc ngoi tm tay ca tr em

377.

OFLOCET

HOECHST-MARION-ROUSSEL
[AVENTIS PHARMA]
Vin nn d b 200 mg : hp 10 vin.
Dung dch tim truyn tnh mch 200 mg/40 ml : hp 1 l 40 ml.
THNH PHN
cho 1 vin
Ofloxacine

200 mg

(Lactose)

cho 1 l
Ofloxacine

200 mg

(Na)

(5,47 mEq)

DC LC
Oflocet l khng sinh tng hp thuc h fluoroquinolone.
Ph khng khun :
Cc loi thng nhy cm (nng c ch ti thiu <= 1 mg/l) : Escherichia coli, Klebsiella
oxytoca, Proteus vulgaris, Morganella morganii, Salmonella, Shigella, Yersinia, Haemophilus
influenzae, Branhamella catarrhalis, Neisseria, Bordetella pertussis, Campylobacter, Vibrio,
Pasteurella, Staphylocoques nhy vi mticilline, Mycoplasma hominis, Legionella,
Propionibacter acnes, Mobiluncus.
Cc loi nhy cm trung bnh : Streptococcus pneumoniae, Corynebactries, Mycoplasma
pneumoniae, Chlamydiae, Ureaplasma urealyticum.
Cc loi nhy cm khng thng xuyn : Enterobacter cloacae, Citrobacter freundii, Klebsiella
pneumoniae, Proteus mirabilis, Providencia, Serratia, Pseudomonas aeruginosa.
i vi Mycobact ries atypiques : ofloxacine c tc ng trung bnh in-vitro trn mt vi loi
mycobactries : Mycobacterium fortuitum, yu hn trn M. kansasii v yu hn na trn M.
avium.
Cc loi khng (nng c ch ti thiu > 4 mg/l) : Entrocoques, Staphylocoques khng

mticilline, Listria monocytogenes, Nocardia, Acinobacter baumannii, vi khun k kh ngoi tr

Propionibacterium acnes v mobiluncus.
CH NH
- Nhim trng do cc vi khun nhy cm : nhim trng h hp thp, nhim trng tai mi hng,
nhim trng da v m mm, nhim trng sinh dc, nhim trng tit niu, cc nhim trng nng
thuc tuyn tin lit, bnh ly qua ng sinh dc nh lu, vim niu o v c t cung do
Chlamydia trachomatis, nhim trng xng khp, nhim trng tiu ha v ng mt, nhim
trng huyt.
- Ofloxacine khng c hiu qu i vi bnh giang mai.
CHNG CH NH
- C tin s tng cm vi ofloxacine, vi cc quinolones khc hay vi bt c thnh phn no ca
thuc.
- Tin cn c bnh v gn do dng fluoroquinolone.
- Thiu glucose-6-phosphate dehydrogenase.
- Khng dng cho tr em, thanh thiu nin di 18 tui, ph n c thai, ph n cho con b,
bnh nhn c th d b co git : x cng ng mch no nng, ng kinh, ri lon chc nng
thn, ang dng thuc khng vim khng steroid.
THN TRNG LC DNG
- Thn trng bnh nhn suy thn : phi gim liu.
- Vim gn : him khi xy ra nhng i khi gy t gn. Nu c cc triu chng vim gn xut
hin, ngng dng thuc ngay.
- Ung nhiu nc trong ngy.
- Trnh tip xc vi nh nng v tia UV.
- ng ung thuc chung vi thc n.
- Nn ung th liu u tin ti nh xem phn ng i vi thuc : nu b chng mt ng li
xe hoc vn hnh my mc.
- Ngng thuc ngay khi c bt kz du hiu mn cm no xut hin th d nh ni mn da.
- Khng c tim tnh mch hay truyn tnh mch nhanh. Phi truyn chm 1 l trong 60 pht.
Khng c truyn tnh mch cc thuc khc cng mt ng truyn vi Oflocet.
LC C THAI
Khng dng cho ph n ang mang thai.
LC NUI CON B
Khng dng cho ph n ang cho con b.
TNG TC THUC
- Nu dng cc thuc sau, nn ung cch Oflocet 2 gi : mui khong, vitamin c st hay mui
khong, thuc khng acid c calcium, aluminium hay magnesium, sucralfate.
- C th lm tng nng trong mu ca cc thuc bin dng bi men cytochrom P450 nh :

warfarin, cyclosporine, theophylline.

Theophylline : phi iu chnh liu theophylline.
Warfarin : phi theo di st cc th nghim v ng mu.
- Khng vim khng steroid : tng kch thch h thn kinh trung ng.
- Thuc tiu ng : theo di ng huyt.
TC DNG NGOI
- Bun nn, mt ng, nhc u, chng mt, tiu chy, i, ni mn, nga, vim m o, sng
au ch chch.
- au c v/hoc khp.
- Cc phn ng phn v nng, co git, vim i trng gi mc, nhy cm vi nh sng c th a
n nhim c quang. Nu nghi vim i trng gi mc, phi ngng ngay thuc v iu tr thch
hp vi vancomycine hay metronidazole ung.
- Bnh nhn tiu ng : ngng ngay thuc nu b phn ng h ng huyt.
LIU LNG v CCH DNG
Thuc ung v thuc tim truyn tnh mch c hiu qu v liu dng nh nhau. Khi ngi bnh
khng th dng thuc qua ng ung, hoc s hp thu qua ng ung khng tt th dng
ng tim. Khng dng thuc tim qu 10 ngy. Nn i sang thuc ung nu tip tc iu
tr.
- Chc nng thn bnh thng : 200-400 mg x 2/ngy ty bnh v cn nng ca ngi bnh.
- Suy thn : gim liu :
- thanh thi creatinin 10-50 ml/pht : 200-400 mg x 1/ngy.
- thanh thi creatinin < 10 ml/pht : 100-200 mg x 1/ngy.
- X gan : khng qu 400 mg/ngy.

378.

OFRAMAX TIM

RANBAXY
thuc tim 1 g : hp 10 l.
THNH PHN
cho 1 l
Ceftriaxone sodium, tng ng Ceftriaxone

1g

TNH CHT
Ceftriaxone l mt khng sinh cephalosporine c tc dng dit khun nh s c ch tng hp

vch t bo. N lm acyl ha cc enzyme transpeptidase gn trn mng t bo, do ngn cn

lin kt cho gia peptidoglycan cn cho s bn vng ca vch t bo. Ceftriaxone c tnh bn
vng cao i vi men bta-lactamase sinh ra bi cc vi khun Gram (+) v Gram (-).
Ph khng khun :
Ph khng khun ca ceftriaxone bao gm Neisseria gonorrhoeae (gm cc chng sinh v
khng sinh penicillinase), Neisseria meningitidis, Escherichia coli, Proteus mirabilis, Proteus
vulgaris, Morganella morganii, Serratia marcescens, Haemophilus influenzae. Ceftriaxone cng
c hot tnh vi nhiu chng Pseudomonas aeruginosa v Haemophilus ducreyi.
Ceftriaxone cng c hiu qu in vitro i vi cc vi khun sau : Citrobacter freundii, Citrobacter
diversus, cc chng Providencia (gm Providencia rettgeri), Salmonella spp. (gm S. typhi) v
cc chng Shigella.
DC NG HC
Ceftriaxone khng hp thu tt qua ng tiu ha nn phi c dng bng ng tim. Sau
liu tim bp ngi ln khe mnh, thuc hu nh hp thu hon ton. Nng nh trong
huyt tng t c sau 2-3 ting. Sau liu tim bp ceftriaxone 500 mg v 1 g, nng nh
t c l 43 mg/l v 76 mg/l tng ng. Ceftriaxone c phn b rng ri nhiu m v
dch trong c th. Thuc c nng cao m ng h hp, xng khp, ng tiu, da , m
di da v cc c quan trong bng. Thuc phn b tt vo dch no ty, c bit qua mng
no b vim. T l gn kt vi protine huyt tng vo khong 85-95%. Ceftriaxone khng b
chuyn ha gan v thn. Thuc c bi tit qua c ng thn v ngoi thn. Thi gian
bn hy ca ceftriaxone khong 7 gi. Sau liu tim bp v tim mch duy nht ngi ln c
chc nng gan v thn bnh thng, 33-67% liu c thi qua nc tiu dng khng i
trong khi phn cn li c thi qua mt, b chuyn ha bi vi khun trong lng rut v thi ra
phn di dng khng c hot tnh.
CH NH
Oframax c ch nh iu tr nhim trng h hp di, vim mng no, nhim trng da v
cu trc da, nhim trng tiu, nhim lu cu (c bin chng v khng bin chng), vim nhim
vng chu, nhim trng xng khp, nhim trng trong bng do cc vi khun nhy cm v d
phng trc phu thut.
CHNG CH NH
Ceftriaxone chng ch nh nhng bnh nhn c tin s qu mn vi pnicilline, cc dn xut
pnicilline, penicillamine hay cephalosporine.
THN TRNG LC DNG
Vim i trng gi mc c bo co xy ra khi dng cephalosporine v cc khng sinh ph
rng khc. Cn nghi ng bnh l ny nu bnh nhn tiu chy khi ang dng ceftriaxone. Nu
xy ra bi nhim khi ang dng ceftriaxone, cn c cc bin php thch hp. D c tng BUN v
creatinine huyt tng thong qua, kh nng gy c thn liu ngh ca ceftriaxone cng

tng t nh cc cephalosporine khc.

Cn cn nhc nguy c v ch li khi dng Oframax cc bnh nhn c tin s ri lon ng
mu, v cephalosporine c th gy gim prothombine mu.
Oframax cn c dng cn thn cc bnh nhn c bnh l{ ng tiu ha, c bit vim
lot i trng, vim rut tng vng hoc vim i trng do khng sinh v cephalosporine c th
gy vim i trng gi mc.
Kh nng gy ung th/bin d :
Cc nghin cu di hn loi vt v tnh sinh ung th cha c tin hnh vi ceftriaxone.
Ceftriaxone cha cho thy kh nng sinh bin d vi th nghim Ames, th nghim vi ht nhn
v th nghim lm sai lch nhim sc th t bo lympho ngi in vitro.
S dng cho tr em : Ceftriaxone gn kt cao vi protine huyt tng, n c th y bilirubin
khi albumine huyt tng. Cn dng cn thn tr c bilirubine mu cao.
S dng cho ngi gi : Khng c tai bin no ngi gi c ghi nhn cho n nay. Tuy
nhin, ngi gi c th b suy chc nng thn, nu c, cn iu chnh liu hoc khong cch
gia hai liu.
LC C THAI
Cc th nghim loi vt khng cho thy bng chng no v c tnh trn phi, thai v v kh
nng gy bu qui.
Cc th nghim y v c kim sot ph n c thai cha c tin hnh.
LC NUI CON B
Ceftriaxone c tit qua sa nng thp. Cn lu { khi dng ceftriaxone cho ph n ang
cho con b.
TNG TC THUC
- Ru : ceftriaxone dng chung vi ru c th gy cc phn ng nh disulfuram.
- Thuc khng ng, heparin hoc tan cc mu ng : ceftriaxone c th c ch s tng hp
vitamine K bng cch c ch h vi khun ng rut. Do dng chung thuc ny vi
ceftriaxone c th lm tng nguy c chy mu.
Thay i gi tr xt nghim :
- Thi gian prothombine c th b ko di v cephalosporine c ch qu trnh tng hp vitamine
K bng cch c ch h vi khun ng rut.
- Th nghim Coomb : Phn ng Coomb dng tnh thng xy ra bnh nhn dng
cephalosporine liu cao.
TC DNG NGOI
Ceftriaxone thng c dung np tt. Tuy nhin, cc tc dng ph sau y thng gp khi
dng ceftriaxone :
Tiu ha : Thay i h vi khun trong lng rut c th xy ra khi dng ceftriaxone, v thuc thi
nhiu qua mt; tiu chy thng xy ra hn tr em. Bun mt hoc si gi do calcium thnh

thong xut hin.

Cc tc dng ph trn ng tiu ha khc bao gm bun nn, nn, n khng ngon, au bng
v vim i trng gi mc.
Ceftriaxone gn kt cao vi protine v c kh nng y bilirubine ra khi cc v tr gn kt vi
albumine, gy tnh trng tng bilirubine mu.
Cc tc dng ph khc bao gm :
Phn ng ti ch : au cng vng tim, vim tnh mch sau khi dng ng tim tnh mch.
Qu mn : sn, nga, st, n lnh, co tht ph qun, h p.
Huyt hc : tng bch cu a acide, tng tiu cu, gim bch cu, thiu mu gim bch cu a
nhn trung tnh, gim lympho bo, gim tiu cu, ko di thi gian prothrombine.
Tng SGOT v phosphatase kim.
Thn : tng BUN v creatinine, gim lng nc tiu hoc gim c c nc tiu.
Sinh dc : nhim nm Candida m o.
Ming : nhim nm Candida ming.
LIU LNG v CCH DNG
Liu thng dng ngi ln
Oframax c th c dng liu tim mch hoc tim bp. Liu thng dng ngi ln l 1
n 2 g mi ngy mt ln, hay 500 mg n 1 g mi 12 gi. Tng liu khng c qu 4 g chia
lm 2 liu bng nhau trong ngy.
D phng trc phu thut : Tim mch, 1 g na gi n 2 gi trc phu thut.
Nhim lu cu khng bin chng : Tim bp liu duy nht 250 mg.
Liu thng dng tr em
Tim mch t 25 n 37,5 mg mi kg cn nng mi 12 gi.
Vim mng no : Tim mch 100 mg mi kg cn nng mt ln mi ngy, hoc 50 mg/kg cn
nng mi 12 gi, c th km hay khng km liu ti 100 mg/kg cn nng. Thng dng trong 7
ti 14 ngy.
iu tr cc nhim trng nng khng phi vim mng no tr em : liu dng mi ngy
c ngh l 50 n 75 mg/kg chia lm hai ln mi 12 gi.
Tng liu hng ngy ti a tr em khng c qu 4 g i vi vim mng no v 2 g i vi
cc nhim trng khc.
Khng cn chnh liu bnh nhn suy gan hoc suy thn, tuy nhin cc bnh nhn suy gan ln
suy thn, liu mi ngy khng qu 2 g.
Hng dn s dng
Tim tnh mch
Pha Oframax tim nh sau :

Hm lng l

Lng dung dch cn pha

250 mg

2,4 ml

1g

9,6 ml

Dung dch pha c th l nc ct pha tim, NaCl 0,9%, Dextrose 5%.

Tim bp
Oframax cng c th dng tim bp. Pha vi lng dung dch ph hp sau :
Hm lng l

Lng dung dch cn pha

250 mg

0,9 ml

1g

3,6 ml

Oframax cn c a vo c th bng cch tim vo mt khi c ln. Tim su vo mng

lm gim bt au nhc.
QU LIU
V khng c cht gii c c hiu, iu tr qu liu cephalosporine bao gm iu tr nng v
iu tr triu chng.
Vi bnh nhn c th b vim i trng gi mc do thuc khng sinh, gy ra do c t ca
Clostridium difficile, trong v sau khi dng cephalosporine. Cc trng hp nh s p ng vi
vic ngng thuc. i vi cc trng hp trung bnh v nng, cn dng dung dch truyn, in
gii v b m. Nu khng c p ng, dng metronidazole ung (250-500 mg mi 8 gi),
bacitracine (25.000 n v, ung 4 ln mi ngy trong 5 n 10 ngy), cholestyramine (4 g, 4 ln
mi ngy) hay vancomycine (125-500 mg mi 6 gi trong 5 n 10 ngy).
BO QUN
Bt Oframax v trng phi c bo qun nhit khng qu 25oC, trnh nh sng, m v
trnh lm ng lnh.

379.

OKACIN

NOVARTIS OPHTHALMICS
thuc nh mt : l 5 ml.
THNH PHN
cho 1 ml
Lomefloxacine

3 mg

T dc : Glycerol, disodium edetate,

sodium hydroxide va 1N, nc ct
va .
Cht bo qun : Benzalkonium chloride
0,02 mg
DC LC
c dn xut t difluorinated quinolone, Lomefloxacin l mt cht c ch men gyrase ca vi
khun, hiu qu i vi vi khun gram m v gram dng. c tnh cp ca Lomefloxacin khi
dng ton thn v khi dng nh mt th thp. Lomefloxacin can thip vo cc qu trnh c lin
h vi ADN ca vi khun nh cc giai on bt u, ko di, v kt thc ca qu trnh nhn i,
sao chp m, sa cha ADN, ti hp, dch m, ti xon v ngh ngi ca ADN. Phn t mc tiu
ca cc quinolone l tiu n v A ca men gyrase ca vi khun (men topoisomerase II). S hnh
thnh mt phc hp n nh gia quinolone v ton b phn t men gyrase (gm 4 tiu n v)
A2B2 lm cho chc nng ca men ny b h hi, gy nn s hy dit nhanh chng vi khun nhy
cm. Cho n nay ngi ta cha thy c s truyn tnh khng thuc qua trung gian plasmid.
Tn s xut hin tnh khng thuc do t bin t nhin nh hn 10-8 n 10-9, nh vy cng
ging nh cc quinolone khc.
Tnh khng cho ch xy ra i vi cc quinolone khc, v khng c khng ch o i vi cc
nhm khng sinh khc. Cha c cc nghin cu lm sng v hiu qu cu thuc i vi cc
trng hp nhim Chlamydia.
PH KHNG KHUN
Ph khng khun bao gm cc vi khun gram dng v gram m, theo s ghi nhn t cc
nghin cu thc nghim khc nhau.
Phn tch c h thng da trn cc nghin cu lm sng giai on II v III cho thy cc vi khun
nhy cm nh sau :
Cc vi khun nhy cm (nng c ch ti thiu MIC90 < 4 mg/ml) :
Gram dng : Staphylococcus epidermidis, S. aureus, Bacillus, Corynebacterium.
Gram m : Branhamella catarrhalis, Neisseria sp., Acinetobacter spp., Alcaligenes faecalis,

Enterobacter spp., Flavobacterium spp., Haemophilus influenzae, Klebsiella, Moraxella, Proteus,

Pseudomonas aeruginosa, Pseudomonas spp., Serratia spp.
Vi khun k kh : Propionibacterium acnes
Cc vi khun nhy cm trung gian (MIC90 = 4-16 mg/ml) :
Gram dng : Streptococcus pneumoniae, Streptococcus spp., Micrococcus, Enterococcus
faecalis
Cc vi khun khng (MIC90 > 16 mg/ml) :
Clostridium difficile, Mycobacterium, nm.
DC NG HC
th, khi nh 50 ml dung dch cha Lomefloxacin nh du 14C nng 0,3% cho thy kt qu
nh sau :
Cmax (mg-Eq/g)

Tmax (pht)

Gic mc

55,68

15

Kt mc

11,39

15

Thy dch

7,58

60

Trong cc nghin cu th nghim trn ng vt, nng thuc trong nc mt sau 2 ln nh

50 ml Lomefloxacin 0,3% l 40-200 mg/ml vo gi th 2 v vn cn 7-27 mg/ml vo gi th 6.
Ngay c vo gi th 24 nng thuc vn cn hn 3 mg/ml. Mc d khng th p dng trc
tip nhng kt qu ny ln mt ngi v sinh l hc gic mc v s thm thuc qua gic mc
khc nhau ng k gia ngi v th, nhng s xuyn thm ca Lomefloxacin qua gic mc
ngi c xc nh. ngi, nng thuc trong tin phng l 1,3-2,7 mg/ml vo thi
im 90-180 pht sau khi nh thuc. Tuy nhin, nng ny khng cao iu tr nhim
trng ni nhn.
Hp thu ton thn sau khi nh Lomefloxacin 0,3% ti ch th thp. Sau khi nh mt trong 2 tun
(mi ngy 4 ln, mi ln 2 git), nng trong mu thp hn mc c th pht hin (0,005
mg/ml).
CH NH
Cc nhim trng ca phn trc mt do nhng vi khun nhy cm vi Lomefloxacin.
CHNG CH NH
Qu mn cm vi hot cht, t dc, hay vi cc quinolone.
Trong nhng th nghim trn ng vt, c tnh trn khp ca nhng chut tr c ghi nhn
khi dng liu cao (300 mg/kg) v khng xy ra khi dng nhng liu thp (< 100 mg/kg). Nu
dng ti ch, ngay c khi thuc c hp thu hon ton, th tng liu cng ch khong 2

mg/ngy. Nh vy, liu dng ti a mi ngy trn 1 kg cn nng bin thin trong khong 20-50
mg/kg v nhiu ln nh hn ngng c cho khp. Khng thy tc dng ph no xy ra tr
em trong cc cuc nghin cu lm sng, mc d nhng s liu ny cng cn hn ch.
THN TRNG LC DNG
iu tr di hn vi khng sinh c th lm tng nguy c bi nhim nm hoc c th thc y s
pht trin ca cc vi khun bnh thng khng gy bnh.
Mt vi trng hp ring r xy ra hin tng tng nhy cm ca da i vi nh sng c
ghi nhn sau khi dng Lomefloxacin ton thn v cha thy khi dng nh mt. Tuy nhin, trong
khi iu tr vi Okacin nn trnh ra nng hoc tip xc vi bc x cc tm qu nhiu.
Lu { i vi bnh nhn mang knh tip xc : Khng nn mang knh tip xc trong khi mt b
nhim trng.
Khi phi dng ng thi nhiu loi thuc nh mt, nn nh cc thuc cch nhau ti thiu 5 pht
trnh thuc chy ra ngoi.
LC C THAI v LC NUI CON B
Sau khi dng Lomefloxacin ng ton thn liu cao (50-100 mg/kg), s thay i ng vt c
xng sng c ui c quan st thai nhi th. Hn na, cc nghin cu trn ng vt
cho thy sau khi dng ton thn vi liu 20 mg/kg, Lomefloxacin i qua c hng ro nhau
thai v c tit vo sa m. Cha c cc nghin cu lm sng v vic dng Lomefloxacin dng
nh mt cho ph n c thai hoc cho con b. Do , ch nn dng thuc cho i tng ny khi
li ch do thuc mang li nhiu hn nguy c cho thai hoc cho tr. Thai kz loi C.
TNG TC THUC
trnh lm gim hiu qu cu thuc, khng nn dng cc thuc nh mt c cha kim loi
nng nh km trong vng 15 pht trc v sau khi nh Okacin.
Khng nn dng ng thi vi Okacin cc thuc nh mt cha khng sinh c tc dng km
khun. Ngoi ra, cho n nay cha ghi nhn s tng tc vi cc thuc khc.
TC DNG NGOI
Cm gic xt nh thong qua sau khi nh thuc c ghi nhn 4,7% bnh nhn s dng. Mc
d s tng nhy cm ca da i vi nh sng cha c ghi nhn khi dng dng nh mt, tc
dng ph ny c th xy ra. V nhng phn ng d ng sau y c ghi nhn sau khi dng
Lomefloxacin ton thn, nn cng c lit k y i vi dng nh mt : cc phn ng d
ng, hen, kh th, m ay, nga, qu mn cm.
LIU LNG v CCH DNG
Ngi ln v tr em (trn 1 tui) : nh 1 git x 2-3 ln/ngy vo ti kt mc di.
Khi mi bt u iu tr, nn nh thng xuyn hn : nh 5 git trong vng 20 pht hay nh 1
git mi gi trong vng 6-10 gi. Thi gian iu tr ko di 7-9 ngy.
QU LIU
V mt thc hnh, khng c nguy c xy ra tc dng ph do nhm ln ung phi thuc bi v

mt l thuc nh mt 5 ml ch cha 15 mg Lomefloxacin. Lng ny ch bng 3,75% liu dng

hng ngy ngi ln theo ng ung (400 mg Lomefloxacin). i vi tr em khi nhm ln
ung phi thuc, c th ra d dy hn ch hp thu hn na.
BO QUN
Chai thuc nh mt Okacin c th c dng cho n ngy ht hn ghi trn hp.
ng np chai thuc ngay sau khi dng. Bo qun thuc nhit phng (< 25oC) v khng
thuc ngoi nh sng. Khng nn dng 1 l thuc lu hn 1 thng k t ngy m np. Nh
thuc ngoi tm tay ca tr em

380.

ONKOVERTIN 40 - ONKOVERTIN 70

B. BRAUN
Onkovertin 40 : dch truyn 10% : chai 500 ml.
Onkovertin 70 : dch truyn 6% : chai 500 ml.
THNH PHN
Onkovertin 40 :
cho 100 ml dch truyn Onkovertin 40
trong Natri Clorid 0,9%
Dextran MW 40.000

10 g

Natri clorid

0,9 g

Nc ct pha tim v

100 ml

Nng p lc thm thu

khong 330 mOsm/l

Cc cht in gii :
Na+

154 mmol/l

Cl-

154 mmol/l

cho 100 ml dch truyn Onkovertin 40 trong

Glucose 5%
Dextran MW 70.000

10 g

Glucose monohydrat pha tim

5,5 g

Nc ct pha tim v

100 ml

Nng p lc thm thu

khong 365m Osm/l

Onkovertin 70 :
cho 100 ml dch truyn Onkovertin 70
trong Natri Clorid 0,9%
Dextran MW 70.000

6,0 g

Natri clorid

0,9 g

Nc ct pha tim v

100 ml

Nng p lc thm thu

khong 315 mOsm/l

Cc cht in gii :
Na+

154 mmol/l

Cl-

154 mmol/l

cho 100 ml dch truyn Onkovertin 70 trong

Glucose 5%
Dextran MW 70.000

6,0 g

Glucose monohydrat pha tim

5,5 g

Nc ct pha tim v

100 ml

Nng p lc thm thu

khong 350 mOsm/l

DC LC
Onkovertin 40 l dung dch ng trng 10% dextran c phn t thp nhng c p sut thm
thu keo cao c pha ch vi natri clorid 0,9% hoc glucose 5%.
Onkovertin 70 l dung dch ng trng 6% dextran c phn t ln nhng c p sut thm thu
keo cao c pha ch vi natri clorid 0,9% hoc glucose 5%.
Cc tnh cht chnh gm c :
- Tc dng gia tng th tch nhanh (tc dng gin n).
- Tc dng duy tr th tch trong vng 3-4 gi i vi Onkovertin 40 v 6-8 gi i vi
Onkovertin 70.
- Tc dng phng chng tc nghn mch.
- ng trng vi mu do c pha vi glucose 5% hoc natri clorid 0,9%.
- Khng nh hng n nhm mu.
Do dung dch dextran c p sut thm thu keo cao hn huyt tng, nn cht lng b rt t k
gian bo vo lng mch, iu ny gii thch tc dng gin n th tch ca thuc. Kt qu l th
tch tun hon mu tng cao hn so vi th tch thc t ca dung dch dextran truyn vo c
th. Tc dng gin n th tch ny ch bt u biu hin sau khi truyn dch c 15 pht v
thy c mt cch r rt dextran MW 40.000 so vi dextran MW 70.000.
Onkovertin 40 lm mu phn phi n m nhiu hn v ci thin s cung cp oxy do tc dng
lm long mu, gim nhn ca mu, tng th tch nht bp v lm gim khng lc ngoi
bin. Ngoi ra, Onkovertin 40 cn c ch s kt tp tiu cu v s hnh thnh cc phc hp
fibrinogen-fibrin. c tnh ny cng gii thch ti sao dextran phn t thp cng c th c s
dng trong d phng tc-nghn mch.
Onkovertin 70 c tc dng duy tr th tch ko di t 6-8 gi. Ngoi ra, dextran c phn t
lng 70.000 c dng phng chng tc-nghn mch mt cch c hiu qu.
CH NH
Onkovertin 40 :
- iu chnh p lc keo.
- Ri lon vi tun hon.
- ic t ngt.
- D phng bnh huyt khi.
- Chng sc trong st xut huyt.
Onkovertin 70 :
- Thay th th tch keo trong liu php thm thu keo.
- iu tr sc tc thi.
- Phng chng tc-nghn mch.
- Pha long mu trc khi m.
CHNG CH NH

- Bnh tim mt b
- Ph phi.
- Chy mu no.
- Thiu niu hay v niu.
- Tng bnh a chy mu.
- Thiu ht dch ngoi bo.
- bit r l mn cm vi dextran.
THN TRNG LC DNG
- Phi theo di cht ch ngi bnh c truyn dung dch keo thay th th tch v cc phn
ng ph c th xy ra.
- Trong trng hp thiu fibrinigen mu th nn truyn mu.
- Nn tn trng trit liu ti a khuyn co 1,5 g dextran/kg th trng/ngy trnh xy ra
ri lon c ch ng mu.
- T l th tch huyt cu hematocrit thp hn 30% cn phi truyn mu hoc truyn hng cu.
- B sung cc cht in gii nu cn.
- Dch truyn Onkovertin 40 v 70 c tnh thm thu keo cao, khng thch hp thay th
huyt dch nguyn gc v nguy c gy thiu niu tm thi. Vi nhng ngi bnh b mt nc,
iu u tin l phi b p lng dch ngoi bo b thiu ht bng cc dung dch tinh nh
Ringer's Lactate hoc cc dung dch carbohydrat.
- Cc dch truyn dextran lm sai lch kt qu xt nghim ng huyt bng phng php
Hagedorn-Jensen, Crecelius-Seifert v Hultman (phng php o-toluidin).
- i vi vic xc nh ng niu, tt c cc phng php x t nghim lm sng thng thng
u c th s dng c, ngoi tr phng php o phn cc v phng php x t nghim
theo Nylander.
- Nu cc xt nghim v nhm mu hoc tnh tng hp huyt thanh (th nghim cho) cn
phi c thc hin nhng ngi bnh hoc ang c truyn cc dung dch keo thay th
th tch vo thi im cc xt nghim ang c tin hnh, th phi thng bo cho xt nghim
vin bit (W. Kox, H. Bush and R. Kiehl, Infusionstherapie 5:337-338 [1978]).
- truyn cc dung dch dextran nn s dng cc b dy truyn dch thch hp c mng lc
dung dch vi kch thc l lc l 15 micron.
LC C THAI v LC NUI CON B
Cm dng cc dung dch dextran trong khi ang mang thai v trong phu thut sn khoa chng
hn nh m .
TNG TC THUC
Khng nn thm cc thuc sau y vo cc dung dch dextran v s xy ra cc phn ng tng
k nh phn hy ha hc, hp th v to phc :
- Acid aminocaproic.

- Ampicillin.
- Acid ascorbic.
- Clorpromazin.
- Clortetracyclin.
- Cc barbiturat ha tan.
- Phytomenadion.
- Promethazin.
- Streptokinase.
Vic phi hp dextran vi clortetracyclin hydroclorid s gy ra cc phn ng tng k chng
hn nh b c hoc kt ta.
Tc dng gy c i vi thn ca cc aminoglycosid c th tng ln khi dng phi hp vi
dextran. V vy khi phi iu tr k o di nn trnh dng ng thi c hai loi thuc ny.
TC DNG NGOI
Tt c cc dung dch keo thin nhin v tng hp dng thay th th tch c bn trn th
trng u c th gy ra cc phn ng phn v hay th phn v vi tn s v mc nghim
trng khc nhau. C ch bnh l ca cc phn ng ny sau khi truyn dextran cha c gii
thch cn k.
Vi ngi bnh b tc dng ph nng, mc khng th khng dextran tng cao n mc c th
chun c.
Hng dn cch phng chng v iu tr cc tc dng ph :
- Cn nm r v tnh cht v mc nghim trng c th c ca cc tc dng ph.
- Theo di cht ch ngi bnh trong thi gian truyn thuc v c bit l trong khi ang
truyn 20-30 ml u ca dung dch tim truyn ny.
- Phi chun b sn sng dng c v thuc men hi sc cp cu.
Du hiu lm sng v mc
nghim trng

I. Cc phn ng ngoi da

iu tr
Ngng
Cc thuc
truyn dch khng
histamin

II. Tim mch nhanh, tt

huyt p, bun nn, nn
ma

Cc thuc
khng
histamin + cc
corticosteroid

III. Sc, co tht ph qun, Pht tn

Hi sc

1. Adrenalin 0,05-0,1 mg tim

co tht t cung
IV. Ngng h hp v tun
hon

hiu bo
ng

n nh t th TM
H hp nhn 2. Cc corticosteroid, v d
to v xoa bp prednisolon 250-1000 mg tim
tim
TM
3. Truyn dch, v d albumin
5%

Cc du hiu lm sng v liu php cp cu cc phn ng phn v hay th phn v sau khi dng
cc dung dch keo thay th th tch.(Theo nguyn tc chung, u tin phi dng adrenalin
kim ch cc phn ng phn v hay th phn v, v sau 5-10 pht cc corticosteroid mi pht
huy tc dng).
LIU LNG v CCH DNG
Liu lng :
Truyn tnh mch. Tr khi c ch nh khc, thng dng liu 500 ml truyn lin tc.
Liu ti a : 1,5 g dextran/kg cn nng/ngy, tc truyn : 40-80 git/pht tc l 120-240
ml/gi.
Tr em : liu ti a 15 ml/kg cn nng/ngy.
Cch dng :
Trong trng hp c bit cn truyn nhanh di p lc bn ngoi c th l cn thit cho cc
tnh hung cp cu, trc khi bt u truyn, phi ui ht khng kh ra khi chai c khong
khng gian cha kh bn trong, v nu khng s c nguy c gy tc mch do bt kh trong qu
trnh truyn.
Khng c s dng nu thy dung dch khng trong sut hoc chai hoc np chai c du hiu
b h hi.

381.

OPEAZITRO

O.P.V. (OVERSEAS)
Vin nn 500 mg : hp 3 vin.
Bt pha hn dch ung 200 mg/5 ml : chai 15 ml + ng nc ct 7,5 ml
THNH PHN
cho 1 vin

Azithromycin dihydrate, tng ng vi azithromycin

500 mg

cho 5 ml
Azithromycin dihydrate, tng ng vi azithromycin

200 mg

TNH CHT
Azithromycin l mt khng sinh bn tng hp loi azalide, mt phn nhm ca macrolide. V
mt cu trc, thuc khc vi erythromycin bi s thm nguyn t nitrogen c thay th
nhm methyl vo vng lactone. Do , v mt ha hc, n l mt khng sinh thuc h
macrolide phn nhm azalide. Azithromycin tc ng bng cch gn kt vo tiu n v 50S ca
ribosom v qua c ch s tng hp protein ca vi khun. Azithromycin c ph khng khun
rng v sau khi ung, nng nh trong huyt tng t c sau 2-3 gi. Do thc n lm
gim s hp thu ca thuc, khng nn dng azithromycin vi thc n. Cc nghin cu dc
ng cho thy nng azithromycin trong m cao hn trong huyt tng (n 50 ln).
Nng trong cc m nh phi, amian v tin lit tuyn vt qu gi tr MIC90 i vi nhiu
vi khun khc nhau sau mt liu n 500 mg.
Thuc c t l sinh kh dng 37%. S tit qua mt ca azithromycin, ch yu di dng khng
i, l ng o thi ch yu ; khong 6% liu s dng c tm thy trong nc tiu. Thi
gian bn hy o thi trong huyt tng l 2 n 4 ngy.
Azithromycin cho thy hot tnh in vitro trn nhiu vi khun Gram dng v Gram m bao gm
Streptococcus pneumoniae, Streptococcus pyogenes (nhm A) v cc loi Streptococcus khc ;
Staphylococcus aureus, Corynebacterium diphtheriae, Haemophilus influenzae, Haemophilus
parainfluenzae, Branhamella catarrhalis, Bacteroides fragilis, Escherichia coli, Bordetella
pertusis, Bordetella parapertusis, Shigella sp., Pasteurella sp., Vibrio sp., Peptococcus sp. v
Peptostreptococcus sp., Fusobacterium necrophorum, Fusobacterium propionibacterium acnes,
Yersinia sp., Clostridium perfringens, Borrelia burgdorferi, Haemophilus ducreyi, Neisseria
gonorrhoeae, Chlamydia trachomatis, Chlamydia pneumoniae.
Azithromycin cng cho thy hot tnh trn Legionella pneumophilla, Mycoplasma pneumoniae,
Mycoplasma pneumoniae, Mycoplasma hominis, Mycobacterium avium, Campylobacter sp.,
Ureaplasma urealyticum, Toxoplasma gondii v Treponema pallidum.
CH NH
Opeazitro c ch nh cho cc nhim khun do vi khun nhy cm trong :
- Nhim khun ng h hp di,
- Nhim khun ng h hp trn,
- Nhim khun da v m mm,

- Cc nhim khun ly truyn qua ng tnh dc ngoi lu,

v
- Cc nhim Chlamydia trachomatis khng bin chng ng sinh dc.
CHNG CH NH
Opeazitro chng ch nh bnh nhn c qu mn bit vi cc thnh phn ca thuc hay vi
cc khng sinh thuc nhm macrolide.
CH PHNG v THN TRNG LC DNG
Do nguy c bi nhim vi khun khng nhy cm v vim i trng gi mc khi s dng cc
khng sinh ph rng, nn cn thn khi dng azithromycin. Do trn l thuyt c th xy ra kh
nng ng c nm ca g, khng nn s dng ng thi Opeazitro v cc dn xut nm ca g.
Khng cn thit phi iu chnh liu lng cho bnh nhn suy thn nh (thanh thi creatinine >
0,5 ml/pht). Tuy nhin, do cha c s liu v vic s dng Opeazitro bnh nhn suy thn
mc nng hn, nn cn thn khi dng thuc cho nhng bnh nhn ny. Do h thng gan
mt l ng o thi ch yu ca Opeazitro, khng nn s dng thuc cho bnh nhn suy
gan.
LC C THAI v LC NUI CON B
Cc nghin cu trn th vt chng minh rng azithromycin i qua nhau thai nhng khng
cho thy bng chng nguy hi n thai nhi.
Hiu qu v tnh an ton ca azithromycin cha c chng minh ph n c thai. Do ,
khng nn dng thuc trong thai kz ngoi tr khi tuyt i cn thit.
Khng bit c l azithromycin c tit vo sa hay khng. Do , khng nn dng thuc cho
ph n ang nui con b ngoi tr khi tuyt i cn thit.
TNG TC THUC
Cc thuc khng acid lm gim s hp thu azithromycin ; do khi cn s dng ng thi, nn
dng vo 1 gi trc khi hoc 2 gi sau khi dng thuc khng acid. Do c th xy ra tng tc
gia azithromycin v cyclosporin, nn kim tra nng cyclosporin v iu chnh liu nu cn
thit phi s dng ng thi. Mt vi khng sinh macrolide lm gim sinh chuyn ha ca
digoxin. Mc d khng c bo co v nh hng ny khi s dng azithromycin, nn lu { n
kh nng tng tc ny v nn kim tra nng digoxin. Cng nh cc khng sinh macrolide
khc, khng nn s dng ng thi azithromycin vi cc dn xut nm ca g.
TC DNG NGOI
Azithromycin l mt thuc c dung np tt. Hu ht cc tc dng ngoi xy ra trn ng
tiu ha (bun nn, au bng, nn ma, trng bng v tiu chy). Cng nh cc macrolide v
penicillin khc, i khi c s gia tng c hi phc transaminase gan.
Thnh thong c gim tm thi bch cu trung tnh trong cc th nghim lm sng, mc d
cha xc nh mi lin quan h qu vi s s dng azithromycin.
Trong trng hp xy ra phn ng khng mong i, nn tham kho kin ca bc s.

LIU LNG v CCH DNG

Nn dng tng liu hng ngy mt ln duy nht trong ngy.
Ngi ln : Liu n 1 g (2 vin n n) azithromycin cho hiu qu cha bnh trong cc nhim
Chlamydia trachomatis ly truyn qua ng tnh dc. Nhng nhim khun do cc vi khun
nhy cm khc : 500 mg/ngy (1 vin nn/ngy) mi ngy mt ln, trong vng 3 ngy [tng liu
l 1,5 g (3 vin nn)].
C th dng theo phc khc l dng liu n 500 mg (1 vin n n) vo ngy th nht sau
250 mg (1/2 vin nn) mi ngy mt ln, trong 4 ngy [tng liu trong 5 ngy l 1,5 g].
Tr em : Nn dng dng hn dch Opeazitro cho tr em c cn nng di 45 kg (liu cho tr em
l 10 mg/kg/ngy, trong 3 ngy). Liu lng cho tr em trn 45 kg cng tng t nh liu dng
cho ngi ln. Khng nn dng thuc trong ba n (nn dng 1 gi trc khi n hoc 2 gi sau
khi n).
Liu lng cho tr em di 45 kg :
< 15 kg (6 thng- < 3 tui) : Tng liu hng ngy l 10 mg/kg. Nn dng mi ngy mt ln trong
3 ngy.
15-25 kg (3-7 tui) : 1 mung lng (km trong hp) (5 ml = 200 mg) mi ngy mt ln trong 3
ngy.
26-35 kg (8-11 tui) : 1,5 mung lng (7,5 ml = 300 mg) mi ngy mt ln trong 3 ngy.
36-45 kg (12-14 tui) : 2 mung lng (10 ml = 400 mg) mi ngy mt ln trong 3 ngy.
Cha c thng tin v hiu qu v tnh an ton ca azithromycin s dng cho tr di 6 thng
tui ; do khng nn dng thuc cho tr em nhm tui ny.
Pha hn dch :
- Lc k chai bt dng pha hn dch azithromycin.
- Xoay m np ng nha km trong hp.
- Thm nc ct trong ng vo chai v lc k.
Hn dch pha n nh trong 5 ngy nhit phng.
QU LIU
Khng c s liu v vic qu liu azithromycin. Triu chng tiu biu ca qu liu cc khng sinh
macrolide bao gm gim thnh gic, bun nn, nn ma v tiu chy nng. Nu cn thit, nn
ch nh ra d dy v h tr tng qut.
BO QUN
Bo qun nhit trong khong 15-30oC.
Trnh xa tm vi tr em.

382.

OPEDROXIL

O.P.V. (OVERSEAS)
Vin nang 500 mg : hp 14 vin.
Hn dch ung 250 mg : gi 3 g, hp 12, 24 v 100 gi.
THNH PHN
cho 1 vin
Cefadroxil monohydrate, tng ng vi cefadroxil base

500 mg

cho 1 gi
Cefadroxil monohydrate, tng ng vi cefadroxil base

250 mg

TNH CHT
Opedroxil (cefadroxil monohydrate) l mt khng sinh bn tng hp c ph rng. V mt ha
hc, n c danh php l : 7-[D- (-)-a-amino-a- (4-hydroxyphenyl) - acetamido]-3 methyl-delta 3
cefem - 4 carboxylic acid monohydrate.
DC LC
Dc l lm sng
Opedroxil n nh trong mi trng acid v c nhanh chng hp thu vi nng nh trong
huyt thanh t c trong vng 1 n 11/2 gi sau khi ung. Nng o c hin din 12
gi sau khi ung. Thi gian bn hy trung bnh ca Opedroxil ngi trng thnh khe mnh
l 1,4 gi. Cefadroxil gn kt vi protein huyt thanh ngi khong 20%. Trn 90% thuc c
o thi di dng khng i trong nc tiu trong vng 24 gi. Sau khi dng liu u tin,
nng cefadroxil trong nc tiu trong 12-18 gi c duy tr trn mc nng c ch ti
thiu (MIC) ca cc vi khun gy bnh nhy cm.
Vi sinh hc
Opedroxil l khng sinh c tnh dit khun c tc dng trn nhiu vi khun Gram m v Gram
dng.
Vi khun Gram dng :
Cc Staphylococcus (sinh v khng sinh penicillinase), cc Streptococcus huyt gii beta,
Streptococcus (Diplococcus) pneumoniae, Streptococcus pyogenes.
Vi khun Gram m :
Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Haemophilus influenzae, Salmonella
v mt vi loi Shigella.

CH NH
Opedroxil c ch nh trong cc nhim khun sau do cc chng vi khun nhy cm.
Nhim khun ng h hp : Vim amian, vim hng, vim ph qun, gin ph qun, vim
phi, p xe phi, vim m mng phi, vim mng phi, vim xoang, vim thanh qun, vim tai
gia.
Nhim khun da v m mm : Vim mch bch huyt, p xe, vim m t bo, lot do nm,
vim v, nht, vim qung.
Nhim khun ng niu dc : Vim thn b thn, vim bng quang, vim b phn ph, vim
ni mc t cung.
Cc nhim khun khc : Vim c xng, vim khp nhim khun, nhim khun huyt, vim
phc mc, nhim khun chu sinh.
CHNG CH NH
Opedroxil chng ch nh bnh nhn c qu mn bit vi cephalosporin.
CH PHNG
Opedroxil nn c dng cn thn bnh nhn c tin s d ng vi penicillin. C bng chng
v phn ng d ng cho mt phn ca penicillin v cephalosporin. Nu xy ra phn ng d ng
vi Opedroxil, nn ngng thuc v iu tr vi cc thuc thng dng (cc amine tng huyt
p, khng histamin v/hoc corticosteroid).
THN TRNG LC DNG
Do kinh nghim v s s dng thuc tr nh v tr s sinh cn gii hn, nn dng Opedroxil
mt cch cn thn nhng i tng bnh nhn ny. Nn cn thn khi k toa Opedroxil trong
trng hp b suy thn ng k. Cha xc nh c tnh an ton khi s dng thuc trong thai
kz.
c bo co v xt nghim Coombs trc tip cho kt qu dng tnh trong qu trnh iu tr
vi cc cephalosporin v penicillin. Bnh nhn c iu tr vi Opedroxil c th cho phn ng
glucose niu dng tnh gi khi xt nghim vi dung dch Fehling hay Benedict, ng sulfate
hay vin nn Clinitest ; phn ng ny khng xy ra vi cc xt nghim da trn enzyme. iu tr
ko di vi Opedroxil c th lm tng bi vi khun khng nhy cm.
TC DNG NGOI
Cng ging nh cc cephalosporin khc, Opedroxil c th gy phn ng d ng ; ni ban, nga
ngy, my ay v ph mch c th c quan st d khng thng xuyn.
Cc tc dng ngoi bao gm : bun nn, nn ma, tiu chy, kh tiu, chng mt, nhc u
v vim m o do Candida c th xy ra d him.
LIU LNG v CCH DNG
Ngi ln v tr em cn nng trn 40 kg :
Ty theo mc trm trng ca nhim khun, nn 1-2 g dng mi ngy mt ln hay chia lm
hai. i vi cc nhim khun e da n tnh mng, nn dng cc cephalosporin theo ng

tim.
Tr em :
i vi cc nhim khun ng tiu, liu hng ngy khuyn co cho tr em l 30 mg/kg/ngy
chia lm hai ln mi 12 gi. i vi vim hng, vim amian v chc l, liu khuyn co hng
ngy cho tr em l 30 mg/kg/ngy dng liu duy nht trong ngy hay chia lm nhiu ln mi 12
gi. i vi cc nhim khun da v cu trc da, liu hng ngy khuyn co l 30 mg/kg/ngy
chia lm hai ln mi 12 gi. i vi cc nhim Streptococcus huyt gii beta, nn dng
Opedroxil t nht 10 ngy.
Cc nhim khun ng tiu mn tnh c th cn iu tr tp trung ko di cng vi theo di
lin tc v lm sng v vi khun hc.
Tr em di 12 tui :
Tng liu hng ngy l 25 mg/kg chia lm hai liu mi 12 gi.
Liu lng trong trng hp suy thn :
Khng cn iu chnh phc liu lng bnh nhn c thanh thi creatinine > 50 ml/pht.
nhng bnh nhn c thanh thi creatinine <=50 ml/pht, nn theo phc iu chnh
hng dn nh sau da trn thanh thi creatinine (ml/pht/1,73 m2). Nn xt ring cho
tng trng hp bnh nhn.
Bnh nhn suy thn c th c iu tr vi liu khi u bng vi liu khi u dnh cho bnh
nhn c chc nng thn bnh thng.
C th p dng bng sau cho cc liu tip theo sau :
Thanh thi creatinine (ml/pht/1,73 m2)

Liu (mg) Khong cch dng (gi)

0-10

500

36

10-25

500

24

25-50

500

12

C th cn phi iu chnh liu thp hn khi dng cho tr em. Tip tc dng thuc ti thiu 48
n 72 gi sau khi c bng chng sch khun.
Hng dn pha dng hn dch ung :
bt vo ly. Thm 5 ml nc vo ly. Sau khuy vi giy. Theo ng liu c k toa.

383.

OPEROXOLID

O.P.V. (OVERSEAS)
Vin nn 150 mg : v 10 vin.
THNH PHN
cho 1 vin
Roxithromycin

150 mg

DC LC
Roxithromycin l khng sinh km khun thuc h macrolide.
Nhng vi khun nhy cm bao gm : Lin cu, t cu nhy methicillin, Rhodococcus,
Branhamelia catarrhalis, Bordetella pertussis, Helicobacter pylori, Campylobacter jejuni,
Corynebacterium diphteriae, Chlamydiae, Coxiella. Mycoplasma pneumoniae, Moraxella,
Legionella, Borrelia burgdorferi, Treponella pallidum, Propionibacterium acnes, Leptospires,
Actinomyces, Porphyromonas, Mobiluncus, Eubacterium.
Nhng vi khun t nhy cm hn : Haemophilus influenzae, Haemophilus para-influenzae,
Neisseria gonorrhoeae, Vibrio, Ureaplasma urealyticum.
a s nhng vi khun cn li thng l nhy cm.
DC NG HC
Hp thu : hp thu nhanh, nng nh trong huyt thanh t c sau khong 2 gi. Thc n t
lm nh hng n s hp thu thuc.
Phn b : thuc i vo c m xng, c bit l m phi, amidan, tin lit tuyn. Thuc
thm nhp v tch t trong cc thc bo (a nhn trung tnh, n nhn i thc bo). 96%
thuc gn vi protein huyt. Thuc i vo sa m 1 lng khng ng k.
o thi : o thi ch yu qua phn, hn na liu lng s dng c o thi di dng
khng i.
CH NH
Operoxolid c ch nh trong nhim khun do cc vi khun nhy cm nh : Lin cu, t cu
nhy methicillin, Rhodococcus, Branhamella catarrhalis, Bordetella pertussis, Helicobacter
pylori, Campylobacter jejuni, Corynebacterium diphteriae, Chlamydiae, Coxiella. Mycoplasma
pneumoniae, Moraxella, Legionella, Borrelia burgdorferi, Treponella pallidum,
Propionibacterium acnes, Leptospires, Actinomyces, Porphyromonas, Mobiluncus,
Eubacterium, gy bnh :
- ng h hp trn v di
- Da v m mm
- ng sinh dc (khng do lu cu)
- Vng rng ming

CHNG CH NH
- Nhy cm vi nhm macrolid.
- Khng nn dng chung vi ergotamine v dihydroergotamine.
CH PHNG v THN TRNG LC DNG
Ht sc thn trng nhng bnh nhn suy gan.
Thuc c th gy chng mt do phi cn thn khi dng thuc lc li xe hay s dng my
mc.
LC C THAI
Cha c bng chng gy qui thai ng vt nhng ni chung khng nn dng.
LC NUI CON B
C 1 lng nh thuc c tit qua sa m.
TNG TC THUC
- Khng dng chung vi ergotamine v dihydroergotamine.
- Khng nn dng ng thi vi triazolam : c th gy ri lon hnh vi.
- Cc thuc theophylline, ciclosporine, bromocriptine c th b tng nng trong mu khi
dng chung vi Operoxolid.
TC DNG NGOI
- Chng mt, i khi gy ph Quincke, phn ng ging phn v.
- C th gy tng thong qua SGOT v SGPT khi dng liu cao.
- Bun nn v nn, au d dy, tiu chy.
- i khi gy d ng ngoi da.
LIU LNG v CCH DNG
Ngi ln : 150 mg, ngy 2 ln.
Tr em trn 4 tui : 5-8 mg/kg/ngy, chia lm 2 ln.
Nn ung thuc trc ba n.

384.

OPTALIDON

NOVARTIS
Vin bao : hp 25 vin.
THNH PHN
cho 1 vin

Noramidopyrine

125 mg

Caffeine

25 mg

TNH CHT
Optalidon l mt thuc gim au, h st c hiu qu, tc dng nhanh, dung np tt, khng nh
hng ti kh nng lm vic.
DC NG HC
Noramidopyrine : nng ti a trong huyt tng t c sau khi dng thuc 1-3 gi. Thi
gian bn thi t 1-1,5 gi. Khong 0,6% thi tr qua nc tiu di dng khng i.
Caffeine : c hp thu nhanh chng v hon ton ; n c chuyn ha mnh. Cc cht
chuyn ha ch yu c o thi qua nc tiu. Thi gian bn thi l 3,5 gi. T l gn vi
protein huyt tng l 35%.
CH NH
Optalidon c dng trong iu tr cc chng au sau :
- au u do nhiu nguyn nhn khc nhau.
- au rng v au sau khi nh rng.
- au dy thn kinh thuc : vng mt, gian sn, thn kinh ta...
- au cp tnh trong cc bnh thp khp nh thoi ha khp, vim khp v cc ri lon thn
kinh-c khc.
- au sau chn thng hay phu thut.
- au bng kinh.
- au c, au trong cm lnh hay cm.
CHNG CH NH
Mn cm vi cc dn xut ca pyrazolone.
THN TRNG LC DNG
Nn dng thuc trong mt thi gian nht nh ch khng nn dng ko di.
Nh mi thuc khc, ch nn dng Optalidon cho ph n c thai hay cho con b theo ch nh
ca bc s.
Cn thn trng khi dng thuc cho cc bnh nhn c ri lon chc nng gan, thn.
thuc ngoi tm vi ca tr em.
TC DNG NGOI
Him khi c chng mt hay bun nn. Rt him gp cc phn ng qu mn nh da hay cc
triu chng khc kiu phn v.
Cc dn xut pyrazolone nh noramidopyrine c bit c trng hp gy mt bch cu ht.
LIU LNG v CCH DNG
Nut c vin thuc vi mt t nc.

Ngi ln :
1-2 vin/ln ; nu cn, c th nhc li liu ny 1-2 ln/ngy.
Liu ti a : 6 vin/ngy.
Tr em t 6 tui tr ln :
1 vin/ln.
Liu ti a hng ngy : 1-3 vin ty theo tui.
QU LIU
- Triu chng : au bng, bun nn, nn, ng g, kch thch, co git ; nhp tim nhanh ; hn m.
- iu tr : iu tr triu chng ; nn ra d dy nu thy cn.

385.

ORACFAL

BRISTOL-MYERS SQUIBB
vin nn d ha tan dng pha hn dch ung 1 g : v 2 vin, hp 3 v.
vin nang 500 mg : hp 12 vin.
bt pha xir 250 mg/5 ml : chai 60 ml xir sau khi pha (12 mung lng 5 ml).
THNH PHN
cho 1 vin 1 g
Cfadroxil monohydrate tnh theo dng khan

1g

cho 1 vin 500 mg

Cfadroxil monohydrate tnh theo dng khan

500 mg

(Lactose)

cho 1 mung lng

Cfadroxil monohydrate tnh theo dng khan

250 mg

(Saccharose)

(1,85 g)

(Na)

(0,80 mg)

DC LC
Cfadroxil l khng sinh dit khun thuc h bta-lactamine, nhm cphalosporine th h 1.
PH KHNG KHUN
Cc vi khun nhy cm thng xuyn : Staphylocoque nhy vi mticilline ; Streptocoque trong
c Streptococcus pneumoniae nhy vi pnicilline ; Branhamella catarrhalis, Neisseria
gonorrhoeae, Pasteurella ; Corynebacterium diphteriae, Propionibacterium acnes.
Cc vi khun nhy cm trung bnh : Haemophilus influenzae ; Salmonella, Shigella, Citrobacter
diversus, Proteus mirabilis ; Clostridium perfringens, Peptostreptococcus.
Cc vi khun nhy cm khng thng xuyn : Klebsiella, Escherichia coli ; Fusobacterium,
Prevotella.
Cc vi khun khng : Staphylocoque khng m ticilline ; Streptococcus pneumoniae khng
hoc km nhy cm vi pnicilline ; Enterococcus ; Listeria monocytogenes ; Enterobacter ;
Serratia ; Citrobacter freundii ; Proteus vulgaris ; Morganella morganii ; Providencia ;
Pseudomonas sp. ; Acinetobacter, cc vi khun gram m khng ln men khc ; Bacteroides ;
Clostridium difficile.
DC NG HC
- C fadroxil c hp thu rt tt (80-90%) qua ng tiu ha.
- Thc n khng lm thay i s hp thu thuc.
- Ung 500 mg Oracfal s cho nng 15 mg/ml sau 1 gi 30 pht.
- Nng ca thuc trong huyt thanh duy tr mc c hiu qu trong hn 6 gi.
- T l kt dnh vi protine huyt tng l 15%.
- Thi gian bn hy : 1 gi 30 pht.
- Thuc c o thi ch yu qua nc tiu di dng c hot tnh. Nng trong nc tiu
cao, khong 1.000 mg/ml trong nc tiu trong 6 gi, sau khi ung liu duy nht 500 mg.
Trn 90% liu s dng c tm thy trong nc tiu trong 24 gi.
CH NH
Nhim trng do vi khun nhy cm cn phi iu tr bng khng sinh ng ung, ngoi tr cc
nhim trng mng no, ch yu trong :
- Nhim trng tai mi hng : vim hng, vim xoang, vim tai ;
- Nhim trng ng h hp di :
. nung m ph qun cp v cn kch pht cp tnh ca vim ph qun mn,
. bnh phi cp tnh do vi khun ;
- Nhim trng ng tiu nht l phn di c bin chng hoc khng.
CHNG CH NH
D ng vi khng sinh nhm cphalosporine.

CH PHNG
Ngng tr liu nu xut hin cc biu hin d ng.
Cn phi hi tin s d ng thuc trc khi k toa nhm cphalosporine do c d ng cho gia
nhm pnicilline v nhm cphalosporine xy ra trong 5-10% trng hp. Tht thn trng khi
dng cphalosporine cho bnh nhn nhy cm vi pnicilline ; phi theo di chuyn mn
nghim ngt ngay t ln tim thuc u tin.
Cphalosporine b cm dng cho cc i tng c tin s d ng vi cphalosporine kiu phn
ng tc th. Trong trng hp nghi ng, thy thuc cn phi tc trc bn cnh bnh nhn trong
ln dng thuc u tin x l tai bin phn v nu xy ra.
THN TRNG LC DNG
- Trng hp bnh nhn b suy thn, liu c iu chnh theo mc thanh thi cratinine
hoc theo cratinine huyt.
- Nn theo di chc nng thn nu c phi hp cfadroxil vi khng sinh c c tnh trn thn
(c bit l cc aminoside) hoc vi thuc li tiu loi furosmide hoc acide tacrynique.
- Ch { n lng saccharose trong bt pha hn dch ung.
LC C THAI
Tnh v hi ca cfadroxil khi dng cho ph n c thai cha c xc nhn mt cch chnh
thc, tuy nhin cc nghin cu tin hnh trn nhiu loi ng vt khng cho thy c tc dng
sinh qui thai hay c c tnh trn thai nhi.
LC NUI CON B
C fadroxil c bi tit qua sa m vi nng thp hn nng iu tr, do c th cho
con b trong thi gian iu tr. Tuy nhin, ngng cho con b nu thy xut hin tiu chy, nm,
mn da trn nh nhi.
TNG TC THUC
Phn ng cn lm sng :
Test de Coombs dng tnh c ghi nhn trong qu trnh iu tr vi c phalosporine, iu ny
cng c th xy ra i vi cfadroxil.
C fadroxil cng c th cho kt qu dng tnh gi trong xt nghim tm glucose trong nc tiu
vi cc cht kh, nhng khng gy tc dng ny khi p dng cc phng php chuyn bit vi
glucose oxydase.
TC DNG NGOI
- Biu hin d ng : ni my ay, pht ban.
- Biu hin mu : tng tm thi bch cu a acide.
- c tnh trn thn : mt s trng hp suy gim chc nng thn c ghi nhn khi s dng
thuc khng sinh cng nhm, nht l khi phi hp vi nhm aminoside v cc thuc li tiu
mnh.
- Cng nh i vi a s cc khng sinh khc cng nhm, rt him trng hp b vim kt trng

gi mc c ghi nhn.
LIU LNG v CCH DNG
Liu lng :
Ngi ln : 2 g/ngy, chia lm 2 ln (mi ln ung 2 vin 500 mg hay 1 vin 1 g).
iu tr vim hng v vim amidan do streptocoque nhm A : 1 g liu duy nht trong ngy hoc
chia lm 2 ln trong ngy.
Tr em/Tr cn b : 50 mg/kg/ngy, chia lm 2 ln.
Suy thn :
- thanh thi cratinine t 20 n 40 ml/pht : 1 g/24 gi.
- thanh thi cr atinine di 20 ml/pht : 1 g/48 gi.
Cch dng :
Vin nn : vin nn phi c ha trong nc trc khi ung.
Vin nang : ung thuc vi mt t nc, trc hoc trong ba n.
Bt pha xir : cho nc un si ngui vo chai cho n mc vch. Sau lc u, nu thy
mc nc thp hn vch th chm thm nc vo n ngang vch - lc u. Khi , bn c
60 ml dung dch thuc tng ng 3 g Orac fal. Sau khi pha, xir c th gi c mt tun
nhit phng.
Cch rt thuc vo mung lng : lc chai trc khi rt. Cm mung sao cho ming mung
nm ngang, rt thuc vo cho n ng mc vch trn cn mung. Mt mung lng tng
ng vi 250 mg Oracfal.
BO QUN
Sau khi pha : xir gi c 1 tun nhit phng.

386.

ORNICTIL 5 g

JACQUES LOGEAIS
c/o HYPHENS
Bt pha tim ng tim truyn tnh mch v bt pha ung 5 g : l bt.
THNH PHN
cho 1 l
L-ornithine oxoglurate trung tnh

5g

tng ng : Azote

685 mg

DC LC
Ornithine oxoglurate ng vai tr trong :
- ci thin s chuyn ha protide bnh nhn c cung cp dinh dng bng ng tim.
- tng bi tit insuline v hormone tng trng.
- c ch gii c ammoniac.
CH NH
Dng trong bnh no do gan.
Nui dng qua ng tim truyn v ng ung i vi nhng bnh nhn suy dinh dng
do gim chuyn ha protide, thm d chc nng ca tuyn yn.
TC DNG NGOI
C biu hin trn da (him).
TNG K
Khng phi hp trong cng mt dch truyn : Atarax, Hmineurine, Penthotal, Pervincamine,
Rifocine, Soludactone, Valium, Vitamine K1.
LIU LNG v CCH DNG
p Thm d chc nng tuyn yn :
Ngi ln : 10 g trong 100 ml dung dch NaCl 0,9 %, trong 30 pht.
Tr em trn 7 tui : tng i liu.
p Dinh dng qua ng tim truyn v ng ung : 0,35 g/kg/ngy, tim truyn gin on
t 1 n 3 gi hoc tim truyn lin tc trn 24 gi, hoc pha mt l Ornictil 5 g trong 100 ml
nc ung (2 n 3 l/ngy).
p Bnh no do gan : 4 n10 chai/24 gi, cho n 1 g/kg/ngy bng ng tim truyn tnh
mch gin on hoc lin tc. Ha tan phn thuc cha trong l trong 20 ml dung dch glucose,
lvulose, hoc mui nhc trng, u trng hoc ng trng.

387.

PFIZER
c/o ZUELLIG

OROPIVALONE BACITRACINE

vin ngm : hp 40 vin.

THNH PHN
cho 1 vin
Tixocortol pivalate

1,5 mg

Bacitracine mui km

200 UI

Menthol

DC LC
- Corticoide tc dng ti ch, khng c tc dng ton thn khi dng liu iu tr, tixocortol
pivalate c tc dng khng vim ng tai mi hng.
- Phi hp bacitracine v tixocortol pivalate c tc dng iu tr ti ch cc nhim trng do
mm bnh nhy cm vi bacitracine.
- An ton khi s dng : dng n 2 g tixocortol pivalate bng ng ung ngi vn khng
gy thay i cc thng s sinh hc.
DC NG HC
Cc nghin cu trn ng vt v trn ngi cho thy tixocortol pivalate c chuyn ha rt
nhanh, do khng gy tc dng ton thn.
CH NH
iu tr cc chng vim v nhim trng nim mc vng khoang ming - hng - hu : vim hng,
vim hu, vim amygdale, vim thanh qun, vim kh qun.
Tr liu sau cc phu thut : ct amygdale, rch abcs.
CHNG CH NH
C tin s d ng vi thuc.
Tr em di 6 tui (do c nguy c thuc i sai ng)
THN TRNG LC DNG
Cc vn ng vin th thao cn lu { rng thuc ny c cha hot cht cho phn ng dng
tnh khi lm xt nghim tm doping.
TC DNG NGOI
Phn ng khng dung np ti ch (cm gic kim chm) c th xy n lc u tr liu.
Him gp phn ng kiu d ng (ph da - nim mc vng mt, ph nim mc c th phi hp
vi vim li mt gai, ngoi l c th gy ph Quincke). Cc triu chng ny s ht khi ngng

dng thuc.
LIU LNG v CCH DNG
iu tr ti a trong 8 n 15 ngy. thuc tan trong ming khng nhai.
Ngm t 4 n 10 vin / ngy

388.

OTIPAX

BIOCODEX
c/o TEDIS
dung dch nh tai : chai 15 ml cha 16 g dung dch, c km theo ng m git mm.
THNH PHN
cho 100 g
Phnazone

4g

Lidocaine chlorhydrate

1g

T dc : sodium thiosulfate, thanol,

glycerol, nc tinh khit.

DC LC
Gim au ti ch v khng vim s dng cho tai (S : c quan cm gic).
Phnazone : dn xut ca pyrazole c c tnh gim au v khng vim.
Lidocaine : thuc gy t ti ch thuc nhm amide.
DC NG HC
Thuc khng vo mu tr trng hp mng nh b rch.
CH NH
Gim au ti ch, c bit trong :
- Vim tai gia cp trong giai on sung huyt.
- Vim tai chn thng do kh p.
- Vim tai dng phng nc do siu vi cm.
CHNG CH NH
Mng nh b thng do nhim trng hay chn thng.
Mn cm i vi mt trong nhng thnh phn ca thuc, c bit i vi lidocaine.
CH PHNG v THN TRNG LC DNG

Ch { phng :
Nn thn trng kim tra mng nh trc khi nh thuc.
Trong trng hp mng nh b thng, vic nh thuc vo trong tai dn n s tip xc ca
thuc vi nhng cu trc ca tai gia, gy ra nhng tc dng ngoi trn nhng m ny.
Thn trng lc dng :
Thi gian iu tr nn c gii hn trong vng 10 ngy. Qu thi gian trn, nn xem xt li vic
iu tr.
Cc vn ng vin nn lu rng thuc ny c cha mt thnh phn hot cht c th cho kt
qu dng tnh khi lm x t nghim kim tra s dng cht kch thch (doping).
LC C THAI v LC NUI CON B
Nu mng nh khng b thng th kh nng thuc vo mu rt t.
Do nu cn, thuc ny vn c s dng bnh thng ph n c thai hay ph n cho con
b.
TC DNG NGOI
C th xy ra phn ng ti ch nh d ng, kch thch hay sung huyt ng tai ngoi.
LIU LNG v CCH DNG
Dng ng nh git, nh 4 git vo ng tai ngoi, 2 n 3 ln mi ngy.
Thi gian iu tr ti a 10 ngy.
BO QUN
Bo qun nhit di 30oC.

389.

OTRIVIN

NOVARTIS
thuc nh mi 0,05% : l 10 ml.
kh dung bm mi 0,1% : l 10 ml.
THNH PHN
cho 100 ml thuc nh mi
Xylometazoline hydrochloride

50 mg

cho 100 ml kh dung bm mi

Xylometazoline hydrochloride

100 mg

DC LC
Xylometazoline thuc nhm cc arylalkyl imidazoline.
Otrivine khi c s dng trong mi c tc dng gy co mch, chng sung huyt nim mc
mi v hu hng.
Otrivin gy tc dng nhanh trong vng vi pht v duy tr trong nhiu gi. Otrivin c dung
np tt, ngay c khi cc nim mc d nhy cm, thuc vn khng gy cn tr chc nng ca
biu m ca tim mao.
DC NG HC
Sau khi bm hoc nh vo mi, nng ca hot cht trong huyt tng rt thp khng th
kim tra c bng cc phng php phn tch thng thng hin nay.
CH NH
- S mi, nght mi trong cm lnh, cm v do cc nguyn nhn khc.
- Tr gip ti cc dch tit khi b tn thng vng xoang.
- H tr iu tr sung huyt nim mc mi hng trong vim tai gia.
- To iu kin ni soi mi d dng.
CHNG CH NH
Nh cc thuc gy co mch khc, khng nn dng Otrivin trong cc trng hp sau :
- Ct tuyn yn qua ng xng bm (hay sau cc phu thut bc l mng cng qua ng
ming hoc mi).
- Mn cm vi cc thnh phn ca thuc.
THN TRNG LC DNG
Nh vi tt c cc thuc cng nhm tr liu, Otrivin phi c s dng thn trng trong trng
hp c phn ng giao cm qu mc, th hin qua vic mt ng, chng mt...
Nh vi cc thuc gy co mch ti ch, vic iu tr lin tip v ko di bng Otrivin, nh trong
bnh vim mi mn tnh, l khng nn.
LC C THAI v LC NUI CON B
S dng thn trng cho ph n mang thai.
Ph n cho con b ch dng Otrivin khi c ch nh ca bc s.
TC DNG NGOI
Cc tc dng ph sau y c th c ghi nhn trong mt vi trng hp : cm gic nng rt

mi v c hng, gy kch ng ti ch, bun nn, nhc u, kh nim mc mi.

LIU LNG v CCH DNG
nThuc nh mi 0,05% :
Dng cho tr nh nhi v tr em di 6 tui : thng nh 1 n 2 git vo mi bn mi, 1 n 2
ln/ngy ; khng nn nh qu 3 ln/ngy.
nKh dung 0,1% :
Dng cho ngi ln v tr em trn 7 tui : mi ln xt 1 liu vo trong mi bn mi, thng
khong 4 ln/ngy l .
p Cch s dng bnh xt kh dung : Bnh kh dung v tr thng ng, np pha trn. Lc l
thuc vi ln. Cho ng tra mi vo mi v bm nhanh v mnh vo nt bm pha trn ca
bnh kh dung ; rt ng tra mi ra trc khi th tay bm. Ht nh qua mi trong lc bm thuc
s gip thuc c phn tn ti u. y nt bo v li sau mi ln dng.
QU LIU
Khng c hin tng qu liu no c ghi nhn i vi ngi ln.
Trong mt vi trng hp b ng c tr em do v , mt s triu chng sau y c ghi
nhn : mch p nhanh v khng u, tng huyt p v mt vi ri lon nhn thc. Nu c th,
iu tr triu chng di s theo di y khoa.
BO QUN
Trnh nng ( thuc nhit di 30oC)

390.

OXYTOCIN SYNTH. RICHTER

GEDEON RICHTER
dung dch tim 5 UI/ml : ng 1 ml, hp 100 ng - Bng B.
THNH PHN
cho 1 ml thuc tim
Oxytocine

5 UI

DC LC
Oxytocine tng hp hot ng nh hormon t nhin c sn xut bi thy sau ca tuyn
yn, nhng oxytocine tng hp khng c cc tc dng ph nh cc ch phm t nhin. N c
gi tr cao trong sn khoa, do c tnh thc v tng hot ng co tht t cung mt cch nhp

nhng.
CH NH
Thc , kh, giai on 1 v 2 ca cuc sinh . Phng v kim sot s xut huyt nhau v
xut huyt do tr t cung. Bo m s co tht t cung trong trng hp phu thut ly thai.
Thi kz sinh , km ch s thoi trin khng hon ton v s xut huyt. Trong trng hp xy
thai khng hon ton v xy thai km st. Khi xut huyt ph khoa xy ra sau sinh thit m.
CHNG CH NH
T l gia bo thai v xng chu thiu cn i, ngi ngang hoc nghing, e da v t cung.
Hp khung chu.
CH PHNG v THN TRNG LC DNG
Bm tim trong cn nn ra bng nc ct tit khun sch cn trc khi dng bm tim
ly oxytocine t trong ng thuc.
TC DNG NGOI
Nhng phn ng bt li sau y c gp cc b m : sc phn v, lon nhp tim, xut huyt sau
khi sinh, nn ma, bun nn. nhng bnh nhn hen, s co tht ph qun c th pht trin.
Dng thuc qu liu hoc qu mn cm thuc c th dn n kt qu lm tng trng lc t
cung, co tht, co tht kiu un vn, hoc v t cung.
C th gp nhng phn ng bt li sau y bo thai v tr em : nhp tim chm, lon nhp tim,
h hi no hoc thn kinh trung ng vnh vin. im Apgar thp 5 pht sau khi dng thuc.
LIU LNG v CCH DNG
Thng dng tim bp. Nu tim bp khng hiu qu hoc cn c hiu qu tc th, th nn
tim tnh mch mt cch t t. Liu tim tnh mch hoc tim bp l 1-3 UI. Trong trng hp
phu thut ly thai, nn tim 5 UI vo c t cung. Trong nhng trng hp ph khoa tim di
da hoc tim bp 5-10 UI.

391.

OZOTHINE WITH DIPROPHYLLIN

LAPHAL
c/o HYPHENS
Vin bao : hp 50 vin.
THNH PHN
cho 1 vin

Cc sn phm oxy ha ca tinh du Terebenthine

20 mg

Diprophylline

150 mg

DC LC
Thuc c tc ng lm long dch tit ng h hp.
Cc sn phm oxy ha ca tinh du terebenthine : c s dng nh cht lm long dch tit
ng h hp.
Diprophylline : l mt dn xut ca theophylline, lm gin ph qun do lm gin c trn.
DC NG HC
Diprophylline khng chuyn ha thnh theophylline trong th nghim in vivo.
CH NH
iu tr h tr trong cc bnh ph qun cp tnh.
CHNG CH NH
- bit c d ng vi tinh du terebenthine.
- Khng dung np vi diprophylline hay vi theophylline.
- Suy thn.
- Tr em di 15 tui.
CH PHNG v THN TRNG LC DNG
Cn nh gi li vic iu tr trong nhng trng hp :
- ho m m , st hoc trong cc bnh phi v ph qun mn tnh,
- cc triu chng dai dng trn 5 ngy.
Thn trng khi dng trong nhng trng hp :
- suy tim nng,
- suy mch vnh,
- tng huyt p,
- lot d dy t trng,
- c tin s b ng kinh
LC C THAI v LC NUI CON B
Lc c thai :
Hin cha c cc th nghim trn ng vt v kh nng gy qui thai ca tinh du terebenthine
hay diprophylline.
Trn lm sng, thuc c s dng tng i rng ri, khng thy c trng hp d tt hay c
tnh trn phi no c ghi nhn cho n nay. Tuy nhin, cn tin hnh thm nhiu nghin cu
dch t hc khng nh iu ny. Tm li, do thn trng, nn trnh dng thuc trong thi kz
mang thai.

Lc nui con b :
Diprophylline qua c sa m, trnh dng thuc ny khi cho con b.
TNG TC THUC
Thn trng khi phi hp :
- Probenicide : lm tng nng ca diprophylline trong huyt tng vi nguy c qu liu (do
c ch s bi tit qua ng thn). Gim liu diprophylline trong thi gian iu tr vi
probenicide.
TC DNG NGOI
Lin quan n cc sn phm oxy ha ca tinh du terebenthine :
- D ng.
Lin quan n diprophylline :
- Bun nn, nn, au thng v.
- Chng mt, nhc u, kch ng, mt ng.
- Nhp tim nhanh.
- Run u chi.
LIU LNG v CCH DNG
Dnh cho ngi ln.
4-6 vin/ngy.
QU LIU
Triu chng :
Trng hp ung mt lng ln, c th xy ra cc triu chng :
Lin quan n cc sn phm oxy ha ca tinh du terebenthine :
- au thng v, bun nn.
- Ho, ri lon h hp.
Lin quan n diprophylline :
- tr em : kch ng, nhc u, nhp tim nhanh, rung tht, co git.
- ngi ln : bun nn, nn, nhp tim nhanh, ngoi tm thu, nhc u, mt ng, kch ng.
X l :
iu tr triu chng.

THUC VN P

392.

PADRYL

GERDA
c/o KENI - OCA
vin bao : hp 20 vin.
xir : chai 150 ml.
THNH PHN
cho 1 vin
Codine phosphate hmihydrat

19,5 mg

ng vi : Codine

15,22 mg

Saccharose

70 mg

cho 1 mung canh

Codine phosphate hmihydrat

21,9 mg

ng vi : Codine

16,12 mg

Alcool 2% (v/v)

240 mg

Saccharose

9,5 g

DC LC
Thuc ho c opium (R : h h hp).
Codine : alcaloide ca opium ; thuc ho c tc ng trung ng, c ch cc trung tm h hp.
DC NG HC
Cod ine dng ng ung :
- thi gian thuc t nng ti a trong huyt tng khong 1 gi ;
- thuc c chuyn ha gan ;
- khong 10% cod ine c loi gc mthyl v chuyn thnh morphine trong c th ;
- thi gian bn hy trong huyt tng khong 3 gi ( ngi ln) ;
- thuc qua c nhau thai v c bi tit qua sa m.
CH NH
iu tr triu chng ho khan, ho do kch thch gy kh chu.
CHNG CH NH

Tuyt i :
- Qu mn cm vi mt trong cc thnh phn ca thuc.
- Suy h hp.
- Ho suyn.
- Ph n cho con b (xem mc Lc c thai v Lc nui con b).
Tng i :
- Alcool (xem mc Tng tc thuc).
CH PHNG v THN TRNG LC DNG
Ch { phng :
- iu tr ko di liu cao c th gy l thuc thuc.
- V ho c m l mt yu t c bn bo v ph qun-phi, nn cn phi c tn trng.
- Phi hp thuc long m hoc thuc tan m vi thuc ho l khng hp l.
- Trc khi k toa thuc chng ho, cn tm nguyn nhn gy ho c iu tr c hiu.
- Nu cn ho khng gim vi mt loi thuc ho dng theo liu thng thng, khng nn tng
liu m cn khm li tnh trng lm sng ca bnh nhn.
- Cn lu { rng trong thnh phn ca dng xir c cha alcool.
Thn trng lc dng :
- Cn thn trong trng hp tng p lc ni s.
- Khng nn ung ru hay cc thc ung c cha ru trong thi gian iu tr.
- Bnh nhn tiu ng cn lu { n hm lng saccharose c trong thuc vin v xir.
- Cn lu { cc vn ng vin th thao do thuc c th cho kt qu xt nghim s dng cht
kch thch dng tnh.
- Ngi li xe v vn hnh my mc cn phi lu { v c nguy c b bun ng khi dng thuc.
LC C THAI v LC NUI CON B
Lc c thai :
Cc nghin cu thc hin trn ng vt cho thy cod ine c tc ng gy qui thai.
Tuy nhin trn lm sng, cc s liu dch t hc trn mt s lng gii hn ph n khng cho
thy codine c tc dng gy d dng no c bit.
Trong 3 thng cui ca thai kz, nu ngi m dng di hn codine d vi liu lng nh th
no cng c th l nguyn nhn gy hi chng cai sa tr s sinh.
Dng liu cao codine vo cui thai kz ngay c ngn hn cng c th gy c ch h hp tr s
sinh.
C th kt lun rng ch nn dng codine ngn hn trong thi gian mang thai, khi tht cn
thit.
Lc nui con b :
Cod ine c bi tit qua sa m ; mt vi trng hp gim huyt p v ngng th c
ghi nhn nh nhi sau khi m dng qu liu codine. Khng dng thuc ny trong thi gian cho

con b m.
TNG TC THUC
Khng nn phi hp :
- Alcool : ru lm tng tc dng an thn ca thuc ho tc ng trung ng. Vic gim tp
trung v thc cnh gic c th gy nguy him trong khi li xe hay vn hnh cc my mc i
hi s tp trung. Trnh ung ru v cc thuc c cha alcool.
Lu { khi phi hp :
- Cc thuc gy c ch thn kinh trung ng : thuc gim au morphine, mt vi thuc chng
trm cm, thuc khng histamine H1 c tc dng an thn, barbiturate, benzodiazpine,
clonidine v cc thuc cng h, thuc ng, thuc gii lo, thuc an thn kinh : tng c ch thn
kinh trung ng c th gy hu qu nguy him trong khi li xe hay vn hnh cc my mc i
hi s tp trung.
TC DNG NGOI
liu iu tr :
Cc tc dng ngoi { tng t nh ca nhm opium, tuy nhin him xy ra hn v nh hn.
- C th gy to bn, bun ng, chng mt, bun nn, i ma.
- Him hn, c th gy co tht ph qun, d ng da, c ch h hp (xem mc Chng ch nh).
Qu liu iu tr :
C th gy l thuc thuc v hi chng ngng thuc t ngt ngi dng thuc v tr s
sinh c m b nghin codine.
LIU LNG v CCH DNG
Dng cho ngi ln.
iu tr triu chng thng ngn hn (vi ngy) v nn ung thuc vo nhng thi im
thng xy ra cn ho.
Nu khng phi hp vi thuc khc c cha codine hoc vi thuc ho tc ng trung ng,
liu codine hng ngy khng c vt qu 120 mg ngi ln.
Liu thng thng :
- Ngi ln : mi ln ung 1-2 vin hay 1-2 mung canh xir, lp li sau 6 gi nu cn, khng
ung qu 8 vin hay 8 mung canh xir/ngy.
- Ngi gi v ngi b suy gan : liu khi u nn gim phn na so vi liu khuyn co dng
cho ngi ln, sau c th tng ln ty theo mc dung np thuc v nhu cu.
Cc ln ung thuc phi cch nhau t nht 6 gi.
QU LIU
Triu chng :
- Ngi ln : c ch cc trung tm h hp (tm ti, th chm), ng gt, pht ban, bun nn,
nga, tht iu.
- Tr em (ngng ng c khong 2 mg codine/kg, liu duy nht) : th chm, ngng th, hp

ng t, co git, ng v sng hp mt, ni my ay, try mch, b tiu.

iu tr :
- Tr h hp.
- Dng naloxone trng hp ng c lng nhiu.

393.

PAM-A

CHOONG WAE PHARM

c/o CT TNHH DP HONG KHANG
thuc vin 500 mg : hp 50 vin, 100 vin, 250 vin v 500 vin.
bt pha tim 500 mg : hp 2 l + 2 ng dung mi 20 ml.
THNH PHN
cho 1 vin
Pralidoxime chlorure (USP)

500 mg

cho 1 l
Pralidoxime chlorhydrate

500 mg

ng dung mi : Nc ct pha tim

20 ml

TNH CHT
Tc dng ch yu ca Pralidoxime l khi phc li s hot ng ca men cholinestrase, sau khi
b phosphoryl ha bi nhng tc nhn gy c c phosphore hu c.
Ph hy vic tch ly ac tylcholine, phc hi chc nng ca nhng u mi thn kinh-c tr li
bnh thng.
Lm chm qu trnh lo ha ca giai on cholinestrase b phosphoryl ha thnh dng khng
th ti phc hi.
Gii c tt cc t chc, c quan trong c th khi b nhim c do cc ha cht c phosphore
hu c bng phn ng ha hc trc tip.
Lm gim nhanh s t lit ca cc c h hp, co git, tim p chm v m hi.
DC LC

Cc cht phosphore hu c khng cholinest rase l nhng c cht trn h thn kinh thc vt,
c tc ng trc tip v v hot ha do phosphore ha cc enzyme iu ha s truyn thn
kinh. Pralidoxime c c nh trn nhm alkyl-phosphate ca cholinestrase alkylphosphoryl
v tch nhm actyl-cholinesthrase ra v phc hi li cht ny.
DC NG HC
Phn tn km qua h thng thn kinh trung ng, do tc ng phc hi cc enzyme u
mi thn kinh c b gii hn.
Chuyn ha gan. Bi tit nhanh ng thn (sau vi gi).
CH NH
Gii c, chng hn m trong cc trng hp nhim c t ha cht.
CHNG CH NH
Nhim c bi thuc tr su khng cholinestrase khng c phosphore hu c.
Thuc dit cn trng h carbamate, c ch tm thi cholinest rase : trong trng hp ny
khng cn s dng pralidoxime phc hi enzyme ; cht ny cn c th lm nng thm mt
vi trng hp ng c.
CH PHNG
Pralidoxime cng s dng sm sau khi nhim c cng c hiu qu (di 36 gi).
Trong thc t, nn th nghim pralidoxime do ng c vi bt kz loi thuc c no c
phospho hu c v thi gian b ng c l bao nhiu. Phi ngng iu tr nu sau liu u
tin khng thy c du hiu kh quan no. Ngc li, nu thy c hiu qu, phi tip tc dng
cho n khi cht gii c ny lm gim cc du hiu tng tit cholin v/hoc vic ngng s dng
thuc lm bnh nng tr li.
Trong mi trng hp, dng pralidoxime phi c phi hp vi iu tr triu chng, gii c
cho nn nhn v dng atropine.
THN TRNG LC DNG
Nn thn trng khi s dng thuc cho cc bnh nhn b suy nhc c v c th dn n cc
phn ng khc vi bnh nhn bnh thng.
i vi cc trng hp nng : nn dng thuc sau khi tim atropine hoc dng kt hp vi
atropine nu khng tc dng tn cng ca thuc c th b chm li.
LC C THAI
Khi s dng vi liu cao thai ph, thuc c th truyn qua bo thai. Do ch dng cho ph
n c thai hay nghi ng c thai trong trng hp li ch ca vic iu tr ln hn nguy c gy
c trn thai.
TC DNG NGOI
Chong vng, nhn mt ha hai, suy yu s iu tit mng, ng g, nhc u, ng ming, nn
ma, lon nhp, tng huyt p, tng h hp v c th suy nhc c.
LIU LNG v CCH DNG

Ngi ln :
Tim tnh mch : 1 g (2 l)/1 ln/ngy, tim tnh mch chm bng cch ha 2 l bt vi 2 ng
nc pha tim.
Tim truyn tnh mch : 1-2 g (2-4 l)/1 ln/ngy, tim truyn chm trn 30 pht, pha trong 100
ml dung dch mui 0,9%.
Dng ung : 1-2 g, 1 ln/ngy.
Tr em :
Dng tim : 20-40 mg/kg, 1 ln/ngy.
Dng ung : 40-80 mg/kg, 1 ln/ngy.
C th dng lp li nu thy cn thit

394.

PANANGIN

GEDEON RICHTER
vin bao 140 mg/158 mg : hp 50 vin.
dung dch tim 400 mg/452 mg : ng 10 ml, hp 5 ng.
THNH PHN
cho 1 vin
Magnesium aspartate

140 mg

Tng ng : Mg2+

11,8 mg

Potassium aspartate

158 mg

Tng ng : K+

36,2 mg

cho 10 ml thuc tim

Magnesium aspartate

400 mg

Tng ng : Mg2+

33,7 mg

Potassium aspartate

452 mg

Tng ng : K+

103,3 mg

pH

6,0-7,0

DC LC
Mg2+ v K+ l nhng cation ni bo quan trng. Chng ng mt vai tr quan trng trong chc
nng ca nhiu loi enzyme, lin kt i phn t vi cc yu t ca t bo, c ch phn t ca
co tht c. S co tht c tim b nh hng bi t s ca nng ni v ngoi bo K+, Ca2+, Na+.
Trong khi iu tr bng glycoside tim, Panangin b li s suy gim hm lng K+ v Mg2+ ca c
ct sng, c tim, huyt tng, hng cu gy ra do thuc.
CH NH
Phng nga v chm dt s suy gim Mg2+, tng nhu cu K+ v Mg2+, tng dng cc ion thiu,
mt cht in gii ng k.
Ph tr au tht ngc, nhi mu c tim cp, lon nhp tim, cao huyt p.
Tng kch ng thn kinh c, co tht c.
CHNG CH NH
Suy thn cp v mn, bnh Addison, trong khi iu tr li tiu li kali.
TNG TC THUC
Thuc c ch s hp thu tetracyclin ung, mui st v NaF. Khong cch an ton gia thi gian
dng Panangin v cc thuc trn l 3 gi.
Trong trng hp tim tnh mch hiu qu cc thuc chng cao huyt p tng.
TC DNG NGOI
Khi tim tnh mch, nhng triu chng tng magn huyt c th xy ra.
LIU LNG v CCH DNG
Liu hng ngy l 1-2 vin x 3 hay 2 ng tim pha trong 50-100 ml dung dch glucose 5% tim
tnh mch chm hay truyn dch nh git chm.
Panangin thch hp cho iu tr kt hp.
BO QUN
Bo qun nhit phng (t 15-30oC

395.

DB PHARMA
c/o GALIEN

PANCRLASE

Vin bao : hp 60 vin.

THNH PHN
cho 1 vin
Pancratine*

100 mg

Men cellulase t nm**

100 mg

* 1 vin cha ti thiu 2.000 n v hot lc tiu m (theo Dc in Chu u) ; 2.400 n v

hot lc tiu bt ng (theo Dc in Chu u) ; 140 n v hot lc tiu m (theo Dc
in Chu u).
** 1 vin cha ti thiu 130 n v FIP (Fdration Internationale Pharmaceutique : Hip hi
Dc Quc t).
DC LC
Liu php men tiu ha.
CH NH
Chng ri lon tiu ha do kh tiu.
CHNG CH NH
Qu mn vi thnh phn ca thuc.
CH PHNG v THN TRNG LC DNG
gi cho pancrlase cn tc dng tt, khng c trn vi thc n nng trn 60oC.
LC C THAI v LC NUI CON B
Lc c thai :
Khng c d liu xc ng v tc ng gy qui thai trn ng vt. Trn lm sng, cho n nay
cha c trng hp no c ghi nhn b d tt hay c phi thai do dng thuc, tuy nhin
khng th loi hn mi nguy c. Do thn trng, khng nn dng thuc ny trong thi gian mang
thai.
Lc nui con b :
Do khng c d liu, trnh dng thuc ny trong thi gian cho con b.
LIU LNG v CCH DNG
Dng cho ngi ln.
Mi ln 1 vin vo u 2 ba n chnh, ung thuc vi 1 ly nc.
BO QUN
Bo qun trnh nh sng v trnh m, nhit di 25oC.
PANSIRON G
ROHTO

Thuc bt : gi 1,452 g.
THNH PHN
cho 1 gi
Sodium bicarbonate

650 mg

Magnesium carbonate nng

200 mg

Calcium carbonate ta

100 mg

Sanalmin

133 mg

Dch chit Scopolia

10 mg

Diasmen SS

80 mg

Prozyme

17 mg

V qu

50 mg

Tinh du qu

2 mg

Sa nhn

30 mg

Chng nha thi

1 mg

L-Glutamine

135 mg

DC LC
Dng trong bi thc, qu chn, chua, au d dy.
Pansiron G, thuc tiu ha dng trung ha acid, tng nhu ng rut v tng co bp d dy
vi nhng c tnh sau y :
- Thnh phn gm nhng cht trung ha acid c tc ng nhanh v ko di, do vy iu chnh
acid trong d dy sut thi gian, lm mt i nhng kh chu trong d dy.
- Gia tng hm lng nhng Enzym tiu ha, gip tiu ha, lm nh nhng bng cch lm gim
lng thc n trong d dy v trong rut.
- Thuc tho mc gip hi phc chc nng tiu ha b suy yu.
- Cha L-Glutamine, cht lm hi phc nim mc d dy.
- Dng ht nh d ung v d ha tan.

Tng thnh phn hot cht ca Pansiron G c cc tc dng nh sau :

Cht trung ha acid :
Sodium bicarbonate, Magnesium bicarbonate nng, Calcium carbonate ta : c tc dng trung
ha acid nhanh, hiu qu trong chng d acid, chua ; nhanh chng iu chnh acid ca d
dy, gip cc men tiu ha tc ng c d dng hn.
Sanalmin : c tc ng trung ha acid ko di, do vy iu chnh acid d dy trong thi gian
di, bo v c thnh d dy.
Dch chit Scopolia : c tc ng trn thn kinh iu khin s tit dch v.
Men tiu ha :
Diasmen SS, Prozyme : lm d dng s tiu ha cho ring bit tng cht : carbohydrate (go,
bnh m) v Protein (tht, c) lm gim s qu ti trong d dy.
Cht tng co bp (tho mc) :
V qu, Tinh du qu, Sa nhn, Chng nha thi : tho mc dng trong s tng co bp d dy
vi mi thm ring bit v v ng, gia tng s tit dch v, tng n ngon, ng thi gia tng
chc nng co bp d dy v rut.
Cht phc hi nim mc :
L-Glutamine : c tc ng chng li thnh d dy b au v vim ; sa cha v phc hi nim
mc d dy.
CH NH
- chua, au d dy, d acid, hi.
- Ung qu chn, bun nn, i ma, cm gic kh chu d dy.
- Bi thc, n khng tiu, n khng ngon, ri lon tiu ha.
- y bng, cm gic tc bng.
THN TRNG LC DNG
Thn trng khi dng trong nhng trng hp sau :
- C tin cn d ng vi thuc.
- Ri lon chc nng thn.
- ang theo mt liu trnh tr liu.
Khi dng thuc, nn lu { nhng im sau :
- Khng dng qu liu, v thuc cha vi hot cht c tc dng mnh.
- Tr em cn c s dng di s hng dn ca ngi ln.
- Khng dng chung vi thuc chng co tht, thuc gim au d dy.
Trong v sau khi dng thuc, cn ch nhng im sau :
- Nu thuc gy ra nhng triu chng d ng, ngng dng thuc v hi kin ca bc s hoc
dc s.
- Trong mt vi trng hp (rt him khi xy ra), thuc c th gy kh ming do tc dng ca
dch chit Scopolia, ngng dng nu thy cc tc dng ph ny nng.

- Nu nhng triu chng khng ci thin sau 2 tun, ngng dng v hi kin ca bc s hoc
dc s.
LIU LNG v CCH DNG
Liu lng :
Dng 1 gi sau mi ba n. Ngy 3 ln.
Gim liu cn 2/3 tr 11 n 15 tui.
Gim liu cn 1/2 tr 8 n 11 tui.
Gim liu cn 1/3 tr 5 n 8 tui.
Khng dng cho tr di 5 tui.
Cch dng :
- X gi thuc.
- gi thuc vo ming.
- Ung vi mt t nc.
BO QUN
thuc ngoi tm tay ca tr em.
Bo qun thuc ni mt, trnh nh sng trc tip.
Khng dng thuc qu hn.
Nu gi thuc c dng nhiu ln, chia nhiu liu nh : cn dn kn v phi dng ht sau
2 ngy.

396.

PANTOLOC

BYK GULDEN
c/o TRIDEM PHARMA
Vin nang tan trong rut 40 mg : hp 14 vin.
Bt pha tim tnh mch 40 mg : hp 1 l.
THNH PHN
cho 1 vin
Pantoprazole

40 mg

cho 1 l
Pantoprazole

40 mg

DC LC
Cht c ch chn lc bm proton ; v cu trc ha hc l dn xut ca benzimidazol.
CH NH
- Lot t trng.
- Lot d dy.
- Vim thc qun tro ngc trung bnh v nng.
- Ngoi ra, dng vin cn c dng phi hp vi hai khng sinh thch hp (xem phn Liu
lng v Cch dng) dit Helicobacter pylori nhng bnh nhn lot d dy, nhm gim ti
pht chng lot t trng v d dy do vi sinh vt ny gy ra.
CHNG CH NH
- Khng nn dng Pantoloc trong iu tr phi hp dit Helicobacter pylori nhng bnh
nhn b ri lon chc nng gan v thn mc trung bnh n nng, v hin thi cha c d liu
v tnh cng hiu v an ton ca Pantoloc trong iu tr phi hp cho cc bnh nhn ny.
- Ni chung, khng nn dng Pantoloc cho cc trng hp c tin s nhy cm vi mt trong
cc thnh phn ca Pantoloc hoc vi thuc dng phi hp cng Pantoloc.
- Kinh nghim lm sng v Pantoloc khi dng trong thai kz hin cn hn ch. Trong nghin cu
v sinh sn ng vt, thy c tnh nh ca Pantoloc i vi thai sc vt, liu dng trn 5
mg/kg. Hin khng c thng tin v bi xut ca pantoprazole qua sa m.
Ch dng Pantoloc khi li ch cho ngi m c xem l ln hn ri ro i vi thai nhi v em b.
THN TRNG LC DNG
- Ch khuyn ngh dng dng tim khi dng ng ung khng thch hp.
- Khng ch nh Pantoloc cho nhng ca ri lon tiu ha nh nh chng kh tiu lin quan ti
thn kinh.
- Trong liu php phi hp thuc, cn phi quan tm n c tnh ca thuc phi hp.
- Trc khi iu tr vi Pantoloc, phi loi tr kh nng lo t d dy c tnh hoc vim thc qun
c tnh, v iu tr vi pantoprazole c th nht thi lm mt cc triu chng ca bnh lot c
tnh, do c th lm chm chn on ung th.
- Chn on vim thc qun tro ngc cn c khng nh bng ni soi.
- Khng vt qu liu 40 mg pantoprazole khi dng cho bnh nhn cao tui hoc suy thn.
- bnh nhn suy gan nng, liu dng hng ngy phi gim xung 20 mg pantoprazole. Ngoi
ra cc bnh nhn ny cn phi gim st cc enzyme gan trong liu trnh Pantoloc IV. Khi
enzyme gan tng, phi ngng dng Pantoloc IV.

- Hin cha c kinh nghim v vic iu tr vi Pantoloc tr em.

- Hin cha r tc dng ca thuc khi dng cho ngi li xe hay vn hnh my mc.
TNG TC THUC
- Pantoloc c th lm gim hp thu ca cc thuc khc dng ng thi m hp thu ph
thuc vo pH (th d : ketoconazole). iu ny cng xy ra vi nhng thuc dng trc
Pantoloc IV mt thi gian ngn.
- Hot cht ca Pantoloc c chuyn ha gan nh h enzyme cytochrome P450. Khng loi
tr kh nng pantoprazole tng tc vi nhng thuc khc chuyn ha cng h enzyme
cytochrome P450. Tuy nhin, lm sng cha thy tng tc ng k trong nhng th nghim
c hiu vi mt s thuc hoc hp cht c tnh cht ni trn, nh carbamazepine, cafein,
diazepam, diclofenac, digoxine, ethanol, glibenclamide, metoprolol, nifedipine,
phenprocoumon, phenytoin, theophylline, warfarine v cc thuc trnh thai dng bng ng
ung.
- Cng khng thy Pantoloc tng tc vi thuc khng acid (tr au d dy) ung ng thi.
- Khng thy c tng tc vi cc khng sinh dng phi hp (clarithromycine, metronidazol,
amoxicylline) trong iu tr dit Helicobacter pylori.
TC DNG NGOI
- iu tr vi Pantoloc c th thnh thong dn n nhc u hay tiu chy.
- c bo co v nhng trng hp him gp : bun nn, au bng trn, y hi, ban da,
nga v chong vng.
- Trong nhng trng hp c bit, xy ra ph n, st, vim tnh mch huyt khi, cn trm
cm v ri lon th gic (nhn m).
LIU LNG v CCH DNG
Dng vin :
Liu khuyn co :
nhng bnh nhn lot d dy v t trng, nhim Helicobacter pylori (dng tnh), cn thc
hin vic dit vi khun bng tr liu phi hp. Ty theo kiu khng thuc, c th theo cc s
phi hp sau dit Helicobacter pylori :
Phc 1 :
Mi ngy 2 ln x (1 vin Pantoloc + 1000 mg amoxicylline + 500 mg clarithromycine).
Phc 2 :
Mi ngy 2 ln x (1 vin Pantoloc + 500 mg metronidazol + 500 mg clarithromycine).
Phc 3 :
Mi ngy 2 ln x (1 vin Pantoloc + 1000 mg amoxicylline + 500 mg metronidazol).
Nu khng cn dng tr liu phi hp, ngha l bnh nhn th nghim m tnh v
Helicobacter pylori, hng dn sau y v liu lng c p dng cho n liu php Pantoloc
:

Lot t trng, lot d dy v vim thc qun tro ngc :

- Trong phn ln cc trng hp, dng mi ngy 1 vin Pantoloc tan rut. Trong trng hp
c bit, c th tng liu dng gp i (mi ngy ti 2 vin Pantoloc), c bit khi m tr liu khc
khng cho p ng.
- i vi bnh nhn suy gan nng, liu dng cn gim xung 1 vin (40 mg pantoprazole), hai
ngy mt ln. Ngoi ra, i vi cc bnh nhn ny, cn theo di cc enzyme gan trong liu trnh
Pantoloc. Nu gi tr enzyme gan tng, nn ngng dng Pantoloc.
- Khng c dng qua 1iu 40 mg pantoprazole mt ngy ngi c tui hoc suy thn.
Ngoi l l tr liu phi hp dit Helicobacter pylori, trong ngi c tui cng phi dng liu
pantoprazole thng thng (2 x 40 mg/ngy) trong mt tun iu tr.
Cch dng v thi gian iu tr :
- Khng c nhai hoc nghin nh vin Pantoloc m phi ung nguyn vin vi nc, mt gi
trc ba n sng. Trong tr liu phi hp dit Helicobacter pylori, cn ung vin Pantoloc th
hai trc ba ti.
- Nu qun khng dng thuc ng gi, khng nn dng liu b vo lc mun trong ngy, nn
tip tc dng liu bnh thng vo ngy hm sau trong liu trnh.
- Ni chung, liu php phi hp thc hin trong 7 ngy c th ko ti a trong 2 tun. Nu cn
iu tr thm vi pantoprazole cha lnh bnh lot, cn ch ti khuyn ngh v liu lng
dng trong lot t trng v lot d dy. Ni chung, c th cha lnh lot t trng trong vng 2
tun. Nu thi gian iu tr 2 tun cha , trong hu ht cc trng hp c th cha lnh lot
t trng khi dng Pantoloc thm 2 tun na. Thng thng, thi gian 4 tun l cn thit iu
tr lot d dy v lot thc qun tro ngc. Nu thi gian ny khng , thng c th cha
khi bnh nu dng Pantoloc thm 4 tun na.
- V hin cha kinh nghim dng di hn, iu tr vi Pantoloc khng c vt qu 8 tun.
Dng tim tnh mch :
Ch khuyn ngh dng Pantoloc IV khi dng ng ung khng thch hp.
Liu Pantoloc tnh mch l 1 l (40 mg pantoprazole) mi ngy.
Hng dn cch dng v pha ch :
- pha thuc tim, bm 10 ml dung dch NaCl sinh l vo l cha cht ng kh
(pantoprazole). C th dng dung dch ny tim trc tip sau khi pha long vi 100 ml dung
dch NaCl, glucose 5% hoc 10%.
- Khng pha ch hay hn hp Pantoloc IV vi dung mi no khc ngoi cc dung mi ni trn.
Gi tr pH ca dung dch phi l 9.
- Thuc Pantoloc IV c tim tnh mch trong thi gian 2 n 15 pht.
- Dung dch ti to ( pha ch) cn c dng trong vng 3 gi sau khi pha ch.
QU LIU
Hin cha bit triu chng khi dng qu liu ngi.

Trong trng hp dng qu liu v c triu chng nhim c lm sng, p dng cc quy tc gii
c thng thng.
BO QUN
Bo qun nhit di 25oC

397.

PARIET

EISAI
c/o DIETHELM
Vin nn 10 mg : v 14 vin, hp 1 v.
THNH PHN
cho 1 vin
Rabeprazole sodium

10 mg

DC LC
c ch H+, K+ - ATPase (trong thc nghim) :
Rabeprazole sodium c ch mnh H+, K+ - ATPase iu ch t nim mc d dy ca ln.
c ch tit acid d dy :
- Rabeprazole sodium c ch tit acid d dy c kch thch bi dibutyl cyclic AMP trong cc
tuyn d dy ca th c phn lp (trong thc nghim).
- Rabeprazole sodium c ch mnh s tit acid d dy c kch thch bi histamine hoc
pentagastrin ch mc bnh r d dy mn tnh cng nh s tit acid d dy trong iu kin
bnh thng hoc c kch thch bi histamine chut.
S o ngc hot ng chng bi tit ca Rabeprazole sodium nhanh hn v s tng mc
gastrin trong mu ca Rabeprazole sodium thp hn cc cht c ch bm proton khc.
Hot ng chng lot :
chut, Rabeprazole sodium chng t c tc dng chng lot mnh i vi nhiu loi vt
lot v ci thin cc sang thng nim mc d dy thc nghim (stress do nhim lnh, stress do
b nhng trong nc, tht mn v, dng cysteamine hoc ethanol-HCl).
DC NG HC
Nng trong mu : Gi tr trung bnh ca nhng thng s dc lc hc c xc nh cho
tng c th ring bit khi dng Pariet lc i v sau n c biu th trong Bng 1. Tmax t

c khi dng thuc lc i lu hn 1,7 gi so vi khi dng thuc sau n v s hp thu khc
nhau gia cc c th cng c ghi nhn.
Bng 1. Hiu qu ca thc
n trn cc thng s dc
ng hc
Tnh trng khi dng thuc
Thng s
Lc i

Sau n

Cmax (ng/ml)

437 +/- 237

453 +/- 138

tmax (gi)

3,6 +/- 0,9

5,3 +/-1,4

AUC (ng.gi/ml)

937 +/- 617

901 +/- 544

t1/2 (gi)

1,49 +/- 0,68

1,07 +/- 0,47

(Trung bnh +/- S.D., n=12)

Dng ng ung lc i liu 10 mg hay 20 mg Rabeprazole sodium cho nhng ngi tnh
nguyn khe mnh. Gi tr trung bnh ca cc thng s dc ng hc c biu th trong Bng
2.
Bng 2. Thng
s dc ng
hc sau khi dng
Pariet liu n
10 mg v 20 mg
cho nhng
ngi tnh
nguyn khe
mnh
Liu

Cmax (ng/ml)

tmax (gi)

AUC (ng.gi/ml) t1/2 (gi)

10 mg

247 +/- 24

3,8 +/- 0,5

440 +/- 24

0,85 +/- 0,04

20 mg

406 +/- 64

3,1 +/- 0,2

809 +/- 186

1,02 +/- 0,16

(Trung bnh
+S.D., n=6)
kh dng sinh hc ca liu ung 20 mg (so vi ng tim tnh mch) khong 51,8% phn
ln l do chuyn ha trc h thng. Hn na, kh dng sinh hc khng tng khi dng liu
lp li.
94,8 - 97,5% Rabeprazole kt hp vi protein huyt thanh ngi.
S thi tr qua nc tiu : Dng khng chuyn ha ca thuc khng c pht hin trong nc
tiu ca 6 ngi tnh nguyn khe mnh sau khi dng Rabeprazole sodium liu 20 mg trong
72 gi, v khong 30% liu trn c thi tr qua nc tiu dng chuyn ha carboxylate v
dng kt hp vi acid glucuronic.
Hiu qu lm sng : Kt qu cc th nghim lm sng m v m i, khi dng Pariet trong lo t
d dy, lot t trng, vim thc qun do tro ngc v lot nim mc ming c tm tt
trong Bng 3.
Bnh

T l lnh bnh

Lot d dy

95,2% (401/421)

Lot t trng

98,1% (364/371)

Vim thc qun do tro ngc

90,9% (50/55)

Lot nim mc ming

83,3% (10/12)

T l ci thin chung trn 2 bnh nhn c hi chng Zollinger-Ellison l 100%.

Cc th nghim dc l lm sng cho thy s tng pH d dy ca liu 20 mg ln hn so vi liu
10 mg. ch li ca Pariet trong vic iu tr cc vt lot trm trng c xc nh l liu 20 mg
x 1 ln/ngy.
Hiu qu lm sng ca Pariet trong iu tr lot d dy - t trng c chng minh trong cc
th nghim m i.
CH NH
- Lot d dy, t trng v nim mc ming.
- Vim thc qun do tro ngc.
- Hi chng Zollinger-Ellison.

THN TRNG LC DNG

Pariet nn c dng thn trng cho nhng bnh nhn c tin s qu mn vi thuc.
Dng Pariet c th che lp cc triu chng ca ung th d dy. Do cn phi xc nh bnh
nhn khng c ung th trc khi dng thuc.
Bnh nhn nn c theo di cn thn trong sut thi gian dng thuc, v liu tch ly nn
c duy tr mc ti thiu ty theo tnh trng bnh.
Dc phm ny cng khng nn dng iu tr duy tr v cha c nhng thng k y v vic
s dng trong thi gian di.
Tng trng lng tuyn gip v nng thyroxine trong mu cng c ghi nhn trn cc thc
nghim ng vt (cho chut ung liu >= 25 mg/kg/ngy), do chc nng ca tuyn gip
nn c theo di cn thn trong qu trnh dng thuc.
Suy chc nng thn v gan : vic iu chnh liu l khng cn thit i vi bnh nhn suy chc
nng thn v gan.
Ung th nim mc : c bo co ghi nhn ung th nim mc xy ra khi cho chut ung liu 5
mg/kg/ngy Rabeprazole sodium trong thi gian 2 nm. Ung th nim mc d dy cng quan
st thy chut ci.
S dng thuc ph n mang thai : Pariet ch nn dng cho ph n c thai hoc nghi ng c
thai khi li ch ca vic dng thuc ln hn so vi bt kz cc nguy c no c th xy ra. *c
tnh cho thai (nh lm chm qu trnh ha xng chut, gim cn v chm ha xng th)
c ghi nhn khi dng Rabeprazole sodium trong cc thc nghim trn ng vt ( liu
ung 400 mg/kg cho chut v tim tnh mch 30 mg/kg cho th)].
S dng thuc ph n cho con b : Khng nn dng Pariet cho ph n ang cho con b. Tuy
nhin, trong trng hp qu cn thit nn ngng cho b khi dng thuc. Nghin cu trn ng
vt cho thy Rabeprazole sodium c bi tit qua sa m.
S dng tr em : an ton khi s dng Pariet cho tr em cha c xc nh (cha c cc
th nghim lm sng y ).
S dng cho ngi ln tui : Pariet c chuyn ha ch yu gan. Do chc nng sinh l{ gan
ca ngi ln tui suy gim nn h d b phn ng ph ca thuc. V vy, nu c phn ng ph
xy ra nh cc triu chng tiu ha (xem phn Tc dng ngoi ), nn p dng cc phng
php nh c nhng khong thi gian khng dng thuc, km theo di k.
TNG TC THUC
Thn trng khi dng ng thi Pariet vi nhng thuc sau :
Digoxin : nng trong mu ca digoxin c th tng. C ch v nhng yu t nguy c : hp
thu ca digoxin s c tng do pH d dy tng.
Phenytoin : c bo co ghi nhn hp cht ng ng (omeprazole) k o di chuyn ha v
bi tit ca phenytoin.
Antacid cha Aluminum Hydroxide Gel hoc Magnesium Hydroxide : c bo co ghi nhn

nng AUC trung bnh trong huyt thanh gim 8% sau khi dng ng thi Pariet-Antacid v
6% khi dng Pariet 1 gi sau khi dng Antacid so vi dng Pariet n thun.
TC DNG NGOI
Tc dng khng mong mun c bo co 22 trong s 1.244 bnh nhn dng thuc (1,77%)
v nhng tr s xt nghim bt thng l 82 bnh nhn (6,59%).
Tc dng khng mong mun ng k v mt lm sng ( cc hp cht ng ng).
Shock :
Cc phn ng phn v hay shock him khi xy ra khi dng cc hp cht ng ng (omeprazole
v lansoprazole). Ngng dng thuc v s dng cc bin php iu tr thch hp nu c bt kz
mt bt thng no.
Ri lon th lc khi dng cc hp cht ng ng (omeprazole) c ghi nhn cc nc ngoi
Nht Bn.
Huyt hc :
Cc chng gim hai dng t bo mu, gim tiu cu, mt bch cu ht, v thiu mu tn huyt
him khi xy ra. Chng gim bch cu ht v thiu mu t gp khi dng cc hp cht ng ng
(omeprazole v lansoprazole). Ngng dng thuc v s dng cc bin php iu tr thch hp
nu c bt kz mt bt thng no.
Tc dng khng mong mun khc :
Mn cm (trong trng hp xy ra cc triu chng nh vy, nn ngng dng Pariet) : 0,1 n <
5% pht ban hay ni m ay ; < 0,1% nga.
Huyt hc (nn thc hin cc xt nghim sinh ha v huyt hc nh kz trong thi gian dng
Pariet. Nu thy bt kz du hiu bt thng no, nn c nhng bin php iu tr thch hp
hoc ngng dng thuc) : 0,1 n < 5%: chng gim hng cu, chng gim bch cu, bnh bch
cu, tng bch cu a acid, tng bch cu trung tnh hoc gim dng lympho.
Gan (nn thc hin cc xt nghim sinh ha nh kz trong thi gian dng Pariet. Nu thy bt
kz du hiu bt thng no, nn c nhng bin php iu tr thch hp hoc ngng dng
thuc) : 0,1 n < 5% gia tng GOT, GPT, AL-P, g-GTP, LDH hoc bilirubin ton phn.
Tim mch : < 0,1% hi hp.
Tiu ha : 0,1 n < 5% to bn, tiu chy hoc cm gic y bng ; < 0,1% bun nn, au vng
h v v cm gic kh tiu.
Tm thn kinh (yu chi, gim cm gic, gim sc cm nm, yu c ng li v nhc u nh
c ghi nhn nhng bnh nhn x gan, v khu vc ngoi Nht Bn c nhng bo co
bnh nhn x gan c tin s bnh l no do gan, b l m, mt phng hng v ng lm) : 0,1
n < 5% nhc u ; < 0,1% chong vng, bun ng, yu chi, gim cm gic, gim sc cm nm,
yu c ng li v nhc u nh.
Nhng tc dng khng mong mun khc : 0,1 n < 5% ph n, tng nng cholesterol ton
phn, triglycerides v BUN, hoc protein niu ; < 0,1% kh chu.

LIU LNG v CCH DNG

Liu thng thng i vi ngi ln l 10 mg Rabeprazole sodium, ung 1 ln/ngy. Tuy nhin,
liu c th tng ln 20 mg Rabeprazole sodium, ung 1 ln/ngy ty theo mc trm trng
ca triu chng.
Hu ht cc bnh nhn lot t trng lnh bnh trong 4 tun. Tuy nhin, mt vi bnh nhn c
th cn thm 4 tun iu tr t n giai on lnh bnh.
Hu ht bnh nhn lot d dy, nim mc ming, v vim thc qun do tro ngc lnh bnh
trong 6 tun. Tuy nhin, mt vi bnh nhn c th cn thm 6 tun iu tr t n giai
on lnh bnh.
Pariet nn c ung liu 20 mg mi ngy trong trng hp bnh nng, lot ti pht v lot
kh tr.
Bnh nhn nn c hng dn khng nhai hoc b vin thuc ; nn ung nguyn vin thuc.
BO QUN
Pariet nn c s dng ngay sau khi m bao b.
Tn tr nhit phng. Bo qun trnh m sau khi m bao b

398.

PAXLADINE

BEAUFOUR IPSEN
Vin nang 40 mg : hp 15 vin.
Sir 0,2% : chai 125 ml + mung lng 5 ml.
THNH PHN
cho 1 vin
Oxladine citrate

40 mg

T dc : bt talc, polyvidone, gomme

laque, bt bp, saccharose.

cho 1 mung lng

Oxladine citrate

10 mg

T dc : phm mu vng cam S (E 110),

rythrosine (E 127), mi thm cacao,
saccharose (4,25 g/mung lng), nc
tinh khit. Cht bo qun : mthyl
parahydroxybenzoate, propyl
parahydroxybenzoate

DC LC
Thuc ho c tnh cht lm d th.
Paxladine c hot cht l mt cht tng hp, oxladine citrate. Phn t chng ho ny khng c
lin h no v ha hc vi opium hay dn xut ca opium cng nh vi cc cht khng
histamine.
Paxladine c tc dng chn lc trn cc trung tm ho ca h thng thn kinh trung ng.
liu chng ho, thuc khng c ch trung tm h hp v c tc dng nh lm d th.
Paxladine khng gy bun ng v c th dng cho ngi lm nhng cng vic i hi ch
cao.
Paxladine khng lm chm nhu ng rut.
DC NG HC
Nng trong mu t nh cao vo khong 4 n 6 gi v vn cn tm thy 9 gi sau khi ung
thuc.
CH NH
iu tr triu chng ho do nhiu nguyn nhn khc nhau :
Ho do cm cm, vim mi hng, vim kh qun, vim thanh qun, bnh ph qun phi, ho g v
si ;
Ho triu chng v do phn x ;
Ho do kch thch.
CHNG CH NH
Khng c.
THN TRNG LC DNG
Khng c.
TC DNG NGOI
Khng c.
LIU LNG v CCH DNG
Thuc ho dng iu tr triu chng nn s dng ngn hn v ung thuc vo cc thi im
thng xy ra cn ho.
Ngi ln :

- Dng vin phng thch ko di (ch dnh cho ngi ln) : mi ln ung 1 vin nang, 2 n 3 ln
mi ngy.
- Xir : 2 n 5 mung lng mi ngy.
Tr em : 1 mung lng xir cho 10 kg th trng trong 24 gi.
- < 4 tui : 1 n 2 mung lng mi ngy.
- T 4 n 15 tui : 2 n 3 mung lng mi ngy

399.

PEDIASURE

ABBOTT
Sa bt dinh dng : hp 400 g.
THNH PHN
Tinh bt thy phn, sucrose, natri caseinat, du hng dng giu oleic, du u nnh, du
MTC, khong cht : (canxi phosphat tribasic, magi chlorid, kali xitrat, kali phosphat dibasic, kali
chlorid, natri xitrat, st sulfat, km sulfat, mangan sulfat, ng sulfat, chrom chlorid, kali iodid,
natri molybdat, natri selenit), whey protein c c, hng liu, sinh t : (cholin chlorid, ascorbic
acid, niacinamid, a-tocopheryl acetat, canxi pantothenat, pyridoxin hydrochlorid, thiamin
hydrochlorid, riboflavin, vitamin A palmitat, folic acid, biotin, vitamin D 3, phylloquinon,
cyanocobalamin), inositol, taurin, ascorbyl palmitat, L-carnitin v b-caroten.
Phn tch thnh phn
Bt (100 g)

PediaSure pha chun (100 ml)

kcal

496

100

KJ

2076

418

Cht m (%)

12

12

Cht bo (%)

44,2

44,2

Nng lng

Phn b nng lng

Bt ng (%)

43,8

43,8

Cht m (g)

14,9

3,0

Cht bo (g)

24,7

4,98

Linoleic Acid (g)

5,0

1,0

Bt ng (g)

54,3

10,95

Nc (g)

2,5

85,29

Inositol (mg)

40

8,0

Taurin (mg)

36

7,2

Carnitin (mg)

8,4

1,7

Khong cht (g)

3,6

0,72

Canxi (mg)

486

98

Pht pho (mg)

397

80

Magi (mg)

99,2

20

Natri (mg)

228

46

Kali (mg)

645

130

Clo (mg)

496

100

Km (mg)

1,2

St (mg)

1,4

ng (mg)

0,50

0,10

Mangan (mg)

1,2

0,25

It (mg)

48

9,6

Thnh phn dinh dng

Selen (mg)

11,4

2,3

Chrom (mg)

15

3,0

Molybden (mg)

18

3,6

Vitamin A (I.U.)

1280

258

Vitamin D (I.U.)

253

51

Vitamin E (I.U.)

11,4

2,3

Vitamin K1 (mg)

19,0

3,8

Vitamin C (mg)

50

10

Vitamin B1 (mg)

1,3

0,27

Vitamin B2 (mg)

1,0

0,21

Vitamin B6 (mg)

1,3

0,26

Vitamin B12 (mg)

3,0

0,6

Niacinamid (mg)

9,9

2,0

Pantothenic Acid (mg)

5,0

1,0

Folic Acid (mg)

184

37

Biotin (mg)

159

32

Cholin (mg)

149

30

Sinh t

CH NH
Bt PediaSure - khi pha vi nc, cung cp ngun dinh dng y v cn i cho tr t 1
n 10 tui. C th dng PediaSure nh ngun dinh dng thay th ba n hay b sung
dng cht gip tr n y hn.
Thnh phn u vit ca PediaSure vi t lactose* thch hp cho :
- Tr hiu ng.
- Tr trong thi kz tng trng.

- Giai on phc hi sau khi m.

- n dm gia cc ba n chnh.
- Tr khng dung np lactose.
* Khng nn dng cho tr b bnh galactosemia.
LIU LNG v CCH DNG
Khng dng qua ng tnh mch.
Khng cha gluten.
PediaSure cha 100% hay hn theo chun RDA (Bn khuyn co nhu cu dinh dng ca Vin
Hn Lm Khoa Hc Hoa Kz) v hm lng m, vitamin v khong cht trong 1.000 ml cho tr
t 1-6 tui v trong 1.300 ml cho tr t 7-10 tui. Vi tr di 1 tui, ch dng theo hng dn
ca bc s.
Hng dn s dng :
c 225 ml PediaSure : cho 190 ml nc chn ngui vo ly. Va t t cho vo ly 5 mung
gt ngang (hay 45,4 g) bt PediaSure (mung c sn trong hp), va khuy cho tan u. Khi pha
ng theo hng dn, 1 ml PediaSure cung cp khong 1 kcal. Mt hp PediaSure 400 g pha
c khong 9 ly, mi ly 225 ml.
PediaSure dng qua ng thng :
Theo hng dn ca bc s / nhn vin dinh dng. Khi bt u nui n qua ng thng, lu
lng, th tch v pha long ty thuc vo tnh trng v s dung np ca ngi bnh. Phi
cn thn nhm trnh s nhim khun trong qu trnh chun b v nui n.
BO QUN
Hp m phi c y v bo qun ni kh mt (nhng khng cho vo t lnh) v phi
c dng trong vng 3 tun. PediaSure va pha phi c dng ngay hay y kn, cho vo t
lnh v dng trong 24 gi.

400.

PEFLACINE

RHNE-POULENC RORER
[AVENTIS PHARMA]
Vin bao phim 400 mg : hp 2 vin, hp 10 vin.
Dung dch tim truyn tnh mch dng cho ngi ln 400 mg/5 ml : hp 5 ng thuc 5 ml.
Dung dch tim truyn tnh mch dng cho ngi ln 400 mg/125 ml : ti nha 125 ml.
THNH PHN

cho 1 vin
Pfloxacine msilate dihydrate

558,5 mg

ng vi : pfloxacine

400 mg

cho 1 ng thuc
Pfloxacine msilate dihydrate

558,5 mg

ng vi : pfloxacine

400 mg

cho 1 ti
Pfloxacine msilate dihydrate
ng vi : pfloxacine

558,5 mg
400 mg

DC LC
Pfloxacine l khng sinh tng hp thuc h quinolone.
PH KHNG KHUN
Vi khun nhy cm (CMI < 1 mg/ml) : Escherichia coli, Klebsiella oxytoca, Proteus vulgaris,
Morganella morganii, Salmonella, Shigella, Yersinia, Haemophilus influenzae, Moraxella
catarrhalis, Neisseria, Bordetella pertussis, Campylobacter, Vibrio, Pasteurella, Staphylococus
nhy cm vi meticillin, Mycoplasma hominis, Legionella, P. acnes, Mobiluncus.
Vi khun nhy cm trung bnh : khng sinh c hot tnh va phi in vitro, hiu qu lm sng tt
c th c ghi nhn nu nng khng sinh ti nhim cao hn CMI : Mycoplasma
pneumoniae.
Vi khun khng (CMI > 4 mg/ml) : Staphylococcus khng vi mticilline, Streptococcus
pneumoniae, Enterococcus, Listeria monocytogenes, Nocardia, Acinetobacter baumannii,
Ureaplasma urealyticum, vi khun k kh ngoi tr Propionibacterium acnes, Mobiluncus,
Mycobacterium tuberculosis.
Vi khun khng thng xuyn nhy cm : V t l khng th c thay i, nn nhy cm
ca vi khun khng th xc nh nu khng thc hin khng sinh : Enterobacter cloacae,
Citrobacter freundii, K. pneumoniae, Proteus mirabilis, Providencia, Serratia, Pseudomonas

aeruginosa.
DC NG HC
- Hp thu :
Sau khi ung 400 mg pfloxacine :
Cng 90% ty theo i tng.
Vn tc : rt nhanh (khong 20 pht).
- Phn b (nng trong huyt thanh) :
Liu duy nht : sau khi tim truyn (1 gi) hoc 1 gi 30 sau khi ung liu duy nht 400 mg,
nng ti a trong huyt thanh t khong 4 mg/ml. Thi gian bn hy huyt thanh khong
12 gi.
Liu lp li : sau khi dng liu lp li mi 12 gi bng ng tim truyn hoc ung, sau 9 liu,
nng ti a trong huyt thanh t khong 10 mg/ml. Thi gian bn hy huyt thanh khong
12 gi.
- Khuch tn vo m :
Th tch phn b khong 1,7 l/kg sau khi dng 1 liu duy nht 400 mg.
Nng trong m sau khi dng nhiu liu lin tip nh sau :
Dch tit ph qun : t nng ti a > 5 mg/ml gi th 4. T s gia nng trong cht
nhy ph qun v trong huyt thanh biu hin kh nng khuch tn ca thuc vo cht nhy
ph qun, t s ny gn bng 100%.
Dch no ty : 11 bnh nhn b vim mng no, sau khi tim truyn hoc ung 3 liu 400 mg
nng t c dch no ty l 4,5 mg/ml. t 9,8 mg/ml sau khi dng 3 liu 800 mg.
Kim tra :
Trong lc iu tr vim mng no do vi khun cho thy, sau ln tim truyn th 5, nng
pfloxacine trong dch no ty t 89% nng huyt tng.
Nng trung bnh trong nhiu m khc nhau thi im 12 gi sau ln cui cng dng thuc
: - tuyn gip trng 11,4 mg/g - tuyn nc bt 7,5 mg/g - m 2,2 mg/g - da 7,6 mg/g - nim
mc ming - hu 6 mg/g - amygdale 9 mg/g - c 5,6 mg/g.
Lin kt vi protine huyt thanh khong 30%.
- Chuyn ha sinh hc :
S bin dng ch yu gan. Hai cht chuyn ha chnh l : dmthylpfloxacine (hay
norfloxacine) v pfloxacine N-oxide.
- Bi tit :
nhng ngi chc nng gan v thn bnh thng :
Thuc c thi tr ch yu di dng cc cht bin dng v nhiu nht qua thn. S thi tr
qua thn ca p floxacine di dng khng i v ca hai cht bin dng tng ng vi
41,7% liu dng, i vi d m thylp floxacine tng ng 20% v i vi pfloxacine Noxyde tng ng vi 16,2% liu dng.

Nng pfloxacine dng khng i trong nc tiu t khong 25 mg/ml gia gi th nht v
gi th 2 ; nng cn 15 mg/ml gia gi th 12 v gi th 24.
Pfloxacine dng khng i v hai cht bin dng vn c tm thy trong nc tiu 84 gi
sau ln cui cng dng thuc.
Pfloxacine thi tr qua mt ch yu di dng khng i, dng lin hp vi acide
glucuronique v dng N-oxyde.
ngi suy gim chc nng thn :
Nng huyt thanh v thi gian bn hy ca p floxacine khng thay i ng k, bt k mc
suy yu ca thn. P floxacine t c thm tch (23%).
ngi suy gim chc nng gan :
Nghin cu dng liu 8 mg/kg liu duy nht bnh nhn x gan cho thy dc ng hc ca
p floxacine c thay i, biu hin qua thanh thi huyt tng gim nhiu, ko theo s gia tng
ng k thi gian bn hy huyt tng (gp 3-5 ln) v s gia tng dng pfloxacine khng thay
i thi tr trong nc tiu (gp 3-4 ln).
CH NH
iu tr ngoi tr :
- Vim tuyn tin lit cp v mn tnh, k c cc th nng,
- iu tr tip theo nhim khun xng khp.
bnh vin :
Nhim khun nng do trc khun Gram - v t cu, c bit trong :
- Nhim trng thn v tit niu ;
- Nhim trng sinh dc ;
- Nhim trng bng v gan mt ;
- Nhim trng xng khp ;
- Nhim trng da ;
- Nhim trng mt ;
- Nhim trng huyt v ni tm mc ;
- Nhim trng mng no ;
- Nhim trng h hp ;
- Nhim trng tai mi hng.
Ch : V lin cu khun v ph cu khun ch nhy cm trung gian vi p floxacine do khng
nn s dng tin khi P flacine cho cc trng hp nghi ng nhim cc chng vi khun ny.
Trong lc iu tr bnh nhim do Pseudomonas aeruginosa v Staphylococcus aureus, c ghi
nhn chng khng, nn cn phi hp vi mt khng sinh khc.
CHNG CH NH
- Mn cm vi pfloxacine v cc cht khc thuc nhm quinolone.
- Tr em trong thi kz tng trng.

- Thiu Glucose-6 phosphate dhydrogenase.

- Ph n mang thai, ph n cho con b.
- Tin s bnh gn vi mt fluoroquinolone.
CH PHNG v THN TRNG LC DNG
Trnh ra nng hay tip xc vi tia cc tm t nht 4 ngy sau khi dng thuc v c nguy c nhy
cm vi nh sng. Nguy c ny s bin mt khi ht thi hn trn.
Vim gn :
- Vim gn i khi c nhn thy, c th gy t gn, nht l gn Achille v ngi ln tui.
- Vim gn c th xy ra trong 48 gi u iu tr v lan ra hai bn. S t gn thng xy ra
hn nhng bnh nhn dng corticoide di ngy.
- gii hn nguy c b vim gn, trnh dng thuc nhng ngi gi, nhng ngi c tin s
vim gn hoc ang iu tr di hn bng corticoide hay ang luyn tp nng.
- Khi c triu chng vim gn phi ngng i li v hi kin bc s chuyn khoa.
S dng pfloxacine thn trng bnh nhn c tin s b co git hoc c nhng yu t thun
li xy ra cn co git.
S dng pfloxacine thn trng cho bnh nhn b nhc c, b suy gan nng.
LC C THAI
Cc nghin cu trn th vt khng cho thy thuc c tc ng gy qui thai.
Mc khc ngi ta ghi nhn c tn thng khp phc hi khi ngng dng thuc loi vt
non c iu tr bng quinolone ngay sau khi sanh.
Trong bi cnh cha c s liu lm sng, khuyn khng nn iu tr bng quinolone trong
sut thi gian c thai.
LC NUI CON B
Chng ch nh.
TNG TC THUC
Cn thn khi s dng pfloxacine chung vi :
- Cc mui Fe (dng ng ung) : gim kh dng sinh hc ca pfloxacine, nn ung cc mui
Fe sau khi ung pfloxacine ti thiu 2 gi.
- Cc mui Zn (ung vi nng > 30 mg/ngy) : gim s hp thu p floxacine qua ng tiu
ha, nn ung sau pfloxacine ti thiu 2 gi.
- Cc mui, oxyde v hydroxyde aluminium, magnsium, v calcium : gim s hp thu ca
quinolone qua ng tiu ha. Nn ung thuc khng acide cch xa pfloxacine khong 4 gi.
- Cc thuc khng vitamine K : do c vi tng tc thuc gia thuc khng vitamine K v mt s
fluoroquinolone, cn theo di c bit khi dng phi hp.
- Th ophylline v aminophylline : tng nng thophylline trong mu gy nguy c qu liu
(lm gim s bin dng thophylline). Cn theo di v lm sng v theo di nng
thophylline trong mu nu cn.

TC DNG NGOI
- Ri lon tiu ha : bun nn, nn ma, au d dy.
- Nhy cm i vi nh sng.
- Phn ng d ng, bao gm m ay v ph Quincke.
- au c v/hoc au khp, vim gn, t gn Achille, c th xy ra trong 48 gi u v trn c
hai bn.
- Nhc u, ri lon cnh gic, mt ng.
- Cc tc dng ph khc nh : gim tiu cu, gim bch cu trung tnh.
Nhng ri lon ny s phc hi khi ngng iu tr.
LIU LNG v CCH DNG
ngi chc nng gan bnh thng :
Trung bnh 800 mg/ngy, chia lm 2 ln hoc bng cch tim truyn hoc bng cch ung 1 vin
Pflacine sng, 1 vin ti, gia ba n trnh kh chu ng tiu ha. C th dng mt liu
u tin 800 mg t nhanh nng huyt thanh hiu nghim.
ngi suy gim chc nng gan : ngi suy gan hoc ngi gim ti mu gan cn iu
chnh liu bng cch tng khong cch gia 2 ln dng thuc.
- Ngy 2 ln nu khng c vng da, c trng.
- Ngy 1 ln nu vng da.
- Mi 36 gi nu c trng.
- Mi 2 ngy nu vng da v c trng.
Bnh nhn ln hn 70 tui :
400 mg/ngy, chia lm hai ln 200 mg (2 ln 1/2 vin hoc 2 ln truyn 200 mg), cch nhau 12
gi.
Cch dng : Tim truyn tnh mch chm (1 gi) dung dch Pflacine 400 mg cha trong ti
nha hoc sau khi pha long 1 ng Pflacine 400 mg trong 125 ml hoc 250 ml dung dch
glucose 5% (tim truyn 2 ln mi ngy, sng v ti).

401.

PEPSANE

ROSA-PHYTOPHARMA
c/o TEDIS
gel ung : hp 30 gi.
THNH PHN

cho 1 gi
Gaiazulne

4 mg

Dimticone

3g

DC LC
- Dimticone to mt lp mng trn nim mc ng tiu ha v c tc dng chng to bt.
- Pepsane khng cn tia X.
DC NG HC
Khi dng liu cao hn nhiu so vi liu iu tr, gaiazulne c tm thy trong mu di dng
vt.
CH NH
- iu tr triu chng nhng cn au d dy.
- Bo v nim mc d dy khi dng thuc kch thch d dy.
- c s dng iu tr chng trng bng ng rut.
LIU LNG v CCH DNG
Liu thng thng c khuyn co l 1 n 2 gi, 2 n 3 ln/ngy, ung trc ba n hoc
khi c cn au.
Pepsane khng cha ng do khng chng ch nh cho bnh nhn tiu ng.

402.

PFIZER

PFIZER
c/o ZUELLIG
bt pha tim 1 g : l c np xuyn kim c.
THNH PHN
cho 1 l
Cefoperazone sodium

1g

M T
Cefobis l tn thng mi ca cefoperazone sodium. l khng sinh bn tng hp nhm
cephalosporin, c ph khng khun rng v ch dng ng tim. L mui Na ca 7-[-D(-)-a-(4ethyl-2,3-dioxo-1-piperazinecarboxamido)-a-(4-hydroxyphenyl)acetamido]-3-[(1-methyl-Htetrazol-5-yl)thiomethyl]-3-cephem- 4-carboxylic acid.
Mi gram Cefobis cha 34 mg Na (1,5 mEq).
Cefobis c dng bt tinh th mu trng, tan t do trong nc.
pH ca dung dch ha tan Cefobis trong nc ti nng 25% l 5,0-6,5. Dung dch khng mu
hoc c mu vng rm ty theo nng .
Cng thc ha hc l C25H26N9NaO8S2.
Cefobis c trnh by di dng l bt hm lng 1 g cefoperazone Na.
DC LC
Vi sinh hc (kh nng nhy trn thc nghim) :
C ch khng khun ca Cefobis l do c ch s tng hp vch t bo vi khun.
Cefobis c hot tnh dit khun rng trn thc nghim v khng li nhiu loi b-lactamase.
Nhng vi khun nhy cm vi thuc gm :
Vi khun Gram dng :
Staphylococcus aureus, c dng khng v khng khng penicillin.
Staphylococcus epidermidis.
Streptococcus pneumoniae (Diplococcus pneumoniae).
Streptococcus pyogenes (b-hemolytic streptococci nhm A).
Streptococcus agalactiae (b-hemolytic streptococci nhm B).
Nhiu dng Streptococcus faecalis (enterococci).
Nhng dng bta-hemolytic streptococci khc.
Vi khun Gram m :
Escherichia coli.
Klebsiella.
Enterobacter.
Citrobacter.
Haemophilus influenzae (c nhng dng c bta-lactamase v khng c bta-lactamase).
Proteus mirabilis.
Proteus vulgaris.
Morganella morganii (Proteus morganii).
Providencia rettgeri (Proteus rettgeri).
Providencia.
Serratia (gm c S. marcescens).
Salmonella v Shigella.

Pseudomonas aeruginosa v mt vi Pseudomonas khc.

Mt s dng Acinetobacter calcoaceticus.
Neisseria gonorrhoeae (c nhng dng c bta-lactamase v khng c bta-lactamase).
Neisseria meningitidis.
Bordetella pertussis.
Yersinia enterocolitica.
Vi khun ym kh :
Vi khun Gram dng v Gram m (gm c Peptococcus, Peptostreptococcus v Veillonella).
Trc khun Gram dng (gm c Clostridium, Eubacterium v Lactobacillus).
Trc khun Gram m (gm c Fusobacterium, nhiu dng Bacteroides fragilis v nhng
Bacteroides khc).
DC NG HC
Ch cn dng liu duy nht, nng Cefobis t c trong huyt tng, dch mt v nc tiu
rt cao. Bng 1 biu th nng Cefobis trong huyt thanh nhng ngi tnh nguyn khe
mnh khi dng thuc theo mt trong hai cch sau :
- Cch th I : Truyn tnh mch liu duy nht trong 15 pht 1 g, 2 g, 3 g hoc 4 g.
- Cch th II : Tim bp liu duy nht 1 g hoc 2 g.
Probenecid khng nh hng n nng Cefobis trong huyt thanh.
Bng 1. Nng cefoperazone trong huyt thanh
Nng
trung bnh
cefoperazone
Liu/ng tim trong huyt
thanh
(mg/ml)
0*

0,5 gi

1 gi

2 gi

4 gi

8 gi

12 gi

1 g IV

153

114

73

38

16

0,5

2 g IV

252

153

114

70

32

3 g IV

340

210

142

89

41

4 g IV

506

325

251

161

71

19

1 g IM

32**

52

65

57

33

2 g IM

40**

69

93

97

58

14

* S gi sau khi tim, 0 l thi im chm dt truyn tnh mch

** Nng huyt thanh sau khi tim 15 pht
Thi gian bn hy trong huyt thanh trung bnh khong 2 gi, khng ph thuc vo ng
dng thuc.
Cefobis t nng iu tr tt c cc m v dch ca c th bao gm : dch bng, dch no
ty ( bnh nhn vim mng no), nc tiu, dch mt v thnh ti mt, m v phi, hch
vm hng v nim mc ca xoang, tiu nh, thn, niu qun, tuyn tin lit v tinh hon, t
cung v vi trng, xng, mu cung rn v nc i.
Cefobis bi tit qua nc tiu v dch mt. Nng ti a trong dch mt t c sau khi tim
thuc t 1 ti 3 gi, ng thi vt cao hn nng trong huyt thanh ti 100 ln. Sau khi
tim tnh mch trc tip 2 g cho nhng bnh nhn khng b tc mt, nng Cefobis trong dch
mt khong t 66 mg/ml sau 30 pht v t ti 6000 mg/ml sau 3 gi.
Sau khi dng Cefobis ( mi liu, mi ng tim) ngi c chc nng thn bnh thng,
khong 20% ti 30% thuc bi tit nguyn vn qua nc tiu trong khong thi gian 12 gi.
Nng trong nc tiu t c cao hn 2200 mg/ml sau khi truyn 2 g Cefobis trong 15
pht. Sau khi tim bp 2 g, nng ti a t c trong nc tiu khong 1000 mg/ml.
ngi bnh thng liu Cefobis lp li khng lm tch ly thuc trong c th. Nng thuc
ti a, bin thin nng thuc theo thi gian v thi gian bn hy ca thuc ngi suy
thn tng ng vi ngi bnh thng.
Trn nhng bnh nhn b ri lon chc nng gan, thi gian bn hy k o di v tng bi tit
trong nc tiu. bnh nhn b suy chc nng thn v gan, Cefobis c th tch ly trong huyt
thanh.
CH NH
Cefobis ch nh trong nhng trng hp nhim trng do nhng vi khun nhy vi thuc sau
y :- Nhim trng ng h hp (trn v di).
- Nhim trng ng tiu (trn v di).
- Vim phc mc, vim ti mt, vim ng mt, v nhng nhim trng khc trong bng.
- Nhim trng huyt.
- Vim mng no.
- Nhim trng da v m mm.
- Nhim trng xng v khp.
- Vim vng chu, vim ni mc t cung, lu m v nhng nhim trng khc ng sinh dc.
D phng :
Ch nh s dng d phng nhim trng hu phu cho nhng bnh nhn phu thut bng, ph
khoa, tim mch v chn thng chnh hnh.

S dng kt hp :
Do Cefobis c ph khng khun rng, nn ch cn s dng Cefobis n thun cng c th iu
tr hu hiu hu ht cc nhim trng. Tuy nhin, Cefobis c th dng kt hp vi nhng khng
sinh khc nu cn. Khi kt hp vi aminoglycoside phi kim tra chc nng thn trong sut t
iu tr (xem phn Liu lng v Cch dng).
CHNG CH NH
Khng s dng nhng bnh nhn d ng vi nhm khng sinh cephalosporin.
CH PHNG v THN TRNG LC DNG
Ch { phng :
Trc khi iu tr bng Cefobis, cn xc nh xem bnh nhn c tin cn b phn ng qu mn
vi cephalosporin, penicillin hoc nhng thuc khc khng. Thuc s dng d dt nhng
bnh nhn hay b d ng, c bit l d ng vi thuc.
Nu b d ng, phi ngng thuc ngay v chuyn sang ch iu tr thch hp hn. Khi c
chong phn v phi cp cu ngay bng adrenalin. ng thi hi sc tch cc bng oxy, tim
tnh mch steroid, lm thng ng th k c t ni kh qun.
Thn trng lc dng :
Tng qut :
Cefobis thi tr ch yu qua dch mt. nhng bnh nhn b bnh gan hoc tc mt, thi gian
bn hy trong huyt thanh ca Cefobis k o di v tng thi tr qua nc tiu. Ngay c nhng
bnh nhn b bnh gan nng, nng iu tr ca cefoperazone cng t c trong dch mt
v thi gian bn hy ch tng 2 ti 4 ln.
nhng bnh nhn b tc mt nng, bnh gan nng, hoc i km ri lon chc nng thn phi
iu chnh li liu.
bnh nhn b ri lon chc nng gan v suy thn cng lc, phi theo di nng thuc trong
huyt tng v phi iu chnh liu. Trong nhng trng hp ny, khi dng liu qu 2 g mt
ngy phi theo di st nng trong huyt tng.
Thi gian bn hy trong huyt tng ca Cefobis b gim nh trong khi thm lc mu. Do ,
liu lng phi ph hp trong sut thi kz lm thm lc mu.
Ging nh nhng khng sinh khc, mt vi bnh nhn b thiu vitamin K khi iu tr bng
Cefobis. Nguyn nhn thng l do gim khun ng rut rt cn cho s tng hp vitamin
K. Nhng ngi c nguy c cao l nhng bnh nhn n ung km, gim hp thu (v d ti mt
x ha) v bnh nhn nui n ng tnh mch lu ngy. nhng bnh nhn ny phi theo di
thi gian prothrombin v dng thm vitamin K.
Khi bnh nhn dng ru trong thi gian s dng thuc v ngay c sau khi ngng thuc 5 ngy,
c mt s ngi b phn ng mt, m hi, nhc u v nhp tim nhanh. Khi dng nhng
cephalosporin khc, i khi cng b phn ng tng t nu bnh nhn c ung bia ru trong
thi gian dng thuc. i vi nhng bnh nhn phi nui n bng ng ung hoc ng tnh

mch, trnh dng dung dch c ethanol.

Nu dng thuc lu ngy, phi lu { tnh trng qu sn ca nhng vi sinh vt khng nhy cm
vi thuc. Do , phi theo di st bnh nhn trong sut t iu tr.
Tng tc gia thuc v xt nghim cn lm sng :
Xt nghim ng niu c th b dng tnh gi khi dng dung dch Benedict hoc Fehling.
S dng trong nhi khoa :
Cefobis c tc dng tt c mi liu trn tinh hon ca chut tin dy th. Tim di da 1000
mg/kg/ngy (cao hn liu ngi 10 ln) gy gim khi lng tinh hon, ngng sn xut tinh
trng, gim s lng t bo mm v c hc trong bo tng ca t bo Sertoli. Mc nghim
trng ty thuc vo liu dng t 100 ti 1000 mg/kg ngy ; Liu thp gy gim khng ng k
t bo tinh trng. Nhng nh hng ny khng thy chut trng thnh. Trong tt c cc
trng hp, nhng tn thng m hc u tr v bnh thng, ngoi tr tn thng khi dng
liu cao nht. Tuy nhin, nhng nghin cu ny khng nh gi hu qu v chc nng sinh sn
chut. Nhng nh hng ny trn ngi cng cha c xc nh r.
S dng tr nh nhi :
Cefobis s dng rt hiu qu tr nh nhi. Thuc cha c nghin cu rng ri tr nh nhi
v s sinh non thng. Do , trc khi iu tr phi cn nhc k li ch v nguy c c th xy ra.
Cefobis khng chim ch ca bilirubin khi gn kt vi protein huyt tng.
LC C THAI v LC NUI CON B
Lc c thai :
Nghin cu trn chut v kh, dng liu cao hn ngi 10 ln cho thy khng c nh hng
no trn kh nng sinh sn v khng gy qui thai. Tuy nhin vn cha c nghin cu y
trn ph n c thai. Bi v nghin cu trn vt khng th tin lng chc chn trn ngi nn
trnh dng thuc trong thai kz tr khi tht cn thit.
Lc nui con b :
Cefobis c bi tit qua sa rt t. Tuy nhin phi lu { khi s dng ngi ang cho con b.
TC DNG NGOI
Tng mn cm :
Ging nh tt c cephalosporin khc, triu chng ca tng mn cm l ni sn , m ay, tng
bch cu i toan v st. Phn ng d xy ra ngi c tin cn d ng, c bit l d ng vi
penicillin.
Huyt hc :
Bch cu trung tnh c th gim nh. Ging nh nhng khng sinh h bta-lactam khc, khi
iu tr lu di c th b gim bch cu trung tnh. Mt s bnh nhn khi iu tr bng
cephalosporin, test Coombs dng tnh. Trong y vn thng bo co gim hemoglobin v
hematocrit khi iu tr bng cephalosporin. Tng bch cu i toan v gim prothrombine mu
thong qua cng c th xy ra (xem phn Thn trng lc dng v thiu vitamin K).

Gan :
Tng tm thi SGOT, SGPT v phosphatase kim.
ng tiu ha :
C th thay i chc nng rut (phn lng hoc tiu chy). Hu ht ch mc nh hoc
trung bnh. Trong tt c trng hp, ch cn iu tr triu chng hoc ngng thuc s hi phc.
Phn ng ti ch :
Cefobis dung np tt khi dng ng tim bp. Him khi b au ti ch. Ging nh nhng
cephalosporin khc, khi Cefobis c truyn tnh mch bng catheter, mt vi bnh nhn b
vim tnh mch ti v tr tim truyn.
LIU LNG v CCH DNG
Liu thng thng ngi ln l 2 g ti 4 g mt ngy chia lm hai ln. Trong nhng trng hp
nhim trng nng tng liu ti a n 8 g mt ngy chia hai ln. Cng c th dng liu 12 g mt
ngy chia lm ba ln, c trng hp dng ti 16 g mt ngy vn khng c bin chng. C th
bt u iu tr trc khi c kt qu xt nghim chnh xc.
Liu iu tr cho vim niu o do lu cu khng bin chng l tim bp liu duy nht 500 mg.
Do thn khng phi l ng thi tr chnh cho nn nhng bnh nhn suy thn dng liu nh
bnh thng (2 g ti 4 g mt ngy).
bnh nhn b gim tc lc cu thn di 18 ml/pht hoc creatinin trong huyt thanh cao
hn 3,5 mg/dl, liu ti a ca Cefobis l 4 g/ngy.
Dung dch Cefobis khng c pha chung vi aminoglycoside bi v hai loi khng tng hp.
Khi s dng kt hp (xem phn Ch nh) phi truyn tnh mch ring lm hai ln. Lu { phi
thay dy truyn dch khi truyn dung dch th hai hoc phi ra sch dy truyn bng mt dung
dch thch hp. Nn truyn Cefobis trc aminoglycoside.
tr nh nhi v tr em dng liu t 50-200 mg/kg/ngy Cefobis chia hai ln mi 12 gi hoc
liu cao hn nu cn thit. i vi tr s sinh di 8 ngy tui, cho thuc mi 12 gi. C th
cho liu ti 300 mg/kg/ngy tr nh nhi v tr em nu c nhim trng nng nh vim mng
no do vi trng khng c bin chng.
Dng khng sinh d phng trong phu thut, 1 g hoc 2 g ng tnh mch trc khi bt u
cuc m 30 pht ti 90 pht. C th lp li liu mi 12 gi v trong hu ht cc trng hp
khng qu 24 gi. Trong nhng cuc m c nguy c nhim trng cao (v d : phu thut trc
trng) hoc khi c nhim trng th rt nguy him (v d : phu thut tim h v phu thut to
hnh khp), liu d phng Cefobis tip tc ti 72 gi sau khi hon tt phu thut.
ng dng tnh mch :
L bt v trng Cefobis c th pha khi u vi bt c dung dch truyn tnh mch tng hp
no nh nu Bng 2, t l pha t nht 2,8 ml cho 1 g cefoperazone. d nh, nn pha 5 ml
dung dch thch hp cho 1 g Cefobis.
Bng 2. Dung dch pha thuc khi u :

Dextrose 5%.
Dextrose 10%.
Dextrose 5% v Natri chlorua 0,9%.
Natri chlorua 0,9%.
Normosol M v Dextrose 5%.
Dextrose 5% v Natri chlorua 0,2%.
Normosol R.
Nc ct.
Ton b s lng pha khi u tip tc c pha long hn na bng mt trong nhng
dung dch truyn tnh mch sau y :
Bng 3. Dung dch truyn tnh mch :
Dextrose 5%.
Dextrose 10%.
Dextrose 5% v Lactated Ringer.
Lactated Ringer.
Natri Chlorua 0,9%.
Dextrose 5% v Natri Chlorua 0,9%.
Normosol M v Dextrose 5%.
Normosol R 5%.
Dextrose v 0,2% Natri Chlorua.
Khi truyn tnh mch khng lin tc, pha t 20 ml ti 100 ml dung dch thch hp vo l 1 g
hoc 2 g Cefobis v truyn t 15 pht ti 1 gi. Nu dng vi nc ct, khng pha qu 20 ml
cho mt l.
Khi truyn tnh mch lin tc, pha long mi gam Cefobis trong 5 ml nc ct, sau thm
dung dch thch hp truyn tnh mch.
Khi tim tnh mch trc tip, mi ln tim Cefobis ti a l 2 g ngi ln v 50 mg/kg tr
em, tim chm ti thiu t 3 ti 5 pht.
Tim bp :
Pha thuc vi nc ct tim bp. Khi nng pha t 250 mg/ml tr ln, c th dng dung
dch lidocain. Pha vi nc ct v lidocaine hydrochloride 2% thnh dung dch lidocaine
hydrochloride 0,5%. Nn pha thuc theo hai bc : u tin pha thuc vi nc ct, ri lc u
bt thuc tan ht. Sau , thm lidocaine 2% v lc u.
H{m lng
thuc
Hm lng
ng gi

Nng
lidocaine

Bc 1

Bc 2

Th tch nc
ct

Th tch lidocaine
2%

Th tch rt
ra*

l 1,0 g

250 mg/ml
2,6 ml
0,9 ml
4,0 ml
333 mg/ml
1,8 ml
0,6 ml
3,0 ml
* Th tch rt v tim
Tim bp su nhng khi c ln nh c mng to hoc vng i trc.
Tnh n nh :
Di y lit k mt s dung dch pha long v nng pha trong iu kin nht nh v
khong thi gian cho php bo m tnh n nh ca thuc (sau thi gian cho php, nhng
thuc pha m khng dng phi hy b) :
Nhit trong phng c kim sot (15-25oC)
Nng pha
24 gi
Nc tit khun
300 mg/ml
Dextrose 5%
2 mg ti 50 mg/ml
Dextrose 5% v Lactated Ringer's
2 mg ti 50 mg/ml
Dextrose 5% v Natri chlorua 0,9%
2 mg ti 50 mg/ml
Dextrose 5% v Natri chlorua 0,2%
2 mg ti 50 mg/ml
Dextrose 10%
2 mg ti 50 mg/ml
Lactate Ringer's
2 mg/ml
Lidocaine hydrochlorua 0,5%
300 mg/ml
Natri chlorua 0,9%
2 mg ti 300 mg/ml
Normosol M v Dextrose 5%
2 mg ti 50 mg/ml
Normosol M
2 mg ti 50 mg/ml
Nc ct
300 mg/ml
C th gi thuc pha bng ng tim thy tinh hoc nha, bng chai thy tinh hoc chai
nha.
Nhit trong t lnh (2-8oC)
Nng pha
5 ngy
Nc ct
300 mg/ml
Dextrose 5%
2 mg ti 50 mg/ml
Dextrose 5% v Natri Chlorua 0,9%
2 mg ti 50 mg/ml
Dextrose 5% v Natri chlorua 0,2%
2 mg ti 50 mg/ml
Lactate Ringer's
2 mg/ml
Lidocaine hydrochlorua 0,5%
300 mg/ml
Natri chlorua 0,9%
2 mg ti 300 mg/ml
Normosol M v Dextrose 5%
2 mg ti 50 mg/ml
Normosol R
2 mg ti 50 mg/ml
Nc tit khun
300 mg/ml
C th gi thuc bng ng tim thy tinh hoc nha, bng chai thy tinh hoc chai nha.

Nhit ng lnh (-20 ti -10oC)

Nng pha
3 tun
Dextrose 5%
50 mg/ml
Dextrose 5% v Natri chlorua 0,9%
2 mg/ml
Dextrose 5% v Natri chlorua 0,2%
2 mg/ml
5 tun
Natri chlorua 0,9%
300 mg/ml
Nc ct
300 mg/ml
Gi thuc pha trong ng tim nha hoc chai nha.
Thuc ng lnh phi cho tan nhit phng trc khi s dng. Sau khi tan, phn
thuc khng dng phi b, khng c ng lnh li.

403.

PHARMATEX

INNOTECH
c/o ZUELLIG
vin t m o : hp 12 vin.
THNH PHN
cho 1 vin
Benzalkonium chlorure

20 mg

DC LC
Benzalkonium chlorure ng thi va l thuc dit tinh trng va l thuc st trng.
Cht ny ph v mng ca tinh trng. Trn phng din dc l, tc dng dit tinh trng chia
lm hai giai on : u tin n hy phn ui ca tinh trng, sau lm v phn u ca tinh
trng. Do c im ny, trng khng th no th tinh c vi tinh trng b hng. Hiu lc
ca thuc trn lm sng c nh gi bng ch s Pearl di 1, nu thuc c s dng
ng vi ch dn. Cc trng hp tht bi thng l do qun dng thuc hoc dng thuc
khng ng cch. Hiu lc ca thuc c nh gi v mt l thuyt l 100% do tinh trng
khng th tn ti c khi c mt hot cht, ngay c ch mt lng rt nh. Tuy nhin, hiu lc
ca phng php ny cn ty thuc vo vic s dng thuc c ng vi ch dn hay khng.
Thuc khng lm thay i cc vi khun hoi sinh : trc khun Doderlein khng b nh hng bi
tc ng ca thuc.
Benzalkonium chlorure cng c tc ng khng khun :

- in vitro, thuc c tc ng trn mt s tc nhn gy cc bnh truyn qua ng sinh dc nh :

Gonocoque, Chlamydiae, Herps virus type 2, VIH, Trichomonas vaginalis, Staphylococcus
aureus. Ngc li, thuc khng c tc ng trn Mycoplasma v tc ng yu trn Gardnerella
vaginalis, Candida albicans, Haemophilus ducreyi v Treponema pallidum ;
- in vivo, thuc c tc ng ngn nga mt s bnh truyn qua ng sinh dc mc d bng
chng v tc dng ny cha c tng kt mt cch y .
DC NG HC
Benzalkonium chlorure khng hp thu qua nim mc m o m ch hp thu ln thnh ca m
o v c o thi sau theo nc tiu hoc ra bng nc sch.
CH NH
Nga thai ti ch : phng php ny lm gim ng k kh nng th thai nhng khng bo m
tuyt i.
Thuc cng c hiu lc cao khi c s dng tht ng vi ch dn.
Phng php ny c th c dng cho mi ph n trong giai on sinh , c bit l :
- khi c chng ch nh tm thi hoc vnh vin dng thuc ung nga thai hoc t vng trnh
thai trong t cung ;
- sau khi sanh, trong thi kz cn cho con b, hoc trong giai on tin mn kinh ;
- nu ngi ph n mun dng thm mt bin php nga thai ph ;
- khi ngi ph n ang dng thuc ung nga thai nhng li ung tr hay qun ung 1 vin :
trong trng hp ny, nn dng thm Pharmatex trong nhng ngy cn li ca chu kz.
H tr cc bin php nga thai ti ch bng mng chn m o hoc vng trnh thai t trong
t cung (nht l khi phi iu tr bng mt s thuc c th lm gim tc dng nga thai ca cc
bin php nga thai ti ch nu trn, nh khi dng thuc khng vim khng stroide).
CHNG CH NH
Khng ch nh thuc ny cho ngi mc bnh tm thn hoc khng hiu r hoc khng chp
nhn bin php nga thai ny do nhng ngi ny kh c th dng thuc ng qui cch.
CH PHNG v THN TRNG LC DNG
Hiu qu nga thai ph thuc vo cch s dng v s tun th phng php. Cn chp hnh
ng cc iu kin sau y :
- t vin thuc vo su trong m o trc mi ln giao hp, d giai on no ca chu kz
kinh nguyt ;
- khi t thuc phi t th nm, iu ny gip cho vic t thuc vo su trong m o ;
- ch n khi vin thuc tan hon ton (8 n 10 pht) cho hot cht c gii phng hon
ton ;
- t thm mt vin trc ln giao hp th hai nu c giao hp nhiu ln ;
- khng c bm ra m o v s dng x phng trc khi t thuc v sau khi giao hp. Ch
c php ra bn ngoi bng nc sch sau khi giao hp.

- do c hot cht l benzalkonium chlorure, ngng iu tr nu c xut hin hay lm nng thm
cc tn thng sinh dc.
Nu cn phi iu tr hoc dng cc thuc khc qua ng m o, phi ch n khi ngng
iu tr mi bt u (hoc dng tr li) s dng vin thuc nga thai Pharmatex. Trnh ch nh
thuc ny cho bt kz ai khng hiu r hoc khng chp nhn bin php nga thai ny.
LC C THAI
Cho n nay, cha thy c nguy c no lin quan n vic s dng thuc dit tinh trng trong
thi gian mang thai.
LC NUI CON B
c php s dng thuc dit tinh trng iu ch t benzalkonium trong thi gian cho con b,
do hot cht khng vo mu v khng bi tit qua sa m.
TNG TC THUC
Khng nn phi hp :
- Cc thuc s dng ng m o : c th lm mt tc dng nga thai ti ch dit tinh trng.
- X phng : x phng lm mt tc dng dit tinh trng ca benzalkonium chlorure, do khng
c ra bng x phng trc hoc sau khi giao hp ngay c khi ch dng mt lng tht t x
phng.
LIU LNG v CCH DNG
Lm m vin thuc. t 1 vin thuc vo su trong m o, 10 pht trc khi giao hp, t
th nm. Phng php ny c hiu qu trong t nht 3 gi. Sau khi giao hp, c th lm v sinh
bn ngoi, nhng phi ch n t nht 2 gi sau mi c tht ra m o bng nc sch.

404.

PHO-L

AHN GOOK
c/o IC VIET NAM
Vin nang : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
DL-Phosphoserine

30 mg

L-Glutamine

30 mg

Cyanocobalamine

200 mg

TNH CHT
PHO-L l mt phi hp hon ho gia 3 hot cht :
- DL-Phosphoserine : tham gia vo thnh phn cu to m no, c tc dng tng cng hot
ng ca tr tu v dn truyn xung ng thn kinh.
- L-Glutamine : tham gia vo qu trnh tng hp protein ca no, l tin cht to GABA (acid gaminobutyric), cht trung gian dn truyn thn kinh c ch v no, L-Glutamine - amide ca
acid glutamic, cn thit cho hot ng ca chu trnh Krebs (ngun nng lng t bo). LGlutamine l dng vn chuyn -NH3 quan trng trong no, l con ng ch yu loi -NH3,
trnh nhim c cho no. Do L-Glutamine c tc dng phc hi chc nng t bo no, c
ch nhng kch thch qu mc v duy tr nhng chc nng bnh thng khc ca no b.
- Cyanocobalamine : cn thit cho s pht trin ca m thn kinh v to mu, nui dng biu
m (epithelium) v bao myeline ca si thn kinh.
DC LC
Tng cng chc nng thn kinh v no b : tr nh, t duy v s tp trung.
Cung cp phosphor-protein v cc cht chuyn ha cho no, duy tr y nng lng cho hot
ng ca no.
Gim cc ri lon c nng ngi suy nhc thn kinh : nng u, nhc u, mt ng, tai,
chng mt.
Kch thch chuyn ha ca t bo no, tng thi tr amoniac b tch t trong no do hot ng
tr c qu mc.
Kch thch s pht trin v hon thin no b tr em.
B sung cc c cht cn thit cho pht trin v hot ng ca no.
CH NH
Ngn nga v cha tr cc triu chng suy nhc thn kinh : mt ng, nhc u, tai, nng
u, chng mt... trong cc tnh trng suy sp thn kinh, mt mi, suy nhc th lc v tinh
thn do lm vic qu , thi kz dng bnh.
LIU LNG v CCH DNG
Ngi ln : mi ln ung 1 vin, ngy 3 ln.
Tr em : na liu ngi ln.
C th tng hay gim liu ty theo tui tc, mc nng nh ca cc triu chng v p ng
ca bnh nhn.

405.

PIASCLDINE 300

PHARMASCIENCE
c/o GALIEN
Vin nang : hp 15 vin.
THNH PHN
cho 1 vin
Cao ton phn khng x phng ha du qu b

100 mg

Cao ton phn khng x phng ha du u nnh

200 mg

DC LC
- Bnh h khp (M : h vn ng).
- Bnh cn rng (A : b my tiu ha v chuyn ha).
Thuc c tc ng dinh dng.
CH NH
Khoa ming :
- iu tr b tr trong cc bnh nha chu.
Khoa thp khp :
- iu tr b tr trong cc chng au khp.
LC C THAI v LC NUI CON B
D liu trn ng vt :
Khng c d liu ng tin cy v kh nng gy qu thai khi th nghim trn ng vt.
D liu lm sng :
Trn lm sng, cho n nay cha c d liu y nh gi v kh nng gy d dng hay c
i vi bo thai ca Piascldine khi s dng thuc ny trong thi gian mang thai.
Do thn trng, khng nn dng Piascldine trong thi gian mang thai.
TC DNG NGOI
Him khi gy c mi cht bo, c th trnh bng cch ung thuc trong khi n.
LIU LNG v CCH DNG
1 vin/ngy, ung thuc trong khi n.
Ung thuc vi nhiu nc.

406.

PIVALONE - PIVALONE NOMYCINE

PFIZER
c/o ZUELLIG
huyn dch tra mi 1 % : bnh phun 10 ml (khong 100 nht xt).
huyn dch tra mi : bnh phun 10 ml (khong 100 nht xt).
THNH PHN
cho 100 ml huyn dch Pivalone
Tixocortol pivalate

1g

cho 100 ml huyn dch Pivalone Nomycine

Tixocortol pivalate

1g

Nomycine sulfate tnh theo dng base

340.000 UI

DC LC
Corticoide dng ti ch : khng vim phi hp vi khng sinh.
- Tixocortol pivalate l mt corticoide khng gy tc dng ton thn. Tc dng ca n tng t
vi cc corticoide thng dng khc, nhng khng gy tc dng xa ni s dng. ngi, dng
n 130 ln liu iu tr hng ngy vn khng gy mt tc dng ton thn no.
- Nomycine l mt khng sinh dit khun c tc dng ti ch thuc h aminoside, c tc ng
trn cc cu khun gram + v gram - cng nh cc trc khun gram + v gram -.
Huyn dch tra mi Pivalone v Pivalone N omycine khng cn tr s dn lu mi th hin
qua ng tc php phng ca cc tim mao nim mc mi.
DC NG HC
Cc nghin cu trn ng vt v trn ngi cho thy rng tixocortol pivalate c chuyn ha
rt nhanh do khng gy tc dng ton thn.
Tixocortol pivalate c hp thu tt qua ng ung ; tuy nhin, ngay c khi dng n liu rt
cao (2 g), ngi ta vn ch tm thy trong mu nhng cht chuyn ha khng c hot tnh do
khng c tc ng ca glucocorticoide. iu ny l do tixocortol pivalate c chuyn ha rt
nhanh, ch yu gan.
Nomycine l mt khng sinh c tc ng ti ch, khng c hp thu qua ng tiu ha.
CH NH
Pivalone :

Cc biu hin vim v d ng vng mi hu : vim mi d ng, vim mi sung huyt cp tnh v
mn tnh, vim mi vn mch.
Pivalone Nomycine :
iu tr h tr cc chng vim v nhim trng mi - hu v vim xoang.
iu tr h tr vim xoang mi d ng c bi nhim.
CHNG CH NH
Tuyt i :
Qu mn cm vi mt trong cc thnh phn ca thuc, nht l vi cc aminoside.
Mi ang b nhim siu vi nh zona, thy u, herps.
Chy mu cam.
Tng i :
Ph n c thai v ang cho con b (xem phn Lc c thai v Lc nui con b).
CH PHNG v THN TRNG LC DNG
S hin din ca corticoide khng ngn c cc biu hin d ng vi nomycine nu c, tuy
nhin n c th lm gim cc biu hin lm sng.
Trng hp nhim trng c biu hin ton thn, cn s dng khng sinh ng ton thn.
Ngay sau ln s dng u, vi khun c th ly nhim qua phn u ca bnh thuc. trnh
iu ny, nn dng thuc sau khi h mi v lau sch mi.
Khng nn iu tr ko di.
LC C THAI v LC NUI CON B
Lc c thai :
Cha khng nh c tnh v hi ca nomycine sulfate khi dng trong thi gian mang thai (c
th c c tnh trn c - tin nh ca bo thai). Vic thuc thm qua nim mc mi vo mu l
c th xy ra.
Do khng nn ch nh thuc ny cho ph n c thai.
Lc nui con b :
Cc aminoside ni chung c bi tit qua sa m, do khng nn dng thuc trong thi gian
cho con b.
TC DNG NGOI
Phn ng khng dung np ti ch (cm gic kim chm) c th xy ra lc u tr liu.
Him gp phn ng d ng (ph da - nim mc vng mt, ngoi l c th gy ph Quincke).
Trong trng hp ny, phi ngng dng thuc.
LIU LNG v CCH DNG
Lc chai trc khi s dng.
Pivalone :
Mi ln xt 1 n 2 nht xt trong mi bn mi, 2 n 4 ln/ngy.
Pivalone Nomycine :

Ngi ln :
Xt mi ln 1 n 2 nht trong mi bn mi, 4 ln/ngy.
Tr em v nh nhi :
Xt mi ln 1 nht trong mi bn mi, 2 n 4 ln/ngy.

407.

PLENYL

OBERLIN
c/o UPSA
vin nn nhai : ng 15 vin, hp 2 ng v hp 1 ng.
vin nn si bt : ng 15 vin, hp 2 ng v hp 1 ng.
THNH PHN
cho 1 vin
Rtinol palmitate (vitamine A)

3000 UI

Tocophrol DL actate (vitamine E)

20 UI

Cocarboxylase (vitamine B1)

1,6 mg

Riboflavine phosphate Na (vitamine B2)

2 mg

Panthnol mui Ca (vitamine B5)

6,87 mg

Pyridoxine chlohydrate (vitamine B6)

4,11 mg

Cyanocobalamine (vitamine B12)

4 mg

Acide ascorbique (vitamine C)

150 mg

Nicotinamide (vitamine PP)

30 mg

D-biotine (vitamine B8)

0,15 mg

Acide folique (vitamine B9)

0,4 mg

Zinc sulfate tnh theo zinc

1,43 mg

Cuivre sulfate tnh theo cuivre

0,42 mg

Slnite Na tnh theo slnium

0,02 mg

(Na : 204 mg/vin si bt)

(Aspartam)

DC LC
Phi hp vitamine v cc nguyn t vi lng.
CH NH
Ngn nga hoc iu chnh nhng ri lon lin quan n ch n thiu dinh dng hoc mt
cn i ngi ln v thanh thiu nin.
THN TRNG LC DNG
Do c cha vitamine A, phi ch liu dng trong cc trng hp phi hp nhng ch phm
khc c vitamine ny.
Mi vin si bt cha 204 mg Na.
LC C THAI v LC NUI CON B
Lng vitamine A (tnh lun thc phm) a vo c th phi gi mc di 6.000 UI/ngy, tr
khi c l do chnh xc.
TNG TC THUC
liu rt cao mt s vitamine c th lm gim hiu lc ca phnytoine, phnobarbital,
primidone, lvodopa.
LIU LNG v CCH DNG
1 vin/ngy, mt t iu tr 15 ngy n 1 thng.
Vin nn si bt c ha tan trong 1/2 ly nc.
QU LIU
Cc biu hin qu liu vitamine A c th xy ra trong : trng hp ch nh dng liu quan trng
ko di, hoc cng c th xy ra trng hp hp thu mt liu rt ln tr nh nhi.

408.

POLARAMINE

SCHERING-PLOUGH
Vin nn d b 2 mg : hp 30 vin.
Vin bao 6 mg : hp 30 vin.
THNH PHN
cho 1 vin
Dexchlorpheniramine maleate

2 mg

cho 1 vin
Dexchlorpheniramine maleate

6 mg

DC LC
Thuc khng histamin ng ung, c cu trc propylamin, c cc c tnh nh sau :
- tc dng an thn liu thng thng do tc ng khng histamin v c ch adrenalin thn
kinh trung ng ;
- tc dng khng cholinergic l ngun gc gy ra tc dng ngoi ngoi bin ;
- tc dng c ch adrenalin ngoi bin c th nh hng n ng lc mu (c th gy h
huyt p t th).
Cc thuc khng histamin c c tnh chung l i khng, do i khng tng tranh t nhiu
mang tnh thun nghch, vi tc dng ca histamin, ch yu trn da, mch mu v nim mc
kt mc, mi, ph qun v rut.
Bn thn cc khng histamin c tc ng chng ho nh nhng khi c dng phi hp s lm
tng tc ng ca cc thuc ho nhm morphin cng nh ca cc thuc gin ph qun khc nh
cc amin giao cm.
DC NG HC
Dexchlorpheniramine c sinh kh dng vo khong 25-50% do b chuyn ha ng k khi qua
gan ln u. Thuc t nng ti a trong mu sau 2-6 gi. Hiu lc ti a t c sau khi
ung thuc 6 gi. Thi gian tc ng t 4-8 gi.
T l gn kt vi protein huyt tng l 72%. Thuc c chuyn ha ch yu gan v to ra
cht chuyn ha c loi gc methyl, cht ny khng c hot tnh. Thuc ch yu c o
thi qua thn v ty thuc vo pH nc tiu, 34% dexchlorpheniramine c bi tit di dng
khng i v 22% di dng cht chuyn ha loi gc methyl.
Thi gian bn hy t 14 -25 gi.
Dc ng hc trong nhng trng hp c bit :
- Suy gan hay suy thn lm tng thi gian bn hy ca dexchlorpheniramine.

- Dexchlorpheniramine qua c nhau thai v sa m.

CH NH
iu tr triu chng cc biu hin d ng khc nhau : vim mi (theo ma hay quanh nm), vim
kt mc, m ay.
CHNG CH NH
Tuyt i :
- Qu mn cm vi mt trong cc thnh phn ca thuc.
- C nguy c b b tiu lin quan n ri lon niu o tuyn tin lit.
- C nguy c b glaucome gc ng.
- Vin nn d b hm lng 2 mg chng ch nh cho tr em di 6 tui do c im ca dng
bo ch.
- Vin 6 mg chng ch nh cho tr em di 15 tui.
Tng i :
- Ph n c thai (xem Lc c thai v Lc nui con b).
CH PHNG v THN TRNG LC DNG
Ch { phng :
Nu sau mt thi gian iu tr m cc triu chng d ng vn cn hoc nng ln (kh th, ph,
sang thng da...) hoc c nhng du hiu c lin quan n nhim virus, cn phi nh gi li
vic iu tr.
Thn trng lc dng :
Thn trng khi ch nh dexchlorpheniramine cho :
- bnh nhn ln tui c kh nng cao b h huyt p t th, b chng mt, bun ng ; b to bn
kinh nin (do c nguy c b tc rut lit) ; b sng tuyn tin lit ;
- bnh nhn b suy gan v/hay suy thn nng, do c nguy c tch t thuc.
Tuyt i trnh ung ru hay cc thuc c cha ru trong thi gian iu tr.
Li xe v vn hnh my mc :
Cn thng bo cho ngi phi li xe hay vn hnh my mc v kh nng b bun ng khi dng
thuc, nht l trong thi gian u. Hin tng ny cng r hn nu dng chung vi cc thc
ung hay cc thuc khc c cha ru. Nn bt u iu tr vo bui ti.
LC C THAI v LC NUI CON B
Lc c thai :
Kho st v tc dng gy d dng (trong 3 thng u) :
Cc nghin cu thc hin trn ng vt khng cho thy thuc c tc ng gy qui thai. Trn
lm sng, cc nghin cu dch t hc dng nh loi ra kh nng gy d dng ca
dexchlorpheniramine.
Kho st v c tnh trn phi thai (trong 3 thng th hai v 3 thng cui) :
tr s sinh c m c iu tr di hn vi liu cao cc thuc c c tnh khng cholinergic,

cc du hiu v tiu ha c lin quan n tc dng ging atropine (cng bng, tc rut phn su,
chm i tiu phn su, nhp tim nhanh, ri lon thn kinh...) him khi c ghi nhn.
Da trn cc d liu trn, thuc ny c th c k toa cho ph n c thai 3 thng u v 3
thng th nh ca thai kz ; phi cn nhc v ch k toa khi cn thit 3 thng cui v ch k toa
ngn hn. Nu dng thuc vo cui thai kz, phi theo di chc nng thn kinh v tiu ha ca
tr s sinh mt thi gian.
Lc nui con b :
Thuc qua c sa m vi mt lng nh. Do c c tnh gy an thn, khng nn dng thuc
ny trong khi cho con b.
TNG TC THUC
Khng nn phi hp :
- Ru : lm tng tc dng an thn ca thuc khng histamin H1. Vic gim tp trung v tnh to
c th gy nguy him khi li xe hay vn hnh my mc. Trnh ung ru v cc thc ung c
cha ru trong thi gian dng thuc.
Nn lu { khi phi hp :
- Cc thuc c ch thn kinh trung ng khc (thuc gim au v chng ho h morphine, thuc
chng trm cm c tc dng an thn, thuc ng nhm benzodiazepines, nhm barbiturat,
clonidine v cc thuc cng h, thuc ng, methadone, thuc an thn kinh, thuc gii lo) : tng
c ch thn kinh trung ng. Vic gim tp trung v tnh to c th gy nguy him khi li xe hay
vn hnh my mc.
- Atropine v cc thuc c tc ng ging atropine (thuc chng trm cm nhm imipramine,
thuc chng lit rung c tc ng khng cholinergic, thuc chng co tht c tc ng ging
atropine, disopyramide, thuc an thn kinh nhm phenothiazine) : tng cc tc dng ngoi
ca nhm atropine nh gy b tiu, to bn, kh ming.
TC DNG NGOI
Cc c tnh dc l ca dexchlorpheniramine cng l nguyn nhn ca mt s tc dng ngoi
vi nhiu mc khc nhau v c hay khng c lin quan n liu dng (xem Dc lc) :
Tc dng trn thn kinh thc vt :
- thiu thiu hoc bun ng, nht l vo thi gian iu tr u ;
- tc ng khng cholinergic lm kh nim mc, ri lon iu tit, gin ng t, tim p nhanh,
nguy c b tiu ;
- h huyt p t th ;
- ri lon cn bng, chng mt, gim tr nh hoc kh nng tp trung ;
- mt iu ha vn ng, run ry, thng xy ra hn ngi ln tui ;
- ln, o gic ;
- him hn, ch yu nh nhi, c th gy kch ng, cu gt, mt ng.
Phn ng qu mn cm :

- ni ban, eczema, nga, ban xut huyt, m ay ;

- ph, him hn c th gy ph Quincke ;
- sc phn v ;
Tc dng trn mu : gim bch cu, gim bch cu trung tnh, gim tiu cu, thiu mu huyt
gii.
LIU LNG v CCH DNG
Vin 2 mg :
Dng cho ngi ln v tr em trn 6 tui.
- Tr em t 6-12 tui : 1/2 vin, ngy 2-3 ln.
- Ngi ln v tr em trn 12 tui : 1 vin, ngy 3-4 ln.
Cc liu cch nhau t nht 4 gi.
Vin 6 mg :
Dng cho ngi ln v tr em trn 15 tui.
1 vin, ngy 2 ln vo bui sng v ti.
Thi gian iu tr phi ngn, nn bt u iu tr vo bui ti do thuc c th gy bun ng.
QU LIU
Du hiu qu liu ca dexchlorpheniramine : co git (nht l nh nhi v tr em) ; ri lon nhn
thc, hn m.
iu tr triu chng bnh vin.

409.

POLERY

VEYRON FROMENT
c/o MARKETING SANPROMEX
Sir dnh cho ngi ln : chai 200 ml.
Sir dnh cho tr em : chai 125 ml vi bm nh liu 0,5 ml v 5 ml.
THNH PHN
cho 1 mung canh xir ngi ln
Codeine

11,8 mg

Erysimum, cao lng

443 mg

T dc : xir polygala, sodium benzoate,

methyl parahydroxybenzoate, acide
citrique khan, mi thm (benzaldehyde,
mi du, ethanol, nc), saccharose (9
g/mung canh), nc tinh khit.
Chun cn : 2% th tch/th tch.
Lng ethanol khan : 369 mg/mung canh.
cho 1 ml xir tr em
Pholcodine

1 mg

Erysimum, cao lng

29,6 mg

T dc : xir polygala, sodium benzoate,

methyl parahydroxybenzoate, acide
citrique khan, mi du (ethyl acetate,
vanilline, isoamyle acetate, acetaldehyde,
cis-3 hexenol, propylene glycol),
saccharose (0,6 g/ml), nc tinh khit.
Chun cn : 1,2% th tch/th tch.
Lng ethanol khan : 14,8 mg/mung canh.
DC LC
Thuc ho opium (R : h h hp).
Codeine : alcaloid ca opium ; thuc ho tc ng trung ng, c tc ng c ch cc trung tm
h hp.
Pholcodine : dn xut ca morphine, thuc ho tc ng trung tm, t c tc ng c ch cc
trung tm h hp hn so vi codeine.
Erysimum : tho dc c tc ng chng ho.
DC NG HC
Xir ngi ln :
Thi gian thuc t nng nh trong huyt tng vo khong 1 gi.
Thuc c chuyn ha ch yu gan, ti y xy ra cc phn ng loi gc methyl ti Oxy, loi
gc methyl ti Nit v phn ng lin hp glucuronide.
Codeine gn kt yu vi protein huyt tng (khong 25%), qua c nhau thai v sa m.
Codeine c bi tit qua thn, ch yu di dng cc cht chuyn ha lin hp glucuronide.
Cc cht ny t c i lc vi cc th th ca opium.

Thi gian bn hy trong huyt tng l 3 gi ( ngi ln).

Xir tr em :
Pholcodine c hp thu hon ton qua ng tiu ha.
Thuc ch yu c o thi qua nc tiu v c khong 30 n 50% liu dng c tm thy
di dng khng i.
CH NH
iu tr triu chng cc dng ho khan gy kh chu.
Dng xir ngi ln c ch nh cho ngi ln v tr em trn 15 tui.
Dng xir tr em c ch nh cho tr em trn 30 thng tui v nng trn 15 kg.
CHNG CH NH
- Qu mn vi mt trong cc thnh phn ca thuc.
- Suy h hp.
- Ho do hen ph qun.
- Ph n cho con b.
Xir ngi ln :
- Tr em di 15 tui.
- Cc cht ch vn - i khng morphine (buprenorphine, nalbuphine, pentazocine).
Xir tr em :
- Tr di 30 thng tui.
CH PHNG v THN TRNG LC DNG
Ch { phng :
- Thuc c cha cn (xem Thnh phn).
- Trng hp ho c m cn phi t nhin v l c ch c bn bo v phi-ph qun.
- Phi hp thuc long m hoc thuc tan m vi thuc chng ho l khng hp l.
- Trc khi k toa thuc chng ho, cn tm nguyn nhn gy ho c iu tr c hiu.
- Nu cn ho khng c ci thin vi mt loi thuc ho dng theo liu thng thng, khng
nn tng liu m cn nh gi li tnh trng lm sng ca bnh nhn.
Xir ngi ln :
- iu tr ko di liu cao c th gy l thuc thuc.
- Cn lu { cc vn ng vin th thao v trong thuc c cha thnh phn hot cht c th cho
kt qu dng tnh x t nghim kim tra doping.
Thn trng lc dng :
- Cn thn trong trng hp tng p lc ni s.
- Khng c ung ru trong khi dng thuc.
- Trng hp bnh nhn b tiu ng hoc n king cht ng, nn lu { rng thuc c cha
ng (xem Thnh phn).
- Cn lu { cc vn ng vin th thao do thuc c th cho kt qu xt nghim s dng cht

kch thch dng tnh.

- Cn lu { ngi li xe v vn hnh my mc v kh nng b bun ng khi dng thuc.
LC C THAI v LC NUI CON B
Lc c thai :
i vi codeine, cc nghin cu thc hin trn ng vt cho thy c tc ng gy qui thai. Tuy
nhin trn lm sng, cc s liu dch t hc trn mt s lng gii hn ph n khng cho thy
codeine c tc dng gy d dng no c bit. Dng liu cao codeine vo cui thai kz ngay c
ngn hn cng c th gy c ch h hp tr s sinh.
i vi pholcodine, hin cha c cc th nghim v kh nng gy qui thai trn ng vt. Trn
lm sng, cho n nay khng c ghi nhn no v tc dng gy d tt hay c tnh trn bo thai.
Tuy nhin cha th loi hn nguy c ny v s lng nghin cu cha kt lun.
Trong 3 thng cui ca thai kz, nu ngi m dng di hn codeine hay pholcodine d vi liu
lng nh th no cng c th l nguyn nhn gy hi chng cai nghin tr s sinh.
Do , ch nn dng codeine hay pholcodine trong thi gian mang thai khi tht cn thit.
Lc nui con b :
Codeine v pholcodine c bi tit qua sa m ; mt vi trng hp gim huyt p v ngng
th c ghi nhn nh nhi sau khi m dng qu liu codeine. Do thn trng, trnh dng
thuc c codeine hay pholcodine trong thi gian cho con b.
TNG TC THUC
Khng nn phi hp :
- Alcool : ru lm tng tc dng an thn ca benzodiazpine. Trnh ung ru v cc thuc c
cha alcool. Vic gim tp trung v thc cnh gic c th gy nguy him cho ngi li xe v
ang iu khin my mc.
Lu { khi phi hp :
- Cc thuc gy c ch thn kinh trung ng khc (thuc gim au morphine, mt vi thuc
chng trm cm, thuc khng histamine H1 c tc dng an thn, barbiturate, benzodiazpine,
clonidine v cc thuc cng h, thuc ng, thuc gii lo, thuc an thn kinh) : tng c ch thn
kinh trung ng c th gy nguy him cho ngi li xe v ang iu khin my mc.
- Cc dn xut khc ca morphine (gim au hay tr ho) : c ch h hp (hip ng tc dng c
ch ca morphine), nht l ngi gi.
TC DNG NGOI
Lin quan n codeine :
- liu iu tr, cc tc dng ngoi { tng t nh ca nhm opium, tuy nhin him hn v
nh hn. C th gy to bn, bun ng, chng mt, bun nn, i ma ; him hn, c th gy co
tht ph qun, d ng da, c ch h hp.
- Qu liu iu tr, c th gy l thuc thuc v hi chng ngng thuc t ngt ngi dng
thuc v tr s sinh c m b nghin codeine.

Lin quan n pholcodine :

- C th gy to bn, bun ng ; him hn, c th gy chng mt, bun nn, nn, co tht ph
qun, d ng da.
LIU LNG v CCH DNG
iu tr triu chng phi ngn hn (vi ngy) v gii hn thi im xy ra ho.
Xir ngi ln :
Dng cho ngi ln v tr em trn 15 tui.
Nu khng phi hp vi thuc khc c cha codeine hoc vi thuc chng ho tc ng trung
ng, liu codeine hng ngy khng c vt qu 120 mg ngi ln.
Liu thng thng :
Ngi ln v tr em trn 15 tui : mi ln 1 mung canh, lp li sau 6 gi nu cn, khng qu 4
ln/ngy.
Ngi gi v bnh nhn b suy gan : gim liu khi u cn phn na liu khuyn co cho ngi
ln, sau c th tng liu ln ty theo dung np v nhu cu. Cc liu phi cch nhau t nht 6
gi.
Xir tr em :
Dng cho tr em trn 30 thng tui v nng trn 15 kg.
Nu khng phi hp vi thuc khc c cha pholcodine hoc vi thuc chng ho tc ng
trung ng, liu pholcodine hng ngy khng c vt qu 1 mg/kg tr t 6 n 15 tui v
0,5 mg/kg tr t 30 thng n 6 tui.
Tr t 15 n 20 kg (khong t 30 thng n 6 tui) : mi ln 1 ml, lp li sau 4 gi nu cn,
khng qu 6 ln/ngy.
Tr t 20 n 35 kg (khong t 6 n 12 tui) : mi ln 2,5 ml, lp li sau 4 gi nu cn, khng
qu 6 ln/ngy.
Tr t 35 n 50 kg (khong t 12 n 15 tui) : mi ln 5 ml, lp li sau 4 gi nu cn, khng
qu 6 ln/ngy.
Trng hp tr b suy gan : gim liu khi u cn phn na liu khuyn co, sau c th
tng liu ln ty theo dung np v nhu cu, cc liu phi cch nhau t nht 4 gi.
QU LIU
Xir ngi ln :
Du hiu qu liu :
Ngi ln : suy h hp (tm ti, th chm), ng gt, pht ban, bun nn, nga, tht iu, ph
phi (him).
Tr em (ngng ng c khong 2 mg codeine/kg, liu duy nht) : th chm, ngng th, hp
ng t, co git, bng v sng ph mt, ni m ay, b tiu, try.
iu tr : dng naloxone, tr h hp.
Xir tr em :

Du hiu qu liu : hn m, c ch h hp, co git.

iu tr triu chng :
- trng hp c ch h hp : dng naloxone, tr h hp.
- trng hp b co git : dng benzodiazepines.

410.

POLY-PRED

ALLERGAN
hn dch nh mt : l 5 ml - Bng B.
THNH PHN
cho 1 ml
Prednisolone acetate

5 mg

Neomycine sulfate

5 mg

tng ng : Neomycine base

3,5 mg

Polymyxine B sulfate

10.000 n v

T dc khng c hot tnh : cn

polyvinyl, thimerosal, polysorbat 80,
propylene glycol, natri acetate v nc
tinh khit.
CH NH
Poly-Pred c ch nh iu tr cc ri lon v mt cn iu tr bng liu php khng vim,
v nhng bin chng mt gy ra bi tnh trng nhim trng do vi khun nhy cm i vi
Neomycine v/hoc Polymyxine, hay do mt nguy c bnh tim n nh : vim kt mc khng
mng m v vim mi mt, vim cng mc, vim kt mc khng do herpes, vim ti l v i vi
iu tr d phng tip theo phu thut mt, ly d vt, b bng nhit hay ha hc, try, rch da
hoc do chn thng mt.
CHNG CH NH
Bnh Herpes cp tnh, vim gic mc dng ui gai, bnh u b, bnh thy u v hu ht cc

bnh do virus khc ca gic mc v kt mc, lao mt, cc bnh nm mt v cc bnh nhn mn
cm vi bt kz thnh phn no ca thuc.
CH PHNG v THN TRNG LC DNG
Ch { phng :
Trong cc bnh do vi khun gy ra, hin tng nhim trng c th b che lp hoc bng pht do
tc dng ca steroid. Ko di vic iu tr ti ch bng steroid c th a n kt qu lm tng
nhn p, hu qu l bnh tng nhn p lm tn thng thn kinh th gic, nh hng n th
lc, th trng v c thy tinh th di bao sau. Nn kim tra thng xuyn nhn p. i vi
cc bnh mt khc, vic dng ko di cc corticoid ti ch gy ra mng gic mc v cng mc.
Dng cc corticoid ti ch trong cc trng hp mng gic mc v cng mc c th dn n
thng. Dng ko di c th a n kt qu l cc vi khun khng nhy cm pht trin nhanh.
Nu xy ra bi nhim th ngng s dng thuc ny v thay th liu php thch hp. Khi cc triu
chng ca tnh trng vim mt vn tn ti sau khi dng liu corticoid ko di th kh nng
nhim trng nm ca gic mc phi c lu { xem x t. Vt thng c th chm lnh do s
dng corticoid ti ch.
S dng thuc corticoid trong vic iu tr cho cc bnh nhn c tin s b herpes yu cu phi
rt thn trng. Trong cc iu kin b mng m cp tnh mt, cc corticoid c th che lp tnh
trng nhim trng hoc lm bng pht tnh trng nhim trng hin c.
Neomycine sulfate c kh nng gy mn cm da. nh hng chnh xc ca phn ng ny
cha c bit r.
Thn trng lc dng :
An ton trong vic s dng cc steroid ti ch trong thi kz c thai cha c xc lp. An ton
v hiu qu i vi tr em cha c nh gi.
LIU LNG v CCH DNG
iu tr mt : Mi 3-4 gi nh mt git hoc thng xuyn hn theo yu cu.
iu tr mi mt : Mi 3-4 gi, nh mt git vo mt, nhm mt li, chi phn tha trn mi v
mp b mi.
iu tr vng da chung quanh : Khi mt hoc mi mt ng thi b vim gm c da chung quanh
th c th nh rng ra trn b mt v cho kh.
BO QUN
Bo qun nhit 15oC-25oC, trnh bo qun ng lnh, lc k trc khi dng.

411.

POLYDEXA A LA PHNYLPHRINE

BOUCHARA
c/o TEDIS
Thuc nh mi : bnh phun 15 ml.
THNH PHN
cho 100 ml
Phnylphrine chlorhydrate

0,250 g

Dexamthasone mtasulfobenzoate sodique

0,025 g

Nomycine sulfate

1g

tng ng : Nomycine

650 000 UI

Polymyxine B sulfate

1 M UI

DC LC
Thuc nh mi Polydexa phi hp vi cc c tnh chng d ng ca dexamthasone, kh nng
khng khun ca hai loi khng sinh v tc ng gy co mch ca phnylphrine chlorhydrate.
Do c tnh khng vim, dexam thasone m tasulfobenzoate tc ng ln cc nim mc b tn
thng.
N omycine v polymyxine B c tc ng in vitro v in vivo trn cc mm bnh Gram + v Gram l tc nhn gy cc hin tng vim nhim vng xoang-mi.
Ph nyl phrine chlorhydrate cn c tc ng gy co mch, lm gim s thuyn tc mi.
CH NH
iu tr ti ch gy co mch, khng khun v khng vim trong cc bnh nim mc mi, vng
mi-hu v cc xoang.
Trng hp c biu hin nhim trng ton thn cn s dng n liu php khng sinh.
CHNG CH NH
- Khng s dng cho bnh nhn c nguy c b glaucome gc ng.
- Tr em di 30 thng tui do kh nng nhy cm ca tr em vi cc thuc ging giao cm.
- Khng dng chung vi cc IMAO do nguy c lm tng cao huyt p.
- Thn trng khi s dng nu c bnh do virus (do c hydrocortisone trong thnh phn).
- Qu mn vi mt trong cc thnh phn ca thuc, c bit vi nomycine hoc cc
aminoglycoside khc ch yu l streptomycine, kanamycine hoc gentamicine (d ng cho).
- Bnh thn (albumine niu).
- Ph n mang thai v cho con b (xem Lc c thai v Lc nui con b).

CH PHNG
- Khng dng thuc k o di do nguy c gy hiu ng ny ngc v vim mi do dng thuc.
- C th b d ng.
- C th gy chn lc chng vi khun khng.
THN TRNG LC DNG
- Khng s dng phng php Proetz.
- Khng dng dng kh dung cho ngi suy thn.
- Do c hin din ca thuc ging giao cm, cn thn trng khi dng cho bnh nhn cao huyt
p, bnh mch vnh, cng gip v tr em di 30 thng tui.
LC C THAI
Khng dng trong lc mang thai.
LC NUI CON B
Khng dng khi cho con b.
TNG TC THUC
Do c phnylphrine :
Khng nn phi hp :
- Guanthidine v cc hp cht cng h : tng tc dng cao huyt p ca phnylphrine, gin
ng t quan trng v k o di (guan thidine ngn trng lc h giao cm). Nu s phi hp
khng th trnh, cn theo di st.
TC DNG NGOI
Dng nomycine bng cch nh mi c th gy d ng vi khng sinh nhm aminoglycoside,
ngoi l c th gy cc triu chng d ng da.
LIU LNG v CCH DNG
iu tr ngn hn. Khi xt thuc, bnh xt phi thng ng.
Ngi ln : 3 n 5 ln/ngy, trong vng 5 n 10 ngy.
Tr em 30 thng n 15 tui : 3 ln/ngy trong vng 5 n 10 ngy.
Khng iu tr trn 10 ngy ; nu qu thi hn ny, cn nh gi li phng php iu tr.

412.

POLYDEXA solution auriculaire

BOUCHARA
c/o TEDIS
thuc nh tai : l m git 10,5 ml.
THNH PHN

cho 100 ml
Nomycine sulfate

1g

Polymyxine B sulfate

1 M UI

Dexamthasone mtasulfobenzoate sodique

0,100 g

DC LC
Thuc khng vim v khng sinh dng trong khoa tai.
Thuc nh tai Polydexa c tc dng nh mt tr liu ti ch v a nng do tnh cht khng vim
ca dexam thasone (ester tan trong nc), kh nng khng khun ca phi hp hai khng sinh.
Phi hp nomycine v polymyxine B cho php m rng ph khng khun trn cc mm bnh
Gram + v Gram - l tc nhn gy cc nhim trng ng tai ngoi v tai gia.
N omycine c bit c tc ng trn cc mm bnh sau : Staphylococcus aureus, Escherichia
coli, Klebsiella pneumoniae, Haemophilus influenzae.
Polymyxine c bit c tc ng trn cc mm bnh Gram -, ch yu l Escherichia coli,
Haemophilus influenzae, Klebsiella pneumoniae, Pseudomonas aeruginosa.
DC NG HC
Thuc khng i vo mu tr trng hp mng nh b rch hay xy xc (xem Ch { phng v
Thn trng lc dng).
CH NH
Vim tai ngoi mng nh cn nguyn, c bit chm bi nhim ng tai.
Vim tai gia cp va rch mng nh.
CHNG CH NH
Mn cm vi mt trong cc thnh phn ca thuc.
Thng mng nh do nhim trng hoc chn thng (xem Ch { phng v Thn trng lc
dng).
CH PHNG
Phi kim tra mng nh trc khi k toa v m bo mng nh cn nguyn vn.
Trng hp thng mng nh, dng thuc trong tai c th khin thuc tip xc vi cc cu trc
ca tai trong c th gy cc tai bin nng (ic, ri lon cn bng).
S hin din ca corticoide khng ngn chn cc biu hin d ng vi khng sinh, nhng c th
iu chnh cc biu hin lm sng ny.
Nu c cc biu hin ngoi da do qu mn vi nomycine hoc polymyxine B, sau ny nu dng
cc khng sinh ny ng tng qut s d gy d ng hn.
TC DNG NGOI

Ngoi l, c th gy d ng vi aminoside vi cc biu hin ngoi da. i vi nomycine, c th

xy ra d ng cho vi cc khng sinh cng h aminoside.
Do c hin din ca hai thnh phn c kh nng gy c tnh trn tai, trng hp mng nh b
thng : c nguy c b c tnh c tai v tin nh.
LIU LNG v CCH DNG
Lm m l thuc.
Ngi ln : ra tai (1-5 git), 2 ln/ngy, trong 6-10 ngy.
Tr em : ra tai (1 hoc 2 git), 2 ln/ngy ty theo tui, trong 6-10 ngy.
Khi ra tai, u nn gi nghing trong vi pht.
Thi gian iu tr khng nn qu 10 ngy. Qu thi hn ny, nn nh gi li phng php iu
tr.
Theo nguyn tc chung, khng nn dng di p sut.

413.

POLYGYNAX

INNOTECH
c/o ZUELLIG
vin nang mm t m o : hp 12 vin.
THNH PHN
cho 1 vin
Nomycine sulfate

35.000 UI

Polymyxine sulfate

35.000 UI

Nystatine

100.000 UI

(Dimthylpolysiloxane)

DC LC
Liu php khng sinh iu tr ti ch (ph khoa).
Phi hp ba tc ng trong c ph khng khun ch yu l ca nomycine v polymyxine B,
y l cc khng sinh cng c tc ng trn a s cc mm bnh Gram + v Gram -.
Streptocoque v vi khun k kh khng vi hai khng sinh trn.

Nystatine l mt thuc khng nm c tc ng rt hiu qu trn Candida albicans.

Dim thylpolysiloxane c tc ng bao ph, che ch nim mc m o ng thi gip cho thuc
c dung np tt ti ch.
CH NH
iu tr ti ch cc nhim trng m o v c t cung do vi trng hay hn hp (nht l nhim
Candida albicans).
CHNG CH NH
Mn cm vi mt trong cc thnh phn ca thuc.
CH PHNG
Tnh trng mn cm vi mt khng sinh khi dng ti ch c th nh hng xu n vic dng
khng sinh hoc mt khng sinh tng t theo ng ton thn sau ny.
THN TRNG LC DNG
- Khng nn iu tr lu di do c nguy c gy chn lc chng khng v nguy c b bi nhim
gy bi cc mm bnh ny.
- Do thiu s liu v mc hp thu qua nim mc ca nomycine v polymyxine B, nn khng
th loi hn kh nng gy tc dng ton thn ca thuc.
Mc du cho n nay khng c ghi nhn g v tc dng ngoi trn ton thn ca thuc, cng
nn lu { n iu ny, nht l bnh nhn b suy thn.
TC DNG NGOI
- C th b eczma d ng do tip xc, thng gp trong trng hp dng thuc di hn.
- Sang thng ecz ma c th lan ra ngoi vng iu tr.
- i vi nomycine, c th gy d ng cho vi khng sinh nhm aminoside.
- C th gy c tnh trn thn, trn tai... : iu tr ngn hn s gii hn c nguy c ny.
LIU LNG v CCH DNG
Liu lng :
iu tr ngn hn.
t 1 vin vo bui ti lc i ng, trong 12 ngy.
Cch dng :
t thuc vo su trong m o, tt nht t th nm. Nn bi thm kem nu nm Candida
lan ra m h v quanh hu mn.
Khng dng x bng pH acide.
Khng tim thuc qua ng m o, khng t bng thm bn trong khi ang iu tr.

414.

POLYTONYL

UPSA
gi bt pha thnh dung dnh ung dng cho ngi ln : gi 3 g, hp 18 gi, phn liu ring
l.
gi bt pha thnh dung dnh ung dng cho tr em : gi 1,5 g, hp 18 gi, phn liu ring l.
THNH PHN
cho 1 gi 3 g
Fructoheptonate calcium

600 mg

tng ng : Ca

49 mg

Aspartate magnesium

200 mg

tng ng : Mg

29,65 mg

Aspartate kali

95,20 mg

tng ng : K

20,66 mg

Acide ascorbique

500 mg

Pyridoxine chlorhydrate

25 mg

Nicotinamide

50 mg

T dc : vng cam S (E 110) (C.I. 15985),

hng v cam, aspartam, saccharose,
magnesium citrate khan va 1,3 g/gi.

cho 1 gi 1,5 g
Fructoheptonate calcium

300 mg

tng ng : Ca

24,5 mg

Aspartate magnesium

100 mg

tng ng : Mg

14,82 mg

Aspartate kali

47,60 mg

tng ng : K

10,33 mg

Acide ascorbique

250 mg

Pyridoxine chlorhydrate

12,5 mg

Nicotinamide

25 mg

T dc : vng cam S (E 110) (C.I. 15985),

hng v cam, aspartam, saccharose,
magnesium citrate khan va 0,68 g/gi.

DC LC
Chng mt mi c nng, suy nhc (A : h tiu ha v chuyn ha).
CH NH
Gi 3 g :
iu tr ph tr cc chng mt mi chc nng ngi ln v tr em trn 15 tui.
Gi 1,5 g :
iu tr ph tr cc chng mt mi chc nng tr em trn 6 tui.
CHNG CH NH
Thuc ny khng c dng trong nhng trng hp sau :
- Tng cm vi mt trong nhng thnh phn ca thuc.
- Tng calci huyt hoc tng calci niu.
- Si thn.
- Phi hp vi levodopa, v trong thnh phn c pyridoxine.
- Phnylctone-niu v thuc c cha aspartam.
- Si thn khi dng liu vitamine C qu 1 g.
CH PHNG v THN TRNG LC DNG
Cn phi tnh n lng calci (49 mg v 24,5 mg), magnesium (29,6 mg v 14,8 mg) v kali (20,6
mg v 10,3 mg) trong mi gi.
Trong trng hp ngi c ch n gim glucide hoc mc bnh tiu ng, cn phi tnh
n lng saccharose (1,3 g v 0,68 g) c trong mi gi vo khu phn n hng ngy.
LC C THAI v LC NUI CON B
Khng nn ung thuc ny trong thi kz mang thai.

Trnh dng thuc ny thuc ny trong thi kz cho con b.

Ni chung, trong thi kz mang thai hay cho con b, nn thn trng khi dng bt kz thuc g.
TNG TC THUC
- Lin quan n s hin din ca pyridoxine, chng ch nh phi hp vi levodopa.
- Do c hin din ca calcium, trong trng hp c phi hp vi t tracycline ng ung, nn
cch khong t nht 2 gi gia cc ln dng thuc.
- Digitalis : Nguy c lon nhp.
- Phi hp cn lu { khi dng vi thuc li tiu thiazide : nguy c tng calci huyt do gim o
thi calcium qua nc tiu.
TC DNG NGOI
mt s ngi, liu cao vitamine C (trn 1 g) c th gy ra si thn oxalat v urat v tng kh
nng tn huyt nhng ngi thiu G6PD.
LIU LNG v CCH DNG
Liu lng :
Gi 3 g :
Ch dnh cho ngi ln v tr em trn 15 tui.
Hai gi mi ngy, chia lm 2 ln, ha tan thuc vo mt t nc, tt nht l nn ung trong ba
n sng hoc n tra.
Gi 1,5 g :
Ch dnh cho tr em trn 6 tui.
1 n 3 gi mi ngy, ha tan vo mt t nc, tt nht l nn ung vo trc ba n sng
hoc n tra.
V thuc c cha vitamine C, do khng nn ung thuc vo lc chiu ti.
Cch dng :
ng ung.
Ha tan bt trong gi vo mt cc nc trc khi ung.
Thi gian iu tr :
Khng ko di qu 4 tun.
BO QUN
Bo qun nhit di 30oC.

415.

PONSTAN

PFIZER
c/o ZUELLIG
Vin nang 250 mg : v 10 vin, hp 50 v.
Vin nn bao phim 500 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Acide mfnamique

250 mg

cho 1 vin
Acide mfnamique

500 mg

DC LC
Khng vim khng stroide, gim au (M : h vn ng, G : h tit niu - sinh dc).
Acide mfnamique l mt thuc khng vim khng stroide, thuc nhm fnamate, c :
- Tc ng gim au,
- Tc ng khng vim,
- Tc ng c ch s tng hp cc prostaglandine.
DC NG HC
Hp thu : sau khi ung thuc, acide m f namique c hp thu nhanh v t nng ti a
trong huyt tng khong sau hn 2 gi. Cc nng trong huyt tng c ghi nhn l t l
vi liu dng ; khng c hin tng tch ly thuc.
Phn phi : thi gian bn hy trong huyt tng t 2 n 4 gi ; thuc c khuch tn u
tin n gan v thn trc khi n cc m khc ; acide m f namique qua c hng ro nhau
thai v c th c bi tit qua sa m di dng vt ; thuc c kh nng lin kt cao vi
protine huyt tng.
Chuyn ha : acide mfnamique v hai cht chuyn ha khng c hot tnh ca n (dn xut
hydroxymthyl v dn xut carboxyl) c chuyn ha gan di dng lin hp vi acide
glucuronique.
Bi tit : ngi, khong xp x 67% liu dng c bi tit qua nc tiu, ch yu di dng
cht chuyn ha lin hp v mt t l thp (khong 6%) di dng acide mfnamique lin hp
; 10 n 20% liu dng c bi tit qua phn trong 3 ngy, di dng dn xut carboxyl.
CH NH
- iu tr cc triu chng au t nh n trung bnh (nhc u, au rng).
- au b my vn ng.

- au bng kinh sau khi xc nh bnh cn.

- Rong kinh chc nng.
CHNG CH NH
Tuyt i :
- bit chc chn b qu mn cm vi acide mfnamique v vi cc cht c tc ng tng
t nh cc thuc khng vim khng stroide khc, aspirine.
- Lot d dy t trng ang tin trin.
- Suy t bo gan nng.
- Suy thn nng.
- Ph n ang mang thai (t thng th 6 tr i) : xem mc Lc c thai v Lc nui con b.
Tng i :
Chng ch nh tng i khi dng chung vi :
- Cc thuc khng vim khng stroide khc, k c cc salicylate liu cao, thuc chng ng
dng ung, hparine dng tim, lithium, mthotrexate liu cao v ticlopidine (xem mc Tng
tc thuc).
CH PHNG v THN TRNG LC DNG
Ch { phng :
- Do i khi c th gy cc biu hin nng d dy-rut khi dng cho bnh nhn ang c
iu tr bng thuc chng ng, nn c bit theo di s xut hin cc triu chng trn ng
tiu ha.
- Trng hp b xut huyt d dy-rut, phi ngng thuc lp tc.
- Nu xy ra tiu chy c lin quan n vic dng thuc, nn ngng iu tr.
- Phi thn trng khi s dng acide mfnamique trong cc bnh nhim khun hoc c nguy c
b nhim khun ngay c khi c kim sot tt do acide mfnamique c th lm gim kh
nng khng t nhin ca c th chng li nhim trng v che lp cc du hiu v triu chng
thng thng ca nhim trng.
- Tnh an ton v hiu qu tr em di 14 tui vn cha c xc nh.
Thn trng lc dng :
- Nu cn c th gim liu ngi ln tui.
- mt s ngi c th xy ra cn hen suyn c th do d ng vi aspirine hay vi cc thuc
khng vim khng stroide. Chng ch nh acide m f namique trong trng hp ny.
- Khi bt u iu tr, cn tng cng theo di th tch bi niu v chc nng thn nhng
bnh nhn b suy tim, suy gan hay suy thn mn tnh, nhng bnh nhn ang c iu tr
bng thuc li tiu, sau phu thut ln c lm gim th tch mu, v c bit l bnh nhn
ln tui.
Li xe v vn hnh my mc :
Dng thuc ny c th gy chng mt v ng gt.

LC C THAI v LC NUI CON B

Lc c thai :
ngi, khng c tc dng gy d dng c bit no c ghi nhn. Tuy nhin cn phi lm
thm nhiu nghin cu dch t hc kt lun chc chn l khng c nguy c ny.
Trong qu 3 ca thai kz, tt c cc thuc c ch tng hp prostaglandine u c th gy :
- trn bo thai : c tnh trn tim phi (tng p lc phi vi ng sm knh ng mch), ri
lon chc nng thn c th i n suy thn vi t nc i ;
- m v a tr : vo cui thai kz, c th ko di thi gian mu chy.
Ngoi vic phi tht gii hn khi s dng trong sn khoa v nu s dng phi tng cng theo
di, ch nn k toa thuc khng vim khng st roide trong 5 thng u ca thai kz. Chng ch
nh bt u t thng th su.
Lc nui con b :
Thuc khng vim khng st roide c bi tit qua sa m, do nn thn trng trnh k toa
cho ph n ang trong giai on nui con bng sa m.
TNG TC THUC
Dng ng thi acide mfnamique vi cc thuc c lit k di y cn phi tng cng
theo di tnh trng lm sng v sinh hc ca bnh nhn.
Khng nn phi hp :
- Thuc chng ng dng ung, hparine dng tim : tng nguy c xut huyt do thuc khng
vim khng stroide c ch chc nng ca tiu cu, ng thi tn cng ln nim mc d dy t
trng. Nu buc phi phi hp, cn theo di lm sng v sinh hc cht ch.
- Cc thuc khng vim khng stroide khc, k c cc salicylate liu cao : tng nguy c gy lo t
v xut huyt tiu ha do hip ng tc dng.
- Lithium (m t cho rt nhiu thuc khng vim khng st roide) : tng lithium huyt c th n
cc gi tr gy c, do lm gim s bi tit lithium thn. Nu cn, theo di cht ch lithium
huyt v chnh liu lithium trong thi gian phi hp v sau khi ngng dng thuc khng vim
khng stroide.
- Mthotrexate liu cao >= 15 mg/tun : tng c tnh trn mu ca mthotrexate do lm gim
s thanh thi cht ny thn.
- Ticlopidine : tng nguy c gy lo t v xut huyt tiu ha do hip ng tc dng. Nu buc
phi phi hp, tng cng theo di lm sng v sinh hc, k c thi gian mu chy.
Thn trng khi phi hp :
- Thuc li tiu : c nguy c gy suy thn cp bnh nhn b mt nc, do gim lc cu thn
tip theo vic gim tng hp prostaglandine thn. Cung cp nc cho bnh nhn v theo di
chc nng thn trong thi gian u iu tr phi hp.
- Mthotrexate liu thp < 15 mg/tun : tng c tnh trn mu ca mthotrexate do cc thuc
khng vim khng stroide ni chung lm gim s thanh thi ca cht ny thn. Kim tra

huyt hng tun trong cc tun l u iu tr phi hp. Tng cng theo di nu chc nng
thn b hng, k c mc nh, cng nh ngi ln tui.
- Pentoxifylline : tng nguy c xut huyt. Tng cng theo di lm sng v kim tra thng
xuyn thi gian mu chy.
- Zidovudine : tng c tnh trn dng hng cu do tc ng ln cc hng cu li, vi gy thiu
mu nng xy ra sau 8 ngy dng thuc khng vim khng stroide. Kim tra cng thc mu v
lng hng cu li sau 8 n 15 ngy dng thuc khng vim khng stroide.
Lu { khi phi hp :
- Thuc tr cao huyt p nh thuc chn bta, thuc c ch men chuyn, thuc li tiu (do suy
lun t indomtacine) : lm gim hiu lc ca thuc tr cao huyt p do thuc khng vim
khng stroide c ch cc prostaglandine gy gin mch.
- Dng c t trong t cung : cn ang tranh ci v kh nng c th lm gim tc dng ca dng
c t trong t cung.
- Thuc lm tan huyt khi : tng nguy c xut huyt.
TC DNG NGOI
Tc dng trn d dy rut :
Thng gp mt s ri lon trn d dy rut nh tiu chy, bun nn km theo i hoc khng,
au d dy, mt s trng hp nng cn phi ngng thuc ; chn n, nng, y hi, to bn,
lo t ng tiu ha c xut huyt hoc khng. Trng hp gy xut huyt xy ra thng hn
khi dng liu cao.
Ung thuc trong ba n s lm gim kh nng xy ra cc tc dng ngoi ; mc xy ra tc
dng ngoi { c lin quan n liu lng, v thng s gim khi gim liu v c th ngay sau khi
ngng thuc.
Phn ng qu mn :
- trn da : ban, mn, nga...
- ng h hp : c th xy ra cn hen ph qun mt s ngi, nht l nhng ngi b d ng
vi aspirine v cc thuc khng vim khng stroide khc.
Tc dng trn thn : suy thn vi hoi t nh thn c ghi nhn mt s ngi ln tui v
b mt nc. Hn hu c th gp : i ra mu v kh tiu tin.
Tc dng trn c quan to mu :
Nhng trng hp thiu mu huyt gii do t min c ghi nhn sau khi dng lin tc
acide mfnamique trn 12 thng, thng s t hi phc khi ngng thuc.
Cng ghi nhn thy : gim h matocrite trn 2 n 5% bnh nhn trng hp dng ko di ;
ngoi l : gim bch cu, tng bch cu i toan, ban xut huyt tiu cu, mt bch cu ht, gim
huyt cu ton th, gim sn ty.
Tc dng trn h thn kinh trung ng : chng mt, ng gt, cng thng, nhc u, ri lon th
gic.

Cc tc dng khc : nga mt, au tai, ra nhiu m hi, bt thng chc nng gan nh, tng
nhu cu v insuline bnh nhn b tiu ng, nh trng ngc, kh th v mt kh nng nhn
mu (hi phc khi ngng thuc).
LIU LNG v CCH DNG
Dng cho ngi ln v tr em trn 12 tui :
iu tr au : 0,75 n 1,5 g/ngy, chia lm 3 ln.
Gim liu cho ngi ln tui.
iu tr au bng kinh : 1,5 g/ngy, chia lm 3 ln.
iu tr rong kinh chc nng : 1,5 g/ngy chia lm 3 ln ung ngay ngy u tin ca chu kz cho
n khi kinh nguyt bnh thng tr li, khng dng qu 5 ngy.
Thuc c ung vi mt ly nc, trong cc ba n.
QU LIU
Chuyn ngay lp tc n bnh vin.
Ra d dy.
Dng than hot tnh lm gim s hp thu ca acide mfnamique.
iu tr triu chng.

416.

POSTINOR

GEDEON RICHTER
vin nn 0,75 mg : hp 4 vin.
THNH PHN
cho 1 vin
Levonorgestrel

0,75 mg

DC LC
Levonorgestrel l mt progestogen c ch s bm ca trng vo ni mc t cung, kch thch s
chuyn ng ca vi t cung, v lm tng nht ca nim mc t cung. Dng vo gia chu kz
kinh Postinor c ch rng trng.
CH NH
Thuc nga thai ung c bit cho ph n giao hp khng thng xuyn, nn dng thm cc
thuc nga thai kt hp dng lin tc.
CHNG CH NH

Mang thai hay nghi ng mang thai, xut huyt m o khng r nguyn nhn, bnh gan v
thn, vng da khi mang thai, c tin s ung th v, bung trng v t cung.
CH PHNG v THN TRNG LC DNG
Nn cn thn khi dng vi bnh nhn c tin s suyn, suy tim, cao huyt p, nhc na u,
ng kinh, suy thn, tiu ng, tng lipid huyt, trm cm v vim tnh mch huyt khi ko
di, ri lon nghn mch huyt khi v xut huyt no.
Trong trng hp nn hay tiu chy nn dng thm cc phng php nga thai khc (khng
hormon).
TNG TC THUC
Dng ng thi vi ampicillin, rifampicin, tetracyclin, chloramphenicol, neomycin,
sulphonamide, barbiturate, v phenylbutazone c th lm gim tc dng nga thai, do nn
dng thm cc phng php nga thai khc (khng hormon).
TC DNG NGOI
Tc dng ngoi { thng xuyn nht l bun nn, rong huyt xy ra sau 2, 3 ngy dng thuc,
ri ngng ngay. Trong trng hp xut huyt ko di, nn khm ph khoa. Him khi cng v v
nhc u xy ra.
LIU LNG v CCH DNG
Mt vin trong vng 1 gi sau khi giao hp. Khi giao hp nhiu ln, ung thm 1 vin na sau 8
gi ung vin th nht. Thng thng dng 1-2 vin nhng khng qu 4 vin/thng.
Nu cn dng nhiu hn, nn dng thm cc phng php nga thai khc.
BO QUN
Bo qun nhit phng (15-30oC).

417.

PREDIAN

SANOFI SYNTHELABO VIETNAM

Vin nn d b 80 mg : v 10 vin, hp 10 v - Bng B.
THNH PHN
cho 1 vin
Gliclazide

80 mg

DC LC
Gliclazide l sulfamide h ng huyt, v phng din dc l c 2 tc dng : tc dng trn s
chuyn ha v trn vi mch.

Nhng tnh cht trn s chuyn ha :

Predian l tc nhn kch thch bi tit insuline v lm tng tc dng bi tit insuline ca glucose.
Predian lm tng p ng ca ty tng v ti lp li nh bi tit sm insuline sau khi n.
Nhng tnh cht trn vi mch :
- Predian lm gim s kt dnh v s ngng tp ca tiu cu, lm bnh thng ha hot ng
phn hy fibrine.
- Trong bnh l vng mc do tiu ng : Predian lm chm s tin trin ca bnh l vng mc
do tiu ng giai on khng tng sinh.
- Trong bnh l thn do tiu ng : dng di lu Predian khng nhng khng gy ra nhng
bin i trn chc nng thn, m cn lm gim tiu protine song song vi s kim sot tt
huyt p v ng huyt.
DC NG HC
Predian nhanh chng c hp thu qua d dy-rut v t nng ti a trong mu trong
khong gi th 2 v th 6. Gn 94,2% trn protine huyt tng.
Thi gian bn hy sinh hc trung bnh l 12 gi.
Chuyn ha : cht chuyn ha chnh chim 2-3% liu dng v khng c hot tnh h ng
huyt nhng li c nhng tnh cht sinh ha-mu.
Thi tr ch yu qua thn : di 1% liu ung vo c tm thy di dng khng i trong
nc tiu.
CH NH
Predian c dng trong cc trng hp tiu ng thc s cn n cc thuc iu tr tiu
ng ng ung : tiu ng khng nhim ctone-acide, tiu ng khng ph thuc
insuline ngi ln v ngi gi, khi ch bng ch n khng thit lp s cn bng
ng huyt.
C th kt hp Predian vi insuline trong iu tr tiu ng l thuc insuline, nhng cn phi
theo di k bnh nhn trong trng hp ny.
CHNG CH NH
- Tiu ng tr em, tiu ng ngi tr.
- Nhim ctone nng, nhim toan.
- Tin hn m v hn m do tiu ng.
- Suy thn nng.
- Suy gan nng.
- Tin s d ng vi sulfamide.
- Kt hp vi miconazole.
- Ph n mang thai.
CH PHNG v THN TRNG LC DNG
C th dng kt hp Predian vi cc thuc chng ng mu, nhng phi tng cng kim tra

sinh hc.
Trng hp suy thn, gim liu dng hoc ngng s dng mi thuc ung.
H ng huyt c th xy ra, do :
- cho thuc khng ng, khi tiu ng c kim sot ch bng ch n ;
- dng qu liu, nht l trn nhng bnh nhn ln tui ;
- n ung khng y hay ch n b mt cn bng carbone hydrate ;
- suy thn v/hay suy gan nng.
TNG TC THUC
- Chng ch nh kt hp vi cc sulfamide h ng huyt khc, vi dng ung ca miconazole
do lm h ng huyt nng (hn m).
- Gim hot tnh ca cc thuc barbiturate.
- Mt s thuc lm tng ng huyt : corticoide, thuc li tiu...
TC DNG NGOI
- Xo trn tiu ha : nn, bun nn, to bn, tiu chy.
- Cc phn ng d ng da-nim, c bit l nga sn, pht ban, m ay, gim khi ngng iu tr.
- Ri lon v huyt hc : nhn chung c hi phc nh gim tiu cu, mt bch cu ht hay gim
bch cu, thiu mu.
LIU LNG v CCH DNG
Trong tt c cc th tiu ng khng kim sot c ch bng ch n.
Tiu ng mp ph :
Trong phn ln cc trng hp : 2 vin/ngy, chia lm 2 ln.
Nhng liu lng ca Predian rt linh ng v c th iu chnh trong tt c cc trng hp :
- 1 vin trong nhng th tiu ng nh ;
- 3 vin trong nhng th tiu ng nng hn.
Khi cn iu tr thay th : ngng iu tr thuc cn thay th trc, sau mi k toa Predian.
Cht lng iu tr lin quan cht ch vi gim th trng.
Tiu ng vi th trng bnh thng, khng thiu insuline :
Theo ui ch n, sau mi dng Predian. Trong a s trng hp : 2 vin/ngy, chia lm
2 ln.
Liu lng ca Predian rt mm do v c th iu chnh trong tt c cc trng hp (xin xem
tiu ng mp ph).
QU LIU
Qu liu do tai bin hay do t ch yu biu hin bng hin tng h ng huyt.
Trong trng hp nng, nu nh c ri lon thc : tim tnh mch ngay tc th glucose u
trng 10 hay 30%, sau a bnh nhn nhanh chng n bnh vin.
BO QUN
Gi ni kh mt, nhit khng qu 25oC.

418.

PREVACID

TAKEDA
c/o MEGA PRODUCTS
vin nang tan trong rut 30 mg : v 10 vin, hp 30 vin.
THNH PHN
cho 1 vin
Lansoprazole

30 mg

DC LC
Thuc chng lot.
Lansoprazole l mt cht c ch chuyn bit bm proton (H+ K+) ATPase ca t bo thnh d
dy.
Nh vo c ch tc ng trn pha cui cng ca s bi tit, lansoprazole lm gim s bi tit
acide cho d ngun gc ca s kch thch bi tit acide l th no i chng na. Ung liu duy
nht mi ngy 30 mg, lansoprazole gy c ch nhanh v hu hiu trn s bi tit acide d
dy.
Mc lnh so ni soi ca lot t trng l 75% trong 2 tun l v 95% trong 4 tun l ; mc
ny i vi vim thc qun ng tiu ha l 80% sau 4 tun l iu tr v 95% sau 8 tun l.
DC NG HC
Hp thu v phn phi :
Lansoprazole b phn hy trong mi trng acide, do thuc c bo ch di dng vi nang
tan trong rut.
Hp thu nhanh, nng ti a t n sau khong 1 gi 30.
Dng ng thi vi thc n s lm gim kh dng sinh hc ca thuc, tuy nhin khng lm
thay i tc dng ca thuc trn s c ch bi tit acide.
97% lansoprazole lin kt vi protine huyt tng.
Chuyn ha v o thi :
Thi gian bn hy trong huyt tng khong 1,4 gi. Thi gian ny khng b bin i trong thi
gian iu tr.
Lansoprazole c o thi hon ton sau khi c bin i sinh hc ch yu gan.
Cc sn phm chuyn ha ca lansoprazole khng c hot tnh cng nh khng c c tnh,
c o thi ch yu mt. Tc ng dc l ca thuc khng thay i ngi ln tui, tuy

nhin c thay i ngi b suy gan (xem mc Ch { phng v Thn trng lc dng).
CH NH
- Lot t trng tin trin.
- Vim thc qun do tro ngc d dy-thc qun (c xc nh qua ni soi vi nhng vt
st v lot).
- Lot d dy tin trin.
- Hi chng Zollinger-Ellison.
- Lot d dy - t trng do nhim Helicobacter pylori.
CH PHNG
Cng nh cc thuc chng tit d dy khc, lansoprazole c th thun li cho s pht trin vi
khun trong d dy bi v gim th tch v tnh acide ca dch v.
THN TRNG LC DNG
- bnh nhn suy gan : sau khi dng liu duy nht bnh nhn b x gan, phn din tch di
ng cong c tng ln, s o thi chm ; cn phi iu chnh liu.
- tr em : hiu lc v mc dung np thuc cha c kho st.
- ngi gi : khng cn thit phi iu chnh liu do khng ghi nhn thy c tng cc tc dng
ngoi khi dng lansoprazole.
LC C THAI
Tnh v hi cha c xc nh khi dng cho ph n c thai, tuy nhin, cc kho st trn ng
vt cho thy thuc khng gy qui thai v c tnh trn phi thai. Do thn trng, khng nn
dng thuc trong thi kz c thai.
LC NUI CON B
Chng ch nh do thiu kho st vic thuc c i qua sa m hay khng. Trong trng hp bt
buc phi s dng th phi ngng cho con b.
TNG TC THUC
+ Cc thuc p d dy-rut : Thn trng khi phi hp v c th lm gim hp thu. Nu s dng
cch khong 1 gi th khng nh hng n hp thu ca thuc.
TC DNG NGOI
Lansoprazole thng c dung np tt.
Him gp ri lon nhu ng rut (tiu chy, bn) bun nn, nhc u. Cc ri lon ny thng
l tm thi, khng nng v khng cn phi ngng dng thuc.
LIU LNG v CCH DNG
n Lot t trng tin trin : 1 vin/ngy trong 4 tun.
n Vim thc qun do tro ngc d dy-thc qun : 1 vin/ngy trong 4 tun, c th dng tip
trong 4 tun nu cn thit.
n Lot d dy tin trin : 1 vin/ngy trong 4 tun, c th dng tip trong 2 n 4 tun nu cn
thit.

n Hi chng Zollinger-Ellison : 1-2 vin/ngy. Thi gian iu tr ty thuc vo p ng bnh l.

n Lot d dy - t trng do nhim Helicobacter pylori : 1 vin x 2/ngy phi hp vi 2 khng sinh
khc nh amoxicilline 1 g x 2/ngy + clarithromycine 500 mg x 2/ngy hoc metronidazole.
QU LIU
Khng c tr liu chuyn bit, ch gii hn iu tr triu chng

419.

PRIMOLUT-NOR

SCHERING AG
c/o ZUELLIG
Vin nn 5 mg : hp 20 vin - Bng B.
THNH PHN
cho 1 vin
Norethisterone acetate

5 mg

CH NH
Xut huyt do ri lon chc nng, v kinh nguyn pht hoc th pht, hi chng tin kinh
nguyt, bnh tuyn v, iu kinh, lc ni mc t cung, carcinoma v tin trin.
CHNG CH NH
C thai, ri lon chc nng gan, hi chng Dubin-Johnson, hi chng Rotor, hoc ang c u
gan (trong ung th v tin trin, u gan l chng ch nh khi l ung th nguyn pht), tin s
vng da hoc nga nhiu khi mang thai, tin s herpes khi c thai, bnh tc mch do huyt
khi.
CH PHNG
Cc l do cn phi ngng dng thuc ngay lp tc : Cn nhc u migraine xy ra ln u tin
hoc nhc u d di bt thng xy ra nhiu ln, ri lon gic quan t pht (nh ri lon th
gic hoc thnh gic), du hiu u tin ca vim tnh mch huyt khi hoc c triu chng
thuyn tc do huyt khi (nh au hoc sng chn, au nhi khng r nguyn nhn khi th hay
ho) cm gic au hoc tc ngc, tin phu (trong vng 6 tun ti) v nm bt ng (chng hn
nh sau tai nn), mi b vng da, khi pht vim gan, nga ton thn, tng huyt p, c thai,
tng calci-huyt ( ph n b ung th v).
THN TRNG LC DNG
Trc khi bt u iu tr vi Primolut-Nor, nn khm tng qut th trng v ph khoa (bao
gm khm v v pht t bo c t cung) v phi khng c thai. Nn khm kim tra nh kz
khong 6 thng khi dng thuc di ngy.

Phi thng bo cho bc s nu bnh nhn b i tho ng v bnh ny cn c theo di cn

thn. Thuc c th lm thay i nhu cu thuc ung chng i tho ng hoc insulin.
Kt qu nguyn cu dch t hc kt lun rng cn ch khi s dng estrogen ung v/hoc
thuc c ch rng trng cha progestogen do t l gia tng chng thuyn tc do huyt khi.
Mc d Primolut-Nor khng cha estrogen, nn phng kh nng nguy c thuyn tc do
huyt khi, c bit khi c tin s bnh thuyn tc do huyt khi hay i tho ng nng c
tn thng mch mu hoc bnh thiu mu hng cu hnh lim.
Trong mt s him trng hp u gan lnh tnh v hn hu hn l u gan c tnh, thy vi
trng hp c th dn n xut huyt nng trong bng sau khi dng cc ni tit t nh
norethisterone. Do , phi bo cho bc s khi b au vng bng trn ko di.
TNG TC THUC
Nhu cu thuc tiu ng ung v insulin c th thay i.
TC DNG NGOI
Trong mt s him trng hp c th xy ra bun nn.
LIU LNG v CCH DNG
Nut trn vin thuc vi nc.
Ngoi tr c ch nh khc ca bc s, nn dng thuc theo phc sau :
Xut huyt t cung do ri lon chc nng :
Ung mi ln mt vin 5 mg, ngy 2 ln trong 10 ngy s ngng xut huyt khng km theo
sang thng thc th trong vng 1-4 ngy. Trong mt s trng hp c bit, xut huyt s
gim bt vi ngy u sau khi dng thuc v ngng vo khong 5-7 ngy sau. iu tr hon
ton, nn ung Primolut-Nor u n ngay c khi ngng xut huyt (cho n khi dng tng
cng 20 vin nn 5 mg). Xut huyt ging nh kinh nguyt v mc cng nh thi gian ko
di s xy ra khong 2-4 ngy sau khi ngng thuc.
Xut huyt nh trong qu trnh ung thuc : i khi, c th c xut huyt nh sau khi t xut
huyt ht. Khng c ngng thuc trong trng hp ny.
Khng ngng xut huyt, xut huyt t : Nu xut huyt khng ngng c mc d ung
thuc u n, nn xem x t n mt nguyn nhn thc th. Phi thng bo ngay cho bc s
iu tr bit s kin ny v trong hu ht cc trng hp, cn p dng thm cc bin php tr
liu ngay sau . iu ny cng nn thc hin trong trng hp trong t dng thuc m vn
cn xut huyt kh nhiu sau t ngng xut huyt.
D phng ti pht : ngn nga ti pht xut huyt t cung do ri lon chc nng, nn dng
Primolut-Nor d phng trong 3 chu kz tip theo, ngha l mt vin 5 mg hai ln mi ngy t
ngy th 19-26 ca chu kz (ngy th nht ca chu kz l ngy u ca t xut huyt va qua).
Xut huyt do ngng thuc s xy ra vi ngy sau khi ung vin thuc cui cng.
Ch c bc s mi c th quyt nh khi no cn p dng iu tr ny. Quyt nh iu tr da
trn qu trnh theo di thn nhit c bn o hng ngy.

V kinh nguyn pht v th pht :

Trong trng hp v kinh th pht, nn sm iu tr ni tit trong vng tm tun sau kz kinh
nguyt cui cng.
gy xut huyt ging kinh nguyt, dng mt estrogen (chng hn nh Progynon Depot 10
mg) trc khi ung Primolut-Nor.
Tuy nhin, trc khi bt u iu tr, nn loi b kh nng c khi u tuyn yn bi tit prolactin
do theo hiu bit hin nay, khng th loi tr kh nng u tuyn ln (macroadenomas) gia tng
kch thc vi liu cao estrogen dng ko di.
Bt u iu tr : tim bp hai ng Progynon Depot 10 mg vo ngy th nht ca iu tr v 1
ng Progynon Depot 10 mg vo ngy th 14, tip theo ung 1 vin Primolut-Nor 5 mg hai ln
mi ngy t ngy iu tr th 19 n ngy th 26.
Xut huyt s bt u vo khong ngy th 28.
Tip tc iu tr (trong t nht 2-3 chu kz) nh sau : tim bp 1 ng Progynon Depot 10 mg vo
ngy th 6 v 16 ca kz kinh nhn to, tip theo l 1 vin Primolut-Nor 5 mg mi ngy t
ngy th 19-26 ca chu kz (ngy u xut huyt l ngy u ca chu kz).
Nn th ngng dng estrogen v gy xut huyt theo chu kz bng cch ung mi ngy mt vin
Primolut-Nor 5 mg t ngy th 19-26 ca chu kz.
Ngoi l : Bnh nhn xc nh c l b thiu ht sn xut estrogen ni sinh (v kinh
nguyn pht do lon tuyn sinh dc).
Ghi ch : Nn p dng nga thai vi phng php khng dng ni tit t (vi ngoi l l khng
dng phng php tnh theo chu kz kinh nguyt v phng php theo di thn nhit). Nu
khng thy xut huyt theo nhng khong thi gian u n khong 28 ngy trong qu trnh
iu tr, nn xem x t n kh nng c thai, k c khi p dng nhng bin php phng nga.
Nn ngng iu tr cho n khi c kt qu chn on phn bit r rng.
Hi chng tin kinh nguyt, bnh tuyn v :
C th lm gim nh cc triu chng tin kinh nguyt nh nhc u, trm cm, nc, cng v
bng cch ung 1 vin Primolut-Nor mi ngy 1-2 ln, t ngy 19-26 ca chu kz.
Cc nhn xt phn Ghi ch v ch nh ca v kinh nguyn pht v th pht cng p dng
c cho ch nh ny.
n nh ngy hnh kinh :
C th di kz kinh gn hn hay hon i mt thi gian trong nhng trng hp cn thit c
bit. Tuy nhin, vic di kz kinh gn hn vi kt hp progestogen-estrogen thng c la
chn nhiu hn do kh nng c thai hu nh b loi b bi s c ch rng trng.
Ngc li, hon kz kinh cn s dng Primolut-Nor ti thi im kh ngn nga kh nng c
thai, do Primolut-Nor phi c s dng ti thi im khng th ngn cn vic c thai, vy vic
c thai phi c loi tr bng cc phng php hin hnh. Do , phng php ny cn gii
hn trong nhng trng hp khng c kh nng c thai sm trong chu kz kinh ang c iu

tr.
Liu lng : Mt vin nn 5 mg hai ln mi ngy trong khong thi gian khng qu 10-14 ngy,
bt u 3 ngy trc kz kinh d tnh. Xut huyt s xut hin 2-3 ngy sau khi ngng thuc.
Nu khng c xut huyt, phi i khm bc s.
Lc ni mc t cung :
iu tr bt u vo ngy th 5 ca kz kinh vi mt vin 5 mg hai ln mi ngy, gia tng n hai
vin 5 mg hai ln mi ngy nu thy c vt xut huyt. Khi ngng xut huyt, c th dng li
liu ban u. Thi gian iu tr t nht l 4-6 thng. Trong qu trnh iu tr s khng c kinh v
khng rng trng. Sau khi ngng iu tr ni tit, s xy ra xut huyt do ngng thuc.
Ung th v tin trin :
Cc th nghim lm sng chng minh rng Primolut-Nor c th nh hng ln ung th v
tin trin.
Liu lng do bc s ch nh c th thay i khc nhau ty tng trng hp v phi c trit
chp hnh.

420.

PRIMPRAN

SANOFI SYNTHELABO VIETNAM

vin nn d b 10 mg : hp 40 vin - Bng B.
dung dch tim bp, tnh mch 10 mg/2 ml : ng 2 ml, hp 12 ng - Bng B.
THNH PHN
cho 1 vin
Mtoclopramide chlorhydrate khan

10 mg

cho 1 ng
Mtoclopramide chlorhydrate khan

10 mg

DC LC
Kch thch s vn ng ng tiu ha.
Mtoclopramide : thuc an thn kinh c tc ng i khng vi dopamine, ngn nga triu
chng bun nn do c ch cc th th dopaminergic.

DC NG HC
Hp thu : trng hp dng bng ng ung, m toclopramide c hp thu nhanh qua ng
tiu ha. Sinh kh dng ca thuc vo khong 50% i vi dng vin.
Chuyn ha : m toclopramide t c chuyn ha.
Phn phi : m toclopramide c phn phi rng n cc m. Th tch phn phi t 2,2 n
3,4 l/kg. Thuc t gn vi protine huyt tng. Thuc qua c nhau thai v sa m.
Bi tit : mtoclopramide ch yu c o thi qua nc tiu di dng t do hay sulfonyllin hp. Thi gian bn hy o thi t 5 n 6 gi v tng trong trng hp bnh nhn b suy
gan hay suy thn.
CH NH
Cc biu hin kh tiu do ri lon nhu ng rut.
iu tr triu chng bun nn v i ma.
Chun b cho mt vi xt nghim ng tiu ha (dng tim).
CHNG CH NH
Trong trng hp m s kch thch vn ng d dy - rut c kh nng gy nguy him : xut
huyt d dy - rut, tc rut c nng hay thng ng tiu ha.
Bnh nhn c biu hin ri lon vn ng mun do thuc an thn kinh hay do mtoclopramide.
i tng c bit r hoc nghi ng b u t bo a crm (nguy c gy cn kch pht cao huyt
p).
Tin cn vim hoc chy mu trc trng.
CH PHNG v THN TRNG LC DNG
Ch { phng :
Cc tc dng ngoi trn thn kinh (hi chng ngoi thp) c th xy ra, c bit l tr em v
thanh nin (xem phn Tc dng ngoi ).
Trng hp b nn thuc mt phn hoc ton b, vn gi khong cch liu trc khi dng tr
li.
Trng hp nn ma nhiu, phi nga nguy c mt nc. B nc thng bng ng ung
vi dung dch "ng-mui" v cho ung nhiu ln, mi ln mt t.
Thn trng lc dng :
Khng nn ch nh thuc ny cho bnh nhn ng kinh (c th gia tng tn s v cng ca
cn ng kinh).
Nn gim liu ngi suy gan, suy thn.
Lu { cc i tng iu khin phng tin giao thng v my mc v kh nng b ng gt khi
dng thuc.
LC C THAI
loi vt : khng c tc dng sinh qui thai.
ngi : cho n nay khng thy c tc dng sinh qui thai liu thng thng.

LC NUI CON B
Vn c th cho con b nu ch dng thuc c tnh tm thi (v d nh chng nn sau phu
thut Csar) vi iu kin l tr phi sinh thng v c sc khe tt. Trng hp tr sinh
thiu thng hay dng thuc liu cao hay ko di th khng nn cho con b.
TNG TC THUC
Chng ch nh phi hp :
- L vodopa : do c i khng tng tranh gia lvodopa v thuc an thn kinh.
Khng nn phi hp :
- Alcool : ru lm tng tc dng an thn ca thuc an thn kinh. Vic gim s tp trung c th
gy nguy him khi li xe hay iu khin my mc. Trnh ung ru v cc thuc c cha ru.
Lu { khi phi hp :
- Thuc cao huyt p : tng tc dng h huyt p v c th gy h huyt p t th (do hip ng
tc dng).
- Cc thuc c ch thn kinh trung ng khc : thuc chng trm cm c tc dng an thn,
thuc khng histamine H1 c tc dng an thn, barbiturate, thuc an thn gii lo u, clonidine
v cc thuc cng h, thuc ng, m thadone : tng c ch thn kinh trung ng, c th gy hu
qu xu, nht l khi phi li xe hay iu khin my mc.
TC DNG NGOI
Ng gt, mt mi, chng mt, him khi nhc u, mt ng, tiu chy, h huyt p, chy m hi
va.
Cc triu chng ngoi thp thng ht khi ngng iu tr.
Ri lon vn ng mun khi iu tr ko di.
Tc dng ni tit : tng prolactine mu, v kinh, tng tit sa, v to n ng.
Vi trng hp gy methmoglobine huyt tr s sinh.
LIU LNG v CCH DNG
Ngi ln :
ng ung : 1/2-1 vin 10 mg, 3 ln/ngy trc cc ba n, cch khong t nht 6 gi gia cc
ln ung.
ng tim : 1 mi tim bp hoc tnh mch, c th lp li nu cn thit, 2-10 mg/kg/24 gi.
Tr em :
ng ung : tr em vi cn nng > 20 kg, 4 mg/kg/ngy (1 vin 10 mg/20 kg/ngy) chia lm 4
ln.
Suy thn nng : gim liu.
QU LIU
Khng gy t vong trong cc trng hp s dng liu qu cao hay vi mc ch t t. Mt s
ri lon nhn thc trung bnh v hi chng ngoi thp c ghi nhn.
Cp cu :

Trng hp hi chng ngoi thp c lin quan hoc khng c lin quan n qu liu, vic iu
tr ch gii hn iu tr triu chng. tr em, khuyn co dng benzodiazepine.
Trng hp b methemoglobine, truyn chm dung dch xanh methylene liu 1 mg/kg c ghi
nhn l c hiu qu.

421.

PRO-DAFALGAN 1 g UPSA

UPSA
bt pha tim bp, tnh mch v tim truyn tnh mch 1 g : hp 2 l bt + 2 ng dung mi 5 ml.
bt pha tim bp, tnh mch v tim truyn tnh mch 1 g : hp 5 l bt + 5 ng dung mi 5 ml.
THNH PHN
cho 1 n v
Propactamol chlorhydrate

1g

ng dung mi : Citrate trisodique 100 mg,

nc ct pha tim va 5 ml

DC LC
Gim au, h st.
DC NG HC
Propactamol l mt tin cht sinh hc ca paractamol. Cht ny c thy phn nhanh
chng bi cc estrase trong huyt tng v gii phng paractamol ngay sau khi chm dt
thao tc tim tnh mch hoc tim bp. S chuyn ha ca propac tamol cng chnh l s
chuyn ha ca paractamol.
Chuyn ha gan : parac tamol c chuyn ha theo 2 ng v c o thi trong nc
tiu di dng lin hp glucuronic (60-80%) v lin hp sulfonic (20-30%), v di 5% di
dng khng i. Mt phn nh (< 4%) c chuyn ha di tc dng ca cytochrome P450
thnh cht chuyn ha, cht ny sau c kh c nhanh chng bi glutathion. Trng hp
ng c do dng liu cao, lng cht chuyn ha ny tng ln.
CH NH
iu tr triu chng cn au :
- trong phu thut, c bit giai on hu phu,

- trong khoa ung th.

iu tr triu chng st trong cc bnh nhim trng, bnh c tnh, khi cc ng dng khc
(nht l ng ung) khng thch hp.
CHNG CH NH
Tuyt i :
- Tng cm vi propactamol.
- Nghi ng c d ng vi propactamol nhng ngi thao tc propactamol, nht l nhng
nhn vin y t tip xc vi thuc ny m li c chm do tip xc.
- D ng vi paractamol hoc mt trong nhng thnh phn ca thuc.
- Suy t bo gan.
- ang iu tr bng thuc chng ng mu (nguy c gy bc mu nh i vi tt c cc thuc
tim bp).
Tng i :
- C thai 3 thng u.
CH PHNG v THN TRNG LC DNG
- iu tr bng thuc tim ny cn c thay th ngay khi c th dng paractamol bng ng
ung.
- c bo co v chm do d ng cc nhn vin y t sau khi pha ch thuc ny.
l do khi ha tan bt thuc propactamol bng dung mi th c nhng git nh dung dch
thuc c th b phng ra khi l do tng p lc khi rt kim tim.
Nh vy :
Phi eo gng tay khi pha thuc.
- Nu thiu h thng bm ht thuc th khng nhn vin thao tc pha thuc nu ngi
c tin s eczema khi tip xc vi propactamol.
Hn na, dng thuc ngi mn cm vi thuc s c nguy c tai bin d ng (chm lan ta,
nga nhiu ni, thm ch ph Quincke).
TC DNG NGOI
Thuc ny c th gy mt s tc dng t nhiu kh chu ngoi t nng n nh i vi mt s
ngi.
- Pht ban v/hoc phn ng d ng c th xy ra mt s him cc trng hp.
- c bit c th c nhng thay i sinh hc nh t l thp bt thng ca tiu cu (phn nh
chy mu cam, chy mu li).
- C th gp nhng tc dng ngoi { do ng dng thuc : chng mt, kh , gim huyt p
nh sau khi tim tnh mch, hoc au ti ch tim.
- Trng hp chm do tip xc ( tay, cnh tay, c, mt) do mn cm vi propac tamol
c ghi nhn trn nhn vin y t sau khi thao tc pha ch thuc c bit khi thuc c th b
phng ra khi l.

- Nhng trng hp phn ng d ng nng c ghi nhn khi s dng propactamol trn
nhng nhn vin y t trc mn cm trong thi gian thao tc propactamol.
LIU LNG v CCH DNG
1 g propactamol phng thch 0,5 g paractamol. Tim bp hoc tim tnh mch trc tip (1
n 2 pht) hoc tim truyn tnh mch (125 ml dung dch ng trng, hoc glucose 5% hoc
NaCl 0,9%, trong 15 pht). Cc ln dng phi c cch khong t nht 4 gi.
Dnh cho ngi ln v tr em >= 17 kg.
Tr em : 30 mg/kg cho mi ln tim. Khng vt qu liu ti a l 120 mg/ngy propac tamol,
ngha l 60 mg/kg paracetamol.
Ngi ln : 1-2 g, 2 n 4 ln/ngy, khng dng qu 6 g/ngy, ngoi l c khi n 8 g/ngy.
Suy thn nng (thanh thi cr atinine di 10 ml/pht) : khong cch gia 2 ln dng ti thiu
phi l 8 gi.
QU LIU
- Triu chng : bun nn, i ma, chn n, xanh xao, au bng trong vng 24 gi u.
Dng liu qu cao, trn 10 g paractamol ngi ln (liu thp hn ngi nghin ru) v
trn 150 mg/kg tr em, dng mt liu, c th gy phn hy t bo gan a n hoi t hon
ton v khng hi phc, nhim toan chuyn ha, bnh l no dn n hn m hoc t vong.
- X tr cp cu :
Chuyn ngay n bnh vin.
Dng cng sm cng tt cht gii c N- actylcystine ung hoc tim tnh mch : 140 mg/kg
ln u, sau l 70 mg/kg/4 gi trong 3 ngy.

422.

PROCTOLOG

PFIZER
c/o ZUELLIG
kem bi trc trng : tube 20 g.
ta dc : hp 10 ta dc.
THNH PHN
cho 100 g
Trimbutine

5,8 g

Ruscognines

0,5 g

cho 1 ta dc
Trimbutine

120 mg

Ruscognines

10 mg

DC LC
Thuc dng ti ch c tc dng tr tr.
Trimbutine : chng co tht.
Ruscognines : tr tnh mch v c tc dng bo v mch mu.
CH NH
iu tr cc triu chng au v nga hu mn, c bit trong cn tr v trong hi chng nt
(hu mn).
CHNG CH NH
Qu mn cm vi mt trong cc thnh phn ca thuc, c bit l vi propylneglycol c trong
thnh phn t dc ca dng kem bi trc trng.
THN TRNG LC DNG
Vic iu tr ny khng th thay th c vic iu tr chuyn bit cc bnh khc hu mn.
Ch iu tr ngn hn. Nu nhng triu chng vn dai dng, cn thm khm li trc trng.
LIU LNG v CCH DNG
iu tr ngn hn.
Kem bi trc trng : thoa t 1 n 2 ln/ngy.
Ta dc : t t 1 n 2 ta dc/ngy

423.

PROFENID glule 50 mg

XNLD RHNE POULENC RORER

[AVENTIS PHARMA]
vin nang 50 mg : hp 24 vin.
THNH PHN
cho 1 vin
Ktoprofne

50 mg

DC LC
Ktoprofne l thuc khng vim khng stroide thuc nhm propionique, dn xut ca acide
arylcarboxylique. C tc dng khng vim, chng au, h st. c ch tng hp prostaglandine,
c ch s kt tp tiu cu.
DC NG HC
Hp thu :
Hp thu nhanh, nng huyt thanh ti a t sau 60 - 90 pht.
Phn phi :
Thi gian bn hy huyt thanh trung bnh l 1,5-2 gi. Lin kt 99% vi protine huyt tng.
Khuch tn vo hot dch v tn ti ko di ti vi nng cao hn nng huyt thanh
sau gi th t. Thuc qua c hng ro nhau thai.
Chuyn ha :
Bin i sinh hc ca ktoprofne xy ra theo 2 c ch : mt phn nh c hydroxyl ha,
phn ln lin hp vi acide glucuronique. Di 1% liu dng c tm thy trong nc tiu
di dng khng thay i, trong lc 65-75% di dng lin hp glucuronique.
Thi tr :
5 ngy sau khi dng thuc, 75-90% liu dng thi tr bi thn v 1-8% qua phn.
Bi tit rt nhanh, ch yu qua ng niu (50% liu dng c bi tit trong nc tiu trong
vng 6 gi, bt k ng dng thuc).
ngi ln tui :
S hp thu khng thay i, nhng thi gian bn hy thi tr ko di v gim s thanh thi ton
phn phn nh s chuyn ha b chm li.
ngi suy thn :
C s gim thanh lc huyt tng v gia tng thi gian bn hy thi tr.
CH NH
iu tr di hn cc triu chng trong :
- Vim thp khp mn tnh, ch yu vim a khp dng thp, vim cng khp ct sng, hoc
cc hi chng tng t nh hi chng Fiessinger-Leroy- Reiter v thp khp trong bnh vy
nn.
- Bnh cng khp gy au v tn ph.
iu tr ngn hn cc triu chng trong cc cn cp tnh ca cc bnh :
- Bnh thp khp ngoi khp (au vai cp tnh , vim gn ...).
- Vim khp vi tinh th.
- Thoi khp.
- au lng, au r thn kinh trm trng.
CHNG CH NH
Tuyt i :

- D ng i vi ktoprofne v cc cht c tc dng tng t : c ghi nhn mt vi bnh nhn

b ln cn suyn, nht l nhng ngi d ng vi aspirine.
- Lot d dy-t trng tin trin.
- Suy thn nng, suy gan nng.
- Tr em di 15 tui.
- Ph n c thai (3 thng cui thai kz) v cho con b : xem phn "Lc c thai v Lc nui con
b".
Tng i :
- Thuc chng ng ng ung, cc khng vim khng stroide khc, k c salicylate liu cao,
h parine (ng ngoi tiu ha), lithium, methotrexate liu cao > 15 mg/tun, ticlopidine : xem
phn Tng tc thuc.
CH PHNG
- Bnh nhn b suyn km theo vim mi mn tnh, vim xoang mn v/hoc polyp mi, khi
dng aspirine v/hoc thuc khng vim khng st roide, c nguy c d ng cao hn nhng
ngi khc. Vic dng thuc cho nhng ngi ny c th dn ti cn suyn.
- Do cc biu hin d dy-rut c th mang tnh trm trng, nht l cc bnh nhn ang
iu tr vi thuc chng ng mu, cn c bit theo di s xut hin cc triu chng ng
tiu ha ; trng hp xut huyt tiu ha, ngng iu tr ngay.
THN TRNG LC DNG
- Tin s lot d dy-t trng.
- Khi bt u iu tr, phi theo di k th tch bi niu v chc nng thn nhng bnh nhn
suy tim, x gan, thn h, bnh nhn ang dng thuc li tiu, suy thn mn v c bit ngi
ln tui.
- Cn thn nn gim liu ngi ln tui.
- Lu { ngi li xe v vn hnh my mc : v c th b chong vng
- Trong trng hp iu tr di ngy, cn theo di cng thc mu, chc nng gan v thn.
LC C THAI v LC NUI CON B
Lc c thai :
ngi, cha ghi nhn trng hp d dng no do dng thuc. Tuy nhin, cng cn phi lm
thm nhiu kho st dch t hc xc nhn hoc ph nhn iu ny.
Trong 3 thng cui ca thai kz, tt c cc thuc c ch tng hp prostaglandine u c th gy
c hi trn tim, phi v thn i vi bo thai, nguy c k o di thi gian chy mu m v con
vo cui thai kz ; do chng ch nh dng cc thuc khng vim khng stroide 3 thng
cui thai kz.
Lc nui con b :
Cc khng vim khng st roide qua c sa m ; nn thn trng khng dng ph n cho
con b.

TNG TC THUC
Khng nn phi hp :
- Thuc chng ng mu ng ung : tng nguy c xut huyt do c ch s kt tp tiu cu v
tn cng nim mc d dy ca cc thuc khng vim khng stroide.
Nu cn thit kt hp, phi theo di cht ch v mt lm sng v sinh hc.
- Cc khng vim khng stroide khc (k c cc salicylate liu cao) : tng nguy c lo t v xut
huyt ng tiu ha do tc dng hip lc.
- Heparin (ng ngoi tiu ha) : tng nguy c xut huyt (c ch s kt tp tiu cu v tn
cng nim mc d dy-t trng bi cc khng vim khng stroide).
Nu cn thit phi kt hp, phi theo di cht ch v mt lm sng (v sinh hc i vi heparin
khng phn on).
- Lithium (i vi diclofenac, k toprofne, indomethacine, phenylbutazone, piroxicam) : tng
lithium huyt, c th t n cc gi tr gy c, do gim bi tit lithium qua thn.
Nu cn phi dng chung, cn theo di cht ch lithium huyt v iu chnh liu trong v sau
khi ngng iu tr vi thuc khng vim khng stroide.
- Mthotrexate (dng liu cao > 15 mg/tun) : tng c tnh trn mu ca mthotrexate, do
gim thanh thi thn v b cc khng vim khng stroide thay th trong lin kt vi protein
huyt tng.
Ch nh cho dng k toprofne trc v sau khi dng m thotrexate, u phi gi khong cch
t nht 12 gi.
- Ticlopidin : gia tng nguy c xut huyt do hip lc tc dng kt tp tiu cu.
Nu cn thit phi kt hp, phi theo di cht ch v mt lm sng v sinh hc (bao gm c
thi gian chy mu).
Thn trng khi phi hp :
- Thuc li tiu, thuc c ch men chuyn, thuc c ch angiotensine II : nguy c suy thn cp
bnh nhn b mt nc (gim thanh lc vi cu thn do gim tng hp prostaglandine thn).
Hn na, lm gim hiu qu ca thuc c ch men chuyn v thuc c ch angiotensine II. Cho
bnh nhn ung nhiu nc, theo di chc nng thn trong thi gian u iu tr.
- Mthotrexate s dng liu thp (< 15 mg/tun) : tng c tnh trn mu ca mthotrexate, do
gim thanh thi thn v b cc khng vim khng stroide thay th trong lin kt vi protein
huyt tng.
Kim tra huyt hng tun trong cc tun l u iu tr phi hp. Tng cng theo di trong
trng hp suy gim chc nng thn (d nh), v ngi ln tui.
- Pentoxifylline : tng nguy c xut huyt. Theo di cht ch v lm sng v kim tra thng
xuyn hn thi gian chy mu.
Lu { khi phi hp :
- Thuc chn bta do ngoi suy t indomethacine : gim hiu lc chng cao huyt p do khng

vim khng stroide c ch prostaglandine gin mch.

- Ciclosporine : nguy c thm tnh c vi thn kinh, nht l ngi ln tui.
- Dng c t cung : c th lm gim hiu qu.
- Thuc lm tan cc mu ng : tng nguy c xut huyt.
TC DNG NGOI
- ng tiu ha : kh chu vng d dy-rut, au d dy, bun nn, nn ma, to bn, tiu
chy (khi bt u iu tr). Cc tc dng ph nng nht l : lot d dy, xut huyt tiu ha,
thng rut (sau khi iu tr ko di).
- Nhc u, chng mt, bun ng.
- Phn ng qu mn da (ni ban, m ay, nga) v ng h hp (suyn, nht l nhng ngi
d ng vi aspirine v cc khng vim khng stroide khc), rt him trng hp ph Quincke
v sc phn v..
- Gim nh hng cu ngi b thiu mu, mt vi trng hp gim bch cu nh c ghi
nhn.
- Mt vi trng hp lm nng thm bnh thn b trc.
- Rt him trng hp gy bnh da bng nc.
LIU LNG v CCH DNG
Liu tn cng : 300 mg (6 vin nang)/ngy, chia lm 2-3 ln.
Liu duy tr : 150 mg (3 vin nang)/ngy, chia lm 2 - 3 ln.
Ung Profnid trong ba n. Trong trng hp b au d dy, nn dng thm thuc bng d
dy. Khng thy s hp thu ca ktoprofne gim i khi dng chung vi gel aluminium.

424.

PROGESTOGEL

BESINS-ISCOVESCO
c/o TEDIS
Gel bi ngoi da 1% : ng 80 g + 1 thc nh chun.
THNH PHN
cho 100 gel
Progesterone

1g

DC LC
Progesterone bi ngoi da (G : h tit niu - sinh dc v ni tit t sinh dc).
DC NG HC
- Thm qua da : khong 10% liu s dng.

- Chuyn ha ti ch (da, v : tuyn v m m).

- Progesterone khng hoc vo mu rt t.
CH NH
Bnh v lnh tnh. au v do mt cn bng gia estrogene v progesterone.
LC C THAI v LC NUI CON B
C th dng c v thuc c tc dng ti ch.
LIU LNG v CCH DNG
Mt liu thoa trn mt thc nh chun trn mi v. Ngy 1 ln, sau khi tm, bi ln mi v
cho n khi thuc thm, ra tay sau khi bi thuc. Mi thc nh chun cha 2,5 g gel tc
0,025 g progesterone.
Thi gian iu tr : dng mi ngy k c lc hnh kinh v lin tc trong 3 thng.

425.

PROGYLUTON

SCHERING AG
c/o ZUELLIG
vin nn : v thuc c lch hng dn ghi trc tip mt sau, gm 21 vin n n, trong 11
vin, mi vin cha 2 mg estradiol valerate v 10 vin, mi vin cha hn hp : 2 mg estradiol
valerate v 0,5 mg norgestrel.
THNH PHN
cho 1 vin (trong 11 vin u)
Estradiol valerate

2 mg

cho 1 vin (trong 10 vin sau)

Estradiol valerate

2 mg

Norgestrel

0,5 mg

DC LC
Thnh phn v hiu qu ca Progyluton c iu chnh theo mt cch thc m nu ung
thuc u n, s to c mt chu kz kinh nguyt tng ng vi nhng iu kin sinh l ca
c th. Hn na, thuc cng lm mt nhng than phin ch quan do thiu hormone, xy ra lc
bt u ca thi kz mn kinh hoc i khi sm hn. Nhng than phin ny gm c bc ha, hay

v m hi, ri lon gic ng, trng thi trm cm, d cu gin, nhc u, chng mt. Progyluton
cng c tc dng i vi bng quang d kch thch - mt triu chng thng xy ra hi chng
mn kinh, nhng du hiu ca thoi trin c v thn kinh (c bit vng sinh dc) thng xy
ra tui gi, v nhng than phin do long xng.
CH NH
Triu chng tin mn kinh v mn kinh (hi chng quanh mn kinh) ; v kinh nguyn pht, th
pht ; kinh nguyt khng u ; triu chng sau ct b bung trng hoc ct b bung trng
bng x tr i vi nhng bnh nhn khng phi ung th.
CHNG CH NH
C thai, ri lon chc nng gan nng, tin s vng da hoc nga nhiu trong ln c thai trc,
hi chng Dubin-Johnson, hi chng Rotor, tin s hoc ang c bu gan, tin s hoc ang
b bnh huyt khi tc mch (nh t qu, nhi mu c tim), thiu mu hng cu hnh lim,
c hoc nghi ng c bu ph thuc ni tit t t cung hoc tuyn v, lc ni mc t cung,
i tho ng nng km nhng bin i mch mu, ri lon chuyn ha lipid, tin s
Herpes khi c thai, chng x cng tai nng khi c thai.
THN TRNG LC DNG
Lu { c bit :
Progyluton khng phi l thuc nga thai.
Khi dng thuc, nn nga thai bng cc phng php khng dng ni tit (ngoi l : khng
dng phng php tnh theo chu kz Ogino-Knauss v theo di thn nhit). Nu xut huyt
khng xy ra theo chu kz 28 ngy, nn ngh n kh nng c thai d ang p dng cc phng
php nga thai. Trng hp ny, phi ngng iu tr cho n khi c chn on r rng. Nu
xut huyt "khng theo lch" xy ra trong vng 3 tun t khi ung thuc, phi hi kin bc s
nhng lc ny khng c ngng thuc.
Trc khi iu tr v kinh th pht bng Progyluton phi chc chn rng khng c thai. Nn
kim tra loi tr bu tuyn yn sn xut prolactin, v ngy nay ngi ta vn cha loi tr kh
nng cc macroadenoma gia tng kch thc khi estrogen liu cao c s dng trong mt thi
gian di.
Li ch ca vic s dng cc ch phm c cha estrogen c cng nhn v c chng
minh mt cch khoa hc. Tuy vy, gn y c { kin cho rng s dng lu di estrogen n
thun trong giai on mn kinh c th lm gia tng tn xut ung th ni mc t cung. V khng
th loi tr hon ton nguy c ny, nn phi ngn s tng sn ni mc t cung khi iu tr bng
estrogen n thun. iu ny c th t c tt nht bng cch dng thm progestogen, nh
trong trng hp iu tr bng Progyluton. pha th hai ca chu kz kinh nguyt, progestogen
lm bin i ni mc t cung giai on ch tit v sau l s xut huyt khi ngng thuc nh trong chu kz kinh nguyt t nhin.
Phi bo cho bc s bit nu bnh nhn ang c cc bnh sau y : i tho ng, cao huyt

p, dn tnh mch, x cng tai, x cng ri rc, ng kinh, ri lon chuyn ha porphyrin, co
cng c, ma vn nh. Nhng trng hp ny, v cng nh khi c tin s vim tnh mch cn
phi c theo di cht ch.
Trong mt s him trng hp c bu gan lnh tnh v him hn na ngay c khi c bu
gan c tnh, trong mt vi trng hp c th xy ra xut huyt nng trong bng e da tnh
mng bnh nhn sau khi dng cc hormone nh nhng cht c trong Progyluton. Do phi
bo cho bc s nu c than phin au bt thng phn bng trn khng t bin mt sau mt
thi gian ngn.
L{ do ngng thuc ngay :
Cn au u Migrain xy ra ln u hoc nhng cn au u d di xy ra thng xuyn hn,
ri lon t ngt v gic quan (th gic hoc thnh gic), nhng triu chng u tin ca vim
tnh mch huyt khi hoc bnh huyt khi tc mch (th d, au bt thng chn hoc sng
chn, cn au nhi lc th hoc ho khng c nguyn nhn r rng), cm gic cng au ngc,
ch phu thut (ngng thuc trc 6 tun), bt ng (nh sau tai nn), khi pht vng da, t
vim gan, nga ton thn, tng cn ng kinh, tng huyt p, c thai.
TNG TC THUC
Phi bo cho bc s bit nhng loi thuc ang dng hng ngy (nh barbiturates,
phenylbutazone, hydantoins, rifampicin, ampicillin) v c th lm gim tc dng ca Progyluton.
Nhu cu thuc ung chng i tho ng v insulin c th thay i.
TC DNG NGOI
Trong nhng trng hp him, c th c cm gic cng v, kh chu d dy, bun nn, nhc
u, nh hng i vi th trng v ham mun tnh dc, v xut huyt "khng theo lch".
LIU LNG v CCH DNG
Trc khi bt u iu tr bng Progyluton, nn khm tng qut v khm ph khoa (gm c
khm v v pht t bo t cung) v phi chc chn rng khng c thai.
Thn trng : nn khm nh kz mi 6 thng khi iu tr lu di bng Progyluton.
V thuc c km mt ming dn c ghi cc ngy trong tun. Sau khi bc nhn bo v, phi dn
ming ny ln mt trng ca v thuc sao cho ngy (trong tun) bt u dng thuc phi ngay
di phn mu c ch "Bt u" ; th d, nu vin thuc u tin c ung vo ngy Th
t, phn "Bt u" phi c t khp vi ngy c ghi "Th t". V vy mi vin thuc tng
ng vi mt ngy trong tun v ch cn nhn thong qua ta c th thy vin thuc ca ngy
c c ung hay cha.
Lun lun bt u ung thuc t ch v thuc c nh du "Bt u" v ung thuc hng ngy
theo mi tn hng dn cho n ht 21 vin. Nn nut nguyn vin thuc vi mt t nc.
Bt u ung Progyluton t ngy th 5 ca chu kz kinh nguyt (ngy u tin ca t kinh va
qua = ngy u tin ca chu kz)
Bnh nhn v kinh hoc c kinh khng u c th bt u dng Progyluton ngay sau khi c

bc s ghi toa.
Sau 21 ngy ung thuc s c mt thi gian khng ung thuc 7 ngy m trong khong thi
gian ny - khong 2-4 ngy sau khi ung vin thuc cui cng. - xut huyt ging nh c kinh s
xy ra. Nu khng c bc s thay i liu, hy bt u v thuc Progyluton k tip sau 7 ngy
ngng thuc, cng bt u vo ngy trong tun ging nh ngy u tin ung thuc ca v
thuc trc. Ung thuc vo gi no trong ngy khng phi l vn quan trng, nhng khi
chn c thi im thch hp - tt hn nn ung thuc sau n sng hay sau n ti - th nn
gi lun gi gic . Nu qun ung thuc vo gi gic thng thng, nn ung vin thuc ny
trong vng 12 gi sau .
BO QUN
Bo qun thuc ng cch v thuc ngoi tm tay tr em.

426.

PROPOFOL ABBOTT

ABBOTT
nh tng tim tnh mch 10 mg/1 ml : ng 20 ml, chai 20 ml, chai 50 ml, chai 100 ml - Bng A.
THNH PHN
cho 1 ml
Propofol

10 mg

M T
Propofol Abbott dng nh tng v trng, khng c cha nhit t, cha 10 mg/ml dng tim
tnh mch ; cng thc ha hc : 2,6-diisopropylphenol v c trng lng phn t 178,27.
Propofol t tan trong nc, nn c trnh by di dng nh tng trng c. pKa 11,03.
pH sinh l h s Octanol/nc ca Propofol l 6761:1. Dng nh tng ng trng c pH
t 6,0 n 6,5. Cc thnh phn khc l du u nnh (100 mg/ml), glycerol (22,5 mg/ml),
phosphatide trng (12 mg/ml) ; vi nc lng va v sodium hydroxide cho pH t 6,0
n 8,5.
DC LC
Propofol l thuc ng, an thn, gy m tnh mch tc dng nhanh c dng khi m, duy tr
hay an thn lin tc cho ngi bnh th my. Khi tim tnh mch vi liu iu tr, Propofol gy
ng nhanh v m du, thng khong 40 giy t lc bt u tim (thi gian tun hon t cnh
tay ln no). Cng nh nhng thuc gy m tnh mch tc dng nhanh khc, Propofol c thi
gian bn cn bng trong mu no khong t 1 n 3 pht nn cho tc dng nhanh.
DC NG HC
Tnh cht dc ng hc ca Propofol ty thuc vo nng Propofol trong mu. Vi mt

ngi bnh, tnh trng n nh ca nng thuc trong mu ty thuc tc thuc truyn
vo.
Hiu qu huyt ng hc ca Propofol trong thi gian khi m thay i. Nu ngi bnh t
th, hiu qu huyt ng hc chnh yu l gy tt huyt p (i khi gim hn 30%) km theo
thay i mt t nhp tim v t c thay i cung lng tim. Nu ngi bnh c h hp h tr
hay iu khin (h hp vi p lc dng), mc gim cung lng tim cng trm trng hn.
Nhng hu qu ny c l do hiu qu cng ph v hay c ch giao cm trung ng. Nu dng
thuc opioids mnh (v d : Fentanyl) trong tin m, s c ch h hp v tun hon cng nng
hn. Nu duy tr m vi Propofol truyn tnh mch, s kch thch ca ng ni kh qun hay ng
tc phu thut c th lm tng huyt p v mc bnh thng nhng cung lng tim vn cn
gim.
Nhng d kin cha y v vic dng Propofol khi m, duy tr m hay dng cho ngi
bnh phi th my c tng trng suy kit hay gi yu, bnh tim mch (sc phun < 50%) hay
ngi bnh thuc ASA III, IV ; nhng c nhn xt rng nhng ngi bnh ny s c nhng ri
lon huyt ng hc nng n hn v ngi ta khuyn nn dng liu lng Propofol t hn (xem
phn Liu lng v Cch dng).
Khi khi m vi Propofol ngi bnh thng ngng th d ngi ln hay tr em.
Trong khi duy tr m, Propofol gy suy gim h hp thng kt hp vi ng thn kh ty mc
tim truyn v kt hp vi nhng thuc khc (v d : thuc an thn, opioids.v.v..).
Nhng ngi bnh c p lc ni nhn bnh thng, Propofol s lm gim p lc ni nhn kt
hp vi s gim sc cn mch mu ton thn. Nhng nghin cu mi y chng minh rng khi
dng Propofol trong tnh trng gim thn kh s tng sc cn mch mu no v gim lng mu
qua no, gim nhu cu tiu th dng kh v gim p lc ni s. Propofol khng nh hng n
s p ng ca mch mu no i vi s thay i p lc thn kh trong mu ng mch.
Nhng nghin cu trn sc vt v nhng kinh nghim cn hn ch trn ngi bnh khng thy
bng chng no Propofol gy ra chng st c tnh.
Nhng nghin cu tin lm sng nhn thy rng Propofol t gy tng lng histamine trong
huyt tng.
Nhng nghin cu trong phng th nghim chng t rng Propofol vi nng lm sng khng
nh hng n s tng hp cc kch thch t tuyn thng thn.
Cn hiu r nhng c tnh, s phn phi, thi tr ca Propofol s dng cho chnh xc.
Propofol c i lc cao vi cht m, v kt hp vi protein khong t 97- 98%.
Dc ng hc ca Propofol c phn u ba ngn hin din trong huyt tng, cn bng
nhanh chng trong m v thy tr chm. Theo sau mt liu tim tnh mch, lng Propofol
trong huyt thanh gim nhanh do thuc phn tn vo m nhanh (na thi gian : 2-4 pht) v
thi tr nhanh (na thi gian : 30-60 pht). Lng phn tn mt na cho s gim ny cho mt
ln tim. Sau mt thi gian truyn thuc lu di, nng thuc trong huyt thanh gim xung

chm hn do lng thuc tch t trong m thi ra. Nng thuc trong huyt thanh cn 50%
nh cao sau ngng khi truyn 5 pht nu thi gian truyn mt gi v sau khi ngng truyn 7
pht nu thi gian truyn l 10 gi. Truyn ngt qung ngi bnh sn sc c bit c
nhng p ng lm sng tng ng vi nng Propofol trong huyt thanh khong 1 mg/ml.
Nng gim 50% lng ny (0,5 mg/ml) thng ngi bnh s tnh dy.
Propofol phn tn mnh v thi tr nhanh khi c th (thanh thi ton c th 1,5 - 2 l/pht), s
bin dng chnh gan thnh cht glucoronide khng hot tnh kt hp vi quinol thi ra nc
tiu.
Dc ng hc ca thuc ty thuc lng thuc truyn v khng c s tch ly vi tc thuc
truyn bnh thng.
ngi gi :
Lng Propofol dng gy m gim dn theo tui ca ngi bnh, s gim liu ny khng ty
thuc vo dc ng hc hay s nhy cm ca t bo no c kim chng bng in no .
Khi tim tnh mch, Propofol t n nng cao trong mu nhanh hn ngi gi, iu ny
gii thch tnh cht dc lc hc ca thuc v cn gim liu lng thuc. Nng thuc trong
mu cao gy ri lon h hp - tun hon nh : tt huyt p, ngng th, tc ng th gy thiu
dng kh. Nng thuc trong mu cao phn nh s gim th tch phn phi v thanh thi
ca thuc ngi gi gia cc khoang ca c th ; v vy c khuyn co dng liu thp trong
khi m hay duy tr m ngi gi (xem phn Liu lng v Cch dng).
tr em :
Dc ng hc ca Propofol tr t 3 n 12 tui c m t r rng nh kiu ba ngn ca
c th. Mt nghin cu tr em phi m khong 1 ti 2 gi v mu mu c ly trong vng 8
gi sau cho thy na thi gian thi tr t 250-400 pht ; th tch phn phi ti 10 l/kg v
thanh thi vo khong 35 ml/kg/pht. S c tnh ny cho thy tnh tan trong m v thanh
thi cao ca Propofol. Nhng s khc nhau v thi gian thi tr v th tch phn phi ngi
bnh trng thnh v tr em cho thy thuc tc dng k o di hn ngi ln. thanh thi
tr em cao hn 50% so vi ngi ln.
Suy nhc c quan :
Dc ng hc ca Propofol khng thay i nhng ngi x gan hay suy thn mn tnh.
Dc ng hc ca Propofol trn ngi bnh suy gan, suy thn cp tnh cha c nghin cu.
CH NH
Propofol l thuc m tnh mch c th dng khi m hay duy tr m trong phng php gy
m cn bng cho ngi bnh m chng trnh hay ngoi tr, ngi ln v tr em ln hn 3
tui.
Propofol ch c dng t ni kh qun cho ngi bnh trng thnh th my sn sc
c bit mc ch an thn hay ngn chn nhng xung kch ; trong nhng trng hp ny, ch
c nhng chuyn vin c kh nng v kinh nghim v hi sc h hp tun hon i vi

nhng ngi bnh nng.

CHNG CH NH
Propofol khng c dng cho nhng ngi c tin cn d ng vi n hoc d ng vi cc cht
cha trong dung dch thuc hoc ngi bnh c chng ch nh v an thn, gy m ton din.
Propofol cng khng c dng cho tr em di 3 tui, ph n c thai, gy m sn khoa v
dng gy an thn cho nhng tr em di 16 tui (xem phn Ch { phng).
CH PHNG
Propofol c th gy ra nhng rung c, co git ; nhng dng phn ng qu mn nh ni mn ,
co tht kh ph qun cng c th xy ra.
S ngng th thng xy ra khi tim khi m c th ko di qu 60 giy cn h hp h tr.
c mt vi bo co v tnh trng ph phi cp hay ngng tim khi dng Propofol, nhng
nguyn nhn cha c xc nh.
Khng nn dng Propofol cho nhng ngi bnh ng kinh v c th gy cn khi tnh dy.
Propofol khng c tnh ly gii i giao cm nn c th gy chm nhp tim t trung bnh cho ti
nng. Nhng trng hp nhp tim chm hay dng nhng dc cht gy chm nhp tim nn
dng cht chng cholinergic trc hay trong khi duy tr m vi Propofol. Ngi bnh phi c
theo di cn thn pht hin tt huyt p hay nhp tim chm. Propofol khng nn s dng
cho nhng trng hp iu tr bng in.
An thn trong sn sc c bit (xem phn Ch , Liu lng v Cch dng).
Propofol c bt u dng vi liu nh v thay i chm (t nht l 5 pht mi tng liu)
hn ch tt huyt p v trnh qu liu. Cng nh nhng thuc an thn khc, Propofol thay i
theo tng ngi bnh v tng thi gian.
Cn theo di st ngi bnh pht hin sm nhng bin i v tim mch nh tt huyt p
trm trng, c th ci thin nu ngng thuc, truyn dch hay dng thuc vn mch.
Nu ngng Propofol t ngt, ngi bnh s tnh nhanh kt hp vi s lo u, vt v chng th
my v s cai th my s gp kh khn v vy ngi ta khuyn nn duy tr mt lng Propofol
duy tr mt m nh trong sut thi gian cai th my cho ti khi t 10 ti 15 pht
trc khi rt ng ni kh qun.
Bi v Propofol c pha trong nh tng nn nu truyn nhiu, lu s gy tng lng
triglycerides ; ngi bnh c nguy c tng lipide mu cn theo di tnh trng ny. Khi dng
Propofol cn ch { n lng m c trong dung dch ; 1 ml Propofol cha khong 0,1 g m.
Thng bo cho ngi bnh :
Ngi bnh cn c khuyn co v nhng hot ng cn s iu khin ca tr tu nh iu
khin my mc, xe c... c th thay i sau khi gy m mt thi gian ngn vi Propofol. Nn
trnh ung ru.
THN TRNG LC DNG
Tn trng nguyn tc v trng tuyt i trong khi s dng. Sn phm Propofol dng duy nht

 tim tnh mch n khng cha mt cht chng vi trng no v vy vi trng s sinh sn nhanh.
B phn d khng dng trong thi gian ngn (xem phn Liu lng, Cch dng v Bo qun).
c nhng bo co do khng tn trng nguyn tc v trng khi dng Propofol gy nhim vi
trng kt qu gy st, nhim trng hoc e da s sng hay t vong cho ngi bnh. Khng
c dng Propofol khi nghi ng khng c sch.
Trong gy m ton din hay an thn trong sn sc c bit, Propofol ch c s dng bi
nhng ngi c kinh nghim v gy m hi sc x tr vi nhng ri lon h hp - tun hon ;
cn phi c nhng monitors theo di ngi bnh.
Nhng ngi bnh gi, suy kit (ngi bnh ASA III, IV) khng c dng Propofol tim nhanh
hay liu lng nhiu nu khng s gy nhng tai bin nh suy h hp - tun hon, tt huyt p,
ngng th, nght ng th hay thiu dng kh.
Nhi khoa :
m bo an ton cao, Propofol khng dng gy m cho tr em di 3 tui v khng
dng vi mc ch an thn cho tt c tr em sn sc c bit.
Suy chc nng gan, thn :
Propofol khng nn dng lu di cho ngi bnh c chc nng, gan thn suy km.
Gy m thn kinh s no :
Khi dng Propofol cho ngi bnh tng p lc ni s hay ri lon tun hon no s gy gim p
lc ti mu no nn lm gim t p lc trung bnh ; nn tim thuc chm v khng nn dng
liu cao cho nhng ngi ny.
Khi nghi ng c tng p lc ni s, nn tng thng kh gim nng thn kh khi dng
Propofol.
AN TON TIN LM SNG
Kh nng sinh ung th, t bin gen, thay i tnh sinh sn :
Propofol khng gy sinh ung th loi vt th nghim.
Propofol khng gy t bin gen loi vt trong th nghim hay trong lm sng.
Nghin cu trn nhng con chut ci vi liu tim tnh mch ti 15 mg/kg/ngy (gp 6 ln ln
hn liu dn u ngi) trong 2 tun trc khi th thai ti ngy th 7 cho b v chut c
dng liu tnh mch ti 15 mg/kg/ngy trong 5 ngy u khng thy s thay i tnh sinh sn.
LC C THAI v LC NUI CON B
Propofol khng gy qui thai trn chut v con b. Cha c nghin cu trn con ngi.
Chuyn d v sinh n :
Khng dng Propofol v n qua nhau thai.
Lc nui con b :
Propofol khng dng cho ngi m ang cho con b v mt lng nh Propofol tim hay ung
u qua sa m.
TNG TC THUC

Khi m vi Propofol phi gim liu khi dng thuc tin m, c bit vi thuc gim au gy
nghin (v d : morphine, meperidine, fentanyl.v.v...). v kt hp opioids vi thuc an thn (v
d : thuc ng, benzodiazepines, droperidol.v.v...). Nhng thuc ny lm tng tc dng an thn,
gy m ca Propofol v c th gy gim huyt p tm thu, tm trng hay huyt p trung bnh
v gim cung lng tim.
Trong thi gian duy tr m hay an thn, liu lng Propofol cn iu chnh theo mc m yu
cu v phi gim liu lng Propofol khi kt hp vi thuc gim au (v d : N2O, opioids). Khi
dng ng thi Propofol vi cc thuc m h hp mnh (v d : isoflurane, enflurane,
sevoflurane v halothane) m kh xc nh. Nhng thuc m h hp ny s lm tng hiu
qu an thn, gy m v h hp tun hon ca Propofol.
Nhng thuc m ch ng thn kinh trung ng khc (thuc ng, an thn, thuc m h hp,
opioids) c th lm tng tnh ch ng thn kinh ca Propofol. Tin m bng morphine (0,15
mg/kg) dng N2O nng 67% vi dng kh cho thy gim c liu lng Propofol cn thit
duy tr m hn l dng Propofol vi thuc khng gy nghin (lorazepam) lm thuc tin
m.
Propofol khng lm thay i tim thi, thi gian tc dng, mnh ca cc thuc dn c thng
thng (v d : succinylcholine v cc thuc dn c khng kh cc).
Propofol dung np vi gy t di, ngoi mng cng, thuc tin m, thuc dn c, thuc m h
hp v thuc gim au.
Chm nhp tim gy ra do suxamethonium, neostigmine nu dng Propofol c th nguy him.
ngi bnh dng cyclosporine nu dng m nh tng c th gy ra leucoencephalopathy.
TC DNG NGOI
Nhng kt qu nghin cu su rng cho thy hu ht nhng phn ng khng mong mun ch
nh v thong qua.
gim au ti ni tim thuc, c th dng ng thi vi lidocain hay chn tnh mch ln
cnh tay. Vim hay thuyn tc tnh mch t khi xy ra. Tim thuc ra ngoi mch trn ngi
bnh hay vt th nghim ch thy phn ng m nh ti ch ni tim. Tim thuc vo ng
mch vt th nghim khng thy gy bin chng ti ch hay vng xa.
Propofol dng khi m thng m du, i khi c nhng c ng hay kch thch, kch ng nh
nh nc ct, ho mt vi ngi bnh.
Cng nh nhng thuc m tnh mch khc, Propofol c th gy tt huyt p hay ngng th
trong khi khi m ty vo liu lng nhp thuc tim vo v phi hp vi thuc tin m, i
lc s tt huyt p cn phi tng lng dch truyn hay dng thuc vn mch hay gim lng
Propofol.
ng th phi lun lun c quan st chc ch v tro ngc, ho hay i ma cng xy ra
vi ngi bnh trong khi th nghim.
Nhng phn ng d ng nh ni mn , co tht kh ph qun v tt huyt p t khi xy ra.

Ri lon nhp tim nh nhp chm, nhp nhanh, ngoi tm thu cng t khi xy ra.
Ph phi, co cng c hay co git cng t gp sau khi dng Propofol.
Rt t trng hp nhn thy thay i mu sc nc tiu sau mt thi gian di dng Propofol.
Mt s t ngi bnh cm thy bun nn, i, au u hoc st sau khi tnh m.
Nhng phn ng khc cng c ghi nhn sau khi m hoc duy tr :
Ton thn : mi mt, au khp ngi hay t chi, au ngc, tng tc dng ca thuc, cng c.
Tim mch : rung nh, phn ly nh tht, bloc nhnh, nhp i, ri lon nhp tim cc loi, chy
mu... k c tim ngng p.
H thn kinh trung ng : mt mi, lo, lng, kch ng, o gic, c nhng gic m bt thng,
l ln, mt ng, bun ng...
Tiu ha : kh ming, tiu chy, tng bi tit nc bt, ph i tuyn mang tai...
Huyt hc : tng bch cu, ri lon ng mu...
Ni tim : nga , thay i mu sc...
Bin dng : tng kali huyt, tng lipide huyt...
C xng: au c...
H hp : cm gic nng, th kh, th nhanh, thiu dng kh, vim thanh qun...
Da nim : mt , chy nc mt, da ni mn, nga...
Niu sinh dc : tiu t, b tiu...
Gic quan : cn vin th, nhn i, au tai, au mt, co git nhn cu.
Nhng phn ng khc cng c ghi nhn sau khi dng Propofol sn sc c bit :
Ton thn : mi mt, nhim trng.
Tim mch : gim cung lng tim, suy tim phi, nhanh tht.
H thn kinh trung ng : tng p lc ni s, suy ngh bt thng.
Tiu ha : lit rut, ri lon chc nng gan.
Bin dng : BUN, creatinine tng; thiu nc, tng ng huyt, tng lipide huyt, tng p lc
thm thu.
Niu sinh dc : suy chc nng thn.
LIU LNG v CCH DNG
Ngi bnh trng thnh :
Khi m :
Hu ht nhng ngi bnh di 55 tui ; c ASA I, II cn khong t 2 n 2,5 mg/kg Propofol
khi m khi khng c tin m hay c dng benzodiazepines ung hay dng thuc gim
au tim bp. Khi khi m, nn tim Propofol ngt qung (khong 40 mg mi 10 giy), theo di
s p ng ca ngi bnh cho n khi t yu cu m. Khi kt hp vi nhng thuc ng,
thuc an thn, thuc gim au tim tnh mch hay tin m vi benzodiazepine u nh hng
n liu lng Propofol dng khi m.
Duy tr :

 ngi ln, c th duy tr m bng cch tim tnh mch ngt qung Propofol. Liu lng thuc
tim hay truyn ty thuc vo s p ng ca ngi bnh.
Truyn lin tc :
Lng thuc Propofol truyn nn bt u ngay khi va khi m duy tr m n nh.
Lng Propofol truyn cho ngi ln thng t 4 n 12 mg/kg/gi. Trong thi gian 10 ti 15
pht u sau khi khi m nn duy tr lng thuc cao duy tr m, nhng khong 30 pht
sau thng gim bt liu lng xung t 30 n 50%.
Tim ngt qung :
Duy tr m ngi ln, thng dng liu 25 mg (2,5 ml) ti 50 mg (5 ml) mi ln ty theo
du hiu lm sng m thay i liu lng thuc dng cho thch hp.
An thn sn sc c bit :
Liu lng Propofol dng ty theo tnh trng lm sng, s p ng ca ngi bnh cng nh
lng lipide mu. i vi ngi ln, c t ni kh qun th my, dng Propofol vi mc
ch an thn nn bt u vi liu nh truyn chm t hiu qu mong mun v trnh tai
bin tt huyt p, cn duy tr liu nh t hiu qu c th theo di nhng du hiu v thn
kinh. Khi chm dt s dng Propofol nn thc hin t t trnh nhng tai bin do cai thuc
t ngt hay cai th my (xem phn Thn trng).
Propofol bt u vi liu 0,3 mg/kg/gi (5 mg/kg/pht) ; vn tc truyn sau duy tr t 0,3 ti
0,6 mg/kg/pht cho ti khi t an ton thch hp. Ti thiu phi sau 5 pht mi iu chnh
liu lng thuc ; hu ht ngi ln liu lng thuc duy tr khong 0,3 ti 4 mg/kg/pht.
Ngi gi, suy nhc hay ngi bnh thuc ASA III, IV :
Khng c tim tnh mch Propofol nhanh nhng ngi bnh ny; m nn theo cch lm
sau : (xem phn Ch ).
Khi m :
Hu ht ngi gi yu, nng thuc trong mu cao, thanh thi k m nn lng thuc
Propofol thng dng 1,5 mg/kg/pht (khong 20 mg mi 10 giy) v theo di s p ng ca
ngi bnh.
Duy tr :
So vi ngi tr, lng thuc Propofol dng ngi gi thp hn.
Bnh thn kinh s no :
trnh tt huyt p nhiu v gim p lc ti mu no, lng thuc Propofol truyn hay tim
chm tnh mch vo khong 20 mg mi 10 giy thay v dng liu lng ln v tim nhanh. Khi
m t t, theo di s p ng ca ngi bnh thng gim c liu thuc (1-2 mg/kg).
Nhi khoa :
Propofol khng dng cho tr em di 3 tui.
Khi m :
Propofol phi c tim chm v theo di du hiu lm sng v s p ng ca ngi bnh,

liu lng thuc phi cn c vo trng lng ca c th b. Tr em ln hn 8 tui thng dng

khong 2,5 mg/kg. Tr cng b liu dng cng cao hn. Cha c kinh nghim dng cho tr em
c tnh trng km, ASA III, IV.
Duy tr :
Tnh trng m c duy tr bng cch tim Propofol tnh mch ngt qung hay truyn lin tc ;
tc truyn thng t 9 ti 15 mg/kg/gi c th duy tr c m thch hp.
An thn :
Propofol khng dng vi mc ch an thn cho tr di 16 tui.
Cch dng :
Propofol c sn xut dng cho mi mt ngi bnh ring.
Lc tht u trc khi s dng.
Propofol c th dng trc tip t l thuc bng thy tinh hay c th pha long trong dung dch
ngt 5% (Dextrose 5%) trong chai bng thy tinh hay chai bng nha. pha long ti a khng
vt qu 1/5 (2 mg Propofol trong 1 ml).
Propofol khng c dng vi nhng dng c lc vi trng v nhng dng c ny s lm thay i
vn tc truyn hay c th lm bin i nh tng dng pha thuc Propofol.
Nhng dung dch Propofol pha long ch c thc hin tc thi ngay khi s dng trong iu
kin v trng v ch dng trong vng 6 gi. Khi mun pha dung dch Propofol, lng Dextrose
5% c ly ra khi chai v thay vo mt th tch Propofol tng ng.
Nhng dng c dng vi Propofol: ng tim, dy truyn dch, chai l phi c vt b ti a 12
gi sau v dung dch Propofol khng cha cht kh trng nn c th gip vi trng sinh si nhanh
chng (xem phn Ch ).
Dung dch Propofol c th dng vi cc phng php tim truyn khc nhau, nhng nn dng
ring l trnh dng qu liu ; nhng dng c o m phi c iu chnh kim sot chu
o. Khi dng Propofol cho cc ngi bnh chp cng hng t (MRI) cn kim tra dng c
theo di liu lng thuc.
Khng nn dng Propofol cng vi ng truyn mu hay huyt tng (xem phn Ch ).
Propofol c th pha vi dung dch lidocaine 0,5% hay 1% khng cha cht t dc ngay trc
khi s dng lm gim au ni tim (20 phn Propofol, mt phn lidocaine). Propofol khng
c pha vi bt c mt loi thuc no trc khi tim.
Khi pha thuc hay dch truyn no vi Propofol cn gn st nhau.
Propofol c th gn vo ng ba u (ng ch Y) truyn khi dch truyn tng hp.
Propofol tng hp vi cc dung dch sau y :
- Dung dch Dextrose 5%, USP.
- Dung dch Lactated Ringers, USP.
- Dung dch Lactated Ringers trong Dextrose 5%, USP.
- Dung dch Dextrose 5% trong Sodium Chloride 0,45%, USP.

- Dung dch Dextrose 5% trong Sodium Chloride 0,2%, USP.

- Dung dch Sodium Chloride 0,9%.
Nhng thuc, dch truyn tnh mch cn kim tra trong v cn cn thn trc khi dng.
Khng nn dng Propofol nu dung dch nh tng khng thun nht.
Propofol khng cha cht bo qun hay dit trng nn vi trng sinh sn nhanh.
Khi pha trn hay ht thuc Propofol cn thc hin mt cch v trng v ngay khi b ng thuc
Propofol, cng nh trong sut thi gian truyn dng thuc Propofol.
QU LIU
Nu qu liu xy ra, phi ngng truyn Propofol ngay lp tc ; qu liu Propofol thng gy ch
ng h hp - tun hon. Ch ng h hp phi thng kh nhn to vi dng kh. Ch ng tun
hon x tr bng cch k chn ngi bnh cao, tng tc dch truyn v dng thuc vn mch
hay thuc chng cholinergic.
Liu lng v vn tc thuc dng ty thuc vo mi ngi bnh, mc m cn thit, theo
nhng yu t lm sng, thuc tin m v phi hp s dng cng nh tui tc, tnh trng suy
yu ca ngi bnh c nh gi theo ASA.
i vi mt ngi bnh, nng Propofol trong mu ty thuc vo vn tc thuc truyn vo.
Nhng hiu qu khng mong mun nh try h hp - tun hon thng xy ra do nng
thuc trong mu cao kt qu ca s truyn nhanh hay dng liu lng cao. Nn tim thuc
theo nhng khong thi gian thch hp (thng t 3 n 5 pht) trnh thuc qu liu. Cn
thn trng tr em. Cn phi dng thm thuc gim au trong khi gy m vi Propofol. Trong
nhng trng hp m nh (trn b mt c th), c th kt hp Propofol vi N2O nng 6070%. Vi nhng phu thut kch thch nhiu (v d : phu thut bng) hay s kt hp vi N2O
khng hiu qu cn tng liu lng Propofol ln hay kt hp thm vi thuc gim au t
m thch hp.
Propofol c th dng vi nhng thuc thng thng trong gy m nh atropine, scopolamine,
glycopyrrolate, diazepam, thuc dn c phn cc hay khng phn cc cng nh thuc m h
hp hay thuc t.
BO QUN
Propofol s b oxide ha khi tip xc vi dng kh v vy c ng gi di p lc Nit.
Bo qun nhit t 15 n 30oC. Khng cn ng lnh

427.

PROTAMINE SANOFI

SANOFI SYNTHELABO VIETNAM

Dung dch tim 1000 AHU : l a liu 10 ml.
THNH PHN
cho 1 ml
Protamine sulfate

1000 AHU*

*AHU : Antiheparine unit

DC LC
Cht i khng vi hparine v fraxiparine.
CH NH
Trung ha ngay lp tc tc dng chng ng ca Heparine v Fraxiparine.
CH PHNG v THN TRNG LC DNG
m bo vic trung ha hiu lc, cn theo di thi gian thrombine. Thi gian ny s v
bnh thng khi heparine khng cn trong mu.
TC DNG NGOI
- Xut huyt do qu liu protamine.
- H p.
- Chm nhp tim.
LIU LNG v CCH DNG
- 1 ml protamine trung ha 1000 n v heparine.
- 0,6 ml protamine (625 AHU) trung ha khong 0,1 ml (2.500 n v ICU AXa hay 1.025 IU AXa)
fraxiparine. Tim tnh mch chm.

428.

PROTOLOC

USV
c/o CT TNHH DP THIN TH
Vin nang cha cc vi ht tan trong rut 20 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Omeprazole
T dc : mannitol, lactose, sucrose,

20 mg

hydroxypropylmethylcellulose,
hydroxypropylmethylcellulosephtalate.
M T
Omeprazole thuc nhm cc hp cht chng tit th h mi c tc dng ngn chn tit acid d
dy bng cch c ch c hiu h thng enzym H+/K+ ATPase ti mt tit ca t bo thnh d
dy.
DC LC
Omeprazole l mt hp cht chng tit, khng c tc dng khng ph giao cm ca cht i
khng histamine H2, nhng c tc dng ngn chn tit acid d dy bng cch c ch c hiu h
thng enzym H+/K+ ATPase ti mt tit ca t bo thnh d dy. Do h thng ny c xem nh
l bm acid (protein) trong nim mc d dy, Omeprazole c m t nh mt cht c ch
bm acid d dy, phong ta giai on cui cng ca s sn xut acid. Tc dng ny c lin quan
n liu dng v dn n c ch c s tit acid c bn ln s tit acid kch thch bt k do tc
nhn kch thch no.
Hot tnh chng tit : Sau khi ung, tc dng chng tit bt u xut hin trong vng 1 gi, hiu
qu ti a t c trong vng 2 gi. S c ch tit cn vo khong 50% hiu qu ti a sau 24
gi v thi gian c ch k o di n 72 gi. Do tc dng chng tit tn ti lu hn d thi
gian bn hy ngn, hin nhin do bi s lin kt ko di vi enzym H+/K+ ATPase thnh d
dy. Hiu qu c ch tit acid ca Omeprazole gia tng sau khi dng lin tc liu duy nht mi
ngy, liu dng t n bnh n sau 6 ngy.
DC NG HC
Protoloc cha Omeprazole di dng vi ht tan trong rut (v Omeprazole b phn hy trong
mi trng acid) nhm mc ch l s hp thu Omeprazole ch bt u sau khi cc vi ht ny ri
khi d dy. Thuc c hp th nhanh ; nh trong huyt tng t c trong vng t 0,5
n 3,5 gi. Sinh kh dng tuyt i khong 30-40% liu 20-40 mg ch yu do bi c ch
chuyn ha tin h thng. Thi gian bn hy trong huyt tng t 0,5 n 1 gi v khong 95%
lin kt vi protein huyt tng. Phn ln liu dng (77%) c o thi qua nc tiu di
dng t nht 6 cht chuyn ha.
CH NH
iu tr ngn hn lot t trng.
iu tr ngn hn lot d dy v vim thc qun do tro ngc d dy - thc qun.
CHNG CH NH
Cha c ghi nhn v chng ch nh ca Omeprazole.
THN TRNG LC DNG
Khi nghi ng lot d dy, nn loi tr kh nng bnh c tnh v iu tr c th lm gim triu
chng v gy tr ngi cho chn on.

LC C THAI v LC NUI CON B

Cng nh tt c cc thuc mi, khng nn dng Omeprazole trong thi kz mang thai v cho con
b tr khi tht cn thit. Nghin cu trn ng vt khng cho thy bt kz bng chng no v
nguy hi khi dng Omeprazole trong thi kz mang thai v cho con b v cng khng c bng
chng no v c tnh trn bo thai hay tc dng gy qui thai.
TNG TC THUC
Omeprazole c th ko di qu trnh thi tr ca diazepam, warfarin v phenytoin, nhng
thuc c chuyn ha bi oxy ha gan. Nn theo di bnh nhn dng ng thi vi
warfarin hoc phenytoin, i khi cn phi gim liu phenytoin hoc warfarin. Khng c tng
tc no c ghi nhn vi propranolol hoc theophylline. C th tng tc vi cc thuc
chuyn ha qua h thng enzym cytochrome P450. Khng tng tc vi cc thuc trung ha acid
dng ng thi.
TC DNG NGOI
Omeprazole c dung np tt. Bun nn, nhc u, tiu chy, to bn v y hi c ghi
nhn nhng rt him. Pht ban ngoi da xy ra mt vi bnh nhn. Nhng phn ng ny
thng nh v thong qua v khng lin h nht qun vi iu tr.
LIU LNG v CCH DNG
Lot t trng, lot d dy v vim thc qun do tro ngc :
Liu ngh l 20 mg, 1 ln mi ngy.
bnh nhn lot t trng, triu chng gim nhanh chng v lnh bnh trong vng 2 tun trong
a s trng hp. i vi nhng bnh nhn khng lnh bnh hon ton sau t iu tr khi
u, thng thng bnh s khi trong 2 tun iu tr thm.
bnh nhn lot d dy v vim thc qun do tro ngc, triu chng gim nhanh chng v
lnh bnh trong vng 4 tun trong a s trng hp. i vi nhng bnh nhn khng lnh
bnh sau t iu tr khi u, bnh s khi trong 4 tun iu tr thm.
nhng bnh nhn khng vi nhng thuc khc, dng 40 mg Omeprazole 1 ln mi ngy v
bnh s khi, thng trong 4 tun bnh nhn lot t trng v trong 8 tun bnh nhn lot
d dy v vim thc qun do tro ngc.
Hi chng Zollinger-Ellison :
Liu khi u ngh l 60 mg Omeprazole, 1 ln mi ngy. Nn iu chnh liu dng theo tng
bnh nhn v thi gian iu tr ty theo biu hin lm sng. bnh nhn trm trng v khng
p ng y vi nhng thuc khc, bnh c kim sot mt cch hiu qu v hn 90%
bnh nhn duy tr liu 20-120 mg mi ngy. Vi liu trn 80 mg, nn chia 2 ln mi ngy.
Liu lng trong cc trng hp c bit :
- Bnh nhn b suy gan hay suy thn : Khng cn iu chnh liu bnh nhn suy gan hoc thn.
- Tr em : Cha c kho st v tc dng ca Omeprazole tr em.
- Ngi gi : Khng cn iu chnh liu ngi gi.

QU LIU
Cha c thng tin v nh hng ca vic dng qu liu ngi v cng khng th ngh c
th v iu tr.
Liu ung mt ln n 360 mg vn c dung np tt.

429.

PROVIRONUM

SCHERING AG
c/o ZUELLIG
Vin nn : hp 25 vin - Bng B.
THNH PHN
cho 1 vin
Mesterolone

25 mg

DC LC
Provironum lm cn bng s thiu ht to androgen. S to androgen bt u gim t t khi
tui cng cao. Do , Provironum thch hp dng iu tr tt c cc tnh trng gy ra do
thiu to androgen ni sinh. liu iu tr c khuyn co, Provironum khng lm gim s
to tinh trng. Provironum c bit c gan dung np tt.
CH NH
Gim hiu nng tui trung nin v tui gi :
Nhng than phin do thiu androgen, nh gim hiu nng, d mt, thiu tp trung, gim tr
nh, ri lon v kh nng (libido), d b kch thch, ri lon gic ng, trng thi trm cm, v
nhng than phin v ri lon thn kinh thc vt, c th c khc phc hay ci thin nh dng
Provironum.
Ri lon kh nng :
Ri lon kh nng do thiu androgen s ht khi dng Provironum. Nu c cc yu t khc l
nguyn nhn chnh hay cc yu t khc gp phn gy ra nhng ri lon ny, Provironum c th
c dng h tr cho cc bin php iu tr khc.
Thiu nng sinh dc :
S tng trng, pht trin v chc nng ca cc c quan ch ph thuc androgen c kch
thch bi Provironum. Provironum khi pht s pht trin ca cc c tnh nam gii th pht
trong nhng trng hp thiu androgen trc tui dy th.
Provironum loi b cc triu chng do thiu androgen trong nhng trng hp mt chc nng
sinh dc xy ra tui sau dy th.

V sinh :
S gim tinh trng v gim tit ca t bo Leydig c th l nguyn nhn ca v sinh. Khi dng
Provironum, s lng v cht lng ca tinh trng cng nh nng fructose trong lc xut
tinh c th c ci thin hay tr v bnh thng, do lm tng c hi c con.
CHNG CH NH
Ung th tin lit tuyn, tin s hoc ang c u gan.
THN TRNG LC DNG
Androgens khng thch hp lm tng s pht trin c ngi kho mnh hoc tng
cng kh nng th lc.
Provironum ch dng cho nam gii.
Nn u n thm khm d phng tin lit tuyn.
Trong mt s him trng hp u gan lnh tnh, hoc cc him l ung th gan m mt s trng
hp l t quan st c dn n xut huyt trong bng e da tnh mng sau khi dng cc
cht ni tit t tng t cc cht c trong Provironum.
TNG TC THUC
Phenobarbital lm tng chuyn ha ca androgen gan, do tc dng ca androgen b gim
i hoc thi gian tc dng ngn li.
TC DNG NGOI
Trong mt s trng hp c bit, nu xy ra cng cng thng xuyn hay ko di, nn gim
liu hoc ngng thuc trnh lm tn thng dng vt.
LIU LNG v CCH DNG
Nut nguyn vin thuc vi nc.
Ngoi tr nhng trng hp c bit, liu lng sau y thng c khuyn co :
Gim hiu nng v ri lon v kh nng :
Bt u iu tr : 1 vin, 3 ln mi ngy. Sau khi t c s ci thin lm sng mong mun
c th th gim liu.
Tip tc iu tr : 1 vin, 1 hoc 2 ln mi ngy. Ty theo loi v nng ca cc than phin,
liu iu tr tip theo c th c hiu chnh theo cc nhu cu ca tng ngi bnh. Nn iu
tr lin tc trong khong thi gian nhiu thng.
Thiu nng sinh dc cn iu tr lin tc :
gip pht trin cc c tnh nam gii th pht : 1-2 vin, 3 ln/ngy trong nhiu thng.
Liu duy tr : 1 vin, 2-3 ln/ngy thng l .
V sinh - nhm ci thin s lng v cht lng tinh trng :
1 vin, 2-3 ln/ngy cho mt chu kz sinh tinh trng, v d khong 90 ngy. Nu cn thit, c th
iu tr li sau mt khong thi gian vi tun.
t c nng fructose cao hn trong lc xut tinh trong trng hp thiu nng t bo
Leydig sau dy th : 1 vin, 2 ln/ngy trong nhiu thng.

430.

PULVO 47 NOMYCINE

FOURNIER
[FOURNIER GROUP VIETNAM]
bt dng ngoi da : bnh xt 4 g.
THNH PHN
* UC : lng men phn gii 1 micromole hydro peroxyde trong 1 pht iu kin th
nghim.
cho 100 g bt
Catalase

2.107 UC*

Neomycine sulfate

2.800.000 UI

T dc : magnesium stearate, lactose

khan.
Cht to lc y : HFA 134a.
DC LC
Liu php khng sinh ti ch : neomycine phi hp vi catalase l cht c ngun gc sinh hc c
hot tnh enzyme (oxy ha kh).
Neomycine : khng sinh dit khun thuc h aminoside.
Catalase (chit t gan nga) : can thip vo tin trnh oxy ha m v thc y qu trnh to
m ht trong tin trnh lnh so ca vt thng.
DC NG HC
Bt t tiu khng gy bt vt thng.
CH NH
iu tr h tr ti ch cc vt thng trong giai on m ht, cc vt lot da v cc mng m
hoi t.
CHNG CH NH
- D ng vi protein l (catalase ca nga) hoc vi neomycine.
- Tr em di 2 tui do c nguy c neomycine xuyn thm qua da gy c trn tai.
- C tn thng v ph n ang nui con bng sa m do a b c nguy c hp thu thuc.
CH PHNG
Nguy c d ng tng ln trong mt vi iu kin s dng :
- dng thuc ko di trn 8 ngy,
- dng thuc di tnh trng bt kn (bng b kn),

- dng thuc kt hp vi thuc m,

- dng thuc trn nhng bnh da mn tnh, eczema v vim da ch yu do dch.
Nu xut hin phn ng khng dung np thuc, phi ngng iu tr v hi kin bc s.
Khi s dng thuc trn nhng thng tn rng, lo t chn, v trong trng hp dng thuc ko
di, s c nguy c l neomycine ngm vo mu.
Hin tng d ng thuc xy ra bt ng c th ngn cn vic dng v sau mt khng sinh cng
h s dng theo ng ton thn.
THN TRNG LC DNG
Dng lu di s c nguy c chn lc vi khun khng thuc nn phi hn ch thi gian tr liu : ti
a 8 ngy.
LC C THAI v LC NUI CON B
Khng khuyn dng cho ph n c thai.
Trnh dng thuc trong thi kz nui con bng sa m, nht l khng nn dng trn v (trng
hp nhim trng v) do nguy c a b nut phi thuc.
Ni chung, trong khi c thai v ang nui con b, trc khi dng thuc phi lun lun hi kin
bc s hoc dc s.
TC DNG NGOI
Nguy c d ng vi catalase ca nga v/hoc vi neomycine, thng xy ra bt ng :
- trong trng hp dng cho lot chn, xung quanh cc vt lot,
- trong trng hp dng ko di,
- trong trng hp dng di dng bng b bt kn.
LIU LNG v CCH DNG
Liu lng :
Dng thuc cho mi ln thay bng, iu tr khng qu 8 ngy. Din tch iu tr khng c qu
rng.
Cch dng :
Ra sch vt thng ri thm kh bng mt ming gc.
Lc chai trc khi dng.
Gi chai thng ng cch xa vt thng 20 cm.
Xt thuc thnh mt mng mng ch hi nhn thy bng cch n lin tip 3 hay 4 ln, mi ln n
ch trong vi phn ca mt giy.
Bng cc vt thng theo cc phng php thng thng.
Cc khuyn co quan trng :
Cn lm kh vt thng trc khi xt thuc nht l sau khi ra vi ammonium bc bn.
Vic gi khong cch xa vt thng rt quan trng trnh cm gic au c th c ngay khi
ang xt hoc sau .
Trng hp vt thng au, xt thuc ln ming gc ri p ln vt thng.

Khng cn xt thuc qu nhiu v lng bt d tha khng lm tin trnh lnh so nhanh hn.
Thi gian iu tr :
Thi gian iu tr khng c qu 8 ngy.
Trng hp cc tn thng cn dai dng, phi hi kin bc s.
BO QUN
Bo qun nhit di 30oC.
Dng chai phun xt :
Trnh nh nng trc tip.
Khng nhit qu 50oC.
Khng chc thng hay t chai ngay c khi ht thuc.

431.

PYLOBACT

RANBAXY
Mi b thuc gm 2 vin nang Omeprazole, 2 vin nn Tinidazole v 2 vin nn Clarithromycin :
hp 7 b.
THNH PHN
cho 1 vin nang
Omeprazole

20 mg

(di dng ht bao tan trong rut)

cho 1 vin nn
Tinidazole

500 mg

cho 1 vin nn
Clarithromycin

250 mg

M T
Pylobact l mt b thuc gm omeprazole, clarithromycin v tinidazole vi ng liu ca 3

thuc ny trong 1 gi v gm 7 gi cho liu php iu tr 7 ngy, to iu kin thun li cho

bnh nhn v bnh nhn d dng tun th ch iu tr dit tr H. pylori trong bnh l lot
d dy t trng.
Omeprazole l mt cht c ch bm proton. N ngn cn s tit acid d dy. N c dng
trong iu tr bnh l lot d dy t trng v bnh l{ tro ngc d dy thc qun. Cu to ha
hc ca omeprazole l 5-methoxy-2-[4 methoxy-3,5 dimethyl-2 pyridinyl methyl sulfinyl]-1Hbenzimidazole. Cng thc phn t l C17H19N3O3S, khi lng phn t l 345,4.
Tinidazole l mt cht thuc nhm nitroimidazole c tc dng dit khun i vi cc vi khun
k kh, cc ng vt nguyn sinh v vi khun H. pylori. Cu to ha hc ca tinidazole l 1-[2(Ethyl sulfonyl) ethyl]-2-methyl-5-nitroimidazole. Cng thc phn t l C8H13N3O4S, khi lng
phn t l 247,30.
Clarithromycin l 1 khng sinh thuc nhm macrolide, c tc dng dit khun i vi nhiu vi
khun hiu kh v k kh Gr(+), Gr(-), bao gm c H. pylori. Cu to ha hc ca clarithromycin l
(2R, 3S, 4S, 5R, 6R, 8R, 10R, 11R, 13R)-3-(2,6-dideoxy-3-C-30- dimethyl-a-L-ribohexopyranosyloxy)-11,12-dihydroxy-6-methoxy-2,4,6,8,10,12- hexamethyl-9-oxo-5-(3,4,6trideoxy-3-dimethylamino-b-D-xylo-hexopyranosyloxyl) pentadecan -13-olide-6-Omethylerythromycin. Cng thc phn t l C38H69NO13. Khi lng phn t l 748,0.
DC LC
C s y hc :
Vai tr ca H. pylori (xon khun, trng roi, vi khun Gram-) c coi l nguyn nhn sinh bnh
chnh trong bnh l lot d dy t trng. T l ca H. pylori nhng bnh nhn lot d dy t
trng t 80-100%. S dit tr H. pylori s thc y tin trnh lnh lot, gim t l bin chng
v ti pht t 70-80% xung cn 5-10%.
C nhiu liu php iu tr bao gm n liu php, liu php dng 2 thuc v liu php dng 3
thuc c nghin cu dit tr H. pylori. Cc khng histamin thng thng, cc khng
th th khng c ch hoc dit c H. pylori v c t l ti pht lot cao. Liu php 1 thuc vi
hp cht bismuth hay mt khng sinh dng dit tr H. pylori khng c ng h do t l dit
tr H.pylori thp v c nguy c khng thuc. Liu php 2 thuc vi mui bismuth v 1 khng
sinh ch dit tr c H. pylori trong 50% trng hp. Liu php 2 thuc vi 1 cht c ch bm
proton v 1 khng sinh cng tht bi trong iu tr nhim H. pylori 30% bnh nhn.
Trong cc cng thc iu tr 3 thuc c th s dng c (v d mui bismuth hay c ch bm
proton + khng sinh + nitro-imidazole), cng thc 3 thuc vi omeprazole, clarithromycin v
tinidazole cho kt qu tt nht. Cc th nghim lm sng cho thy liu php 3 thuc vi 3 thuc
ny l l{ tng v t l sch khun i vi H. pylori cao (90-100%). Nhng thun li khc ca b
thuc phi hp ny l thi gian iu tr ngn (1 tun), dung np tt v bnh nhn d tun th
iu tr. Clarithromycin l mt macrolide mi vi kh nng dit H. pylori rt tt c in vitro v in
vivo. Nng c ch ti thiu ca clarithromycin v cht chuyn ha c hot tnh ca n l 14-

hydroxy clarithromycin ln lt l 0,03 mg/ml v 0,06 mg/ml i vi H. pylori. Clarithromycin l

khng sinh cho t l dit H. pylori cao nht so vi cc khng sinh khc khi dng n c.
Omeprazole gip to ra mt mi trng thun li hn cho hot ng khng khun. N c ch
s tng trng ca H. pylori. S dng ng thi clarithromycin v omeprazole cho thy c s
thay i thun li v cc c tnh dc ng hc ca c 2 thuc. T l sch khun i vi H.
pylori s gia tng ng k khi phi hp thm mt nitro-imidazole. Tinidazole c thi gian bn
hy ko di v dung np tt. Do , phi hp omeprazole vi khng sinh s lm gim triu
chng v lnh lot nhanh nht.
B thuc c thit k cho bnh nhn thun li trong vic s dng c 3 thuc theo ch iu
tr, v v vy bnh nhn s d tun th iu tr hn. S tun th tt ca bnh nhn khi iu tr
s m bo s dit tr H. pylori v ngn nga tnh trng khng thuc ca H. pylori.
C ch tc dng :
Omeprazole c ch s tit acid ca d dy thng qua c ch c hiu h thng H+/K+ ATPase
b mt ch tit ca t bo thnh d dy. Omeprazole c ch c s ch tit d dy cn bn v
khi b kch thch. Sau khi ung, tc dng c ch tit acid ca omeprazole xy ra trong vng 1 gi.
Thi gian c ch ko di 24 gi. Sau khi lp li liu 20 mg omeprazole/ngy th lng acid d
dy trong 24 gi gim i 97%.
Tinidazole gy cn tr qu trnh tng hp DNA. Nhm 5-nitro chuyn sang cht trung gian c
hot tnh c ch s tng hp DNA v lm mt cu trc xon ca DNA.
Clarithromycin gn vo tiu n v ribosom 50s ca n v ribosom 70s ca vi khun nhy cm,
do s c ch s tng hp protein ph thuc RNA ca vi khun.
DC NG HC
Tt c 3 thuc trong b thuc u c hp thu tt qua ng tiu ha.
Omeprazole c hp thu nhanh vi kh dng sinh hc tuyt i khong 40%. S hp thu
ca omeprazole khng b nh hng bi thc n. Omeprazole u tin tp trung trong t bo
thnh ca d dy. Omeprazole c chuyn ha ch yu gan. Thi gian bn hy thi tr
trong huyt tng t 30 pht n 1 gi. Thuc c bi tit qua nc tiu khong 80%.
Clarithromycin c phn b rng ri vo trong cc m bao gm c nim mc d dy t trng.
Nng nh trong huyt thanh sau khi ung 250 mg clarithromycin ln lt l 0,6 mg/ml i
vi clarithromycin v 0,7 mg/ml i vi cht chuyn ha hot ng c bn ca n, 14-hydroxy
clarithromycin. Clarithromycin c chuyn ha ch yu gan. Thi gian bn hy thi tr
trong huyt tng khong 3-4 gi. Khong 20% c bi tit di dng khng i v 15% di
dng 14-hydroxy clarithromycin qua thn.
Ung ng thi clarithromycin v omeprazole cho thy c s thay i thun li v cc c tnh
dc ng hc ca clarithromycin. Khi dng chung clarithromycin vi omeprazole, Cmax trung
bnh ln hn 10% Cmin trung bnh ln hn 27% v AUC trung bnh ln hn 15% so vi khi ch
dng n thun clarithromycin. Nng ca clarithromycin trong m d dy v cht nhy cng

gia tng khi dng ng thi clarithromycin v omeprazole.

kh dng sinh hc ca tinidazole l 100%. Thi gian bn hy thi tr trong huyt tng l
12-14 gi. Thuc c phn b nhanh vo trong cc m c th. Tinidazole bi tit ra trong mt
vi nng nh hn 50% nng ca tinidazole trong huyt thanh. Khong 25% liu c bi
tit di dng nguyn thy qua nc tiu. Cc cht chuyn ha c bi tit qua nc tiu
khong 12%. Tinidazole cn c bi tit mt phn qua phn.
DC L LM SNG
Hiu qu lm sng ca liu php phi hp gm omeprazole, tinidazole v clarithromycin
c cng nhn trong nhiu th nghim lm sng.
Gn y, Bazzoli v cng s bo co t l dit H. pylori l 93-100% nhng bnh nhn dng
liu php phi hp omeprazole (20 mg), clarithromycin (250 mg) v tinidazole (500 mg) trong
cc th nghim lm sng.
Liu php cho thy kt qu dung np tt v s tun th iu tr ca bnh nhn t hn 90%
trong cc th nghim ny.
Jaup v Norrby (1996) thc hin mt nghin cu trn 116 bnh nhn xc nh hiu qu v
tnh dung np ca liu php iu tr mi, liu thp v ngn hn bng 3 thuc trong dit tr H.
pylori. Bnh nhn c iu tr trong thi gian 1 tun vi omeprazole 20 mg 2 ln/ngy,
clarithromycin 250 mg 2 ln/ ngy v tinidazole 500 mg 2 ln/ngy. 4 tun sau khi ngng iu
tr, s dit tr H. pylori c nh gi bng urease test nhanh v lm m hc. T l sch khun
l 93%. Ngoi ra, tt c bnh nhn lot d dy t trng tin trin cho thy c s lnh lot hon
ton mc d khng iu tr thm. S dung np thuc v kh nng chp nhn thuc l rt tt.
Moayyedi v cng s (1995) tin hnh mt nghin cu nh gi hiu qu iu tr trong
thi gian mt tun vi omeprazole, clarithromycin v tinidazole trn trn 157 bnh nhn. Trong
pha 1 bnh nhn c dng 20 mg omeprazole, 250 mg clarithromycin v 500 mg tinidazole 2
ln/ngy trong 1 tun. Trong pha 2 tt c bnh nhn c dng 250 mg clarithromycin v 500
mg tinidazole 2 ln/ngy trong 1 tun. Ngoi ra, cc bnh nhn cn c dng ngu nhin hoc
l 20 mg omeprazole 2 ln/ngy, hoc l omeprazole 1 ln/ngy hoc l khng dng
omeprazole. T l sch khun H. pylori c ghi nhn trong pha 1 v pha 2 nhng bnh nhn
c dng omeprazole mt hoc 2 ln/ngy l 88% ; nhng bnh nhn khng dng omeprazole
trong pha 2 th t l dit tr H. pylori ch c 63%. Trong nhm s dng omeprazole c 22 bnh
nhn mang chng vi khun khng vi metronidazole. Do , t nghin cu ny c th kt
lun l omeprazole, clarithromycin v tinidazole c hiu qu trong dit tr H. pylori.
Tnh sinh ung th/ sinh t bin :
Khng tm thy kh nng gy t bin ca omeprazole v clarithromycin trong cc th nghim
khc nhau v tnh sinh t bin. Tinidazole c bo co l c kh nng gy t bin v gy ung
th trong cc th nghim trn sc vt.
S pht trin ca cc khi u ung th chut cng ca Omeprazole do tng nng gastrin

trong mu c ghi nhn.

Trong thi gian c thai v cho con b :
Clarithromycin, omeprazole v tinidazole : Cc nghin cu c kim sot y cha c tin
hnh y ngi. Tuy nhin cc nghin cu trn sc vt cho thy thuc c gy c cho m
v bo thai.
CH NH
Pylobact c ch nh dit tr H. pylori trong vim d dy mn tin trin, lot d dy v t
trng.
CHNG CH NH
Khng s dng b thuc ny nhng bnh nhn qu mn cm vi omeprazole, clarithromycin
hay tinidazole. B thuc ny cng chng ch nh nhng ph n c thai v bnh nhn c ri
lon to mu. S dng ng thi vi cc thuc nhm ergo cng l mt chng ch nh.
THN TRNG LC DNG
Tng qut :
Bnh nhn ang dng b thuc ny khng nn ung nc gii kht c cn v tinidazole c th
gy ra cc tng tc dng disulfiram vi ru.
S dng thn trng nhng bnh nhn suy gan hay suy thn.
Ch { chn on tnh trng vim i trng mng gi nhng bnh nhn b tiu chy sau khi
dng thuc khng sinh.
Trnh dng thuc nhng bnh nhn c ri lon thn kinh thc th.
Cnh gic :
Khng dng thuc nhng bnh nhn nghi ng c tn thng c tnh d dy v omeprazole
c th che giu triu chng v lm chm tr chn on.
Khng nn dng clarithromycin nhng bnh nhn ang iu tr vi terfenadine hay
astemizole, s dng ng thi c th lm gia tng nng ca cc khng histamin ny trong
mu, iu ny c th lm cho khong thi gian QT ko di hay gy ra ri lon nhp tim.
TNG TC THUC
- Theophyline : S dng ng thi vi clarithromycin s lm gia tng nng theophylline. Do
, cn phi theo di nng ca theophylline.
- Terfenadine : S dng ng thi vi clarithromycin s lm gia tng nng ca terfenadine,
iu ny s lm cho khong QT ko di hay gy ra ri lon nhp tim.
- Thuc chng ng ng ung : S dng ng thi vi clarithromycin c th lm tng tc
dng ca cc thuc chng ng ung nh warfarin. Do cn phi theo di thi gian
prothrombin ca bnh nhn.
- Carbamazepine, cyclosporine, phenytoin, disopyramide, lovastatin, valproate, cisapride,
pimozide, astemizole, digoxin : Nng ca cc thuc ny c th tng ln khi dng ng thi
vi clarithromycin.

- Ketoconazole, ampicillin, v cc mui st : Do tnh c ch tit acid rt mnh, omeprazole c

th gy tr ngi cho vic hp thu cc thuc ny.
- Phenytoin, diazepam, warfarin : Omeprazole lm chm tr s bi tit ca thuc ny.
TC DNG NGOI
Cc thnh phn ca b thuc c ghi nhn l dung np tt trong cc th nghim lm sng.
Cc tc dng ngoi { thng l nh v thong qua.
Tc dng ngoi { trn ng tiu ha gm bun nn, nn, kh chu trong d dy, bt thng v
v gic, chn n, to bn, y hi v c th gy tng thong qua cc men gan.
Phn ng qu mn, nga, pht ban, ni m ay c ghi nhn vi cc tc nhn ring r. Nhc
u, hoa mt chng mt, mt, l ln c th xy ra trong mt vi trng hp. Tinidazole c th
gy ra gim bch cu thong qua.
LIU LNG v CCH DNG
Pylobact c sn xut cung cp ng liu omeprazole, clarithromycin v tinidazole. Mt
gi dng cho mt ngy gm c 2 vin nang omeprazole (20 mg), 2 vin nn clarithromycin (250
mg) v 2 vin nn tinidazole (500 mg). Mt gi dng cho mt ngy iu tr.
Vi dng ng gi c bit ny, bnh nhn s ung 1 vin nang omeprazole, 1 vin nn
clarithromycin v 1 vin nn tinidazole vo bui sng v ung thm 1 ln tng t vo bui
chiu ti.
Mi hp thuc c 7 gi v thi gian iu tr hon tt l 1 tun.
Tip tc iu tr : Omeprazole 20 mg, 2 ln/ngy hay lansoprazole 30 mg, 1 ln/ngy trong 3
tun.
BO QUN
Gi nhit di 25oC, trnh nh sng.

THUC VN Q-R

432.

QUAMATEL

GEDEON RICHTER
vin bao phim 20 mg : v 14 vin, hp 2 v.
vin bao phim 40 mg : v 14 vin, hp 1 v.

bt pha tim 20 mg : hp 5 l bt ng kh + 5 ng dung mi 5 ml.

THNH PHN
cho 1 vin
Famotidine

20 mg

cho 1 vin
Famotidine

40 mg

cho 1 l
Famotidine

20 mg

ng dung mi : dung dch NaCl 0,9%

5 ml

DC LC
Famotidine lm gim tit dch v do b kch thch v dch v c bn bng cch i khng vi
histamin ti th th H2 cc t bo vch trong nim mc d dy.
DC NG HC
Dng thc n hay cc thuc khng acid ng thi khng c nh hng n hp thu ca thuc.
Khi ung, tc dng pht trin sau 1 gi v ko di 10-12 gi. Sau khi tim tnh mch tc dng ti
a pht trin trong vng 30 pht.
Sinh kh dng ca famotidin l 40-50%, thi gian bn thi l 2,3-3,5 gi ; nhng nu thanh
thi creatinin l 10 ml/pht, th thi gian bn thi c th ko di ti 20 gi ; 30-35% liu ung
v 65-70% liu tim tnh mch c thi tr qua thn di dng khng chuyn ha.
CH NH
Lot d dy v lo t t trng, tro ngc d dy - thc qun v cc tnh trng tng tit khc (v
d hi chng Zollinger-Ellison).
D phng ti pht lot, d phng ht acid trong gy m (hi chng Mendelson).
CHNG CH NH
Qu mn cm vi hot cht, mang thai, thi kz cho con b.
Chng ch nh vi tr em v thiu cc kinh nghim cho la tui ny.
CH PHNG v THN TRNG LC DNG
Trc khi khi u dng famotidine, phi loi tr u c tnh. ngi bnh tn thng gan, nn

gim liu.
TNG TC THUC
Famotidine khng nh hng n h enzyme cytochrome P-450, do thuc khng nh hng
n s chuyn ha ca cc thuc b chuyn ha bi h ny. Do famotidine lm tng pH d dy,
nn s hp thu ketoconazole c th gim nu dng ng thi.
TC DNG NGOI
Him gp thn nhit cao, nhc u, mt mi, tiu chy hoc to bn, d ng, lon nhp tim,
vng da mt, tng transaminase huyt tng, bing n, nn, bun nn, kh ming. Rt him
khi mt bch cu ht, gim ton th tiu cu, gim bch cu, gim tiu cu, au c, au khp,
ri lon tm thn nht thi, co tht ph qun, rng tc, trng c, nga, da kh, tai, thay i v
gic.
C th kch ng thong qua ti ch tim.
LIU LNG v CCH DNG
Vin nn :
Lot d dy v t trng :
40 mg mt ln/ngy lc i ng, hoc 20 mg mi ln, ung 2 ln/ngy (vo bui sng v bui ti).
Thi gian iu tr l 4-8 tun.
D phng ti pht :
Ung 20 mg mt ln/ngy, lc i ng ti.
Tro ngc d dy - thc qun :
Mi ln ung 20 mg, 2 ln/ngy (vo bui sng v bui ti) trong 6 tun, nu c thm vim thc
qun ung 20-40 mg mi ln, dng 2 ln/ngy v ko di trong 12 tun.
Hi chng Zollinger- Ellison :
Liu lng ty theo tng c th, thng thng liu khi u l c mi 6 gi th ung mt ln 20
mg.
Dng lin tc theo i hi lm sng.
Trong gy m d phng chng ht acid :
Ung 40 mg vo bui ti trc ngy phu thut hay vo bui sng ca ngy phu thut.
Thuc tim :
Ch dng trong cc trng hp trm trng, hoc khi ngi bnh khng th ung.
Liu thng thng l mi ln 20 mg, tim tnh mch 2 ln/ngy (mi 12 gi tim mt ln).
Hi chng Zollinger- Ellison :
Liu khi u l 20 mg tim tnh mch, mi 6 gi tim mt ln, sau liu lng ty thuc vo
lng acid tit ra v tnh trng lm sng ca ngi bnh.
Trong gy m d phng chng ht acid :
Tim tnh mch 20 mg vo bui sng trong ngy phu thut hay ti thiu l 2 gi trc khi phu
thut.

Liu tim tnh mch n khng th cao hn 20 mg. Trong trng hp tim tnh mch, nn pha
thuc trong 5-10 ml dung dch nc mui sinh l (ng dung mi), sau tim chm (ti thiu l
trong 2 pht). Nu truyn dch, nn pha thuc trong 100 ml dung dch glucose 5% v truyn
trong 15-30 pht. Ch pha dung dch ngay trc khi dng. Ch dng dung dch khng mu v
trong. Dung dch pha s bn trong t nht 24 gi nhit 25oC.
Trong suy thn :
Nu thanh thi creatinine < 30 ml/pht (creatinine huyt tng > 3 mg/100 ml), th liu
hng ngy nn gim xung 20 mg hoc ko di khong thi gian gia cc liu ln 36-48 gi vi
c vin nn v thuc tim.
QU LIU
Ra d dy, iu tr triu chng v iu tr h tr.
BO QUN
Vin nn bao phim :
Bo qun nhit 15-30oC, trnh nh sng.
Thuc tim :
Bo qun nhit 15-25oC, trnh nh sng.

433.

RABIPUR

CHIRON VACCINES
c/o HONG LAN PHARMA
Bt pha tim >= 2,5 UI : l pha 1 liu 1 ml.
THNH PHN
cho 1 liu
Virus bnh di c bt hot

>= 2,5 UI

M T
Mi l cha bt ng kh l virus bnh di c bt hot, cy trn t bo nguyn bo si
ca g con, cy >= 2,5 UI v n nh, dng pha 1 liu min dch (1 ml).
Cc khng sinh neomycin, chlortetracycline v amphotericin B s dng trong qu trnh nhn
ging t bo c loi i sau v ch hin din trong thnh phm dng vt.
Vaccin di Rabipur c Vin Paul-Ehrlich, thuc Hip hi Huyt thanh v Vaccin c,
cng nhn.
CH NH
iu tr sau khi c tip xc vi ng vt nghi di.

D phng bnh di.

CHNG CH NH
Tim chng iu tr sau khi c tip xc vi ng vt nghi di : V y l bnh gy t vong,
do bt c ngi no sau khi c tip xc vi ng vt nghi di u phi c tim chng
(xem Bng 1). Trong trng hp ny khng c chng ch nh.
D phng bnh di : Nn hon li vic tim chng vi mc ch d phng ph n c thai,
ngi bnh, ang trong thi kz phc hi sc khe sau bnh hay nghi l ang trong tnh trng
bnh.
Khng dng Rabipur vi mc ch d phng cho ngi bit rng s b d ng nng vi vaccin
ny.
Nu c chng ch nh, nn cn nhc vic tim chng d phng vi nguy c b nhim. Nu
cn, c th vn tim chng c nhng phi thn trng.
THN TRNG LC DNG
Dng cho ph n c thai v cho con b : Khng c trng hp no gy tn hi n m v con
c lin quan n vic tim chng trong thi gian mang thai. Trong thi kz cho con b, khng c
l{ do no cho rng vic tim chng cho m c th nh hng n con.
TNG TC THUC
bnh nhn ang c iu tr bng thuc c ch min dch, hiu qu ca vic tim chng c
th b hn ch. Trong trng hp ny, nn tng liu khi u ca vaccin ln gp i hay gp ba.
Trnh dng thuc c ch min dch sau khi tim chng.
Khng dng globulin min dch bnh di hay huyt thanh min dch bnh di qu liu khuyn
co, nu khng n c th nh hng n vic hnh thnh khng th trong qu trnh tim chng.
Khng c gii hn v thi gian gia vic tim chng bnh di vi cc tim chng khc.
TC DNG NGOI
C th xy ra phn ng nh ti ch tim, nh au, ng hay sng. i khi phn ng c th
nng hn v st cao qu 38oC, sng hch bch huyt, au khp v kh chu ng tiu ha.
Hn hu c th gy nhc u, mt mi v phn ng d ng ; tuy nhin, ch cn iu tr trong
nhng trng hp ngoi l. Mt s trng hp c bit c ghi nhn c gy nh hng ln
thn kinh nh d cm, au thn kinh, lit nh.
LIU LNG v CCH DNG
Ngi ln v tr em c tim chng cng mt liu nh nhau. Mi liu l 1 ml.
iu tr sau khi c tip xc vi ng vt nghi di : Phi tim chng ngay lp tc. Mt t iu tr
bao gm 6 mi tim (cho ngi ln v tr em) : mi ln tim 1 liu vo cc ngy 0, 3, 7, 14, 30
v 90. Quy nh ca T chc Y t Th gii v mi tim ngy th 90 l khng bt buc.
Bnh nhn c vt thng gy bi th nui hay th hoang b di hay nghi di, hay phn nim
mc hay vt thng da c tip xc vi nc bt ca nhng ng vt ny (xem Bng 1), cn phi
tim thm mt liu globulin min dch bnh di (ngun gc ngi) vi liu 20 UI/kg, hay huyt

thanh min dch bnh di (ngun gc ng vt) vi liu 40 UI/kg, tim ng thi vi liu th
nht ca vaccin, nhng tim v tr khc (xem Bng 1).
D phng bnh di : Rabipur c th c dng d phng bnh di mi nhm tui. Vic
tim chng d phng c th p dng cho nhn vin trong ngnh th y, nhn vin nui th,
ngi i sn, nhn vin lm vic trong phng xt nghim bnh di hay nhng i tng tng
t.
Mt t d phng gm 1 liu vo nhng ngy 0, 28 v 56 hay trong trng hp khn cp hn,
vo cc ngy 0, 7 v 21.
Tim chng tng cng : Nhng bnh nhn c chng nga bnh di c th tim chng
tng cng, c nu r Bng 2. Nhng ngi cha tng c tim chng hay tim chng
khng y , xem hng dn Bng 3.
La chn gia phc B hay C (Bng 3), T chc Y t Th gii khuyn co mt phc c rt
ngn gm 2 liu vo ngy 0, sau 1 liu vo ngy 7 v 1 liu vo ngy 21.
Vic tim chng phi c ghi vo s tim chng v thc hin bi nhn vin y t. Vic d
phng ch c hiu lc tt khi phi tim chng y v ng lch.
Globulin min dch hay huyt thanh min dch dng chung vi vaccin phi c bo co v ghi
vo s tim chng.
Bng 1. Chn la phc tim chng
ty theo mc nng
Mc nng

Tnh trng ca
Phc chn la
ng vt

C tip xc, nhng khng vi nc nc ng vt b

bt ng vt. Da bnh nhn khng try di
xc trc v trong thi gian c tip xc

Khng cn tim chng

Nu s c nguy c vo nhng
ln tip xc sau, tim chng
theo phc A (xem Bng 3)
Trng hp c nghi ng,
tim chng theo phc B
(xem Bng 3)

Da c tip xc vi nc bt ng vt,
ng vt nghi
hay da b try xc nh trong khi tip
b di* v c
xc do b try xc, cn ngoi da (ngoi th em x t
tr u, c, vai, tht lng, tay, bn

Tim chng ngay theo phc

B, nu cn c th p dng
bin php iu tr ng thi
khc** theo phc C (xem

tay)

nghim c Bng 3)
Nu kt qu xt nghim ng
vt khng b bnh, nn tip
tc phc A
ng vt b
di l th
hoang hay
khng th
em i x t
nghim

Nim mc ca bnh nhn tip xc vi

nc bt ca th, hay b cn, nht l
u, c, vai, tht lng, tay, bn tay

Dng ngay bin php iu tr

ng thi** theo phc C

ng vt nghi Dng ngay bin php iu tr

b di* hay ng thi** theo phc C
b di
Nu kt qu xt nghim ng
vt khng b bnh, nn tip
tc phc A

* Bt kz ng vt no trong vng c dch bnh di u c xem l c bnh. Ngay c xc

ng vt cng c th truyn bnh.
** Dng ng thi vaccin v globulin min dch hay huyt thanh min dch.
Bng 2. Phc tim chng cho ngi c tim
chng y trc
Tim chng trc (theo phc A n C) s dng
vaccin di vi hm lng >= 2,5 UI/liu, tnh t ngy c
tip xc vi ng vt tr v trc:

Phc tim chng

< 1 nm

Tim chng 1 ln: ngy 0

(chng ln 2: ngy 3)*

1-5 nm

Tim chng 2 ln: ngy 0 v

3 (chng ln 3: ngy 7)*

> 5 nm

Tim chng tr li y
theo phc B hay C (ty

theo mc nng)
* Trng hp c nguy c cao (xem Bng 1)
Bng 3. Phc
tim
chng dnh
cho bnh
nhn cha
tng c
tim chng
di hay tim
chng di
cha y
Phc A: trc Phc B: sau
Chng nga
Phc C: sau khi c tip xc iu tr
khi c tip xc D khi c tip xc
di trc
ng thi
phng
iu tr
Cha tng Rabipur ngy 0, 28, Rabipur IM 1
tim chng 56 v 1 nm sau liu ngy 0, 3,
di hay tim hay 1 liu vo ngy 7, 14, 30 v
chng khng 0, 7, 21 v 1 nm (khng bt
y
sau
buc) 90

iu tr nh phc B, cng thm

20UI/kg globulin min dch hay
40UI/kg huyt thanh min dch, 1
liu cng lc vi ln tim chng
Rabipur u tin

Tim chng
Tim chng tng
tng cng: 1 Tim chng tng cng: 1 ln tim
cng: 1 ln tim
ln tim chng chng mi 2-5 nm
chng mi 2-5 nm
mi 2-5 nm
Cch dng :
Vaccin kh c pha vi dung mi km theo ngay trc khi tim, lc nh ha tan.
Tim IM vo c delta, i vi tr nh th c th tim vo mt trc i.
Nu cn phi tim liu gp i hay gp 3 (xem Tng tc thuc), tim mi liu vo 1 v tr khc
nhau.
Khng tim IV.
Nu v tim IV c th gy phn ng nng, nh sc.
Cp cu : Adrenaline, corticoid liu cao, thay th mu, th oxy.
Vaccin phi t nhng tiu chun ca T chc Y t Th gii v phi khng c ch nhit t. Trong

a s trng hp, vo ln tim chng th 3, lng khng th t n nng d

phng bnh di.
Lng khng th gim dn theo thi gian, do mt s trng hp phi tim chng tng
cng t c hiu qu min dch tt.
Lu { : i vi nhng ngi c tip xc vi ng vt nghi b di, cc bc sau y l quan
trng :
iu tr vt thng ngay lp tc : loi virus di, ra ngay vt thng bng x phng v ra
k vi nc. Sau lau vt thng vi cn (40-70%) hay dung dch 0,1% ca mui ammonium
bc 4. Nu dng mui ammonium bc 4, phi khng cn vt x phng v x phng c th lm
gim tc dng ca cht ny.
Trng hp vt thng do b cn, khng nn may vt thng tr phi phi ghp da.
Nga un vn : kim tra tnh hnh tim chng un vn ca bnh nhn.
Tim chng iu tr di theo khuyn co ca T chc Y t Th gii. Cc bc tim chng ty
theo mc (xem Bng 1) v vic tim chng di trc y ca bnh nhn ny (xem Bng 2 v
Bng 3).
BO QUN
Bo qun +2oC n +8oC.

434.

RANTUDIL forte - RANTUDIL retard

BAYER PHARMA
Vin nang 60 mg : hp 20 vin.
Vin nang tc dng ko di 90 mg : hp 20 vin.
THNH PHN
cho 1 vin Rantudil forte
Acemetacin

60 mg

cho 1 vin Rantudil retard

Acemetacin

90 mg

DC LC
Vin nang Rantudil forte, Rantudil retard c dng iu tr cc tn thng vim v au, c
bit tn thng c lin quan vi h c xng. Acemetacin, thnh phn hot cht ca vin nang
Rantudil forte, Rantudil retard l mt thuc khng vim khng thuc nhm steroid (AINS), c
tnh gim au, khng vim v khng bnh thp.
CH NH
Dng iu tr chng au v hn ch vn ng kt hp vi :
- Vim khp dng thp mn tnh.
- Vim khp mn tnh trong bnh vy nn.
- Kch ng cp tnh lin quan vi bnh thoi ha khp, c bit cc khp ln v ct sng (vim
xng khp hot ha, thoi ha ct sng).
- Bnh Bechterew (vim cng ct sng).
- t cp ca bnh thng phong (gout).
- Vim khp, c v gn, vim bao gn v vim bao hot dch.
- au lng v thn kinh ta.
- Vim v sng hu phu v tn thng m mm.
- Vim tnh mch nng (vim tnh mch huyt khi) v cc tnh mch khc (vim mch mu).
CHNG CH NH
Ri lon to mu cha chn on r nguyn nhn.
Qu mn cm vi thnh phn hot cht acemetacin, hay vi indometacin (cht cng nhm
c dng iu tr au v vim).
Khi ang mang thai ba thng cui ca thai kz.
V cha c kinh nghim s dng, khng nn dng vin nang Rantudil forte, Rantudil retard
cho tr em di 14 tui.
CH PHNG v THN TRNG LC DNG
iu tr bng vin nang Rantudil forte, Rantudil retard c th lm nng thm cc triu chng
ca bnh nhn b ng kinh (bnh co git), bnh Parkinson hay c tin cn ri lon tm thn.
Trn bnh nhn c khuynh hng gia tng s chy mu, kt tp tiu cu c th b nh
hng.
Tr s ca cc xt nghim chc nng gan v thn c th tng khi iu tr bng vin nang Rantudil
forte, Rantudil retard trn mt s bnh nhn.
Ch nn dng vin nang Rantudil forte, Rantudil retard trong cc trng hp sau, sau khi cn
nhc cn thn v li hi :
- Bnh nhn b lot d dy t trng (hay c tin cn b bnh ny).
- Bnh nhn ang mang thai ba thng u v ba thng gia ca thai kz.
Ch nn dng vin nang Rantudil forte, Rantudil retard trong cc trng hp sau, di s gim
st cht ch v y khoa :

- Bnh nhn b ri lon tiu ha, hay c tin cn lo t d dy hay rut, hay vim rut (nh vim
lo t i trng, bnh Crohn).
- Bnh nhn c tn thng gan hay thn, b cao huyt p v/hoc c cung lng tim thp (suy
tim).
- Bnh nhn ln tui.
Ch nn dng vin nang Rantudil forte, Rantudil retard mt cch thn trng trn bnh nhn b
phn ng qu mn vi thuc gim au v khng vim khng thuc nhm steroid (AINS), vi
biu hin nh ln cn hen, phn ng da hay vim mi d ng cp tnh (phi sn sng phng
tin cp cu).
Bnh nhn b hen, b bnh phi tc nghn mn tnh (tc nghn ng th), st rm r (hay
fever), hoc b sng nim mc mi mn tnh (polyp mi) c th d b xy ra phn ng vi cc
thuc khng vim khng thuc nhm steroid (AINS) vi biu hin nh ln cn hen, ph khu tr
da hay nim mc (ph mch thn kinh) hay ni m ay.
Li xe v vn hnh my mc : Ngay c khi dng thuc theo ng hng dn, vin nang Rantudil
forte, Rantudil retard cng c th nh hng ln tc phn ng n mc lm ri lon kh
nng iu khin phng tin, vn hnh my mc, hay lm vic ni chnh vnh, c bit l
vo thi im bt u iu tr, khi tng liu, khi ch phm b thay i, hay khi ung chung vi
ru.
LC C THAI v LC NUI CON B
Khng nn dng vin nang Rantudil forte, Rantudil retard trong ba thng cui ca thai kz, v
hot cht acemetacin c th gy c ch s co tht t cung v lm tng khuynh hng xut
huyt. Cc nghin cu trn ng vt vn cha ghi nhn c hin tng bt thng ca thai.
V cha c kinh nghim s dng acemetacin khi c thai, ch nn dng vin nang Rantudil
forte, Rantudil retard trong ba thng u v ba thng gia ca thai kz sau khi cn nhc li
hi cn thn. Cng nn thn trng tng t khi cho con b, v mt lng nh hot cht c th
i qua sa m.
TNG TC THUC
Cc tng tc thuc sau c m t khi dng chung vin nang Rantudil forte, Rantudil
retard vi cc thuc sau :
- Cc ch phm digoxin (c dng iu tr cung lng tim thp) : c th lm tng nng
digoxin trong mu.
- Lithium ( iu tr cc ri lon hnh vi) : phi theo di s bi tit ca lithium qua thn.
- Thuc c ch ng mu (cht khng ng) : tng nguy c chy mu.
- Corticosteroid hay cc thuc khng vim khc : tng nguy c xut huyt tiu ha.
- Acetylsalicylic acid ( iu tr vim v au) : gim nng acemetacin trong mu.
- Probenecid ( lm gim nng acid uric b gia tng trong mu) : s bi tit ca acemetacin
c th b chm li.

- Khng sinh nhm penicillin ( iu tr bnh nhim trng) : lm chm bi tit penicillin.
- Thuc li tiu v cc thuc h huyt p khc : c th gim tc dng h huyt p ; thuc li tiu
frusemide lm tng bi tit acemetacin.
- Thuc li tiu gi kali (mt loi thuc li tiu c bit v chng cao huyt p) : c th lm tng
nng kali trong mu (tng kali huyt) ; phi theo di thng xuyn nng kali.
- Cc thuc tc ng ln thn kinh trung ng (c tc dng ln no) hay ru : cn phi lu {
c bit.
- Cha c bo co no v cc phn ng tng tc gia vin nang Rantudil forte, Rantudil retard
vi cc hot cht gn kt mnh vi protein huyt tng (protein trong mu).
TC DNG NGOI
Thnh thong : bun nn, nn, cm gic say sng, au bng, tiu chy, n mt ngon, xut huyt
tiu ha kn o (mt s trng hp him, c th gy thiu mu), lo t ng tiu ha (thnh
thong km theo xut huyt v thng ng tiu ha), nhc u, chng mt, ng g, mt mi,
tai.
Him gp : lo u, l ln, lon tm thn, hoang tng, trng thi trm cm, kch thch, yu c,
bnh l thn kinh ngoi bin, tn thng thn, ph (gi nc trong m), tng huyt p, tng
kali huyt (nng kali mu tng), phn ng qu mn vi biu hin da (hng ban), ni ban
ngoi da (ngoi ban), ni ban trong nim mc (ni ban), ph mch thn kinh (sng m lin quan
vi thanh qun, hng v/hoc li), v m hi nhiu, ni m ay, nga, rng tc, phn ng
dng phn v (phn ng d ng cp ton thn), gim bch cu (gim s lng bch cu), tng
men gan, tng ur huyt.
Trng hp iu tr di hn : gim sc t vng mc (gim chc nng ca vng mc i vi cc
thay i mu sc), c gic mc.
Cc trng hp c bit : gim hng cu (thiu mu tn huyt hay bt sn), hay gim tiu cu,
gim bch cu ht (gim ng k s lng bch cu), gim ton b huyt cu (gim ng thi
hng cu, bch cu v tiu cu), phn ng trm trng da, phn ng d ng vi ph mt
v/hoc ph m mt, vim da do nhim c nh sng (vim da trm trng do tng nhy cm vi
nh sng), vim nim mc ming (vim ming), lot ming p t (bng nc), tn thng gan,
vim gan do nhim c (vim gan trm trng), suy thn cp, tng ng huyt (tng nng
ng trong mu), ng niu (bi tit lng ln ng trong nc tiu), au tht ngc, gim
thnh lc, ri lon th gic vi biu hin nhn i v m nhp nhy hay m mu trc mt, ri
lon tiu tin, xut huyt m o.
Trong mt s trng hp him, c nhng tnh trng vim nng hn kt hp vi nhim trng
(nh xut hin vim cn hoi t), lin quan vi vic s dng mt vi thuc khng vim (cc
thuc khng vim khng thuc nhm steroid, k c vin nang Rantudil forte, Rantudil retard).
LIU LNG v CCH DNG
Liu lng :

Ty theo trm trng v bn cht ca bnh, liu dng cho ngi ln l mi ln 1 vin nang
Rantudil forte 1-3/ngy v trong nhng trng hp bnh mn tnh nn dng 1 vin Rantudil
retard mt ln mi ngy.
Ty theo trm trng v mc cp tnh ca bnh, nu cn, c th tng liu vin nang
Rantudil retard ln hai ln mi ngy.
Liu dng cho t cp ca bnh thng phong (gout) :
i vi t cp ca bnh thng phong (gout), liu thng c khuyn dng l 180 mg
acemetacin/ngy (tng ng 1 vin nang Rantudil forte, 3 ln/ ngy hoc 1 vin Rantudil
retard, 2 ln/ngy), v ung cho n khi ht triu chng.
i vi cc bnh nhn khng b ri lon tiu ha, c th tng liu ln 300 mg acemetacin/ngy
trong mt thi gian ngn khi bt u iu tr : khi u 2 vin nang Rantudil forte (tng
ng vi 120 mg acemetacin), sau thm mt vin nang Rantudil forte (tng ng 60 mg
acemetacin) mi 8 gi.
Nu cn, c th tip tc phc trn vo ngy iu tr th hai. Nn gim liu khi tt c cc triu
chng thuyn gim.
i vi cc triu chng trm trng, c th tng liu hng ngy ln liu ti a 600 mg
acemetacin (tng ng 10 vin nang Rantudil forte) trong mt thi gian ngn.
Cch dng :
Nn nut trn vin nang trong ba n vi mt t nc.
Khong thi gian ung vin nang Rantudil forte v Rantudil retard ty thuc vo bn cht ca
bnh.
Nu qun ung mt c thuc, khng c ung b thuc vo ln sau, ch tip tc iu tr vi
liu c ch nh.
QU LIU
Qu liu thuc hay dng sai thuc c th gy ra cc triu chng nh bun nn, nn, au
thng v, v m hi, ri lon h thn kinh trung ng, cao huyt p, sng mt c chn (ph),
gim lng nc tiu trm trng (thiu niu), bi tit hng cu trong nc tiu (huyt niu), c
ch h hp, co git v hn m.
Cha c thuc i khng c hiu

435.

RECOL

THEMIS CHEMICALS
c/o GEDEON RICHTER
vin nn 10 mg : v 25 vin, hp 5 v.

vin nn 20 mg : v 25 vin, hp 5 v.
THNH PHN
cho 1 vin
Lovastatin

10 mg

cho 1 vin
Lovastatin

20 mg

M T
Recol l loi thuc lm gim cholesterol t chng Aspergillus terreus. Sau khi ung, lovastatin mt lactone bt hot - c thy phn thnh dng hydroxyacid tng ng. y l cht chuyn
ha chnh v l cht c ch men kh 3-hydroxy-3 methylglutarylcoenzyme A (HMG-CoA). Men
kh ny xc tc phn ng chuyn HMG-CoA thnh mevalonate, y l mt bc sm v bc
hn ch s sinh tng hp cholesterol.
Lovastatin l {1S-[1a(R*), 3a, 7b,8b (2S*, 4S*), 8ab]} -1,2,3,7,8,8a-hexahydro-3,7-dimethyl-8 [2(tetrahydro-4-hydroxy-6-oxo-2H-pyran-2-yl) ethyl] 1-napthalenyl 2- methylbutanoate. Cng
thc thu gn ca lovastatin l C24H36O5 v phn t lng l 404,55.
Lovastatin l mt bt kt tinh trng, khng ht m, khng tan trong nc, tan km trong
ethanol, methanol v acetonitrile.
DC L LM SNG
Vn cholesterol lipoprotein t trng thp (LDL) trong nguyn sinh bnh ng mch c
ghi nhn y trong cc nghin cu bnh hc v lm sng, cng nh trong nhiu th nghim
trn ng vt. Nghin cu dch t hc cho thy cholesterol LDL cao v cholesterol LDL thp,
th c hai u l nhng yu t nguy c cho bnh tim mch vnh.
Vic gim cholesterol LDL lm gim t l phi hp ca t vong do bnh tim mch vnh cng vi
nhi mu c tim khng gy t vong.
Recol lm gim c hm lng cholesterol LDL bnh thng v cholesterol LDL b tng cao.
LDL c to ra t VLDL v c chuyn ha ch yu nh th th LDL i lc cao. C ch tc
dng gim LDL ca Recol c th l do gim hm lng cholesterol VLDL, v cm ng th th
LDL, ko theo gim sn xut v tng d ha LDL cholesterol. Apolipoprotein B cng gim ng k
trong khi iu tr Recol. V mi phn LDL cha mt phn t apolipoprotein B, v v
apolipoprotein B nh c tm thy trong cc lipoprotein khc, iu ny tht s ni ln rng
Recol khng lm cho cholesterol mt LDL, nhng n cng gim c hm lng ca cc phn

LDL lu thng. Ngoi ra, Recol c th lm tng lng thay i trong cholesterol HDL, v lm
gim va phi cholesterol VLDL v triglyceride huyt tng (xem bng 1). Recol l mt cht c
ch c hiu ca men kh HMG-CoA, l enzyme xc tc cho s chuyn HMG-CoA thnh
mevalonate, l mt bc sm trong chu trnh sinh tng hp cholesterol.
DC NG HC
Lovastatin l mt lactone c thy phn trong c th to b-hydroxyacid tng ng, l mt
cht c ch mnh men kh HMG-CoA.
Sau khi ung lovastatin ngi, 10% liu ny b thi qua nc tiu, 83% qua phn. Sau khi
ung, lovastatin c tnh chn lc cao vi gan, l ni n tht s t hm lng cao hn trong
cc m khc. Lovastatin chuyn ha u tin mnh qua gan, y l im tc ng u tin ca
n, sau thi thuc dng khng i qua mt.
C lovastatin v cht chuyn ha b-hydroxyacid u lin kt mnh (< 95%) vi huyt tng
ngi. Nhng nghin cu trn ng vt cho thy lovastatin qua c hng ro mu no v
hng ro nhau thai.
Nng nh trong huyt tng ca hot cht v tng cht c ch t c trong vng 2-4 gi
sau khi dng.
Kt qu nghin cu nhng bnh nhn c chng cholesterol huyt cao c trnh by trong
bng 1 sau y.
Bng 1
Recol so snh vi placebo
(T l phn trm so vi gi tr ban u - Gi tr trung bnh t tun 12 n tun 48)
Liu

N** C-tp (TB)

LDL-C
(TB)

HDL-C
(TB)

LDL-C/ HDL-C
(TB)

C-tp/HDL-C
(TB)

TRIG
(TB)

Placebo

1633 +0,7

+0,4

+0,2

+0,2

+0,6

+04

20 mg/ngy 1642 -17

-24

+6,6

-27

-21

-10

40 mg/ngy 1645 -22

-30

+7,2

-34

-26

-14

20 mg
x2/ngy

1646 -24

-34

+8,6

-38

-29

-16

40 mg
x2/ngy

1649 -49

40

+9,5

-44

-34

-19

Recol

CH NH
Recol c ch nh nh mt thuc ph tr vi n king gim hm lng cholesterol LDL v
cholesterol ton phn b tng cao nhng bnh nhn tng cholesterol huyt tin pht (loi
IIa v IIb), khi p ng vi n king v cc liu php khng dng thuc khc khng .
Recol cng c ch nh lm chm tin trin va x ng mch vnh bnh nhn tim
mch vnh nh l mt phn ca chin lc iu tr gim cholesterol LDL v cholesterol ton
phn n mc mong mun.
Hng dn iu tr theo chng trnh gio dc cholesterol quc gia (NCEP) c tm tt theo
bng di :
LDL- cholesterol
(mg/dl)
Bnh x va ng mch xc Hai yu t nguy c hay
nh*
hn**

Hm lng khi
Mc tiu
u

Khng

Khng

>=190

<160

Khng

>=160

<130

C hay khng

>=130

<=100

*Bnh tim mch vnh hay bnh mch ngoi bin.

**Cc yu t nguy c khc vi bnh tim mch gm triu chng bnh ng mch cnh, bnh
mch vnh bao gm : tui (nam >=45 ; n >=55 hay mn kinh sm m khng dng liu php
thay th estrogen) ; tin s gia nh mc bnh tim mch vnh sm, ang nghin thuc l, cao
huyt p, xc nh HDL-C < 35 mg/dl v tiu ng. Tr i mt yu t nguy c nu HDL-C >= 60
mg/dl.
V mc tiu iu tr l gim LDL-C, NCEP khuyn co l hm lng LDL-C c dng khi
ng v nh gi p ng iu tr. Ch khi no hm lng LDL-C khng c sn, th cholesterol
ton phn mi dng kim sot iu tr.
Recol c th hu ch gim hm lng LDL-C tng cao bnh nhn b kt hp chng tng
cholesterol huyt v tng triglyceride huyt, trong chng tng cholesterol huyt l s bt
thng chnh (chng tng lipoprotein huyt loi IIb).
CHNG CH NH
Qu mn cm vi bt kz thnh phn no ca thuc.
Bnh gan tin trin hoc tng k o di khng gii thch c v transaminase huyt tng.
Mang thai, thi kz cho con b, lovastatin chng ch nh trong khi mang thai. Lovastatin ch
dng cho ph n tui sinh ch khi cc bnh nhn ny mun. Nu h mang thai trong khi

ang dng thuc, nn ngng dng lovastatin ngay v bo cho bnh nhn bit nguy c tim tng
cho thai nhi.
CH PHNG
Suy gan :
Chng tng k o di ng k (hn 3 ln gii hn trn ca mc bnh thng) v transaminase
huyt tng c th xy ra 1,9% bnh nhn dng lovastatin trong ti thiu 1 nm trong cc
nghin cu lm sng trc y.
Khi ngng thuc nhng bnh nhn ny, hm lng transaminase thng tt dn dn n
mc trc khi iu tr.
Tuy nhin, trong nhng kinh nghim lm sng vi Recol, bnh gan c triu chng him khi xy
ra vi cc liu iu tr ca lovastatin.
Ngi ta khuyn co rng th test chc nng gan nn c hon thnh trc khi khi u iu
tr, lc 6 v 12 tun sau khi iu tr hay tng liu, sau phi kim tra nh kz.
Thuc nn c dng cn thn nhng bnh nhn ung nhiu ru hay c tin s bnh
gan. Bnh gan tin trin hay tng transaminase khng gii thch c l nhng chng ch nh
dng lovastatin.
C xng :
Tiu c vn thng i km lovastatin n liu php, khi kt hp vi thuc c ch min dch, k
c cyclosporin nhng bnh nhn ghp tim, v khi kt hp vi gemfibrozil hoc vi acid
nicotinic vi liu h lipid (1 g/ngy), nhng bnh nhn khng ghp. Mt vi bnh nhn
mc trc bnh suy thn, thng l do kt qu ca i tho nht lu di. Suy thn cp do tiu
c vn thng c thy hn khi kt hp lovastatin - gemfibrozil, v cng c bo co
nhng bnh nhn cy ghp dng lovastatin v cyclosporin.
bnh nhn dng cyclosporin, nn tm ngng lovastatin, nu liu php chng nm ton thn
dn xut azole l cn thit ; nhng bnh nhn khng dng cyclosporin nn c gim st cn
thn, nu liu php chng nm ton thn dn xut azole l cn thit.
Tiu c vn km hay khng km theo suy thn c bo co nhng bnh nhn trm trng
dng erythromycin ng thi vi lovastatin.
Nn trnh kt hp lovastatin vi fibrate khc.
Nn tm dng hay ngng lun liu php lovastatin nhng bnh nhn c bnh c trm trng,
cp tnh hay c nhng yu t nguy c pht trin suy thn a n tiu c vn, bao gm : nhim
khun cp trm trng, h huyt p, i phu, chn thng, ri lon in gii, chuyn ha v ni
tit trm trng, ngt khng kim sot c.
Bnh c nn c xem xt nhng bnh nhn au c lan ta, mm v yu c v hay tng
ng k CPK. Cc bnh nhn nn c khuyn bo co kp thi nu au c khng gii thch
c, mm v yu c, c bit khi km theo chng mt hay st. Liu php lovastatin phi c
ngng nu hm lng CPK tng ng k xy ra hoc khi bnh c c chn on hay nghi ng.

Hu ht cc bnh nhn u pht trin bnh c (k c tiu c vn) khi dng lovastatin ng thi
vi thuc c ch min dch, gemfibrozil hay nhng liu gim lipid ca acid nicotinic.
THN TRNG LC DNG
Tng qut :
Lovastatin c th lm tng hm lng creatin phosphokinase v transaminase. iu ny nn
c xem xt trong cc chn on phn bit au ngc cc bnh nhn iu tr lovastatin.
Chng tng cholesterol huyt do ng hp t c tnh gia nh :
Recol thng km hiu qu hn bnh nhn mc chng bnh him chng tng cholesterol
huyt do ng hp t c tnh gia nh, c th v nhng bnh nhn ny khng c cc th th LDL
chc nng. Recol hnh nh c hiu qu hn v tc dng tng transaminase nhng bnh nhn
ng hp t ny.
Thng tin cho bnh nhn :
Cc bnh nhn cn bo co kp thi chng au c, chng au c lc n khng gii thch c,
c bit khi km theo chng mt hoc st.
Dng trong nhi khoa :
an ton v hiu qu tr em v thiu nin cha c xc nh.
TNG TC THUC
Thuc c ch min dch, itraconazole, gemfibrozil, niacin (nicotinic acid), erythromycin (xem
phn Ch { phng : C xng).
Thuc chng ng mu coumarin : Xut huyt v thi gian prothrombin tng c bo co
vi bnh nhn dng thuc chng ng mu coumarin ng thi vi lovastatin. Ngi ta
khuyn co rng nhng bnh nhn dng thuc chng ng mu, thi gian prothrombin nn
c xc nh trc khi dng lovastatin v thng xuyn trong giai on khi u iu tr
bo m rng khng c s thay i ng k v thi gian prothrombin xy ra. iu tr lovastatin
khng c km theo xut huyt hay nhng thay i thi gian prothrombin nhng bnh
nhn khng dng thuc chng ng mu.
TC DNG NGOI
Recol thng c dung np tt : cc tc dng ngoi mun thng nh v tm thi.
ng tiu ha : y hi, tiu chy, to bn v bun nn l nhng tc dng ngoi { thng
xuyn nht c bo co vi lovastatin. Nhng tc dng ngoi { trn ng tiu ha khc l
au bng, co c bng, bing n, nng v lon v gic.
C xng : bnh c c trng l au v yu c c bo co. Tiu c vn km theo suy thn
cp cng c th xy ra. Tng khng triu chng hm lng huyt tng ca isozyme creatin
phosphokinase cng xy ra 11% bnh nhn dng lovastatin.
Mt : c th m mt. c thy tinh th c th pht trin nhng bnh nhn iu tr lovastatin.
Tc dng ngoi khc : nhc u, bun ng, ni ban, nga, lit dng v mt ng.
LIU LNG v CCH DNG

Liu khi u thng thng c ngh l 20 mg, mt ln mi ngy, dng vi ba n chiu.

Dy liu ngh l 10-80 mg/ngy dng mt ln hoc chia lm 2 ln. Liu ti a l 80 mg/24 gi.
Liu ty theo tng c nhn theo mc tiu iu tr (xem hng dn NCEP) v p ng ca bnh
nhn. Bnh nhn cn phi gim LDL-C 20% hay hn t mc tiu, bt u dng 20 mg
Recol/ngy. Liu khi u 10 mg nn c xem xt cho nhng bnh nhn cn liu nh hn. S
iu chnh nn tin hnh 4 tun mt ln hay hn.
bnh nhn dng thuc c ch min dch ng thi vi lovastatin (xem phn Ch { phng,
C xng), liu php nn c bt u vi 10 mg Recol v khng qu 20 mg/ngy.
Liu 10 mg nn dng cho ph n hu mn kinh vi chng tng cholesterol huyt t nh n
trung bnh.
Hm lng cholesterol nn c kim sot nh kz v xem xt gim liu Recol nu hm lng
cholesterol st mnh di mc mc tiu.
Liu php ng thi :
Cc chng c u tin cho thy rng tc dng h cholesterol ca lovastatin v acid mt,
cholestyramine c hip ng.
Liu bnh nhn suy thn trm trng (thanh thi creatinin (30 ml/pht), liu tng trn 20
mg/ngy nn c xem xt thn trng v nu tht s cn, th phi dng cn thn (xem phn
Dc l{ lm sng v Ch { phng : C xng)
QU LIU
5 ngi tnh nguyn khe mnh dng 200 mg lovastatin liu n m khng c phn ng ph
lm sng ng k no. Vi trng hp dng qu liu c bo co : khng c bnh nhn
no c nhng triu chng c trng, tt c cc bnh nhn u khi v khng km theo di
chng. Liu ti a dng l 5-6 g.
Cho n nay, vn cha c kinh nghim no thu c, khng c iu tr qu liu c hiu no
cho Recol.
BO QUN
Bo qun di 25oC, trnh nh sng v m.

436.

RENOVA

ORTHO
c/o JANSSEN-CILAG
c/o MEGA PRODUCTS

Kem bi ngoi da 0,05% : tup 10 g.

THNH PHN
cho 1 g kem
Tretinoin

50 mg

T dc: du khong nh, dung dch

sorbitol, hydroxyoctacosanyl
hydroxystearat, methoxy PEG-22/dodecyl
glycol, PEG-45/dodecyl glycol,
stearoxytrimethylsilan v stearyl alcol,
dimethicon (50 cs), chemoderm 6401/B,
methylparahydroxybenzoat, dinatri
edetate, quaternium-15,
butylhydroxytoluen, acid citric
monohydrat, nc tinh khit.
CH NH
iu tr ti ch vng da b lo ha do tip xc nh nng mt tri ko di, lm gim tnh trng
tng sc t lm m(m nu, tn nhang), np nhn da mnh v th rp da (Renova nn c
dng trong mt chng trnh chm sc da ton din : chm sc da ni chung, trnh nng, mc
qun o trnh nng, s dng kem chng nng v cc sn phm lm m da).
CHNG CH NH
Tin s nhy cm, phn ng qu mn vi bt kz thnh phn no ca thuc.
CH PHNG v THN TRNG LC DNG
Kch ng ti ch : khi ang c sn tnh trng kch ng da (v d : da, bong da, nga, bng
nng...) th khng nn bt u dng Renova cho n khi tnh trng trn gim i. Nu chc chn
c tnh trng kch ng da, ngi dng nn thoa Renova t ln hn mi tun hoc tm thi
ngng x dng.
mt s ngi nhy cm (v d : ngi b chm, bng nng...) dng Renova c th gy ra da
ti ch nng, sng, nga, nng, rt, phng da, to vy hoc bong da ti ch thoa thuc. c
bo co rng tretinoin gy kch ng nng khi thoa vng da b chm do nn ht sc lu {.
Khi dng tretinoin nhng ngi b chm, nu c tnh trng kch ng da nng hoc dai dng
nn ngng dng Renova.
Nn thn trng khi c dng cc thuc khc c cht kch ng ti ch, c bit l cht n mn,
lm kh hoc c tc dng lm bong da.
Thi tit nhiu gi, lnh hoc m thp cng c th gy kch ng vng da ang thoa v c th

lm tng mc kh da.
Tip xc vi nh nng mt tri : khi dng tretinoin, nn trnh hoc gim thiu tip xc vi nh
sng mt tri, k c n cc tm (UVB). Ngi b bng nng khng nn dng sn phm ny cho
n khi bng nng ht hon ton v c th gy kch ng nng cho vng da nhy cm. Ngi phi
tip xc nhiu vi nh nng mt tri do yu cu ca cng vic hoc ngi vn nhy cm vi
nh nng mt tri th nn c bit thn trng. Khi khng th trnh vic tip xc vi nh nng th
nn dng cc sn phm chng nng hoc mc o qun hay i nn che ph vng da ang thoa
Renova.
Trnh dy thuc vo mt, mi mt, b l mi, ming, nim mc hoc cc vng da khng nh
thoa thuc gim thiu kh nng b thm kch ng da.
Trc khi thoa Renova nn ra sch k vng da nh thoa. Nn dng x phng nh, khng c
ho cht, v nh vng da cho kh ch khng dng khn lau. Ch 20-30 pht vng da t
kh trc khi thoa Renova. Ch cn ra sch vng da thoa thuc 2 ln mi ngy l .
Kh nng sinh ung th :
Nhng bng chng hin nay cho thy dng tretinoin ngoi da khng gy ung th, khng gy t
bin.
LC C THAI v LC NUI CON B
Cha c cc nghin cu y c kim chng tt trn ph n mang thai. V vy, ch nn dng
Renova trn ph n c thai ch khi li ch dng thuc cao hn nguy c c th xy ra cho thai
nhi.
Khng r tretinoin c c tit ra theo sa m hay khng. Do vy vn nn thn trng khi dng
Renova ph n cho con b.
TNG TC THUC
Thn trng khi phi hp :
- Cc thuc ngoi da khc.
- Cc sn phm v sinh k c x phng, du gi, m phm nc hoa c cha cht n mn, lm
kh da hoc bong da (c bit l cc sn phm c cn, chanh...).
TC DNG NGOI
Cc phn ng ti ch thng c bo co l : kh hoc bong da, rt nh, chm chch, nng da,
ban , nga v tng hay gim sc t tm thi. Cc phn ng ny thng nh hoc va phi v
ni chung dung np tt. Cc phn ng ny thng xy ra vo 1-3 tun u dng thuc, ngoi
tr kh da hoc bong da trong thi gian iu tr.
Cc nghin cu lm sng cho thy Renova khng gy tnh nhy cm d ng tip xc tht s.
c bo co tng nhy cm vi nh nng mt tri hoc ngun tia cc tm UVB.
LIU LNG v CCH DNG
Thoa Renova mt ln mi ngy vo bui ti ch vi mt lng va ph nh ton b vng
da cn thoa (mt hoc cnh tay).

Thoa Renova c th gy cm gic chm chch thong qua v nng nh da. Khi dng Renova,
bnh thng da s nh, thong qua tng t nh bng nng. Dng nhiu ln hn hoc dng
nhiu thuc hn s khng ci thin kt qu iu tr m li c th gy kch ng da nhiu nh
da, bong da, nga...
Thi gian iu tr : Khi dng Renova, ci thin cc du hiu lo ha da do tc hi nh nng mt
tri khng phi tc th m xy ra t t qua mt thi gian iu tr. Thi im bt u thy cc
ci thin u tin thay i theo cc nghin cu lm sng khc nhau, ni chung, bt u thy
c cc ci thin ni trn trong vng 3 thng sau khi bt u dng thuc. C th cn n 6
thng dng thuc thy c cc tc dng r rng ca Renova.
Khi t c kt qu ti a, c th duy tr kt qu ny bng cch thoa Renova 1-3 ln mi tun.
C th dng m phm v cc sn phm lm m da trong thi gian dng Renova. Nn ra k da
trc khi thoa Renova.
Dng tr em : an ton v hiu qu khi dng Renova trn tr em cha c xc nhn.
QU LIU
Thoa qu nhiu Renova khng ci thin kt qu iu tr m li c th kch ng da nhiu nh
da, bong da, nga... Ung tretinoin c th dn n cc tc dng ph tng t do ung qu
nhiu vitamin A (nh nga, kh da, au khp, bun nn, nn).
BO QUN
Bo qun 15-25oC. Khng lm ng.

437.

RETROVIR

GLAXOWELLCOME
vin nang 100 mg : hp 100 vin - Bng A.
THNH PHN
cho 1 vin
Zidovudine

100 mg

DC LC
Zidovudine l mt tc nhn khng virus c tc ng mnh in vitro vi retrovirus bao gm virus
gy suy gim min dch ngi (HIV).
Zidovudine c phosphoryl ha trn c t bo b nhim hay khng b nhim thnh dn xut
monophosphate (MP) do men thymidine kinase ca t bo. S phosphoryl ha sau ca
zidovudine-MP thnh dn xut diphosphate v sau l triphosphate c xc tc bi men
thymidine kinase ca t bo v cc kinase khng c hiu ln lt. Zidovudine-TP tc ng nh

mt cht c ch v mt cht nn cho men reverse transcriptase t bo. S thnh lp ADN tin
virus b ngng tr do s gn kt ca zidovudine-TP vo trong chui v a n s kt thc
chui sau .
S cnh tranh bi zidovudine-TP vi men reverse transcriptase HIV vo khong 100 ln ln hn
ADN polymerase alpha ca t bo.
Vi khun hc : mi lin quan gia tnh nhy cm in vitro ca HIV vi zidovudine v p ng lm
sng vi tr liu vn cn ang c kho st. In vitro, cc th nghim nhy cm cha c
chun ha v do cc kt qu c th thay i ty theo cc yu t v phng php.
Nhng s liu in vitro trong s pht trin khng vi zidovudine cn gii hn. S gim tnh
nhy cm in vitro vi zidovudine c bo co cho cc mu c lp HIV t nhng bnh nhn
c iu tr ko di vi Retrovir. Cc thng tin nhn c ch ra rng, i vi bnh nhim HIV
trong giai on sm, t l v mc gim tnh nhy cm in vitro t hn ng k hn giai on
tin trin bnh.
DC NG HC
Zidovudine c hp thu tt qua rut v vi tt c cc liu lng c nghin cu, sinh kh
dng l 60-70%. Trong mt nghin cu pha I, nng ti a (Css, max) v ti thiu (Css, min )
trung bnh trng thi n nh trong huyt tng khi ung zidovudine (dng dung dch) vi cc
liu 5 mg/kg mi 4 gi tng ng l 7,1 v 0,4 mmol (hay 1,9 v 0,1 mg/ml). Trong mt nghin
cu s tng ng sinh hc, nng Css, max v Css, min sau khi ung vin nang Retrovir
mi 4 gi v liu thng thng n 200 mg tng ng l 4,5 mg (hay 1-2 mg/ml) v 0,4 mmol
(hay 0,1 mg/ml).
Cht 5'-glucuronide ca zidovudine l cht chuyn ha chnh trong c huyt tng v nc tiu
v chim khong 50-80% liu lng c o thi qua thn. Khng quan st c cc cht
chuyn ha khc.
Cc s liu trn dc ng hc ca zidovudine trn bnh nhn suy thn hay suy gan vn cn
gii hn (xem Liu lng). Khng c s liu v dc ng hc ca zidovudine ngi gi.
Dc ng hc tr em : tr trn 5 tui, dc ng hc ca thuc cng ging nh trn
ngi ln.
Zidovudine c hp thu tt qua rut v vi mi liu lng c nghin cu, sinh kh dng
ca thuc vo khong 60-74% vi mc trung bnh l 65%. Nng Css, max l 4,45 mmol
(1,19 mg/ml) sau mt liu 120 mg zidovudine (dng dung dch)/m2 din tch b mt c th v
7,7 mmol (2,06 mg/ml) vi liu 180 mg/m2 din tch c th.
Phn b : ngi ln, t l nng zidovudine trong dch no ty/huyt tng 2-4 gi sau khi
dng thuc c tm thy vo khong 0,5. Cc s liu cn hn ch cho thy rng zidovudine
i qua nhau thai v c tm thy trong dch i v mu ca thai nhi. Zidovudine cng c
tm thy trong tinh dch.
tr em, t l trung bnh nng zidovudine trong dch no ty/huyt tng nm trong

khong 0,52-0,85, nh c xc nh 0,5-4 gi khi iu tr vi thuc dng ng ung.

S gn kt vi protine huyt tng tng i thp (43-38%) v cc tng tc thuc lin quan
n s thay th v tr gn kt khng d kin trc c.
Tng ng sinh hc : dung dch ung Retrovir cho thy c tng ng sinh hc vi vin
nang Retrovir x t tng ng vi vng din tch di ng cong nng zidovudine trong
huyt tng-thi gian (AUC). S hp th Retrovir sau khi ung thuc dng dung dch nhanh hn
mt cht so vi vin nang, vi thi gian trung bnh t n nng ti a tng ng l 0,50,8 gi. Gi tr trung bnh Css, max vi liu trung bnh 200 mg l 5,8 mmol (1,55 mg/ml) v 4,5
mmol (1,2 mg/ml) tng ng cho dung dch ung v vin nang. Cc s liu ny thu c vi
xir Retrovir US nhng khng th xem nh c th c p dng tng ng cho dung dch
ung Retrovir.
CH NH
Vin nang Retrovir c ch nh iu tr bnh nhn nhim virus gy suy gim min dch
ngi (HIV).
Vin nang Retrovir cng c ch nh trong vic iu tr bnh nhn bnh HIV tin trin nh cc
bnh nhn b AIDS hay giai on ARC (AIDS related complex).
Tnh hu hiu c chng minh qua mt vi nghin cu c kim sot placebo bnh nhn
trng thnh c v khng c biu hin triu chng vi s lng t bo T4 (T-helper) di
500/mm3. Cc kt qu t cc nghin cu m tr em c nhim HIV c triu chng v mc
suy gim min dch ng k th cng tng t vi kinh nghim iu tr ngi ln. S kho st
ch li/nguy c da trn cc s liu c sn h tr cho s can thip tr liu trc khi i n giai
on cui ca bnh.
CHNG CH NH
Bnh nhn c qu mn bit vi zidovudine hay vi bt kz thnh phn no ca cng thc.
Khng nn dng Retrovir cho bnh nhn c s lng bch cu trung tnh thp bt thng (<
0,75 x 109/l) hay nng hmoglobine thp bt thng (< 7,5 g/dl).
CH PHNG v THN TRNG LC DNG
Bnh nhn nn cn thn khi dng ng thi vi cc thuc khc (xem Tng tc thuc).
Nn lu { bnh nhn rng tr liu vi zidovudine khng lm gim nguy c truyn HIV cho ngi
khc do tip xc tnh dc hay nhim qua ng mu.
c tnh trn mu : thiu mu (thng xy ra sau 6 tun dng zidovudine nhng i khi sm
hn), gim bch cu trung tnh (thng xy ra bt kz lc no sau 4 tun tr liu nhng i khi
sm hn) v gim bch cu (thng th pht sau gim bch cu trung tnh) c th c d
on c xy ra thng xuyn trn bnh nhn mc HIV tin trin ang dng vin nang Retrovir,
v do nn kim tra cn thn cc thng s huyt hc. Khuyn co nn thc hin cc th
nghim t nht mi hai tun trong 3 thng u tr liu v t nht mi thng sau .
Nn c bit cn thn i vi bnh nhn c trc du hiu suy ty (nh h moglobine < 9

g/dl hay lng bch cu trung tnh < 1,0 x 109/l). Vic dng liu hng ngy thp hn lc bt u
qu trnh tr liu c th thch hp hn cho nhng bnh nhn ny.
nhng bnh nhn mc HIV trong giai on sm (lc ny ni chung d tr ty xng cn tt),
c tnh huyt hc t xy ra thng xuyn hn. Ty theo tnh trng tng th ca bnh nhn, c
th t thc hin cc xt nghim mu hn, ngha l mi 1-3 thng. S gim mc hmoglobine
di 25% mc trung bnh v s lng bch cu trung tnh thp hn 50% trung bnh c th
i hi phi kim tra thng xuyn hn.
Nu xut hin chng thiu mu trm trng hay suy ty, nn iu chnh liu (xem Liu lng v
Cch dng). Cc bt thng ny thng nhanh chng hi phc khi ngng thuc. Trn bnh
nhn thiu mu ng k, i khi cng cn truyn mu sau khi iu chnh liu.
Tnh gy t bin : khng c bng chng gy t bin no c quan st thy trong xt nghim
Ames. Tuy nhin, zidovudine cng c tnh gy t bin yu trn th nghim t bo u bch
huyt chut v cho kt qu dng tnh trong mt th nghim chuyn i t bo in vitro. Tc
ng gy tho xon quan st c trong mt nghin cu in vitro trn lympho bo ngi v trn
cc nghin cu in vivo vi liu ung lp i lp li chut ln v chut nht. Mt nghin cu v
s pht sinh t bo in vivo chut ln khng cho thy c tc hi ln nhim sc th. ngha lm
sng ca nhng khm ph ny khng c r rng.
Tnh gy ung th : zidovudine c cho ung vi 3 mc liu cho nhng nhm chut ln
v chut nht ring bit (60 con ci v 60 con c cho mi nhm). Cc liu khi u ring r l
30, 60 v 120 mg/kg/ngy v 80, 220 v 600 mg/kg/ngy tng ng cho chut nht v chut
ln. Cc liu chut nht c gim thnh 20, 30 v 40 mg/kg/ngy sau ngy th 90 do chng
thiu mu do iu tr, trong khi chut ln ch c liu cao c gim (thnh 450 v sau l
300 mg/kg/ngy tng ng vi vo ngy th 91 v 279).
chut nht, 7 khi u m o (5 carcinome t bo c vy v 1 polyp c vy) xut hin chm
(sau 19 thng) vi liu cao nht. Mt u nh t bo c vy xut hin chm xy ra m o trn
mt th vt dng liu trung bnh. Khng c khi u m o no c tm thy vi liu thp nht.
chut ln, 2 carcinome t bo c vy m o xut hin chm (sau 20 thng) th vt c
cho dng liu cao nht. Khng c khi u m o xut hin vi liu trung bnh hay liu thp
chut ln.
Khng c khi u do thuc khc c quan st thy trn c hai loi gii tnh ca hai loi th vt.
Gi tr c on ca cc nghin cu v tnh gy ung th trn loi gm nhm i vi loi ngi
khng chc chn v do , { ngha lm sng ca nhng khm ph ny khng r rng.
LC C THAI v LC NUI CON B
Tnh gy qui thai : cc nghin cu trn chut v th c thai c cho ung zidovudine vi liu
tng ng ln n 450 v 500 mg/kg/ngy trong thi kz ch yu to ra c quan cho thy khng
c bng chng ca sinh qui thai. Tuy nhin, c mt s gia tng ng k v mt thng k
s tiu tan ca phi chut c cho dng 150-450 mg/kg/ngy v th c cho liu 500

mg/kg/ngy.
Kh nng sinh sn : zidovudine khng lm suy yu kh nng sinh sn chut ln c v ci
c cho ung liu ln n 450 mg/kg/ngy. Khng bit c rng zidovudine c gy nh
hng ln kh nng sinh sn ngi hay c th gy tc hi ln thai nhi khi dng cho ph n c
thai. S s dng zidovudine trong thai kz nn c xem xt cn nhc ch khi c ch nh r
rng.
Cc s liu gii hn cho thy rng zidovudine c tit qua sa th vt. Khng bit c rng
ngi zidovudine c tit qua sa hay khng. Do thuc c th i qua sa m v c th gy nn
nhng c tnh trm trng cho tr c cho b, khuyn co rng ngui m ang dng vin
nang Retrovir khng nui con b.
TNG TC THUC
Do cc kinh nghim v tng tc thuc vi zidovudine c gii hn, nn cn thn khi phi hp
phc dng cc thuc khc vi vin nang Retrovir. Cc tng tc thuc lit k di y khng
nn xem nh l hon ton thu o m ch nn coi nh l i din ca nhm thuc cn lu {
cn thn khi dng.
Nng phnytoine thp trong mu c bo co mt vi bnh nhn dng zidovudine,
trong khi 1 bnh nhn c ghi nhn c nng cao trong mu. Cc quan st ny
ngh ra rng nn cn thn kim tra nng phnytoine trong mu khi bnh nhn dng c hai
th thuc.
Parac tamol dng trong qu trnh iu tr vi Retrovir trong mt th nghim c kim sot
placebo c th gy gia tng t l xy ra gim bch cu trung tnh, c bit trong qu trnh iu
tr ko di. Tuy nhin, cc s liu dc ng hin c cho thy rng parac tamol khng lm tng
nng trong huyt tng ca zidovudine hay cht chuyn ha glucuronide ca n.
Cc thuc khc (nh aspirine, cod ine, morphine, indom tacine, ketoprofne, naproxne,
oxazpam, lorazpam, cimtidine, clofibrate, dapsone v isoprinosine) c th lm thay i
chuyn ha ca zidovudine bng cch c ch hon ton s glucuronide ha hay trc tip c
ch chuyn ha vi th gan. Nn cn thn suy xt kh nng tng tc thuc trc khi dng cc
thuc ny kt hp vi vin nang Retrovir, c bit khi dng thuc ko di.
Tr liu ng thi vi cc thuc c kh nng lm suy ty hay suy thn mnh (nh dapsone,
pentamidine dng ton thn, pyrimthamine, amphotricine, flucitosine, ganciclovir,
interf ron, vincristine, vinblastine v doxorubicine) cng c th lm gia tng nguy c gy c
tnh ca vin nang Retrovir. Nu cn thit dng ng thi vi mt trong nhng thuc trn, nn
cn thn kim tra thm cc thng s v chc nng thn v huyt hc, v nu cn, nn gim liu
ca mt hoc c hai tc nhn.
Cc ng ng nucl oside, ribavirine, i khng li in vitro tc ng khng virus ca zidovudine
v do , nn trnh s dng ng thi cc thuc ny.
Do mt vi bnh nhn dng zidovudine c th tip tc b nhim khun c hi, c th phi xem

xt vic dng ng thi liu php khng khun d phng. Bin php d phng ny bao gm cotrimoxazole, pentamidine dng kh dung, pyrimthamine v acyclovir. Cc s liu cn gii hn
t cc th nghim lm sng khng cho thy nguy c gia tng ng k c tnh vi nhng thuc
ny. Cc s liu gii hn ngh rng prob n cide lm gia tng thi gian bn hy trung bnh v
din tch di ng cong nng trong huyt tng ca zidovudine, bng cch gim s
glucuronide ha. S o thi qua thn ca cc glucuronide (v c th chnh bn thn
zidovudine) b gim khi c s hin din ca probncide.
TC DNG NGOI
Ngi ln : tc dng ngoi trm trng nht bao gm thiu mu (c th cn phi truyn mu),
gim bch cu trung tnh v gim bch cu. Cc chng ny xy ra thng xuyn hn liu cao
(1200-1500 mg/ngy) v bnh nhn mc HIV tin trin (c bit khi c d tr ty suy gim
trc khi iu tr), v c bit cho bnh nhn c s lng t bo T4 (T-helper) di 100/mm3.
C th cn thit phi gim liu hay ngng tr liu (xem Liu lng v Cch dng). T l xut hin
gim bch cu trung tnh cng gia tng bnh nhn c s lng bch cu trung tnh,
hmoglobine v nng vitamine B12 thp lc bt u tr liu vi zidovudine v trn nhng
ngi dng ng thi parac tamol (xem Tng tc thuc).
Tc dng ngoi { thng gp khc c bo co trong cc th nghim lm sng c kim sot
placbo rng ri bao gm bun nn, nn ma, chn n, au bng, nhc u, ni ban, st, au
c, d cm, mt ng, kh , suy nhc v kh tiu. Ngoi tr chng bun nn c gp thng
hn nhiu trong mi nghin cu bnh nhn dng vin nang Retrovir, tc dng ph khc
khng c bo co xut hin thng xuyn hn bnh nhn dng placebo. Nhc u, au c
v mt ng trm trng thng gp hn bnh nhn mc HIV tin trin c iu tr vi
Retrovir, trong khi chng nn ma, chn n, kh v suy nhc thng thy hn bnh nhn
nhim HIV giai on sm c iu tr vi Retrovir.
Tc dng ngoi { khc c ghi nhn bao gm bun ng, tiu chy, nhc u, m hi, kh
th, trng bng, thay i v gic, au ngc, mt kh nng suy lun, lo lng, tiu thng xuyn,
trm cm, au chung chung, n lnh, ho, my ay, nga v hi chng dng st. T l ca cc
tc dng ny v cc tc dng ngoi khc t gp hn th tng t trn c hai nhm bnh nhn
c iu tr vi Retrovir v placebo.
Cc s liu thu c t nghin cu m v c kim tra bng placebo cho thy rng t l ca
chng bun nn v cc tc dng ngoi { thng gp trn lm sng khc c bo co u nht
qun gim theo thi gian trong vi tun u tr liu vi Retrovir.
Cc tai bin sau c bo co xut hin trn bnh nhn c iu tr vi Retrovir trong mt
nghin cu m. Cc chng ny cng c th xy ra nh mt phn ca tin trnh bnh. Do , c
th gp kh khn khi kho st mi lin quan gia cc tc dng ny v s s dng Retrovir, c
bit trong trng hp c bin chng c trng cho nhim HIV tin trin : co git v cc tai bin
trn no khc, bnh c, nhim sc t mng, gim ton th huyt cu vi s gim sn ty v

gim tiu cu n c v ri lon trn gan nh to gan, cc thay i v m v gia tng men gan
v bilirubine trong mu.
Tr em : do khng c cc nghin cu c kim sot placebo, ch c nhng s liu gii hn t
nghin cu m tr em b nhim HIV c biu hin triu chng.
Ging nh ngi ln, tc dng ngoi trm trng nht bao gm thiu mu (c th cn n s
truyn mu), gim bch cu trung tnh v gim bch cu. Vic iu chnh liu lng c th rt
cn thit (xem Liu lng v Cch dng). Thng tin thu c v cc tc dng ngoi khc tr
em khng mu thun vi s xy ra cc tc dng ngoi do zidovudine ngi ln.
LIU LNG v CCH DNG
Ngi ln : liu khi u 200 mg zidovudine mi 4 gi (1200 mg/ngy) ni chung c khuyn
co cho bnh nhn nng 70 kg.
Mt khong liu rng t 500 v 1500 mg/ngy c dng. Phc liu lng ti u (liu
hng ngy v thi gian dng thuc) vn cn c xc nh v thay i theo tng c nhn. Trong
thc t, nhiu bnh nhn c th c duy tr tho ng vi liu 1000 mg/ngy chia lm 4 hay 5
ln. Trong cc trng hp c bit, bc s c th cn chn mt liu hng ngy thp hn, ty theo
giai on bnh v cc yu t c lin quan (nh d tr ty hay th trng bnh nhn). Khng bit
c tnh hu hiu ca liu thp hn trong vic iu tr hay phng nga cc suy thoi chc
nng thn kinh i km vi SIDA v tnh cht c tnh. Tnh hu hiu ca vic dng liu cch xa
hn (trong khong thi gian lu hn 6 gi) vn cn cha c xc nh.
Tr em : tr em trn 3 thng tui, liu khi u khuyn co l 180 mg/m2 din tch b mt c
th mi 6 gi (720 mg/kg/ngy). Liu ti a khng nn vt qu 200 mg mi 6 gi.
Phc liu lng ti u vn cn c xc nh v c th thay i theo tng ngi. Mt
khong liu rng t 120 v 180 mg/m2 din tch b mt c th mi 6 gi (trong khong 480-720
mg/m2/ngy), c dng. Khng bit c tnh hu hiu ca cc liu lng thp trong vic
iu tr v d phng suy thoi chc nng thn kinh i km vi HIV v tnh cht c tnh. Tnh hu
hiu ca vic dng liu cch khong xa hn trn tr em vn cn c xc nh.
iu chnh liu i vi bnh nhn c c tnh trn mu : c th cn thit phi iu chnh liu
cho bnh nhn c c tnh trn mu. iu ny hu nh thng hn bnh nhn c d tr ty
k m trc khi iu tr, c bit trn bnh nhn mc HIV trong giai on tin trin. Nu nng
hmoglobine gim xung trong khong gia 7,5 g/dl v 9 g/dl hay s lng bch cu trung tnh
gim xung gia 0,75 x 109/l v 1 x 109/l, liu hng ngy c th gim cho n khi c bng chng
ca s hi phc ty, ni cch khc, s hi phc c th c tng cng bi mt thi gian
ngng thuc ngn hn. Nu cn phi xem xt gim liu, c th gim mt na liu hng ngy v
sau tng thm dn, ty theo dung np thuc ca bnh nhn, cho n liu ban u.
iu tr vi Retrovir nn gin on nu mc hmoglobine xung thp di 7,5 g/dl hay s
lng bch cu trung tnh di 0,75 x 109/l. S hi phc ty thng c quan st thy xy ra
trong vng 2 tun sau thi gian dng zidovudine vi mt liu c gim bt c th c ti

p dng. Sau 2-4 tun sau, c th dn dn gia tng liu, ty theo dung np thuc ca bnh
nhn, cho n liu ban u.
Liu lng cho ngi gi : hin nay khng c sn s liu c hiu ; tuy nhin, nn p dng cc
bin php thn trng thng thng cho ngi gi.
Liu lng trong trng hp suy thn : cc s liu cn gii hn bnh nhn suy thn khng
ra nhu cu c bit v iu chnh liu khi u do nng zidovudine khng gia tng mt cch
ng k. Tuy nhin, s tch t ca cc cht chuyn ha glucuronide c th xy ra trong suy thn,
mc d khng bit c tc ng ca s tch t ny. Vic kim tra nng zidovudine trong
huyt tng (v cht chuyn ha glucuronide ca n), kt hp vi kim tra cc thng s huyt
hc, c th cho thy nhu cu iu chnh liu lng sau . Lm thm phn mu cho thy ch
cho mt tc dng gii hn trong vic o thi zidovudine nhng lm tng cng s o thi
cht chuyn ha glucuronide ca n.
Liu lng trong trng hp suy gan : cc s liu gii hn trn bnh nhn x gan cho thy rng
s tch t zidovudine c th xy ra trn bnh nhn suy gan v gim s glucuronide ha. C th
cn thit phi iu chnh liu nhng hin ti khng th cho cc khuyn co chnh xc. Nu
khng th thc hin c kim tra nng zidovudine trong huyt tng, bc s s phi ch
c bit i vi nhng du hiu khng dung np v gia tng khong cch gia cc liu cho thch
hp.
QU LIU
Triu chng : cc s liu hin nay cn gii hn v tc ng ca vic ung qu liu cp trn c
ngi ln v tr em. Khng c trng hp t vong no xy ra v tt c bnh nhn u hi
phc. Nng cao nht trong mu ca zidovudine c ghi nhn l 185 mmol (49,4 mg/ml).
Khng nhn thy c cc triu chng hay du hiu c hiu xy ra cng vi s qu liu.
Cc liu cao ln n 1250 mg Retrovir ung mi 4 gi trong vng 4 tun c cho 2 bnh
nhn HIV tin trin. Mt ngi b thiu mu v gim bch cu trong khi ngi kia khng b
nh hng nguy hi no.
Cc liu cao 7,5 mg/kg theo ng tim tuyn mi 4 gi trong vng 2 tun c dng cho 5
bnh nhn. Mt ngi trong s b phn ng lo lng trong khi bn ngi cn li khng b nh
hng nguy hi no.
iu tr : nn theo di bnh nhn k cng v cc du hiu c tnh (xem Tc dng ngoi ) v p
dng cc bin php h tr cn thit. Lm thm phn mu cho thy ch cho mt tc dng gii
hn trong vic o thi zidovudine nhng c th lm tng cng s o thi cht chuyn ha
glucuronide ca n.

438.

RHINATHIOL

SANOFI SYNTHELABO VIETNAM

vin nang dnh cho ngi ln 375 mg : hp 30 vin.
xir dnh cho ngi ln 5% : chai 125 ml.
xir dnh cho nh nhi v tr em 2% : chai 125 ml.
THNH PHN
cho 1 vin
Carbocistine

375 mg

(Lactose)

cho 1 mung lng xir 5%

Carbocistine

750 mg

(Ethanol)

(0,25 ml)

(Saccharose)

(6 g)

cho 1 mung caf xir 2%

Carbocistine

100 mg

(Ethanol)

(0,04 ml)

(Saccharose)

(3,5 g)

DC LC
Thuc bin i dch tit, c tnh cht tiu nhy.
DC NG HC
Sau khi ung, thuc c hp thu nhanh v t nng ti a trong huyt tng sau 2 gi.

Sinh kh dng k m, di 10% liu dng do c chuyn ha mnh v chu nh hng khi qua
gan ln u.
Thi gian bn hy o thi khong 2 gi.
Thuc v cc cht chuyn ha ch yu c o thi qua thn.
CH NH
iu tr cc bnh l{ ng h hp km hin tng kh khc m.
CHNG CH NH
Qu mn cm vi cc thnh phn ca thuc.
CH PHNG
Trng hp ho c nhiu m cn phi c tn trng v l yu t c bn bo v phi - ph
qun.
Phi hp thuc tan m vi thuc ho hoc cc thuc lm kh m (tc dng atropinic) l khng
hp l.
THN TRNG LC DNG
Dng thn trng ngi b lot d dy - t trng.
Trng hp bnh nhn b tiu ng, cn lu { lng ng c trong thnh phn ca dng
xir :
- 1 mung lng xir 5% c cha 6 g saccharose.
- 1 mung caf xir 2% c cha 3,5 g saccharose.
Do trong thnh phn ca dng xir c alcool nn phi lu { ngi li xe v vn hnh my mc
v kh nng b bun ng khi dng thuc.
LC C THAI
Ch dng trong thi gian mang thai khi tht s cn thit.
LC NUI CON B
C th cho con b trong thi gian dng thuc.
TC DNG NGOI
C th xy ra hin tng khng dung np ng tiu ha (au d dy, bun nn, i ma v
tiu chy), nn gim liu trong trng hp ny.
LIU LNG v CCH DNG
Thi gian iu tr ngn v khng qu 5 ngy.
Ngi ln v tr em trn 15 tui : mi ln ung 2 vin hoc 1 mung lng xir 5%, ngy 3 ln,
nn ung thuc xa ba n.
Nh nhi v tr em di 15 tui : dng dng xir 2%, liu 20-30 mg/kg/ngy, chia lm 2-3 ln,
ung xa ba n.
- Di 5 tui : 1-2 mung caf/ngy.
- Trn 5 tui : 3 mung caf/ngy

439.

RHINATHIOL Promethazine

SANOFI SYNTHELABO VIETNAM

xir : chai 125 ml.
THNH PHN
cho 1 mung canh
Carbocistine

300 mg

Promthazine chlorhydrate

7,5 mg

(Saccharose)

(9 g)

(Alcool)

cho 1 mung lng

Carbocistine

100 mg

Promthazine chlorhydrate

2,5 mg

(Saccharose)

(3 g)

(Alcool)
DC LC
Thuc khng histamine ng ung.
Promthazine :
Promthazine l mt thuc khng histamine H1 thuc nhm ph nothiazine, c cc c tnh nh
sau :
- tc dng an thn liu thng thng do tc ng khng histamine v c ch adrnaline
thn kinh trung ng,
- tc dng khng cholinergic gy tc dng ngoi ngoi bin,
- tc dng c ch adrnaline ngoi bin c th nh hng n ng lc mu (c th gy h
huyt p t th).
Cc thuc khng histamine c c tnh chung l i khng, do i khng tng tranh t nhiu

mang tnh thun nghch, vi tc dng ca histamine, ch yu trn da, mch mu, ph qun v
rut.
a s cc thuc khng histamine c tc ng chng ho va phi, nhng li lm tng hiu lc
chng ho ca cc thuc ho dn xut morphine c tc ng trung tm v cc thuc gin ph
qun thuc nhm amine c tc ng giao cm m chng thng hay c phi hp iu tr.
DC NG HC
Carbocistine :
Sau khi ung, carbocist ine c hp thu nhanh v t nng ti a trong huyt tng sau 2
gi.
Sinh kh dng k m, di 10% liu dng do c chuyn ha mnh v chu nh hng khi qua
gan ln u.
Thi gian bn hy o thi khong 2 gi.
Carbocistine v cc cht chuyn ha ch yu c o thi qua thn.
Promthazine :
Promthazine c sinh kh dng t 13 n 40%.
Thi gian t nng ti a trong huyt tng t 1,5 n 3 gi.
Th tch phn phi cao do c i lc vi lipide, khong 15 l/kg.
T l gn kt vi protine huyt tng t 75 n 80%.
Thi gian bn hy t 10 n 15 gi.
S chuyn ha theo hng sulfoxyde ha, sau loi tip gc mthyl.
Thanh thi thn chim di 1% thanh thi ton phn v c khong 1% c tm thy trong
nc tiu di dng khng b chuyn ha. Cc cht chuyn ha c tm thy trong nc tiu,
ch yu l sulfoxide, chim 20% liu dng.
Thuc khng histamine c kh nng b tch t bnh nhn suy thn hay suy gan nng.
CH NH
iu tr triu chng ho khan gy kh chu, nht l ho vo ban m.
CHNG CH NH
Tuyt i :
C tin s qu mn cm vi mt trong cc thnh phn ca thuc.
C tin s b mt bch cu ht.
C nguy c b b tiu lin quan n ri lon niu o - tuyn tin lit.
C nguy c b glaucome do khp gc.
Tng i :
Phi hp vi sultopride (xem Tng tc thuc).
CH PHNG v THN TRNG LC DNG
Ch { phng :
Trng hp ho c m cn phi c tn trng v l yu t c bn bo v phi - ph qun.

Trc khi k toa thuc ho, cn tm hiu nguyn nhn gy ho c iu tr thch hp.
Nu dng thuc ho liu thng thng m vn khng ht ho, khng nn tng liu thuc ho
m phi chn on li tnh trng lm sng ca bnh nhn.
Cng nn lu { rng trong thnh phn t dc ca xir c alcool.
Thn trng lc dng :
Lin quan n carbocistine :
Dng thn trng ngi b lot d dy - t trng.
Lin quan n promthazine :
Do hin nay ngi ta cn gi nh rng phnothiazine c th l mt yu t trong nhng trng
hp t t nh nhi, khng nn s dng thuc ny cho tr di 1 tui.
Cn tng cng theo di (lm sng v in no ) bnh nhn b ng kinh do cc dn xut
phnothiazine c th lm gim ngng gy ng kinh.
Thn trng khi ch nh promthazine trong nhng trng hp :
- bnh nhn ln tui c kh nng cao b h huyt p t th, b chng mt, bun ng ; bnh nhn
b to bn kinh nin (do c nguy c b tc rut do lit) ; bnh nhn b ph i tuyn tin lit ;
- bnh nhn b bnh tim mch do cc dn xut phnothiazine c th gy nhp tim nhanh v h
huyt p mt s ngi ;
- bnh nhn b suy gan v/hay suy thn nng, do c nguy c tch t thuc.
Trng hp dng thuc cho tr em, cn phi bit chc l tr khng b hen ph qun hay b tro
ngc d dy - thc qun trc khi k toa thuc ho.
Tuyt i trnh ung ru hay cc thuc c cha ru trong thi gian iu tr.
Do cc dn xut phnothiazine c th gy cm quang, trnh phi nng trong thi gian iu tr.
Lin quan n dng bo ch :
Trng hp bnh nhn b tiu ng hay phi theo ch n king t ng, nn lu { n
hm lng saccharose trong thnh phn ca dng xir.
Li xe v vn hnh my mc :
Cn thng bo cho ngi phi li xe hay vn hnh my mc v kh nng b bun ng khi dng
thuc, nht l trong thi gian u.
Hin tng ny cng r hn nu dng chung vi cc thc ung hay cc thuc khc c cha
ru.
LC C THAI v LC NUI CON B
Lc c thai :
Kho st v tc dng gy d dng (trong 3 thng u thai kz) :
Cc nghin cu trn ng vt :
- Khng cho thy tc dng gy qui thai ca carbocistine.
- Khng c s liu ng tin cy v tc dng gy qui thai ca promthazine.
Trn lm sng :

- Khng c s liu i vi carbocistine.

- Dng promthazine trn mt s lng hn ch ph n c thai khng cho thy thuc c nh
hng gy d dng hay c phi no. Tuy nhin cn phi lm thm nhiu nghin cu na c
kt lun chnh xc v nh hng ca thuc khi dng trong thai kz.
Kho st v c tnh trn phi thai (trong 6 thng cui thai kz) :
tr s sinh c m c iu tr di hn vi liu cao thuc khng histamine c c tnh khng
cholinergic, cc du hiu v tiu ha c lin quan n tc dng atropinic (cng bng, tc rut
phn su, chm i tiu phn su, nhp tim nhanh, ri lon thn kinh...) him khi c ghi nhn.
Da trn cc d liu trn, khng nn ung thuc ny trong 3 thng u ca thai kz, nhng
thng tip theo c th k toa nhng khi no tht cn thit v ch s dng ngn hn trong 3
thng cui thai kz.
Nu c ung thuc ny vo cui thai kz, cn phi theo di mt thi gian cc chc nng thn
kinh v tiu ha ca tr s sinh.
Lc nui con b :
Do thuc khng histamine ni chung c bi tit mt lng nh qua sa m v do tc dng an
thn ca promthazine, khng nn dng thuc ny trong thi gian cho con b.
TNG TC THUC
Khng nn phi hp :
- Alcool : ru lm tng tc dng an thn ca thuc khng histamine. Vic gim tp trung v
tnh to c th gy nguy him khi li xe hay vn hnh my mc. Trnh ung ru v cc thc
ung c cha ru trong thi gian dng thuc.
- Sultopride : c nguy c tng ri lon nhp tht, nht l nguy c gy xon nh, do phi hp cc
tc dng in sinh l.
Nn lu { khi phi hp :
- Atropine v cc thuc c tc ng atropinic (thuc chng trm cm nhm imipramine, thuc
chng lit rung c tc ng khng cholinergic, thuc chng co tht c tc ng atropinic,
disopyramide, thuc an thn kinh nhm ph nothiazine) : tng cc tc dng ngoi atropinic
nh gy b tiu, to bn, kh ming.
- Cc thuc c ch thn kinh trung ng khc (thuc gim au v chng ho h morphine, thuc
chng trm cm c tc dng an thn, thuc ng, nhm barbiturate, clonidine v cc thuc cng
h, mthadone, thuc an thn kinh, thuc gii lo u) : tng c ch thn kinh trung ng. Vic
gim tp trung v tnh to c th gy nguy him khi li xe hay vn hnh my mc.
TC DNG NGOI
Lin quan n carbocistine :
C th xy ra hin tng khng dung np ng tiu ha (au d dy, bun nn, i ma v
tiu chy), nn gim liu trong trng hp ny.
Lin quan n promthazine :

Cc c tnh dc l ca thuc cng l nguyn nhn ca mt s tc dng ngoi vi nhiu mc

khc nhau v c hay khng c lin quan n liu dng (xem phn Dc lc) :
Tc dng trn thn kinh thc vt :
- thiu thiu hoc bun ng, nht l vo thi gian iu tr u ;
- tc ng khng cholinergic lm kh nim mc, ri lon iu tit, gin ng t, tim p nhanh,
nguy c b tiu ;
- h huyt p t th ;
- ri lon cn bng, chng mt, gim tr nh hoc kh nng tp trung ;
- mt iu ha vn ng, rung ry, thng xy ra hn ngi ln tui ;
- ln, o gic ;
- him hn, ch yu nh nhi, c th gy kch ng, cu gt, mt ng.
Phn ng qu mn cm :
- ni ban, eczema, nga, ban xut huyt, m ay ;
- ph, him hn c th gy ph Quincke ;
- sc phn v ;
- cm quang.
Tc dng trn mu :
- gim bch cu, gim bch cu trung tnh ;
- gim tiu cu ;
- thiu mu tan mu.
LIU LNG v CCH DNG
Dng cho ngi ln v tr em trn 1 tui.
Nn dng thuc ngn hn (vi ngy) v nn ung thuc vo thi im xy ra cn ho.
Ngi ln : 3-4 mung canh (15 ml) mi ngy.
Tr em :
- t 12 n 30 thng : 3 n 4 mung lng (5 ml) mi ngy.
- t 30 thng n 12 tui : 4 n 6 mung lng mi ngy.
- t 12 n 15 tui : 6 n 9 mung lng mi ngy.
Nn u tin ung thuc vo bui chiu ti do promthazine c th gy bun ng.
QU LIU
Du hiu qu liu promthazine : co git (nht l nh nhi v tr em), ri lon nhn thc, hn
m.
Cho nhp vin v iu tr triu chng

440.

RIGEVIDON

GEDEON RICHTER
vin nn : v 21 vin + 7 vin Fe, hp 3 v hoc 100 v.
THNH PHN
cho 1 vin
Levonorgestrel

0,15 mg

Ethinylestradioll

0,03 mg

cho 1 vin "Fe"

Fe2+ (di dng fumarate st khan)

25 mg

DC LC
Vin nn Rigevidon 21 + 7 "Fe" l thuc ung nga thai bng cch c ch s rng trng, qua
trnh vic c thai ngoi mun.
CH NH
Thuc ung nga thai. C hiu qu iu tr trong cc trng hp ri lon xut huyt chc nng,
au gia chu kz kinh v au kinh.
CHNG CH NH
ang mang thai, tnh trng sau vim gan, c tin s bnh vng da t pht v nga khi mang
thai. Hi chng Dubin-Johnson v hi chng Rotor. Ri lon chc nng gan, vim ti mt,
khuynh hng huyt khi tng, bnh tim thc th nng, vim mt mn tnh, tiu ng nng,
ri lon cc chc nng ni tit khc, cc bnh c tnh, c bit l ung th v v ung th b phn
sinh dc. Thi kz cho con b. Khng dung np thuc.
CH PHNG v THN TRNG LC DNG
Cn ch khi dng thuc trong cc trng hp gin tnh mch, ng kinh, tng huyt p, ri
lon tm thn km theo trm cm, tiu ng nh, u c t cung rng hn, bnh tuyn v v
ngi trn 40 tui.
Ht thuc c th lm tng tn sut v trm trng ca tc dng ph. Hng nm, nn kim tra
ph khoa. Nu tiu chy hoc nn ma, tc dng nga thai c th b gim hoc ngng v thuc
gim hp thu. Khi k toa cho bnh nhn, nn cn nhc tt c cc bnh gian pht i km tiu
chy hoc nn ma. Trong trng hp b tiu chy hoc nn mn tnh, th nn ngng thuc v
nn dng cc phng php trnh thai khc.

 bo v bo thai, nn ngng thuc 3 thng trc khi c k hoch mang thai v nn s dng
phng php trnh thai khng cha hormon khc.
Nn ngng thuc trong trng hp bnh mn tnh v 6 tun trc khi i phu thut (v phi
nm trn ging lu).
TNG TC THUC
Tc dng ca thuc c th b gim (xut huyt bt thng) hoc mt hn tc dng - do cm ng
enzyme - khi dng ng thi thuc ny vi cc thuc sau y : rifampicin, dn xut
phenobarbital, phenytoin, khng sinh ph rng, sulphamid v dn xut pyrazolone.
TC DNG NGOI
C th gp cc triu chng ng tiu ha, cng v, tng hoc gim th trng, nhng chng s
gim khi dng quen thuc. Ngng thuc ngay trong trng hp mang thai, huyt khi, nghn
mch, vim tnh mch huyt khi, ri lon mch no, nhi mu c tim, gim th lc, chng li
mt, chng nhn i, nhc u nng ko di v ti pht, v mt vi bnh mn tnh khc.
LIU LNG v CCH DNG
Vic dng thuc Rigevidon 21 + 7 "Fe" nn bt u vo ngy th 5 ca chu kz kinh vi nhng
vin mu trng v dng lin tc trong 21 ngy. Trong 7 ngy tip theo, dng vin bao phim c
mu. Ch dng thuc ny phi c ni tip (21 vin mu trng, ri tip theo l 7 vin bao
phim c mu) cho n khi vn cn nhu cu trnh thai, tc l ch dng thuc 28 ngy nn
c p dng mt cch lin tc. Nn ung thuc vo nhng gi ging nhau trong ngy, tt nht
l gi i ng ti.
S c ch rng trng s khng bo m, nu khong thi gian ung gia 2 vin qu 36 gi.
Khng cn thit phi ngng thuc khi c hin tng huyt ra lm tm. Nu xut huyt nng
hn, th nn ngng thuc v khm ph khoa. Nu kt qu kim tra khng c g, c th bt u
chu kz 21 + 7 mi vo ngy th 5 ca chu kz kinh. S ra kinh bt thng v xut huyt lm tm
s gim v ht hon ton mt cch t nhin khi tip tc dng thuc.
BO QUN
Trnh m, gi nhit trong khong 15-30oC.

441.

RISORDAN 5 mg - 10 mg - RISORDAN LP 20 mg

RHNE-POULENC RORER
[AVENTIS PHARMA]
vin nn d b 5 mg : hp 30 vin.
vin nn d b 10 mg : hp 60 vin.

vin nn tc dng ko di 20 mg : hp 60 vin.

THNH PHN
cho 1 vin
Isosorbide dinitrate

5 mg

(Na)

(10-7mEq)

cho 1 vin
Isosorbide dinitrate

10 mg

(Na)

(10-2mEq)

cho 1 vin LP
Isosorbide dinitrate

20 mg

DC LC
Gin mch, chng au tht ngc. Isosorbide dinitrate c tc dng sau :
- Gin tnh mch v a n :
- gim p lc tin gnh n cc tm tht (gim p lc y mu v th tch ca tm tht phi v
tri).
- gim p lc cui tm trng tm tht tri. iu ny lm ci thin hot ng ca tim m
khng lm thay i nhp v cc ch s ca tim.
- Gin mch vnh a n vic ti mu tt hn cho cc vng thiu mu di ni tm mc.
- Tc dng chng co tht.
- Gin cc tiu ng mch liu cao, a n s gim sc khng mch mu ngoi bin v
nh th lm gim p lc hu gnh trn cc tm tht.
Cc tc dng ny gp phn ci thin tnh trng huyt ng hc vi s gim nhu cu oxy ca c
tim m li tng s chuyn ti oxy ; nhng yu t ny l nn tng cho cc ch nh ca thuc
trong cn au tht ngc v suy tim.
Risordan 5 mg c c trng bi :
- tc dng nhanh (hp thu di li) tng ng trinitrine.
- thi gian tc dng ko di nhiu gi (2-6 gi) ty theo liu v cch s dng.

Risordan 10 mg :
Isosorbide dinitrate t nng hiu nghim trong huyt tng (lm gim gnh nng ca tim,
gim p lc mao qun phi ca phn t m v cht chuyn ha mononitrate).
Risordan LP 20 mg :
Bo m tc dng tr liu lin tc. Trong cc th nghim v gng sc thc hin trong vng 8 gi
sau khi ung mt vin Risordan LP 20 mg, ngi ta nhn thy ngng xut hin cn au tht
ngc c nng ln trong sut thi gian th nghim.
DC NG HC
Isosorbide dinitrate l mt nitrate hu c b bin dng nhanh chng v hon ton bi cc
glutathion-S-transferase. Thi gian bn hy ca liu ung duy nht mt vin l 40 pht ngi.
Thuc c chuyn ha thnh 2 cht l isosorbide 2-mononitrate v isosorbide 5-mononitrate
hin din vi nng cao hn v thi gian bn hy di hn 4-5 gi so vi phn t m. Nhng
cng trnh nghin cu vi cc cht ng v phng x nh du cho thy liu ung isosorbide
dinitrate c hp thu hon ton bi c th. Thuc c thi gn nh hon ton qua nc
tiu (99%).
Vin 5 mg LI :
Vin phng thch nhanh (ngm di li), vin tc ng ko di (ung).
Vin 10 mg LI :
Vin phng thch nhanh nhng tc ng ko di. Bng ng ung, nng huyt tng sau
30 pht l 9 mg/ml vi vin 10 mg.
Vin LP 20 mg :
K thut bo ch vin Risordan LP 20 mg bo m phng thch hot cht t t, do cho ph p
gi lu di nng hiu qu trong huyt tng.
Sau khi ung mt liu duy nht Risordan LP 20 mg, nng huyt tng ca isosorbide
dinitrate t ti a sau 40 pht v gi trong vng 6 gi, sau 10 gi vn cn ng k. Nng
huyt tng ti a gi n nh trong khong 10 gi i vi isosorbide dinitrate v 12 gi i vi
cc cht chuyn ha mononitrate.
CH NH
ng ngm di li (vin 5 mg) :
- iu tr cn au tht ngc.
- Ph phi cp tnh, phi hp vi iu tr c in.
ng ung (vin 5 mg, 10 mg, 20 mg, LP 20 mg) :
- D phng cn au tht ngc.
- iu tr b tr suy tim tri.
Ghi ch : cc dn cht nitrate thng c s dng trong suy tim nng mn tnh. Vai tr quan
trng ca chng c cng nhn trong iu tr ngn ngy. Gn y, n cn c xc nhn
trong iu tr k o di (dng n tr liu hoc phi hp vi mt thuc gin ng mch).

CHNG CH NH
- Qu mn i vi dn cht nitrate.
- Bnh l{ c tim th tc nghn (nguy c mt b).
CH PHNG
Suy tim phi n thun khng phi l mt chng ch nh.
Trong trng hp s dng liu cao, khng nn ngng thuc t ngt.
THN TRNG LC DNG
- Vin 5 mg, 10 mg, 20 mg :
Liu hu hiu phi c t ti t t, do c th gy h huyt p ng mch v nhc u d
di mt vi i tng. Liu dng trong ngy phi c chia ra v iu chnh ty theo hiu qu
v mc dung np thuc ca ngi bnh.
Tc dng gin mch ca ru v tc dng gin mch ca cc dn cht nitrate c nguy c lm
tng thm tc dng h p khi dng phi hp.
Nhng thuc gin mch, thuc h huyt p, thuc li tiu c th b tng tc ng h huyt p
bi cc dn cht nitrate, nht l ngi ln tui.
- Vin 5 mg :
Cc thuc khng cholinergic do lm gim bi tit nc bt, c th lm chm s ha tan ca
Risordan t di li.
LC C THAI
Khng nn dng cho ph n mang thai (khng c tc dng sinh qui thai ng vt, tuy nhin
cha c s liu ngi).
LC NUI CON B
Khng nn cho con b trong thi gian iu tr v khng c cc d liu v thuc i qua sa m.
TC DNG NGOI
- C th b nhc u lc mi dng thuc, thng s t t bin mt.
- H huyt p c th km theo cm gic chng mt, xy xm, him khi bt tnh (ch yu ngi
gi v khi phi hp vi thuc gin mch khc).
Mthmoglobine mu c khi xy ra ; khng c biu hin lm sng vi liu iu tr nhng li
ng k vi liu cao.
Gin mch gy da.
Ri lon tiu ha.
LIU LNG v CCH DNG
Dng phng thch nhanh : 5 mg, 10 mg (LI : libration immdiate).
Dng phng thch chm : 20 mg (LP : libration prolonge).
ng ngm di li : vin 5 mg (tc dng nhanh : khong 2 pht).
- Cn au tht ngc : 5-10 mg, ngm tip tc nu cn au ti pht.
- Ph phi cp tnh : 5-10 mg, phi hp vi iu tr kinh in.

ng ung :
vin 5 mg, 10 mg (tc dng ko di 4-6 gi)
vin 20 mg LP
Vin phi nut, khng nhai hay ngm cho tan.
Phng nga cn au tht ngc :
Liu ban u : nn bt u iu tr vi liu nh nht. Cho ung Risordan 2-3 ln/24 gi, tn
trng mt khong trng iu tr t nht l 12 gi (th d : 8 gi, 12 gi, 18 gi).
Ring vi Risordan LP c th tng liu ln ti 40 mg, 2 ln/24 gi (khng i xng, v d : 8 v
18 gi).
Liu duy tr : sau liu c chnh ty theo hiu qu lm sng mong mun v p ng ca
tng bnh nhn.
Liu thng thng l 10-60 mg/24 gi chia lm 2-3 ln.
Vi Risordan LP : Liu thng thng l 40-80 mg/24 gi chia lm 2-3 ln.
Tn trng mt khong trng iu tr t nht l 12 gi (th d : 8 gi, 12 gi, 18 gi).
Suy tm tht tri hay ton phn :
Liu ban u : nn bt u iu tr vi liu nh nht. Cho ung Risordan 2-3 ln/24 gi, tn
trng mt khong trng iu tr t nht l 12 gi (th d : 8 gi, 12 gi, 18 gi).
Liu duy tr : sau liu c chnh ty theo hiu qu lm sng mong mun v p ng ca
tng bnh nhn. Liu thng thng l 20-60 mg/24 gi chia lm 2-3 ln, tn trng mt khong
trng iu tr t nht l 12 gi (th d : 8 gi, 12 gi, 18 gi).
Suy tm tht tri mu :
Liu ban u : nn bt u iu tr vi liu nh nht Risordan LP 20 mg, 2-3 ln/24 gi, tn
trng mt khong trng iu tr t nht l 12 gi (th d : 8 gi, 12 gi, 18 gi). C th tng liu
ln ti 40 mg, 2 ln/24 gi (khng i xng, v d : 8 v 18 gi).
Liu duy tr : sau liu c chnh ty theo hiu qu lm sng mong mun v p ng ca
tng bnh nhn. Liu thng thng l 40-80 mg/24 gi chia lm 2-3 ln, tn trng mt khong
trng iu tr t nht l 12 gi (th d : 8 gi, 12 gi, 18 gi).
Suy tim tr : do cn bng huyt ng tm thi bnh nhn, liu dng c tng dn dn ln
n ti a l 240 mg/24 gi. Nhng liu cao c dng cho nhng trng hp c bit ca
nhng bnh nhn nm vin v c theo di lm sng cht ch, dng phng thch chm c
bit thch hp vi loi bnh nhn ny v n cho ph p t c nhng nng hu hiu trong
huyt thanh mt cch t t.
QU LIU
Trng hp ung qu liu do bt cn, biu hin thuc hai loi :
- gin mch ton thn vi try mch.
- tm ti do mthmoglobine mu.
iu tr :

T mthmoglobine mu 0,8 g/100 ml tr i, dng xanh m thylne 1% tim tnh mch (1-2
mg/kg), hoc cho ung : 50 mg/kg trong cc trng hp nh nht. Vic iu tr cn thc hin
cc bnh vin chuyn khoa.

442.

RISPERDAL

JANSSEN PHARMACEUTICA
c/o JANSSEN-CILAG
c/o MEGA PRODUCTS
Vin nn bao phim b c 1 mg : v 6 vin, hp 2 v hoc v 10 vin, hp 2 v v hp 6 v - Bng
B.
Vin nn bao phim b c 2 mg : v 10 vin, hp 2 v v hp 6 v - Bng B.
Vin nn bao phim b c 3 mg : v 10 vin, hp 2 v v hp 6 v - Bng B.
Vin nn bao phim b c 4 mg : v 10 vin, hp 2 v v hp 6 v - Bng B.
Vin nn bao phim 6 mg : v 7 vin, hp 4 v - Bng B.
Vin nn bao phim 8 mg : v 7 vin, hp 4 v - Bng B.
Dung dch ung 1 mg/ml : chai 100 ml + ng ht 3 ml (c nh chun bng mg v ml, th tch
nh nht l 0,25 ml v th tch ln nht l 3 ml).
THNH PHN
cho 1 vin
Risperidone

1 mg

T dc : lactose, tinh bt ng, cellulose vi

tinh th, hypromellose, Mg stearate, silic
dng keo khan, natri lauryl sulfate v
propylene glycol.

cho 1 vin
Risperidone
T dc : lactose, tinh bt ng, cellulose vi
tinh th, hypromellose, Mg stearate, silic
dng keo khan, natri lauryl sulfate,

2 mg

propylene glycol, talc, titane dioxide v

phm mu vng cam S-nhm.

cho 1 vin
Risperidone

3 mg

T dc : lactose, tinh bt ng, cellulose vi

tinh th, hypromellose, Mg stearate, silic
dng keo khan, natri lauryl sulfate,
propylene glycol, talc, titane dioxide v
vng quinoline.

cho 1 vin
Risperidone

4 mg

T dc : lactose, tinh bt ng, cellulose vi

tinh th, hypromellose, Mg stearate, silic
dng keo khan, natri lauryl sulfate,
propylene glycol, talc, titane dioxide, vng
quinoline v phm mu chm disulfonate
nhm.

cho 1 vin
Risperidone
T dc : lactose, tinh bt ng, cellulose vi
tinh th, hypromellose, Mg stearate, silic
dng keo khan, natri lauryl sulfate,
propylene glycol, talc, titane dioxide,
phm mu vng quinoline nhm v phm
mu vng cam S nhm.

6 mg

cho 1 vin
Risperidone

8 mg

T dc : lactose, tinh bt ng, cellulose vi

tinh th, hypromellose, Mg stearate, silic
dng keo khan, natri lauryl sulfate,
propylene glycol, talc, titane dioxide,
phm mu vng quinoline nhm v phm
mu chm disulfonate nhm.

cho 100 ml
Risperidone

100 mg

T dc : acid tartric, acid benzoic, natri hydroxide v nc tinh

khit.
DC LC
Risperdal, c hot cht l risperidone, l thuc chng lon thn mi thuc nhm dn xut
benzisoxazole.
Risperidone l mt cht i khng monoaminergic c chn lc vi nhng c tnh ring bit.
Risperidone c i lc cao vi cc th th serotonin 5-HT2 v dopamine D2.
Risperidone cng gn kt vo th th a1-adrenergic v c i lc thp hn vi th th histamin
H1 v th th a2-adrenergic.
Risperidone khng c i lc vi cc th th cholinergic. Mc du risperidone l cht i khng
mnh vi th th D2, c xem l ci thin cc triu chng dng tnh ca bnh tm thn phn
lit, nhng risperidone t gy c ch cc hot ng v vn ng v t gy chng gi nguyn th
hn cc thuc an thn kinh c in ch yu. L cht i khng cn bng gia th th serotonin
v dopamine trung ng, risperidone c th lm gim nguy c gy tc dng ph ngoi thp v
m rng tc ng iu tr i vi cc triu chng m tnh v triu chng cm xc bnh nhn
tm thn phn lit.
DC NG HC
Risperidone c hp thu hon ton sau khi ung, t n nng nh trong huyt tng
trong vng 1-2 gi. S hp thu khng b nh hng bi thc n, v vy risperidone c th dng

lc no hoc i.
Risperidone c chuyn ha mt phn thnh 9-hydroxy-risperidone, cht ny c tc dng
dc l{ tng t nh risperidone. Risperidone cng vi 9-hydroxy-risperidone to nn thnh
phn c hot tnh chng lon thn. ng chuyn ha khc ca risperidone l loi gc alkyl
Nit.
nhng bnh nhn tm thn, sau khi ung risperidone c thi tr vi thi gian bn thi
khong 3 gi. Thi gian bn hy ca 9-hydroxy-risperidone v thnh phn c hot tnh chng
lon thn l 24 gi.
Nng n nh trong mu ca risperidone t c trong vng 1 ngy hu ht cc bnh
nhn. Nng n nh trong mu ca 9-hydroxy-risperidone t c trong vng 4-5 ngy sau
khi dng thuc. Trong khong liu iu tr, nng trong huyt tng ca risperidone t l vi
liu dng.
Risperidone c phn b nhanh chng. Th tch phn b l 1-2 l/kg. Trong huyt tng,
risperidone gn kt vi albumin v a1-acid glycoprotein. S gn kt vi protein huyt tng ca
risperidone l 88%, ca 9-hydroxy-risperidone l 77%.
Mt tun sau khi ung, 70% liu ung c thi tr trong nc tiu v 14% trong phn. Trong
nc tiu, risperidone v 9-hydroxy-risperidone chim 35-45% liu dng. Phn cn li l nhng
cht chuyn ha khng c hot tnh.
Mt nghin cu liu duy nht cho thy nng cht c hot tnh trong huyt tng cao hn v
s thi tr ca risperidone chm hn ngi gi v bnh nhn suy thn. Nng trong
huyt tng ca risperidone bnh nhn suy gan l bnh thng.
CH NH
Risperdal c ch nh trong iu tr tm thn phn lit cp v mn tnh v cc bnh lon thn
khc, trong ni bt cc triu chng dng tnh (nh o gic, hoang tng, ri lon t duy,
th hn, a nghi) v/hoc cc triu chng m tnh (nh cm xc cn mn, co rt v tnh cm v
x hi, ngn ng ngho nn).
Risperdal cng ci thin cc triu chng cm xc (nh trm cm, mc cm ti li, lo u) kt hp
vi tm thn phn lit.
CHNG CH NH
Risperdal c chng ch nh vi nhng bnh nhn qu mn vi thuc.
CH PHNG v THN TRNG LC DNG
Do tc dng chn alpha ca Risperdal, chng h huyt p t th ng c th xy ra, c bit
trong giai on iu chnh liu ban u.
Risperdal nn c dng thn trng i vi nhng bnh nhn c bit c bnh v tim mch
(v d nh suy tim, nhi mu c tim, bt thng v dn truyn, mt nc, gim th tch mu
hoc bnh mch mu no) v liu dng nn c iu chnh t t nh c khuyn co
(xem phn Liu lng v Cch dng). Nn xem xt vic gim liu nu h huyt p xy ra.

Nhng thuc c tnh cht i khng th th dopamine c lin quan vi vic gy ra ri lon vn
ng mun c trng bi : cc c ng nhp nhng khng t , ch yu li v/hoc mt.
c bo co rng s xut hin cc triu chng ngoi thp l mt yu t nguy c cho vic pht
trin ri lon vn ng mun, bi v Risperdal t c kh nng gy ra cc triu chng ngoi thp
hn so vi cc thuc an thn kinh c in ch yu nn Risperdal t c nguy c to ra ri lon
vn ng mun hn so vi cc thuc an thn kinh c in ch yu. Nu nhng du hiu v triu
chng ca ri lon vn ng mun xy ra, vic ngng s dng cc thuc chng lon thn nn
c xem xt.
Hi chng c tnh ca cc thuc an thn kinh ch yu, c trng bi st cao, cng c, s
khng n nh v thn kinh t ng, ri lon thc v tng nng creatine phosphokinase
(CPK) c bo co xy ra vi cc thuc an thn kinh c in ch yu. Trong trng hp
ny, tt c cc thuc chng lon thn, k c Risperdal nn c ngng s dng.
Nn gim phn na liu khi u v phn tng liu cho cc liu k tip ngi gi, bnh nhn
suy thn hoc suy gan. Cng cn thn trng khi k toa Risperdal i vi bnh nhn bnh
Parkinson bi v theo l thuyt, n c th lm cho bnh nng thm.
Nhng thuc an thn kinh c in ch yu c bit c th lm gim ngng ng kinh. Nn
thn trng khi iu tr cho nhng bnh nhn c bnh ng kinh.
Bnh nhn nn c khuyn trnh n qu nhiu v c kh nng tng cn.
nh hng n vic li xe v s dng my mc :
Risperdal c th nh hng n nhng hot ng i hi s tnh to v tinh thn. Do ,
nhng bnh nhn ang dng Risperdal c khuyn khng nn li xe hoc vn hnh my mc
cho n khi bit r s nhy cm ca h.
LC C THAI v LC NUI CON B
Lc c thai :
an ton ca Risperdal khi s dng cho ph n c thai cha c xc nh. Mc d qua th
nghim trn ng vt, risperidone khng cho thy c tnh trc tip trn s sinh sn, mt s
tc dng gin tip qua trung gian ca prolactin v h thn kinh trung ng c ghi nhn.
Tc ng gy qui thai ca risperidone khng c ghi nhn bt c nghin cu no. Do ,
ch nn dng Risperdal trong lc mang thai nu li ch iu tr hn hn nguy c tai bin.
Lc nui con b :
Risperdal cng khng c bit c bi tit trong sa m hay khng. nhng nghin cu trn
ng vt, risperidone v 9-hydroxy-risperidone c bi tit qua sa. Do , ph n ang s
dng Risperdal khng nn cho con b.
TNG TC THUC
Nguy c dng kt hp Risperdal vi nhng thuc khc cha c nh gi mt cch c h
thng. Do Risperdal c tc dng ch yu trn h thn kinh trung ng v vy nn thn trng khi
dng vi cc thuc tc ng trn h thn kinh trung ng.

Risperdal c th i khng tc ng ca Levodopa v cc cht ng vn dopamine khc.

Carbamazepine cho thy lm gim nng phn c hot tnh chng lon thn ca Risperdal
trong huyt tng. Nhng thuc cm ng men gan khc cng c tc dng tng t. Liu ca
Risperdal nn c iu chnh li v gim liu nu cn thit khi ngng dng carbamazepine v
nhng thuc cm ng men gan khc.
Nhm phenothiazine, cc thuc chng trm cm 3 vng v mt s thuc chn beta c th lm
tng nng risperidone trong huyt tng nhng khng lm tng nng phn c hot tnh
chng lon thn. Khi Risperdal c ung cng vi cc thuc gn kt cao vi protein th khng
c s th ch ln nhau c { ngha v mt lm sng ca bt c thuc no t protein huyt
tng.
TC DNG NGOI
Nhn chung Risperdal c dung np tt v trong nhiu trng hp, kh phn bit tc dng
ph vi nhng triu chng tm thn. Nhng tc dng ph c quan st thy khi s dng
Risperdal nh sau :
Thng gp : mt ng, bt rt, lo u, nhc u.
t gp : ng g, mt mi, chong vng, mt tp trung, to bn, n khng tiu, nn, ma, au
bng, nhn m, chng cng dng vt, ri lon chc nng cng dng vt, ri lon s xut
tinh, tiu khng kim sot, vim mi, ban v phn ng d ng khc.
Risperdal t gy ra tc dng ph ngoi thp hn so vi cc thuc an thn kinh c in ch yu.
tuy nhin, trong mt s trng hp, nhng triu chng ngoi thp sau y c th xy ra : run,
cng c, tng tit nc bt, vn ng chm chp, ng ngi khng yn, lon trng lc c cp.
Nhng triu chng ny thng nh v hi phc khi gim liu v/hoc cho dng nhng thuc
chng Parkinson nu cn thit.
Thnh thong, h huyt p t th ng, nhp tim nhanh phn x hoc cao huyt p c
nhn thy sau khi ung Risperdal c bit vi liu khi u cao (xem phn Thn trng lc dng).
Risperdal c th gy tng nng prolactin trong huyt tng ph thuc vo liu dng. Cc
biu hin c th kt hp l chy sa, to v n ng, ri lon chu kz kinh nguyt v v kinh.
Tng cn (xem phn Thn trng lc dng), ph v tng men gan c quan st thy trong
khi iu tr bng Risperdal.
Cng nh nhng thuc an thn kinh c in ch yu, nhng triu chng sau thnh thong c
ghi nhn bnh nhn lon thn : ng c nc hoc do ung nc nhiu hoc do hi chng
SIADH (s tit khng thch hp ca ni tit t chng li tiu), ri lon vn ng mun, hi
chng c tnh cc thuc an thn ch yu, ri lon iu ha thn nhit v cc cn ng kinh.
LIU LNG v CCH DNG
Risperdal c th c dng di dng vin nn hoc dung dch ung.
Chuyn t cc thuc chng lon thn khc sang Risperdal :
Khi iu kin tr liu thch hp, nn ngng dn dn s iu tr trc trong khi bt u iu

tr bng Risperdal. Cng nh vy, trong iu kin tr liu thch hp khi chuyn bnh nhn ang
dng cc thuc chng lon thn c tc dng ko di sang Risperdal, th nn bt u dng
Risperdal thay cho ln tim thuc tip theo. Nhu cu cho vic tip tc dng nhng thuc chng
Parkinson nn c nh gi li nh kz.
Ngi ln :
Risperdal c th c dng 1 ln/ngy hoc 2 ln/ngy.
iu chnh liu tng dn cho bnh nhn n 6 mg trong vng 3 ngy. Bnh nhn cp tnh hoc
mn tnh, nn dng Risperdal liu khi u 2 mg/ngy. Nn tng liu ln 4 mg vo ngy th hai
v 6 mg vo ngy th ba. T v sau c th duy tr liu ny hoc thay i ty tng bnh nhn
nu cn thit. Liu ti u thng thng l 4-8 mg/ngy. Tuy nhin, mt vi bnh nhn c th
ch cn dng liu thp hn.
Giai on iu chnh liu chm hn c th tch hp v mt tr liu.
Liu trn 10 mg/ngy khng thy c hiu qu cao hn so vi nhng liu thp hn v c th gy
ra cc triu chng ngoi thp. V an ton ca liu trn 16 mg/ngy cha c nh gi, do
khng nn dng liu cao hn mc ny.
Benzodiazepine c th c phi hp thm vi Risperdal nu cn c thm tc dng an thn.
Ngi gi :
Liu khi u nn dng l 0,5 mg x 2 ln/ngy. Liu ny c th c iu chnh tng thm 0,5
mg x 2 ln/ngy ty theo tng bnh nhn cho n liu 1-2 mg x 2 ln/ngy. Risperdal c
dung np tt ngi gi.
Tr em :
Cha c kinh nghim dng thuc ny cho tr em di 15 tui.
Ngi bnh gan v thn :
Liu khi u nn dng l 0,5 mg x 2 ln/ngy. Liu ny c th c iu chnh tng thm 0,5
mg x 2 ln/ngy ty theo tng bnh nhn cho n liu 1-2 mg x 2 ln/ngy. Risperdal nn c
dng thn trng nhm bnh nhn ny cho n khi c c nhiu kinh nghim hn.
QU LIU
Triu chng :
Nhn chung, nhng du hiu v triu chng c ghi nhn l kt qu t tc dng qu mc v
tc ng dc l{ c bit ca thuc. Nhng triu chng ny bao gm bun ng v an thn,
nhp tim nhanh, h huyt p v triu chng ngoi thp. S qu liu cho n 360 mg c
bo co.
Nhng bng chng hin c gi Risperdal c khong an ton rng. mt bnh nhn c km
theo h kali huyt m ung 360 mg Risperdal, on QT k o di c bo co.
Trong trng hp qu liu cp tnh, nn xem xt kh nng dng nhiu thuc.
iu tr :
Thit lp v duy tr s thng thng ng h hp v bo m y oxy v thng kh. Ra d

dy (sau khi t ni kh qun, nu bnh nhn bt tnh) v nn xem xt vic dng than hot
kt hp vi thuc x. Nn bt u theo di tim mch ngay k c theo di in tm lin tc
pht hin lon nhp c th xy ra.
Khng c thuc gii c c hiu i vi Risperdal. Do nhng bin php h tr thch hp
nn c p dng. H huyt p v suy tun hon nn c iu tr bng nhng bin php thch
hp nh truyn dch tnh mch v/hoc thuc tc dng ging thn kinh giao cm. Trong trng
hp c triu chng ngoi thp nng, nn dng cc thuc khng cholinergic. Nn tip tc gim
st v theo di cht ch v mt y khoa cho n khi bnh nhn hi phc.
BO QUN
Vin n n Risperdal nn c bo qun nhit 15-30oC.
Dung dch ung Risperdal nn c bo qun nhit 15-30oC v nn c bo v trnh
ng.
Gi thuc ngoi tm tay vi tr em.

443.

ROCALTROL

HOFFMANN - LA ROCHE
Vin nang mm 0,25 mg : hp 30 vin.
THNH PHN
cho 1 vin
Calcitriol

0,25 mg

DC LC
Calcitriol, mt trong nhng cht chuyn ha c hot tnh ca vitamine D3, bnh thng c
to thnh thn t mt tin cht ca n l 25-hydroxycholcalcifrol (25-HCC). Bnh thng,
lng cht ny c hnh thnh mi ngy l 0,5-1,0 mg, v tng nhiu hn trong giai on m
s to xng tng cao (chng hn trong giai on tng trng hoc lc c thai). Calcitriol lm
thun li cho s hp thu calci rut v iu tit s khong ha xng.
Calcitriol ng vai tr ch cht trong s iu ha bt bin ni mi ca calci, ng thi kch thch
s to xng, y l mt c s dc l{ cho tc ng iu tr chng long xng.
bnh nhn b suy thn nng, s tng hp calcitriol ni sinh gim v c th ngng hon ton.

Thiu calcitriol trong trng hp ny l nguyn nhn chnh gy lon dng xng do thn.
bnh nhn b long xng do thn, Rocaltrol ung lm bnh thng ha s hp thu calci vn
b suy gim rut, nh th iu chnh tnh trng h calci huyt v cc nng cao trong
huyt thanh ca phosphatase kim v hormone cn gip. Rocaltrol lm gim cc chng au
xng v c, iu chnh cc tnh trng sai lch v m hc bnh vim xng x ha v ri lon
khc ca s khong ha.
nhng bnh nhn b thiu nng tuyn cn gip sau phu thut, thiu nng tuyn cn gip t
pht hay thiu nng tuyn cn gip gi, dng Rocaltrol s lm gim h calci huyt cng nh ci
thin cc triu chng trn lm sng.
nhng bnh nhn b ci xng c p ng vi vitamine D, nng ca calcitriol trong huyt
thanh thp, thm ch khng c. Do vic to calcitriol ni sinh thn khng , vic dng
Rocaltrol phi c xem nh l mt tr liu thay th.
nhng bnh nhn b ci xng khng p ng vi vitamine D (ci xng gim phosphate
huyt nguyn pht), phi hp vi nng calcitriol thp trong huyt tng, vic iu tr bng
Rocaltrol lm gim s o thi phosphate qua ng thn v bnh thng ha vic hnh thnh
xng do b sung ngun phosphore.
Ngoi ra, vic iu tr bng Rocaltrol t ra c ch nhng bnh nhn b cc dng ci xng
khc, chng hn ci xng c lin quan n vim gan tr s sinh, thiu pht trin ng mt,
bnh lon dng cystine hoc vic cung cp calci v vitamine D qua thc n khng y .
DC NG HC
Hp thu :
Calcitriol c hp thu nhanh rut. Sau khi ung liu duy nht 0,25 n 1 mg Rocaltrol, cc
nng ti a t c sau 3 n 6 gi.
Sau khi ung lp li nhiu ln, nng ca calcitriol trong huyt thanh t tnh trng cn bng
sau 7 ngy.
Phn phi :
Hai gi sau khi ung liu duy nht 0,5 mg Rocaltrol, cc nng trung bnh trong huyt thanh
ca calcitriol tng t 40,0 +/- 4,4 pg/ml n 60,0 +/- 4,4 pg/ml, v gim cn 53,0 +/- 6,9 pg/ml
sau 4 gi, 50 +/- 7,0 pg/ml sau 8 gi, 44 +/- 4,6 pg/ml sau 12 gi v 41,5 +/- 5,1 pg/ml sau 24
gi.
Calcitriol v cc cht chuyn ha khc ca vitamine D lin kt vi nhng protine chuyn bit
ca huyt tng trong qu trnh vn chuyn trong mu.
Calcitriol c ngun gc ngoi sinh qua c hng ro nhau thai v bi tit qua sa m.
Chuyn ha :
Nhiu cht chuyn ha khc nhau ca calcitriol, th hin cc tc ng khc nhau ca vitamine
D, c nhn dng : 1a,25-dihydroxy-24-oxo-cholcalcifrol, 1a,24R,25-trihydroxy-24-oxocholcalcifrol, 1a,24R,25-trihydroxycholcalcifrol, 1a,25R-dihydroxycholcalcifrol-26,23S-

lactone, 1a,25S,26-trihydroxycholcalcifrol, 1a,25-dihydroxy-23-oxo-cholcalcifrol,

1a,25R,26-trihydroxy-23-oxo-cholcalcifrol v 1a-hydroxy-23-carboxy-24,25,26,27ttranorcholcalcifrol.
o thi :
Thi gian bn hy o thi ca calcitriol khong 9 n 10 gi. Tuy nhin thi gian duy tr tc
dng dc l ca mt liu duy nht khong 7 ngy. Calcitriol c bi tit qua mt v chu nh
hng ca chu kz gan-rut. 24 gi sau khi tim tnh mch calcitriol c nh du phng x
ngi khe mnh, khong 27% hot tnh phng x c tm thy trong phn v khong 7%
trong nc tiu. 24 gi sau khi ung liu 1 mg calcitriol c nh du phng x ngi khe
mnh, khong 10% liu calcitriol c nh du c tm thy trong nc tiu. Lng o thi
tng cng ca hot tnh phng x trong 6 ngy sau khi tim tnh mch calcitriol c nh du
phng x chim khong 16% trong nc tiu v 36% trong phn.
CH NH
Long xng sau mn kinh.
Lon dng xng do thn bnh nhn b suy thn mn, c bit bnh nhn lm thm phn
mu.
Thiu nng tuyn cn gip sau phu thut.
Thiu nng tuyn cn gip nguyn pht.
Thiu nng tuyn cn gip gi.
Ci xng p ng vi vitamine D.
Ci xng khng vi vitamine D, km theo gim phosphate huyt.
CHNG CH NH
Chng ch nh Rocaltrol (hoc tt c cc thuc cng nhm) trong nhng chng bnh c lin
quan n tng calci huyt, cng nh khi c qu mn cm vi mt trong nhng thnh phn ca
thuc.
Rocatrol cng b chng ch nh nu c du hiu r rng ng c vitamine D.
THN TRNG LC DNG
Gia vic iu tr bng calcitriol v tng calci huyt c mi tng quan cht ch. Trong cc
nghin cu trn bnh lon dng xng c ngun gc do thn, c gn 40% bnh nhn c
iu tr bng calcitriol c tng calci huyt. Nu tng t ngt cung cp calci do thay i thi
quen n ung (nh n hoc ung nhiu sn phm ch bin t sa) hoc dng khng kim sot
cc thuc c cha calci c th s gy tng calci huyt. Nn khuyn bnh nhn chp hnh tt ch
n ung v thng bo cho bnh nhn v nhng triu chng ca tng calci huyt c th xy
ra.
Bnh nhn nm bt ng lu ngy, chng hn sau phu thut, d c nguy c b tng calci huyt.
Bnh nhn c chc nng thn bnh thng, nu xy ra tng calci huyt mn tnh c th s phi
hp vi tng cr atinine huyt thanh.

c bit thn trng khi dng cho bnh nhn c tin s b si thn hoc bnh mch vnh.
Calcitriol lm tng nng cc phosphate v c trong huyt thanh. Trong khi tc dng ny
c mong mun nhng bnh nhn b h phosphate huyt, cn phi thn trng bnh nhn
b suy thn, do nguy c gy vi ha lc ch. Trong nhng trng hp ny, nn duy tr nng
phosphate trong huyt tng mc bnh thng (2 n 5 mg/100 ml, tng ng 0,65 n
1,62 mmol/l) bng cch dng cc cht to phc chelate vi phosphore nh hydroxyde hay
carbonate aluminium.
bnh nhn b ci xng khng vitamine D (ci xng gim phosphate huyt gia nh) v c
iu tr bng Rocaltrol, nn tip tc dng thm phosphate bng ng ung. Tuy nhin cng
nn lu { n kh nng Rocaltrol c th kch thch s hp thu phosphate rut, v iu ny c
th lm thay i nhu cu v phosphate b sung.
Nn u n kim tra nng calci, phosphore, magnsium v phosphatase kim trong huyt
thanh, cng nh nng ca calci v phosphate trong nc tiu trong 24 gi. Trong giai on
u iu tr bng Rocaltrol, nn kim tra nng calci trong huyt tng t nht 2 ln mi tun
(xem Liu lng v Cch dng).
Calcitriol l cht chuyn ha c hot tnh mnh nht ca vitamine D, do khng nn dng
km thm nhng thuc khc c cha vitamine D trong thi gian iu tr bng Rocaltrol, nhm
trnh tnh trng tng vitamine D bnh l c th xy ra.
Nu chuyn t iu tr bng ergocalcifrol (vitamine D2) qua iu tr bng calcitriol, c th cn
phi n nhiu thng nng ergocalcifrol tr v gi tr ban u (xem Qu liu).
Bnh nhn c chc nng thn bnh thng c iu tr bng Rocaltrol cn lu { tnh trng mt
nc c th xy ra, v nn ung nc.
LC C THAI v LC NUI CON B
Cc nghin cu v c tnh trn th vt khng cho cc kt qu thuyt phc, khng c nhng
nghin cu c kim sot tng i ngi v tc dng ca calcitriol c ngun gc ngoi sinh
trn thai kz v s pht trin ca bo thai. Do , ch s dng Rocaltrol khi li ch iu tr cao
hn nhiu so vi nguy c c th xy ra cho bo thai.
Calcitriol c ngun gc ngoi sinh c bi tit qua sa m, c th gy nhng tc dng ngoi
cho tr, do khng nn cho con b trong thi gian iu tr vi Rocaltrol.
TNG TC THUC
Calcitriol l mt trong nhng cht chuyn ha chnh c hot tnh ca vitamine D, do khng
nn phi hp thm vi vitamine D hay cc dn xut, nhm trnh tc dng cng lc c th xy ra
vi nguy c tng calci huyt.
Nn chp hnh tt li khuyn ca bc s v ch n ung, ch yu cc thc n c th cung cp
nhiu calci, trnh dng cc thuc c cha calci.
Dng ng thi vi thuc li tiu thiazide lm tng nguy c tng calci huyt bnh nhn b
thiu nng tuyn cn gip. nhng bnh nhn ang c iu tr bng digitalis, nn xc nh

liu calcitriol mt cch cn thn, do tng calci huyt c th pht ng lon nhp.
C mt s i khng v chc nng gia cc cht ging vitamine D v corticoide : cc cht ging
vitamine D to thun li cho s hp thu calci, trong khi corticoide th c ch qu trnh ny.
trnh tng magnesium huyt, trnh dng cho nhng bnh nhn phi chy thn mn tnh
nhng thuc c cha magnesium (nh cc thuc khng acide) trong thi gian iu tr bng
Rocaltrol.
Calcitriol cng tc ng ln s vn chuyn phosphate rut, thn v xng ; dng cc
thuc to phc chelate vi phosphate phi c iu chnh theo nng trong huyt thanh
ca phosphate (gi tr bnh thng : 2-5 mg/100 ml, tng ng 0,6-1,6 mmol/l).
nhng bnh nhn b ci xng khng vitamine D (ci xng gim phosphate huyt gia nh),
cn tip tc dng phosphate bng ng ung. Tuy nhin cng nn lu { rng calcitriol c th
kch thch s hp thu phosphate rut, do c th lm gim nhu cu v phosphate b sung.
Dng cc thuc gy cm ng men nh ph nytoine hay phnobarbital c th lm tng s
chuyn ha ca calcitriol v nh th lm gim nng ca cht ny trong huyt thanh.
Colestyramine c th lm gim s hp thu cc vitamine tan trong du v nh th cng nh
hng n s hp thu ca calcitriol.
TC DNG NGOI
Rocaltrol khng gy mt tc dng ngoi no nu khng dng qu nhu cu ca c th. Tuy
nhin, cng nh vitamine D, nu dng Rocaltrol liu qu cao c th gy nhng tc dng ngoi
tng t nh khi qu liu vitamine D : hi chng tng calci huyt hoc ng c calci, ty theo
mc v thi gian tng calci huyt.
Nu ng thi b tng calci huyt v tng phosphate huyt (> 6 mg/100 ml, hay > 1,9 mmol/l)
c th s gy vi ha cc phn mm, c th nhn thy qua tia X.
Do c thi gian bn hy ngn, vic bnh thng ha mt nng cao ca calci trong huyt
tng ch cn khong vi ngy sau khi ngng thuc, nhanh hn rt nhiu so vi vitamine D3.
LIU LNG v CCH DNG
Liu thng thng :
Phi xc nh cn thn liu ti u hng ngy ca Rocaltrol cho tng bnh nhn theo calci huyt.
Vic iu tr bng Rocaltrol phi lun lun bt u liu khuyn co thp nht c th c v
ch tng khi c s kim sot cht ch calci huyt.
Ngay khi tm c liu ti u ca Rocaltrol, phi kim tra calci huyt mi thng (hoc theo
cc ngh pha di, cho nhng ch nh khc nhau). Khi ly mu nh lng calci phi
c thc hin khng c dy tht garrot.
Ngay khi nng calci trong huyt thanh vt qu 1 mg/100ml (hay 0,25 mmol/l) gi tr bnh
thng (9-11 mg/100 ml, hay 2,25-2,75 mmol/l), cn phi gim liu hoc tm thi ngng dng
Rocaltrol cho n khi calci huyt tr v bnh thng.
Trong thi gian bnh nhn b tng calci huyt, phi kim tra nng calci v phosphate trong

huyt thanh hng ngy. Khi cc gi tr tr v bnh thng, c th dng tr li Rocaltrol vi liu
thp hn 0,25 mg so vi dng trc .
Rocaltrol c hiu lc ti u, trong giai on u bnh nhn phi c b sung mt lng
calci y , nhng khng c nhiu qu.
ngi ln, liu calci hng ngy (c ngun gc t thc n v thuc) vo khong 800 mg, khng
c vt qu 1000 mg.
Do lm ci thin s hp thu calci ng tiu ha, c th gim lng calci trong thc n v thc
ung nhng bnh nhn c iu tr bng Rocaltrol. Bnh nhn c khuynh hng tng calci
huyt ch cn dng liu thp calci, thm ch khng cn b sung calci.
Cc hng dn c bit v liu lng :
Long xng sau mn kinh :
Liu khuyn co l 0,25 mg, 2 ln/ngy, ung thuc khng nhai. bnh nhn c cung cp
di 500 mg calci t thc n, nn k toa thm calci. Lng calci cung cp hng ngy khng
vt qu 1000 mg.
Nng calci v cratinine trong huyt thanh phi c kim tra vo tun th 4, thng th 3
v thng th 6, sau mi 6 thng.
Lon dng xng c ngun gc do thn (bnh nhn phi chy thn) :
Liu khi u hng ngy l 0,25 mg. ngi c calci huyt bnh thng hay h calci huyt nh,
dng liu 0,25 mg mi 2 ngy l . Nu cc thng s lm sng v sinh ha khng tin trin
theo chiu hng tt sau khong 2 n 4 tun, c th tng liu hng ngy thm 0,25 mg cch
khong sau 2 n 4 tun. Trong giai on ny, cn kim tra nng calci trong huyt tng t
nht 2 ln mi tun. a s bnh nhn c p ng tt vi liu t 0,5 n 1 mg/ngy. C th cn
dng liu cao nu c phi hp vi barbiturate hay cc thuc chng ng kinh.
Thiu nng tuyn cn gip v ci xng :
Liu khi u c khuyn co l 0,25 mg/ngy, ung vo bui sng. Nu cc thng s lm
sng v sinh ha khng tin trin theo chiu hng tt, c th tng liu hng ngy thm 0,25
mg cch khong sau 2 n 4 tun. Trong giai on ny, cn kim tra nng calci trong huyt
tng t nht 2 ln mi tun.
bnh nhn b thiu nng tuyn cn gip, i khi ghi nhn c hi chng km hp thu ; trong
nhng trng hp ny, dng liu cao Rocaltrol t ra c hiu qu.
Nh nhi v tr em :
iu tr cho nh nhi v tr em, c th dng Rocaltrol di dng dung dch. Nh i vi
ngi ln, liu ti u hng ngy phi c xc nh theo nng calci huyt.
tr em c t l lc cu thn di 25% so vi bnh thng, nn dng Rocaltrol vi mc ch
d phng. Nu th trng < 20 kg, liu Rocatrol l : 0,01-0,03 mg/kg th trng/ngy ; nu th
trng > 20 kg : 0,25 mg/ngy.
iu tr ci xng c ngun gc do thn, liu khi u c khuyn co trong 2 nm tui

u l 0,01-0,1 mg/kg th trng, khng c vt qu 2 mg/ngy.

Trng hp ci xng khng p ng vi vitamine D, c th cn dng n liu cao hn, c
xc nh ty theo nguyn nhn gy bnh.
QU LIU
iu tr tng calci huyt khng c triu chng : xem trong mc "Cc hng dn c bit v liu
lng".
Calcitriol l mt cht chuyn ha ca vitamine D, tt c cc trng hp qu liu Rocaltrol s cho
nhng triu chng lm sng tng t nh i vi qu liu vitamine D. Nu ng thi c ung
nhiu calci v phosphate vi Rocaltrol, c th gy cc triu chng tng t. Nng calci cao
trong dch thm tch phn nh c tng calci huyt.
Du hiu ng c cp tnh vitamine D : chn n, nhc u, bun nn, to bn.
Du hiu ng c mn tnh : lon dng (yu t, st cn), ri lon cc gic quan, c th b st
km theo kht, a niu, mt nc, v cm, ngng tng trng v nhim trng ng tiu. Ng
c mn tnh s gy tng calci huyt th pht vi vi ha v thn, c tim, phi v ty tng.
Cc bin php iu tr qu liu do ung nhm bao gm : ra d dy lp tc hoc gy nn
trnh hp thu thuc vo mu. Dng du paraffine lm tng o thi thuc qua phn. Tin
hnh kim tra nhiu ln calci huyt. Nu calci huyt vn cn cao, c th dng phosphate v
corticoide, v dng cc bin php tng bi niu thch hp.

444.

ROCALTROL

HOFFMANN - LA ROCHE
vin nang mm 0,25 mg : hp 30 vin.
THNH PHN
cho 1 vin
Calcitriol

0,25 mg

DC LC
Calcitriol, mt trong nhng cht chuyn ha c hot tnh ca vitamine D3, bnh thng c
to thnh thn t mt tin cht ca n l 25-hydroxycholcalcifrol (25-HCC). Bnh thng,
lng cht ny c hnh thnh mi ngy l 0,5-1,0 mg, v tng nhiu hn trong giai on m
s to xng tng cao (chng hn trong giai on tng trng hoc lc c thai). Calcitriol lm

thun li cho s hp thu calci rut v iu tit s khong ha xng.

Calcitriol ng vai tr ch cht trong s iu ha bt bin ni mi ca calci, ng thi kch thch
s to xng, y l mt c s dc l{ cho tc ng iu tr chng long xng.
bnh nhn b suy thn nng, s tng hp calcitriol ni sinh gim v c th ngng hon ton.
Thiu calcitriol trong trng hp ny l nguyn nhn chnh gy lon dng xng do thn.
bnh nhn b long xng do thn, Rocaltrol ung lm bnh thng ha s hp thu calci vn
b suy gim rut, nh th iu chnh tnh trng h calci huyt v cc nng cao trong
huyt thanh ca phosphatase kim v hormone cn gip. Rocaltrol lm gim cc chng au
xng v c, iu chnh cc tnh trng sai lch v m hc bnh vim xng x ha v ri lon
khc ca s khong ha.
nhng bnh nhn b thiu nng tuyn cn gip sau phu thut, thiu nng tuyn cn gip t
pht hay thiu nng tuyn cn gip gi, dng Rocaltrol s lm gim h calci huyt cng nh ci
thin cc triu chng trn lm sng.
nhng bnh nhn b ci xng c p ng vi vitamine D, nng ca calcitriol trong huyt
thanh thp, thm ch khng c. Do vic to calcitriol ni sinh thn khng , vic dng
Rocaltrol phi c xem nh l mt tr liu thay th.
nhng bnh nhn b ci xng khng p ng vi vitamine D (ci xng gim phosphate
huyt nguyn pht), phi hp vi nng calcitriol thp trong huyt tng, vic iu tr bng
Rocaltrol lm gim s o thi phosphate qua ng thn v bnh thng ha vic hnh thnh
xng do b sung ngun phosphore.
Ngoi ra, vic iu tr bng Rocaltrol t ra c ch nhng bnh nhn b cc dng ci xng
khc, chng hn ci xng c lin quan n vim gan tr s sinh, thiu pht trin ng mt,
bnh lon dng cystine hoc vic cung cp calci v vitamine D qua thc n khng y .
DC NG HC
Hp thu :
Calcitriol c hp thu nhanh rut. Sau khi ung liu duy nht 0,25 n 1 mg Rocaltrol, cc
nng ti a t c sau 3 n 6 gi.
Sau khi ung lp li nhiu ln, nng ca calcitriol trong huyt thanh t tnh trng cn bng
sau 7 ngy.
Phn phi :
Hai gi sau khi ung liu duy nht 0,5 mg Rocaltrol, cc nng trung bnh trong huyt thanh
ca calcitriol tng t 40,0 +/- 4,4 pg/ml n 60,0 +/- 4,4 pg/ml, v gim cn 53,0 +/- 6,9 pg/ml
sau 4 gi, 50 +/- 7,0 pg/ml sau 8 gi, 44 +/- 4,6 pg/ml sau 12 gi v 41,5 +/- 5,1 pg/ml sau 24
gi.
Calcitriol v cc cht chuyn ha khc ca vitamine D lin kt vi nhng protine chuyn bit
ca huyt tng trong qu trnh vn chuyn trong mu.
Calcitriol c ngun gc ngoi sinh qua c hng ro nhau thai v bi tit qua sa m.

Chuyn ha :
Nhiu cht chuyn ha khc nhau ca calcitriol, th hin cc tc ng khc nhau ca vitamine
D, c nhn dng : 1a,25-dihydroxy-24-oxo-cholcalcifrol, 1a,24R,25-trihydroxy-24-oxocholcalcifrol, 1a,24R,25-trihydroxycholcalcifrol, 1a,25R-dihydroxycholcalcifrol-26,23Slactone, 1a,25S,26-trihydroxycholcalcifrol, 1a,25-dihydroxy-23-oxo-cholcalcifrol,
1a,25R,26-trihydroxy-23-oxo-cholcalcifrol v 1a-hydroxy-23-carboxy-24,25,26,27ttranorcholcalcifrol.
o thi :
Thi gian bn hy o thi ca calcitriol khong 9 n 10 gi. Tuy nhin thi gian duy tr tc
dng dc l ca mt liu duy nht khong 7 ngy. Calcitriol c bi tit qua mt v chu nh
hng ca chu kz gan-rut. 24 gi sau khi tim tnh mch calcitriol c nh du phng x
ngi khe mnh, khong 27% hot tnh phng x c tm thy trong phn v khong 7%
trong nc tiu. 24 gi sau khi ung liu 1 mg calcitriol c nh du phng x ngi khe
mnh, khong 10% liu calcitriol c nh du c tm thy trong nc tiu. Lng o thi
tng cng ca hot tnh phng x trong 6 ngy sau khi tim tnh mch calcitriol c nh du
phng x chim khong 16% trong nc tiu v 36% trong phn.
CH NH
Long xng sau mn kinh.
Lon dng xng do thn bnh nhn b suy thn mn, c bit bnh nhn lm thm phn
mu.
Thiu nng tuyn cn gip sau phu thut.
Thiu nng tuyn cn gip nguyn pht.
Thiu nng tuyn cn gip gi.
Ci xng p ng vi vitamine D.
Ci xng khng vi vitamine D, km theo gim phosphate huyt.
CHNG CH NH
Chng ch nh Rocaltrol (hoc tt c cc thuc cng nhm) trong nhng chng bnh c lin
quan n tng calci huyt, cng nh khi c qu mn cm vi mt trong nhng thnh phn ca
thuc.
Rocatrol cng b chng ch nh nu c du hiu r rng ng c vitamine D.
THN TRNG LC DNG
Gia vic iu tr bng calcitriol v tng calci huyt c mi tng quan cht ch. Trong cc
nghin cu trn bnh lon dng xng c ngun gc do thn, c gn 40% bnh nhn c
iu tr bng calcitriol c tng calci huyt. Nu tng t ngt cung cp calci do thay i thi
quen n ung (nh n hoc ung nhiu sn phm ch bin t sa) hoc dng khng kim sot
cc thuc c cha calci c th s gy tng calci huyt. Nn khuyn bnh nhn chp hnh tt ch
n ung v thng bo cho bnh nhn v nhng triu chng ca tng calci huyt c th xy

ra.
Bnh nhn nm bt ng lu ngy, chng hn sau phu thut, d c nguy c b tng calci huyt.
Bnh nhn c chc nng thn bnh thng, nu xy ra tng calci huyt mn tnh c th s phi
hp vi tng cr atinine huyt thanh.
c bit thn trng khi dng cho bnh nhn c tin s b si thn hoc bnh mch vnh.
Calcitriol lm tng nng cc phosphate v c trong huyt thanh. Trong khi tc dng ny
c mong mun nhng bnh nhn b h phosphate huyt, cn phi thn trng bnh nhn
b suy thn, do nguy c gy vi ha lc ch. Trong nhng trng hp ny, nn duy tr nng
phosphate trong huyt tng mc bnh thng (2 n 5 mg/100 ml, tng ng 0,65 n
1,62 mmol/l) bng cch dng cc cht to phc chelate vi phosphore nh hydroxyde hay
carbonate aluminium.
bnh nhn b ci xng khng vitamine D (ci xng gim phosphate huyt gia nh) v c
iu tr bng Rocaltrol, nn tip tc dng thm phosphate bng ng ung. Tuy nhin cng
nn lu { n kh nng Rocaltrol c th kch thch s hp thu phosphate rut, v iu ny c
th lm thay i nhu cu v phosphate b sung.
Nn u n kim tra nng calci, phosphore, magnsium v phosphatase kim trong huyt
thanh, cng nh nng ca calci v phosphate trong nc tiu trong 24 gi. Trong giai on
u iu tr bng Rocaltrol, nn kim tra nng calci trong huyt tng t nht 2 ln mi tun
(xem Liu lng v Cch dng).
Calcitriol l cht chuyn ha c hot tnh mnh nht ca vitamine D, do khng nn dng
km thm nhng thuc khc c cha vitamine D trong thi gian iu tr bng Rocaltrol, nhm
trnh tnh trng tng vitamine D bnh l c th xy ra.
Nu chuyn t iu tr bng ergocalcifrol (vitamine D2) qua iu tr bng calcitriol, c th cn
phi n nhiu thng nng ergocalcifrol tr v gi tr ban u (xem Qu liu).
Bnh nhn c chc nng thn bnh thng c iu tr bng Rocaltrol cn lu { tnh trng mt
nc c th xy ra, v nn ung nc.
LC C THAI v LC NUI CON B
Cc nghin cu v c tnh trn th vt khng cho cc kt qu thuyt phc, khng c nhng
nghin cu c kim sot tng i ngi v tc dng ca calcitriol c ngun gc ngoi sinh
trn thai kz v s pht trin ca bo thai. Do , ch s dng Rocaltrol khi li ch iu tr cao
hn nhiu so vi nguy c c th xy ra cho bo thai.
Calcitriol c ngun gc ngoi sinh c bi tit qua sa m, c th gy nhng tc dng ngoi
cho tr, do khng nn cho con b trong thi gian iu tr vi Rocaltrol.
TNG TC THUC
Calcitriol l mt trong nhng cht chuyn ha chnh c hot tnh ca vitamine D, do khng
nn phi hp thm vi vitamine D hay cc dn xut, nhm trnh tc dng cng lc c th xy ra
vi nguy c tng calci huyt.

Nn chp hnh tt li khuyn ca bc s v ch n ung, ch yu cc thc n c th cung cp

nhiu calci, trnh dng cc thuc c cha calci.
Dng ng thi vi thuc li tiu thiazide lm tng nguy c tng calci huyt bnh nhn b
thiu nng tuyn cn gip. nhng bnh nhn ang c iu tr bng digitalis, nn xc nh
liu calcitriol mt cch cn thn, do tng calci huyt c th pht ng lon nhp.
C mt s i khng v chc nng gia cc cht ging vitamine D v corticoide : cc cht ging
vitamine D to thun li cho s hp thu calci, trong khi corticoide th c ch qu trnh ny.
trnh tng magnesium huyt, trnh dng cho nhng bnh nhn phi chy thn mn tnh
nhng thuc c cha magnesium (nh cc thuc khng acide) trong thi gian iu tr bng
Rocaltrol.
Calcitriol cng tc ng ln s vn chuyn phosphate rut, thn v xng ; dng cc
thuc to phc chelate vi phosphate phi c iu chnh theo nng trong huyt thanh
ca phosphate (gi tr bnh thng : 2-5 mg/100 ml, tng ng 0,6-1,6 mmol/l).
nhng bnh nhn b ci xng khng vitamine D (ci xng gim phosphate huyt gia nh),
cn tip tc dng phosphate bng ng ung. Tuy nhin cng nn lu { rng calcitriol c th
kch thch s hp thu phosphate rut, do c th lm gim nhu cu v phosphate b sung.
Dng cc thuc gy cm ng men nh ph nytoine hay ph nobarbital c th lm tng s
chuyn ha ca calcitriol v nh th lm gim nng ca cht ny trong huyt thanh.
Colestyramine c th lm gim s hp thu cc vitamine tan trong du v nh th cng nh
hng n s hp thu ca calcitriol.
TC DNG NGOI
Rocaltrol khng gy mt tc dng ngoi no nu khng dng qu nhu cu ca c th. Tuy
nhin, cng nh vitamine D, nu dng Rocaltrol liu qu cao c th gy nhng tc dng ngoi
tng t nh khi qu liu vitamine D : hi chng tng calci huyt hoc ng c calci, ty theo
mc v thi gian tng calci huyt.
Nu ng thi b tng calci huyt v tng phosphate huyt (> 6 mg/100 ml, hay > 1,9 mmol/l)
c th s gy vi ha cc phn mm, c th nhn thy qua tia X.
Do c thi gian bn hy ngn, vic bnh thng ha mt nng cao ca calci trong huyt
tng ch cn khong vi ngy sau khi ngng thuc, nhanh hn rt nhiu so vi vitamine D3.
LIU LNG v CCH DNG
Liu thng thng :
Phi xc nh cn thn liu ti u hng ngy ca Rocaltrol cho tng bnh nhn theo calci huyt.
Vic iu tr bng Rocaltrol phi lun lun bt u liu khuyn co thp nht c th c v
ch tng khi c s kim sot cht ch calci huyt.
Ngay khi tm c liu ti u ca Rocaltrol, phi kim tra calci huyt mi thng (hoc theo
cc ngh pha di, cho nhng ch nh khc nhau). Khi ly mu nh lng calci phi
c thc hin khng c dy tht garrot.

Ngay khi nng calci trong huyt thanh vt qu 1 mg/100ml (hay 0,25 mmol/l) gi tr bnh
thng (9-11 mg/100 ml, hay 2,25-2,75 mmol/l), cn phi gim liu hoc tm thi ngng dng
Rocaltrol cho n khi calci huyt tr v bnh thng.
Trong thi gian bnh nhn b tng calci huyt, phi kim tra nng calci v phosphate trong
huyt thanh hng ngy. Khi cc gi tr tr v bnh thng, c th dng tr li Rocaltrol vi liu
thp hn 0,25 mg so vi dng trc .
Rocaltrol c hiu lc ti u, trong giai on u bnh nhn phi c b sung mt lng
calci y , nhng khng c nhiu qu.
ngi ln, liu calci hng ngy (c ngun gc t thc n v thuc) vo khong 800 mg, khng
c vt qu 1000 mg.
Do lm ci thin s hp thu calci ng tiu ha, c th gim lng calci trong thc n v thc
ung nhng bnh nhn c iu tr bng Rocaltrol. Bnh nhn c khuynh hng tng calci
huyt ch cn dng liu thp calci, thm ch khng cn b sung calci.
Cc hng dn c bit v liu lng :
Long xng sau mn kinh :
Liu khuyn co l 0,25 mg, 2 ln/ngy, ung thuc khng nhai. bnh nhn c cung cp
di 500 mg calci t thc n, nn k toa thm calci. Lng calci cung cp hng ngy khng
vt qu 1000 mg.
Nng calci v cratinine trong huyt thanh phi c kim tra vo tun th 4, thng th 3
v thng th 6, sau mi 6 thng.
Lon dng xng c ngun gc do thn (bnh nhn phi chy thn) :
Liu khi u hng ngy l 0,25 mg. ngi c calci huyt bnh thng hay h calci huyt nh,
dng liu 0,25 mg mi 2 ngy l . Nu cc thng s lm sng v sinh ha khng tin trin
theo chiu hng tt sau khong 2 n 4 tun, c th tng liu hng ngy thm 0,25 mg cch
khong sau 2 n 4 tun. Trong giai on ny, cn kim tra nng calci trong huyt tng t
nht 2 ln mi tun. a s bnh nhn c p ng tt vi liu t 0,5 n 1 mg/ngy. C th cn
dng liu cao nu c phi hp vi barbiturate hay cc thuc chng ng kinh.
Thiu nng tuyn cn gip v ci xng :
Liu khi u c khuyn co l 0,25 mg/ngy, ung vo bui sng. Nu cc thng s lm
sng v sinh ha khng tin trin theo chiu hng tt, c th tng liu hng ngy thm 0,25
mg cch khong sau 2 n 4 tun. Trong giai on ny, cn kim tra nng calci trong huyt
tng t nht 2 ln mi tun.
bnh nhn b thiu nng tuyn cn gip, i khi ghi nhn c hi chng km hp thu ; trong
nhng trng hp ny, dng liu cao Rocaltrol t ra c hiu qu.
Nh nhi v tr em :
iu tr cho nh nhi v tr em, c th dng Rocaltrol di dng dung dch. Nh i vi
ngi ln, liu ti u hng ngy phi c xc nh theo nng calci huyt.

 tr em c t l lc cu thn di 25% so vi bnh thng, nn dng Rocaltrol vi mc ch

d phng. Nu th trng < 20 kg, liu Rocatrol l : 0,01-0,03 mg/kg th trng/ngy ; nu th
trng > 20 kg : 0,25 mg/ngy.
iu tr ci xng c ngun gc do thn, liu khi u c khuyn co trong 2 nm tui
u l 0,01-0,1 mg/kg th trng, khng c vt qu 2 mg/ngy.
Trng hp ci xng khng p ng vi vitamine D, c th cn dng n liu cao hn, c
xc nh ty theo nguyn nhn gy bnh.
QU LIU
iu tr tng calci huyt khng c triu chng : xem trong mc "Cc hng dn c bit v liu
lng".
Calcitriol l mt cht chuyn ha ca vitamine D, tt c cc trng hp qu liu Rocaltrol s cho
nhng triu chng lm sng tng t nh i vi qu liu vitamine D. Nu ng thi c ung
nhiu calci v phosphate vi Rocaltrol, c th gy cc triu chng tng t. Nng calci cao
trong dch thm tch phn nh c tng calci huyt.
Du hiu ng c cp tnh vitamine D : chn n, nhc u, bun nn, to bn.
Du hiu ng c mn tnh : lon dng (yu t, st cn), ri lon cc gic quan, c th b st
km theo kht, a niu, mt nc, v cm, ngng tng trng v nhim trng ng tiu. Ng
c mn tnh s gy tng calci huyt th pht vi vi ha v thn, c tim, phi v ty tng.
Cc bin php iu tr qu liu do ung nhm bao gm : ra d dy lp tc hoc gy nn
trnh hp thu thuc vo mu. Dng du paraffine lm tng o thi thuc qua phn. Tin
hnh kim tra nhiu ln calci huyt. Nu calci huyt vn cn cao, c th dng phosphate v
corticoide, v dng cc bin php tng bi niu thch hp.

445.

ROCPHINE

HOFFMANN - LA ROCHE
Bt pha tim bp 250 mg : l bt + ng dung mi 2 ml.
Bt pha tim bp 500 mg : l bt + ng dung mi 2 ml.
Bt pha tim bp 1 g : l bt + ng dung mi 3,5 ml.
Bt pha tim tnh mch 250 mg : l bt + ng dung mi 5 ml.
Bt pha tim tnh mch 500 mg : l bt + ng dung mi 5 ml.
Bt pha tim tnh mch 1 g : l bt + ng dung mi 10 ml.
Bt pha tim truyn tnh mch 2 g : l bt.
THNH PHN

cho 1 n v tim bp 250 mg

Ceftriaxone mui disodique tnh theo ceftriaxone

250 mg

ng dung mi : Lidocaine chlorhydrate dung dch 10% lng va

2 ml

cho 1 n v tim bp 500 mg

Ceftriaxone mui disodique tnh theo ceftriaxone

500 mg

ng dung mi : Lidocaine chlorhydrate dung dch 10% lng va

2 ml

cho 1 n v tim bp 1 g
Ceftriaxone mui disodique tnh theo ceftriaxone

1g

ng dung mi : Lidocaine chlorhydrate dung dch 10% lng va

3,5 ml

cho 1 n v tim tnh mch 250 mg

Ceftriaxone mui disodique tnh theo ceftriaxone

250 mg

ng dung mi : Nc ct pha tim

5 ml

cho 1 n v tim tnh mch 500 mg

Ceftriaxone mui disodique tnh theo ceftriaxone

500 mg

ng dung mi : Nc ct pha tim

5 ml

cho 1 n v tim tnh mch 1 g

Ceftriaxone mui disodique tnh theo ceftriaxone

1g

ng dung mi : Nc ct pha tim

10 ml

cho 1 n v tim truyn tnh mch 2 g

Ceftriaxone mui disodique tnh theo ceftriaxone

2g

PH KHNG KHUN
Ceftriaxone l mt cphalosporine bn tng hp dng tim, c ph khng khun rt rng, c
tc dng dit khun do ngn cn s tng hp thnh t bo ca vi khun : ceftriaxone rt bn
vng vi beta lactamase, k c pnicillinase v cphalosporinase. Ceftriaxone c tc dng trn
hu ht cc vi khun Gram m v Gram dng.
- Loi vi khun nhy cm c nh : Haemophilus influenzae, Haemophilus parainfluenzae,
Gonococcus, Meningococcus, Proteus mirabilis, Streptococus pneumoniae, Streptococcus
pyogenes, Colibacillus, Klebsiella pneumoniae, Staphylococcus aureus nhy cm methicilline,
Salmonella, Shigella, Proteus indole dng tnh, Citrobacter, Vibrio, Enterobacter aerogenes,
Enterobacter cloacae, Peptococcus, Peptostreptococcus, Brucella, Yersinia pestis.
- Loi vi khun khng c nh : Staphylococcus epidermis, Bactoroides fragilis, Clostridium
perfringens, Pseudomonas aeruginosa, Chlamydia trachomatis.
- Loi khng : Streptococcus faecalis, Acinetobacter, Staphylococcus aureus khng
methicilline, Listeria monocytogenes.
DC NG HC
c im ca ceftriaxone l thi gian bn hy di khong 8 gi ngi lnh mnh. AUC (din
tch di ng cong) sau khi tim tnh mch v tim bp ging nhau. iu ny c ngha l
kh dng sinh hc ca ceftriaxone tim bp l 100%. Khi tim tnh mch ceftriaxone khuch tn
nhanh chng vo dch gian bo v tnh dit khun ti ni ny k o di trong sut 24 gi.
- Thi tr :
Thi gian bn hy ngi ln lnh mnh khong 8 gi. tr s sinh di 8 ngy tui v ngi
gi trn 75 tui, thi gian bn hy tng gp i.
ngi ln, khong 50-60% ceftriaxone c o thi qua thn di dng khng chuyn ha ;
40 - 50% cn li o thi qua mt v b vi khun ng rut bin i thnh dng khng tc
dng. tr s sinh, 70% ceftriaxone c o thi qua thn. bnh nhn c ri lon chc
nng thn hay gan, dc ng hc ceftriaxone ch b nh hng rt t v thi gian bn hy tng
t. Nu suy gim chc nng thn, vic o thi qua mt tng ln, ngc li, nu suy gim chc
nng gan, vic o thi qua thn s tng ln.
- Gn kt vi protine :
Ceftriaxone c gn kt thun nghch vi albumine, s gn kt gim khi nng tng.

Th d :
Nng thuc trong huyt tng < 100 mg/l ; t l gn kt l 95%.
Nng thuc trong huyt tng 300 mg/l ; t l gn kt l 85%.
Do lng albumine thp, t l ceftriaxone t do trong dch gian bo cao hn trong huyt
tng.
Khuch tn vo dch no ty : ceftriaxone khuch tn tt vo no ang b vim nhim ca tr s
sinh v tr nh. khuch tn vo dch no ty l 17% so vi nng trong huyt tng v
nh vy cao gp 4 ln no khng nhim trng. Nng Rocphine trong DNT sau 24 gi > 1,4
mg/l khi tim tnh mch vi liu 50-100 mg/kg. Nng Rocphine trong DNT sau khi dng liu
50 mg/kg th trng, s cao hn rt nhiu ln MIC ca hu ht vi khun gy vim mng no
trong vng 2 n 24 gi.
CH NH
1/ iu tr ni tr :
Cc nhim trng nng do cc vi khun nhy cm vi Rocphine. Th d : nhim trng huyt,
vim mng no, nhim trng bng (vim phc mc, nhim trng ng mt v ng tiu
ha), nhim trng xng, khp, da v m mm, nhim trng vt thng.
D phng nhim trng trc, trong v sau m.
Nhim trng bnh nhn b suy gim min dch.
Nhim trng thn v ng tiu.
Nhim trng h hp, nht l vim phi v nhim trng tai, mi, hng.
Nhim trng ng sinh dc, k c bnh lu.
2/ iu tr ngoi tr :
Tip tc iu tr sau khi xut vin.
Cc th nng nhim trng ng h hp di, c bit ngi c nguy c (ln tui, nghin
ru, suy gim min dch, ht thuc, suy h hp...), ng ch { l :
Bnh phi do vi khun Pneumococcus, thng d on l trc khun Gram m.
Cn bc pht ca vim ph qun mn, thng do bi nhim.
Nhim trng ng tiu nng v/hoc do cc chng khng thuc.
Vim i b thn cp.
Nhim trng ng tiu di, km hi chng nhim khun.
Cn bc pht ca vim tuyn tin lit mn tnh.
CHNG CH NH
Qu mn vi cphalosporine.
Khng dng dng tim bp c cha lidocaine cho ngi mn cm vi lidocaine v tr di 30
thng tui.
THN TRNG LC DNG
Nh i vi cc cphalosporine khc, khng loi tr kh nng sc phn v ngay c khi r tin

s bnh nhn. Cn chun b sn bin php chng sc nh pinephrine tim tnh mch (hoc
adrnaline) v theo sau l glucocorticoide. Rt him trng hp, siu m ti mt thy bng m
lm lin tng n bn mt. Hin tng ny s bin mt khi ngng thuc hoc khi ht t iu
tr vi Rocphine ; khng cn phu thut k c khi c km triu chng au.
Cc nghin cu in vitro cho thy, ceftriaxone cng nh cc c phalosporine khc c th chim
ch bilirubine ca albumine huyt tng. Nn thn trng khi dng Rocphine cho tr s sinh c
bilirubine huyt cao, nht l tr s sinh thiu thng. Nn theo di cng thc mu.
TC DNG NGOI
Roc phine c dung np tt.
Cc tc dng ngoi { thng thong qua hay chm dt khi ngng thuc.
Biu hin ng tiu ha (khong 2%) : tiu chy, vim i trng gi mc (rt him).
Biu hin mu (khong 2%) : tng bch cu i toan, gim bch cu, gim tiu cu.
Biu hin da (khong 1%) : ni m ay, pht ban dng si, nga, ni ban.
Cc tc dng ngoi khc rt him : nhc u, kh chu, tng transaminase, tng cratinine
huyt, ur huyt...
Vim tnh mch ti ch c th xy ra sau khi tim.
Nn tim chm : 2 - 4 pht.
TNG TC THUC
Gim hot tnh ca diazpam, ca furosemide.
Tng nh tc dng suy gim min dch do cc thuc cyclophosphamide v dexamethasone nu
phi hp hai cht ny vi ceftriaxone.
Roc phine khng c pha trn vi cc dung dch cha calcium.
LIU LNG v CCH DNG
Cch dng :
Rocphine c th tim tnh mch, truyn tnh mch ngn hn, tim bp v cng c th tim
di da.
Tim tnh mch : ha tan Rocphine vo dung dch pha, tim chm 2-4 pht thng vo tnh
mch hay qua ng truyn dch. pha long ti thiu : 1 g cho 10 ml.
Truyn tnh mch : ho tan 2 g Rocphine trong 40 ml mt trong cc dung dch sau : chlorure
natri 0,9%, glucose 5% hay 10%, chlorure natri 0,45% + glucose 0,25%, levulose 5%, dextran 6%.
Thi gian truyn 5-15 pht.
Tim bp :
Ho tan Rocphine vi dung dch c 1% lidocaine, tim su.
Khng nn tim qu 1 g vo cng mt bn.
Dung dch pha bn vng trong 6 gi nhit phng v trong 24 gi 5oC.
iu tr ni tr :
Ngi ln : 1 n 2 g, tim mt ln duy nht mi ngy.

Tr em : trung bnh 50 mg/kg/ngy, tim 1 ln.

Tr nh v tr s sinh :
- Tr s sinh di mt thng tui, liu khuyn co l 50 mg/kg/24 gi, trong tt c cc ch nh.
- tr nh nhi, liu trung bnh l 50 mg/kg/24 gi, tim mt ln.
Trong vim mng no : tim 1 ln liu 50-100 mg/kg/ngy, liu 100 mg thng iu tr tn
cng. Tuy nhin, tr nh nhi, 3-12 thng tui, do thi gian bn hy ngn hn, c th tim mi
12 gi 1 ln.
Trong suy thn : khng cn gim liu hay chia liu. Trong trng hp va suy thn v suy gan,
nn kim sot nng thuc trong mu iu chnh liu tim thch hp.
Trong thm tch mu : Rocphine t b thm phn. Liu 2 g sau mi t thm tch hiu qu
n ln sau.
Trong lu cp : dng liu duy nht 250 mg tim bp.
Trong d phng nhim trng phu thut : trong cc phu thut c bi nhim hoc nguy c bi
nhim cao, ty thuc vo mc nguy c tim 1 liu duy nht 1-2 g Roc phine, trc khi m
30 - 90 pht.
iu tr ngoi tr :
Ngi ln : 1 g mi ngy, tim 1 ln.
Tr em : 50 mg/kg/24 gi, tim 1 ln. Khng nn qu 1 g mi ngy.

446.

ROCGEL

JACQUES LOGEAIS
c/o HYPHENS
hn dch ung : hp 24 gi.
THNH PHN
cho 1 gi
Oxyde d'aluminium hydrate (Boemite)

8,074 g

tng ng : theo Al2O3

1,212 g

(Saccharose)

(1,9 g)

DC LC
- Khng acide.
- Trng, bo v nim mc d dy, t trng.
CH NH
iu tr triu chng nhng cn au do bnh thc qun - d dy - t trng.

CH PHNG v THN TRNG LC DNG

Trng hp b tiu ng hay ang p dng ch n kin t ng, nn lu { n lng
ng c trong mi gi thuc.
Bnh nhn suy thn hay chy thn nhn to cn lu { n thnh phn aluminium (do c th gy
bnh no).
TNG TC THUC
Cc thuc khng acide c th tng tc vi mt s thuc khc dng bng ng ung.
Khng nn phi hp :
- Nhm quinidine : lm tng nng ca quinidine trong huyt tng vi nguy c gy qu liu
(do lm gim bi tit s bi tit ca quinidine thn do lm kim ha nc tiu). Nn dng
mt thuc khng acide khc.
Thn trng khi phi hp :
ghi nhn rng s hp thu qua ng tiu ha ca mt s thuc b gim nu c ung cng
lc vi thuc khng acide. Do thn trng, nn ung thuc khng acide xa thi im ung cc
thuc khc, trn 2 gi nu c th, i vi nhng thuc sau : thuc khng lao (thambutol,
isoniazide), khng sinh nhm cyclines, nhm fluoroquinolones, lincosamides, khng histamine
H2, atnolol, mtoprolol, propranolol, chloroquine, diflunisal, digoxine, diphosphonates, sodium
fluorure, glucocorticoides (prednisolone v dexamthasone), indomtacine, kayexalate,
ktoconazole, thuc an thn kinh nhm phnothiazines, pnicillamine, mui st, sparfloxacine.
Nn lu { khi phi hp :
- Nhm salicylate : Tng bi tit cc salicylate thn do kim ha nc tiu.
TC DNG NGOI
Lin quan n aluminium hydroxyde : lm gim phosphore mu khi iu tr lu di hay vi liu
cao, c th gy to bn.
LIU LNG v CCH DNG
Ung mt gi khi c cn au, khng ung qu 6 gi mt ngy.
Phn thuc trong gi c ung trc tip, nguyn cht khng phi pha long

447.

RODOGYL

RHNE-POULENC RORER
[AVENTIS PHARMA]
Vin bao phim : hp 20 vin.
THNH PHN

cho 1 vin
Spiramycine base

750 000 UI

Mtronidazole

125 mg

DC LC
Rodogyl l thuc phi hp spiramycine, khng sinh h macrolide, v mtronidazole, khng sinh
h 5-nitroimidazole, c tr cc bnh nhim trng rng ming.
Ph khng khun :
Hot tnh khng khun ca spiramycine trn cc vi khun thng gy bnh vng rng ming
nh sau :
- Vi khun thng nhy cm : lin cu khun khng phi D, ph cu khun, mng no cu,
Bordetella pertussis, Actinomyces, Corynebacterium, Chlamydia, Mycoplasma ;
- Vi khun khng thng xuyn nhy cm : t cu khun, lu cu khun, lin cu khun D,
Haemophilus influenzae ;
- Vi khun khng (CMI > 8 mg/ml): trc khun hiu kh Gram - .
Hot tnh khng khun ca mtronidazole trn cc vi khun thng gy bnh vng rng ming
nh sau :
- Vi khun thng nhy cm : (CMI : 0,8-6,2 mg/ml) : trc khun k kh bt buc : Clostridium,
C. perfringens, Bifidobacterium bifidum, Eubacterium, Bacteroides fragilis, Melaninogenicus,
Pneumosintes, Fusobacterium, Veillonella, Peptostreptococcus, Peptococcus ;
- Vi khun thng khng : Propionibacterium acnes, Actinomyces, Arachnia ;
- Vi khun khng : trc khun k kh khng bt buc, trc khun hiu kh.
Tc dng hip lc : cc CMI trung bnh ca 2 hot cht ring l hoc khi phi hp cho thy c s
hip lc c ch mt s chng vi khun nhy cm.
CMI tnh bng mg/ml
Chng Bacteroides

melaninogenic

fragilis

Metronidazole

0,25

0,5

Metronidazole + spiramycine 0,125 mg/ml

0,062

0,125

Spiramycine

32

Spiramycine + metronidazole 0,125 mg/ml

0,125

Nh vy, i vi B. fragilis, ch cn spiramycine 16 ln t hn v metronidazole 4 ln t hn.

DC NG HC
- Spiramycine hp thu nhanh nhng khng hon ton. Bin dng gan cho ra cht bin
dng cha bit r v cu trc ho hc nhng c hot tnh. Macrolides xuyn vo v tp trung
trong thc bo (bch cu a nhn trung tnh, bch cu n nhn, i thc bo ph nang).
ngi, t nng cao trong thc bo. c tnh ny gii thch hot tnh ca cc macrolides
i vi cc vi khun ni bo.
Thi tr qua nc tiu v mt, ti nng t 15-40 ln cao hn nng huyt thanh. Thi
gian bn hy huyt tng khong 8 gi. Spiramycine i qua sa m.
- M tronidazole c hp thu, nng hiu nghim trong huyt thanh t sau 2-3 gi v ko
di hn 12 gi sau 1 liu ung duy nht. Nng cao trong gan v mt. Thi tr ch yu qua
nc tiu lm nc tiu c mu nu . Mtronidazole xuyn qua nhau thai v sa m.
- S khuch tn vo cc m vng rng ming :
Hai hot cht thnh phn ca Rodogyl tp trung trong nc bt, nuu v xng rng. Nng
spiramycine v mtronidazole (mg/ml hoc mg/g) o ngi 2 gi sau khi ung 2 vin
Rodogyl nh sau :
Nng

Huyt thanh

Nc bt

Nu

Xng rng

Spiramycine

0,68 +/- 0,22

1,54 +/- 0,41

26,63 +/- 9,65

113,9 +/- 41,16

15,32 +/- 3,16

7,43 +/- 6,34

5,73 +/- 2,72

Mtronidazole 35,03 +/- 12,35

CH NH
- Nhim trng rng ming cp tnh, mn tnh hoc ti pht, c bit l p-xe rng, vim ty,
vim m t bo quanh xng hm, vim quanh thn rng, vim nu, vim ming, vim nha
chu, vim tuyn mang tai, vim di hm.
- Phng nga nhim khun rng ming hu phu.
CHNG CH NH
Tuyt i :
- Qu mn cm vi imidazole v/hoc spiramycine v/hoc t dc cochenille A.
- Qu mn cm hoc khng dung np vi gluten, v c s hin din ca tinh bt m (gluten).
- Tr di 6 tui (do dng bo ch khng thch hp).
Tng i :
- Disulfiram, alcool : xem phn Tng tc thuc.
LC C THAI v LC NUI CON B
Lc c thai :
ng vt, metronidazole khng gy qui thai v khng c vi phi thai.

 ngi, do thn trng, trnh dng Rodogyl trong 3 thng u thai kz v Rodogyl qua c
nhau thai.
Lc nui con b :
Metronidazole v spiramycine qua sa m, trnh s dng Rodogyl trong lc nui con b.
CH PHNG v THN TRNG LC DNG
Ch { phng :
- Ngng iu tr khi mt iu ha, chng mt v ln tm thn.
- Lu { nguy c c th lm trm trng thm trng thi tm thn ca ngi b bnh thn kinh
trung ng hay ngoi bin, n nh hay tin trin.
- Khng ung ru (hiu ng antabuse).
- Do s hin din ca cochenille A trong t dc : c th phn ng d ng, k c suyn, c
bit bnh nhn d ng vi aspirin.
Thn trng lc dng :
Theo di cng thc bch cu trong trng hp c tin s ri lon th tng mu hoc iu tr
vi liu cao v/hoc di ngy.
Trong trng hp gim bch cu, vic tip tc iu tr hay khng ty thuc mc nhim
trng.
TNG TC THUC
Lin quan n spiramycine :
- Thn trng khi phi hp vi l vodopa, lin quan n carbidopa : c ch s hp thu carbidopa
vi vic gim nng lvodopa trong huyt tng. Theo di lm sng v iu chnh liu
lvodopa.
Lin quan n mtronidazole :
Khuyn khng nn phi hp :
- Disulfiram : c th gy nhng cn hoang tng v ri lon tm thn.
- Alcool : hiu ng antabuse (nng, , nn ma, tim p nhanh).
Thn trng khi phi hp :
- Cc thuc chng ng mu dng ung (nh warfarine) : tng tc dng thuc chng ng mu
v tng nguy c xut huyt (do gim s d ha gan). Kim tra thng xuyn hm lng
prothrombine. iu chnh liu dng ca thuc chng ng trong thi gian iu tr vi
m tronidazole n 8 ngy sau khi ngng iu tr.
- Vcuronium (dn cht curare khng kh cc) : m tronidazole lm tng tc dng ca
vcuronium.
- 5 Fluoro-uracil : lm tng c tnh ca 5 Fluoro-uracil do gim s thanh thi.
- Mtronidazole c th lm tng nng lithium huyt.
Xt nghim cn lm sng :
Mtronidazole c th lm bt ng xon khun, do lm sai kt qu xt nghim Nelson.

TC DNG NGOI
- Ri lon tiu ha : au d dy, bun nn, nn ma, tiu chy.
- Phn ng d ng : ni m ay.
Lin quan ti mtronidazole :
- V kim loi trong ming, vim li, vim ming. Gim bch cu va phi, hi phc ngay sau khi
ngng dng thuc.
- Him thy, v lin quan n thi gian iu tr ko di : chng mt, mt phi hp, mt iu
ha, d cm, vim a thn kinh cm gic v vn ng.
- Nc tiu c mu nu- do s hin din ca cc sc t tan trong nc to ra t s chuyn
ha thuc.
LIU LNG v CCH DNG
Ngi ln : 4-6 vin/ngy, chia lm 2-3 ln, ung trong ba n. Trng hp nng (iu tr tn
cng), liu c th ti 8 vin/ngy.
Tr em : 6 - 10 tui : 2 vin/ngy ; 10-15 tui : 3 vin/ngy.

448.

ROHTO ANTIBACTERIAL

CT TNHH ROHTO - MENTHOLATUM (VIT NAM)

Thuc nh mt : chai 10 ml.
THNH PHN
Sodium Sulfamethoxazole

4,00%

epsi-Aminocaproic Acid

2,00%

Chlorpheniramine Maleate

0,02%

Dipotassium Glycyrrhizinate

0,10%

Thnh phn khng hot tnh :

Benzalkonium Chloride, Disodium Edetate
v Polyoxyethylene Sorbitan Mono-oleate.
DC LC
Lo mt (chng sng mi mt cp tnh) l mt cn bnh nhim trng gy bi vi khun nh
staphylocoque.

Tr liu cng hiu cao i vi lo mt l nh thuc sulfamide c tc dng di, ngay vi mt

lng rt nh cng cho mt tc ng khng khun mnh v iu ny c chng minh bng
nhiu th nghim lm sng khc nhau.
Cng thc mi ca thuc nh mt Rohto Antibacterial da trn cc tc dng khng khun ca
sulfamide trn nhiu loi vi khun. Ngoi ra, thuc cn c ba loi hot cht khc lm gim vim,
l mt triu chng ca nhim trng (sng m mt, xung huyt kt mc, nhc mt) v nga mt.
c im ca thuc nh mt Rohto Antibacterial :
1. u tin : Hiu lc dit khun :
Ba hot cht (Chlorpheniramine Maleate,e-Aminocaproic Acid, Dipotassium Glycyrrhizinate)
c kt hp vi sulfamide nhm lm tng tc dng iu tr, chng cc bnh nhim trng mt.
Nghin cu v tc dng cng hng ca cc cht vi tc dng ring bit ca sulfamide cho thy
khi dng kt hp nh vy lm tng tc dng dit khun ln 4 n 10 ln so vi ch dng cht
sulfamide ring bit.
2. Lm gim vim mt v nhng triu chng kh chu khc thng i km vi bnh nhim
khun :
Hai cht khng vim,e-Aminocaproic Acid, Dipotassium Glycyrrhizinate lm gim nhng triu
chng vim mt (ph, xung huyt, au), cng vi tc dng khng histamine ca
Chlorpheniramine Maleate, c tc dng loi tr nhanh chng nhng triu chng kh chu
nh nga mt.
3. Thnh phn n nh v t kch ng :
Thuc nh mt Rohto Antibacterial c tnh n nh cao, m bo tc dng trong sut qu trnh
s dng. Thuc lm gim cm gic au n kh chu v tr em dng cng c.
CH NH
Lo mt, vim kt mc, vim m mt, mt nga.
THN TRNG LC DNG
Hi kin bc s, dc s trc khi dng :
- C tin cn d ng vi thuc sulfamide ( mt, nga, i, st).
- au mt nng.
- C tin cn d ng vi thuc nh mt (nh xung huyt kt mc, nga, ph, mt).
- ang theo mt liu trnh tr liu.
Lu { trc khi dng :
- Dng ng liu qui nh.
- Tr em ch c dng thuc di s hng dn ca ngi ln.
- Khng chm m mt vo ming l trnh nhim trng c th xy ra hoc lm vn c dung
dch do cht tit hoc cc mm vi khun.
- Khng dng dung dch vn c.
- Mt vi thnh phn c th kt tinh ming l do iu kin bo qun. Nu c, lau ming l

bng gc sch trc khi dng.

- Khng dng thuc ny mang knh tip xc mm. Khng nh thuc vo mt khi ang mang
knh tip xc mm.
- Thuc ny ch dng nh mt.
Lu { trong v sau khi dng thuc :
- Nu thuc gy xung huyt, nga, sng mt hoc c cc triu chng khc, ngng dng thuc
v hi kin bc s hoc dc s.
- Khng dng thuc lin tc trong mt thi gian di.
- Nu triu chng khng ci thin sau khi dng vi ngy, ngng dng thuc hoc hi kin bc
s hoc dc s.
- Sau khi nh thuc, nu thy v ng, do thuc chy qua ng l. y l vic bnh thng, khng
ng ngi.
Bo qun v s dng :
- thuc ngoi tm tay ca tr em.
- Vn cht np l sau khi dng. thuc ni mt, trnh nh sng trc tip, trnh thuc ni
c nhit qu cao hay qu lnh.
- trnh dng nhm ln v thay i cht lng, khng ng thuc vo chai l khc.
- Khng dng chung vi ngi khc trnh nhim khun c th xy ra.
- Khng dng thuc qu hn (in bn ngoi hp thuc).
Ch v lo mt :
- Trnh kch ng mt, nh di mt chng hn.
- Mn lo c th xut hin nh mt bnh bm sinh. Tuy nhin, c th l do sc khe suy gim
do phi lm vic qu sc, ng khng gic, do vy, cn trnh lm vic qu sc v phi ng
gic.
LIU LNG v CCH DNG
Nh mt mi ln 2-3 git, 5 n 6 ln mi ngy

449.

ROHTO KODOMO SOFT

ROHTO
Thuc nh mt dng cho tr em : chai 15 ml.
THNH PHN
Aminoethylsulfonic Acid

1,00%

epsi-Aminocaproic Acid

1,00%

Chlorpheniramine Maleate

0,01%

Potassium L-Aspartate

0,20%

Thnh phn khng hot tnh : boric acid,

sodium borate, benzalkonium chloride v
du polyoxyethylene hydrogenated castor.
TNH CHT
Khi bi li hoc i chi, cht chlorine (cht dng kh trng h bi), tia cc tm, phn hoa,
v.v... c th kch thch mt tr gy , nga v cc triu chng khc.
Thuc nh mt Rohto Kodomo Soft ngn nga vim mt, bo v mt tr khi nhng bnh do
bi li, lm gim triu chng mt, nga v cc triu chng khc.
Mt khc, Rohto Kodomo Soft vi pH v p sut thm thu tng t nh nc mt t nhin
to cm gic m du khi nh mt, rt thch hp cho tr.
DC LC
- Aminoethylsulfonic Acid : lm gim kch ng mt do cht chlorine, dng kh trng h bi,
v bo v mt tr khi nhng bnh do bi li. Ngoi ra, n cn cung cp dinh dng cho mt v
nhanh chng phc hi tnh trng mi mt.
- epsi-Aminocaproic Acid : loi tr mt nh tc dng khng vim v ngn nga cc bnh mt
khc.
- Chlorpheniramine Maleate : loi tr mt, nga mt do vim mt.
- Potassium L-Aspartate : lm tng chuyn ha v duy tr chc nng bnh thng ca mt.
CH NH
Mi mt, xung huyt kt mc, ngn nga bnh mt (do bi li, bi, m hi), vim mt do tia
cc tm hay cc nguyn nhn khc (th d nh m tuyt), vim b mi, nga mt v m mt (do
cht tit qu nhiu).
THN TRNG LC DNG
Hi kin bc s hoc dc s trc khi dng trong trng hp :
- au mt nng.
- C tin cn d ng vi thuc nh mt (th d nh mt xung huyt, nga, sng, ni mn, ,
v.v...).
- Tng nhn p.
- ang theo mt liu trnh tr liu lin tc.
Trc khi dng thuc, ch :
- Dng ng liu qui nh.

- Tr em dng thuc di s hng dn ca cha m. Dng cho tr trn 4 thng tui.

- Khng mi mt chm vo ming l, trnh nhim trng hoc lm c dung dch do cc
cht tit hoc cc vi sinh vt.
- Mt vi hot cht c th kt tinh ming l trong qu trnh bo qun. Nu c kt tinh, lau
ming l bng gc sch trc khi dng.
- Khng dng thuc ny nh thuc mang knh tip xc mm, khng nh vo mt khi mang
knh tip xc mm.
- Ch dng thuc ny nh mt.
Trong v sau khi dng, ch :
- Nu thuc gy xung huyt mt, nga, sng hoc cc triu chng khc, ngng dng thuc v
hi kin bc s hoc dc s.
- Nu khng khi m mt sau khi dng, ngng dng thuc v hi kin bc s hoc dc s.
- Sau khi dng 2 tun m bnh vn khng , ngng dng thuc v hi kin bc s hoc dc
s.
Lu { trong bo qun v s dng :
- thuc ngoi tm tay tr em.
- Vn cht nt l sau khi dng. Bo qun ti ni mt, trnh nh nng trc tip.
- trnh nhm ln v gim cht lng, khng ng thuc vo chai hoc l khc.
- Khng dng chung l thuc vi ngi khc trnh ly nhim.
- Khng dng thuc qu hn (c in trn hp). Khi m l thuc, nn s dng cng nhanh cng
tt v thuc c th b ly nhim trong khi s dng.
- trnh nhm ln, hy l thuc ngay sau khi dng ht.
Lu { khc :
- Sau khi nh, thuc c th chy xung ming to v ng. ng lo lng v triu chng ny.
Khng dng l thuc nhm mc ch khc.
LIU LNG v CCH DNG
Nh mt 2-3 git/ln, 5-6 ln/ngy cho tr di 15 tui.
Nu tr cha quen nh mt, xin hy thc hin cc bc sau :
- u tin, ra vng quanh mt cho tr tht k. Sau bo tr nhm mt li.
- Nh 2-3 git thuc ri bo tr t t m mt ra.
- Thuc s i vo mt. Sau cng, lau vng quanh mt tr bng gc sch.

450.

ROSAMPLINE

L.D.P
c/o KENI - OCA
vin nang 500 mg : v 10 vin, hp 100 v.
bt pha tim bp, tnh mch 1 g : hp 100 l bt.
THNH PHN
cho 1 vin
Ampicilline trihydrate

500 mg

cho 1 l
Ampicilline dng mui Na, tnh theo ampicilline

1g

(Na)

(62 mg)

DC LC
Ampicilline l mt khng sinh thuc h bta-lactamine, nhm pnicilline A.
PH KHNG KHUN
Cc loi thng nhy cm : Streptococcus A, B, C, F, G khng phn nhm c, S. pneumoniae
nhy vi pnicilline, Enterococcus faecalis, Listria monocytogenes, Corynebacterium
diphteriae, Erysipelothrix rhusopathiae, Eikenella, Neisseria meningitidis, Bordetella pertussis,
Clostridium sp., Propionibacterium acnes, Peptostreptococcus, Actinomyces, Leptospires,
Borrelia, Treponema.
Loi nhy cm khng c nh : Enterococcus faecalis, Streptococcus pneumoniae khng nhy
cm vi pnicilline hoc khng pnicilline, Escherichia coli, Proteus mirabilis, Samonella,
Shigella, Vibrio cholerae, Haemophilus influenzae, Neisseria gonorrhoeae, Fusobacterium,
Prevotella.
Cc loi khng : Staphylocoque, Branhamella catarrhalis, Klebsiella, Enterobacter, Serratia,
Citrobacter diversus, C. freundii, providencia, Morganella morganii, Proteus vulgaris, P. rettgeri,
Yersinia enterocolitica, Pseudomonas sp., Acinetobacter sp., Xanthomonas sp., Flaviobacterium
sp., Alcaligenes sp., Nocardia sp., Campylobacter sp., Mycoplasmes, Chlamydiae, Rickettsies,
Legionella, Mycobacteries, Bacteroides fragilis.
DC NG HC
Hp thu :
- ampicilline c hp thu qua ng tiu ha khong 40% sau khi ung, phn cn li c
o thi qua phn.

- s hp thu qua rut gim khi c thc n.

Phn phi :
- Nng ti a trong huyt thanh sau khi ung 500 mg l t 3 n 4 mg/ml, t c sau 2
gi.
- Sau khi tim bp 1 g, nng nh trong huyt tng khong 15 n 18 mg/ml v t c
sau khong 1 gi.
- Sau khi tim tnh mch 500 mg, nng nh trong huyt tng khong 50 mg/ml.
- bnh nhn c chc nng thn bnh thng, thi gian bn hy trong huyt tng trung bnh
khong 1 gi.
- Phn tn n a s cc m : s hin din ca khng sinh nng iu tr c tm thy
trong cc cht tit ph qun, cc xoang, nc i, nc bt, thy dch, dch no ty, thanh mc,
tai gia.
- ampicilline qua c sa m.
- lin kt vi protine huyt tng khong 20%.
Bin i sinh hc :
- ampicilline hu nh khng c chuyn ha trong c th.
Bi tit :
- o thi ch yu qua nc tiu (75%) di dng hot ng (75-80%) ;
- khong 20% ampicilline c o thi qua mt.
CH NH
Nhim trng do chng nhy cm, ch yu trong cc biu hin nhim trng ng h hp, tai
mi hng v ming, thn v tit niu-sinh dc, ph khoa, tiu ha v mt.
Cc biu hin nhim trng mng no (thuc i qua hng ro mu-no tt), nhim khun huyt
v vim mng trong tim.
CHNG CH NH
- Qu mn vi nhm pnicilline.
- Chng ch nh nghim ngt khi c tin s d ng in hnh vi thuc.
- Nhim virus nhm Herpes, nht l bnh tng bch cu n nhn nhim trng (tng nguy c b
bin chng ngoi da).
CH PHNG
- Ngng tr liu nu xut hin cc biu hin d ng.
- Mt vi trng hp c ghi nhn c cc phn ng qu mn (phn v) nng c th gy t
vong cc bnh nhn c iu tr bng nhm p nicilline. Do phi hi bnh s trc khi
dng thuc.
THN TRNG LC DNG
- Lu { nguy c xy ra d ng cho vi cc khng sinh thuc h cphalosporine.
- Trng hp bnh nhn b suy thn, liu c iu chnh theo thanh thi cratinine hoc theo

cratinine huyt.
LC C THAI
Nhm p nicilline i qua hng ro nhau thai. Do thn trng khi s dng cho ph n mang
thai.
LC NUI CON B
Nhm p nicilline i qua sa m v c th gy tai bin d ng tr. Do khng nn cho con b
trong thi gian iu tr.
TNG TC THUC
Khng nn phi hp :
- Allopurinol : tng nguy c gy phn ng da.
TC DNG NGOI
Biu hin d ng : st, ni my ay, tng bch cu a acide, ph Quincke, him khi gp sc phn
v.
Ri lon tiu ha : bun nn, i ma, tiu chy, bnh nm do Candida.
Phn ng mu c th hi phc : thiu mu, gim tiu cu, gim bch cu.
Vic dng pnicilline vi liu rt cao c th gy bnh no nng (ri lon thc, c ng bt
thng, cn co git c th dn n hn m) nht l bnh nhn suy thn.
Mn ngoi da dng dt-sn do nguyn nhn d ng hay khng.
Vim thn k cp tnh.
Tng lng transaminase va phi v tm thi.
Him trng hp b vim tiu-i trng gi mc.
Him trng hp b vim li, vim ming, vim da trc vy v ban a dng.
LIU LNG v CCH DNG
ng ung :
- Ngi ln : 2 g/24 gi, chia lm 2 ln.
- Tr em : 50 mg/kg/24 gi, chia lm 2 ln.
ng tim :
- Ngi ln :
ng tim bp : 2 g/24 gi,
ng tnh mch : 2 g n 12 g/24 gi.
- Tr em/Tr cn b :
ng tim bp : 50 mg/kg/24 gi, tim 2 ln vo bui sng v ti,
ng tnh mch : 100-300 mg/kg/24 gi.
- Tr s sinh :
ng tnh mch : 100-300 mg/kg/24 gi.
- Ngi suy thn :
Ty thuc thanh thi cratinine :

- 30 n 60 ml/pht : 2-4 g/24 gi ; ti a : 4 g/24 gi, chia 2 mi tim.

- 10 n 30 ml/pht : 1 g, sau 500 mg/12 gi.
- < 10 ml/pht : 1 g, sau 500 mg/24 gi.

451.

ROVACOR

RANBAXY
vin nn 10 mg v 10 vin, hp 10 v - Bng B.
vin nn 20 mg v 10 vin, hp 10 v - Bng B.
THNH PHN
cho 1 vin Rovacor 10
Lovastatine

10 mg

cho 1 vin Rovacor 20

Lovastatine

20 mg

M T
Rovacor c hot cht chnh l lovastatin, c tn ha hc l acid butanoic 2-methyl-1, 2, 3, 7, 8,
8a-hexahydro-3,7-dimethyl-8-[2-(tetrahydro-4-hydroxy-6-oxo-2H-pyran-2-yl)-ethyl]-1naphthalenyl ester, [1S-(1a(R'), 3a, 7b, 8b (2S', 4S'), 8ab)]. Cng thc phn t C24H36O5 v phn
t lng l 404,6.
DC LC
C ch tc dng :
Sau khi c hp thu qua ng tiu ha, lovastatin c thy phn ngay lp tc to thnh
acid hydroxy dng mch h, l cht c ch cnh tranh ca men kh HGM-CoA. Enzyme ny xc
tc cho qu trnh chuyn i HMG-CoA thnh mevalonate, l bc gii hn ch yu trong qu
trnh tng hp cholesterol.
Nghin cu dc lc hc :
Lovastatin c ch hot ng ca men kh HGM-CoA ty theo liu. N hot ng cnh tranh vi
HGM-CoA c men ny.
Thuc lm gim tng hp cholesterol c in vivo ln in vitro v lm gim ng k cholesterol v
cholesterol lipoprotein trng lng phn t thp trong huyt tng ng vt hn l i vi
loi gm nhm c lipid mu bnh thng hoc tng cholesterol mu. Nghin cu dc ng hc

 ngi tnh nguyn khe mnh chng t lovastatin liu 12,5 n 100 mg mi ngy lm gim
ng k nng cholesterol ton phn trong huyt thanh m khng lm thay i ng k nng
cholesterol lipoprotein trng lng phn t cao, cholesterol lipoprotein trng lng phn t
rt thp v nng triglyceride huyt thanh.
Lovastatin lm gim 25-30% nng apolipoprotein B ngi tnh nguyn khe mnh ung
6,25 n 50 mg mi ngy hai ln v gim 23-33% nng apolipoprotein B bnh nhn tng
lipid mu ung 20 n 40 mg mi ngy hai ln, ngi ta cng nhn thy c mt lng tng t
khong 10% nng apolipoprotein AI v AII khi cho nhng liu tng t bnh nhn cng gia
nh d hp t hoc khc gia nh b chng tng cholesterol mu.
Lovastatin lm tng s th th lipoprotein trng lng phn t thp gan v lm tng t l d
ha phn on lipoprotein trng lng phn t thp.
Lovastatin khng lm suy yu chc nng v thng thn bt c mc no sau mt thi gian
ngn s dng lovastatin ngi tnh nguyn khe mnh v bnh nhn tng cholesterol mu.
DC NG HC
Hp thu :
Lovastatin c hp thu qua ng tiu ha. Thuc tri qua chuyn ha ln u gan, l ni
tc ng u tin. Do sinh kh dng ca thuc trong vng tun hon ln l thp v thay i.
hp thu ca lovastatin, c c lng lin quan n liu tim tnh mch trung bnh
khong 30% liu ung. hp thu gim khong 30% khi ung lc d dy rng so vi khi c thc
n. Kh nng gn vi protein huyt tng cao (95%).
Chuyn ha sinh hc :
Lovastatin b thy phn gan thnh cht chuyn ha acid b-hydroxy c hot tnh. Cn c 3 cht
chuyn ha khc cng c phn lp.
Thi gian bn hy : 3 gi.
Thi gian t nng nh : 2-4 gi.
Thi gian tc ng : 4 n 6 tun sau khi ngng iu tr lin tc.
Thi tr : Lovastatin c thi ch yu qua phn l phn thuc ch yu khng hp th chim
83% liu dng theo ng ung. 10% thuc c thi tr qua ng thn.
DC L LM SNG
- nh gi lm sng m rng ca Lovastatin (EXCEL) : Lovastatin c so snh vi gi dc
8245 bnh nhn tng cholesterol mu (cholesterol ton phn 240-300 mg/dl, cholesterol
lipoprotein trng lng phn t thp (> 160 mg/dl) trong mt nghin cu song song, m i,
ngu nhin. Tt c cc thay i v cc thng s lipid cc bnh nhn iu tr lovastatin c lin
quan n liu v c bit khc hn gi dc (p < 0,001). Cc kt qu ny duy tr trong sut qu
trnh nghin cu.
Lovastatin gy gim triglyceride ng k t trung bnh 10% liu 20 mg mt ln mi ngy cho
ti 19% liu 40 mg hai ln mi ngy. Nhm gi dc c mc tng trung bnh 4%. Nhng bnh

nhn khng c thay i hoc tng triglyceride chim 54% nhm gi dc v 37% (20 mg mi
ngy mt ln) n 25% (40 mg hai ln mi ngy) ca nhm lovastatin.
- Lovastatin vi liu trung bnh 36 mg/ngy trong 16 tun lm gim cholesterol ton phn v
cholesterol lipoprotein trng lng phn t thp ln lt chim 21+/-11% v 29+/-11% 331
bnh nhn tng cholesterol mu b x va ng mch vnh. Lovastatin lm chm tin trnh x
va ng mch vnh v ngn chn s pht trin ca tn thng ng mch vnh mi.
- Lovastatin hu hiu hn pravastatin trong vic gim cholesterol ton phn v cholesterol
lipoprotein trng lng phn t thp trong mt th nghim ngu nhin, m i v c kim sot
i vi 672 bnh nhn tng cholesterol mu.
- Lovastatin lm gim cholesterol ton phn v cholesterol lipoprotein trng lng phn t
thp ln lt 20% v 28% v lm tng 8% cholesterol lipoprotein trng lng phn t cao trong
th nghim ko di 12 tun trn 182 bnh nhn mi b tng cholesterol mu. Kt qu c cho
l tt hn so vi dng gemfibrozil.
Tnh sinh ung th / t bin :
th vt th nghim, lovastatin chng t lm tng tn sut cc khi u t bo gan v u tuyn v
u nh mng nhy khng tuyn ca d dy. Tuy nhin, iu ny xy ra liu gp 3-4 ln liu ti
a khuyn co cho ngi. Cc th nghim khc nhau v t bin gen ca lovastatin cho thy
thuc khng gy t bin gen.
CH NH
Rovacor c ch nh phi hp vi ch n king lm gim cholesterol ton phn v
cholesterol lipoprotein trng lng phn t thp bnh nhn mi b tng cholesterol mu
(tng lipoprotein mu type IIa v IIb) do tng nng cholesterol lipoprotein trng lng phn
t thp bnh nhn c nguy c b bnh ng mch vnh m khng p ng vi ch n
king hay cc bin php ring l khc.
Rovacor cng c ch nh lm gim tng cholesterol lipoprotein trng lng phn t thp
bnh nhn va b tng cholesterol mu va tng triglyceride mu.
CHNG CH NH
- Qu mn cm vi bt c thnh phn no ca thuc.
- Bnh gan tin trin hoc tng transaminase huyt thanh khng r nguyn nhn.
- Ph n c thai v cho con b.
THN TRNG LC DNG
Tng qut :
Lovastatin c th lm tng nng creatine phosphokinase v transaminase huyt thanh. iu
ny cn c xem xt trong cc chn on phn bit au ngc bnh nhn iu tr lovastatin.
Rovacor t hu hiu bnh nhn tng cholesterol mu cng gia nh ng hp t him, c th
do cc bnh nhn ny khng c th th lipoprotein trng lng phn t thp c chc nng.
Rovacor c th lm tng transaminase huyt thanh nhng bnh nhn ng hp t ny.

Bnh nhn c yu cu bo co ngay cc triu chng au c, nhy au hoc yu khng gii

thch c c bit c km theo st.
Cnh bo :
- Cc bnh nhn l ngi ln ung lovastatin t nht 1 nm c bo co c gia tng ng k
(n hn 3 ln mc trn ca gii hn bnh thng) transaminase huyt thanh. Do vy, cc xt
nghim v chc nng gan cn c thc hin trong sut qu trnh iu tr lovastatin. Cn theo
di transaminase huyt thanh trc khi bt u iu tr, mi 6 tun trong sut 3 thng u
tin, mi 8 tun trong sut thi gian cn li trong nm u, v nh kz sau .
- Thuc nn c dng thn trng i vi nhng bnh nhn ung ru nhiu v/hoc c tin
s bnh gan.
- iu tr lovastatin nn c tm ngng bnh nhn c tnh trng nng, cp tnh gi bnh
c hay c nguy c tin trin suy thn th pht thnh globin c niu kch pht, nhim khun cp
nng, h huyt p, tri qua i phu, chn thng, ri lon chuyn ha nng, ri lon ni tit v
ri lon cht in gii v cc cn ng kinh khng kim sot c.
S dng trong nhi khoa :
Cc nghin cu y v mi quan h gia tui tc v tc dng ca cht c ch HMG-CoA tr
em cha c tin hnh. Tuy nhin, khng khuyn co s dng cho tr em di 2 tui v
cholesterol cn cho s pht trin bnh thng.
LC C THAI v LC NUI CON B
Cc cht c ch men kh HMG-CoA khng c khuyn co s dng trong sut thi kz mang
thai hoc ngi chun b mang thai.
Khng c s dng cht c ch men kh HMG-CoA trong thi kz cho con b do cc tc dng
ngoi tr ang b m.
TNG TC THUC
- Cht chng ng, dn xut coumarine hoc indandione : S dng ng thi vi cht c ch
men kh HMG-CoA c th lm tng thi gian chy mu hoc thi gian prothrombin ; cn theo
di thi gian prothrombin bnh nhn dng cht c ch men kh HMG-CoA cng vi cht
chng ng.
- Cyclosporin hoc Erythromycin hoc Gemfibrozil hoc thuc c ch min dch hoc Niacin : S
dng ng thi vi lovastatin c th lin quan vi nguy c gia tng chng globin c niu kch
pht v suy thn cp, iu tr kt hp cht c ch men kh HMG-CoA vi gemfibrozil, cht c
ch min dch hoc niacin nn theo di cn thn pht hin cc triu chng bnh c hoc
globin c niu kch pht.
TC DNG NGOI
Tiu ha : y hi, tiu chy, to bn v nn l nhng tc dng ngoi { thng c gp nht
vi lovastatin. Cc tc dng ph trn ng tiu ha khc nh au bng, co tht, chng kh
tiu, nng v ri lon v gic.

C xng : Bnh c, c trng bng au c, yu c. Cng c th xy ra globin c niu kch pht

km suy thn cp. Tng nng isozyme c ca creatine phosphokinase trong huyt thanh
khng c triu chng c th xy ra 11% bnh nhn s dng lovastatin.
Mt : C th xy ra nhn m. c thy tinh th c th nng ln trong qu trnh iu tr
lovastatin.
Ngoi ra : C cc tc dng ngoi { khc nh nhc u, chng mt, pht ban/nga, bt lc v
mt ng.
LIU LNG v CCH DNG
Liu khuyn co cho ngi ln :
Liu khi u khuyn co l 20 mg mi ngy mt ln vo lc n ti. Khong liu khuyn co
thay i t 10-80 mg/ngy c cho mt ln duy nht hay chia lm nhiu ln.
Liu ti a khuyn co l 80 mg/ngy. Nn iu chnh liu sau mi 4 tun hoc lu hn. Liu
dng nn c iu chnh ring cho tng ngi ty thuc p ng ca bnh nhn. Rovacor nn
c dng vi ba n. Nu dng mi ngy mt ln th nn ung thuc vo ba cm ti.
i vi bnh nhn ang iu tr thuc c ch min dch, lovastatin nn c bt u vi liu 10
mg/ngy v khng c qu 20 mg/ngy. Liu khuyn co cho ph n mn kinh b tng
cholesterol mu mc nh n va l 10 mg/ngy.
Bnh nhn suy thn :
bnh nhn suy thn nh n va khng cn iu chnh liu. Tuy nhin trong trng hp suy
thn nng khng c dng qu 20 mg/ngy.
BO QUN
Bo qun nhit khng qu 25oC, bo v trnh nh sng v trnh m.

452.

ROVAMYCINE

RHNE-POULENC RORER
[AVENTIS PHARMA]
Vin bao phim 1,5 MUI : hp 16 vin.
Vin bao phim 3 MUI : hp 10 vin.
Bt pha hn dch ung 0,375 MUI cho nh nhi : hp 10 gi.
Bt pha hn dch ung 0,750 MUI cho tr em : hp 10 gi.
THNH PHN
cho 1 vin

Spiramycine

1,5 MUI

cho 1 vin
Spiramycine

3 MUI

cho 1 gi
Spiramycine

0,375 MUI

cho 1 gi
Spiramycine

0,750 MUI

DC LC
Spiramycine l khng sinh h macrolide.
Ph khng khun :
Vi khun thng nhy cm (CMI <= 1 mg/ml) : hn 90% chng nhy cm.
Streptococcus, Staphylococcus nhy cm vi mticilline, Rhodococcus equi, Branhamella
catarrhalis, Bordetella pertussis, Helicobacter pylori, Campylobacter jejuni, Corynebacterium
diphteriae, Moraxella, Mycoplasma pneumoniae, Coxiella, Chlamydia trachomatis, Treponema
palidum, Borrelia burgdorferi, Leptospira, Propionibacterium acnes, Actinomyces, Eubacterium,
Porphyromonas, Mobiluncus, Mycoplasma hominis.
Vi khun nhy cm trung bnh : khng sinh c hot tnh trung bnh in vitro, hiu qu lm sng
tt c th c ghi nhn nu nng khng sinh ti nhim cao hn CMI : Neisseria
gonorrhoeae, Vibrio, Ureaplasma, Legionella pneumophila.
Vi khun khng thng xuyn nhy cm : V t l khng th c thay i nn nhy cm
ca vi khun khng th xc nh nu khng thc hin khng sinh : Streptococcus
pneumoniae, Enterococcus, Campylobacter coli, Peptostreptococcus, Clostridium perfringens.
Vi khun khng (CMI > 4 mg/ml) : hn 50% chng khng.
Staphylococcus khng meticillin, Enterobacteriaceae, Pseudomonas, Acinetobacter, Nocardia,
Fusobacterium, Bacteroides fragilis, Haemophilus influenzae v para-influenzae.
Spiramycine c tc dng in vitro v in vivo trn Toxoplasma gondii.
DC NG HC

Hp thu :
Hp thu nhanh (thi gian bn hp thu : 20 pht), nhng khng hon ton, s hp thu khng b
nh hng bi thc n.
Phn b :
Sau khi ung 6 triu n v, nng huyt thanh ti a t 3,3 mg/ml, thi gian bn hy 8 gi.
Khuch tn cc tt vo nc bt v m : Phi : 20-60 mg/g ; Amygdale : 20-80 mg/g ; Xoang b
nhim trng : 75-110 mg/g ; Xng : 5-100 mg/g . 10 ngy sau khi ngng iu tr, vn cn 5-7
mg/g hot cht trong l lch, gan, thn. Rovamycine khng qua dch no ty, qua sa m. t lin
kt vi protine huyt tng (khong 10%).
Macrolides xuyn vo v tp trung trong thc bo (bch cu a nhn trung tnh, bch cu n
nhn, i thc bo ph nang).
ngi, t nng cao trong thc bo. c tnh ny gii thch hot tnh ca cc macrolides
i vi cc vi khun ni bo.
Bin i sinh hc : Chuyn ha chm ti gan. Cc cht bin dng cha bit r.
Thi tr : 10% liu ung c thi tr qua nc tiu, thi tr rt nhiu qua mt ; nng trong
mt 15-40 ln cao hn nng huyt thanh. Mt lng kh ln c tm thy trong phn.
CH NH
Cc bnh nhim do vi khun nhy cm :
- Vim hng.
- Vim xoang cp.
- Bi nhim vim ph qun cp.
- Cn kch pht vim ph qun mn.
- Vim phi cng ng nhng ngi :
- khng c yu t nguy c,
- khng c du hiu lm sng nng,
- thiu nhng yu t lm sng gi n nguyn nhn do pneumocoques.
Trong trng hp nghi ng vim phi khng in hnh, macrolides c ch nh trong bt c
trng hp bnh nng nh hoc c a no.
- Nhim trng da lnh tnh : chc l, chc l ha ca bnh da, chc lot, nhim trng da - di
da (c bit vim qung), bnh nm.
- Nhim trng ming.
- Nhim trng sinh dc khng do gonocoques.
- Phng nga vim mng no do mng no cu : Trong trng hp chng ch nh vi
rifampicine, mc ch l dit N. meningitidis mi hu. Spiramycine khng dng iu tr
vim mng no do mng no cu, m ch c ch nh trong phng nga cho bnh nhn
iu tr lnh bnh, trc khi tr li sinh hot trong tp th v cho ngi tip xc vi bnh
nhn trong 10 ngy trc khi nhp vin.

- Phng nga ti pht thp khp cp bnh nhn d ng vi pnicilline.

- Bnh Toxoplasma ph n c thai.
CHNG CH NH
D ng vi spiramycine.
THN TRNG LC DNG
Spiramycine khng bi tit di dng c hot tnh qua thn, do khng cn iu chnh liu
trong trng hp suy thn.
LC C THAI v LC NUI CON B
Lc c thai : Rovamycine c th dng cho ph n c thai m khng gy bt c mt phn ng
bt li no.
Lc nui con b : V spiramycine qua sa m, nn khuyn ngng cho con b khi ang dng
thuc.
TNG TC THUC
Lu { khi phi hp :
- Lvodopa : c ch s hp thu ca carbidopa vi gim nng lvodopa trong huyt tng.
Theo di lm sng v iu chnh liu lvodopa.
TC DNG NGOI
Him : bun nn, nn ma, tiu chy, biu hin d ng ngoi da.
LIU LNG v CCH DNG
Ngi ln : 2-3 vin 3 MUI hoc 4-6 vin 1,5 MUI (tc 6-9 MUI) mt ngy, chia lm 2 hoc 3 ln.
Nh nhi v tr em : 150.000 - 300.000 UI/kg/ngy, chia lm 2-3 ln. Hoc :
- Nh nhi : 2 gi 0,375 MUI/ mi 5 kg/ngy.
- Tr em : 1 gi 0,750 MUI/ mi 5 kg/ngy.
- Tr ln : 1 vin 1,5 MUI/ mi 10 kg/ngy.
Vin 3 MUI khng s dng cho tr em.
Phng nga vim mng no do no cu khun :
Ngi ln : 3 MUI/12 gi, trong 5 ngy.
Tr em : 75.000 UI/kg/12 gi, trong 5 ngy.
Cch dng :
Thuc bt : bt trong gi ra ly, nc y gi, tr ra ly, khuy cho tan.

453.

RULID

HOECHST-MARION-ROUSSEL / ROUSSEL VIETNAM

[AVENTIS PHARMA]
Vin nn pha hn dch ung 50 mg : hp 10 vin.
Vin nn 150 mg : hp 10 vin.

THNH PHN
Vin nn pha hn dch ung :
cho 1 vin
Roxithromycine

50 mg

Vin nn 150 mg :
cho 1 vin
Roxithromycine

150 mg

DC LC
Roxithromycine l mt khng sinh bn tng hp thuc h macrolide.
Ph khng khun :
- Cc loi thng nhy cm (CMI <= 1 mg/l) : Bordetella pertussis, Borrelia burgdorferi,
Branhamella catarrhalis, Campylobacter coli, Campylobacter jejuni, Chlamydia trachomatis,
psittaci v pneumoniae, Clostridium perfringens, Corynebacterium diphteriae, Enterococcus,
Gardnerella vaginalis, Helicobacter pylori, Legionella pneumophila, Listeria monocytogenes,
Meti-S Staphylococcus, Mobiluncus, Mycoplasma pneumoniae, Neisseria meningitidis,
Pasteurella multocida, Peptostreptococcus, Porphyromonas, Propionibacterium acnes,
Rhodococcus equi, Streptococcus pneumoniae, Streptococcus spp.
- Cc loi nhy cm trung bnh (1 mg/l <= CMI <= 4 mg/l) : Haemophilus influenzae, Ureaplasma
urealyticum, Vibrio cholerae.
- Cc loi khng (CMI > 4 mg/l) : Acinetobacter spp., Bacteroides fragilis, Enterobacteriaceae,
Fusobacterium, Meti-R Staphylococcus (S. aureus v coagulase m tnh), Mycoplasma hominis,
Nocardia, Pseudomonas spp.
CH NH
Nhim trng do chng c xc nh l c nhy cm vi khng sinh, ch yu trong :
- Nhim trng ng h hp trn : vim hng, vim amidan, vim xoang.
- Nhim trng ng h hp di : vim phi, vim ph qun, bnh ph qun kinh nin bi
nhim, vim phi khng in hnh.
- Nhim trng da v m mm.
- Nhim trng c quan sinh dc khng do lu cu : vim niu o, vim c t cung-m o.
- Nhim trng rng ming.
CHNG CH NH
Qu mn vi nhm macrolide.

Khng dng chung vi cc alcaloide gy co mch ca nm ca g (ergotamine v

dihydroergotamine).
CH PHNG v THN TRNG LC DNG
Ch { phng :
Khi dng khng sinh macrolide kt hp vi cc alcaloid gy co mch ca nm ca g, co mch
cc u chi c th dn n hoi t c ghi nhn. Trc khi k toa Rulid phi chc l bnh
nhn khng ang dng cc alcaloid ny.
Thn trng lc dng :
Thn trng trong trng hp suy gan nng : gim na liu nu cn phi dng Rulid.
Trng hp suy thn, ngi gi : khng cn iu chnh liu.
Cnh gic cc i tng iu khin phng tin giao thng v s dng my mc v nguy c gy
chng mt ca thuc.
LC C THAI v LC NUI CON B
Lc c thai :
Khng c tc dng sinh qui thai ng vt.
ngi, s an ton i vi thai nhi cha c xc nh.
Lc nui con b :
Bi tit yu qua sa m. Khng dng thuc cho m cho con b hoc ngng cho con b.
TNG TC THUC
Chng ch nh phi hp : cc alcaloides gy co mch ca nm ca g (ergotamine,
dihydroergotamine).
Khng nn phi hp : terfenadine, astemizole, cisapride, pimozide.
Thn trng khi phi hp : cht i khng vitamine K, disopyramide, digoxine v cc glycosides
khc.
Lu { khi phi hp : midazolam, theophylline, ciclosporine A.
TC DNG NGOI
Biu hin tiu ha : bun nn, ma, au d dy, tiu chy.
D ng ngoi da : pht ban, m ay, ph mch.
Khi dng liu cao, lng transaminase tng tm thi, him gp ca gy vim gan mt.
Cm gic chng mt, nhc u, d cm. Him gp trng hp gy phn ng qu mn nng (ph
Quincke, phn ng dng phn v).
LIU LNG v CCH DNG
Dng thuc trc cc ba n, chia lm 2 ln/ngy.
Ngi ln : 300 mg/ngy : 1 vin 150 mg sng v ti.
Tr em : 5-8 mg/kg/ngy. Chia lm 2 ln :
6 - 11 kg : 1/2 vin pha hn dch 50 mg sng v ti.
12 - 23 kg : 1 vin pha hn dch 50 mg sng v ti.

24 - 40 kg : 2 vin pha hn dch 50 mg sng v ti.

tr em iu tr ti a trong 10 ngy.

THUC VN S

454.

SANDIMMUN NEORAL

NOVARTIS
Vin nang mm 25 mg : hp 50 vin - Bng A.
Vin nang mm 100 mg : hp 50 vin - Bng A.
THNH PHN
cho 1 vin
Ciclosporine

25 mg

cho 1 vin
Ciclosporine

100 mg

DC LC
Ciclosporin (cng c bit nh ciclosporin A), mt polypeptid vng bao gm 11 acid amin, l
cht c tc dng c ch min dch. Cc nghin cu trn ng vt cho thy thuc k o di i
sng ca c quan gh p bao gm da, tim, thn, ty, ty xng, rut non v phi. Ciclosporin c
ch s hnh thnh cc phn ng min dch qua trung gian t bo, k c min dch d ghp, phn
ng qu mn mun trn da, vim no ty d ng thc nghim, vim khp Freund's adjuvant
arthritis, bnh mnh ghp chng li vt ch (graft-versus-host disease : GVHD) v c s sn xut
khng th ph thuc t bo T.
Ciclosporin cng c ch s sn xut v gii phng cc lymphokin, bao gm interleukin 2 (yu t
tng trng t bo T : T cell growth factor - TCGF).
C chng c cho rng ciclosporin c ch cc t bo lympho khng hot ng cc pha G0 v
giai on sm ca G1 ca chu kz t bo v c ch s gii phng cc lymphokine t t bo T hot
ha do s kch thch ca cc khng nguyn.

Cc ti liu hin c cho rng ciclosporin tc ng ti cc t bo lymph mt cch c hiu v c

th thay i c. Khng ging cc cht km t bo, ciclosporin khng lm gim qu trnh to
mu v khng nh hng ti chc nng ca cc thc bo, do cc bnh nhn gh p c quan
iu tr vi ciclosporin t c kh nng b nhim trng hn nhng ngi dng cc thuc (km t
bo) khc.
Sandimmun Neoral c s dng thnh cng trong phng nga v iu tr thi ghp v
GVHD ngi ghp tng v ty xng ; cc li ch iu tr cng c ghi nhn trong iu tr
cc bnh t min.
Sandimmun Neoral l mt dng dc cht mi ca ciclosporin da trn nguyn tc cu to vi
nh tng c tc dng lm gim s thay i v dc ng hc, kt hp c mi tng quan
gia nng thuc trong c th vi liu dng vi tnh nng hp thu n nh hn, v t b nh
hng bi thc n a vo. Dng thuc mi l mt loi vi nh tng c c c t trc nh
vy cc nghin cu v dc ng hc v lm sng cho thy mi lin quan cht ch hn rt
nhiu gia nng thuc ti thiu v lng thuc c hp th so vi dng Sandimmun. Dng
vi nh tng hin din ngay khi dch thuc tip xc vi nc (trong nc ung hoc dch d
dy).
DC NG HC
Sinh kh dng hon ton ca Sandimmun c th t ti 50% cc bnh nhn gh p c quan
trong thi gian iu tr 3 thng. Ti tnh trng n nh l khong 20-50%. Hp thu thuc b gim
trong trng hp a chy.
So vi Sandimmun, Sandimmun Neoral cho thy s ci thin v s hp thu ca thuc tng
quan vi liu dng (AUC), s hp thu thuc n nh hn v t b nh hng bi ch n v
nhp thi gian hn. Cc c tnh ny c c l do dc ng hc ca ciclosporin t thay i
hn v mi lin quan cht ch hn gia nng thuc ti thiu vi tng lng thuc c hp
th (AUC).
Hp thu :
Sandimmun Neoral dng vin nang dng dung dch ung c c tnh sinh hc ging nhau.
Cc ti liu cho thy vi liu chuyn i theo t l 1:1 t Sandimmun sang Sandimmun Neoral,
nng thuc ti thiu trong mu l tng ng v gi nguyn c mc nng (ti thiu)
hiu dng. So vi cc dng ung ca Sandimmun, Sandimmun Neoral c hp thu nhanh hn
(thi gian thuc t nng ti a trung bnh sm hn 1 gi v nng thuc ti a trung
bnh cao hn 59%) v cho thy tnh sinh kh dng trung bnh (AUC) cao hn 29% vi liu duy tr
dng cho cc bnh nhn ghp thn. nhng bnh nhn hp thu ciclosporin km t
Sandimmun (c bit vi liu ung cao) s khc bit v sinh kh dng vi Sandimmun Neoral c
th ti hn 100%.
Phn phi :
Ciclosporin c phn phi ch yu ngoi th tch mu vi th tch phn phi trung bnh 3,5

l/kg. Trong mu, phn phi thuc ph thuc vo nng ca hot cht : 33-47% c trong
huyt tng, 4-9% trong t bo lymph, 5-12% trong bch cu ht v 41-58% trong hng cu.
Vi nng m c cao s c bo ha trong t bo bch cu v hng cu. Trong huyt tng,
khong 90% lng thuc gn vi protein (hu ht l lipoprotein).
Chuyn ha :
Ciclosporin c chuyn ha mnh v c hn 15 hot cht c pht hin. Chuyn ha ch
yu qua h cytochrome P450, NF (h CyP 3A) - ph thuc monooxygenase ti gan v con ng
chuyn ha ch yu l monohydroxylation, dihydroxylation v N-demethylation ti cc v tr
phn t khc nhau. Cc thuc c bit c c ch hoc cm ng vi h enzyme ph thuc
cytochrome P450, NF (h CyP 3A) c bit lm tng hoc gim nng ciclosporin trong mu
(xem phn Tng tc thuc). Tt c cc hot cht chuyn ha c pht hin cho ti nay u
c cha cu trc peptid khng b bin i ca hot cht v mt s hot cht chuyn ha c tc
dng c ch min dch nh (ti 10% ca lng thuc di dng khng i).
Thi tr :
Cc thng s v thi gian bn hy sau cng ca ciclosporin thay i ng k ty thuc vo
phng php xc nh v i tng nghin cu, mc t 6,3 gi ngi tnh nguyn khe
mnh ti 20,4 gi bnh nhn c bnh gan nng. o thi ch yu qua mt vi ch 6% liu
ung c thi tr qua nc tiu v t hn 1% di dng khng i.
ng hc trong cc trng hp c bit :
Ngi gi :
Hin cha c ti liu v hp thu thuc ngi gi. Phn phi thuc khng c g khc bit vi
ngi tui trung nin.
Tr em :
o thi thuc ni chung hi nhanh hn ngi ln. V vy c th cn dng liu cao hn
(tng quan vi cn nng) t c nng thuc trong mu tng ng.
Suy thn :
Khng nh hng ti dc ng hc trn lm sng v ciclosporin c o thi qua gan.
Suy gan :
Lm chm qu trnh o thi thuc, cn theo di cht ch creatinine huyt thanh v nng
ciclosporin trong mu so vi mc iu chnh liu nhng bnh nhn suy gan nng.
Hi chng thn h :
Hin khng thy c bo co v thay i dc ng hc nhng bnh nhn iu tr ng ung
v do vy khng cn phi iu chnh liu.
CH NH
Cc ch nh c kim chng :
Gh p c quan :
- Ghp tng : Phng nga phn ng thi ghp trong ghp thn, gan, tim, tim-phi, phi v ty.

iu tr phn ng thi ghp nhng bnh nhn trc iu tr cc thuc c ch min dch
khc.
- Ghp ty xng : Phng nga phn ng thi ghp. Phng nga v iu tr bnh c quan ghp
chng li vt ch (graft-versus-host disease: GVHD).
Cc ch nh khc ngoi gh p c quan :
Vic chn on v quyt nh k n thuc Sandimmun Neoral phi c thc hin bi bc s
c kinh nghim trong s dng cc thuc c ch min dch, c bit vi ciclosporin (xem phn
Thn trng lc dng).
- Vim mng b o ni sinh : Intermediate uveitis hay posterior uveitis tin trin e da n
th gic khng do nguyn nhn nhim trng khi iu tr thng thng khng c kt qu hoc
gy ra cc tc dng ph khng tip tc iu tr c. Vim mng b o Behcet uveitis vi
nhim trng ti din nh hng ti vng mc nhng bnh nhn 7-70 tui vi chc nng thn
bnh thng.
- Bnh vy nn : Cc trng hp nng m cc tr liu khc khng c kt qu hoc khng thch
hp.
- Vim da d ng : Cc trng hp nng trong cc tr liu thng thng khng c kt qu
hoc khng thch hp.
- Vim khp dng thp : Cc trng hp nng trong cc tr liu tiu chun khng c kt qu
hoc khng thch hp.
Cc kh nng c th c dng khc :
- Hi chng thn h : Hi chng thn h nguyn pht ph thuc steroid v khng steroid (sinh
thit cho thy tn thng ti thiu -minimal-change disease [MCD]hoc tn thng x cu
thn mnh, - focal segmental glomerulosclerosis [FSGS] trong hu ht cc trng hp)
iu tr tht bi vi cc thuc thng thng, nhng ch khi cc ch s v chc nng thn bng t
nht 50% hoc bnh thng. C th c dng to tc dng thuyn gim bnh, hoc duy tr
bnh n nh to ra c nh cc thuc khc, bao gm c corticosteroids, v nh vy cho php
ngng thuc .
CHNG CH NH
Cho tt c cc ch nh :
- Qu mn vi ciclosporin hoc vi bt c thnh phn no ca thuc.
Cho cc ch nh khc ngoi gh p c quan :
- Suy thn, tr trng hp bnh nhn c hi chng thn h c lng creatinine huyt thanh
tng va phi (ti a 200 mmol/l ngi ln v 140 mmol/l tr em) c ph p iu tr ci
thin tnh trng bnh mt cch thn trng (ti a 2,5 mg/kg/ngy).
- Cao huyt p khng kim ch c.
- Nhim trng khng kim sot c.
- C tin s hoc c chn on c bnh c tnh bt c loi no ngoi tr nhng thay i tin

c tnh hoc c tnh ti da.

THN TRNG LC DNG
Chung cho mi trng hp :
- Ch c cc bc s c kinh nghim vi iu tr c ch min dch v c iu kin kim tra theo di
thng xuyn (thm khm ton din lm sng, huyt p, cc xt nghim) mi c k thuc
Sandimmun Neoral. Bnh nhn gh p c quan can c iu tr ti cc trung tm c y cc
phng tin cn thit ng thi ngi bc s chu trch nhim iu tr duy tr va tip tc cn
phi c bit mi thng tin cn thit chm sc bnh nhn c tt.
- Dng cho tr em : Ti liu v vic s dng Sandimmun Neoral cn hn ch ngoi tr trng
hp hi chng thn h. Vic s dng thuc cho bnh nhn di 16 tui trong cc ch nh khc
ngoi cy gh p c quan do vy khng c ngh tr trng hp hi chng thn h.
Cc yu t nguy c lin quan n vic chuyn sang dng cc dng thuc ciclosporin khc :
Khi bt u iu tr vi Sandimmun Neoral, cn theo di st nng ciclosporin trong mu,
creatinine huyt thanh v huyt p trc khi chuyn sang mt dng ciclosporin ung khc v
chc chn s c s khc bit v sinh kh dng. Nguyn tc ny khng p dng khi chuyn t
Sandimmun Neoral vin nang mm sang dng Sandimmun Neoral dung dch ung v hai dng
ny c hot tnh sinh hc ging nhau.
Vic s dng kt hp vi cc thuc c ch min dch khc :
Sandimmun Neoral khng c dng kt hp vi cc thuc c ch min dch khc ngoi tr
corticosteroid, mc d c mt s trung tm dng thuc ny kt hp vi azathioprine v
corticosteroid hay cc thuc c ch min dch khc (tt c u vi liu thp) cho bnh nhn
gh p c quan nhm lm gim s xut hin cc tc dng ngoi v chc nng hay cu trc ca
thn. Nu vic dng kt hp c thc hin cn lu { ti nguy c c ch min dch qu mc,
cng vi s tng nhy cm vi nhim trng v s hnh thnh u lympho.
Tc ng ti chc nng thn :
Tng creatinine v ur huyt l mt bin chng kh thng gp v nng c th xut hin trong
mt vi tun u iu tr, tuy vy cc ri lon chc nng ny thng ty thuc vo liu dng v
s tr v bnh thng khi gim liu. Khi iu tr lu di c th dn ti thay i v cu trc ca
thn (nh x k) i hi phi phn bit vi cc du hiu thi ghp mn tnh bnh nhn ghp
thn.
Tc ng ti chc nng gan :
Sandimmun Neoral cng c th lm tng bilirubin huyt thanh ph thuc liu dng v c th
tr v bnh thng c v him gp hn, tng enzyme gan. Do vy cn kim tra thng xuyn
cc ch s v chc nng gan v thn, cng vi vic gim liu nu cn.
Xc nh nng ciclosporin trong mu :
- Nng ciclosporin trong mu c xc nh tt nht bng cch dng mt loi khng th c
hiu n dng v tnh. Mt chn la khc l c th dng HPLC cng nh lng c dng

thuc khng i. Th nghim v huyt tng hay huyt thanh cn c mt bng mu ghi ring
r (thi gian v nhit ). Bt u theo di nng thuc trong mu bnh nhn ghp gan cn
thc hin phng thc dng khng th c hiu n dng hay tin hnh song song c phng
php trn cng vic dng khng th khng c hiu n dng m bo c c nng c
tc dng c ch min dch thch hp.
- Cn lu { nng ciclosporin trong mu, trong huyt tng hay huyt thanh ch l mt trong
nhiu yu t to nn tnh trng lm sng ca bnh nhn. Cc kt qu thu c do vy ch gip
cho vic nh hng liu dng trong mi tng quan vi thc t lm sng v cc ch s v xt
nghim (thng tin chi tit c trong cun Hng dn thc hnh theo di Sandimmun c cung
cp theo nhu cu).
Theo di huyt p :
Cn kim tra huyt p u n trong khi iu tr Sandimmun Neoral v dng cc thuc cha
tng huyt p thch hp khi cn thit.
Cc thay i v sinh ha :
- iu tr vi Sandimmun i khi c th lm tng nh, c hi phc lipid mu nn cn nh lng
lipid trc v sau khi iu tr c 1 thng. Nu trng hp ny xy ra c th thc hin ch
n king v nu c th, gim liu Sandimmun Neoral.
- Bnh nhn iu tr Sandimmun Neoral cn trnh ch n nhiu kali v khng c dng cc
thuc c kali hay thuc li tiu gi kali.V Sandimmun Neoral i khi gy ra hoc thc y tnh
trng tng kali mu, hoc lm gim magi, cn theo di kali v magi huyt thanh nhng
bnh nhn c ri lon chc nng thn nng.
- Thn trng khi iu tr cho bnh nhn tng acid uric mu.
Cc thuc phi hp (xem thm trong Tng tc thuc) :
- Bnh nhn vy nn khng c dng ng thi cc thuc c ch bta hoc li tiu.
- Tim chng c th km hiu qu khi ang iu tr vi Sandimmun Neoral v cn trnh s dng
vaccin sng.
Pht hin sm cc ri lon tng sinh m bch huyt v cc khi u c tnh :
Cng nh vi cc thuc c ch min dch khc, cn lu ti cc nguy c ri lon tng sinh m
bch huyt v khi u c tnh (c bit l da). Bnh nhn dng Sandimmun Neoral lu di phi
c theo di cht ch m bo pht hin sm cc ri lon ny v cn ngng iu tr khi cc
du hiu tin c tnh hoc c tnh c xc nh.
Phn ng vi tia t ngoi :
Do nguy c v cc bin i da c tnh, bnh nhn iu tr Sandimmun Neoral, c bit nhng
ngi iu tr bnh vy nn hay vim da d ng, cn c khuyn co trnh phi nng di nh
sng mt tri m thiu phng tin bo v v phi trnh iu tr ng thi tia t ngoi B cng
nh tr liu quang ha hc PUVA (xem thm trong Tng tc thuc).
LC C THAI v LC NUI CON B

Cc nghin cu v kh nng sinh sn ng vt khng cho thy nguy c tn thng no cho

thai nhi, nhng hin cha c xc nhn bng cc nghin cu c kim sot ph n mang
thai.
Cc kt qu nghin cu ngi c ghp cho thy nguy c v cc tc ng ln qu trnh thai
nghn v chuyn d ca Sandimmun Neoral khng cao hn so vi cc loi thuc thng thng.
Tuy nhin hin cha c nghin cu c kim sot chnh xc no c tin hnh v Sandimmun
Neoral do vy ch c dng khi cc li ch mang li ln hn nguy c c th xy ra.
Ciclosporin c bi tit qua sa v ngi m dng thuc Sandimmun Neoral do vy khng nn
cho con b.
TNG TC THUC
Vi thc n :
Ung nc bi cng lc vi ung thuc c bit lm tng tnh kh dng sinh hc ca
ciclosporin.
Tng tc thuc :
Nhng thuc c bit gy ra tc dng hip lc gy c vi thn : acyclovir, aminoglycosides
(bao gm c gentamycin v tobramycin), amphotericin B, ciprofloxacin, furosemide, mannitol,
melphalan, trimethoprim (+ sulfamethoxazole), vancomycin, NSAIDs (bao gm diclofenac,
indomethacin, naproxen v sulindac).
Nhng thuc c bit lm gim nng cilosporin : barbiturate, carbamazepine, phenytoin,
nafcillin, sulfadimidine dng tnh mch, rifampicin, octreotide, probucol, trimethoprim dng
tnh mch.
Nhng thuc c bit lm tng nng ciclosporin trong mu : khng sinh nhm chloroquine,
macrolide (erythromycin, josamycin, ponsinomycin, pristinamycin), ketoconazole (v, vi tc
dng k m r rng hn, fluconazole v itraconazole), diltiazem, nicardipine, verapamil,
metoclopramide, thuc trnh thai ung, danazol, methyprednisolone (liu cao), allopurinol,
amiodarone, acid cholic v cc dn xut, doxycycline, propafenone.
Mt s thuc khc :
- Tim chng c th b gim tc dng trong khi iu tr vi Sandimmun Neoral v cn trnh
dng cc vaccin sng.
- Vic dng ng thi nifedipine vi Sandimmun Neoral c th lm tng t l ph i li so vi
dng Sandimmun Neoral n tr.
- S dng ng thi diclofenac v Sandimmun c bit lm tng ng k sinh kh dng ca
diclofenac, c th gy bin chng suy thn c hi phc, c th nht l do hin tng gim
lng thuc khng c hp th (first-past effect) vn mc cao ca diclofenac. S dng ng
thi cc thuc NSAID c lng thuc khng c hp th thp (nh acid acetylsalicylic) vi
Sandimmun thng khng lm tng sinh kh dng ca cc thuc .
- Sandimmun c th lm gim thanh thi ca digoxin, colchicine, lovastatin v prednisolone.

iu ny dn ti ng c digoxin v lm tng nguy c ca lovastatin v colchicine gy c c

(gm au v nhc c), vim c v globin c niu kch pht.
ngh : Trong nhng trng hp vic dng thuc phi hp l khng trnh khi, cn tun theo
nhng khuyn ngh di y :
- Vi nhng thuc c tc dng hip ng c vi thn : Cn theo di st chc nng thn (c
bit l creatinine huyt thanh). Trng hp chc nng thn b suy gim ng k cn phi gim
liu hoc chuyn sang phng thc iu tr khc.
- Vi nhng thuc lm gim hoc tng sinh kh dng ca ciclosporin :
nhng ngi c ghp cn xc nh nng ciclosporin mu thng xuyn, c bit khi bt
u hay khi ngng iu tr mt loi thuc khc, v iu chnh liu Sandimmun Neoral nu cn.
Vi cc ch nh khc ngoi gh p c quan, nng ciclosporin mu khng tht gi tr v mi
tng quan gia nng thuc trong mu v hiu qu iu tr km thuyt phc hn. Trong
trng hp dng cc thuc lm tng nng ciclosporin, cn kim tra thng xuyn hn chc
nng thn v theo di st cc tc dng ph ca ciclosporin c th thch hp hn l nh lng
nng thuc trong mu.
- Cn trnh iu tr ng thi vi nifedipine nhng bnh nhn trc c biu hin chng
ph i li khi iu tr vi Sandimmun.
- Cc thuc NSAID c bit c t l khng c hp th cao (first-pass effect) nh diclofenac,
nn cn c dng vi liu thp hn ngi khng iu tr vi ciclosporin.
- Nu iu tr ng thi vi digoxin, colchicine hoc lovastatin cn phi theo di cht ch v lm
sng do vy cc tc dng c c th c pht hin sm v tin hnh gim liu hay ngng
thuc.
TC DNG NGOI
Cc tc dng ngoi { di y gp Sandimmun cng c th xy ra vi Sandimmun Neoral. Cc
triu chng ny thng lin quan n liu dng v p ng vi vic gim liu.
Cc tc dng ph thng ging nhau tt c cc ch nh ca thuc, mc d c s khc bit v
tn s xut hien v mc nng. Do dng liu cao hn trong gh p c quan nn cc tc dng
ngoi { cng thng gp hn v nng hn nhng ngi nhn ghp so vi bnh nhn c
iu tr cho cc bnh khc.
Nhng tc dng ph hay gp nht l :
Gim chc nng thn (chim khong 10-50%), tng huyt p (15-40%), run (10-20%), rm lng
(15-40%), ri lon tiu ha (gm n k m ngon, bun nn, nn, au bng, vim d dy, vim d
dy rut, a chy; 20-40%); ph i li (10-30%), suy gan (khong 20%), nhim trng (15-35%),
mt mi (ti khong 30%), au u (ti khong 15%) v d cm (c bit l cm gic nng rt
tay v chn, thng trong tun u iu tr, t l 10-50%).
Cc tc dng ph di y c ghi nhn l t gp hn (khong 1-3%) :
Mn trng c, ban (c th d ng), tng ng huyt, tng axt urc huyt, tng kali huyt, gim

magi huyt ; thiu mu ; lot d dy t trng, ph, tng cn, co git ; au bng kinh hay mt
kinh c th phc hi c. bnh nhn vim mng b o c bit c trng hp xut huyt
(ti mt v ni khc).
Cc tc dng ngoi khc (khong < 1%) c lit k di y :
Cm gic nng bng, nga, chut rt, yu c, bnh v c ; tng lipid mu, ri lon tng sinh m
bch huyt (c bit thm nhim lymph bo lnh tnh v u lymph bo B) ; gim bch cu,
gim tiu cu ; thiu mu cc b c tim ; vim ty cp ; ln ln ; ri lon thc, ri lon thnh
gic, ri lon th gic, st cao, chng v to nam gii. C mt vi bo co v vim rut kt.
Cc du hiu ca bnh no, ri lon th gic, vn ng v mt thc c ghi nhn, c bit
bnh nhn ghp gan.
C mt vi bo co gp gim s lng tiu cu, trong mt vi trng hp c lin quan vi thiu
mu tan mu mao mch v suy thn (haemolytic uraemic syndrome) c ghi nhn. Cng c
t trng hp bo co v co git.
V iu tr ci Sandimmun c th i khi dn ti tng lipid mu nh c th hi phc, cn nh
lng lipid mu trc khi iu tr v sau mt thng. Trng hp thy tng cn gim liu
v/hoc gim lng cht b o n vo.
Cc ri lon khi u v tng sinh m bch huyt :
C ghi nhn v khi u c tnh v ri lon to m bch huyt, nhng khng c s khc bit ln v
t l v s phn b so vi nhng bnh nhn dng cc thuc c ch min dch khc.
Ri lon tng sinh m bch huyt xut hin mt vi bnh nhn vy nn iu tr vi
Sandimmun nhng s ht sau khi ngng thuc ngay sau .
Din bin c tnh (bao gm c bnh u lymph Hodgkin's) c ghi nhn bnh nhn c hi
chng thn h c iu tr cc thuc c ch min dch (bao gm c Sandimmun).
Vim khp dng thp thng gn lin vi nguy c ri lon tng sinh m bch huyt v ri lon
ny c th tng ln do tc dng c ch min dch ca Sandimmun Neoral. C bit c bo co v
u lymph c tnh bnh nhn vim khp dng thp iu tr Sandimmun.
LIU LNG v CCH DNG
Liu lng :
Dng thuc Sandimmun Neoral ng ung c khuyn ngh trong hu ht cc trng hp.
Cc ngoi l c lit k trong phn thng tin v dng thuc Sandimmun truyn tnh mch.
Sandimmun Neoral c hp thu nhanh hn (thi gian thuc t nng ti a trung bnh
sm hn 1 gi v nng thuc ti a trung bnh cao hn 59%) v cho thy tnh sinh kh dng
trung bnh (AUC) cao hn 29% vi liu duy tr dng cho cc bnh nhn ghp thn. nhng
bnh nhn hp thu ciclosporin km t Sandimmun (c bit vi liu ung cao) s khc bit v
sinh kh dng vi Sandimmun Neoral c th ti hn 100%.
Tng liu lng dng hng ngy ca Sandimmun Neoral nn chia lm hai ln (sng v ti).
Xem thm phn "Chuyn t iu tr Sandimmun sang Sandimmun Neoral" bit chi tit v

liu lng v theo di chc nng thn nhng bnh nhn trc iu tr vi Sandimmun.
Ghp c quan :
Mc liu c ngh di y ch mang tnh cht hng dn gi . Cn theo di u n
nng ciclosporin trong mu ; cng vic ny c th thc hin c bng phng php RIA
da trn cc khng th n dng v tnh. Kt qu thu c gip cho vic quyt nh liu dng
thc t t c nng thuc theo nhu cu (xem mc "Xc nh nng ciclosporin trong
mu" trong phn Thn trng lc dng).
Ghp tng :
Cn bt u vi liu t 10-15 mg/kg chia lm 2 ln trc phu thut ti a 12 gi v tip tc
duy tr hng ngy trong 1-2 tun sau m. Sau gim dn liu lng cho ti khi t c liu
duy tr khong 2-6 mg/kg/ngy chia lm 2 ln (ty theo nng thuc trong mu). Tng liu
lng dng hng ngy ca Sandimmun Neoral nn chia lm hai ln.
cc bnh nhn ghp thn cc liu dng mc thp trong khong trn (< 3-4 mg/kg/ngy),
to c mc nng ti thiu di 50-100 ng/ml, thng gn lin vi nguy c tng thi
ghp.
Khi dng Sandimmun Neoral cng vi cc thuc c ch min dch khc (nh corticosteroid hay
khi dng phi hp 3-4 thuc) c th cn gim liu (v d 3-6 mg/kg/ngy trong giai on u
iu tr).
Ghp ty xng :
Liu ban u c dng mt ngy trc khi gh p, nn dng ng truyn tnh mch. Nu
bnh nhn bt u vi ng ung cn dng vi liu 12,5-15 mg/kg/ngy, bt u 1 ngy trc
khi ghp.
iu tr duy tr vi liu khong 12,5 mg/kg/ngy phi c thc hin t 3-6 thng (nn iu tr
6 thng) trc khi gim dn liu cho ti khi ngng thuc l mt nm sau khi gh p.
C th phi dng liu cao hn hoc theo ng tnh mch trong trng hp c ri lon tiu
ha lm gim hp thu.
Tng liu lng dng hng ngy ca Sandimmun Neoral nn chia lm hai ln (sng v ti).
Bnh c quan gh p chng li vt ch (GVHD) c th xut hin sau khi ngng thuc Sandimmun
nhng thng p ng vi vic dng li thuc. Cn dng vi liu thp trong trng hp iu tr
GVHD nh, mn tnh.
Cc ch nh khc ngoi ghp :
Hin cha c kinh nghim vi dng thuc dng ngoi ng tiu ha vi cc ch nh ngoi
gh p c quan.
Vim mng b o ni sinh :
Liu dng :
Bt u ung 5 mg/kg/ngy chia 2 ln ti khi tnh trng vim v th lc c ci thin. Trng
hp bnh dai dng kh cha c th phi tng liu ti 7 mg/kg/ngy trong mt thi gian ngn.

C th kt hp thm iu tr ton thn steroid (v d prednisone 0,2-0,6 mg/kg/ngy) vi

Sandimmun Neoral y mnh qu trnh lui bnh lc u hoc nhm chng li nhng t
vim mt v/hoc nu dng n tr vi loi ny khng hon ton kim ch c bnh. Cn
ngng thuc Sandimmun Neoral nu khng t c ci thin sau ba thng.
Trong khi iu tr duy tr, cn gim dn ti liu hu dng thp nht v liu ny khng vt qu
5 mg/kg/ngy trong thi kz lui bnh.
Theo di chc nng thn :
Sandimmun Neoral c th nh hng ti chc nng thn v do vy cn xc nh gi tr tin cy
v creatinine huyt thanh trc khi iu tr. Gi tr ny cn c ly t t nht 2 ln xt nghim,
c hai ln u cho thy chc nng thn bnh thng khi dng cc cch xc nh thanh thi
creatinine thch hp (nh DETTLI). nh lng creatinine huyt thanh v o huyt p cn c
tin hnh hng tun trong vng 4 tun u iu tr v hng thng tip theo, hoc thng
xuyen hn khi tng liu. Cn gim liu khong 25-50% nu creatinine huyt thanh vt qu
mc thng thng 30% - ngay c khi gi tr ny vn nm trong gii hn bnh thng - v ngng
thuc Sandimmun Neoral nu ch s khng gim trong vng mt thng. Trong trng hp
creatinine vt qu gi tr thng thng 20-30% trong mt thi gian ngn, cn loi tr kh
nng tng khng do thn bng cch lm xt nghim nhiu ln. Nu huyt p tng ng k so vi
mc bnh thng cn iu tr h p v gim liu Sandimmun Neoral hoc ngng thuc nu tnh
trng bnh thng khng t c sau .
Cc ch nh v da liu :
Liu dng cho bnh vy nn :
to tc dng lui bnh, liu dng ban u (ung) c ngh l 2,5 mg/kg/ngy chia lm 2
ln, tng liu nu tnh trng bnh khng c ci thin sau khi iu tr 4 tun vi mc 0,5-1
mg/kg hng thng cho ti liu 5 mg/kg/ngy. Ngng iu tr nhng bnh nhn khng t
c s ci thin ti ni tn thng trong vng 4 tun vi liu 5 mg/kg/ngy, hay nhng
ngi c mc liu hu dng khng ph hp vi cc hng dn v an ton a ra di y
(xem phn Ch { c bit). Liu ban u 5 mg/kg/ngy c p dng cho nhng bnh nhn
trong tnh trng cn c ci thin nhanh.
iu tr duy tr liu lng cn c iu chnh trong tng trng hp c th cho ti mc liu
hu dng thp nht c th c v khng vt qu 5 mg/kg/ngy. Nu tnh trng lui bnh
c duy tr trong thi gian 6 thng, cn gim liu Sandimmun Neoral cho ti ht, mc d nguy
c ti pht sau khi ngng thuc l rt cao.
Liu dng trong vim da d ng :
Mc liu c ngh ngi ln v thanh nin hn 16 tui l 2,5-5 mg/kg/ngy ung lm 2
ln. Nu liu ban u 2,5 mg/kg/ngy khng t c p ng tt trong 2 tun iu tr, c th
tng nhanh ln ti a l 5 mg/kg. Trong cc trng hp rt nng, tc dng lui bnh tt v nhanh
thng t c vi liu ban u 5 mg/kg/ngy.

Kinh nghim vi Sandimmun trong iu tr di ngy vim da d ng cn hn ch v do vy tng

t iu tr c th cn c p dng v ti a l 8 tun.
Cn ngng iu tr nhng bnh nhn khng p ng thch ng sau mt thng iu tr vi
liu 5 mg/kg/ngy.
Ch { c bit :
- Trc khi iu tr bnh nhn phi c thng bo k v nhng li ch v nguy c c th xy ra
khi iu tr Sandimmun Neoral, v v nhng vn hay gp phi do bnh ti pht sau khi
ngng thuc.
- Bnh nhn suy thn, tng huyt p khng kim ch c hay b nhim trng hoc c cc biu
hin c tnh ngoi tr da, khng c iu tr vi Sandimmun Neoral. Lu { nhng bnh
nhn tng acid uric huyt.
- Ngng Sandimmun Neoral nu c tng huyt p khng p ng vi iu tr.
- Theo di chc nng thn : xem phn "Vim mng b o ni sinh" trn.
- Bnh vy nn v khi u da: s tin trin ca cc biu hin c tnh (c bit ti da) c ghi
nhn trn cc bnh nhn c iu tr vi Sandimmun cng nh khi dng cc phng php
iu tr khc. Nhng tn thng khng c trng cho vy nn hoc c kh nng l c tnh hay
tin c tnh do vy phi c sinh thit trc khi iu tr Sandimmun Neoral. Nhng bnh nhn
c thay i c tnh hay tin c tnh ti da ch c dng Sandimmun sau khi iu tr thch
ng v ch khi khng cn phng php iu tr hiu qu no khc (xem Chng ch nh).
- Vim da d ng v nhim trng da : nhim herpes simplex tin trin cn c iu tr ht
trc khi bt u iu tr Sandimmun Neoral nhng khng nht thit phi ngng thuc khi thy
xut hin trong qu trnh iu tr, ch tr trng hp vim nhim nng. Nhim trng da do
Staphylococcus aureus khng phi l chng ch nh tuyt i dng Sandimmun Neoral, nhng
cn c iu tr vi thuc khng khun thch hp. Tuy nhin khng c dng erythromycin
dng ung v c bit c kh nng lm tng lng ciclosporin trong mu (xem Tng tc
thuc). Nu khng cn chn la no khc th phi theo di st nng ciclosporin trong mu,
chc nng thn v cc tc dng ngoi ca ciclosporin.
Vim khp dng thp :
Liu dng :
Trong 6 tun u, ung 3 mg/kg/ngy chia lm 2 ln. Nu cha t c tc dng tt, cn tng
dn ti liu ti a l 5 mg/kg, ty thuc vo cc iu kin a ra di y. Cn ngng iu tr
nu khng t c p ng r rng sau 3 thng. iu tr duy tr cn iu chnh liu cho tng
trng hp c th ty thuc vo kh nng dung np. Sandimmun Neoral c th c s dng
cng vi corticosteroid liu thp v/hoc NSAID.
Ch { c bit :
- Trc khi iu tr bnh nhn phi c thng bo k v nhng li ch v nguy c c th xy ra
khi iu tr Sandimmun Neoral.

- Nhng bnh nhn suy thn, cao huyt p khng kim ch c hoc b nhim trng, hay bt
c biu hin c tnh no khng c iu tr vi Sandimmun Neoral (xem Chng ch nh). Lu
nhng bnh nhn tng acid uric mu hoc tng kali huyt.
- Sandimmun Neoral c th lm nh hng ti chc nng thn do vy cn nh lng mc
creatinine huyt thanh tin cy trc khi trc khi iu tr. Kt qu ny cn c xc nh t t
nht hai ln xt nghim, c hai ln u cho thy chc nng thn bnh thng khi dng cc cch
xc nh thanh thi creatinine thch hp (nh DETTLI). nh lng creatinine huyt thanh v
o huyt p cn c tin hnh hng tun trong vng 4 tun u iu tr v hng thng tip
theo, hoc thng xuyn hn khi tang liu, v khi NSAID c b sung vo phc iu tr
hoc khi tng liu thuc NSAID ang dng. Cn gim liu creatinine huyt thanh vt qu mc
thng thng 30% t 2 ln tr ln, ngay c khi n vn nm trong gii hn bnh thng. Trng
hp creatinine vt qu mc thng thng 20-30%, s tng nht thi khng do thn phi
c loi tr bng cch lm xt nghim nhiu ln. Trng hp ch s xt nghim tng hn 50%
cn gim mt na liu dng Sandimmun Neoral. Cn ngng iu tr nu khng c p ng vi
vic gim liu trong vng mt thng.
- Nu huyt p tng ng k so vi mc bnh thng cn iu tr h p thch hp v gim liu
Sandimmun Neoral hoc ngng thuc nu tnh trng bnh thng khng t c sau .
- Cng nh vi cc phng php iu tr c ch min dch lu di khc, cn lu { ti kh nng
tng sinh m bch huyt.
Hi chng thn h :
Liu dng :
to tc dng lui bnh nn ung ngy hai ln, ngi ln 5 mg/kg/ngy v tr em 6
mg/kg/ngy, ngoi tr bnh nhn suy thn, liu ban u khng nn vt qu 2,5 mg/kg/ngy
(Chng ch nh khi creatinine huyt thanh > 200 mmol/l ngi ln v > 140 mmol/l tr
em).
Cc bnh nhn (c bit nhm khng steroid) khng p ng thch ng vi Sandimmun Neoral
n tr cn c dng ng thi steroid ung vi liu thp. Sau ba thng iu tr, nu bnh
khng c ci thin cn ngng tr vi Sandimmun Neoral.
Liu dng cn c iu chnh cho tng c th ty theo mc hiu qu v phc hi chc
nng (protein niu) v an ton (ch yu l creatinine huyt thanh), nhng khng vt qu 5
mg/kg/ngy ngi ln v 6 mg/kg/ngy cho tr em.
Khi iu tr duy tr cn gim liu dn ti mc hu hiu thp nht.
Theo di chc nng thn :
Sandimmun Neoral c th lm nh hng ti chc nng thn nn cn nh lng creatinine
huyt thanh t nht 2 ln trc khi iu tr. nh lng creatinine huyt thanh v o huyt p
cn c tin hnh hng tun trong vng 4 tun u iu tr v hng thng tip theo, hoc
thng xuyn hn khi tng liu. Cn gim liu khong 25-50% nu creatinine huyt thanh vt

qu mc thng thng hn 30%, trng hp creatinine vt qu mc thng thng 20-30%,

s tng nht thi ngoi thn phi c loi tr bng cch lm xt nghim nhiu ln.
Nu huyt p tng cao ng k so vi mc bnh thng cn iu tr h p thch hp v gim
liu Sandimmun Neoral hoc ngng thuc nu tnh trng bnh thng khng t c sau .
Nhng bnh nhn c cc ch s v chc nng thn bt thng phi c bt u vi liu iu
tr 2,5 mg/kg/ngy v c theo di cht ch. Khng dng Sandimmun Neoral cho ngi ln c
mc creatinine > 200 mmol/l (> 140 mmol/l tr em) (xem Chng ch nh). Do bn thn hi
chng thn h t n bao gm s suy gim v chc nng thn, nhng thay i do
Sandimmun Neoral c th kh c pht hin, v iu ny gii thch ti sao c mt vi bo
co v nhng thay i v cu trc thn khng km tng creatinine huyt thanh. Do vy sinh
thit thn cn c quan tm n nhng bnh nhn tn thng ti thiu ph thuc steroid
s dng Sandimmun Neoral trong thi gian hn mt nm.
Hin cha c ti liu v Sandimmun Neoral tr nh v ti liu v Sandimmun la tui ny
cn hn ch mc d khng c ri lon no c bo co tr hn mt tui vi liu dng tiu
chun. Mt vi nghin cu v nhi khoa cho thy rng tr em cn v dung np liu thuc tnh
theo kg th trng cao hn ngi ln. Bnh nhn vi cc ri lon suy gan nng cn c theo
di cht ch creatinine huyt thanh v, nu c th nng ciclosporin, km theo l vic iu
chnh liu nu cn thit.
Chuyn t iu tr Sandimmun sang Sandimmun Neoral :
Cc ti liu hin c cho thy sau khi chuyn t Sandimmun sang Sandimmun Neoral vi liu
theo t l 1:1, nng thuc ti thiu ca ciclosporin trong mu l tng ng. Tuy vy nng
nh trong huyt tng (Cmax) v tng lng thuc c hp th (AUC) t c mc cao
hn nhiu bnh nhn (trung bnh l 59% v 29% theo th t) v c mt t l nh cc trng
hp hin tng tng ny r rt biu hin trn lm sng. Mc thay i lin quan cht
ch vi nng ciclosporin c hp thu so vi vic dng Sandimmun trc , c bit l
loi thuc c tnh kh dng sinh hc d thay i (xem Dc lc v Thn trng lc dng).
Bnh nhn vi nng thuc ti thiu hay bin i hoc ngi cn dng liu Sandimmun rt
cao c th l nhng ngi hp thu km hay hp thu khng n nh ciclosporin (nh bnh nhn
x ti mt, bnh nhn ghp gan c km mt hay vic bi tit mt km, tr em hoc mt vi
bnh nhn ghp thn) c th c kh nng hp thu tt khi chuyn sang dng Sandimmun Neoral.
Do vy nhm ngi ny vic tng tnh kh dng sinh hc ca ciclosporin c th mnh hn sau
khi chuyn vi liu tng ng t Sandimmun sang Sandimmun Neoral v liu dng
Sandimmun Neoral do cn iu chnh xung cho ph hp vi nng thuc ti thiu c th
cn t.
Cn nhn mnh rng s hp thu ca ciclosporin t Sandimmun Neoral t b thay i hn v mi
tng quan gia nng ciclosporin ti thiu v lng thuc c hp th (AUC) cht ch hn
nhiu so vi Sandimmun. iu ny lm cho nng ciclosporin ti thiu n nh hn v ng

tin cy hn trong qu trnh theo di iu tr.

Do vic chuyn i t Sandimmun sang Sandimmun Neoral c th lm tng lng thuc c
hp thu nn cn phi lu { ti nhng qui nh di y :
Bnh nhn gh p c quan :
Sandimmun Neoral cn c bt u iu tr vi liu tng ng vi liu Sandimmun. Cn
theo di Cmin khong 4-7 ngy sau khi chuyn sang dng Sandimmun Neoral v cn theo di cc
ch s an ton lm sng nh creatinine huyt thanh v huyt p trong vng 2 thng u sau khi
chuyn thuc v iu chnh liu dng nu nng thuc ti thiu vt ra ngoi mc liu iu
tr v/hoc khi cc thng s an ton lm sng thay i.
Bnh nhn vi cc ch nh khc ngoi gh p c quan :
Sandimmun Neoral cn c bt u vi liu tng ng vi Sandimmun trong trng hp
bc s k thoa thy s gim hiu qu iu tr c th lm xut hin nguy c ng k cho ngi
bnh (nh gim th lc trong vim mng b o ni sinh). Liu lng cn c gim xung nu
thy xut hin cc tc dng ngoi .
Trong nhng trng hp bc s k toa cho rng s gim hiu qu tm thi l chp nhn c
(nh trong cc ch nh v da liu), Sandimmun Neoral cn c bt u vi liu 2,5-3
mg/kg/ngy v sau iu chnh li theo cc thng s v hiu qu v an ton.
Cn theo di huyt p v creatinine hng tun trong thng u sau khi chuyn thuc v hng
thng tip theo. Gim liu nu huyt p tng ng k hoc khi creatinine huyt thanh vt qu
gi tr o c trc 30% qua 2 ln xc nh tr ln (xem thm phn Theo di chc nng
thn trong mc Ch { c bit cho mi Ch nh). Trng hp creatinine vt qu mc thng
thng 20-30%, kh nng tng tm thi khng do thn phi c loi tr bng cch lm xt
nghim nhiu ln. Nu xut hin cc du hiu nhim c khng mong mun hoc ciclosporin
khng to c tc dng mong mun cn xc nh nng thuc toi thiu trong mu.
Cch dng :
Tng liu dng hng ngy ca Sandimmun Neoral nn chia lm hai ln (sng v ti).
C th nhn thy mi v c bit ca thuc khi m v thuc, iu ny l bnh thng v khng
cho thy c s thay i g i vi vin thuc.
Vin nang :
Cn nut c vin khi ung.
Khng nn ly vin thuc ra khi v cho ti ngay trc khi s dng.
Trong trng hp bnh nhn (c bit vi ngi cn nng thp) nu khng t c chnh xc
mc liu mong mun khi dng thuc hai liu nh nhau vo bui sng v ti, c th thc hin
theo cc bc sau :
- C th dng cc liu khc nhau vo bui sng v ti.
- Nu cha t c thnh cng, ngi bnh c th chuyn sang dng dung dch ung.
Dung dch ung :

Hng dn cho ln s dng u tin :

- M np bng plastic.
- Tho ht vng nim phong.
- Tho v b nt l mu en.
- t ng n v c nh c chai.
- a syringe vo.
- Ht lng dch thuc cn thit.
- Bm ra v to thnh cc bt bng ln bng cch n v rt pt-tng vi ln trc khi ly syringe
cha lng dch thuc cn thit ra khi l. S xut hin ca mt vi bt nh khng quan trng
v khng nh hng g ti liu dng.
- Sau khi dng, lm sch syringe ch bn ngoi vi mnh giy vi kh mn dng mt ln. Khng
trng ra bng nc, cn hay bt c mt loi dch no khc. Nt trng v ng nn gi li trong
l. y kn l bng np c sn.
S dng sau :
Thc hin li t bc th 5 tr i.
Syringe c tnh theo milimt, mi vch ng vi 0,1 ml.
Dch thuc phi c pha thm ngay trc khi dng, tt nht l vi nc cam hay nc to,
hay thc ung khc khong cha alcohol cng c th c. Tuy nhin khng c dng nc
bi, do nguy c tng tc ti ch lin quan n h enzyme ph thuc P450. Dch thuc phi
c khuy u v ung ngay. Khng c syringe tip xc vi dch pha long.
chc chn rng s dng ht ton b liu thuc, sau khi ung cn cho thm mt cht dch pha
vo cc, lc u sau ung ht. Cn lun dng cng mt loi dch pha.
QU LIU
Du hiu v triu chng :
Ti liu v s dng qu liu cp vi Sandimmun Neoral cn hn ch. Hu qu lm sng ca liu
ung ti 10 g (khong 150 mg/kg) tng i t, gm c nn, bun ng, au u, mch nhanh
v, trong vi trng hp, suy thn va c hi phc. Tuy vy qu liu do tnh c ung thuc tr
nh gy nn tnh trng ng c nng.
X tr :
iu tr triu chng v dng cc bin php h tr trong tt c cc trng hp. Bin php gy
nn v ra d dy trong vi gi u sau khi ung thuc c th hu ch. C thm phn v truyn
than hot u khng lm sch hon ton c ciclosporin trong c th.
BO QUN
Vin nang phi c bo qun nhit di 30oC.
Dch thuc ung lun phi c gi nhit t 15-30oC, nhng khng c nhit
di 20oC trong mt thi gian di. Thuc khng c trong t lnh do c cha cht du t
nhin c th b ng li nhit thp. nhit di 20oC thuc c th tr thnh dng gel,

ln bng nh hay kt ta. Nhng thay i ny c th tr li dng c nhit 25-30oC v

khng nh hng ti tc dng hay an ton ca thuc hoc ti liu dng khi s dng loi
syringe c cung cp.
Khi l thuc c m, cn dng ht thuc trong thi gian 2 thng.

455.

SANDOSTATIN

NOVARTIS
Dung dch tim 50 mg/ml : ng 1 ml, hp 5 ng - Bng B.
Dung dch tim 100 mg/ml : ng 1 ml, hp 5 ng - Bng B.
Dung dch tim 500 mg/ml : ng 1 ml, hp 5 ng - Bng B.
Dung dch tim 200 mg/ml : l a liu 5 ml - Bng B.
THNH PHN
cho 1 ng
Octreotide acetate, tng ng vi octreotide (peptide t do)

50 mg

(Lactic acid, mannitol)

cho 1 ng
Octreotide acetate, tng ng vi octreotide (peptide t do)

100
mg

(Lactic acid, mannitol)

cho 1 ng
Octreotide acetate, tng ng vi octreotide (peptide t do)
(Lactic acid, mannitol)

500 mg

cho 1 ml (l a liu)
Octreotide acetate, tng ng vi octreotide (peptide t do)

200 mg

(Lactic acid, mannitol)

DC LC
Octreotide l cht octapeptide tng hp c tc dng dc l{ tng t nh somatostatin t
nhin, nhng c thi gian tc dng di hn ng k. Thuc c ch s bi tit ca cc peptide
ca h ni tit d dy - rut - ty (GEP : gastroenteropancreatic) v hormone tng trng (GH).
ng vt, octreotide c tc dng c ch hormone tng trng, c ch s gii phng glucagon
v insulin mnh hn somatostatin, cng nh c tc dng chn lc hn trong vic c ch GH v
glucagon. Dng thuc trong thi gian di (26 tun) vi liu ln ti 1 mg/kg/ngy (tim mng
bng) i vi chut v ti 0,5 mg/kg/ngy (ng tnh mch) ch cho thy dung np tt.
ngi tnh nguyn khe mnh, Sandostatin cho thy cc tc dng c ch i vi :
- S gii phng hormone tng trng (GH) kch thch bi arginine, gim ng huyt do hot
ng th dc hoc do insulin.
- S gii phng insulin, glucagon, gastrin, cc peptide khc thuc h GEP sau ba n v s gii
phng insulin v glucagon kch hot bi arginine.
- S gii phng kch gip t (TSH: thyroid stimulating hormone) trong p ng vi TRH
(thyrotropine-releasing hormone).
bnh nhn to vin cc, bao gm c nhng ngi khng p ng vi iu tr phu thut, tia x
hay dng ch vn dopamine, Sandostatin lm gim nng hormone tng trng v/hoc
somatomedin-C. Vic gim ng k lng GH trn lm sng (50% hoc hn) din ra trn hu
ht bnh nhn, v s bnh thng ha (lng GH trong mu < 5 ng/ml) t c vi khong
50% trng hp. Trn hu ht bnh nhn, c s gim ng k cc triu chng lm sng ca
bnh, v d nh au u, sng n da v cc m mm, tng tit m hi, au khp v d cm.
nhng bnh nhn c khi u tuyn yn ln, iu tr Sandostatine c th lm khi u nh li.
Vi nhng bnh nhn c khi u thuc h ni tit d dy - rut - ty (GEP), Sandostatin, do tc
dng nhiu mt v ni tit, lm thay i nhiu bnh cnh lm sng. Do vy cc bnh nhn vi
cc triu chng nng do khi u mc d trc c iu tr bng phu thut, lm tc ng
mch gan, ha tr liu (nh streptozotocin v 5-fluorouracil) v.v... c th cho thy s ci thin
ng k v lm sng.
Cc tc dng ca Sandostatin c lit k di y :
Hi chng carcinoid :
c bit cc triu chng bng v a chy c th cho thy tnh trng ci thin, trong mt s

trng hp tc dng ny i km vi s gim lng serotonin trong huyt tng v s giam

bi tit 5-hydroxyindole acetic acid qua nc tiu. Nu khng thy c p ng khi iu tr vi
Sandostatin, khng nn tip tc iu tr k o di hn mt tun.
Hi chng VIPoma :
c gi nh vy l do c tnh sinh ha ch yu ca n l s sn xut qu mc cc hormone
peptide rut vn mch (vasoactive intestinal peptide - VIP), hi chng VIPoma c c trng
trn lm sng bi a chy nng do tng xut tit. Tnh trng ny thuyn gim trong hu ht cc
trng hp iu tr vi Sandostatin, nh vy ci thin c cht lng cuc sng cho bnh
nhn.
Tnh trng mt dch v in gii km theo (v d h kali mu) c gim bt, cho php ngng
bi ph nc v in gii qua ng tiu ha hoc ngoi ng tiu ha. mt s bnh nhn,
chp ct lp in ton gi ti s lm chm li hay ngng pht trin ca khi u, hoc thm ch
thu nh li, c bit trong trng hp di cn gan. Ci thin lm sng thng i cng vi s
gim hoc thm ch tr v bnh thng ca nng VIP trong huyt tng.
Glucagonomas (u t bo alpha tiu o ty) :
Trong hu ht cc trng hp c s ci thin ng k tnh trng ban da hoi t di tr l du
hiu c trng ca bnh l ny. Sandostatine t c tc dng ti tnh trng tiu ng nh l du
hiu d mc nhm bnh nhn ny, v ni chung khng phi gim liu dng insulin hay cc
thuc ung h ng huyt. Sandostatin to c s thuyn gim cho bnh nhn b a chy v
lm tng cn. Trong nhiu trng hp c hin tng gim ngay lng glucagon trong huyt
tng nhng qu trnh ny khng k o di ; tnh trng lm sng do vy vn tip tc c ci
thin.
Gastrinoma/hi chng Zolinger-Ellison :
Lot d dy ti din do tng tit acid d dy mn tnh do kch thch tng tit gastrin thng
khng phi lc no cng p ng vi cc thuc phong b chn lc th th H2 v cc antacid,
trong khi tnh trng a chy, c th l du hiu ni tri, t c gim bt.
Trong cc trng hp , iu tr Sandostatin - c th kt hp vi mt thuc i khng th th
H2 - c th lm gim s tng tit qu mc dch v v lm gim cc triu chng lm sng (bao
gm c a chy) trong ti 50% cc trng hp. Cc biu hin khc c th gp do khi u lm tng
sinh peptide (nh nng bng) cng c th c p ng. mt s bnh nhn c s gim lng
gastrin trong huyt tng.
U o ty :
C hin tng gim lng insulin p ng min dch lu thng, nhng thng khng ko di
(khong 2 gi). nhng bnh nhn c kh nng phu thut, c th dng Sandostatin trc m
nhm t c v duy tr mc ng huyt bnh thng. i vi nhng bnh nhn c khi u
lnh hoc c tnh khng c kh nng phu thut, vic kim sot ng huyt c th c ci
thin khng km theo hin tng gim insulin lu thng.

GRFomas :
y l loi khi u him gp tit ra yu t gii phng hormone tng trng (GRF : growth
hormone releasing factor) ring r hay kt hp vi cc peptide hot ng khc, gy ra cc du
hiu v triu chng ca bnh to vin cc. Trong mt na s trng hp c nghin cu cho
ti nay, Sandostatin c tc dng ci thin cc biu hin lm sng, c kh nng l do s c ch
bi tit yu t GRF v hormone tng trng, v km theo c th c s gim bt kch c
tuyn yn.
Ngn nga cc bin chng sau phu thut ty :
nhng bnh nhn phu thut ty, dng Sandostatin trc v sau m lm gim s xut hin
cc bin chng c th (nh d ty, p-xe sau gy nhim khun, vim ty cp sau m).
bnh nhn xut huyt d dy - thc qun do gin v tnh mch :
Cc kt qu nghin cu cho thy dng Sadostatin kt hp vi iu tr lm x trong iu tr xut
huyt do gin v tnh mch d dy -thc qun th pht do x gan to ra kt qu tt hn trong
tc dng kim ch chy mu v chy mu ti pht sm, lm gim nhu cu b dch v lm tng t
l sng cn trong 5 ngy u. Trong khi c ch tc dng c th ca Sandostatin cha c
hiu r hon ton, ngi ta cho rng Sandostatin lm gim lng mu lu thng ni tng nh
c ch cc hormone hot mch nh VIP v glucagon.
DC NG HC
Sau khi tim di da, Sandostatin c hp thu nhanh v hon ton. Nng ti a trong
huyt tng t c trong vng 30 pht. Qu trnh o thi thuc sau khi tim di da c
thi gian bn hy l 100 pht. Sau khi tim tnh mch, thuc c thi tr qua 2 pha vi thi
gian bn hy theo th t l 10 pht v 90 pht. Lng thuc c phn phi l 0,27 l/kg v h
s thanh thi ton b l 160 ml/pht. T l gn vi protein huyt tng ln ti 65%. Lng
Sandostatin gn vi t bo mu l khng ng k.
Dc ng hc bnh nhn suy gan :
X gan, nhng khng phi l gan nhim m, i km vi hin tng gim thi tr octreotide
30%.
CH NH
- Kim ch cc triu chng v gim tit hormone tng trng v somatomedin-C trong huyt
tng nhng bnh nhn to vin cc khng p ng vi iu tr phu thut, x tr hoc
dopamine ch vn ; nhng bnh nhn khng c kh nng hay khng mun phu thut ; hoc
trong giai on c tc dng tim tng trc khi x tr t c tc dng hon ton.
- Lm gim cc triu chng do khi u thuc h ni tit d dy-rut-ty (GEP) :
Cc loi khi u c nhiu bng chng v hiu qu ca thuc :
- U carcinoid vi cc c im ca hi chng carcinoid.
- VIPoma.
- Glucagonoma.

Cc loi khi u cho thy thuc c tc dng trong khong 50% trng hp (hin vi s lng
bnh nhn hn ch). Trong cc trng hp ny, tc dng ca Sandostatine gii hn trong vic
lm gim cc du hiu v triu chng, khng phi l thuc c tr :
- Gastrinomas/hi chng Zollinger-Ellison (thng kt hp vi iu tr thuc khng H2 chn lc
c km hoc khng vi thuc khng acid).
- U o ty (insulinoma, trong vic kim ch h glucose huyt trc khi phu thut v trong
iu tr duy tr).
- GRFoma.
- Phng nga cc bin chng sau phu thut ty.
- iu tr cp cu xut huyt do gin v tnh mch d dy - thc qun do x gan dng kt hp
vi iu tr c hiu nh lm x qua ni soi.
Cng trnh nghin cu ti Vin Lao v Bnh Phi Trung ng dng Sandostatin iu tr cp cu
ho ra mu bnh nhn lao phi bc u cho thy kt qu tt (gio s Hong Minh v cng
s).
CHNG CH NH
Qu mn vi mt trong cc thnh phn ca thuc.
THN TRNG LC DNG
Do khi u tuyn yn bi tit GH i khi c th pht trin gy cc bin chng nng (nh gim th
trng), cn theo di tt c cc bnh nhn cn thn. Nu c cc du hiu khi u tng kch
thc, c th la chn phng thc iu tr khc.
S hnh thnh si mt c ghi nhn t 10-20% bnh nhn dng Sandostatin trong thi gian
di. Kim tra siu m ti mt trc v trong qu trnh iu tr Sandostatin mi 6-12 thng l cn
thit.
mt vi bnh nhn c khi u thuc h ni tit d dy - rut-ty iu tr Sandostatin c gp
trng hp bt pht khng kim ch c cc triu chng vi biu hin ti pht cc triu
chng nng.
nhng bnh nhn u o ty, Sandostatin c th lm tng tnh trng h ng huyt v ko
di do c tc dng c ch bi tit hormone tng trng v glucagon tng i mnh hn l
insulin. Nhng bnh nhn ny cn c theo di cht ch khi bt u iu tr vi Sandostatin
v mi khi thay i liu dng. Nhng bin i v nng glucose trong mu c th c hn
ch bng vic dng nhng liu nh v thng xuyn hn. i vi nhng bnh nhn i ng
ph thuc insulin, c th cn iu chnh lng insulin iu tr khi dng kt hp vi Sandostatin.
bnh nhn x gan trong trng hp xut huyt lm tng nguy c i ng ph thuc
insulin hoc cc thay i v nhu cu dng insulin nhng ngi mc bnh i ng t
trc, vic theo di cht ch nng glucose trong mu l cn thit.
LC C THAI v LC NUI CON B
Cc nghin cu v sinh sn trn ng vt khng cho thy c nguy c no v tn thng bo

thai nhng hin cha c kinh nghim v s dng Sandostatin ph n c thai hoc cho con b.
Nhng bnh nhn ny v vy ch c dng thuc nu tht cn thit.
TNG TC THUC
Sandostatin lm gim hp thu ciclosporin ng tiu ha v lm hp thu chm cimetidine.
TC DNG NGOI
Cc tc dng ph chnh gp phi khi iu tr Sandostatin thng l ti ch v ng tiu ha.
Phn ng ti ch sau khi dng thuc qua ng di da bao gm au hay cm gic nhc, cm
gic nhi hay nng ti ch tim, sng v . Cc du hiu ny thng t khi ko di qu 15 pht
v c th lm gim nh bng cch dch thuc ln ti nhit trong phng trc khi tim hay
tim vi liu lng nh hn vi dch thuc c hn.
Cc tc dng ng tiu ha bao gm chn n, bun nn, nn, au qun bng, chng bng,
y hi, phn lng, a chy v i ngoi phn m.
D lng m o thi qua phn c th tng, hin cha thy c bng chng v vic iu tr lu
di vi Sandostatin c th dn ti suy dinh dng do gim hp thu. Trong mt s t trng hp
c th c cc triu chng ging tc rut cp nh au nng vng thng v v nhy cm au khi
n, chng v n bng. C th lm gim cc tc dng ph nh trnh n quanh thi im
dng thuc, tim thuc khong gia cc ba n hay khi i ng.
iu tr lu di Sandostatin c th to nn si mt (xem Thn trng lc dng).
Do tc dng kim ch s gii phng hormone tng trng, glucagon v insulin, Sandostatin c
th lm nh hng n s iu ha glucose. Dung np glucose sau khi n c th b nh hng
v dn ti lm tng ng huyt thng xuyn mt vi bnh nhn dng thuc trong thi
gian di.
H ng huyt cng c ghi nhn.
Him gp rng tc bnh nhn iu tr vi Sandostatin.
Vim ty cp c ghi nhn mt vi trng hp, thng thy xut hin trong vng vi gi
hay vi ngy u iu tr Sandostatin v ht dn sau khi ngng thuc. Vim ty cp cng c th
gp nhng bnh nhn iu tr Sandostatin lu di c pht trin si mt.
Trng hp c bit, ghi nhn c ri lon chc nng gan khi dng Sandostatin. Cc biu hin ny
bao gm :
- Vim gan cp khng km theo mt v ch s transaminase s tr v bnh thng khi ngng
thuc.
- Tng bilirubin huyt chm km vi s tng alkaline phosphatase, g-glutamyl transferase v
mc thp hn, transaminase.
LIU LNG v CCH DNG
Bnh to vin cc :
Liu ban u 0,05-0,1 mg tim di da mi 8 gi, sau iu chnh liu ty theo nh gi v
lng GH hng thng v cc triu chng lm sng, v kh nng dung np thuc. i vi hu ht

bnh nhn, liu dng hng ngy tt nht l 0,2-0,3 mg. Khng nn dng qu liu 1,5 mg/ngy.
C th gim liu sau vi thng iu tr kt hp vi theo di nng GH trong huyt tng.
Nu lng GH khng gim v cc triu chng lm sng khng c ci thin sau mt thng
iu tr, cn ngh ti vic ngng iu tr.
Khi u thuc h ni tit ng d dy - rut - ty :
Liu dng ban u 0,05 mg, 1-2 ln/ngy, tim di da, tng dn liu ti 0,2 mg, 3 ln/ngy ty
theo tnh trng dung np v p ng vi iu tr (p ng lm sng, nng ca cc hormone
do khi u tit ra). C th cn dng liu cao hn trong mt s trng hp. Liu duy tr cn c
iu chnh ty theo tng trng hp.
Cc bin chng sau phu thut ty :
0,1 mg x 3 ln hng ngy tim di da trong 7 ngy lin tip, bt u vo ngy trc phu thut
t nht 1 gi trc m.
Xut huyt do gin v tnh mch thc qun :
0,025 mg/gi truyn tnh mch lin tc ti a 5 ngy. Sandostatin c th c pha long vi
nc mui sinh l{ (xem Hng dn s dng).
Hin cha c chng c v kh nng dung np b gim hay cn thay i liu dng ngi gi
c iu tr vi Sandostatin.
Kinh nghim iu tr Sandostatine tr em cn rt hn ch.
Lu { : Bnh nhn t tim thuc di da phi c bc s hay y t hng dn c th. gim
cc phn ng ti ch cho bnh nhn, dch thuc cn t ti nhit phng trc khi tim.
Trng hp tim nhiu ln cch nhau trong thi gian ngn, cn trnh tim cng mt v tr.
trnh nhim bn, khng chch qua np l nhiu qu 10 ln (l cha nhiu liu).
bnh nhn suy gan xut huyt do gin v tnh mch d dy-thc qun, Sandostatin c
dung np tt vi liu 0,05 mg/gi truyn tnh mch lin tc trong 5 ngy.
Hng dn s dng :
Trong cc trng hp dng Sandostatin truyn tnh mch, mt ng 0,5 mg thng c ha
tan trong 60 ml dung dch nc mui sinh l. Nhm t c liu dng c ngh l 0,025
mg/gi, dung dch pha long cn c truyn trong 20 gi vi mt bm truyn.
Tr liu ny cn c lp li thng xuyn nu cn thit cho ti khi t c thi gian iu tr
theo ch nh. Sandostatin c truyn vi c thp hn v vi dung dch glucose.
Dung dch truyn bn vng trong 24 gi sau khi c pha.
QU LIU
Hin cha c bo co no v phn ng ph nguy him n tnh mng sau khi dng qu liu cp
c ghi nhn. Liu n tr cao nht cho ti nay cho mt bnh nhn ngi ln l 1 mg tim
tnh mch chm. Cc du hiu v triu chng quan st c l gim nhp tim, bng mt, au
bng, a chy, cm gic trng rng trong d dy v bun nn, tt c cc biu hin ny hi phc
trong vng 24 gi.

Mt bnh nhn c bo co tnh c dng thuc Sandostatin qu liu do truyn lin tip
(0,25 mg/gi trong 48 gi thay v 0,025 mg/gi). Bnh nhn ny khng biu hin tc dng ph.
X tr qu liu ch gm iu tr triu chng.
BO QUN
Bo qun nhit 2-8oC v trnh nh sng. i vi vic dng thuc hng ngy c th
thuc nhit phng trong 2 tun

456.

SANOFORMINE

MAYOLY-SPINDLER
c/o TEDIS
vin nn dng pha dung dch sc ming v ra m o : hp 50 vin.
THNH PHN
cho 1 vin
ng sulfate khan

40 mg

Natri fluorure

40 mg

(Menthol)
(Tinh du)

Lu { s hin din ca menthol.

DC LC
Thuc st khun.
CH NH
V sinh, ty trng nim mc.
- trong khoa tai mi hng : vim ming, vim hng .
- trong ph khoa : vim m o, huyt trng.
CHNG CH NH
Mn cm vi mt trong cc thnh phn ca thuc.
Lin quan n menthol : tr di 30 thng tui.
CH PHNG
Trng hp s dng trn nim mc : s dng thn trng tr di 7 tui.
TC DNG NGOI

C kh nng gy hiu lc ton thn.

LIU LNG v CCH DNG
Khng c ung.
Dng cho Ngi ln/Tr em. S dng thn trng Tr em di 7 tui.
2 n 3 vin/lt nc nng dng sc ming hoc ngm, ra m o.

457.

SECTRAL 200

XNLD RHNE POULENC RORER

[AVENTIS PHARMA]
vin nn 200 mg : hp 20 vin.
THNH PHN
cho 1 vin
Acbutolol chlorhydrate tnh theo dng base

200 mg

(Lactose)
DC LC
Thuc chn bta chn lc trn bta-1.
Ac butolol c c trng bi ba c tnh dc l :
- tc ng chn bta chn lc trn bta-1,
- tc dng chng lon nhp,
- c kh nng ch vn tng phn (hoc tc ng ging giao cm ni sinh).
DC NG HC
- Hp thu : dng ng ung, ac butolol c hp thu nhanh v gn nh hon ton ; tuy nhin
b chuyn ha nhiu khi qua gan ln u v c sinh kh dng l 40% ; nh hp thu trong huyt
tng t c sau khong 2 n 4 gi.
Cn lu { rng tr em, khi dng cng mt liu vi ngi ln, s c nng ti a trong huyt
tng hi cao hn.
- Chuyn ha : phn ln ac butolol c chuyn ha gan thnh dn xut N-actyl l
diactolol l mt cht chuyn ha c hot tnh, cht ny t nng nh trong huyt tng
sau khong 4 gi, chim gp i nng ca acbutolol trong huyt tng.
- Phn phi :
- lin kt yu vi protine huyt tng : 9 n 11% i vi ac butolol, 6 n 9% i vi
diactolol.

- thi gian bn hy o thi trong huyt tng ca acbutolol l khong 4 gi v ca diactolol

l 10 gi.
- o thi : ac butolol v diac tolol c o thi ch yu qua thn.
Dn s c nguy c :
- Suy thn : o thi qua nc tiu gim v tng thi gian bn hy ca acbutolol, nht l ca
diactolol.
C s tng quan rt ng k gia thanh thi cratinine v thanh thi thn ca diactolol.
C nguy c gy tch t khi bnh nhn b suy thn, ch yu khi dng liu 2 ln/ngy. Cn gim
liu v tng cng theo di lm sng, chng hn trn tc dng gy chm nhp tim (xem Ch {
phng v Thn trng lc dng).
- Ngi gi : sinh l ca chc nng thn gim c th dn n tng thi gian bn hy ca
acbutolol v diactolol.
- Ph n c thai : ac butolol qua c nhau thai. T l trung bnh gia nng trong mu dy
rn/mu ngi m ca acbutolol v cht chuyn ha c hot tnh ca n l diactolol l
khong 1,6 i vi cc liu t 200 n 400 mg.
Nng ti a c ghi nhn i vi ac butolol l 4 n 5 gi sau liu dng cui cng, v i
vi diac tolol l 5 n 7 gi sau .
- Ph n nui con b : ac butolol c bi tit qua sa m ; nng ac butolol t ti a
trong sa m t 4 gi 30 n 6 gi sau khi ung thuc. T l trung bnh gia nng trong sa
m / mu ngi m thay i t 4 n 5,5 i vi cc liu t 200 n 400 mg. i vi diactolol,
t l ny thay i t 3 n 4, nng ti a c ghi nhn l 7 gi sau khi dng liu 200 mg
v12 gi sau khi dng liu 400 mg.
CH NH
iu tr cao huyt p.
D phng cn au tht ngc do c gng.
iu tr mt vi ri lon nhp : trn tm tht (nhp tim nhanh, cung ng v rung nh, nhp tim
nhanh b ni) hoc tm tht (ngoi tm thu tht, nhp tim nhanh tht).
iu tr di hn sau nhi mu c tim (ac butolol lm gim nguy c ti pht nhi mu c tim v
gim t vong, nht l t t).
CHNG CH NH
- Hen suyn v cc bnh ph qun-phi mn tnh tc nghn.
- Suy tim khng kim sot.
- Sc tim.
- Bloc nh-tht bc hai v bc ba khng c t my to nhp.
- au tht ngc Prinzmetal.
- Bnh xoang tim (k c bloc xoang-nh).
- Nhp tim chm (< 40-50 ln/pht).

- Hin tng Raynaud v cc ri lon ng mch ngoi bin.

- U ty thng thn khng c iu tr.
- H huyt p.
- Qu mn cm vi acbutolol.
- Tin s c phn ng phn v.
- Phi hp vi floctaf nine v sultopride : xem Tng tc thuc.
- Ph n nui con b : xem Lc nui con b.
Chng ch nh tng i :
- Phi hp vi amiodarone : xem Tng tc thuc.
CH PHNG
Khng c ngng thuc t ngt khi iu tr bng thuc chn bta cho bnh nhn au tht
ngc : ngng thuc t ngt c th gy ri lon nhp nng, nhi mu c tim hoc t t.
THN TRNG LC DNG
Ngng thuc : khng c ngng iu tr t ngt, c bit bnh nhn c bnh tim tc
nghn. Liu dng phi c gim t t, tt nht l trong mt n hai tun, ng thi nu thy
cn, nn bt u mt liu php thay th, trnh lm trm trng thm chng au tht ngc.
Hen suyn v cc bnh ph qun-phi mn tnh tc nghn : ch dng thuc chn bta khi tnh
trng hen suyn v cc bnh ph qun-phi ch dng nh v dng liu thp lc u. Trc khi
bt u iu tr nn lm cc kim tra chc nng h hp.
Nu trong qu trnh iu tr c xy ra cn hen ph qun, c th s dng thuc lm gin ph
qun c tc ng ging bta.
Suy tim : bnh nhn suy tim c kim sot bng mt iu tr thch hp v trong trng hp
cn thit, ac tabutolol c s dng vi liu rt thp sau tng dn v phi c theo di y
khoa cn thn.
Nhp tim chm : nu tn s gim di 50-55 nhp p/pht lc ngh ngi v nu bnh nhn c
nhng du hiu lin quan n bnh nhp tim chm, cn phi gim liu.
Bloc nh-tht mt : do c tnh dn truyn trong tim m tnh, cc thuc chn bta phi c
s dng tht thn trng nhng bnh nhn b bloc nh-tht giai on mt.
au tht ngc Prinzmetal : thuc chn bta c th lm tng s ln v thi gian ko di ca cn
au tht ngc Prinzmetal. C th dng thuc chn bta-1 chn lc trn tim trong cc th nh v
c phi hp, vi iu kin phi km vi mt thuc gy gin mch.
Ri lon ng mch ngoi bin : bnh nhn c nhng ri lon ng mch ngoi bin (bnh
hoc hi chng Raynaud, vim ng mch hoc bnh ng mch mn tnh tc nghn cc chi
di), thuc chn bta c th lm nng thm cc ri lon ny. Trong cc trng hp ny, nn
u tin dng thuc chn bta chn lc trn tim v c kh nng ch vn tng phn, v s dng
mt cch thn trng.
U ty thng thn : dng thuc chn bta trong iu tr cao huyt p do u ty thng thn cn

phi c theo di st v huyt p ng mch.

Ngi gi : ngi gi, cn nghim chnh chp hnh nhng im ghi trong mc Chng ch
nh. Cn bt u iu tr vi liu thp v theo di st.
Suy thn : iu chnh liu theo tnh trng ca chc nng thn, kim tra nhp tim, gim liu nu
nhp tim chm qu mc (< 50-55 nhp/pht lc ngh ngi).
Bnh nhn i tho ng : cnh gic bnh nhn v vic tng cng t theo di ng huyt
thi gian u iu tr. Cc du hiu cho thy h ng huyt c th b che lp, c bit l nhp
tim nhanh, nh trng ngc v tot m hi.
Bnh vy nn : bnh c th b trm trng ln khi bnh nhn c iu tr bng thuc chn bta,
do vic ch nh dng thuc ny cn phi c cn nhc.
Phn ng d ng : nhng bnh nhn c c a c th b phn ng phn v nng, do bt kz
nguyn nhn g, c bit i vi cc thuc cn quang c iode hoc floctaf nine (xem Tng tc
thuc) hoc trong thi gian iu tr bng cc thuc gy gii cm ng, vic iu tr bng thuc
chn bta c th lm phn ng nng thm v dn n khng vi adr naline c s dng
iu tr d ng liu thng thng.
Thuc gy m : dng thuc chn bta s dn n gim phn x lm tim p nhanh v tng nguy
c gy tt huyt p. Nu duy tr vic iu tr bng thuc chn bta s gim nguy c b lon nhp,
thiu mu cc b c tim v cao huyt p kch pht. Cn nn thng bo cho chuyn vin gy
m bit rng bnh nhn ang c iu tr bng thuc chn bta.
- Nu cn thit phi ngng iu tr, vic gin on 48 gi c th c coi l cho bnh
nhn nhy cm tr li vi catcholamine.
- Trong mt vi trng hp khng th ngng thuc chn bta :
- nhng bnh nhn b suy mch vnh, nn tip tc iu tr cho n khi phu thut, v d xut
hin cc nguy c do ngng t ngt thuc chn bta ;
- trong trng hp cp cu hoc khng th ngng thuc c, bnh nhn phi c bo v u
tin trn dy thn kinh ph v bng cch s dng atropine trc phng nga v lp li ty
theo nhu cu. Cn dng thuc gy m t gy suy c tim v nu c mt mu phi c b ngay.
- Nguy c b sc phn v cng phi c lu { n.
Tng nng tuyn gip : thuc chn bta c th che lp mt s du hiu tim mch.
Vn ng vin th thao : cc vn ng vin th thao cn lu do s dng thuc chn bta c
th cho kt qu dng tnh x t nghim s dng cht kch thch.
LC C THAI
Kho st gy qui thai :
Thuc khng gy qui thai trn th vt. Trn ngi, cho n nay cha ghi nhn c trng
hp gy qui thai no do dng thuc v cc kt qu nghin cu thm d c kim sot vi mt
vi loi thuc chn bta khng cho thy c kh nng gy d dng tr s sinh.
Kho st trn tr s sinh :

 tr s sinh c m c iu tr, tc ng ca thuc chn bta c th ko di trong nhiu ngy

sau khi a b ra i : s tn ng ny c th khng gy hu qu g trn lm sng, tuy nhin
cng c th gy try tim cn phi c nhp vin sn sc c bit (xem Qu liu), trnh
dng cc dung dch thay th (c th gy ph phi cp tnh) ; mt khc cng ghi nhn mt s
trng hp b chm nhp tim, suy h hp, h ng huyt. Do tr s sinh cn c theo di
c bit (v tn s tim v ng huyt trong 3 n 5 ngy u ca cuc sng) trong bnh vin
chuyn khoa.
LC NUI CON B
Ac butolol c bi tit nhiu qua sa m (xem Dc ng hc) v gy chn cc th th bta
tr s sinh (h ng huyt, nhp tim chm). Do chng ch nh acbutolol cho b m nui
con b.
TNG TC THUC
Chng ch nh phi hp :
- Floctaf nine : trng hp b sc hoc tt huyt p do floctafnine, thuc chn bta lm gim
cc phn ng b tr tim mch.
- Sultopride : ri lon tnh t ng (nhp tim chm qu mc) do phi hp tc dng lm chm
nhp tim.
Khuyn khng nn phi hp :
- Amiodarone : ri lon co bp, tnh t ng v dn truyn (hy c ch b tr giao cm).
Cn thn trng khi phi hp :
- Thuc gy m bay hi dn xut halogne : thuc chn bta lm gim phn ng b tr tim
mch (c ch bta adrnergic c th tng trong thi gian phu thut c dng cc thuc kch
thch bta). V nguyn tc chung, khng c ngng thuc chn bta, v trong mi trng
hp, trnh ngng thuc t ngt. Thng bo cho chuyn vin gy m v vic bnh nhn ang
dng thuc.
- Thuc i khng calcium (bbridil, diltiazem v vrapamil) : ri lon tnh t ng (chm nhp
tim qu mc, ngng xoang), ri lon dn truyn nh-tht v try tim (hip ng cc tc ng).
- Thuc chng lon nhp (propafnone v nhm I a : quinidine, hydroquinine, dysopyramide) :
ri lon co bp, tnh t ng v dn truyn (hy c ch b tr giao cm).
Tng cng theo di lm sng v in tm .
- Baclofne : tng tc dng h huyt p.
Theo di huyt p ng mch v iu chnh liu ca thuc h huyt p nu thy cn thit.
- Insuline, sulfamide h ng huyt : tt c cc thuc chn bta c th che lp mt vi triu
chng h ng huyt nh nh trng ngc v nhp tim nhanh. Bo trc cho bnh nhn iu
ny v khuyn bnh nhn nn tng cng t theo di ng huyt.
- Lidocaine (m t cho propranolol, mtoprolol, nadolol) : tng nng lidocaine trong huyt
tng v c th lm tng cc tc dng ngoi trn thn kinh v tim mch (do gim chuyn ha

lidocaine gan).
iu chnh liu lidocaine. Theo di lm sng, in tm v nu c th, nng ca lidocaine
trong thi gian v sau khi ngng iu tr bng thuc chn bta.
- Thuc cn quang c iode : trng hp b sc hoc tt huyt p gy bi cc thuc cn quang c
iode, thuc chn bta lm gim cc phn ng b tr tim mch.
Phi ngng iu tr bng thuc chn bta nu c th mi khi cn phi lm cc xt nghim bng
quang tuyn. Nu khng th ngng thuc c, bc s cn phi trang b cc phng tin cp
cu hi sc thch hp.
Mt s phi hp cng cn nn lu { :
- Thuc khng vim khng stroide : gim tc dng h huyt p (do cc thuc khng vim khng
stroide ni chung gy c ch cc prostaglandine gy gin mch v nhm pyrazol gy gi
mui-nc).
- Thuc i khng calcium (dihydropyridine) : h huyt p, try tim bnh nhn c suy tim tim
n hoc khng c kim sot (nhm dihydropyridine c tc dng inotrope m tnh in vitro, t
nhiu ng c lu { ty theo sn phm v c th hip ng vi tc dng inotrope m tnh
ca thuc chn bta). Vic iu tr bng thuc chn bta mt khc c th lm gim cc phn
ng giao cm do phn x trong trng hp ng lc mu tng qu mc.
- Thuc chng trm cm nhm imipramine (ba vng), thuc an thn kinh : tc dng h huyt p
v tng nguy c gy h huyt p th ng (hip ng tc dng).
- Corticoide, ttracosactide : gim tc dng h huyt p (do corticoide c tc dng gy gi
mui-nc).
- M floquine : nguy c b chm nhp tim (hip ng tc dng lm chm nhp tim).
TC DNG NGOI
V phng din lm sng :
Nhng tc dng ngoi { thng c ghi nhn : suy nhc, cm gic lnh u chi, chm nhp
tim, nng hn nu c dp, ri lon tiu ha (au bao t, nn, ma), bt lc, mt ng, c c
mng.
Rt him gp hn : chm dn truyn nh-tht hoc nng thm tnh trng bloc nh-tht c,
suy tim, tt huyt p, co tht ph qun, h ng huyt, hi chng Raynaud, nng thm chng
khp khnh cch hi c, cc biu hin ngoi da khc nhau k c pht ban dng vy nn.
V phng din sinh hc :
Trong mt s trng hp rt him, c th xut hin khng th khng nhn v ch trong trng
hp ngoi l c phi hp vi cc biu hin lm sng kiu hi chng lupus v khi khi ngng
iu tr.
LIU LNG v CCH DNG
Cao huyt p : 400 mg/ngy, dng mt ln vo bui sng hoc chia lm 2 ln vo bui sng v
ti.

D phng cn au tht ngc v ri lon nhp tim nhanh : 400 n 800 mg/ngy.
iu tr di hn sau nhi mu c tim : mi ln 200 mg, 2 ln/ngy, vo bui sng v ti.
QU LIU
Trng hp chm nhp tim hoc huyt p gim qu mc, c th p dng mt s bin php :
- atropine, liu 1 n 2 mg, ng tnh mch,
- glucagon, liu 1 mg, c th lp li,
- sau , nu cn, tim chm isoprnaline 25mg hoc dobutamine 2,5 n 10 mg/kg/pht.
Trng hp tr s sinh b mt b tim do m c iu tr bng thuc chn bta :
- glucagon, liu c bn 0,3 mg/kg,
- nhp vin v sn sc c bit,
- isopr naline v dobutamine : thng dng liu cao v iu tr ko di cn phi c theo di
bnh vin chuyn khoa (xem Lc c thai v Lc nui con b).

458.

SEDUXEN

GEDEON RICHTER
vin nn 5 mg : v 10 vin, hp 10 v.
dung dch tim 10 mg/2 ml : ng 2 ml, hp 5 ng.
THNH PHN
cho 1 vin
Diazepam

5 mg

cho 1 ng
Diazepam

10 mg

Lidocaine

4 mg

DC LC
Diazepam c tc dng gip lm thun li tc dng gy c ch ca GABA, trc ht l vng
cht cu to di v no. Tc dng gii lo ca diazepam khc vi barbiturate v ethanol, v n
khng to ra s c ch ton th h thn kinh. N cng c tc dng lm gin c v chng ng
kinh, v khng gy ra nhng tc dng khng mong mun ngoi thp.

DC NG HC
Sau khi c hp th nhanh, diazepam lin kt mnh vi protein huyt tng. Nhng cht
chuyn ha chnh ca n l N-desmethyldiazepam, oxazepam. Trong huyt tng, nng ca
diazepam gim theo hai pha : pha phn phi nhanh u tin ko di khong 1 gi, tip theo l
pha thi tr ko di 24-48 gi, thm ch cn lu hn nu tnh n c nhng cht chuyn ha.
Ngoi s bi tit vo nc tiu, thuc cng qua vng tun hon gan rut. tr s sinh, ngi
cao tui, ngi bnh suy gan thn thi gian bn thi c th tng gp nhiu ln.
CH NH
Vin nn :
iu tr b sung cc bnh lin quan n chng lo u (bnh thn kinh). iu tr stress thong qua
sau chn thng tm l{, tnh trng bn chn, nhng triu chng thn kinh thc vt ( m hi,
run, hi hp...). iu tr h tr cc chng ri lon tm thn c ngun gc thc th.
Tim bp v tim tnh mch chm :
Dng diazepam trc khi can thip iu tr hoc can thip phu thut (ni soi, kh rung tim,
t ng thng tim, tiu phu, ti nh v sai khp v gy xng, sinh thit, thay bng khi b
bng...) gim kch ng hay cc phn ng stress cp tnh, dn m hoc b sung thuc gy
m.
Trong khoa tm thn : iu tr cc trng thi kch thch, bn chn, hong s c ngun gc t
trng thi kch ng ; m sng ru cp.
iu tr cp tnh cho cc hi chng co git, nh ng kinh cn ln, ng kinh cn b , ng kinh
lin tc v cc tnh trng co git khc (un vn, kinh git).
Ch nh chung cho c ng tim v ng ung :
Trong trng hp chn thng ti ch (tn thng, vim) dng iu tr h tr gim co tht
c phn x.
Trong nhng chn thng ni thn kinh trn gai v ct sng dng diazepam i khng tnh
trng co tht nh co tht ngun gc no, bnh bi lit tr em, chng lit hai chi di, ri lon
vn ng c c tnh tng vn ng, hi chng Stiff-man.
Trong trng hp cai ru cp - vt qua chng nghin ru - vic dng thuc phi c
quyt nh da trn tng trng hp.
CHNG CH NH
- Qu mn cm vi bt c thnh phn no ca thuc hoc vi nhng dn xut benzodiazepine
khc.
- Nhc c nng.
Bnh tng nhn p gc hp v bnh tng nhn p cp th phi chng ch nh dng thuc ny,
nhng diazepam c th c dng cho nhng bnh nhn c bnh tng nhn p gc m
dng liu php iu tr thch hp.
- Bnh tng CO2 huyt mn tnh v trm trng.

- 3 thng u ca thai kz. Thi kz cho con b.

Chng ch nh tng i :
- Dng vi s thn trng cao trong trng hp ngng th gy ng, suy tim-h hp (iu ny
c bit c gi tr i vi thuc tim).
- 3 thng gia v 3 thng cui ca thai kz.
CH PHNG v THN TRNG LC DNG
Tim bp nn tim su vo trong c.
Tim tnh mch ch nn tim chm, tc 0,5 ml/30 giy. Tim nhanh c th gy ngng th.
Thit b hi sc nn c sn. Ngoi ra, nn trnh tim vo nhng tnh mch nh, trnh tim ra
ngoi mch hoc trong ng mch.
Thuc tim Seduxen khng nn dng chung ng tim vi bt kz ch phm no khc, v c nguy
c kt ta.
Nu cn, thuc tim Seduxen nn c ha vi dung dch dch truyn glucose 5% theo cch sau
:
- Khng qu 5 ng tim Seduxen (10 ml) nn ha vi 500 ml dch truyn glucose 5%, hoc
- Khng qu 1 ng tim Seduxen (2 ml) nn ha vi 100 ml dch truyn glucose 5%.
- Dung dch ny nn c pha ngay trc khi dng.
- Ch truyn dch nh git dung dch mi pha.
Th t pha long khng nn thay i, thuc tim Seduxen phi lun lun pha vo dch truyn
glucose 5%.
Trong trng hp suy h hp, ngng th gy ng v hn m, vic s dng thuc ny nn c
cn nhc k cng, do nguy c try h hp.
Liu lng nn c xc nh vi s thn trng ti a trong trng hp ngi bnh suy chc
nng thn v gan, c suy phi mn, ngi gi v suy nhc, nh nhi v tr em.
Nu trm cm nng v nghi ng c trm cm tim n, th ngi bnh ch c th c iu tr
vi s ch { cao , v s nguy him ca khuynh hng t vn tng mnh. Vic dng thuc lu
v ko di c th dn n s l thuc thuc. Trng hp ngng thuc t ngt sau khi iu tr
lu di, th triu chng cai thuc c th xy ra.
Vi tr di 6 tui, khng nn dng cc dng an thn, tr nhng ch nh bt buc.
Trng hp nhy cm vi lactose, nn tnh mi vin Seduxen cha 120 mg lactose.
iu tr thi gian di, nn kim tra nh kz chc nng gan v cng thc mu.
Trng hp nh nhi di 6 thng :
Nn tnh n s chuyn ha thuc cha pht trin, khng nn dng vin n n ny. i vi tr s
sinh di 30 ngy, s an ton v hiu qu ca vic dng thuc tim cha c chng minh.
Li xe v vn hnh my mc :
Trong pha u dng Seduxen, cm li xe hoc lm cc cng vic nguy him 12-24 gi sau khi
dng thuc. Sau mc hn ch nn c xc nh theo tng c th. Thi gian thi tr ko

di, c bit ngi cao tui v nhng bnh nhn suy gan hoc suy thn, nn c cn nhc.
Trong giai on iu tr v do tc dng ca thuc, cm ung cc loi ung c cn.
LC C THAI v LC NUI CON B
Lc c thai :
i vi ngi mang thai, da trn nhng kt qu thc nghim, trong 3 thng u ca thai kz,
benzodiazepin lm tng nguy c xut hin d dng, v th cm dng Seduxen trong thi kz ny.
Dng thuc trong nhng thng tip theo ca thai kz, c th gy c ch h thn kinh trung ng
v suy h hp tr s sinh, v vy thy thuc nn cn nhc vic dng thuc theo tng c th,
cn nhc k gia li v hi.
Lc nui con b :
Trong thi kz cho con b, khng nn dng thuc, v thuc c th bi tit qua sa m.
TNG TC THUC
Cc thuc chng co git hoc hng tm thn khc c th lm tng tc dng ca Seduxen
(thuc ng, barbiturat, phenothiazine, thuc gim au, thuc c ch MAO, v cc thuc chng
trm cm, ru).
Nhng thuc c tc dng gy cm ng enzym chuyn ha thuc, trong c thuc chng ng
kinh (nh carbamazepin, phenytoin) c th lm tng thi tr Seduxen.
Dng cimetidine hoc omeprazol mt thi gian di lm gim s thanh thi ca Seduxen. Dng
chung vi nhng thuc gin c khc, tc dng ca Seduxen khng th on trc c, c th
gp nguy c ngng th.
TC DNG NGOI
Tc dng ngoi { thng xuyn nht nh mt mi, bun ng, yu c ph thuc liu. Trong
phn ln cc trng hp, nhng triu chng ny t bin mt sau mt vi ngy hoc c th
trnh c bng cch gim liu.
Cc phn ng bt li him, nh mt iu ha, l ln, chong vng, nhc u, run s, thay i
tnh kh, ri lon th gic, pht ban, xut hin cc ri lon thn kinh thc vt, to bn, lon vn
ngn, gim huyt p, khng kim ch c nc tiu, b tiu, bun nn, kh ming hoc tng
tit nc bt, ngoi ban, run ry, thay i dc nng, nhp tim chm, ri lon thch nghi.
Rt him khi xut hin s tng chng vng da cng nh cc tr s transaminase v phosphatase
kim. Sau khi tim tnh mch qu nhanh c th lm tng huyt khi tnh mch, vim tnh mch,
kch ng ti ch, sng hoc nhng phn ng mch t hn c th xut hin.
Trng hp tim bp, c th xut hin au ti ch, him khi km ban .
Ch yu sau khi tim tnh mch, xut hin try h hp, chng qun v trc.
Tng hng phn v lo u, o gic, mt ng, tng trng lc c c th xut hin nh nhng phn
ng nghch thng. Trong nhng trng hp ny, nn ngng dng thuc. Trong ti liu, chng
vng da mt v gim bch cu trung tnh cng c cp n.
L thuc thuc :

Benzodiazepine c th gy l thuc thuc - c bit trng hp dng thuc di ngy, liu cao
nhng ngi bnh c khuynh hng .
Trong nhng trng hp t trm trng hn, nhng triu chng b thuc l run ry, bn chn,
ri lon gic ng, s hi, nhc u v gim kh nng tp trung. m hi, co tht bng v c,
ri lon cm gic, m sng v co git do no cng him khi xut hin.
Ch { : lm gim nguy c l thuc thuc, nn dng Seduxen trn c s xem xt thn trng
tng ch nh v tt hn l ch dng trong thi gian ngn.
trnh triu chng cai thuc, nn kt thc iu tr bng cch gim liu t t.
LIU LNG v CCH DNG
Nn cn nhc theo tng c th, tnh trng p ng lm sng, v vy y ch c th a ra
nhng hng dn. Nn bt u iu tr vi liu thp v tng liu dn dn n liu thp nht c
hiu lc.
Thuc tim :
Trng hp dng ng tim tnh mch, cn tim chm (ti a 0,5 ml/30 giy) v tim nhanh
c th gy ngng th (xin c phn Ch { phng v Thn trng lc dng).
Trong trng hp bn chn do tm thn vn ng, lo lng cp tnh :
i vi ngi ln t 10-20 mg tim bp, trong nhng trng hp trm trng th tim tnh mch
(trong nhng trng hp c bit, liu c th c tng n 30 mg cho tim tnh mch hoc
tim bp), tip tc iu tr 10 mg mi ln, dng 3-4 ln/24 gi.
Trong trng hp ng kinh lin tc v cc cn ng kinh ti pht :
Liu khi u 10-30 mg tim tnh mch i vi ngi ln, 2-10 mg i vi tr em, c th c
lp li sau 1/2-1 gi, sau c mi 4 gi th li lp li. Liu hng ngy i vi ngi ln khng
nn vt qu 80-100 mg. Khi cc cn ng kinh ngng hoc gim, c th tip tc iu tr vi
ng tim bp tng 4-6 gi (i vi ngi ln 10 mg, tr em 5 mg) v dng trong mt vi
ngy nu cn thit. phng trnh cc cn ng kinh mi, tim bp 10 mg (tr em, 5 mg).
Trong trng hp cai ru cp, m sng ru cp, o gic :
lm gim cc triu chng, khng nn dng liu cao hn 10 mg tim bp, c th lp li 3-4
ln/ 24 gi. Liu khi u c th tim tnh mch chm, nu cn thit.
Chun b phu thut v kh rung tim :
Liu thp hn 10 mg tim bp, 30 pht trc khi can thip phu thut.
iu tr co tht, cng c v hi chng Stiff-man :
Liu thp hn 10 mg tim bp hoc khi u vi liu tim tnh mch, c th lp li 3-4 ln/ 24
gi, nu cn. iu tr un vn c th phi dng liu cao hn.
Ngi cao tui v bnh nhn suy nhc :
S bi tit Seduxen cc i tng ny c th di hn mt cch ng k, thm ch gp n 3-4
ln. iu tr nhng bnh nhn ny, nn bt u vi liu thp, khng vt qu 1/2 liu bnh
thng, tc l 2-5 mg.

Trng hp suy chc nng gan :

Da trn s cn nhc tng t - nn dng liu rt thn trng.
Tr em :
Trong ch nh cho tr em, liu lng nn c xc nh theo tng c th trong tng phm vi
ch nh, theo tui, giai on pht trin, trng thi chung v phn ng lm sng. tr em nn
tim tht chm (hn 3 pht) vi liu thp hn 0,25 mg/kg th trng. Liu n ny c th c
lp li sau 2-4 gi. Ch dng hn 3 liu n/24 gi trong trng hp un vn v ng kinh lin
tc.
Trong hi chng co git, c th dng 0,2 - 0,3 mg/kg th trng hoc 1 mg/tui, tim tnh mch
hoc tim bp.
Trong nhng ch nh khc, c th dng 0,2 mg/kg th trng.
Thuc ung :
Vic chia liu hng ngy thnh 2-4 phn c xc nh theo tng c th. Nn dng 2/3 liu
hng ngy vo bui ti. Do s khc nhau ln trong p ng thuc gia cc ngi bnh, nn
khi u vi nhng liu nh nht, sau tng ln n liu hiu qu ti u, dung np tt.
Ngi ln :
Trong trng hp ri lon thn kinh, triu chng tm thn c th, lo lng :
Liu n thng thng 2,5-5 mg (1/2-1 vin). Liu thng thng hng ngy i vi ngi ln 520 mg. Liu n khng nn vt qu 10 mg.
iu tr h tr trong hi chng co git :
Liu thng thng 2,5-10 mg (1/2-2 vin), 2-4 ln/24 gi.
Cai ru cp, m sng v ri lon tm thn ni sinh :
Liu khi u thng thng l 20-40 mg/24 gi (4-8 vin), liu duy tr l 15-20 mg/24 gi (3-4
vin).
Co tht c, co cng v co git c :
5-20 mg/24 gi (1-4 vin).
i vi ngi cao tui v bnh nhn suy nhc, hoc suy chc nng gan :
Thi gian thi tr ca Seduxen c th ko di mt cch ng k. Nn bt u iu tr vi liu
thp, khong na liu thng thng, sau c th tng liu ty theo s dung np ca tng c
th.
Liu cho tr em :
Nn c xc nh cho tng c th theo tng phm vi ch nh, cn nhc tui, s trng thnh,
trng thi chung v phn ng lm sng ca tng c th. Liu khi u thng thng i vi tr
em, theo nhng cn nhc trn, l 1,25 - 2,5 mg/24 gi, 2-4 ln, nu cn. Liu ny c th gim
hoc tng ph thuc vo p ng tng c th.
i vi tr em di 6 tui, khng nn dng cc loi thuc an thn hay gii lo, ngoi tr nhng
ch nh bt buc, liu 0,1-0,3 mg/kg th trng/24 gi.

QU LIU
Triu chng :
Suy h thn kinh trung ng c th xut hin vi triu chng yu c, bun ng, l ln v hn
m, him khi km theo nhng hng phn nghch thng.
Qu liu trm trng c th gy hn m, mt phn x, try tim- h hp, ngng th.
X tr :
Nu ung qu liu thuc vin c pht hin sm, c th tin hnh ra d dy.
Tr s h hp v tun hon, chc nng thn ca bnh nhn nn c kim tra lin tc.iu tr
h tr v triu chng chung, nn bo m thng thong ng h hp truyn dch tnh mch
v nu cn, h hp nhn to v s dng ch phm tng trng lc mch. C th dng
flumazenil nh mt thuc i khng th th benzodiazepine c hiu.
Thm tch c t tc dng trong iu tr qu liu.
BO QUN
Thuc tim : nhit 8-15oC, trnh nh sng.
Vin nn : nhit 15-30oC.

459.

SELBEX

EISAI
c/o DIETHELM
vin nang 50 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Teprenone

50 mg

DC LC
Terpene l nhng cht hu c c trong t nhin, c tm thy trong cc loi tinh du, trong
cy v nha cy. Cc cht ny c ngi ta bit n t lu vi c tnh lm phc hi cc
tn thng m.
Teprenone, cht ng ng ca terpene, l hot cht chnh ca Selbex, c tc dng kch thch
s sinh tng hp cc glycoprotein phn t ln v phospholipid - l nhng thnh phn c bn
ca cht nhy v nim mc d dy, tham gia vo qu trnh ti sinh v bo v nim mc d dy.
Teprenone cng lm tng nng bicarbonate trong cht nhy d dy. Hn na, n cn ngn
cn s suy gim kh nng ti sinh ca cc t bo nim mc gy ra do tn thng nim mc d
dy v y mnh qu trnh phc hi cc tn thng.
Teprenone c hiu qu rt tt v mt lm sng trong iu tr vim d dy cp, cn cp ca vim

d dy mn v lot d dy.
DC L LM SNG
Hiu qu chng lot v ci thin cc tn thng nim mc d dy
Teprenone c chng minh c tc dng iu tr cc vt lot thc nghim trn chut (gy ra
do nhiu nguyn nhn bao gm lot do chu nhit lnh, do thuc nh indomethacin, aspirin,
reserpine, acetic acid v do nhit) v ci thin ng k cc loi tn thng thc nghim ca
nim mc d dy (gy ra do HCl + aspirin, cn hoc phng x) ; ng thi Teprenone khng lm
nh hng chc nng sinh l{ bnh thng ca d dy nh s tit dch v nhu ng d dy.
Thc y s sinh tng hp ca glycoprotein phn t ln v phospholipid
Teprenone thc y s sinh tng hp ca glycoprotein phn t ln v phospholipid - l nhng
thnh phn c bn ca cht nhy v nim mc d dy, tham gia vo qu trnh ti sinh v bo v
nim mc d dy ngi v chut. Teprenone cng lm tng nng bicarbonate trong cht
nhy d dy.
Duy tr tnh hng nh ni m ca s ti sinh t bo nim mc d dy
Teprenone lm phc hi cc suy gim ti sinh t bo nim mc d dy gy ra do corticoid v duy
tr tnh hng nh ni m ca s ti sinh cc t bo ny chut. Chnh v th Teprenone thc
y qu trnh lin so ca cc vt lot trong nim mc d dy.
Tng cng s sinh tng hp ca PGs nim mc d dy
Thc nghim trn chut chng minh Teprenone lm tng s tng hp prostaglandin (PGE2
I2) trong nim mc d dy vng mn v v thn v.
Ci thin tun hon nim mc d dy
Teprenone ci thin tun hon ca nim mc d dy sau khi tun hon b suy gim do sc mt
mu hoc do stress khi dm con vt th nghim xung nc.
DC NG HC
Nng trong mu :
Nng ti a trong huyt tng ca Teprenone (Cmax) l 1.669 ng/ml, t c 5 gi sau khi
ung 150 mg Teprenone (3 vin nang Selbex) sau ba n trn 12 ngi tnh nguyn khe mnh.
Tuy nhin, nng trong huyt tng t mt nh khc l 675 ng/ml sau khi ung 10 gi. Biu
hin 2 pha ny l do s khc bit trong thi gian cn thit t c nng ti a Cmax.
Hp thu, phn phi, chuyn ha v thi tr :
Trong vng 24 gi sau khi ung 125 mg/kg Teprenone gn 14C cho chut, khong 27% lng
thuc dng c hp thu qua h thng bch huyt trong khong 84,4% dng cha chuyn
ha. Hot tnh phng x gan, ng tiu ha (dng cha chuyn ha gn b mt nim
mc), tuyn thng thn, thn v ty cao hn trong mu. Hot tnh phng x no v tinh
hon tng ng trong mu.
Thuc c thi tr qua nc tiu 22,7% v qua phn 29,3% liu dng trong vng 4 ngy sau
khi dng. Thi tr qua kh th ra 27,7% liu dng trong vng 3 ngy sau khi dng.

CH NH
Vim d dy cp tnh v cn bc pht ca vim d dy mn tnh.
Lot d dy.
THN TRNG LC DNG
Tnh an ton khi s dng Selbex cho tr em cha c xc nh (cc nghin cu lm sng y
cha c tin hnh).
LC C THAI
Tnh an ton khi s dng Selbex trong thai kz cha c xc nh. Thuc ny ch nn s dng
cho bnh nhn ang mang thai hoc nghi ng c thai nu s ch li ln hn nhiu so vi cc
nguy c c th xy ra.
TC DNG NGOI
Rt him khi gp cc triu chng v du hiu sau :
Tiu ha : to bn, cm gic y bng.
Gan : tng nh GOT v GPT.
Tm thn kinh : nhc u.
Da : pht ban. Ngng iu tr nu triu chng ny xut hin.
Cc phn ng ph khc : tng nng cholestrol ton phn.
LIU LNG v CCH DNG
Thng thng i vi ngi ln l 3 vin/ngy (150 mg Teprenone), chia lm 3 ln ung sau
mi ba n. Liu dng nn c iu chnh ty theo tui ca bnh nhn v mc trm trng
ca triu chng.
BO QUN
Vin nang Selbex nn c lu tr nhit phng.

460.

SELSUN

ABBOTT
Dung dch dng ngoi 2,5% : chai 120 ml.
THNH PHN
cho 100 ml
Selenium sulfide

2,5 g

T dc : bentonite, lauric
diethanolamide, ethylene glycol
monostearate, titanium dioxide,
amphoteric-2, sodium lauryl sulfate,
sodium phosphate (monobasic), glyceryl
monoricinoleate, acid citric, captan v
hng liu.
DC LC
Selenium sulfide c tc dng km ch s tng trng ca biu b v biu m tuyn b, gim s
sn xut vy biu b.
CH NH
iu tr lang ben, vim da tit b da u v iu tr gu.
CHNG CH NH
Khng c s dng cho bnh nhn d ng vi nhng thnh phn ca thuc.
THN TRNG LC DNG
Khng c s dng khi c vim hoc tit dch v c th gia tng hp thu thuc.
Ch dng ngoi da. Khng s dng trn da b try xc hoc nhng vng da b vim. Nu xy ra
phn ng d ng, ngng s dng. Trnh du gi tip xc vi mt hoc tip xc vi vng sinh
dc v nhng vng np gp v c th gy kch thch v phng. Nn ra k nhng vng ny sau
khi dng thuc.
S dng cho tr em : Tnh an ton v hiu qu ca thuc trn tr em cha c xc minh.
AN TON TIN LM SNG
Sinh ung : S dng ngoi da dung dch 25% v 50% ca dung dch 2,5% selenium sulfide trn
chut qua 48 tun, cho thy khng c tc dng sinh ung th.
LC C THAI v LC NUI CON B
Nhng nghin cu v qu trnh sinh sn trn sc vt khng c thc hin vi Selsun. Ngi ta
cng khng bit Selsun c gy nguy him cho thai hay khng khi dng thuc ngoi da trn ph
n mang thai hoc c th nh hng n kh nng sinh sn hay khng. Trong nhng tnh
hung thng thng khng nn dng Selsun iu tr lang ben cho nhng ph n c thai.
TC DNG NGOI
Theo th t trm trng gim dn : kch thch da ; i khi c nhng bo co v tng rng tc
bnh thng ; mt mu ca tc (c th trnh hoc gim n mc ti thiu bng cch ra k tc
sau khi iu tr). Ging nh nhng du gi u khc, tc v da c th b nhn hoc kh.
LIU LNG v CCH DNG
Liu lng :
iu tr lang ben :

Thoa vo vng b tn thng vi mt t nc. thuc trn da khong 10 pht, sau ra

sch. Lp li cch thc ny mi ngy 1 ln trong 7 ngy.
iu tr vim da tit b v gu :
Thng dng 2 ln/tun trong 2 tun, khng ch bnh. Sau , c th s dng t thng
xuyn hn - mi tun, mi 2 tun, hoc mi 3 hoc 4 tun trong mt s trng hp. Khng nn
s dng thng xuyn duy tr s khng ch bnh.
Hng dn s dng :
y np cht.
Lc k trc khi dng. Thuc c th lm hng n trang, nn tho ri n trang trc khi dng.
iu tr lang ben :
- Thoa vo vng da b tn thng vi mt t nc.
- khong 10 pht.
- Ra sch hon ton.
- Lp li cch thc ny mi ngy 1 ln trong 7 ngy.
tr gu v vim da tit b trn da u :
- Thoa khong 1-2 mung du gi u vo da u.
- khong 2 n 3 pht.
- Ra sch hon ton da u.
- Lp li nh trn v ra sch hon ton.
- Sau tr liu, ra tay sch.
- Lp li tr liu ty theo ch dn ca thy thuc.
QU LIU
Ung nhm : Khng c bo co no ghi nhn c tnh trm trng ngi do ung Selsun cp
tnh, tuy nhin, nhng nghin cu v c tnh cp trn sc vt gi rng vic tiu ha lng
ln c th gy ra c tnh tim tng. Ra d dy nn c xem xt trong nhng trng hp
tiu ha qua ng ming cp tnh.
BO QUN
Bo qun di 86oF (30oC

461.

SELSUN GOLD

ABBOTT
Du gi 1% : chai 30 ml, 120 ml.
THNH PHN

cho 100 ml
Selenium sulfide

1g

DC LC
Selenium sulfide c tc dng km ch s tng sng ca biu b v biu m tuyn b, gim s sn
xut vy biu b.
CH NH
Thuc gi tr gu, nga da u.
CHNG CH NH
Khng c s dng cho bnh nhn d ng vi nhng thnh phn ca thuc.
THN TRNG LC DNG
Thuc ch dng ngoi. Khng c dng trn da b try xc hoc cc vng b vim.
Trnh dy vo mt. Nu b dy vo mt, phi ra k mt bng nc.
LIU LNG v CCH DNG
- Xoa u khong 1-2 mung c ph du gi ln vng da u c tc c lm t.
- yn thuc trn da khong 2-3 pht.
- Ra sch vng da u.
- Xoa li mt ln na v ra li tht k.
- Sau khi gi, ra tay sch.
c kt qu tt nht, nn dng thng xuyn, t nht 2 ln mt tun hoc theo hng dn
ca bc s. C th dng cho thuc nhum mu hoc tc un, nu dng theo ng ch dn.
BO QUN
Bo qun di 86oF (30oC).

462.

SEMPREX

GLAXOWELLCOME
vin nang 8 mg : hp 24 vin.
THNH PHN
cho 1 vin
Acrivastine

DC LC

8 mg

Thuc khng histamine.

Acrivastine c tc dng lm gim triu chng trong nhng bnh l ph thuc ton b hay mt
phn s phng thch t histamine.
Acrivastine l cht i khng mnh vi histamine, tng tranh ln th th H1 nhng khng gy
tc ng khng cholinergique v kh nng xuyn thm vo h thn kinh trung ng rt thp.
Sau mt liu ung duy nht 8 mg acrivastine ngi ln, thi gian bt u tc dng ca thuc,
c o bng kh nng ngn chn s xut hin sn ph v hng ban da gy ra bi histamine,
vo khong 30 pht ; tc dng ti a xut hin 90 pht (i vi hng ban) v 2 gi (i vi sn
ph). Mc d tc ng gim dn v sau, tnh khng histamine ng k vn c duy tr n 12
gi sau khi ung trong khi cc triu chng vim mi d ng gim r rng trong vng 1 gi sau
khi dng thuc ng ton thn.
DC NG HC
Acrivastine hp thu tt qua rut. ngi tnh nguyn trng thnh khe mnh, nng ti a
trong huyt tng vo khong 150 ng/ml, t c trong khong 1,5 gi sau khi ung 8 mg
acrivastine. Thi gian bn hy trong huyt tng vo khong 1,5 gi. Trong cc nghin cu
dng nhiu liu lin tip trong vng 6 ngy, khng ghi nhn c c s tch t ca acrivastine.
Chuyn ha : 87% liu acrivastine c nh du phng x dng ngi tnh nguyn c tm
thy trong nc tiu sau khong thi gian l 3 ngy, 80% c tm thy trong 12 gi u, ch
yu di dng khng i, 13% cn li ca liu c tm thy trong phn. Mt cht chuyn ha
trong nhnh bn acide acrylique ca acrivastine b kh, c tm thy trong huyt tng
v nc tiu. Trong nc tiu, cht chuyn ha ny chim khong 1/7 liu dng. Acrivastine v
cht chuyn ha chnh c o thi ch yu thn.
CH NH
Lm gim triu chng vim mi d ng k c d ng phn hoa, bnh da qua trung gian histamine
v d nh ni m ay t pht mn tnh, triu chng ng v ni trn da, ni m ay tit
actylcholine, ni m ay t pht do lnh v nga do eczema d ng.
CHNG CH NH
Bnh nhn c mn cm vi acrivastine hay triprolidine.
Thuc c o thi ch yu qua h thng thn, do , nu cha lm cc x t nghim c hiu,
khng nn dng Semprex cho bnh nhn suy thn nng ( thanh thi cratinine nh hn 50
ml/pht hay cratinine huyt thanh ln hn 150 mmol/l)
THN TRNG LC DNG
Hu ht cc bnh nhn dng Semprex khng b bun ng. Tuy nhin, do c s khc bit p
ng vi thuc mi c nhn, cng nn phng i vi cc bnh nhn c nhng hot ng
cn s tp trung nh li xe hay thao tc my cho n khi h bit c s p ng ca c th
vi thuc.
Nn thng xuyn khuyn bnh nhn khng lm nhng vic cn tp trung trong khi ang b

nh hng ca ru hay nhng cht lm c ch h thn kinh trung ng. Dng ng thi vi
acrivastine c th lm ng thm mt s c nhn.
Tnh gy ung th : acrivastine khng c ghi nhn c gy ung th trong cc nghin cu di
ngy chut cng v chut nht.
Tnh gy bin d : Kt qu ca nhng xt nghim nhiu mc khc nhau v tnh gy bin d
cho thy rng acrivastine khng c nguy c gy thay i v di truyn ngi.
Tnh gy qui thai : dng acrivastine ng ton thn khng gy c thai hay gy qui thai
trong nghin cu v sinh sn sc vt.
Gim kh nng sinh sn : dng acrivastine ng ton thn khng lm gim kh nng sinh sn
trong nghin cu v kh nng sinh sn sc vt. Khng thy c tc ng ca Semprex ln s
sinh sn ngi.
LC C THAI v LC NUI CON B
Khng c thng tin v nh hng ca Semprex trn thai kz ca ngi. Ging nh a s cc
thuc, khng nn dng acrivastine lc c thai tr khi li ch tr liu cao hn cc nguy c c th
xy ra.
Khng c thng tin v cc mc hin din ca acrivastine trong sa m khi dng vin nang
Semprex.
TC DNG NGOI
Rt him c trng hp bun ng trc tip gy ra do Semprex c bo co. Trong cc th
nghim lm sng, tc dng an thn ca thuc cng khng ln hn ca placebo. i vi a s
bnh nhn, tr liu bng Semprex khng gy ra nhng tc dng ngoi { ng k trn lm sng v
tc dng an thn hay khng cholinergique.
i khi c nhng bo co v mt vi trng hp ni ban do iu tr vi Semprex nhng mi
lin quan gia tc dng ny vi thuc khng c xc nh chc chn.
LIU LNG v CCH DNG
Ngi ln v tr em trn 12 tui : 1 vin, 3 ln mi ngy.
Tr em di 12 tui : cha c thng tin v s dng Semprex tr em.
Ngi gi : mc d kt qu nghin cu lm sng cho thy khng cn thn trng c bit khi
dng Semprex cho ngi ln tui, c th nn kim sot chc nng thn.
QU LIU
Triu chng : Mc d cha c trng hp qu liu cp no vi Semprex, 25 bnh nhn dng
acrivastine vi liu cao n 1200 mg mi ngy khng thy c hoc ch xut hin cc du hiu v
triu chng nh (ri lon tiu ha, nhc u v bun ng)
iu tr : Nu cn, ch yu iu tr triu chng v iu tr h tr. C th gy nn bnh nhn
cn tnh to. Nu c ch nh, c th ra d dy. Nn c bin php theo di v h hp, c bit
tr em. Khng c thng tin v s hu hiu ca thm phn.

BO QUN
Di 25oC, ni kh v trnh nh sng.

463.

SEPTRIN

GLAXOWELLCOME
Septrin-S vin nn 400 mg/80 mg.
Septrin vin nang 400 mg/80 mg.
Septrin vin liu gp i 800 mg/160 mg.
Septrin vin cho tr em 100 mg/20 mg.
Septrin hn dch cho tr em : chai 50 ml.
THNH PHN
Septrin -S vin nn :
cho 1 vin
Trimethoprime

80 mg

Sulfamethoxazole

400 mg

Septrin vin nang :

cho 1 vin
Trimethoprime

80 mg

Sulfamethoxazole

400 mg

Septrin vin liu gp i :

cho 1 vin
Trimethoprime

160 mg

Sulfamethoxazole

800 mg

Septrin vin cho tr em :

cho 1 vin

Trimethoprime

20 mg

Sulfamethoxazole

100 mg

Septrin hn dch cho tr em :

cho 5 ml
Trimethoprime

40 mg

Sulfamethoxazole

200 mg

CH NH
Septrin c ch nh cho iu tr :
Nhim trng tit niu (trn v di) : nhim trng cp, d phng di hn ti pht nhim trng
mn tnh sau khi nc tiu sch khun, vim tin lit tuyn nhim khun.
Nhim trng h hp : vim tai gia ; vim xoang ; vim ph qun cp, mn ; vim phi ; iu tr
v d phng vim thnh ph nang do Pneumocystis carinii.
ng sinh dc : lu, vim vi trng, h cam, bnh Nicolas-Favre.
ng tiu ha : bnh do Shigella, thng hn hay ph thng hn, ngi mang vi khun
thng hn mn tnh.
Nhim trng da v vt thng : p-xe, trng c, mn nht, vim da m, vt thng nhim
khun.
Nhim trng do cc vi khun nhy cm khc : bnh Brucella cp, u actinomyces, bnh do
Nocardia tr nhng trng hp thc s do nm, vim xng ty cp v mn, nhim trng
huyt.
Bnh nhim trng do nm : bnh nm Blastomyces Nam M.
Septrin c th dng trong nhim trng rng v nha chu, nhim trng tiu ha do E. coli gy
bnh ng rut, vim mng no do cc chng nhy cm trn in vitro, bnh do Toxoplasmos.
CHNG CH NH
Bnh nhn c tin s d ng vi sulfonamide, trimethoprime hoc co-trimoxazole.
Bnh nhn b tn thng nhu m gan nng. Ngoi tr c s theo di ca bc s, Septrin chng
ch nh cho bnh nhn c bnh nghim trng v huyt hc. Dng co-trimoxazole khng c
hoc c rt t tc dng ph n ty xng v t bo mu ngoi vi nhng bnh nhn ang iu
tr bng thuc c t bo. Khng c dng Septrin cho tr sinh non v tr s sinh.
THN TRNG LC DNG
Cn thng xuyn kim tra cng thc mu pht hin nhng bin i xt nghim mu m
khng biu hin triu chng do thiu acid folic khi dng Septrin ko di. Nhng thay i ny c
th hi phc khi dng acid folic (3-6 mg/ngy) khng nh hng n tc dng khng khun. Cn

theo di c bit nhng bnh nhn ln tui hoc nghi ng thiu acid folic ; cn cn nhc dng
thm acid folic.
Nu dng Septrin liu cao di ngy cng cn phi ung thm acid folic.
i vi nhng bnh nhn suy thn phi theo di cc ch s lin quan (xem phn trn). Cn theo
di duy tr lng nc tiu 24 ting. pht hin tinh th niu, ch tm tinh th mui
sulphonamide trong nc tiu lng. nhng bnh nhn suy dinh dng nguy c ny tng
ln.
iu tr bnh nhn vim amian - hng do lin cu tan huyt beta nhm A bng Septrin khng
hiu qu bng vi penicillin. Khng thuc cho c th xy ra gia Septrin v kt hp ca
pyrimethamine/sulphonamide.
LC C THAI v LC NUI CON B
Cha c ti liu kt lun v an ton s dng Septrin cho ph n mang thai. liu ln hn nhiu
so vi liu ngh, trimethoprime c th gy qui thai chut vi biu hin in hnh ca cc
thuc khng acid folic, v c th phng trnh bng ch n giu acid folic.
Khng c du hiu no cho thy c s lin quan ca thuc vi d dng thai th, nhng vi liu
khong 10 ln ln hn liu iu tr cho ngi th ghi nhn c tng t l thai cht.
TNG TC THUC
C vi bo co v vic dng ng thi co-trimoxazole vi pyrimethamine nh thuc phng st
rt liu cao hn 25 mg/tun c th b thiu mu nguyn bo khng l. Co-trimoxazole cho
thy c th lm tng tc dng chng ng mu ca wafarin mc d c ch cha r rng. Theo
di cht ch nhng bnh nhn ang iu tr vi thuc chng ng mu ng thi dng Septrin.
Co-trimoxazole ko di thi gian bn hy ca phenytoin nn thy thuc cn lu { iu ny khi
cho bnh nhn dng ng thi 2 th thuc trn. Co-trimoxazole c th nh hng n chc
nng ca tuyn gip trng nhng { ngha lm sng cn cn phi kim tra li.
S dng ng thi Septrin vi rifampicine c th lm gim thi gian bn hy trong huyt tng
ca trimethoprime nhng iu ny khng c { ngha lm sng.
TC DNG NGOI
V Septrin c cha trimethoprime v sulfonamide nn c th d on c nhng tc dng
ph do nhng thnh phn ny gy ra.
Nhng tc dng ph c bo co l bun nn, c nn hoc khng v ni mn.
Tiu chy v vim li.
Vim i trng gi mc, v bnh nm monilia c th xy ra.
Him gp phn ng d ng da nng nh ban bng nc a dng (hi chng StevensJohnson) v hoi t biu b nhim c (hi chng Lyell). C mt vi bo co v thay i cng
thc mu ch yu l gim bch cu, tiu cu, mt bch cu ht, thiu mu nguyn hng cu
khng l v ban xut huyt.
Ngi ln tui b lon chc nng gan, thn hoc thiu acid folic th c nguy c cao. Nhng bnh

nhn thiu G6PD, dng Septrin c th c nguy c tan mu. C mt vi ti liu v nhng cm
gic ch quan nh au u, trm cm, chng mt, o gic.
LIU LNG v CCH DNG
Nn ung Septrin vi thc n hoc ung gim thiu cc ri lon tiu ha.
Liu chun :
Septrin vin nn, vin nang :
- Ngi ln v tr trn 12 tui : 2 vin mi 12 gi.
- Tr t 6-12 tui : 1 vin mi 12 gi.
Septrin vin liu gp i :
- Ngi ln v tr trn 12 tui : 1 vin mi 12 gi.
- Tr di 12 tui : khng nn dng dng ny.
Septrin vin cho tr em :
- Tr t 6 -12 tui : 4 vin mi 12 gi.
- Tr 6 thng - 5 tui : 2 vin mi 12 gi.
Septrin hn dch cho tr em :
- Tr 6-12 tui : 10 ml mi 12 gi.
- Tr 6 thng n 5 tui : 5 ml mi 12 gi.
- Tr 6 tun n 5 thng tui : 2,5 ml mi 12 gi.
Hn dch Septrin c th pha long vi sir BP. Trong cc nhim khun cp phi dng thuc
thm 2 ngy sau khi ht triu chng. Phn ln cc trng hp cn dng thuc t nht 5 ngy.
Trong nhng trng nng, mi la tui c th tng liu gp ri.
Liu c bit :
Tr phi c nhng ch nh khc, dng liu chun.
Nu bc s ch nh vin th c hiu l vin cho ngi ln. Nu l cc dng bo ch khc
phi c ch nh c th.
D phng di hn ti pht nhim trng mn tnh sau tit trng nc tiu :
Ngi ln v tr trn 12 tui : 1 vin vo bui ti trc khi i ng.
Tr di 12 tui : dng liu n 2 mg trimethoprime v 10 mg sulfamethoxazole/kg cn nng
trc khi i ng.
iu tr c th ko di 3 -12 thng hoc di hn na nu cn.
Vim tin lit tuyn mn :
Thi gian u, nn dng liu cao hn liu chun thng thng. t iu tr nn ko di 3 thng
gim nguy c ti pht.
Vim thnh ph nang do Pneumocystis carinii :
- iu tr : 20 mg trimethoprime v 100 mg sulfamethoxazole/kg cn nng/mi ngy chia 2 ln
hoc hn v ko di trong 2 tun.
- D phng : dng liu chun trong sut thi gian c nguy c.

Lu :
C th dng nhng liu di y thay cho liu chun cho ngi ln trong 5-7 ngy :
- Lu khng bin chng :
4 vin mi 12 gi trong 2 ngy hoc ung 5 vin ri ung nhc li 5 vin sau 8 ting. Nu bnh
nhn ngho th liu duy nht 8 vin cng c th thch hp nhng cn c theo di ca bc s.
- Nhim khun hu-hng do lu cu : 2 vin x 3 ln/ngy trong 7 ngy.
Bnh h cam v bnh Nicolas-Favre :
Liu trnh iu tr nn ko di 10-15 ngy.
Bnh Brucella cp :
iu tr cn ko di t nht 4 tun, v nn iu tr nhc li
Ngi mang vi khun thng hn v ph thng hn :
Cn iu tr trong t nht 1-3 thng
i vi bnh nhn suy thn :
Cho ngi ln v tr trn 12 tui (khng c s liu i vi tr di 12 tui) :
Liu lng cn iu chnh theo thanh thi creatinin :
Trn 25 ml/pht : Liu chun.
T 15-25 ml/pht : dng liu chun trong ti a 3 ngy u, tip theo bng na liu chun.
Di 15 ml/pht : khng nn dng tr phi c chy thn nhn to th dng bng na liu chun.
C 2-3 ngy mt ln cn o nng sulfamethosazole trong huyt tng sau khi ung Septrin
12 ting. Nu nng ca sulfamethoxazole cao qu 150 mg/ml th ngng dng thuc cho ti
khi ch s xung di 120 mg/ml.
QU LIU
Bun nn, nn, chng mt, v ln c th l triu chng ca qu liu. Ngng iu tr. Nu cha
nn c th cn lm cho bnh nhn nn. C th ra d dy tuy s hp thu t h tiu ha thng
kh nhanh v kt thc trong vng 2 gi. Acid ha nc tiu lm tng s o thi
trimethoprime. Dng thuc li tiu v kim ha nc tiu lm tng s o thi
sulfamethoxazole. Nhng kim ha li lm gim thi trimethoprime. Calci pholinate (3-6
mg/ngy) chng li cc tc dng c hi ln ty xng ca trimethoprime. Cn lm cc xt
nghim kim tra.
C trimethoprime v sulfamethoxazole u c th lc bng cch lc cu thn.
BO QUN
Vin nn (bao gm c vin nn cho tr em) : bo qun di 25oC, trnh nh sng.
Vin n n hm lng gp i : bo qun di 35oC, trnh nh sng.
Hn dch : bo qun di 25oC, trnh nh sng.

464.

SERC

SOLVAY
c/o KENI - OCA
vin nn 8 mg : hp 100 vin.
THNH PHN
cho 1 vin
Btahistine dichlorhydrate

8 mg

DC LC
Thuc tr chng mt.
C ch tc ng ca btahistine v mt tc dng iu tr th cha c nm r. Tuy nhin, in
vitro, btahistine to d dng cho s dn truyn histamine do tc ng ng vn mt phn trn
cc th th H1, v tc dng c ch cc th th H3 (mt khc, btahistine lm gim hot tnh in
ca cc t bo thn kinh a sinape trung tm tin nh sau khi tim tnh mch ng vt).
DC NG HC
Sau khi ung, b tahistine c hp thu nhanh v hon ton. B tahistine c o thi theo
nc tiu di dng cht chuyn ha l acide 2-pyridyl actique.
Thi gian bn hy o thi khong 3 gi ri.
Thuc c o thi gn nh hon ton sau 24 gi.
CH NH
iu tr hi chng Mnire. Hi chng ny thng c biu hin bng chng chng mt, tai,
nn i, nhc u v i khi km theo mt thnh lc.
iu tr chng chng mt nguyn nhn tin nh.
CHNG CH NH
- Cn lo t d dy-t trng.
- U ty thng thn.
THN TRNG LC DNG
Dng thn trng cho ngi b hen suyn do c th gy co tht ph qun.
LC C THAI
Khng nn ch nh cho ph n c thai, mc du khng mt tc dng gy qui thai no c ghi
nhn ng vt th nghim.
TC DNG NGOI
Thuc c dung np tt, do c th c s dng lu di. Tuy nhin, mt s trng hp rt
him c th b au d dy, c th trnh c bng cch ung thuc trong ba n.
LIU LNG v CCH DNG

3 n 6 vin/ngy, chia lm nhiu ln, tt nht nn ung thuc trong ba n. iu tr t 2 n 3

thng.
QU LIU
Triu chng : cc triu chng ging cc triu chng gy bi thuc histamine.
X l : dng thuc khng histamine.
AN TON TIN LM SNG
Dng ng ung vi liu c th ti 250 mg/kg/ngy (chut cng, ch) m khng thy c tc
dng ngoi .
Tim tnh mch, phi n liu 120 mg/kg/ngy (chut cng, ch) mi bt u thy xut hin cc
du hiu ng c : bun nn, sau l cc ri lon c ngun gc thn kinh (ging cc ri lon
gy bi thuc histamine).

465.

SERETIDE ACCUHALER/DISKUS

GLAXOWELLCOME
Accuhaler (bt ht qua ng ming) : hp 60 liu.
THNH PHN
cho 1 liu
Salmtrol xinafoate

50 mg

Fluticasone propionate

100 mg

cho 1 liu
Salmtrol xinafoate

50 mg

Fluticasone propionate

250 mg

cho 1 liu
Salmtrol xinafoate

50 mg

Fluticasone propionate

500 mg

DC LC
C ch tc ng :
Seretide bao gm salmeterol v fluticasone propionate c c ch tc ng khc nhau.
Salmeterol gim co tht ph qun (kim sot triu chng) v fluticasone propionate c tc dng
khng vim (kim sot cn nguyn bnh) v phng nga cc t cp. Seretide c th p ng
mt tr liu thun tin hn cho bnh nhn cn iu tr bng thuc ch vn bta v
corticosteroid ng ht. C ch tc ng ca hai hot cht ln lt c trnh by di y :
Salmeterol :
Salmeterol l thuc ch vn th th bta 2 chn lc tc dng ko di (12 gi) vi 1 chui di gn
kt vi v tr bn ngoi ca th th. Cc c tnh dc l ca salmeterol lm cho vic phng
nga triu chng co tht ph qun do histamin duy tr t nht 12 gi, hiu qu hn khi cng
dng liu khuyn co cc thuc ch vn bta 2 thng quy tc dng ngn.
Cc th nghim in vitro cho thy rng salmeterol c tc ng c ch mnh v ko di vic
phng thch t phi ngi cc cht chuyn ha trung gian t dng bo nh histamine,
leukotrienes v prostaglandin D2.
ngi, salmeterol c ch p ng vi nhng d nguyn ht phi pha sm v pha chm, vic
tc ng ny duy tr trong 30 gi sau mt liu duy nht, khi tc ng gin ph qun khng cn
na. Liu duy nht salmeterol lm suy gim s mn cm ph qun. Cc c tnh ny cho thy
rng salmeterol c tc ng cng thm, ngoi tc ng gin ph qun, nhng du hiu lm
sng cn cha c r rng. C ch ny khc vi tc ng khng vim ca corticosteroid.
Fluticasone propionate :
Fluticasone propionate dng ng ht vi liu khuyn co c tc ng khng vim ca
glucocorticoid trong phi, gip ci thin triu chng v gim cn hen cp, khng c tc dng
ph no nh khi dng corticosteroid ng ton thn.
Lng hormon thng thn tit ra hng ngy vn c duy tr trong gii hn bnh thng
trong qu trnh iu tr di hn vi fluticasone propionate ng ht, ngay c khi dng liu
khuyn co cao nht tr em v ngi ln. Sau khi chuyn t cc steroid ng ht khc sang
fluticasone propionate, lng hormon tit ra hng ngy dn dn c ci thin, mc d trc
kia hay hin ti c dng gin on cc steroid ng ung, nh vy cho thy chc nng thng
thn tr v hot ng bnh thng khi dng fluticasone propionate ng ht. D tr thng
thn vn duy tr bnh thng trong qu trnh iu tr di hn fluticasone propionate ng ht
khi o bng s gia tng bnh thng trong mt test kch thch. Tuy nhin, s suy yu d tr
thng thn tn ti sau cc iu tr trc c th k o di ng k v yu t ny cng cn
c lu { (xem Ch { phng v Thn trng lc dng).

DC NG HC
Khng c bng chng trn ng vt hay ngi cho thy vic dng salmeterol v fluticasone
propionate vi nhau bng ng ht nh hng n dc ng ca tng thnh phn thuc.
Do v mt dc ng hc, cc thnh phn c th c xem xt ring bit.
D rng nng Seretide trong huyt tng rt thp, nhng khng th lai tr kh nng tng
tc vi cc cht nn khc hay cc thuc c ch CYP 3A4.
Salmeterol :
Salmeterol tc ng ti ch trong phi do nng hot cht trong huyt tng thp hn
nng iu tr. Ngoi ra, c hn ch v cc d liu dc ng hc ca salmeterol, do kh
khn v mt k thut xt nghim thuc trong huyt tng v nng thuc liu iu tr
trong huyt tng rt thp (khong 200 pg/ml hay thp hn). Sau khi dng liu thng thng
vi salmeterol xinafoate, hydroxynaphthoic c th c pht hin trong h tun hon, t
nng hng nh khang 100 ng/ml. Nng ny c th ln ti gp 1000 ln trong cc trng
hp ng c. Khng thy tc ng c hi no quan st thy trong cc iu tr di hn thng
xuyn (trn 12 thng) bnh nhn tc nghn ng th.
Fluticasone propionate :
Sau khi tim ng tnh mch, dc ng ca Fluticasone propionate tng ng vi liu.
Fluticasone propionate c phn b rng khp c th (Th tch phn b t khong 300 l) v
c thanh thi rt cao (t ti 1,1 l/pht) qua ng gan.
Nng nh trong huyt tng gim khong 98% trong vng 3-4 gi, v ch cn nng huyt
tng thp lin quan vi thi gian bn thi, khong 8 gi.
Sau khi dng ng ung Fluticasone propionate, 87-100% liu c o thi qua phn.
Sau khi dng liu 1 hay 16 mg, tng ng c n 20 v 75% c o thi trong phn dng hp
cht ban u.
kh dng sinh hc tuyt i l khng ng k (< 1%) do s kt hp gi vic hp thu khng
hon ton t ng tiu ha v chuyn ha ln u qua gan nhiu.
Sau khi dng liu ht, kh dng sinh hc tuyt i ton b ca Fluticasone propionate : l 1226% ph thuc vo dng trnh by.
Vic hp thu Fluticasone propionate : ch yu qua phi, khi u nhanh, sau k o di.
T l gn kt protein l 91%.
Fluticasone propionate: c chuyn ha mnh nh enzym CYP 3A4 thnh dn xut carboxylic
bt hot.
Cc d liu sn c v dc ng hc tr em tng t vi kt qu nghin cu ngi ln.
AN TON TIN LM SNG
Salmeterol xinafoate v fluticasone propionate c nghin cu nhiu trong cc th nghim
c tnh trn ng vt. c tnh ch xy ra khi dng qu liu iu tr cho ngi v lin quan n
thuc ch vn bta 2 v glucocorticosteroid.

Trong cc nghin cu di hn, Salmeterol xinafoate gy cc u lnh tnh c trn mc treo

bung chng v t cung trn chut cng.
Do ng vt gm nhm d b cc u lnh tnh do thuc, salmeterol khng c xem l thuc gy
ung th c hi cho ngi.
Vic dng kt hp salmeterol xinafoate v fluticasone propionate gy ra mt vi triu chng
tim mch khi dng liu cao. chut cng, vim c tim tm nh nh v vim ng mch vnh
trung tm l cc tc ng thong qua lin quan vi liu bnh thng. ch, khi dng kt hp,
nhp tim tng nhanh hn l khi dng salmeterol n thun.
Khng c tc ng tim mch ngoi nng no quan st thy khi nghin cu ngi.
Trn ng vt, vic kt hp 2 hot cht khng lm gy ra thm cc c tnh khc.
CH NH
Seretide c ch nh trong iu tr phng nga cc bnh l tc nghn ng h hp c th
hi phc, bao gm hen ph qun tr em v ngi ln, khi vic s dng phi hp (thuc gin
ph qun v corticosteroid ng ht) l thch hp.
Ch nh ny c th bao gm :
- Bnh nhn iu tr duy tr hiu qu vi thuc ch vn bta tc dng ko di v corticosteroid
ng ht.
- Bnh nhn vn cn triu chng, d ang iu tr bng corticosteroid ng ht.
- Bnh nhn ang iu tr gin ph qun thng xuyn.
CHNG CH NH
Seretide chng ch nh dng cho bnh nhn c tin s qu mn vi bt kz thnh phn no ca
thuc.
CH PHNG v THN TRNG LC DNG
Vic iu tr bnh tc nghn ng th thng nn theo chng trnh iu tr bc thang v
p ng ca bnh nhn vi thuc nn c theo di lm sng v bng cc test o chc nng h
hp.
Seretide khng dng iu tr triu chng cp tnh, nh mt thuc gin ph qun c tc ng
nhanh v ngn hn (nh salbutamol). Bnh nhn nn c khuyn phi lun lun d phng cc
thuc iu tr triu chng cp.
Vic gia tng s dng thuc gin ph qun tc dng ngn hn iu tr triu chng hen ph
qun, lm cho vic kim sot hen ph qun kh khn hn.
Vic gim kim sot cn hen ph qun t ngt v tng dn c kh nng e da n tnh mng
v bnh nhn nn c khuyn n bc s ti khm v nn cn nhc n vic tng liu
corticosteroid. Tng t, khi liu dng hin ti ca Seretide tht bi trong vic kim sot bnh
tc nghn ng th, bnh nhn nn c khuyn i ti khm bc s trong nhng trng hp
ny.
Nn cn nhc dng thm mt corticosteroid v dng thm khng sinh nu c hin tng nhim

trng xy ra.
Khng nn ngng t ngt vic iu tr vi Seretide.
Cng nh vi thuc ng ht cha corticosteroid khc, Seretide nn c dng thn trng
trn bnh nhn lao tin trin hay lao tim n.
Seretide nn c dng thn trng trn bnh nhn b nhim c gip.
Mt s him trng hp glcm v tng nhn p c bo co sau khi dng corticosteroid
ng ht.
Nn thn trng khi cho bnh nhn chuyn sang dng Seretide, c bit nu thy c l do nghi
ng b suy thng thn t cc tr liu steroid ton thn trc .
Li xe v vn hnh my mc :
Khng c nghin cu chuyn bit no v tc ng ca Seretide trn kh nng ny, nhng dc
l thuc khng cho thy nh hng no.
LC C THAI v LC NUI CON B
Vic dng thuc trong thai kz v khi cho con b ch nn cn nhc khi hiu qu mong mun cho
ngi m cao hn cc nguy c c th xy ra cho thai nhi v cho tr.
Hin khng c y kinh nghim v vic s dng salmeterol v fluticasone propionate trn
ph n c thai v cho con b.
Trong cc nghin cu ng vt v c tnh thuc trn kh nng sinh sn, d dng n thun
hay phi hp, cho thy cc tc ng trn thai nhi ch c ghi nhn khi dng thuc ch vn
bta v glucocorticosteroid ng ton thn liu cao.
Cc kinh nghim lm sng vi cc thuc cng nhm cho thy khng c bng chng no v tc
ng c lin quan ti liu iu tr. C salmeterol hay fluticasone propionate khng cho thy kh
nng gy c cho s di truyn.
Nng ca salmeterol v fluticasone propionate trong huyt tng sau khi dng liu iu tr
dng ht rt thp v do nng thuc trong sa m cng rt thp. iu ny cng c ghi
nhn trn cc ng vt nghin cu, nng thuc o c trong sa rt thp. Khng c d
liu sn c v nng thuc trong sa m.
TNG TC THUC
D rng nng Seretide trong huyt tng rt thp, nhng khng th lai tr kh nng tng
tc vi cc cht nn khc hay cc thuc c ch CYP 3A4.
Nn trnh dng cc thuc chn th th bta chn lc v khng chn lc trn bnh nhn c
bnh l tc nghn ng th c th hi phc c, tr khi c cc l do bt buc phi dng.
TC DNG NGOI
Do Seretide bao gm salmeterol v fluticasone propionate, c th c cc loi v mc cc
phn ng ph khc nhau lin quan vi tng thnh phn thuc. Khng c bng chng no v cc
tc dng cng thm khi dng cng lc hai hot cht ny.
Sau y l cc tc dng lin quan vi salmeterol hay fluticasone propionate:

Salmeterol :
Cc phn ng ph v mt dc l ca thuc ch vn bta nh run, nh trng ngc v nhc
u, c bo co, nhng cc phn ng ny thng thong qua v gim khi dng thuc
thng xuyn.
Lon nhp tim (bao gm rung nh, nhp nhanh trn tht v ngoai tm thu) c th xy ra thng
trn bnh nhn nhy cm.
C bo co v triu chng au khp v phn ng qu mn, bao gm ni mn, ph v ph
mch.
Him khi c au c.
Fluticasone propionate :
Khn ging v nhim nm candida ming v hng c th xy ra mt vi bnh nhn.
Phn ng qu mn da c bo co.
C hai triu chng khn ging v tn sut nhim nm candida c th gim bng cch sc ming
vi nc sau khi dng salmeterol v fluticasone propionate.
Triu chng nhim nm candida c th c iu tr bng thuc khng nm ti ch trong khi
vn tip tc dng salmeterol v fluticasone propionate.
Cng nh cc tr liu ng ht khc, c th c xy co tht ph qun nghch thng vi triu
chng kh kh gia tng ngay sau khi dng thuc. Nn iu tr tc thi vi mt thuc gin ph
qun ng ht tc dng nhanh. Nn ngng dng salmeterol v fluticasone propionate, bnh
nhn nn c thm khm v dng phng php iu tr thay khc khi cn.
Cc th nghim lm sng v salmeterol v fluticasone propionate:
Cc phn ng khng mong mun thng c bo co l:
Khn ging/ni kh, kch ng hng, nhc u, nhim candida ming v hng v nh trng
ngc.
LIU LNG v CCH DNG
Thuc ch dng ng ht qua ming.
Bnh nhn nn c thng bo rng Seretide phi c dng thung xuyn t hiu qu ti
u, ngay c khi khng c triu chng.
Bnh nhn nn c khuyn ti khm thng xuyn, nh vy hiu qu ti u ca Seretide
c dng s duy tr v ch thay i theo y lnh. Liu nn c chun cho ti liu thp nht
m vn duy tr hiu qu kim sot triu chng.
Liu khuyn co :
Ngi ln v tr em trn 12 tui :
Mt nht xt (50 mg salmeterol v 100 mg flucasone propionate) ngy 2 ln ; hay
Mt nht xt (50 mg salmeterol v 250 mg flucasone propionate) ngy 2 ln ; hay
Mt nht xt (50 salmeterol v 500 flucasone propionate) ngy 2 ln.
Tr em t 4 tui tr ln :

Mt nht xt (50 mg salmeterol v 100 mg flucasone propionate) ngy 2 ln.

Khng c ti liu sn c v vic dng Seretide cho tr di 4 tui.
Nhm bnh nhn c bit :
Khng cn chnh liu cho bnh nhn ln tui hay bnh nhn b suy thn hay suy gan.
Hng dn s dng :
M np dng c. t phn ming ca dng c vo ming v ngm mi li. Sau ht liu thuc
vo v ng dng c li.
Mc ch liu trn Accuhaler ch ra s liu cn li.
QU LIU
Khng c d liu sn c t cc th nghim lm sng v vic qu liu Seretide, tuy nhin ti liu
v qu liu cho c hai hat cht nh sau :
Du hiu v triu chng qu liu salmeterol l run, nhc u v nhp nhanh. Thuc i khng
thch hp l cc thuc chn th th bta chn lc trn tim, nn c dng thn trng trn bnh
nhn c tin s co tht ph qun. Khi vic iu tr bng Seretide phi ngng do qu liu thnh
phn ch vn bta ca thuc, nn cn nhc vic s dng liu php steroid thay th thch hp.
Dng qu liu khuyn co fluticasone propionate ng ht c th gy suy chc nng thng
thn tm thi.
Khng cn thit phi iu tr cp cu v chc nng thng thn s hi phc trong vi ngy, bng
cch o nng cortisol huyt tng. Tuy nhin, nu liu cao hn liu khuyn co c tip
tc dng ko di, c th gy ra cc mc suy thng thn. Viec theo di s hi phc ca
thng thn l cn thit. Trong trng hp vic qu liu fluticasone propionate trong Seretide
c th vn c tip tc vi liu thch hp nhm kim sot triu chng (xem phn Ch {
phng v Thn trng lc dng).
BO QUN
Bo qun di 30oC, ni kh.

466.

SEREVENT

GLAXOWELLCOME
Inhaler : hn dch bm kh dung qua ming cha trong bnh xt vi van nh liu (120 liu).
Accuhaler : hn dch bm kh dung qua ming cha trong bnh xt vi van nh liu (60 liu).
THNH PHN
cho 1 liu Inhaler

Salmeterol

25 mg

cho 1 liu Accuhaler

Salmeterol

50 mg

DC LC
Serevent l mt cht ch vn tc ng trn th th b2-adrenergic mi v c tnh chn lc. Vi
liu iu tr, thuc c rt t hay khng c tc ng c th o lng c trn tim mch.
Salmeterol c chng minh l cho tc ng gin ph qun ko di ti thiu 12 gi cc i
tng b tc nghn ng thng kh c hi phc. Dng thuc u n s ci thin ko di trn
hot ng chc nng phi, do lm gim cc triu chng tc nghn ng h hp v cc triu
chng hen v m. Trn i a s bnh nhn, vic dng thuc u n s loi b c nhu cu
dng thuc gin ph qun triu chng ph tr thm.
Cc test in vitro cho thy rng salmeterol l mt cht c ch mnh v c tc ng ko di s
phng thch t phi ngi cc cht trung gian dn xut t dng bo nh histamine,
leukotriene v prostaglandine D2. ngi, salmeterol c ch p ng vi nhng d ng nguyn
b ht vo pha sm v pha chm v sau mt liu duy nht, s lm gim tnh p ng qu
trn ph qun, th hin hot tnh khng vim v c hot tnh gin ph qun.
CH NH
iu tr u n v di hn chng tc nghn ng h hp c hi phc, trong hen ph qun
(bao gm nhng bnh nhn b hen v m v hen do vn ng) v vim ph qun mn tnh.
CHNG CH NH
Qu mn vi bt kz thnh phn no ca Serevent.
CH PHNG
Khi bt u iu tr vi Serevent vi nhu cu tr liu gin ph qun, cc triu chng thng
gim do a phn bnh nhn khng cn dng thuc gin ph qun triu chng ph tr thm.
Nu cc triu chng ko di, bnh nhn nn ht mt cht ch vn beta c tc dng ngn hn
(nh salbutamol) gim bt triu chng. Tuy nhin, thng thng nhu cu ny cho thy vic
kim sot tc nghn ng h hp l cha hon ho v nn xem x t iu tr b sung. Vic iu
tr b sung ny c th bao gm gia tng liu Serevent v/hoc bt u hay gia tng liu ca
thuc d phng nh cc corticoide dng ng ht.
Serevent ht c s dng theo phc u n mi ngy hai ln v do nn c xem nh
l b sung cho cc thuc d phng khc nh corticoide dng ng ht. Khi bt u dng
Serevent, bnh nhn c iu tr vi corticoide ht hay hay cc iu tr d phng khc nn
tip tc dng cc thuc ny vi cng liu nh trc.

Vi hu ht cc bnh nhn, nhu cu dng thm thuc gin ph qun h tr s gim ng k.

Nu bnh nhn tiu th ngy cng nhiu cht ch vn beta tc ng ngn (nh salbutamol)
trong mt thi gian ngn, nn theo di k cng. S tng vt cn hen cp nn c iu tr theo
cch thc bnh thng vi thuc gin ph qun dng kh dung v/hoc dng tim v corticoide
dng tim.
Chng h kali huyt c kh nng ln n trm trng c th l kt qu ca vic iu tr vi cht
ch vn b2. Nn c bit thn trng trong hen ph qun nng cp tnh v tc ng ny c th
c tng cng thm do vic dng ng thi nhng dn xut xanthine, stroide, thuc li
tiu v do chng gim oxy. Nn kim tra nng kali huyt thanh trong nhng trng hp ny.
Nn dng cn thn salmeterol cho bnh nhn nhim c gip.
LC C THAI
Trong cc nghin cu trn th vt, mt vi tc ng trn thai nhi c trng cho cht ch vn
beta xy ra vi nng cao hn nhiu so vi cc nng dng tr liu. Kinh nghim iu tr vi
cc cht ch vn b-2 khng cho thy bng chng rng nhng tc ng ny c nh hng n
ngi ph n s dng thuc vi liu tr liu trn lm sng.
Tuy nhin, kinh nghim v s dng salmeterol lc c thai vn cn gii hn. Ging nh mi
thuc khc, nn xem xt s dng thuc ny trong thai kz ch khi li ch mong i cho ngi m
ln hn bt kz nguy c no cho thai nhi.
LC NUI CON B
Nng trong huyt tng ca salmeterol sau khi dng cc liu iu tr theo ng ht l
khng ng k v do , suy ra rng nng tng ng trong sa c th rt thp. Tuy nhin,
do khng c kinh nghim v s dng salmeterol cho ngi m nui con b, ch nn xem xt s
dng thuc trong nhng trng hp trong li ch mong i cho ngi m ln hn mi nguy
c c th xy ra cho a b.
Cc nghin cu trn th cho con b h tr cho quan im rng salmeterol hu nh c tit
qua sa vi mt lng rt nh.
TNG TC THUC
Khng bao gi c k toa cc thuc c ch bta khng chn lc, nh propranolol, trong hen
ph qun v ch nn dng mt cch cn thn cc thuc c ch bta chn lc trn tim bnh
nhn hen ph qun.
TC DNG NGOI
Chng run ry him khi c bo co. Chng ny c khuynh hng thong qua, ph thuc vo
liu lng v gim i khi dng thuc u n. Trong cc th nghim lm sng, chng nhc u
v nh trng ngc ch quan cng c bo co him khi xut hin nhng t l khng khc
bit ng k so vi placebo.
Chng h kali huyt c kh nng ln n trm trng c th l kt qu ca vic iu tr vi cht
ch vn b-2.

LIU LNG v CCH DNG

Serevent ch dng ht.
Ngi ln : 2 ln ht (2 x 25 mg salmeterol) hai ln mi ngy.
i vi bnh nhn b nghn ng h hp nng hn, 4 ln ht (4 x 25 mg salmeterol) hai ln
mi ngy.
Tr em : Hin nay, khng c s liu lm sng khuyn co s dng Serevent tr em.
Ngi ln tui : Khng cn iu chnh liu cho ngi ln tui.
Khng cn iu chnh liu cho bnh nhn suy thn.
t c y li ch tr liu, nn s dng u n Serevent trong iu tr tc nghn
ng h hp c hi phc. Khi pht ca tc ng gin ph qun ca salm t rol thng xy ra
trong vng 5-10 pht. ch li hon ton s tr nn r rng sau mt hay hai liu. Tc ng gin
ph qun ca salmeterol thng ko di 12 gi, iu ny c bit hu ch trong vic iu tr
triu chng hen ph qun v m v trong kim tra cn hen ph qun do vn ng.
Do c th c cc tc dng ngoi { c lin quan n vic qu liu, ch nn tng liu hay rt ngn
khong cch dng thuc dng khi c hng dn ca bc s.
Trn bnh nhn kh s dng bnh xt nh liu, c th s dng mt bu th tch (volumatic
spacer) dng cho Serevent.
QU LIU
Triu chng : Run ry, nhc u v tim nhanh.
iu tr : Cht gii c thng c dng iu tr qu liu Serevent l mt thuc c tnh c
ch bta chn lc trn tim. Nn dng cn thn cc thuc c ch bta chn lc trn tim cho
bnh nhn c tin s co tht ph qun

467.

SRUM ANTIRABIQUE PASTEUR

AVENTIS PASTEUR
Dung dch tim 1.000 UI : hp 1 l 5 ml - Bng B.
THNH PHN
cho 5 ml
Huyt thanh khng bnh di tinh khit (c ngun gc nga)

1.000 UI

CH NH
D phng bnh di vi b sung tr liu bng vaccin.
CH PHNG
Lun lun tin hnh theo phng php gii mn cm (Besredka) : tim 0,1 ml sau 0,25 ml v

phn cn li c tim cch khong 15 pht.

Trong trng hp c tai bin huyt thanh, iu tr ngay lp tc bng adrnaline, khng
histamine v c th dng corticoide ng tim.
LIU LNG v CCH DNG
n iu tr ban u : Vic iu tr cc vt thng rt quan trng v cn phi thc hin ngay sau
khi b cn. Cn phi lau ra vi lng nc nhiu v x phng, sau st trng bng alcool 40o
n 70deg, bng cn iode hoc bng dung dch 0,1% dn xut ca ammonium bc 4 (vi iu
kin khng cn vt x phng do 2 dung dch s trung ha ln nhau).
n Huyt thanh tr liu di s theo di y t : Huyt thanh khng di ca Pasteur c tim cng
nhanh cng tt sau khi b cn, cng mt ngy vi liu vaccin u tin.
Liu tng cng l 40 UI/kg. Cho ngm su vo vt thng v tim xung quanh vt thng cng
nhiu cng tt, phn cn li tim bp mt im xa im tim vaccin.
Nu cn thit, c th b sung d phng un vn v dng khng sinh trnh bi nhim.

468.

SEVORANE

ABBOTT
Dung dch bay hi 100% : chai 250 ml - Bng B.
THNH PHN
Sevoflurane

100%

M T
Sevoflurane l cht lng bay li, khng chy, mi d chu. Tn ha hc l 1,1,1,3,3,3-hexafluoro2-fluoromethoxypropane.
TNH CHT
Tnh cht vt l :
- Phn t lng 200,05.
- Nhit si 760 mmHg l 58,6oC.
- Ch s khc x n20 1,2740-1,2760.
- T trng 20oC l 1,520-1,525.
p sut hi bo ha (mmHg) :
- nhit 20oC l 157.
- nhit 25oC l 197.
- nhit 36oC l 317.
H s ha tan 37oC :
- Nc / Kh : 0,36.
- Mu / Kh : 0,63-0,69.

- Du oliu / Kh : 47,2-53,9.
H s ha tan 25oC i vi cao su v nha tng hp :
- Cao su ng dn / Kh : 14,0.
- Cao su butyl / Kh : 7,7.
- Nha PVC / Kh : 17,4.
- Nha PE / Kh : 1,3.
tinh khit o bng php sc k kh : 99,975% hay hn.
Kh nng chy : khng chy.
Nng ti thiu trong ph nang (MAC) :
nh hng ca
tui tc trn MAC
ca Sevofurane
Tui

Sevofurane trong O2

Sevofurane trong 65% N2O/35% O2*

<3

3,3-2,6%

2,0%

3-<5

2,5%

khng c d liu

5-12

2,4%

khng c d liu

25

2,5%

1,4%

35

2,2%

1,2%

40

2,05%

1,1%

50

1,8%

0,98%

60

1,6%

0,87%

80

1,4%

0,70%

* bnh nhi dng 60% N2O/40% O2.

Sevoflurane ch cha Sevoflurane, khng c thm t dc. Sevoflurane l cht lng bay hi,
khng chy, mi d chu.
Sevoflurane khng n mn th p khng r, ng thau, nhm, ng thau m nickel, ng thau m
chrom hay hp kim ng beryllium.
DC LC
m thay i nhanh theo s thay i nng Sevoflurane ht vo. Tnh v hi phc c bit

nhanh. V vy ngi bnh c th cn n gim au sau m sm.

Cng nh cc thuc m h hp khc, Sevoflurane c ch chc nng tim mch tng ng vi
liu lng. Trong mt cng trnh nghin cu trn ngi tnh nguyn, tng nng Sevoflurane
lm gim huyt p ng mch trung bnh m khng c s thay i nhp tim. Trong nghin cu
ny, Sevoflurane khng c nh hng n nng noradrenaline trong huyt tng.
Khng quan st thy cc cn ng kinh trong chng trnh nghin cu lm sng.
ngi bnh c p lc ni s bnh thng (ICP), Sevoflurane c tc dng rt t trn ICP v trn
s p ng vi CO2. an ton ca Sevoflurane cha c nghin cu trn ngi bnh c
tng ICP. Vi ngi bnh c nguy c tng p lc ni s, cn s dng Sevoflurane thn trng,
phi hp vi cc phng php gim ICP nh tng thng kh.
DC NG HC
tan thp ca Sevoflurane trong mu dn n nng thuc m trong ph nang tng nhanh
vo lc dn m v gim nhanh sau khi ngng ht thuc m.
ngi, < 5% lng Sevoflurane b chuyn ha. S thi tr ca Sevoflurane qua phi lm hn
ch lng thuc tham gia chuyn ha. Sevoflurane b kh fluor nh cytochrome P450(CYP)2E1,
to ra cht chuyn ha hexafluoroisopropanol (HFIP) v gii phng fluorid v c v CO2 (hoc
mt on c 1 carbon). HFIP sau s kt hp nhanh vi acid glucoronic v thi tr qua nc
tiu.
Chuyn ha ca Sevoflurane c th tng ln khi phi hp vi cc cht gy cm ng CYP2E1 (nh
isoniazid v ru) nhng Sevoflurane khng b cm ng bi barbiturate.
C th xy ra tng nht thi fluorid v c trong huyt thanh trong v sau khi gy m bng
Sevoflurane. Thng thng, nng nh ca fluorid v c t c trong vng 2 gi sau khi
kt thc gy m v s tr v mc trc khi phu thut trong vng 48 gi.
CH NH
Dng dn m v duy tr m cho cc phu thut ni tr v ngoi tr c ngi ln v tr em.
CHNG CH NH
Khng dng cho ngi c bit l mn cm vi Sevoflurane. Cng chng ch nh ngi
bit hoc nghi ng c nhy cm do di truyn vi chng st cao c tnh.
THN TRNG LC DNG
Ch nhng nhn vin c o to v gy m mi c th s dng Sevoflurane. Cn phi c
sng nhng phng tin duy tr ng th, h hp nhn to, cung cp oxy, hi phc tun
hon. Nn dng nhng bnh bc hi c chun ha c bit cho Sevoflurane nng
thuc cung cp c kim tra chnh xc. H huyt p v c ch h hp tng ln khi gy m su.
Trong khi duy tr m nu tng nng Sevoflurane s lm gim huyt p ph thuc vo liu
dng. S gim huyt p qu mc c th c lin quan n su ca m, khi c th nng
huyt p ln bng cch gim nng Sevoflurane ht vo. S hi phc sau khi gy m ton thn
nn c nh gi thn trng trc khi chuyn bnh nhn khi phng hi phc.

 mt s ngi mn cm, cc thuc m h hp mnh c th gy tng chuyn ha c xng,

dn ti tng cao nhu cu oxy v hi chng lm sng c bit l st cao c tnh. Hi chng cn
c nhng n t khng c hiu nh co cng c, nhp tim nhanh, th nhanh, tm ti, lon nhp tim,
huyt p khng n nh. iu tr gm loi b cht gy phn ng (chng hn Sevoflurane), tim
tnh mch natri dantrolene, iu tr h tr. Suy thn c th xut hin chm hn, nn theo di v
duy tr lu lng nc tiu nu c th.
V t bnh nhn suy thn (creatinine huyt thanh > 133 mmol/lt) c nghin cu nn an
ton ca Sevoflurane ngi suy thn cn cha c xc nh y . V vy cn thn trng
khi s dng Sevoflurane ngi suy thn.
Khi tip xc trc tip vi cc cht hp ph CO2, Sevoflurane to nn hp cht A
[pentafluoroisopropenyl fluoromethyl ether (PIFE)] vi hm lng thp v vt ca hp cht B
*pentafluoromethoxy isopropyl fluoromethyl ether (PMFE)+. Lng hp cht A tng khi tng
nhit ca bnh ng thuc, tng nng thuc m, gim lu lng kh v tng nhiu hn
khi dng vi Baryt so vi khi dng vi Soda (xem thm phn Thn trng dc hc).
Trong mt s nghin cu trn chut cng, thy sc vt tip xc vi hm lng cht A vt
qu mc thng gp trong thc tin lm sng s b c vi thn. C ch c vi thn ca
Sevoflurane i vi chut cng cha c bit r v mi lin quan ca vn ngi vn
cha c chng minh.
Kinh nghim v vic dng lp li nhiu ln lin tc Sevoflurane cn rt hn ch. Tuy nhin,
khng c tc dng r rng v tc dng bt li gia ln dng u tin v nhng ln tip sau
vi Sevoflurane.
Li xe v vn hnh my mc :
Cng nh cc thuc m khc, cn thng bo cho bnh nhn r l cn trnh lm nhng cng vic
i hi s tnh to v tinh thn trong mt thi gian sau khi c gy m ton thn nh vn
hnh cc my mc. Bnh nhn khng c php li xe trong mt khong thi gian thch hp
sau khi gy m bng Sevoflurane.
LC C THAI v LC NUI CON B
Tr mt nghin cu nhng trng hp m ly thai, cha c nhng nghin cu khc trn ph
n mang thai. Kinh nghim trong m ly thai cn hn ch mt th nghim trn mt s t bnh
nhn.
Nhng nghin cu v s sinh sn c thc hin trn chut cng v th vi liu ti 1 MAC.
Khng thy c nh hng trn kh nng sinh sn ng vt c v ci. Gim th trng ca thai
v s thay i ca xng tng ln c ghi nhn ch khi chut cng m dng nng cao gy
c. Khng c nhng nh hng c hi trn th. Sevoflurane khng gy qui thai.
V vy Sevoflurane ch nn s dng cho ph n mang thai khi tht s cn thit.
Cha r Sevoflurane c bi tit qua sa hay khng nn cn thn trong khi dng Sevoflurane
ngi ang cho con b.

TNG TC THUC
Hiu lc ca cc thuc dn c khng kh cc tng ln r rt khi phi hp vi Sevoflurane, v vy
khi phi hp, cn iu chnh liu lng thuc dn c.
Tnh lm tng nhy cm ca c tim i vi adrenaline ngoi sinh ca Sevorane ging nh
isoflurane.
Gi tr MAC ca Sevorane gim khi thm N2O nh trnh by bng "nh hng ca tui tc
trn MAC ca Sevoflurane" (xem thm phn Liu lng v Cch dng).
Cng nh nhng thuc khc, c th dng nng Sevoflurane thp hn sau khi dng mt
thuc m ng tnh mch chng hn nh propofol.
Chuyn ha ca Sevoflurane c th tng sau khi dng nhng thuc gy cm ng CYP2E1 bit
(nh ru, isoniazid), nhng khng b gy cm ng bi barbiturate.
TC DNG NGOI
Cng nh mi thuc m h hp, Sevoflurane c th c ch tim v h hp ty thuc liu dng.
Hu ht cc tc dng ngoi l nh n trung bnh v cng v thong qua. Thng thy
nn v bun nn trong thi gian sau phu thut vi mt t l tng t cc thuc m h hp
khc. Nhng tc dng ph ny l nhng di chng chung ca phu thut v gy m ton thn, c
th do thuc m h hp hoc do cc cht khc dng trong lc phu thut v hu phu v cn
do s p ng ca tng bnh nhn vi qu trnh phu thut.
Nhng d liu v tc dng ngoi { c rt ra t nhng nghin cu lm sng c kim sot tin
hnh ti Hoa Kz v Chu u trn hn 3.200 bnh nhn. Kiu, tnh nghim trng v tn s ca
nhng tc dng ngoi ca Sevoflurane c so snh vi cc loi thuc m h hp khc.
Hu ht nhng tc dng ngoi lin quan vi Sevoflurane l bun nn (24%), nn (17%). Tr
em thng gp kch ng (23%). Nhng tc dng ngoi khc hay gp (>= 10%) vi Sevoflurane
l ho v h huyt p.
Ngoi bun nn v nn cn mt s tc dng ngoi { thng gp (>= 10%) ph thuc vo tui
tc nh: ngi ln, h huyt p ; ngi cao tui, h huyt p v chm nhp tim; tr em, kch
ng v ho tng ln.
Nhng tc dng ngoi t gp hn (1-< 10%) vi Sevoflurane l : kch ng, bun ng, n lnh,
nhp tim chm, chng mt, tng tit nc bt, ri lon h hp, huyt p cao, nhp tim nhanh,
vim thanh qun, st, nhc u, h thn nhit, tng SGOT.
Mt s tc dng ngoi { i khi gp trong nghin cu lm sng (< 1%) gm : lon nhp tim, tng
LDH, tng SGPT, gim oxy, ngng th, tng bch cu, ngoi tm thu tht, ngoi tm thu trn
tht, hen, l ln, tng creatinine, nc tiu, glucose niu, rung nh, blc nh tht hon ton,
nhp i, gim bch cu.
Rt him gp st cao c tnh v suy thn cp.
t c bo co v vim gan sau m, nhng cng khng c lin quan chc chn vi Sevoflurane.
Cng nh cc thuc m khc, c thy mt s tr em khi m bng Sevoflurane c cc c ng

co tht c v git nhng khi nhanh v khng c lin quan chc chn vi Sevoflurane.
Cc th nghim trong phng th nghim : C th tng glucose v s lng bch cu thong qua
nh khi dng cc thuc m khc.
i khi gp thay i nh kt qu th nghim chc nng gan vi Sevoflurane.
LIU LNG v CCH DNG
Nn dng nhng bnh bc hi c chun ha c bit cho Sevoflurane nng thuc
c kim tra chnh xc. Gi tr MAC ca Sevoflurane gim theo tui v gim nu thm N2O.
Bng trn ch gi tr ca MAC cho cc nhm tui khc nhau.
Tin m : Tin m c chn ty theo trng thi ca tng ngi bnh v theo ca chuyn
vin gy m. Thng dng thuc khng cholinergic.
Dn m : C th dng Sevoflurane dn m ngi ln v tr em. Liu lng ty thuc tng
ngi bnh v chun t tc dng mong mun ty theo tui tc v tnh trng lm sng.
Tip theo Sevoflurane c th tim tnh mch mt barbiturate tc dng ngn hoc mt thuc
dn m ng tnh mch khc (xem phn Tng tc). Dn m bng Sevoflurane c th t
c trong O2 hay trong hn hp O2 vi N2O. Ngi ln ht Sevoflurane nng ti 5% th t
c m phu thut trong vng di 2 pht. Tr em ht Sevoflurane nng ti 7% th t
c m phu thut trong vng di 2 pht. Nu dn m bnh nhn khng c tin m,
c th ht Sevoflurane nng ti 8%.
Duy tr : m phu thut c th c duy tr vi Sevoflurane nng 0,5-3% c hoc khng
km N2O.
Ngi cao tui : Cng nh cc thuc m h hp khc, ngi cao tui thng dng Sevoflurane
nng thp hn duy tr m phu thut. Xem cc gi tr MAC trn.
Hi tnh : Thi gian hi tnh thng ngn sau khi gy m bng Sevoflurane V vy ngi bnh c
th cn n gim au sau m sm.
Thn trng v dc hc : Khng c thn trng c bit no v bo qun. Sevoflurane n nh
v mt ha hc. Cng nh mt s thuc m halogene, Sevoflurane b ging ha mt phn nh
qua tip xc trc tip vi cc cht hp ph CO2. Mc ging ha khng c ngha lm sng,
khng cn iu chnh liu hoc thay i trong thc hnh lm sng khi s dng chu trnh kn. Khi
dng vi Baryt lng hp cht ging ha A sinh ra cao hn khi dng vi Soda.
Hng dn s dng : Mt s thuc m halogene c bo co l tng tc vi cht hp
ph CO2 kh to ra CO. n nay, cha c bng chng l c xy ra phn ng ny i vi
Sevoflurane. Tuy vy, lm gim nguy c to ra CO trong vng ti h hp v kh nng c th
tng hm lng carboxy-heamoglobin, khng nn kh cc cht hp ph CO2.
QU LIU
Nu qu liu, cn ngng thuc ngay, m bo thng ng th, bt u tr gip hoc thng
kh c kim sot vi oxy tinh khit v duy tr chc nng tim mch thch hp.

BO QUN
Bo qun ni mt. y kn nt khi s dng xong

469.

SIBELIUM

JANSSEN PHARMACEUTICA
c/o JANSSEN-CILAG
c/o MEGA PRODUCTS
Vin nang 5 mg : v 10 vin, hp 10 v, 50 v - Bng B.
THNH PHN
cho 1 vin
Flunarizine

5 mg

DC LC
Flunarizine l thuc i khng canxi c chn lc. Thuc ngn chn s qu ti canxi t bo, bng
cch gim canxi trn vo qu mc qua mng t bo. Flunarizine khng tc ng trn s c bp
v dn truyn c tim.
DC NG HC
Thuc c hp thu tt qua ng rut, t nng nh trong vng 2-4 gi v t trng thi
hng nh tun th 5-6. Sau khi chuyn ha hon ton qua gan, thuc v cc cht chuyn ha
c bi tit ra phn qua ng mt. Thi gian bn hy thi tr tn cng khong 18 ngy. Gn
kt protein : 90%.
CH NH
D phng au na u dng c in (c tin triu) hoc au na u dng thng thng
(khng c tin triu).
iu tr triu chng chng mt tin nh do ri lon chc nng h thng tin nh.
iu tr cc triu chng do thiu nng tun hon no v suy gim oxy t bo no bao gm :
chng mt, nhc u nguyn nhn mch mu, ri lon kch thch, mt tr nh, km tp trung v
ri lon gic ng.
CHNG CH NH
Khng dng Sibelium bnh nhn c tin s trm cm hoc ang c triu chng Parkinson
trc hoc cc ri lon ngoi thp khc (xem Tc dng ngoi ).
THN TRNG LC DNG

iu tr ny c th gia tng triu chng ngoi thp, trm cm v bc pht hi chng Parkinson,
c bit nhng bnh nhn d c nguy c nh ngi gi. Do vy nn dng thn trng trn cc
bnh nhn ny.
Trong mt s trng hp him : mt mi c th gia tng trong iu tr Sibelium, trng hp
ny nn ngng iu tr. Khng vt qu liu quy nh. Bnh nhn phi c khm u n
theo kz hn, c bit trong giai on iu tr duy tr, c th pht hin sm triu chng ngoi
thp hay trm cm v ngng iu tr. Nu trong iu tr duy tr, khng t hiu qu iu tr th
ngng iu tr (thi gian iu tr xin xem phn Liu lng v Cch dng).
Tc ng trn kh nng li xe v s dng my mc :
Bi v bun ng c th xy ra, c bit lc bt u iu tr nn thn trng trong cc hot ng
nh li xe hoc vn hnh my mc nguy him.
LC C THAI
S an ton ca Sibelium khi dng trn ph n c thai cha c xc nhn. nh gi cc nghin
cu trn sc vt khng chng t tc ng c hi trc tip hay gin tip v s sinh sn, pht
trin ca phi hoc thai, v tin trnh thai nghn v s pht trin chu sinh v hu sn.
Nghin cu trn ch cho con b chng t Sibelium c bi tit qua sa vi nng trong
sa cao hn trong huyt tng. Khng c d liu ni v s bi tit qua sa ngi. Do ,
khng khuyn khch s dng Sibelium trn ph n cho con b.
TNG TC THUC
Ru, thuc an thn, thuc ng khi dng chung Sibelium lm gia tng tc dng ph bun ng.
Sibelium khng chng ch nh bnh nhn ang dng thuc chn beta.
TC DNG NGOI
Tc dng ph thng gp thong qua : bun ng nh v/hoc mt mi (20%) ; tng cn v/hoc
tng ngon ming (11%).
Mt s tc ng ph nghim trng sau y xy ra trong iu tr ko di :
- Trm cm, c bit c nguy c xy ra bnh nhn n c tin s trm cm.
- Triu chng ngoi thp (nh vn ng chm, cng , ngi nm khng yn, lon vn ng,
run) hoc nhng ngi gi dng nh c nguy c.
Nhng tc dng ph him gp khc :
- Tiu ha : nng bng trong xng c, bun nn, au d dy.
- Thn kinh trung ng : bun ng, lo lng.
- Tng tit sa, kh ming, au c, pht ban.
LIU LNG v CCH DNG
D phng au na u :
Liu khi u : Ung vo bui ti.
Bnh nhn di 65 tui : 10 mg (2 vin)/ngy.
Bnh nhn > 65 tui : 5 mg/ngy.

Nu trong giai on iu tr ny, xy ra cc triu chng trm cm, ngoi thp hoc tc dng ph
ngoi mun nn ngng iu tr. Nu sau 2 thng khng c s ci thin ng k, bnh nhn
c xem nh l khng p ng v nn ngng iu tr.
iu tr duy tr :
Nu bnh nhn p ng tt v nu cn iu tr duy tr th nn gim liu xung 5 ngy vi liu
hng ngy nh nhau v 2 ngy ngh mi tun. Nu iu tr duy tr phng nga thnh cng v
dung np tt th c th ngng iu tr trong 6 thng v ch bt u iu tr li nu ti pht.
Chng mt :
Liu hng ngy tng t nh dng cho au na u, nhng iu tr khi u ch ko di cho
n khi kim sot c triu chng, thng l t hn 2 thng. Cho d khng c s ci thin
ng k sau 1 thng i vi chng mt mn tnh, 2 thng i vi chng mt t th, bnh nhn
c xem nh l khng p ng v nn ngng iu tr.
QU LIU
Triu chng :
Da vo tnh cht dc l ca thuc, bun ng v suy nhc c th xy ra. Mt vi trng hp
qu liu cp (cao n 600 mg ung 1 ln) c bo co, triu chng c quan st l bun
ng, nhp tim nhanh, kch ng.
iu tr :
Khng c thuc gii c c hiu. Trong vng 1 gi sau khi ung qu liu, nn sc ra d dy.
C th dng than hot nu thy thch hp.
BO QUN
Bo qun 15-30oC.

470.

SIDERFOL vin nang

RAPTAKOS BRETT
Vin nang : chai 30 vin.
THNH PHN
cho 1 vin
Fe fumarate

350 mg

Vitamine B12

15 mg

Acide folique

1,5 mg

Vitamine C

150 mg

Vitamine B6

1,5 mg

Cu sulfate

5 mg

(mt vin cung cp khong 120 mg nguyn

t st)

DC LC
- Fumarate st : ngoi vic cht st l mt thnh phn ca huyt st t, c nhiu nghin cu
ng h gi thuyt cho rng vic thiu cht st c nh hng bt li n kh nng hc tp v kh
nng gii quyt vn ca tr em tui cn i hc. Tr em thiu mu c iu tr bng cht st
lm gia tng t l tng cn v ci thin k nng tm thn vn ng (phn ng nhanh, chnh xc)
hn tr thiu mu dng placebo.
- Sulfate ng : ng cn c vai tr h tr cho s hp thu st t h tiu ha v s s dng st
tng hp heme v huyt sc t. Thiu ng l mt trong nhng nguyn nhn gy thiu mu
v gim bch cu ht, nht l trong cc trng hp sau m bc cu rut, bnh nhn c nui
dng bng ng tnh mch, tr suy dinh dng, c bit l tr c nui dng n
thun bng sa v ngi n qu nhiu km. S thiu ng c th gy thiu mu hng cu
nh nhc sc do rut gim hp thu cht st. Tnh trng thiu ng cng dn n s suy gim
s lng mt s enzyme cha ng trong t bo m v c l c lin quan n s suy gim sn
xut ty lp th ca heme. quan st thy trn sc vt th nghim vic thiu ng cn c nh
hng trn h xng, tim mch, thn kinh v lng tc.
Trong trng hp gim bch cu v thiu mu, nu c tnh trng nng ng trong mu thp
v nghi ng l do thiu nguyn t ng th nn nghin cu iu tr bng cht ng vi liu dng
hng ngy c th n 0,1 mg sulfate ng cho mi kg th trng bng ng ung.
- B12 phi hp vi acide folique ng vai tr quan trng trong s tng hp ADN, c bit l
trong h thng to mu. Gip s sinh sn, tng trng ca cc t bo to mu. Thiu chng dn
n thiu mu trm trng loi hng cu to.
- B6 c vai tr trong s tng hp huyt sc t v tch t st.
- Acide ascorbique c tc dng kh st III thnh st II trong d dy v thc y s hp th st ti
rut. Liu 150-200 mg dng km vi st l liu tt nht c th lm gia tng s hp thu st
hn 30% m t gy tc dng ph. Acide ascorbique kch thch trc tip s tng hp collagne
nh lm bn vng m lin kt bao quanh mao mch, lm bn vng mao mch trc p lc

ca dng mu.
DC NG HC
Hp thu :
Bnh thng st c hp thu ti t trng v phn u ca hng trng khong 5-10% lng
ung vo bng c ch vn chuyn tch cc. T l ny c th tng n 20-30% nu d tr st b
thiu ht hoc khi c tnh trng gia tng sn xut hng cu. Thc n, cc phosphate, phytate c
th lm gim hp thu st. Cc mui st II c hp thu d hn cc loi mui st III gp ba ln.
Cc mui st II thng thng c t l hp thu tng ng nhau nhng khc nhau v hm
lng st nguyn t. Fumarate st l dng c hm lng nguyn t st cao nht (33%) v cho t
l hp thu st khong 10-20%.
Hm lng st nguyn t ca cc dng mui st II
Mui st

% st nguyn t

c im

Sulfate st II (FeSO4. 7H2O)

20

Khng mi, v mn cht

Sulfate st II khan nc

30

d b oxy ha

Gluconate st

11,6

Fumarate st

33

Khng v, bn, t b oxy ha

Chuyn ha :
St c chuyn vn trong huyt tng di dng transferrine n dch gian bo, cc m nht
l gan v tr dng ferritine. St c a vo ty xng tr thnh mt thnh phn ca
huyt sc t trong hng cu, vo c thnh mt thnh phn ca myoglobine. Hai ni d tr
st ln nht l hng cu v h vng ni m.
Thi tr :
St c thi tr khong 1 mg/ngy nam khe mnh, a s qua ng tiu ha (mt, t bo
nim mc trc), cn li qua da v nc tiu. ph n, st thi thm qua ng kinh nguyt c
th n 2 mg/ngy. Cht ng ch yu c thi tr qua ng mt.
CH NH
- Cc loi thiu mu.
- Cc trng hp tng nhu cu to mu (ph n mang thai, cho con b, thiu dinh dng, sau
khi m, giai on hi phc sau bnh nng...).
CHNG CH NH

- Qu mn cm vi fumarate st.
- Bnh gan nhim st.
- Thiu mu huyt tn.
- Bnh a hng cu.
THN TRNG LC DNG
Ngi c lng st trong mu bnh thng trnh dng thuc k o di. Ngng dng thuc nu
khng dung np.
TNG TC THUC
Antacide, tr, c ph, trng, sa lm gim hp thu st nu dng cng lc. Bn thn thuc cng
lm gim hp thu pnicillamine, ttracycline nu dng chung.
TC DNG NGOI
i khi c ri lon tiu ha (bun nn, au bng trn, to bn, hoc tiu chy). Phn c th en
do thuc. C th lm gim thiu tc dng ph bng cch ung trong ba n v tng dn t liu
nh.
LIU LNG v CCH DNG
Mi ngy ung mt vin sau khi n hoc theo ch nh ca Bc s.

471.

SIDERPLEX thuc git

RAPTAKOS BRETT
Dung dch ung : chai m git 15 ml.
THNH PHN
cho 1 ml
Fructose st (cha 10 mg nguyn t Fe)

50 mg

Acide folique

50 mg

Cyanocobalamine

1,5 mg

DC LC
Fructose st III : l phc hp st chelate ha duy nht c hp th tt hn loi mui st tt
nht hin nay l sulfate st II. Fructose st III cng c chng minh l dng st c dung np
tt mt cch c bit nht l tr nh v ngi ln tui do c nng kim loi t do thp.
Thc phm ch yu ca tr nh l sa v sa li l thc phm ngho st. V th tr s sinh v
tr nh thng b thiu mu dinh dng. duy tr cn bng, tr nh cn hp thu vo mu

khong 1,5 mg st mi ngy, ngha l cn cung cp qua khu phn hng ngy mt lng st
khong 15 mg. Ngoi vic cht st l mt thnh phn ca huyt sc t, c nhiu nghin cu cho
thy vic thiu st c nh hng bt li n kh nng hc tp v kh nng gii quyt vn ca
tr em tui cn i hc. Tr em thiu mu c iu tr bng cht st lm gia tng t l tng cn
v ci thin kh nng tm thn vn ng (phn ng nhanh, chnh xc) hn tr em thiu mu
dng placebo.
B12 phi hp vi acide folique ng vai tr trong s tng hp AND, c bit l trong h thng
to mu. Chng gip s sinh sn v tng trng ca cc t bo to mu. Thiu chng dn n
thiu mu trm trng loi hng cu to.
DC NG HC
Hp th :
Bnh thng, st c hp th ti t trng v phn u ca hng trng khong 5-10% lng
ung vo bng c ch vn chuyn tch cc. T l ny c th tng n 20-30% nu d tr st b
thiu ht hoc khi c tnh trng gia tng sn xut hng cu. Thc n, cc phosphate, phytate c
th lm gim hp th st.
Chuyn ha :
St c chuyn vn trong huyt tng di dng transferrine n dch gian bo, cc m nht
l gan v tr dng ferritine. St c a vo ty xng tr thnh mt thnh phn ca
huyt sc t trong hng cu, vo c thnh mt thnh phn ca myoglobine. Hai ni d tr
st ln nht l hng cu v h vng ni m.
Thi tr :
St c thi tr ch yu qua ng tiu ha (mt, t bo nim mc trc), s cn li qua da v
nc tiu.
CH NH
Dng phng nga v iu tr "thiu mu sinh l" tr s sinh v cc loi thiu mu dinh dng
khc tr em v tr nh.
CHNG CH NH
Tng cm vi fructose st, bnh nhim sc t st m, thiu mu huyt tn.
THN TRNG LC DNG
Ngng dng thuc nu khng dung np.
TNG TC THUC
Khng c bo co.
TC DNG NGOI
Khng c.
LIU LNG v CCH DNG
Mi ln 1 ml, mi ngy ung hai ln hoc theo ch nh ca Bc s.

472.

SILVIRIN kem bi

RAPTAKOS BRETT
Kem bi ngoi da : tup 20 g.
THNH PHN
cho 100 g
Sulfadiazine bc

1g

DC LC
Dc l hc : Silvirin l ch phm dng kem ca phc hp sulfadiazine bc. C hai thnh phn
trong phc hp u c hot tnh.
Tc dng khng khun : Sulfadiazine bc tc dng theo c ch khc vi cc hp cht bc khc
cng nh khc vi sulfadiazine n c. Sau khi bi kem thuc ln b mt vt phng, thuc gi
vai tr mt kho cha ion bc v lp tc c tc dng dit khun. Hu ht ion bc c gn vi
protine m v cc ion bc t do c phng thch dn dn vi nng c cho vi khun.
Thuc tc ng ln vch v mng t bo vi khun lm bin i cu trc v suy yu hn i. Kt
qu l thnh t bo bin dng, t bo phnh to, cc i phn t c hnh thnh lm t bo mt
kh nng sinh sng. Cc bin i t bo ny khng thy c vi khun vn khng vi
sulfadiazine bc. Ngi ta cha r thuc c thm su vo t bo vi khun khng. Tc ng
khng khun ca sulfadiazine bc khng b acide para-aminobenzoique c ch v thuc cng
khng phi l cht c ch men carbonique anhydrase. C ch tc dng ny gip gii thch ti
sao khng thy c hin tng khng thuc v khng gy t bin vi khun nhy vi
sulfadiazine bc.
Tc dng ln vt phng : Thuc lm mm lp m chy cng (escarre), tuy nhin do lm gim tc
ng ca vi khun ti ch, thuc cng gin tip lm gim s t tiu hy v t trc ca m cht
ny. Do , nn nhn phng 3 nn phi hp vi ng tc ra v ct lc. Ct lc ch hoi t
cng trnh co rt. Thuc lm gim mc nng ca bnh cng nh lm gim t l t vong
mt cch c { ngha. Trong iu kin thun li, vi phng 2, thuc lm ln da non trong
khong 10 ngy.
Thuc cn c tc dng tt i vi vt lot mn tnh do cn.
Khng c bo co no v toan huyt, v vy thuc c gi tr c bit cho tr em phng.
Vi sinh hc : Sulfadiazine bc l mt cht st khun i vi nhiu loi vi khun Gram m ln
Gram dng v c hiu lc khng nm men. Sulfadiazine bc c ch c cc vi khun khng
vi cc thuc khng khun khc v u vit hn sulfadiazine n thun. Sulfadiazine bc c

chng t c hiu lc chng li cc vi khun v vi nm sau :

Pseudomonas species bao gm Pseudomonas aeruginosa, Pseudomonas cepacia, Pseudomonas
maltophilia ; Enterobacter species bao gm Enterobacter aerogenes, Enterobacter
agglomerans, Enterobacter cloacae ; Herellea species ; Mima species ; Klebsiella species bao
gm Klebsiella pneumoniae ; Escherichia coli ; Serratia species bao gm Serratia liquifaciens,
Serratia marcescens, Serratia rubidae ; Proteus mirabilis, Proteus morganii, Proteus rettgeri,
Proteus vulgaris ; Providencia species ; Citrobacter diversus ; Shigella species ; Acinetobacter
anitratum ; Aeromonas hydrophilia ; Arizona hinshawii ; Alcaligenes faecalis ; Staphylococcus
aureus, Staphylococcus epidermidis ; Staphylococcus huyt gii beta ; Streptococcus nhm D
(gm c Enterococcus) ; Bacillus species ; Candida species bao gm Candida albicans ;
Corynebacterium diphtheriae ; Clostridium perfringens.
Lm sng : Thuc c bit c hiu lc trn Pseudomonas aeruginosa. Tnh nhy cm ca vi
khun i vi sulfadiazine bc khng lin quan n tnh nhy cm ca chng i vi
sulfonamide ring r v hiu lc khng khun cao hn l dng ring r sulfadiazine.
Thuc cng khng c Dermatophytes ln Herpes virus hominis. Sulfadiazine bc 10 mg/ml lm
bt hot hon ton in vitro 9/10 ging virus varicella zoster. Thuc cho kt qu tng t trn
bnh nhn herpes zoster.
Trn bnh nhn phng, dng thuc mi ngy tt hn l 3, 4 ngy mt ln. Hiu lc chng vi
khun xm nhp cao hn l chng vi khun nhim sn vt thng. Thuc khng c hiu
lc khng khun ton thn.
DC NG HC
Hp thu :
Nghin cu trn sc vt cho thy hu ht lng thuc tch t lp biu b ca da lnh v ch
hp th nu da b tn thng, try xt, phng. Khong 10% lng sulfadiazine bi ti ch
c hp th. Mc hp th vt phng su bn phn cao hn vt phng su ton phn do
trong trng hp sau khng cn tun hon mch. Trong khi bc c hp th di 1%, th
sulfadiazine c th c hp th n 10%.
Phn phi v chuyn ha :
Nng sulfadiazine trong huyt thanh khong 10-20 mg/l nu bi thuc trn din rng.
Sulfadiazine hp th c chuyn ha mt phn ti gan. Thi gian bn hy trong huyt thanh
trung bnh 10-12 gi. Th tch phn phi l 0,36 l/kg. Gn vi protine huyt tng 29-45%.
Bi thuc mi ngy ln vt phng 47% din tch c th, bn phn hay ton phn, nng bc
huyt thanh ton phn trung bnh khong 300 mg/l v nhiu gp i nu l phng rng hn
60%. bnh nhn phng 12% nng ln su c dng kem thuc trong 21 ngy, bc ch tch t
trong cc t bo biu b v tuyn m hi. Phu thi 2 bnh nhn t vong do phng bn phn v
ton phn 80% v 90% c iu tr vi sulfadiazine bc vi lng ln (12 kg/ngy) trong 3
tun cho thy khng c s tch t bc mu m sinh thit thn. a s bc c hp th, nu

c, c th lu li ch yu gan. Cha c bo co no v c tnh lm sng do bc hp thu tch

t trong c th.
Bi tit :
Sulfadiazine c hp th s c bi tit qua nc tiu khong 50% nguyn dng v khong
40% dng chuyn ha ac tyl ha. Sulfadiazine c bi tit qua sa m nng 15-35% so
vi nng trong huyt thanh. Sulfadiazine c th qua nhau thai. C hai loi bnh gan v thn
u lm gim s o thi sulfadiazine khi mu.
Bc c bi tit qua nc tiu hng ngy trung bnh 100-200 mg, i khi vt qu 1000 mg
nn nhn phng trn 60%. Lng tch t trong gan c thi dn qua mt.
C TNH
Trn chut nht trng, LD90-100 trong 24 gi l > 550 mg/kg ng tim phc mc 1 liu duy
nht. Vi ng ung hay tim di da liu 1050 mg/kg/ngy trong 30 ngy khng thy c
tnh cp hay bn cp cng nh khng c bin i m hc thn, rut, gan v lch. th, bc
tch t ti nh thn sau khi dng sulfadiazine bc 5-15 mg/kg/ngy trong 100 ngy lin nhng
khng tm thy du hiu hy hoi cu trc thn hay tn hi chc nng thn. nh hng tng
t ngi cha thy c bo co.
m hnh chut nht phng gy nhim vi khun Gram m iu tr bng kem sulfadiazine bc
bi ti ch cho thy c s gim tng lng bch cu, gim t l bch cu a nhn hot ng
ang thc bo v gim kh nng dit khun ca cc bch cu ny so vi kem nn i chng.
Sulfadiazine bc khng gy t bin trong th nghim sinh t bin dng Salmonella
typhimurium. khng c bo co no c cng b v kh nng sinh t bin, sinh qui thai, gy
ung th sc vt v ngi.
CH NH
Phng nga v iu tr nhim khun trong phng II v III ; vt thng nhim trng, vt
lo t do t th lu lnh.
CHNG CH NH
Khng c dng cho ph n c thai lc sinh hay gn n lc sinh v cho tr sinh non di 2
thng tui. Trnh dng cho trng hp tng cm vi bc hay vi nhm sulfonamide.
THN TRNG LC DNG
Ngi ta cha r c nhy cm cho vi cc sulfonamide khc hay khng. Nu xy ra phn ng
d ng, cn ngng s dng thuc.
Ngi b thiu glucose-6-phosphate dehydrogenase (G6PD) : dng c th nguy him, v c th
xy ra huyt tn.
S to khm vi nm trong v di lp vy hnh thnh sau khi dng thuc c th xy ra song
song vi s gim pht trin vi khun ; tuy vy, s pht trin bnh nm l him.
Nng ca sulfonamide trong huyt tng : Trong iu tr phng qu rng, nng ca
sulfadiazine trong huyt tng c th t n mc iu tr ngi ln (8-12 mg%). Do ,

 nhng bnh nhn ny cn theo di nng ca sulfadiazine trong huyt tng. Theo di
chc nng thn cn thn v kim tra tinh th sulfadiazine trong nc tiu.
Ph n mang thai : Tnh an ton trong vic dng cho ph n c thai cha c chng minh.
Khng dng cho ph n sp sinh n tr phi phng din rng hn 20% tng din tch da hoc khi
li ch ca thuc l ln hn nguy c cho bo thai.
Ph n ang cho con b : Ngi ta khng r kem bi sulfadiazine bc c bi tit qua sa m
hay khng. Tuy nhin, v tt c cc dn xut ca sulfonamide lm gia tng kh nng vng nhn
no, do cn thn trng khi dng i vi m ang cho con b.
Tr s sinh phng nhit : Cn cn nhc gia li ch ca thuc vi nguy c tng bilirubine mu do
hp thu lng ln sulfadiazine. Nguy c ny l khng ng k trong trng hp phng nh. Tuy
nhin khi iu tr cho tr em ln hn th kh nng an ton cao.
Nu c suy gim chc nng thn hay gan v vt phng qu rng, c th c tnh trng tch ly.
Cn cn nhc gia vic ngng dng thuc vi li ch do vic iu tr mang li.
TNG TC THUC
Bc c th lm bt hot cc enzyme tiu m bi ti ch nu dng chung. Sulfadiazine nu hp
th l cht c ch cnh tranh i vi enzyme chuyn ha diphnyl-hydantoine v tolbutamide
trong gan. Vic pha thm trimthoprime vo kem thuc khng lm tng tc dng phng chng
vi khun ca thuc. Phi hp vi chlorhexidine digluconate 0,2% c th lm tng cng tc
dng chng Staphylococcus aureus.
TC DNG NGOI
Thuc dung np tt, lm du au m khng gy rt ti ch, khng gy ri lon in gii. Tc
dng ph l rt him v thng ty thuc vo lng sulfadiazine hp thu. Kh phn bit mt
tc dng ngoi do sulfadiazine bc vi tc dng ngoi do mt thuc khc dng km. Khng
c bo co no v nh hng nguy him tnh mng hay ng c cp do qu liu ca thuc.
Khong 2,5% trng hp c phn ng lin quan n thuc bao gm cm gic nng rt (2,22%),
ni ban (0,22%), nga (0,08%), v vim thn k (0,04%). Ch phi ngng liu php 0,9% s
trng hp. Mn cm ch yu do thnh phn t dc hn l do hp cht sulfadiazine bc.
i vi phng rng, v mt lng sulfadiazine ng lu { c hp th, do c th xy ra bt
kz tc dng ph no do sulfonamide. Chng gim bch cu (0,2-0,3 x 109/l) ch yu l do
sulfadiazine (vi nng trong mu cng lc l 150 mg/l) c bo co 3-5% trng hp
phng rng trn 30% sau khi dng thuc 2-4 ngy v tr li bnh thng trong vng 2-3
ngy ngay c khi vn tip tc dng thuc.
LIU LNG v CCH DNG
Cch bi : Mi ngy mt hay hai ln, dng tay mang gng v trng bi mt lp thuc dy
khong 1,5 mm ln vt thng c ra sch v ct lc m hoi t. Ch lp kn thuc vo
khe k vt thng. Nn bi ph lin tc vng phng. Nu cn, bi kem thuc li bt kz ch no
b tri i do sinh hot. Khng cn phi bng li, nhng nu cn thit c th ph gc v bng

qun m bo thuc bm st vt thng. Nu thun tin, nn tm ra bnh nhn mi ngy

gip loi b m hoi t. Mt bn tm nc xoy c bit c ch, tuy nhin bnh nhn c th
c tm ra ti ging hay di vi sen.
Thi gian iu tr : tip tc iu tr cho n khi lnh hn hay cho n khi ch phng sn sng
c gh p da. Khng c ngng thuc khi nguy c nhim trng vn cn, tr phi xut hin tc
dng ngoi .

473.

SIMILAC ADVANCE

ABBOTT
Sa bt dinh dng : hp 400 g.
THNH PHN
Sa khng b o, ng lactose, du thc vt (du hng dng, du da, du u nnh), cht
m whey ha tan, khong cht : (kali sulfat, canxi carbonat, kali chlorid, st sulfat, km sulfat,
ng sulfat, mangan sulfat, natri selenat), vitamin : (ascorbic acid, cholin bitartrat, ascorbyl
palmitat, M-inositol, D-a-tocopheryl acetat, hn hp tocopheron, niacinamid, D-canxi
pantothenat, vitamin A palmitat, thiamin hydrochlorid, riboflavin, pyridoxin hydrochlorid, bcaroten, folic acid, vitamine K1 (phylloquinon), biotin, vitamin D3, cyanocobalamin), taurine,
cytidin 5'-monophosphat, dinatri guanoxin 5'-monophosphat, dinatri uridin 5'-monophosphat,
adenoxin 5'-monophosphat. C th cha : magi chlorid, natri chlorid, 3-canxi phosphat.
Phn tch thnh phn
100 g bt

100 ml pha chun

Cht m (g)

10,9

1,4

Cht bo (g)

28,9

3,7

Linoleic Acid (mg)

5257

676

Linolenic Acid (mg)

560

72

Cht bt ng (g)

55,5

7,1

m (g)

2,3

90

Nng lng

- kcal

526

68

- kj

2200

283

Taurine (mg)

35

4,5

Inositol (mg)

24,7

3,2

Vitamin A (I.U.)

1577

203

Vitamin D (I.U.)

315

40

Vitamin E (I.U.)

16

Vitamin K1 (mg)

42

Vitamin C (mg)

47

Vitamin B1 (mg)

526

68

Vitamin B2 (mg)

788

101

Vitamin B6 (mg)

315

40

Vitamin B12 (mg)

1,31

0,17

Niacin (tng ng) (mg)

5,5

0,71

Pantothenic Acid (mg)

2365

304

Folic Acid (mg)

79

10

Biotin (mg)

23

Cholin (mg)

84

11

Khong cht (g)

2,,9

0,4

Natri (mg)

126

16

Kali (mg)

552

71

Vitamin

Clo (mg)

342

44

Canxi (mg)

410

53

Phospho (mg)

221

28

Magi (mg)

32

St (mg)

9,5

1,2

Km (mg)

3,94

0,51

Mangan (mg)

26

ng (mg)

473

61

It (mg)

32

Selen (mg)

12

1,54

Nucleotid (tng ng) (mg)

56

7,2

CH NH
Similac Advance l cng thc dinh dng cho tr nh nhi khi khng b c sa m.
Similac Advance b sung nucleotide vi hm lng v t l tng ng vi tng ton b
nucleotide (TPANTM) trong sa m. TPANTM gip gia tng hm lng khng th trong s p
ng min dch ca b.
Similac Advance cha 100% hn hp du thc vt, khng cha du c, gip s hp thu canxi
tt hn v h tr s pht trin tm thn vn ng ca b.
LIU LNG v CCH DNG
Cn trng :
Khng dng l vi sng pha hay hm nng sa v c th lm hng sa. Dng nhiu ln lng
sa pha khng ng cch c th gy hi.
Ghi ch :
Ch s dng sn phm ny theo ch dn ca cn b y t. Pha ch ng theo hng dn. Cho tr
n bng cc, tha hp v sinh.
Chun b :
Theo hng dn ca bc s. un si nc trc khi dng pha sa v lm theo hng dn
di y. Ch dng mung c sn trong hp sa lng Similac Advance. Lng sa pha d
hn mt ln ung phi c bo qun trong t lnh v dng trong vng 48 gi. C th cho b

ung sa pha trong tch, hoc trn vi bt ng cc hay cc thc n c khc.

Cch pha chun :
Mt mung gt ngang sa bt Similac Advance pha vi 60 ml nc (2 floz), hoc 128,6 g bt
trong mi lt nc ; 30 ml sa cung cp 20 kcal.
Cch pha :
- Ra sch dng c pha sa, bnh sa, nm v v np dy vi x phng.
- Trng li vi nc ri un si tt c trong 5 pht.
- Chun b sch ni pha sa.
- Dng mt ni nh un si lng nc dng pha sa, hi ngui.
- Cho chnh xc lng nc cn pha vo bnh tit trng.
- Mc sa bt vo mung lng v dng dao sch gt bng.
- Mi mung Similac Advance pha vi 60 ml nc trong bnh.
- y np nm v li, lc cho tan u.
- Th nhit ri cho b b. b phn sa cn tha.
BO QUN
Lng sa bt trong hp c th pha c 3 lt sa. Bo qun hp cha s dng nhit
phng. Khi m np, sa bt phi c s dng trong 3 tun. y hp v bo qun ni kh
mt (khng ct trong t lnh).

474.

SINECOD

OVARTIS
xir 7,5 mg/5 ml : chai 200 ml.
thuc git 5 mg/ml : chai 20 ml.
vin bao 50 mg : hp 1 v 10 vin.
THNH PHN
cho 10 ml xir
Butamirate citrate

cho 1 ml thuc git

15 mg

Butamirate citrate

5 mg

cho 1 vin
Butamirate citrate

50 mg

DC LC
Sinecod c hot cht chnh l butamirate citrate, l thuc chng ho c tc ng trn thn kinh
trung ng, khng thuc nhm ha hc hoc dc l ca cc alcaloide ca opium. Ngoi tc
ng chng ho c khng nh, ngi ta cng ghi nhn khuynh hng lm gim sc cn
ng h hp, biu hin qua vic ci thin cc ch s kh dung.
DC NG HC
Sau khi ung, butamirate c hp thu nhanh chng v hon ton. Nng ti a trong huyt
tng ca cht chuyn ha chnh, acide phnyl-2 butyrique, l 6,4 mg/ml sau khi dng 150 mg
butamirate citrate di dng xir, v 1,4 mg/ml sau khi ung vin 50 mg. Cc gi tr ny t
c sau khong 1,5 gi vi dng xir v 9 gi vi dng vin. Thi gian bn thi tng ng
khong 6 gi v 13 gi sau khi dng dng xir v dng vin. Khi dng cc liu lp i lp li, nng
trong huyt tng c lin quan tuyn tnh vi liu dng, v khng ghi nhn c hin tng
tch ly thuc.
S thy phn butamirate, ch yu thnh acide phnyl-2 butyrique v thnh
dithylaminothoxythanol, c bt u trong huyt tng. Hai cht chuyn ha ny cng c
tc dng chng ho, v cng nh butamirate, lin kt mnh vi protine huyt tng (khong
95%). Acide phnyl-2 butyrique c chuyn ha mt phn bng cch hydroxyl ha v tr para.
Ba cht chuyn ha c o thi qua nc tiu, ch yu dng gn kt vi acid glucuronic.
CH NH
Ho cp tnh do nhiu nguyn nhn khc nhau. Lm du ho trc v sau phu thut khi c phu
thut v soi ph qun. Ho g.
CHNG CH NH
Mn cm vi hot cht chnh ca thuc.
LC C THAI v LC NUI CON B
Cc nghin cu trn sc vt cho thy thuc khng gy c tnh cho bo thai, tuy nhin cn
thiu kho st trn ngi, do trnh dng Sinecod trong 3 thng u ca thai kz. Trong thi

gian cn li ca thai kz, c th dng Sinecod khi c ch nh ca bc s.

Khng bit hot cht ca thuc c c bi tit qua sa m hay khng, v vy ch dng thuc
sau khi cn nhc gia li v hi.
TC DNG NGOI
Mt vi trng hp b ngoi ban, bun nn, tiu chy hoc chng mt c ghi nhn (t l
khong 1%). Cc du hiu ny t bin mt sau khi gim liu hoc ngng thuc.
LIU LNG v CCH DNG
nDng git cho tr em :
t 2 thng tui n 1 tui : 10 git/ln x 4 ln/ngy ;
t 1 n 3 tui : 15 git/ln x 4 ln/ngy ;
trn 3 tui : 25 git/ln x 4 ln/ngy.
nXir :
Tr em t 3 n 6 tui : 5 ml, 3 ln/ngy ;
t 6 n 12 tui : 10 ml, 3 ln/ngy ;
trn 12 tui : 15 ml, 3 ln/ngy.
Ngi ln : 15 ml, 4 ln/ngy.
S dng mung lng c km theo vi chai thuc.
nDng vin :
Tr em trn 12 tui : 1 hoc 2 vin/ngy ;
Ngi ln : 2 hoc 3 vin/ngy, ung thuc cch nhau 8-12 gi (nut thuc khng nhai).
QU LIU
Qu liu Sinecod c th gy : ng li b, bun nn, nn, tiu chy, mt thng bng v h huyt
p. Cc bin php iu tr bao gm : than hot tnh, thuc nhun trng thuc nhm mui v
dng cc bin php h tr tim v h hp thng thng.

475.

SIRDALUD

NOVARTIS
Vin nn d b 2 mg : v 10 vin, hp 10 v - Bng B.
THNH PHN
cho 1 vin
Tizanidine chlorhydrate

2 mg

DC LC
Sirdalud l thuc dn c tc ng ti h thn kinh trung ng. V tr tc dng ch yu ti ty
sng, kch thch th th a2 ti vng tin synape, c ch phng thch cc acid amin c vai tr kch

thch th th N-methyl-D-aspartate. c ch dn truyn thn kinh a tip hp ti ty sng, l

ng dn truyn lm tng trng lc c, do thuc c tc dng c ch v lm gim trng
lc c. Ngoi ra, Sirdalud cng c tc dng gim au trung ng va phi.
Sirdalud hu hiu trong trng hp c b co tht gy au cp tnh cng nh trn s co cng
mn tnh c ngun gc no v ty sng. Sirdalud lm gim s khng cc ng tc th ng,
lm du cn co git v chng git rung v ci thin cc ng tc ch ng ca c bp.
DC NG HC
Sau khi ung thuc, Sirdalud c hp thu nhanh v gn nh hon ton. nh hp thu trong
huyt tng t c sau 1 gi. kh dng sinh hc l 34%. Th tch phn phi t c sau
tim tnh mch l 2,6 l/kg. Dc ng hc khng b nh hng bi tui. Thuc c chuyn
ha ch yu gan. Cc cht chuyn ha hu nh khng c hot tnh. Phn hot cht khng b
bin i cng nh cc cht chuyn ha c o thi phn ln theo nc tiu (khong 70%
di dng chuyn ha, ch c 2,7% di dng khng i). Thi gian bn hy t 2 n 4 gi.
T l gn kt protein huyt tng thp (30%). Thc n khng nh hng n dc ng hc
ca Sirdalud.
CH NH
Co tht c gy au :
- trong cc ri lon cn bng v chc nng vng ct sng (hi chng c hoc tht lng,
nh chng vo c hoc chng au lng) ;
- sau phu thut, nh phu thut thot v a sng hoc vim xng khp hng.
Tnh trng co cng do thn kinh : bnh x cng ri rc, bnh ty sng mn tnh, bnh thoi ha
ct sng, tai bin mch mu no v lit no.
CHNG CH NH
Qu mn cm vi thuc, suy gan nng.
THN TRNG LC DNG
Do c trng hp suy gan khi dng tizanidine vi liu 12 mg, khuyn co theo di chc nng
gan trong 4 thng u bnh nhn s dng liu >= 12 mg, v khi bnh nhn c triu chng gi
suy chc nng gan nh bun nn, chn n, mt mi. Ngng thuc khi SGOT v SGPT cao gp 3
ln bnh thng.
bnh nhn suy thn ( thanh thi creatinine < 25 ml/pht), nn dng liu khi u 2
mg/ngy. Tng liu dn t t ty theo dung np v hiu qu. Nu c ci thin, nn dng 1 ln 1
ngy trc khi tng ln vi ln 1 ngy.
Nhng bnh nhn cm thy bun ng khi bt u dng thuc khng c lm cc vic i hi
phi tnh to nh li xe, hoc vn hnh my.
Kinh nghim s dng Sirdalud cho tr em cn gii hn.
LC C THAI v LC NUI CON B
Sirdalud khng gy qui thai trn sc vt. Tuy nhin, tnh an ton khi s dng cho ph n mang

thai cn cha c khng nh khng nn dng.

S hiu bit v s bi tit ca thuc qua sa m hin nay cn hn ch.
TNG TC THUC
Nu dng ng thi vi thuc h huyt p hoc thuc li tiu, i khi c th lm tt huyt p
v chm nhp tim.
Ru v thuc an thn c th lm tng tc dng an thn ca Sirdalud.
TC DNG NGOI
Nu dng theo liu khuyn co iu tr chng co tht c gy au th rt him gp cc tc
dng ph v nu xy ra th ch nh v thong qua, bao gm bun ng, mt mi, chng mt, kh
ming v h nh huyt p. Him gp : nn, ri lon tiu ha, tng transaminase thong qua.
liu cao hn liu khuyn co trong iu tr chng git rung, cc tc dng ph k trn xy ra
thng hn v c th nng. Tuy nhin him khi cn phi ngng iu tr. i khi c th b tt
huyt p v chm nhp tim. Him : yu c, bun ng, ri lon gic ng, o gic. Rt him : vim
gan cp.
LIU LNG v CCH DNG
Lm du chng co tht c gy au :
Mi ln 1-2 vin, 3 ln/ngy. Trng hp nng c th ung thm 1 hoc 2 vin trc lc i ng
ti.
iu tr chng co cng, hu qu ca nhng ri lon thn kinh :
Liu khi u khng vt qu 3 vin/ngy, chia lm hai hoc 3 ln ; sau mi na tun hoc 1
tun tng ln 1 hoc 2 vin. Tc dng iu tr ti u thng c ghi nhn vi liu hng ngy
t 6 n 12 vin, chia lm 3 hoc 4 ln. Khng c vt qu 18 vin (36 mg)/ngy.
QU LIU
Vi ca c bo co, hi phc hon ton k c trng hp bnh nhn ung 400 mg.
Triu chng : nn, ma, h huyt p, chng mt, hp ng t, suy h hp, hn m.
iu tr : ra rut, sau dng than hot tnh v tng bi niu ; tr h hp v tim mch. Cha
c thuc gii c c hiu.

476.

SKENAN LP

UPSA
vin nang phng thch chm 10 mg : hp 14 vin - Bng nghin.
vin nang phng thch chm 30 mg : hp 14 vin - Bng nghin.
vin nang phng thch chm 60 mg : hp 14 vin - Bng nghin.

vin nang phng thch chm 100 mg : hp 14 vin - Bng nghin.

vin nang phng thch chm 200 mg : hp 28 vin - Bng nghin.
THNH PHN
cho 1 vin
Morphine sulfate

10 mg

cho 1 vin
Morphine sulfate

30 mg

cho 1 vin
Morphine sulfate

60 mg

cho 1 vin
Morphine sulfate

100 mg

cho 1 vin
Morphine sulfate

200 mg

DC LC
Thuc gim au loi opium (N : h thn kinh trung ng).
Tc ng trn h thn kinh trung ng :
Morphine c tc ng gim au ph thuc vo liu. N c th tc ng trn hnh vi tm thn vn ng v gy trm du hay kch thch, ty thuc vo liu dng v c a. Ngay liu iu tr,
morphine c tc ng c ch cc trung khu h hp v ho. Hiu lc c ch h hp ca morphine
gim khi dng k o di. Morphine cng c c tnh gy nn do tc ng ln trung khu gy nn,
c th trn trung khu c tai - tin nh v ln phn x gy i ma. Ngoi ra, morphine cn gy
co ng t ngun gc thn kinh trung ng.
Tc ng ln c trn :

Morphine lm gim trng lc v nhu ng ca cc si c dc v lm tng trng lc ca cc

si c vng, gy tng co tht cc c tht (mn v, van hi - manh trng, c tht hu mn, c
tht Oddi, c tht bng quang.
DC NG HC
Dng tc ng ko di cho php dng liu ung mi ngy hai ln.
Hp thu :
Morphine t nng ti a trong huyt thanh sau khi ung t 2 n 4 gi.
Chuyn ha khi qua gan ln u trn 50%.
Sinh kh dng ca dng ung vo khong 50% so vi dng tim di da, v vo khong 30% so
vi dng tim tnh mch.
Phn phi :
Sau khi hp thu, morphine c t l gn kt vi protein huyt tng vo khong 30%.
Chuyn ha :
Morphine c chuyn ha nhiu thnh dn xut lin hp glucuronide, sau phi qua chu
trnh gan - rut. Dn xut 6-glucuronide l cht chuyn ha c hiu lc mnh gp 50 ln so vi
morphine. Morphine cng b chuyn ha bng phn ng loi gc methyl, cho mt dn xut
khc l normorphine.
o thi :
Dn xut lin hp glucuronide c o thi ch yu qua ng tiu, theo hai c ch thanh lc
cu thn v o thi ng thn.
o thi qua phn thp (< 10%).
CH NH
au nhiu, dai dng hay bt tr sau khi dng cc thuc gim au khc, nht l au do ung
th.
CHNG CH NH
- Suy h hp mt b.
- Tr em di 6 thng tui (i vi dng c tc ng ko di).
- Suy gan nng.
- Buprnorphine, nalbuphine v pentazocine (xem Tng tc thuc).
- Ph n cho con b (xem Lc c thai v Lc nui con b).
CH PHNG v THN TRNG LC DNG
Ch { phng :
Dng tc ng k o di khng dng trong iu tr cp cu.
Tng liu, ngay c khi dng liu cao, thng khng lm tng tin trnh gy nghin thuc.
Nu cn tng cng iu tr hay dng liu lp li, cn thng xuyn nh gi li tnh trng ca
bnh nhn, v phi tht s do nhu cu dng thuc gim au, ch khng phi l do tnh trng
nghin thuc.

Trng hp iu tr ko di, nu ngng thuc t ngt s gy hi chng cai thuc, bao gm cc

triu chng nh lo u, bn chn, n lnh, gin ng t, nng phng, tot m hi, chy nc
mt, chy nc mi, bun nn, nn, co rt c vng bng, tiu chy, au khp. trnh tnh
trng ny, cn phi gim liu t t.
Morphine l mt cht gy nghin do c th dn n tnh trng s dng sai lch do gy l
thuc v th cht v tinh thn, gy nghin sau mt thi gian dng thuc ko di.
Tuy nhin khi c nhu cu tht s iu gim gim au, morphine vn c th c k toa.
Thn trng lc dng :
S dng morphine thn trng trong nhng trng hp sau :
- Suy thn : morphine c o thi qua thn di dng cht chuyn ha c hot tnh, do
nn bt u bng liu thp, sau iu chnh liu v tn s s dng ty theo tnh trng lm
sng ca bnh nhn.
- Khi nguyn nhn gy au c iu tr ng thi : iu chnh liu ca morphine ty theo kt
qu ca vic iu tr nguyn nhn gy au.
- Suy h hp : cn c bit theo di nhp th. Ng li b l mt du hiu d bo tnh trng mt
b.
Cn phi gim liu morphine khi c nhiu thuc gim au khc c k toa ng thi, v d gy
suy h hp t ngt.
- Ngi gi : do c nhy cm c bit vi cc tc dng ngoi trn thn kinh trung ng (l ln)
hoc trn ng tiu ha, kt hp vi vic chc nng thn b gim, cn phi thn trng khi ch
nh morphine, nht l nn gim liu khi u cn phn na.
K toa ng thi vi nhng thuc khc, nht l cc thuc chng trm cm loi 3 vng, lm tng
kh nng xut hin cc tc dng ngoi { nh l ln hay to bn.
Ngi gi thng c cc bnh l tuyn tin lit, do d c nguy c b b tiu.
Khng cn phi hn ch s dng morphine ngi gi mt khi tn trng cc im thn
trng khi s dng cho i tng ny.
- To bn : cn phi chc chn rng bnh nhn khng b hi chng tc rut trc khi tin hnh
iu tr.
- Tng p lc ni s : trng hp b tng p lc ni s, phi thn trng khi s dng morphine.
- Vn ng vin th thao : dng morphine c th cho kt qu dng tnh x t nghim tm cht
kch thch.
Li xe v vn hnh my : Do morphine lm gim s tp trung v cnh gic, cn thng bo cho
ngi phi li tu xe hay vn hnh my mc v nguy c ny khi dng thuc.
LC C THAI v LC NUI CON B
Lc c thai :
Cc nghin cu thc hin trn ng vt khng cho thy morphine c tc ng gy qui thai.
Trn lm sng, kho st trn mt s kh nhiu ph n c thai khng cho thy morphine c tc

ng gy d dng hay c phi no c bit.

Trong giai on cui ca thai kz, dng liu cao, ngay c khi ch dng ngn hn, c th gy c ch
h hp tr s sinh.
Trong 3 thng cui thai kz, nu ngi m dng morphine di hn, d vi bt kz liu lng nh
th no, cng u c th gy ra hi chng cai thuc cho tr s sinh, vi cc triu chng nh vt
v, nn, co git v tng kh nng t vong.
Tm li, trong nhng iu kin s dng bnh thng, c th k toa morphine cho ph n ang
mang thai nu cn.
Trong giai on cui ca thai kz, nu c dng morphine liu cao ngn hn, hay iu tr mn
tnh, thm ch ngi b nghin morphine, cn phi tng cng theo di tr trong giai on
chu sinh nhm trnh nguy c tr b suy h hp hay b hi chng cai thuc.
Lc nui con b :
Do morphine qua c sa m, khng c cho con b trong thi gian iu tr.
TNG TC THUC
Chng ch nh phi hp :
- Cc cht ch vn - i khng ca morphine (buprnorphine, nalbuphine, pentazocine) : lm
gim tc dng gim au do cnh tranh th th, vi nguy c gy hi chng cai thuc.
Khng nn phi hp :
- Alcool : cn lm tng tc dng gy trm du ca morphine. Vic gim tp trung v cnh gic c
th gy nguy him khi li tu xe hay vn hnh my mc. Trnh dng cc thc ung v thuc c
cht cn trong thi gian iu tr vi morphine.
Mt s phi hp cn lu { :
- Cc thuc c ch thn kinh trung ng khc : cc dn xut morphine khc (gim au v tr ho),
thuc chng trm cm gy trm du, khng histamine H1 gy trm du, nhm barbiturate, nhm
benzodiazpines, thuc gii lo u khng thuc nhm benzodiazpines, thuc an thn kinh,
clonidine v cc thuc cng nhm : tng c ch thn kinh trung ng (gy trm du v c ch
h hp) c th gy hu qu nghim trng, nht l khi dng thuc khi ang li tu xe hay vn
hnh my mc.
TC DNG NGOI
Cc tc dng ngoi { thng gp khi dng liu thng thng gm bun ng, ln ln, bun
nn, nn, to bn. Cc triu chng u tin thng ch thong qua nhng nu dai dng th phi
tm hiu nguyn nhn. Ngc li, triu chng to bn th vn ko di nu duy tr iu tr. Cc
triu chng ny chc chn s xy ra v phi c d on trc nhm ti u ha vic iu tr,
nht l i vi triu chng to bn. Thng c th dng cc liu php iu chnh.
Ngoi ra, c th ghi nhn mt s tc dng ngoi khc :
- trm du, kch ng, c mng, thng xy ra ngi gi, i khi gy o gic ;
- c ch h hp ;

- tng p lc ni s, cn phi c iu tr trong thi gian u ;

- b tiu nu bnh nhn b adenom tuyn tin lit hay hp niu qun.
LIU LNG v CCH DNG
Dng cho ngi ln v tr em trn 6 thng tui.
Liu lng :
Liu khi u :
- Ngi ln : thng thng, liu khi u l 60 mg/ngy.
- Tr em : liu khi u l 1 mg/kg/ngy.
- Bnh nhn b suy thn : cn nhc gim liu ty theo chc nng thn v nhu cu ca bnh
nhn.
Chnh liu :
Cn nhc chnh liu khi liu c ch nh trc t ra khng hiu qu.
- nh gi :
Khng nn tr qu 24-48 gi khi mt nc liu t tra khng hiu qu. Trn thc t, vo thi
gian u iu tr, nn nh gi tnh trng ca bnh nhn mi ngy.
- Tng liu :
Nu khng kim sot c chng au, nn tng liu morphine khong 50%. Trong qu trnh
chnh liu, khng c gii hn trn ca liu morphine nu c th kim sot c cc tc dng
ngoi .
- Tng quan gia cc ng s dng khc nhau :
Liu dng thay i ty theo ng s dng.
So vi ng ung, liu khi dng bng ng tim tnh mch phi gim 2/3 v gim 1/2 nu
dng ng tim di da.
Khi chuyn t ng s dng ny sang ng s dng khc phi lu { n h s chuyn i
nu trn nhm duy tr cng mt lng sinh kh dng ca morphine trong c th.
Nu chuyn t morphine ung c tc dng nhanh sang dng ung c tc dng ko di, liu
hng ngy ca morphine khng thay i.
Cch dng :
Vi dng gii phng ko di, liu hng ngy phi chia lm 2 ln, thng cch u nhau mi 12
gi.
Trng hp bnh nhn khng th nut c vin nang, phn thuc trong vin c th c cho
vo thc n st (thc n nghin, mt, sa chua) hoc cho vo ng thng d dy hay l m d
dy qua da c ng knh trn 16 F.G, c u xa c m hay c nhng l bn cnh. ng
thng c ra vi 30-50 ml nc l .
QU LIU
Triu chng :
Ng li b l mt du hiu bo trc ca suy h hp.

Co ng t qu mc, h huyt p, h thn nhit, hn m cng c ghi nhn.

X l :
- H tr tng thng kh trc khi chuyn n bnh vin chuyn khoa hi sc tim mch v h
hp.
- iu tr chuyn bit : tim naloxone, tng cng theo di cho n khi ht cc triu chng ng
c.

477.

SMECTA

BEAUFOUR IPSEN
Bt pha hn dch ung v tht trc trng : hp 30 gi, hp 60 gi.
THNH PHN
cho 1 gi
Smectite intergrade bn cht beidellitique

3g

(Glucose monohydrate)

(0,749 g)

(Saccharine sodique)

(0,007 g)

(Vanilline)

(0,004 g)

DC LC
Vi cu trc tng lp v nhy cao, Smecta c kh nng bao ph nim mc tiu ha rt ln.
Smecta tng tc vi glycoprotein ca cht nhy lm tng sc chu ng ca lp gel dnh trn
nim mc khi b tn cng. Nh tc ng trn hng ro nim mc tiu ha v kh nng bm cao
nn Smecta bo v c nim mc tiu ha. Smecta khng cn quang, khng nhum mu
phn, v vi liu lng thng dng, Smecta khng lm thay i thi gian vn chuyn sinh l ca
rut.
DC NG HC
Smecta khng c hp thu v thi ra theo ng tiu ha.
CH NH
- iu tr triu chng au ca bnh thc qun-d dy-t trng v i trng.
- Tiu chy cp v mn tnh tr con v ngi ln.
CHNG CH NH
Khng c.
THN TRNG LC DNG

Phi b nc nu cn (bng ng ung hoc tim tnh mch) ty theo tui, c a bnh nhn
v tm quan trng ca tiu chy.
TNG TC THUC
Tnh cht hp ph ca Smecta c th thay i thi gian v (hoc) s hp thu ca thuc khc, do
nn ung cch khong vi Smecta.
TC DNG NGOI
C th gy ra hoc lm tng to bn nhng rt him, iu tr vn c th tip tc vi liu lng
gim.
LIU LNG v CCH DNG
Tr con :
- di 1 tui : 1 gi/ngy.
- 1 n 2 tui : 1-2 gi/ngy.
- trn 2 tui : 2-3 gi/ngy.
Thuc c th ha trong bnh nc (50 ml) chia trong ngy hoc trn u trong thc n st.
Ngi ln : trung bnh, 3 gi/ngy, ha trong na ly nc.
Thng thng nu tiu chy cp tnh, liu lng c th tng gp i khi khi u iu tr.
Nn s dng :
- Sau ba n vim thc qun.
- Xa ba n cc bnh khc.
Tht ra gi li : 1 n 3 ln tht ra/ngy, mi ln ha 1 n 3 gi trong 50 n 100 ml nc
m

478.

SOLMUX BRONCHO - SOLMUX PEDIATRIC

UNITED LABORATORIES
Solmux Broncho :
Vin nang : v 4 vin, hp 25 v.
Hn dch ung : chai 30 ml, 60 ml, 120 ml.
Solmux Pediatric :
Hn dch ung dng cho tr em 200 mg/5 ml : chai 30 , 60 ml.
THNH PHN
Solmux Broncho :
cho 1 vin

Carbocystine

500 mg

Salbutamol

2 mg

cho 5 ml hn dch
Carbocystine

500 mg

Salbutamol

2 mg

Solmux Pediatric :
cho 5 ml hn dch
Carbocystine

200 mg

DC LC
Solmux Broncho :
Carbocystine l dn xut ca mt acide amine, cyst ine, trong nhm sulfohydryl b kha
bi gc acide carboxylique. Carbocystine b gy cc cu ni disulfure bc ngang cc chui
peptide ca mucine (mng li cu ni ny to nn nht ca dch tit ph qun).
Carbocyst ine cng thay i s chuyn ha ca t bo tit cht nhy bng cch hot ha men
sialyltransferase v c ch men neuraminidase, tit ra nhiu glycopeptide t nhy nht hn
trong khi gim cc thnh phn nhiu nhy nht (glycopeptide trung tnh v acide mucine yu).
Salbutamol l mt cht ch vn bta. Kch thch adenylcyclase, men ny xc tc chuyn ha
AMP vng t ATP. V vy, AMP vng c to thnh lm trung gian cc p ng ca t bo nh
gin c trn ph qun. Salbutamol c i lc i vi cc th th bta-adrenergic, hin din rt
nhiu trong ng h hp. Salbutamol tc ng trn nhng th th ny u th hn so vi
isoproterenol.
Solmux Pediatric :
Hn dch Solmux Pediatric l mt ch phm lm long cht tit nim mc c bit dng cho cc
bnh ng h hp ca tr em i km vi s xut tit ph qun qu v dnh chc.
L mt ch phm lm long m, hn dch Solmux Pediatric gip cn ho c ci thin bn
ngy sm hn so vi bromhexine. L mt cht phn gii cht nhy trc tip, hn dch Solmux
Pediatric c c ch tc ng khc bit hon ton so vi nhng cht long m khc. Solmux
khng bt ng h hp gnh thm mt khi lng cht long m trc khi lm lng v ha
lng cht nhy c, dai v kch ng nh mt s cht long m khc.

Hn dch Solmux Pediatric lm thay i cu trc si ca cht nhy theo c ch lm tiu cht
nhy bng hai cch : lm gim lc lin kt ion gip cc i phn t polysaccharide kt hp li
vi nhau v lm gy lin kt disulfure l mi lin kt cho gia cc chui peptide ca mucine.
Hn dch Solmux Pediatric cn lm gia tng s tng hp cc sialomucine (mt th cht nhy c
nht k m hn) qua s hot ha men sialyl transf rase ng thi lm gim bt s tng hp
fucomucine v acide neuraminique l cc cht gp phn lm tng nht ca m.
Hn dch Solmux Pediatric l mt tc nhn cung cp nc cho cht nhy cho php khc m d
dng hn rt nhiu. Thm vo , hn dch Solmux Pediatric m c hn lm cho vic phn
liu d dng hn v tnh c chnh xc thi gian iu tr. Do , hn dch Solmux Pediatric ci
thin tt th tch thng kh a n gii quyt cc qu trnh vim ca mng nhy ph qun v
lm gim ho do h hp d dng hn.
DC NG HC
Carbocyst ine c hp thu tt v nhanh chng sau khi s dng bng ng ung. Sau khi
ung 1,5 g carbocystine, nng nh trong huyt tng l 13-16 mg/l t c trong 1-2
gi. Thi gian bn hy trong huyt tng l 1,5 n 2 gi. Carbocystine xuyn tt qua m phi
v nim dch ng h hp, v c tc ng ti ch. Carbocystine chuyn ha qua cc giai on
acetyl ha, decarboxyl ha, v sulfoxid ha. Phn ln thuc bi tit qua nc tiu di dng
khng i.
Tng t, salbutamol hp thu tt qua ng tiu ha n 80% lng salbutamol c nh
du phng x hin din trong nc tiu trong vng 24 gi v 85% trong 72 gi. Nng nh
trong huyt tng khong 10-17 mg/l t c 2-3 gi sau khi s dng liu 4 mg. Thi gian bn
hy trong huyt tng thay i t 3-5 gi vi khong 50% lng salbutamol c nh du
phng x hin din trong nc tiu di dng lin hp, khong phn na lng ny bi tit
di dng khng i.
CH NH
Solmux Broncho :
Gim ho, kh th c nhiu m nhy thng i km trong cc ri lon h hp nh vim ph
qun cp v mn tnh, hen ph qun v gin ph qun.
Solmux Pediatric :
Gim ho trong vim ph qun cp, mn tnh, suyn, gin ph qun v kh ph thng.
Ho do vim xoang v do vim tai gia.
Bnh h hp i km theo tng tit dch ph qun.
THN TRNG LC DNG
Cn thn trng khi dng cho bnh nhn mc bnh tim mch, bnh no, bnh gan v bnh nhn
c tin s lo t ng tiu ha.
Nn theo di cn thn khi dng cho tr em.
TNG TC THUC

Khi s dng ng thi, carbocyst ine tng s hp thu ca amoxicilline sodium. Nu trc
iu tr bng cimetidine s lm gim thi tr carbocyst ine sulfoxid trong nc tiu. Khi s
dng ng thi vi thuc li tiu c th gia tng s h kali mu nu dng liu ln salbutamol.
Cc tc dng ca thuc b c ch bi cc thuc chn bta.
TC DNG NGOI
Kh chu ng tiu ha, kch thch h thn kinh trung ng.
LIU LNG v CCH DNG
Solmux Broncho :
Ngi ln : mi ln ung 1 n 2 mung caf hn dch hoc 1 n 2 vin, ngy 3 hay 4 ln.
Tr em :
t 7 n 12 tui : mi ln ung 1/2 n 1 mung caf hn dch, ngy 3 hay 4 ln.
t 2 n 6 tui : theo s hng dn ca Bc s.
Solmux Pediatric :
Ung thuc 3 ln/ngy :
Tr em :
t 1 n 3 tui : mi ln 2,5 ml ;
t 4 n 7 tui : mi ln 5 ml ;
t 8 n 12 tui : mi ln 7,5 ml.
Tr di 1 tui : 0,5 ml/kg th trng/ngy, chia lm nhiu ln bng nhau.
Ngi ln : mi ln 12,5 ml.

479.

SORBITOL DELALANDE

SANOFI SYNTHELABO VIETNAM

bt pha dung dch ung 5 g : hp 20 gi.
THNH PHN
cho 1 gi
Sorbitol

5g

DC LC
- Thuc nhun trng thm thu.
- Thuc c tc ng hng gan-mt.
DC NG HC
Sau khi ung, sorbitol c chuyn ha thnh fructose nh vo men sorbitol-deshydrogenase,

sau chuyn thnh glucose.

Mt t l rt nh sorbitol khng b chuyn ha c o thi qua thn, phn cn li qua ng
h hp di dng CO2.
CH NH
iu tr triu chng to bn.
iu tr triu chng cc ri lon kh tiu.
CHNG CH NH
Bnh kt trng thc th (vim lot trc - kt trng, bnh Crohn).
Hi chng tc hay bn tc, hi chng au bng khng r nguyn nhn.
Khng dung np fructose (bnh chuyn ha rt him gp).
CH PHNG
Khng dng di hn thuc nhun trng. Dng thuc trong chng to bn ch l mt h tr trong
iu tr bng ch v sinh v n ung :
- n thc n giu cht x thc vt v ung nhiu nc,
- khuyn bnh nhn nn tp th dc v tp thi quen i cu.
THN TRNG LC DNG
Khng dng trong trng hp tc mt.
i vi ngi bnh kt trng, trnh dng lc i v nn gim liu.
TNG TC THUC
Khng nn phi hp :
- Kayexalate (ng ung v t hu mn) : c nguy c gy hoi t kt trng.
TC DNG NGOI
C th gy tiu chy v au bng, c bit bnh nhn b bnh kt trng chc nng.
LIU LNG v CCH DNG
iu tr ngn hn.
iu tr triu chng cc ri lon kh tiu :
Ngi ln : 1-3 gi/ngy, pha trong na ly nc, ung trc cc ba n hoc lc c cc ri lon.
Ph tr chng to bn :
Ngi ln : 1 gi, ung vo bui sng lc i.
Tr em : na liu ngi ln.

480.

SPASFON

LAFON
c/o GALIEN
dung dch tim bp, tnh mch : ng 4 ml, hp 6 ng.
vin bao : hp 30 vin.

ta dc : hp 10 vin.
bt ng kh ng ung : hp 10 vin.
THNH PHN
cho 1 ng
Phloroglucinol hydrate

40 mg

Trimthylphloroglucinol

40 mg

cho 1 vin bao

Phloroglucinol hydrate

80 mg

Trimthylphloroglucinol

80 mg

(Lactose)
(Saccharose)

cho 1 ta dc
Phloroglucinol hydrate

150 mg

Trimthylphloroglucinol

150 mg

cho 1 vin lyoc (ngm tan)

Phloroglucinol hydrate

80 mg

DC LC
Thuc chng co tht hng c.
Phloroglucinol c tc dng ly gii co tht trn si c trn v lm du cn au.
CH NH
iu tr triu chng cc biu hin au do ri lon chc nng ca ng tiu ha v ng dn

mt.
iu tr biu hin au hoc co tht trong tit niu (au qun thn v au niu o).
iu tr biu hin au hoc co tht trong ph khoa (au kinh, kh, au t cung hu sn).
iu tr h tr nhng cn co tht trong thai kz, km theo vic ngh ngi.
CHNG CH NH
Qu mn cm vi mt trong cc thnh phn ca thuc.
CH PHNG v THN TRNG LC DNG
Khng nn phi hp phloroglucinol vi cc thuc gim au mnh nh morphine v cc dn xut
do cc thuc ny c tc dng gy co tht.
LC C THAI
Cc nghin cu thc hin trn th vt khng cho thy phloroglucinol c tc dng gy qui thai.
Trn lm sng, s dng tng i rng ri phloroglucinol cho n nay, khng c trng hp d
dng no c bo co. Tuy nhin, cn cn phi lm thm nhng nghin cu dch t hc c
kt lun chnh xc.
Do , v thn trng, ch dng phloroglucinol cho ph n c thai khi tht s cn thit.
LC NUI CON B
Do thiu s liu, nn trnh dng thuc khi cho con b.
TC DNG NGOI
Cc phn ng d ng rt him khi xy ra nhng i khi nng : pht ban, ni m ay, ph
Quincke. c bit, khi s dng dung dch tim tim bp hoc tim tnh mch c th gy h
huyt p dn n sc.
LIU LNG v CCH DNG
Dng tim :
- iu tr tn cng : 1-3 ng/ngy, tim tnh mch hoc tim bp.
- iu tr duy tr : chuyn qua dng dng ung vi liu 6 vin/ngy hoc 3 vin ta dc/ngy.
Dng vin ung : 6 vin/ngy.
Dng thuc t (ta dc) : 3 ta dc/ngy.
Dng lyoc (ngm tan) :
- Ngi ln : liu thng thng 2 vin/ngy, ung lc c cn au, c th lp li nu cn co tht
nhiu.
C th ha vin bt ng kh trong nc ung hoc ngm di li s cho tc dng nhanh.
- Tr em : ngy 2 ln, mi ln 1 vin, ha trong nc ung.

481.

SPASMAVERINE

XNLD RHNE POULENC RORER

[AVENTIS PHARMA]
Vin nn 40 mg : hp 30 vin.
THNH PHN
cho 1 vin
Alvrine citrate tnh theo dng base

40 mg

(Lactose)
DC LC
Chng co tht c trn loi papavrine.
L thuc khng c tc dng kiu atropine, Spasmavrine c th s dng trong trng hp tng
nhn p hoc ph i tuyn tin lit.
CH NH
- iu tr triu chng cc biu hin au do ri lon chc nng ng tiu ha v ng mt.
- iu tr cc biu hin au hay co tht vng tit niu - sinh dc (au bng kinh, au khi sanh,
au qun thn v au ng niu, da sy thai, sanh kh).
LC C THAI v LC NUI CON B
Ph n c thai : Nghin cu thc nghim trn sc vt cha cho thy tc dng gy qui thai
hoc tc dng c hi i vi phi thai. ngi, n nay cha ghi nhn tc dng c hi no.
Cho con b : Khuyn khng nn dng, do cha c cng trnh nghin cu.
LIU LNG v CCH DNG
Dng cho ngi ln : ung thuc vi mt t nc, 1-3 vin/ln, 3 ln/ngy.

482.

SPERSACET C

NOVARTIS OPHTHALMICS
thuc nh mt : l nh git 10 ml.
THNH PHN
cho 1 ml
Sulfacetamide sodium

100 mg

Chloramphenicol

5 mg

(Methylhydroxypropylcellulose)
(Thiomersal)

(0.02 mg)

DC LC
C hai thnh phn hot cht ca Spersacet C c tc dng km khun bng cch can thip vo
qu trnh chuyn ho ca t bo vi trng. Chloramphenicol l khng sinh c trng lng phn
t thp, ch yu tan trong m, v tc ng trn vi khun Gram dng, Gram m, spirochaeta,
salmonella, rickettsiae, v chlamydiae (tc nhn gy bnh mt ht). C ch tc dng l c ch
c chn lc s tng hp protein ca vi khun.
Tnh khng thuc i vi chloramphenicol khng thay i ng k trong nhng nm gn y.
Cc vi khun sau c tnh khng mt phn i vi chloramphenicol : Proteus (20-50% khng),
Serratia (30-70%), Klebsiella (60-70%), Enterobacter (20-50%), E. coli (20%), Staph. aureus (2030%), Enterococci (30-35%), Streptococci (2%), Salmonella (4-9%), Haemophilus influenzae (01%), v Diplococci (0-1%). Chloramphenicol khng hiu qu i vi Pseudomonas,
Mycobacterium, nm, v Protozoa.
Sulfacetamide l cht i khng p-aminobenzoic acid (PAB) v c ch qu trnh tng hp acid
folic t bo vi trng. Khng sinh ny khng c tc dng i vi Enterococci, Serratia,
Providencia, v Pseudomonas.
Phi hp chloramphenicol vi sulfacetamide to nn ph khng khun rng hn.
Th nghim in vitro cho thy chloramphenicol c nng c ch ti thiu (MIC90) nh sau:
Mm bnh

MIC90 (mg/ml)

Vi khun Gram +
Staph. aureus

16

Staph. epidermidis

32

Strept. pneumoniae

Strept. pyogenes

32

Bac. anthracis

5 (13.5)

Vi khun Gram -

E. coli

> 128

Enterobacter

16

Klebsiella pneumoniae

> 128

Klebsiella ssp.

Serratia marcescens

> 128

Shigella sonnei

Haemophilus influenzae

20

Pseudomonas

128

Th nghim in vitro cho thy sulfacetamide c nng c ch ti thiu (MIC90) nh sau :

Cc vi khun nhy cm (MIC90 < 1-100 mg/ml) :
Staph. aureus
Streptococcus pneumoniae
Streptococcus pyogenes
Corynebacterium diphteriae
Haemophilus influenzae
Neisseria gonorrhoeae v N. meningitidis
Cc vi khun nhy trung gian (MIC90 < 100-350 mg/ml) :
Proteus mirabilis
Cc vi khun khng (MIC90 350 mg/ml) :
Staphylococcus epidermidis
Streptococcus viridans
Seratia marcescens
Pseudomonas aeruginosa
Escherichia coli
Klebsiella pneumoniae
Khng thuc i vi sulfonamides kh ph bin v vo khong hn 20% cc vi khun, bao gm
Streptococcus v Neisseria meningitidis. S khng ny l do t bin t nhin hay do s
truyn plasmides.
Spersacet C cha Hydroxypropylmethylcellulose c tc dng lm tng nht ca thuc v s
ko di thi gian thuc lu li trn gic mc.
DC NG HC

Th nghim trn ng vt v kinh nghim lm sng cho thy chloramphenicol ngm hon ton
qua gic mc v trong tin phng, nng hiu qu v mt iu tr t c sau khi nh thuc
ch 15-30 pht. Thi gian bn hy l 3-5 gi. mt vim, thi gian thuc lu li c th ngn
hn nhiu.
V sulfacetamide cng ngm tt qua gic mc, nn nng hiu qu v mt iu tr cng t
c trong thy dch v duy tr nhiu gi sau mt ln nh thuc.
Hin ti, cha c s liu v mc hp thu vo ton thn.
CH NH
Nhim trng phn trc ca mt (gic mc, kt mc, b o mc trc), m mt, v ca h
thng dn nc mt.
D phng nhim trng trc v sau phu thut, sau khi bng ho cht v cc loi bng khc.
Dng bm ra h thng dn nc mt vi mc ch iu tr hay d phng.
Chloramphenicol c ch nh khi tc nhn gy nhim trng khng vi cc khng sinh khc
(xem Thn trng lc dng).
CHNG CH NH
D ng vi cc thnh phn, d ng vi sulfonamides v sulphonyl urea ;
Hng ban xut tit a dng (ngay c trong tin s bnh) ;
Bnh v mu nng do suy ty xng (lon to mu vi gim bch cu, thiu mu bt sn, bnh
ton ty xng, hay vng da tn huyt) ; bnh gan v thn nng ; ri lon chuyn ha porphyrin
cp ;
Thiu men glucose-6-dehydrogenase di truyn trong hng cu, hay bt thung v hemoglobine
nh Hb Cologne, hoc Hb Zurich.
Khng c dng Spersacet C cho tr s sinh hay tr cn nh.
Lu { i vi bnh nhn mang knh tip xc :
Khng nn mang knh tip xc trong khi c nhim trng mt.
THN TRNG LC DNG
Nu tnh trng mt khng ci thin sau 7-8 ngy iu tr, cn cn nhc chn la mt bin php
iu tr khc. Khng nn dng Spersacet C lu qu 10 ngy. Chloramphenicol c nguy c gy
thiu mu bt sn hay cc lon sn mu khc. V th, cn phi cn nhc nh gi li hi khi
dng cho tng bnh nhn. Ch nn dng thuc ny khi cc bin php iu tr khc khng hiu
qu hay c chng ch nh.
Cn thn trng trong trng hp c ri lon chc nng tuyn gip, gan, thn nh, nhy cm vi
khng sinh sulphonyl urea v vi thuc li tiu c ngun gc t sulfonamides.
Tip xc vi tia cc tm v nh sng thy c vi cng mnh sau khi ung sulfonamides
c th gy nhy cm vi nh sng. Trong khi iu tr, nu c au hng hay triu chng cm cm
th phi lm xt nghim mu. Trong 1 vi trng hp ring l c th xy ra cn th thong qua.
Do vy, trong vng 30 pht sau khi nh thuc, khng nn li xe hay vn hnh my.

LC C THAI v LC NUI CON B

Th nghim trn ng vt cho thy c nguy c cho thai. Thuc sulfonamides dng ng ung
vo 3 thng cui thai kz s gy tn huyt trong trng hp c thiu men glucose-6-phosphate
dehydrogenase, cng nh vng da nhn hay d dng xng. Chloramphenicol c nguy c gy
c cho thai v sinh qui thai. Chng ch nh dng Spersacet C i vi ph n c thai hay cho
con b.
Thai kz loi D.
TNG TC THUC
Dng ng thi vi PAB, cng nh PAB-esters (c tnh gim au), hay gentamicin trong iu tr
cc xut tit m s lm gim hiu qu ca thuc.
Khng nn dng ng thi chloramphenicol vi cc thuc dit khun (penicillin, cephalosporin,
gentamicin, tetracyclin, polymyxin B, vancomycin hoc sulphadiazine). Cng khng nn dng
ng thi vi cc thuc iu tr ton thn c tc dng ph trn h to mu, cc thuc
sulphonylurea, dn xut ca coumarin, hydantoin v methotrexate.
nh hng n s gn ca protein huyt tng vo sulfacetamide v vo cc cht khc. Tng
cng tc dng ca cc cht chng ng, thuc h ng huyt ung dn xut t sulphonyl
urea, diphenhydantoin, methotrexate v thiopenthal. Dng ng thi vi probenecid,
indomethacin, phenylbutazon, salicylates, v sulfinpyrazone s tng cng tc dng ca
sulfacetamide.
TC DNG NGOI
Cm gic xt nh hay m mt trong thi gian ngn ngay sau khi nh thuc.
Phn ng d ng di dng chm m mt mt s him trng hp.
iu tr vi sulfonamide thnh thong c th gy : cc triu chng v d dy rut nh bun nn,
nn, tiu chy, phn ng d ng, ban xut huyt, bnh da nhy cm vi nh sng, hng ban nt,
hi chng Stevens-Johnson, hi chng Lyell, vim da trc vy, st do thuc, nhc u, au
khp, v bnh gan mt trong mt s him trng hp. Trong mt vi trng hp ring l
xy ra cc tnh trng sau : lon sn mu vi gim bch cu, tiu cu, xut huyt chm, khng c
bch cu ht, tng bch cu i toan, thiu mu bt sn, hoi t gan khu tr hay lan ta, tinh th
niu, Lupus ban h thng v vim da c, mng gic mc trng trong hi chng kh mt. Tm
do sulphhemoglobinemia hay methemoglobinemia ch xy ra trong trng hp c thiu bm
sinh men glucose-6-phosphate dehydrogenase trong hng cu hay trong trng hp bt
thng hemoglobin nh Hb Cologne hay Hb Zurich. Cn th thong qua xy ra mt s him
trng hp.
Nh mt thuc Spersacet C c th gy kch thch v gic.
Vim dy thn kinh sau khi dng chloramphenicol nh ti ch c m t trong mt vi
trng hp ring l, tuy nhin s hi phc khi ngng thuc.
Lon sn mu bt hi phc mt phn (thiu mu bt sn, gim 3 dng t bo mu, gim bch

cu, gim tiu cu, khng c bch cu ht) xy ra mt vi trng hp ring l sau iu tr
bng chloramphenicol nh mt. Tuy nhin, nng v thi im xut hin khng tng quan
vi liu dng cao v thng xuyn trong cc th nghim ny.
LIU LNG v CCH DNG
Nh mt git vo ti kt mc 2-4 ln/ngy. Trong nhng trng hp cp tnh, c th nh n 1
git/gi.
hn ch thuc hp thu vo ton thn cng t cng tt, cn lm nghn ng dn nc mt
bng cch n vo cnh mi gn gc trong ca mt 1-2 pht sau khi nh thuc.
QU LIU
Qu liu khng th xy ra nu ch dng thuc nh mt v nh ng liu. Trong trng hp
ung nhm l thuc nh mt, cn p dng cc bin php c hiu gim hp thu.
BO QUN
Bo qun thuc nhit 2-8oC.
ng np l thuc ngay sau khi dng. Khng nn dng 1 l thuc lu hn 1 thng sau khi m
np. Nu cha m np, c th dng l thuc Spersacet C cho n ngy ht hn ghi trn hp
thuc. Mu ca Spersacet C c th chuyn thnh vng nht nhng iu ny khng nh hng
ln hiu qu v tnh an ton ca thuc. Nu khng c bo qun ng cch, Spersacet C c
th chuyn sang mu nu, v trong trng hp ny, khng nn s dng.

483.

SPERSADEXOLINE

NOVARTIS OPHTHALMICS
Thuc nh mt : l nh git 5 ml.
THNH PHN
cho 1 ml
Chloramphenicol

5 mg

Dexamethasone sodium phosphate

1mg

Tetryzoline chlorhydrate

0,25 mg

(Methylhydroxypropylcellulose)
(Thiomersal)

(0,02 mg)

DC LC
Dexamethasone c tc dng khng vim gp 25 ln hydrocortisone. Ging nh cc khng vim
glucocorticoid khc, mt trong nhng tc ng ca dexamethasone l c ch phospholipase A2,
giai on u ca qu trnh tng hp prostaglandin. Dexamethasone cng ngn chn hin
tng ha ng ng ca bch cu a nhn trung tnh tin v vim. Chloramphenicol l khng
sinh c trng lng phn t thp, ch yu tan trong m, tc dng trn vi khun gram dng,
gram m, xon khun, salmonella, rickettsiae v chlamydiae (mt ht). C ch tc dng ca
chloramphenicol l c ch c chn lc qu trnh tng hp protein ca vi khun.
Ph khng khun ca chloramphenicol :
Th nghim in vitro cho thy chloramphenicol c nng c ch ti thiu (MIC90) nh sau :
Mm bnh

MIC90 (mg/ml)

Vi khun Gram dng

Staph. aureus

16

Staph. epidermidis

32

Strept. pneumoniae

Strept. pyogenes

32

Bac. anthracis

5 (13.5)

Vi khun Gram m
E. coli

> 128

Enterobacter

16

Klebsiella pneumoniae

> 128

Klebsiella ssp.

Serratia marcescens

> 128

Shigella sonnei

Haemophilus influenzae

20

Pseudomonas

128

Tnh khng thuc bit i vi chloramphenicol khng thay i ng k trong nhng nm gn

y. Cc vi khun sau c tnh khng mt phn i vi chloramphenicol: Proteus (20-50%
khng), Serratia (30-70%), Klebsiella (60-70%), Enterobacter (20-50%), E. coli (20%), Staph.
aureus (20-30%), Enterococci (30-35%), Streptococci (2%), Salmonella (4-9%), Haemophilus
influenzae (0-1%), v Diplococci (0-1%). Chloramphenicol khng hiu qu i vi Pseudomonas,
Mycobacterium, nm, v Protozoa.
Tetryzoline l thuc ging giao cm loi a, c tc dng gy co mch ti ch. Tetryzoline nhanh
chng lm gim cc triu chng ph n, sung huyt v kch thch kt mc.
DC NG HC
Trong vng 10 n 20 pht sau khi nh 1 liu dexamethasone vo mt, thuc ny s hin din
vi nng cao kt mc, gic mc v tin phng.
Th nghim trn ng vt v kinh nghim lm sng cho thy chloramphenicol ngm vo gic
mc hon ton, v nng hiu qu v mt iu tr t c trong thy dch sau nh thuc ch
15 n 30 pht. Thi gian bn hy ca chloramphenicol l 3-5 gi. mt b vim, thi gian ny
s ngn hn.
Hin ti, cha c s liu v mc hp thu vo ton thn ca chloramphenicol,
dexamethasone, v tetryzoline sau khi nh mt.
CH NH
Vim kt mc, gic mc cp v mn do nguyn nhn nhim trng c ph n v sung huyt
nhiu.
Vim mng b o trc (vim mng mt, vim mng mt th mi).
Vim thng cng mc, vim cng mc v vim c (vn nhn). Nhn vim giao cm.
Chloramphenicol c ch nh khi tc nhn gy nhim trng khng vi cc khng sinh khc.
CHNG CH NH
Qu mn cm vi mt trong cc thnh phn ca thuc.
Chn thng (try xt) hay lot gic mc. Nhim Herpes simplex, hay cc virus khc mt.
Bnh u b, cc nhim trng nung m cha c iu tr, lao.
Glaucoma.
Ri lon chc nng gan nng v bnh v mu nng do suy ty xng.
Ri lon chuyn ho porphyrin cp tng cn.
Tin s gia nh c suy ty xng.
Tr s sinh.
Kh mt, c bit trong trng hp vim kt gic mc kh mt (hi chng Sjogren).
THN TRNG LC DNG
Corticoid c th che lp, kch hot hay lm nng thm tnh trng nhim trng ca mt. Nu tnh

trng mt khng ci thin sau 7-8 ngy iu tr, cn cn nhc chn la mt bin php iu tr
khc.
Chloramphenicol c nguy c gy thiu mu bt sn hay cc lon sn mu khc. V th, cn phi
cn nhc nh gi li hi khi dng cho tng bnh nhn. Ch nn dng thuc ny khi cc bin
php iu tr khc khng hiu qu hay c chng ch nh.
Khng nn dng chloramphenicol lu qu 10 ngy.
Trong cc nhim trng c tn hi nhu m ca gic mc v cng mc, cc corticoid nh ti ch c
th lm thng cc m ny.
Do nguy him ca cc phn ng ton thn, khng nn dng thuc cho tr di 2 tui hoc
bnh nhn cao huyt p hay c huyt p thp.
Khng nn dng thuc cho bnh nhn vim mi kh, cng gip, tiu ng, bnh tim, v c
thy tinh th.
i vi bnh nhn mang knh tip xc :
Khng nn mang knh tip xc khi c nhim trng mt.
LC C THAI v LC NUI CON B
Th nghim trn ng vt vi chloramphenicol cho thy c tc dng ph trn thai nhi (c tnh
cho thai v tnh sinh qui thai). Tuy nhin, kt qu ny cha c kim chng trn ngi.
Chloramphenicol d dng i qua hng ro nhau thai v c tit vo sa m. Do , khng nn
dng thuc vo 3 thng cui thai kz, hoc ph n cho con b v c th gy khuyt tt nng tr
s sinh hay tr b m (hi chng Grey, ri lon to huyt).
TNG TC THUC
Khng nn dng ng thi chloramphenicol vi cc thuc dit khun (penicillin, cephalosporin,
gentamicin, tetracyclin, polymyxin B, vancomycin hoc sulphadiazine). Cng khng nn dng
ng thi vi cc thuc iu tr ton thn c tc dng ph trn h to mu, cc thuc
sulphonylurea, cc dn xut ca coumarin, thuc hydantoins v methotrexate.
Mc d t quan trng, cng nn cn nhc cc tng tc thuc bit i vi cc corticoid dng
ton thn.
TC DNG NGOI
Cm gic xt nh thong qua ngay sau khi nh thuc. Thuc c th xung ming gy v ng.
Phn ng d ng di dng chm m mt hoc vim gic mc chm c th xy ra mt s him
trng hp.
Lon sn mu bt hi phc mt phn (thiu mu bt sn, gim 3 dng t bo mu, gim bch
cu, gim tiu cu, khng c bch cu ht) xy ra mt vi trng hp ring l sau iu tr
bng chloramphenicol nh mt. Tuy nhin, nng v thi im xut hin khng tng quan
vi liu dng cao v thng xuyn trong cc th nghim ny.
Mc d thuc co mch c dng vi liu thp trong cc thuc nh ti ch, tc ng ging giao
cm ton thn vn c th xy ra, c bit tr em v ngi gi. Trng ngc, lon nhp tim, tng

trng lc, nhc u vng chm, ti nht, run, m hi, tng nhn p (gc ng), v sung
huyt phn ng c th xy ra.
iu tr ti ch vi corticoid c th gy cc phn ng ph sau :
Vim da quanh mt (tng i thng gp), c ch min dch, nhim trng th pht, lon
dng gic mc c th xy ra trong 1 tun iu tr. Ngoi ra, chm lnh so, gin ng t, sp
mi, v trong mt s him trng hp, li mt c th xy ra.
iu tr ti ch ko di vi corticoid c th gp cc tnh trng sau :
Tng nhn p c hi phc (cn kim tra nhn p thng xuyn) ; c thy tinh th di bao sau
; hoi t gic mc; thng nhn cu ; cc phn ng ph ton thn (c bit tr em).
Vim dy thn kinh sau khi dng chloramphenicol nh ti ch c m t trong mt vi
trng hp ring l, tuy nhin s hi phc khi ngng thuc.
LIU LNG v CCH DNG
Nh 1 git x 4 ln/ngy vo ti kt mc.
Trng hp cp tnh : c th nh mi gi 1 git.
hn ch thuc hp thu vo ton thn cng t cng tt, cn lm nghn ng dn nc mt
bng cch n vo cnh mi gn gc trong ca mt 1-2 pht sau khi nh thuc.
Ging nh vi tt c cc corticoid khc, liu dng cho tr em di 2 tui cn phi c cn
nhc cn thn.
QU LIU
Vic ung nhm thuc c th gy nn cc triu chng sau: lon nhp tim, ti nht, tot m hi,
gin ng t, v tng huyt p.
BO QUN
Bo qun Spersadexoline nhit 2-8oC. ng np li sau khi dng. Khng nn dng mt chai
thuc lu hn mt thng khi m np. Sau t iu tr, nn b i phn thuc cn d. Nu
cha m np, c th s dng chai thuc cho n ngy ht hn ghi trn hp

484.

SPERSALLERG

NOVARTIS OPHTHALMICS
Thuc nh mt : l nh git 10 ml.
THNH PHN
cho 1 ml
Antazoline chlorhydrate

0,5 mg

Tetryzoline chlorhydrate

0,4 mg

(Methylhydroxypropylcellulose)
(Benzalkonium chlorure)

(0,15 mg)

DC LC
Tetryzoline l cht ging giao cm c h hng gn vi naphazoline, gy co cc tiu ng mch
kt mc thng qua kch thch cc th th a-adrenergic, do thuyn gim nhanh chng cc kch
thch do phn ng vim v ph n kt mc. Tetryzoline c th gy h nhn p nh.
Hot cht khng d ng c trong Spersallerg l Antazoline, c tc dng c ch cnh tranh th
th H1 ti t bo p ng. N lm thuyn gim cc triu chng do hu qu ca phng thch
histamin vo m nh gia tng tnh thm v dn cc mao mch, co tht c trn, ph, nga, v
chy nc mt.
S phi hp cc hot cht chnh trong Spersallerg nhm mc ch iu tr triu chng cc tnh
trng d ng ca kt mc, gy ra do phng thch histamin.
Tit nc mt hi gim, trong khi kch thc ng t, iu tit, v nhn p ni chung khng
thay i.
DC NG HC
Cha c th nghim trn ngi cng nh trn ng vt v dc ng hc ca Spersallerg.
Tetryzoline nhanh chng c tc dng v ko di t 4-8 gi. Ging nh cc cht ging giao cm
loi alpha khc, tetryzoline nhanh chng c hp thu qua cc mch mu.
Thnh phn khng histamin H1 (antazoline) thng uc hp thu nhanh v tt. Tuy nhin, cha
c s liu v mc hp thu.
CH NH
Vim kt mc kch thch khng do nhim trng, cc tnh trng vim kt mc d ng, hay fever,
v vim kt mc ma xun.
CHNG CH NH
D ng vi cc thnh phn c trong Spersallerg
Bnh nhn glaucome gc ng, hay c hi chng kh mt.
Tr em di 2 tui.
THN TRNG LC DNG
Dng thuc cn thn tr em.
Cn chn la thuc khc hay bin php iu tr khc trong trng hp d ng ti pht mn tnh.
Thuc ny khng dng iu tr lu di. Nu cn iu tr lu hn 2-3 ngy, thuc cn c
bc s k toa v theo di.
Cn thn trong trng hp c vim mi kh. Do kh nng xy ra hiu qu ging giao cm ton

thn, cn thn khi dng thuc cho bnh nhn tiu ng, bnh nhn c bnh tim nng, cao
huyt p, cng gip, hoc u ty thng thn.
C th che lp du hiu nhim trng mt.
Thng tin cho bnh nhn mang knh tip xc :
Nn tho knh tip xc ra trc khi nh thuc. Sau , i t nht 15 pht mi mang knh tr
li. Spersallerg c th lm gim tit nc mt tm thi, gy gim dung np ca knh tip xc.
LC C THAI v LC NUI CON B
Cha c th nghim i chng trn ng vt, ph n c thai v tr em nh. Do , ch nn
dng thuc cho i tng ny khi li ch do thuc mang li cao gp nhiu ln nguy c cho thai
v cho tr. Cha r antazoline hay tetryzoline c c tit vo sa m hay khng.
Thai kz loi C.
TNG TC THUC
Cc thuc cha tetryzoline khng nn dng cho bnh nhn ang iu tr vi thuc c ch MAO
cho n 10 ngy sau khi ngng thuc c ch MAO (tng huyt p gy ra do dng ng thi
thuc c ch MAO v thuc chng trm cm 3 vng).
TC DNG NGOI
Thnh thong, cm gic xt nh thong qua ngay sau khi nh thuc. Trong mt s him trng
hp c th thy dn ng t.
Sau khi ngng iu tr, c th xy ra sung huyt phn ng. Trong mt s him trng hp, c
th xy ra nhc u, ngy ngt, v tim p nhanh, c bit tr em nh, cng nh m hi,
run, tng huyt p, triu chng kch ng.
LIU LNG v CCH DNG
Nh 1 git mi 3 gi trong giai on cp tnh, iu tr duy tr, ch cn nh 1 git x 2-3
ln/ngy l . i vi tr em, ch cn nh 1-2 git/ngy.
QU LIU
Qu liu khng th xy ra nu ch dng thuc nh mt v nh ng liu. Ung nhm l thuc
Spersallerg thng khng gy hu qu nghim trng cho ngi ln. Ngc li, tr em c th
xy ra bun nn, bun ng, lon nhp tim/nhanh nhp tim, v c th sc, c bit tr em di
2 tui.
BO QUN
ng np li ngay sau khi dng. Khng nn dng 1 chai thuc lu hn 1 thng khi m np.
Cc l thuc cha m np c th dng c cho n ngy ht hn ghi trn hp thuc

485.

SPORAL

JANSSEN PHARMACEUTICA
c/o JANSSEN-CILAG
c/o MEGA PRODUCTS
Vin nang (cha cc vi nang) 100 mg : hp 4 vin.
THNH PHN
cho 1 vin
Itraconazole

100 mg

DC LC
Itraconazole, mt dn xut triazole, c hot tnh i vi vi nm dermatophytes (cc chng
Trichophyton, Microsporum, Epidermophyton floccosum), nm men (Cryptococcus
neoformans, cc chng Candida bao gm C. albicans, C. glabrata v C. krusei, cc chng
Pityrosporum), cc chng Aspergillus, cc chng Histoplasma, Paracoccidioides brasiliensis,
Sporothrix schenckii, cc chng Fonsecaea, cc chng Cladosporium, Blastomyces dermatitidis
v cc vi nm v nm men khc.
Cc nghin cu trong ng nghim xc nhn rng Sporal gy ri lon vic tng hp ergosterol
ca t bo vi nm. Ergosterol l mt thnh phn thit yu ca mng t bo vi nm. S ri lon
vic tng hp cht ny cui cng dn n mt tc dng khng nm.
DC NG HC
Kh dng sinh hc khi ung ca Sporal t ti a khi vin nang Sporal c ung ngay sau khi
n no. Nng nh huyt tng t c 3-4 gi sau mt liu ung. S thi tr thuc khi
huyt tng c hai pha vi thi gian bn hy sau cng l 1 n 1,5 ngy. Khi s dng di hn,
trng thi hng nh t c sau 1-2 tun. Ba n bn gi sau khi ung thuc, nng
itraconazole trong huyt tng trng thi hng nh l 0,4 mg/ml (vi liu 100 mg mt ln
mi ngy), 1,1 mg/ml (vi liu 200 mg mt ln mi ngy) v 2,0 mg/ml (vi liu 200 mg 2 ln
mi ngy).
Sporal kt hp vi protein huyt tng l 99,8%. Nng itraconazole trong mu ton b bng
60% nng trong huyt tng. S xm nhp ca thuc vo cc t chc sng, c bit l da,
n 4 ln cao hn huyt tng, v s thi tr Sporal lin quan vi vic ti sinh biu b. Tri
ngc vi nng trong huyt tng m tr nn kh pht hin trong vng 7 ngy sau khi
ngng thuc, nng iu tr da tn ti cho n 2-4 tun sau khi kt thc mt liu trnh iu
tr 4 tun bng Sporal. Nng itraconazole c pht hin sng mng ngay trong tun
iu tr u tin v tn ti ko di t nht l 6 thng sau khi kt thc mt liu trnh iu tr 3
thng . Sporal cng hin din cht b nhn v vi mt mc t hn m hi.
Sporal cn c phn b rng ri cc m c xu hng b nhim nm. Nng ca thuc
phi, thn, gan, xng, d dy, lch v c bp c pht hin l 2-3 ln cao hn nng huyt

tng tng ng. Nng iu tr ca Sporal m m o c duy tr thm 2 ngy na sau

khi kt thc liu trnh 3 ngy vi liu 200 mg mi ngy v thm 3 ngy na sau khi kt thc liu
trnh iu tr 1 ngy vi liu 200 mg, 2 ln/ngy.
Sporal c chuyn ha mnh m gan thnh nhiu cht chuyn ha. Mt trong nhng cht
chuyn ha ny l hydroxy-itraconazole v c hot tnh khng nm tng ng vi
itraconazole trn vitro. Nng thuc khng nm c o lng bng cc th nghim sinh hc
gp 3 ln nng itraconazole c o bng phng php sc k lng k thut cao. S bi xut
thuc dng cha chuyn ha thay i t 3-18% so vi liu dng. Thuc dng cha chuyn
ha o thi qua thn t hn 0,03% liu dng. Khong 35% ca liu ung c thi tr di
dng cc cht chuyn ha trong nc tiu trong vng mt tun.
CH NH
Sporal c ch nh cho iu tr cc trng hp sau :
Ph khoa : Candida m o - m h.
Ngoi da, nhn khoa :
Lang ben, nhim nm ngoi da, vim gic mc mt do nm v nhim Candida ming.
Nm mng do dermatophyte v/hoc nm men.
Nm ni tng : nhim nm ni tng do nm Aspergillus v Candida, nhim nm Cryptococcus
(k c vim mng no do Cryptococcus), nhim nm Histoplasma, Sporothrix, Paracoccidioides,
Blastomyces v cc nhim nm ni tng hoc nhim nm vng nhit i him gp khc.
CHNG CH NH
- Khng dng Sporal nhng bnh nhn qu mn vi thuc hoc cc thnh phn ca thuc.
- Sporal chng ch nh cho ph n c thai tr khi nhim nm e do tnh mng, v li ch iu
tr ln hn so vi nguy c tim tng i vi thai nhi. Nn thn trng nga thai y sut thi
kz kinh nguyt ph n ang dng Sporal.
- Nhng thuc sau chng ch nh dng chung vi Sporal : terfenadine, astemizole, cisapride,
quinidine, pimozide, cc thuc c ch HMG-CoA reductase c chuyn ha bi CYP3A4 nh l
simvastatin v lovastatin, cc thuc triazolame v midazolame ung.
THN TRNG LC DNG
- Sporal c kh nng gy nhng tng tc thuc quan trng trn lm sng (xem Tng tc
thuc).
- Tnh acid d dy gim : s hp thu thuc s km khi tnh acid d dy gim. nhng bnh nhn
ang dng thuc trung ha acid (v d nh : hydroxyd nhm) cc thuc ny nn c ung t
nht l 2 gi sau khi ung Sporal. bnh nhn thiu toan dch v nh mt s bnh nhn AIDS v
bnh nhn dng thuc khng tit acid (nh cht i khng H2, cht c ch bm proton) c
khuyn co nn ung thuc Sporal cng vi nc gii kht cola.
- S dng trong nhi khoa: cc d kin lm sng v vic dng Sporal bnh nhi cn hn ch, v
vy khng nn dng Sporal tr em tr khi li ch iu tr cao hn nguy c c th xy ra.

- Nn gim st chc nng gan nhng bnh nhn dng thuc iu tr lin tc trong hn mt
thng v nhng bnh nhn thy c nhng triu chng gi { vim gan nh bing n, bun nn,
nn, mt mi, au bng hoc nc tiu sm mu. Nu c bt thng xy ra, nn ngng iu
tr.
- nhng bnh nhn tng men gan hay c bnh gan tin trin hoc b nhim c gan do thuc
khc, khng nn bt u iu tr tr khi li ch mong i nhiu hn nguy c tn thng gan.
Trong nhng trng hp nh vy, theo di st men gan l cn thit.
- Suy gan : Itraconazole c chuyn ha ch yu gan. Thi gian bn hy tn cng ca
itraconazole bnh nhn x gan hi k o di . Kh dng sinh hc ng ung bnh nhn x
gan c hi gim. Nn gim st nng itraconazole trong huyt tng iu chnh liu khi
cn thit.
- Nu xy ra bnh l thn kinh m c th quy cho Sporal, nn ngng iu tr.
- Suy thn: kh dng sinh hc khi ung ca Sporal gim nhng bnh nhn suy thn. Nn gim
st nng Sporal huyt tng v iu chnh liu thch hp.
- Khng c mt thng tin no cp n phn ng cho gia itraconazole v cc thuc khng
nm thuc nhm azole khc. Cn thn trng trong vic k toa Sporal cho nhng bnh nhn
nhy cm vi cc thuc thuc nhm azole khc.
nh hng trn kh nng li xe v iu khin my mc :
Khng nh hng.
LC C THAI v LC NUI CON B
Khi dng liu cao itraconazole trn chut nht c thai (>= 40 mg/kg/ngy) v chut ln c thai
(>= 80 mg/kg/ngy), thy tng tai bin bt thng trn thai v gy ra tc dng ngoi trn
phi. Hin cha c cc nghin cu v vic s dng Sporal trn ph n c thai. V vy, nhng
ph n c thai ch nn dng Sporal trong cc trng hp nhim nm ni tng e da tnh mng
v khi cc trng hp ny li ch iu tr cao hn nguy c c hi cho bo thai.
Ch mt lng rt nh itraconazole c tit ra trong sa m. V vy, nn cn nhc li ch iu
tr bng Sporal vi nguy c tim tng ph n ang cho con b. Trong trng hp nghi ng,
bnh nhn khng c cho con b.
TNG TC THUC
Cc thuc nh hng trn s chuyn ha itraconazole :
- Nhng nghin cu v tng tc thuc c thc hin vi rifampicine, rifabutin, v
phenytoin. V kh dng sinh hc ca itraconazole v hydroxy-itraconazole gim i trong nhng
nghin cu ny ti mt mc lm gim hiu qu iu tr rt nhiu, nn thuc khng c
khuyn kt hp vi nhng cht cm ng men mnh ny. Hin nay cha c mt s liu nghin
cu chnh thc cho cc thuc cm ng men khc nh l carbamazepine, phenobarbital v
isoniazid, nhng cn tin lng nhng hu qu tng t c th xy ra.
- Do itraconazole c chuyn ha ch yu qua CYP3A4, nhng cht c ch mnh enzyme ny

c th lm tng kh dng sinh hc ca itraconazole. Nhng cht l : ritonavir, indinavir, v

clarithromycine.
Tc dng ca itraconazole trn s chuyn ha ca nhng thuc khc :
Itraconazole c th c ch s chuyn ha ca nhng thuc c chuyn ha bi men
cytochrome h 3A. iu ny c th a n s gia tng v/hoc ko di tc dng ca chng k
c tc dng ph. Sau khi ngng iu tr, nng itraconazole trong huyt tng gim dn ty
thuc vo liu dng v thi gian iu tr (xem Tnh cht dc ng hc). Cn quan tm n vn
ny khi xem xt tc dng c ch ca itraconazole trn nhng thuc dng chung.
Cc v d c bit nh :
- Cc thuc khng c dng chung vi itraconazole trong iu tr : terfenadine, astemizole,
cisapride, triazolam, midazolam ung, quinidine, pimozide, cc cht c ch men kh HMG-CoA
reductase c chuyn ha bi CYP3A4 nh simvastatin, lovastatin.
- Nhng thuc cn theo di st nng trong mu, tc dng hay tc dng ph. Nu iu tr
phi hp vi itraconazole, cc thuc ny nn gim liu khi cn.
- Thuc chng ng ng ung.
- Thuc c ch protease HIV nh l ritonavir, indinavir, saquinavir.
- Mt s thuc iu tr ung th nh l vinca alkaloids, busulphan, docetaxel v trimetrexate.
- Thuc c ch canxi chuyn ha bi CYP3A4 nh l dihydropyridines v verapamil.
- Mt s thuc c ch min dch : cyclosporine, tacrolimus, rapamycin .
- Cc thuc khc : digoxine, carbamazepine, buspirone, alfentanil, alprazolam, midazolam tim
mch, rifabutin, methylprednisolone.
Khng thy tng tc gia itraconazole vi AZT (zidovudine) v fluvastatine.
Ngi ta khng thy nh hng ca itraconazole trn chuyn ha ca ethinyloestradiol v
norethisterone.
Tc dng trn s gn protein huyt tng :
Nhng nghin cu trn vitro cho thy khng c s tng tranh trn s gn protein huyt
tng gia itraconazole v imipramine, propranolol, diazepam, cimetidine, indomethacine,
tolbutamide v sulfamethazine.
TC DNG NGOI
Cc tc dng ngoi { c bo thng thng nht c lin quan n vic s dng Sporal l
nhng tc dng ph trn ng tiu ha nh n khng tiu, bun nn, au bng v to bn.
Cc tc dng ngoi t gp c bo co bao gm nhc u, tng men gan c phc hi, ri lon
kinh nguyt, chong vng v phn ng d ng (nh nga, ban, m ay, ph mch). Cng c bo
co cc trng hp ring l ca bnh l thn kinh ngoi bin v hi chng Stevens-Jonhson.
c bit bnh nhn dng thuc iu tr di hn (khong 1 thng), ngi ta nhn thy mt vi
trng hp c gim kali huyt, ph, vim gan v rng tc.
LIU LNG v CCH DNG

 t s hp thu ti a, cn thit phi ung Sporal ngay sau khi n no. Vin nang Sporal nn
c ung trn 1 ln.
Ch nh

Liu

Thi gian

Ph khoa :
- Nhim Candida m o,
m h

200 mg, 2 ln/ngy hoc

1 ngy

200 mg, 1 ln/ngy

3 ngy

- Lang ben

200 mg, 1 ln/ngy

7 ngy

- Nhim nm ngoi da
(dermatophytes)

200 mg, 1 ln/ngy hoc

7 ngy

100 mg, 1 ln/ngy

15 ngy

100 mg, 1 ln/ngy

15 ngy

- Nhim nm gic mc mt 200 mg, 1 ln/ngy

21 ngy

Ngoi da / nhn khoa :

Cc vng sng ha cao nh

trng hp nhim nm
lng bn chn, lng bn tay
:
200 mg, 2 ln/ngy trong 7
ngy, hoc 100 mg, 1
ln/ngy trong 30 ngy.
- Nhim Candida ming
mt s bnh nhn
thng tn min dch nh :
gim bch cu trung tnh,
bnh nhn AIDS, bnh nhn
cy gh p c quan, kh dng
sinh hc ng ung ca
itraconazole c th b gim.
V vy, cn gp i liu
dng.

- Nm mng :
- iu tr t cch khong (xem bng pha di) :
Mt t bao gm : 2 vin nang (200 mg), 2 ln/ngy, trong 1 tun. Dng 2 t iu tr cho
nhim nm mng tay, v 3 t iu tr cho nhim nm mng chn. Cc t iu tr lun lun
c cch nhau bi 1 khong 3 tun khng dng thuc. p ng lm sng s c thy r khi
mng pht trin tr li sau khi ngng iu tr.
V tr ca nm mng

Tun
1

2-3-4

6-7-8

Nm mng chn cng vi c hay khng c nm

mng tay

t Ngng
1
thuc

t Ngng
2 thuc

Ch nm mng tay

t Ngng
1
thuc

t
2

9
t
3

Hoc :
- iu tr lin tc : 2 vin nang mi ngy (200 mg, 1 ln/ngy), trong 3 thng.
S thi tr Sporal khi t chc da v mng chm s thi tr khi huyt tng. Cc hiu qu ti
u v lm sng t c 2-4 tun sau khi kt thc liu trnh iu tr nm da v 6-9 thng sau
khi kt thc liu trnh iu tr nm mng.
- Nm ni tng :
Liu dng thay i ty theo loi vi nm nhim :
Ch nh

Liu

Nhim Aspergillus

200 mg, 1 ln/ngy 2-5 thng

Nhim Candida

100-200 mg, 1
ln/ngy

Nhim nm Cryptococcus ngoi mng no 200 mg, 1 ln/ngy

Vim mng no do Cryptococcus

200 mg, 2 ln/ngy

Nhim Histoplasma

200 mg, 1-2

ln/ngy

Thi gian

Ghi
ch
(1)

3 tun- 7
thng
2 thng- 1
nm

8 thng

(2)

Nhim Sporothrix schenckii

100 mg, 1 ln/ngy 3 thng

Nhim Paracoccidioides brasiliensis

100 mg, 1 ln/ngy 6 thng

Chromomycosis (Nhim Cladosporium,

Fonsecaea)

100-200 mg, 1
ln/ngy

Nhim Blastomyces dermatitidis

100 mg, 1 ln/ngy 6 thng

6 thng

- 200 mg, 2 ln/ngy

1

Tng liu ln 200 mg, 2 ln mi ngy trong trng hp xm nhim hoc lan ta
iu tr duy tr cho cc trng hp vim mng no l : 200 mg, 1 ln/ngy
QU LIU
Hin cha c d kin v qu liu. Trong trng hp tai bin qu liu, nn p dng cc bin
php h tr. Trong vng 1 gi u sau khi ung nn ra d dy. C th s dng than hot nu
nh thy thch hp. Khng th loi b itraconazole bng thm phn mu. Khng c thuc gii
c c hiu.
BO QUN
Bo qun 15-30oC
2

486.

STABLON

LES LABORATOIRES SERVIER

vin bao (trng) : hp 30 vin - Bng B.
THNH PHN
cho 1 vin
Tianeptine

12,5 mg

DC LC
Tianeptine l thuc chng trm cm.
Trn ng vt, tianeptine c cc c tnh sau :
- lm tng hot tnh t pht ca cc t bo thp hippocampe v lm cho chc nng ny c
hi phc nhanh sau khi b c ch ;
- lm tng tc thu hi srotonine ca cc t bo thn kinh v no v hippocampe.
Trn ngi, tianeptine c c trng bi :

- tc ng trn cc ri lon v kh sc, c xp gia hai nhm thuc chng trm cm gy m

du v thuc chng trm cm gy hng phn,
- tc ng tt trn nhng bnh nhn c nhng than phin v c th, nht l nhng than phin
v cc ri lon tiu ha, c nguyn do t s lo u v cc ri lon v kh sc,
- c hot tnh i vi cc ri lon v tnh cch v hnh vi bnh nhn nghin ru trong thi kz
cai nghin.
Mt khc, tianeptine khng nh hng ln :
- gic ng v s tnh to,
- h tim mch,
- h cholinergique (khng c nhng biu hin kiu khng tit choline),
- gy nghin.
DC NG HC
Hp thu nhanh v hon ton qua ng tiu ha.
Phn phi nhanh, gn kt vi protine mnh, khong 94%.
Chuyn ha mnh gan qua tin trnh oxy ha v tr bta v loi gc mthyl nit.
Tianeptine c thi gian bn thi ngn khong 2 gi 30, bi tit ch yu qua thn di dng cc
cht chuyn ha, ch c khong 8% hot cht khng b bin i c thi qua nc tiu.
ngi ln tui : cc nghin cu dc hc c thc hin ngi gi trn 70 tui v iu tr
di hn cho thy thi gian bn thi tng thm 1 gi.
bnh nhn suy gan : cc nghin cu cho thy c nh hng khng ng k ln cc thng s
dc ng hc ca bnh nhn b nghin ru kinh nin, ngay c khi c km x gan.
bnh nhn suy thn : cc nghin cu cho thy thi gian bn thi di ra thm 1 gi.
CH NH
Giai on trm cm ch yu (in hnh).
CHNG CH NH
- Tr em di 15 tui.
- Phi hp vi IMAO.
Nn lu { ch bt u iu tr bng tianeptine sau khi ngng IMAO 15 ngy, v bt u iu
tr bng IMAO sau khi ngng tianeptine 24 gi.
CH PHNG v THN TRNG LC DNG
- Do bnh nhn trm cm vn c khuynh hng t t, cn c theo di nht l trong thi gian
u iu tr.
- Nu cn phi gy m bnh nhn ng ton thn, nn bo trc cho bc s gy m hi sc
bit v ngng Stablon 24 hoc 48 gi trc khi phu thut. Trng hp cp cu, vic phu
thut vn c th tin hnh nhng phi theo di trong sut thi gian phu thut.
- Cng nh tt c cc thuc hng tm thn khc, khi ngng iu tr, cn phi gim liu t t
trong 7 n 14 ngy.

Li tu xe v s dng (vn hnh) my mc :

Dng thuc c th lm gim s tp trung mt vi bnh nhn. Do , kh nng b bun ng khi
dng thuc cng nn c lu {, nht l i vi ngi s dng my mc v iu khin phng
tin giao thng.
LC C THAI
ng vt : cc nghin cu cho thy thuc khng gy nh hng ln s sinh sn. Lng thuc
i qua nhau thai rt thp v khng gy tch t trong bo thai.
ngi : do thiu s liu, nguy c do dng thuc cha c bit n. Trnh k toa cho ph n
mang thai.
LC NUI CON B
Cc thuc chng trm cm c bi tit trong sa m, do khng nn cho con b trong thi
gian iu tr.
TNG TC THUC
Chng ch nh phi hp :
- IMAO khng chn lc : nguy c b tt hoc cao huyt p kch pht, st cao, co git, t vong.
TC DNG NGOI
Him khi xy ra, thng l nh :
- au thng v, au bng, kh ming, chn n, bun nn, nn, to bn, y hi,
- mt ng, bun ng, c mng, suy nhc,
- tim p nhanh, ngoi tm thu, au vng trc ngc,
- chng mt, nhc u, xu, run, nng bng mt,
- th kh, c cm gic c hng b nghn,
- au c, au ct sng.
LIU LNG v CCH DNG
Liu khuyn co l 1 vin, 3 ln/ngy, ung lm 3 ln vo bui sng, tra v ti, vo trc cc
ba n chnh.
- bnh nhn nghin ru kinh nin, c x gan hoc khng, khng cn phi iu chnh liu.
- ngi gi trn 70 tui, v trng hp bnh nhn b suy thn, gim cn 2 vin/ngy.
QU LIU
Trong mi trng hp, cn ngng ngay iu tr v theo di bnh nhn tht cht ch.
- Ra d dy.
- Theo di tim mch, h hp, chuyn ha, thn.
- iu tr triu chng nu cn, nht l h hp h tr cho bnh nhn, iu chnh cc ri lon
chuyn ha v thn.

487.

STAMARIL PASTEUR

AVENTIS PASTEUR
Bt ng kh v dung mi pha huyn dch tim : hp 1 ng vaccin ng kh + 1 bm tim
cha 0,5 ml cht pha long, hp 10 ng 5 liu + hp 10 ng cha 2,5 ml cht pha long*, hp 10
ng 10 liu + hp 10 l cha 5 ml cht pha long*, hp 10 ng 20 liu + hp 10 l cha 10 ml
cht pha long*, hp 10 ng 50 liu + hp 10 l cha 25 ml cht pha long*.
* Hp cha cc ng hay cc l cha cht pha long c cung cp ring.
THNH PHN
cho 0,5 ml
Virus gy bnh st vng, chng 17D khng c virus gy bnh leuco
g, cy trn phi g

ti thiu 1000
LD50

Cht pha long m

0,5 ml

CH NH
Phng nga bnh st vng.
Vaccin c khuyn co dng :
- Nhng ngi du lch, ngay c khi ch i du lch trong thi gian ngn, hay nhng ngi trong
vng dch t.
- Nhng ngi trong vng dch t nhng cha tim nga i n mt vng khng c dch.
- Nhng ngi c nguy c nhim bnh do ngh nghip.
- Nhng ngi nhim HIV khng c triu chng, c nguy c nhim bnh st vng.
c cng nhn chnh thc, vic tim nga vaccin st vng phi c ghi trn mt giy
chng nhn quc t, k tn v xc nhn bi mt trung tm tim nga chnh thc c cng
nhn. Giy chng nhn tim nga c gi tr trong mi nm, k t ngy th 10 sau khi tim.
CHNG CH NH
Cc chng ch nh tim vaccin st vng ni chung cng ging chng ch nh ca cc vaccin
khc :
- Cc bnh nhim trng ang tin trin.
- Cc bnh c tnh ang tin trin.
- ang iu tr c ch min dch.
Cc chng ch nh c bit ca tim nga st vng :
- Thc s d ng vi protein ca trng.
- Suy gim min dch bm sinh hay mc phi.
Ph n c thai v tr em di 6 thng tui khng nn tim nga. Tuy nhin, nu ang c dch,
ph n c thai v tr em t 4 thng tui c th tim nga.
THN TRNG LC DNG

Nhng ngi d ng c ngh th nghim v dung np thuc : tim trong da 0,1 ml vaccin,
theo di, nu trong vng 10 n 15 pht m khng c phn ng, tim di da phn thuc cn
li, tc l 0,4 ml.
Trong vi trng hp c bit, c th quyt nh tim nga st vng nhng ngi iu tr
c ch min dch. Thn trng, th ch nn tim nga sau khi ngng iu tr mt thng, sau khi
chc chn rng, trong mi trng hp, cc ch s sinh hc u bnh thng.
TNG TC THUC
Vaccin Stamaril Pasteur c th tim cng lc vi vaccin vim mng no do no m cu nhm A
v nhm C (vaccin mningococcique A+C), vaccin bi lit dng ung hay dng tim, vaccin si,
vaccin Typhim Vi v vaccin bch hu, un vn v ho g m khng nh hng g n tnh sinh
min dch ca cc vaccin ny.
Chng ch nh tim nga st vng ng thi vi cc vaccin t, thng hn v ph thng hn
A v B dng tim trong vng 3 tun l.
TC DNG NGOI
Phn ng c th xut hin t ngy th t n ngy th by sau khi tim di cc dng nh st,
au mnh my, mt v nhc u.
LIU LNG v CCH DNG
Liu lng :
Tim nga c bn : tim di da hay tim bp mt liu 0,5 ml vaccin pha.
Tim nhc : nhng qui nh quc t v sc khe yu cu tim nhc 0,5 ml vaccin mi 10 nm.
Cch dng :
Dng trnh by n liu :
Pha vaccin cn thn bng cch bm cht pha long trong bm tim vo ng vaccin ng kh.
Sau khi ha tan hon ton, vaccin c rt tr li vo bm tim v tin hnh tim.
Dng trnh by a liu :
Lng cht pha long cn thit pha vaccin :
- 2,5 ml cho ng cha 5 liu,
- 5 ml cho ng cha 10 liu,
- 10 ml cho ng cha 20 liu,
- 25 ml cho ng cha 50 liu,
Pha vaccin ng kh trong ng vi mt lng nh cht pha long, lc v thm dn lng cht
ha tan cn li. Trc khi tim, phi lc k l vaccin pha. Vaccin c tim di da.
Vaccin sau khi pha phi bo qun ni trnh nh sng v nn dng trong vng mt gi sau khi
pha.
BO QUN
Bo qun nhit t +2oC n +8oC (trong t lnh). Khng c ng c.

S dng ngay sau khi pha vaccin.

Khng dng qu thi hn s dng ghi r trn hp thuc.

488.

STILNOX

SANOFI SYNTHELABO VIETNAM

vin nn d b 10 mg : hp 20 vin.
THNH PHN
cho 1 vin
Zolpidem hmitartrate

10 mg

(Lactose)
DC LC
Stilnox l thuc ng thuc nhm dn xut ca imidazopyridine, c cc c tnh ca nhm
benzodiazpine : tc dng an thn kinh vi liu thp hn so vi liu cn thit gy chng co
git, gin c hay chng lo u.
liu iu tr, Stilnox ch yu c tc dng gy ng.
Cc tc dng ca thuc c lin quan n tc ng ng vn c hiu trn nhng th th
"GABA-omga phn t ln" (cn c gi l BZD1 v BZD2) c chc nng iu chnh s m knh
chlore.
Tuy nhin, zolpidem l mt cht ng vn c i tnh trn phn nhm omga 1 (BZD 1).
ngi, zolpidem rt ngn thi gian d gic ng, gim s ln thc gic trong m, k o di tng
thi gian ng v ci thin cht lng gic ng.
Hiu qu ca thuc i km vi ng biu din in no c trng, khc vi ng biu
din ca cc benzodiazpine. Cc nghin cu ghi trong gic ng m cho thy rng zolpidem
k o di giai on II cng nh cc giai on ca gic ng su (III v IV). liu khuyn co,
zolpidem khng nh hng ln tng thi gian ca gic ng nghch (REM).
DC NG HC
Hp thu :
Sau khi ung, zolpidem c sinh kh dng khong 70% v t nng ti a trong huyt tng
sau 0,5 n 3 gi.
Phn phi :

 liu iu tr, ng hc ca thuc c lin quan tuyn tnh vi liu dng. Gn kt vi protine
huyt tng khong 92%.
o thi :
Zolpidem c o thi di dng cht chuyn ha khng c hot tnh (chuyn ha gan), ch
yu qua nc tiu (khong 60%), v qua phn (khong 40%). Zolpidem khng c tc dng gy
cm ng cc enzyme gan. Thi gian bn hy o thi trong huyt tng trung bnh l 2,4 gi
(0,7-3,5 gi).
ngi gi, s thanh thi thuc gim. Nng nh trong huyt tng tng khong 50%
nhng khng lm tng ng k thi gian bn hy (trung bnh khong 3 gi).
bnh nhn suy thn, c lm thm phn hay khng, quan st thy s thanh thi thuc c
gim va phi. Cc thng s ng hc khc khng thay i.
bnh nhn suy gan, sinh kh dng ca zolpidem tng, thanh thi thuc gim v thi gian bn
hy o thi ko di (khong 10 gi).
CH NH
- Mt ng tm thi.
- Mt ng ngn hn.
- Mt ng kinh nin.
CHNG CH NH
Tuyt i :
- Mn cm vi zolpidem.
- Suy h hp nng.
- Suy gan nng.
Tng i :
- Tr em di 15 tui.
- Chng nhc c.
- Ph n c thai hoc ang cho con b : xem Lc c thai v Lc nui con b.
CH PHNG
L thuc thuc :
C nhiu yu t dng nh thun li cho vic dn n tnh trng l thuc thuc, nh :
- thi gian iu tr,
- liu lng,
- phi hp vi benzodiazepine,
- ung ru,
- c tin s b l thuc mt loi thuc hoc khng.
Vic s dng thuc benzodiazepine c th gy hin tng l thuc thuc, nhng iu ny
khng xy ra vi zolpidem (liu iu tr).
Mt ng phn hi :

Cc nghin cu c thc hin cho n nay cho thy rng zolpidem khng gy hin tng mt
ng phn hi (b mt ng tr li vi mc nng hn) trong cc iu kin s dng bnh
thng. Hin tng ny c th xy ra sau khi ngng t ngt mt iu tr ko di hoc vi liu
cao hn liu khuyn dng.
Thi gian iu tr khng nn vt qu 4 tun l.
Mc d cc nghin cu lm sng thc hin liu iu tr khng cho thy lm hng tin trnh
nhn thc, khng nn loi tr kh nng gy qun v trc c lin quan n liu dng, c bit
khi gic ng b gin on (dy sm do mt bin c bn ngoi) hoc ng tr sau khi ung thuc.
THN TRNG LC DNG
- Nguyn nhn gy mt ng v c nhng yu t nguy c cn c xc nh nu c th c
trc khi k toa.
Yu t nguy c :
- S dng benzodiazepine.
- Ru.
- Suy h hp.
- Suy gan nng.
- Ngi gi trn 65 tui.
- Nhc c.
- Cc nghin cu dc l{ trn ngi v ng vt khng cho thy c bt kz tc ng no trn
trung tm h hp. Tuy vy vn nn thn trng khi dng Stilnox trong suy h hp.
- Trong nhng trng hp nhc c : v c kh nng lm tng nhc c nn ch dng zolpidem
trong iu kin c gim st y t cht ch.
- Trong trng hp suy gan : gim liu.
- Li xe v vn hnh my mc : nn lu { cc ti x v cng nhn iu khin my v kh nng b
chong vng khi dng thuc.
LC C THAI
Mc d khng c mt tc dng gy qui thai hay c trn phi thai no c ghi nhn ng
vt th nghim, do thn trng (cng nh i vi tt c cc loi thuc mi), khng nn dng
thuc ny cho ph n c thai.
LC NUI CON B
Mc d zolpidem c bi tit rt yu qua sa m, khng c dng thuc ny khi cho con b
m.
TNG TC THUC
Khng nn phi hp :
- Alcool : trnh ung ru v thuc c cha alcool, do ru lm tng tc dng an thn. Vic
gim s tp trung v cnh gic i khi c th gy nguy him cho ngi li xe v vn hnh my
mc.

Lu { khi phi hp :
- Morphine, barbiturate : nguy c tng suy h hp.
- Cc thuc khc gy c ch h thn kinh trung ng (dn xut ca morphine gim au v
chng ho), barbiturate, mt vi thuc chng trm cm, thuc khng histamine H1 gy ng,
nhm benzodiazpine, thuc an thn kinh, clonidine v cc thuc cng h : tng tc dng c
ch h thn kinh trung ng c th gy hu qu nghim trng nht l i vi ngi li xe v
vn hnh my mc.
TC DNG NGOI
S xut hin ca cc tc dng ny lin quan ti liu v s nhy cm ca mi c nhn (c bit
nhng ngi cao tui) v thng xy ra trong vi gi sau khi ung thuc nu bnh nhn khng
i ng ngay (xem Liu lng v Cch dng) :
- L ln.
- Ri lon tr nh (mt tr nh trc).
- Song th.
- Bun ng ban ngy.
Him hn, c th gy :
- Mt.
- Ri lon tiu ha.
- Thay i v libido.
- Pht ban da, nga.
- Cm gic chng mt, chong vng, suy nhc.
- L thuc thuc.
- Mt ng phn hi.
LIU LNG v CCH DNG
Liu lng :
Trong mi trng hp, ch dng thuc ngay trc khi i ng.
- Ngi ln di 65 tui : liu lng nn ph hp vi tng c nhn. Liu thng thng l 1 vin
10 mg. C th tng liu n 15 hoc 20 mg (1 vin ri hoc 2 vin) ty theo p ng ca bnh
nhn.
- Ngi gi trn 65 tui : nn bt u iu tr vi 5 mg (na vin), liu lng khng nn vt
qu 1 vin 10 mg.
Cch dng :
Thi gian iu tr : cng ngn hn cng tt v khng c vt qu 4 tun k c giai on gim
liu.
Ngi ln :
- Mt ng tm thi : iu tr t 2 n 5 ngy ;
- Mt ng ngn hn : iu tr t 2 n 3 tun ;

- Mt ng kinh nin : iu tr di hn ch khi c kin ca bc s chuyn khoa.

Cch ngng thuc :
- iu tr ngn ngy : khng cn gim liu trc khi ngng thuc.
- Vic ngng thuc t t i vi iu tr ko di hoc vi liu cao gip lm gim nguy c gy
mt ng phn hi.
QU LIU
Cc triu chng ng c do zolpidem ch yu l ri lon h thn kinh trung ng, biu hin bi
ng gt n hn m.
Trng hp nh : l ln tm thn c th c ghi nhn.
Trng hp nng : mt iu ha vn ng, h huyt p, suy h hp, hn m, him khi t vong.
Trng hp ng c do dng zolpidem km vi thuc chng trm cm h thn kinh trung ng
hay alcool : triu chng nng hn, tin lng xu.
Trng hp qu liu, nn dng cc bin php x l{ thng thng : chuyn ti cc bnh vin
chuyn khoa, ra d dy v theo di cc thng s tim mch-h hp.
Dng flumaznil c th c li chn on v/hoc iu tr qu liu do c hoc do ng c
zolpidem.
S i khng ca flumaznil vi tc dng ca zolpidem c th lm d dng xut hin cc ri
lon thn kinh (co git).

489.

STIMOL

BIOCODEX
c/o TEDIS
dung dch ung : ng thuc d b 10 ml, hp 18 ng.
dung dch ung : gi 10 ml, hp 18 gi.
THNH PHN
cho 1 ng
Citrulline malate (dung dch 50%)

2g

cho 1 gi
Citrulline malate (dung dch 50%)

2g

T dc : mi thm t nhin Cam sangria,

dung dch sodium hydroxyde 30% (m/m)
lng va c pH 3,3, nc tinh
khit.
Lng sodium : 30 mg (1,3 mmol) cho mi gi v mi ng.
DC LC
Chng suy nhc : (A : h thng tiu ha v chuyn ha).
CH NH
iu tr h tr trong suy nhc chc nng.
Ghi ch : Stimol c th dng cho ngi tiu ng v khng c cht ng trong cng thc.
CH PHNG v THN TRNG LC DNG
Trng hp bnh nhn ang theo ch n king t mui, nn lu { lng sodium c trong
mi gi hay mi ng l 30 mg.
Do thuc c pH acide, khi dng phi pha long thuc trong mt ly nc.
TC DNG NGOI
Him gp : vi trng hp au bao t thong qua c ghi nhn khi bt u iu tr.
LIU LNG v CCH DNG
Ngi ln : 3 gi hoc 3 ng mi ngy, chia u ra trong ngy.
Tr em trn 5 tui : 2 gi hoc 2 ng mi ngy, chia u ra trong ngy.
Tr em di 5 tui : 1 gi hoc 1 ng mi ngy.
Khi dng, pha long thuc trong mt ly nc.
Nh mi thuc chng suy nhc, thi gian iu tr phi c gii hn.

490.

STREPTASE

HOECHST-MARION-ROUSSEL
[AVENTIS PHARMA]
Bt pha tim 250.000 UI : hp 1 chai bt ng kh - Bng B.
Bt pha tim 750.000 UI : hp 1 chai bt ng kh - Bng B.
Bt pha tim 1.500.000 UI : hp 1 chai bt ng kh - Bng B.
THNH PHN
Streptase 250.000 UI :
cho 1 chai

Streptokinase c nh

250.000 UI

L-glutamate de sodium

25 mg

Dung dch polygline 10% tc l bng polygline*

25 mg

Dung dch albumine ngi 20% tc l bng albumine

100 mg

Hydroxyde de sodium lng va

pH 7,2

Streptase 750.000 UI :
cho 1 chai
Streptokinase c nh

750.000 UI

L-glutamate de sodium

25 mg

Dung dch polygline 10% tc l bng polygline*

25 mg

Dung dch albumine ngi 20% tc l bng albumine

100 mg

Hydroxyde de sodium lng va

pH 7,2

Streptase 1.500.000 UI :
cho 1 chai
Streptokinase c nh

1.500.000 UI

L-glutamate de sodium

25 mg

Dung dch polygline 10% tc l bng polygline*

25 mg

Dung dch albumine ngi 20% tc l bng albumine

100 mg

Hydroxyde de sodium lng va

pH 7,2

* Cht trng hp ca glatine thoi bin (ngun gc t b).

DC LC
Streptokinase, cht lm tan huyt khi, l mt protine rt tinh khit, chit t dch lc canh cy
lin cu tn huyt bta thuc nhm C.

Sau khi b trung ha bi cc khng th lu hnh nu c, streptokinase hot ha h thng sinh l

lm tan fibrine : mt phn t streptokinase v mt phn t plasminogne kt hp thnh lp
phc hp hot ha plasminogne ; cht ny tc dng ln mt s ln phn t plasminogne,
bin i chng thnh plasmine. Tc dng ly gii protine ca plasmine khng ch thc hin trn
fibrine ca huyt khi m lun c trn fibrinogne lu hnh. Mt cht hot ha khc ca
plasminogen l phc hp streptokinase-plasmin.
DC NG HC
Khi bt u iu tr, nng streptokinase trong huyt tng gim rt nhanh chng (thi gian
bn hy khong 10 pht), do s trung ha ca cc khng th khng streptokinase gn nh
thng xuyn hin din v thng nhim lin cu tn huyt. Tip sau s trung ha, thi gian
bn hy ca streptokinase l khong 80 pht.
Thuc c thi qua nc tiu. Tuy nhin tc dng trn s ng mu k o di hn nhiu (xem
Ngng iu tr trong Ch { phng v Thn trng lc dng).
CH NH
- Nhi mu c tim mi : gim t l t vong nhng bnh nhn c iu tr sm, nht l trong
6 gi u.
Hiu qu cng cao khi iu tr cng sm (c bit khi Streptase c dng ngay gi u).
Hot tnh c v nh vn cn gia gi th 6 v gi th 12.
- Thuyn tc phi.
- Huyt khi tnh mch su.
- Thng cc mch ni ng-tnh mch bnh nhn chy thn nhn to v c t ng thng
lu.
- Huyt khi van tim nhn to.
- Tc ng mch vng mc trung ng hoc tnh mch vng mc.
CHNG CH NH
Chuyn bit :
Tuyt i vnh vin :
- d ng hay khng dung np streptokinase.
Lm sng :
Tuyt i vnh vin :
- ang xut huyt hay mi b xut huyt.
- tin cn tai bin mch mu no d lu : phi khm thn kinh trc khi lm tan huyt khi.
- tin cn m s gn y, chn thng u gn y.
- tin cn d dng mch mu no hay xut huyt mng no khng r nguyn do.
- ri lon ng mu bm sinh hay mc phi, khng kim sot c.
- cao huyt p nng khng kim sot c.
- vim ty cp.

Trong 2 thng :
- mi gn van nhn to bng dacron.
Trong 1 thng :
- can thip bng phu thut, tuy nhin, trong mt s trng hp c bit vt m c th p
c hon ton, c th rt ngn thi hn ny.
Trong 15 ngy :
- chc d-sinh thit gan hay thn.
- chc d ng mch (ng mch khng p trc tip c-chp X quang ng mch ch qua
ng lng).
Tng i :
- trn 70 tui.
- lot khng xut huyt, hang phi, vim ph qun nng.
Sinh hc :
Chng ch nh trong trng hp t l prothrombine gim, hoc thi gian Howell hay cphalinekaolin ko di, tr trng hp trc c dng thuc khng vitamine K hay hparine. Khi ,
nn i vi gi hay c th tin hnh iu tr ng thi b tr hay trung ha s thiu ht.
CH PHNG
Mi khi s dng, nn cn nhc k gia nguy c ca vic iu tr v nhng li im mong mun,
c bit khi c cng mt lc.
- xoa bp tim hay chn thng mi y.
- bnh van 2 l vi rung nh.
- cao huyt p c iu tr.
- suy gan nng hoc suy thn nng.
- si niu.
- bu c nguy c xut huyt.
- hp ng mch cnh vi nguy c thuyn tc.
- vim ni tm mc do vi trng hay bnh nhim trng nng.
- tiu ng vi bin chng vng mc nng.
Streptase c th mt hiu lc nu c dng k t sau 5 ngy sau ln tim Streptase hay
streptokinase u tin v c th c hin tng khng thuc do khng th khng streptokinase,
c bit sau 5 ngy n 12 thng, hay sau nhim trng lin cu khun mi y. Thm na, nng
khng th khng streptokinase cao c th lm tng nguy c d ng khi dng thuc tr li.
THN TRNG LC DNG
Ch c dng thuc nu c s theo di cht ch, c phng tin hi sc. Trng hp trc
c iu tr vi thuc khng vitamine K hay hparine : xem Chng ch nh sinh hc.
Khi ang iu tr, tuyt i chng ch nh : tim bp v chc ng mch (trong nhng vng m
ng mch khng th p c).

Theo di iu tr :
o thi gian thrombine mu v (hay) nng fibrinogne c th cho php kim tra, ngay t
cui gi th nht, hiu qu sinh hc ca vic iu tr. Nng fibrinogne lc c th gn 0
g/l. Thng vo khong gia gi th 6 v gi th 9, nng fibrinogne ln tr li trn 1 g/l
thi im c th chuyn sang iu tr tip theo bng hparine.
iu tr tip theo :
C th d kin nhiu phc khc nhau trnh to huyt khi tr li trong cc mch vnh
c thng v trnh s ti pht hoc lan rng ca nhi mu.
- Streptokinase-hparine :
Cch iu tr tip theo c in vi h parine c tin hnh vo gi th 6 n th 9 (xem Theo
di iu tr) sau khi ngng tim truyn streptokinase, lc u vi liu va (75 n 150 mg/24
gi) ri n liu hu hiu [ty thuc thi gian Howell hay cphaline-kaolin (gp 2 ln tr s
chng)+ khi fibrinogne vt qu 1 g/l.
Sau 4 n 8 ngy dng hparine c th dng tip thuc khng vitamine K.
- Streptokinase-aspirine :
Trong mt nghin cu c kim chng, phi hp streptokinase tim tnh mch v aspirine ung
cho thy c hiu qu, vi aspirine (160 mg/ngy) dng cng sm cng tt. T l t vong c gim
vo thi im 1 thng v mt nm.
-Streptokinase - hparine - aspirine :
C th phi hp nh trn v c v khng lm tng nguy c xut huyt.
Ngng iu tr tc khc v (hay) iu chnh tnh trng ly gii fibrine trong trng hp b bin
chng xut huyt.
C th c ch s ly gii fibrine bng cch tim acide epsilone-aminocaproique (4 g, tim tnh
mch, sau c th truyn tnh mch 1 g/gi) v/hay thuc c ch protase (trung bnh 50.000
n v U.I.K/gi, ng tnh mch) cho n khi c ch hon ton cc men ly gii fibrine.
Trc khi m cp cu cho bnh nhn ang c iu tr vi streptokinase, u phi dng
thuc c ch s ly gii fibrine. Ngoi ra, trc khi m cng phi iu chnh tnh trng h
fibrinogne mu v cc ri lon ng mu c th c bng cch truyn fibrinogne, huyt tng
ti, hoc mu ti ton phn.
LC C THAI
Tuy c th dng streptokinase trong lc mang thai, nhng phi tho lun cho tng trng hp
nu thai di 5 thng, v trnh dng, nu mi sy thai hay ngay sau khi sanh.
TNG TC THUC
Tng nguy c xut huyt khi phi hp vi thuc chng ng (h parine, khng vitamine K) hay
chng ngng tp tiu cu. Tuy nhin, aspirine liu thp (100 n 160 mg/ngy), c tc dng
gim t l t vong, cng vo vi tc dng ca streptokinase (xem iu tr tip theo), m khng
lm tng nguy c xut huyt nng.

TC DNG NGOI
Lm sng :
Khi bt u iu tr c th c phn ng khng dung np tm thi. l s phi hp theo nhiu
kiu khc nhau ca :
- h huyt p v (hay) nhp tim nhanh hoc chm
- au tht ngc
-st, lnh run, au c, suy nhc
-bun nn hay nn
-ni m ay hay da
Cn phn bit vi cc phn ng d ng, him gp hn, nh sc phn v sm hay bnh huyt
thanh.
giai on cp ca nhi mu c tim, sau khi thng mch vnh, ng thi vi gim au, thng
thy mt cn lon nhp hi phc t nhin (lon nhp do ti mu tr li).
Xut huyt nh khng ng k (chy mu im tim), him gp hn l xut huyt ni tng
hay thanh mc (xem Thn trng lc dng).
Cng xy ra bin chng thuyn tc pha di do s di chuyn v (hay) v huyt khi hay mt
mng x cng.
Sinh hc :
Tng bch cu a nhn trung tnh c th km theo phn ng khng dung np sm. Him gp
trng hp tng t bo lympho tng i hay tng tng bo.
Rt him, c s tng va phi hot ng ca cc men gan.
LIU LNG v CCH DNG
Ch c dng thuc ti bnh vin di s theo di cht ch v c phng tin hi sc.
Bt ng kh c pha trong nhng dung dch natri clorid hay glucose ng trng.
Nhi mu c tim cp :
Truyn tnh mch 1.500.000 UI trong 30-60 pht trong 100 ml dung dch mui sinh l hoc
glucose 5%.
Dng streptokinase cng sm cng tt sau khi bt u c triu chng.
Thuyn tc phi cp lan rng vi huyt ng hc bt n :
Liu tn cng : truyn tnh mch 250.000 UI trong 100-300 ml dung dch mui sinh l hay
glucose 5% trong 30 pht.
Liu duy tr : 100.000 UI/gi trong 24 gi, bt u ngay sau liu tn cng.
Tc ng mch trong khi ang iu tr ni mch :
Tim vo ng mch chm vo cc huyt khi.
Khong 5.000 UI/gi trong 12-48 gi.
Thuyn tc van tim gi :
Liu tn cng : truyn tnh mch 250.000 UI trong 100-300 ml dung dch mui sinh l hay

glucose 5% trong 30 pht.

Liu duy tr : 100.000 UI/gi, bt u ngay sau liu tn cng. Liu duy tr c tip tc ty theo
kt qu.
Thng mch ni ng-tnh mch ngi lc mu :
5.000-10.000 UI/20 pht.
C th lp li ti a 5 ln.
QU LIU
Streptokinase lm tng plasmine huyt do s tiu th tin cht (plasminogne). Do , dng
qu liu s khng gy hu qu g v tin cht khng cn na.

491.

STRESAM

BIOCODEX
c/o TEDIS
vin nang : hp 60 vin - Bng B.
THNH PHN
Etifoxine chlorhydrate

50 mg

T dc : lactose, bt talc, vi tinh th

cellulose, keo silice, magnsium starate.
DC LC
Etifoxine chlorhydrate thuc nhm ha hc benzoxazine.
Thuc c tc ng an thn, gii lo u. Thuc khng gy ra tc dng ph nh hng n cc chc
nng quan trng ca c th, nhng c tc dng iu ha h thn kinh thc vt.
c im ca etifoxine chlorhydrate l chng li cng lc cc tc dng thuc v hnh vi v cc
phn ng sinh l v sinh ha ca stress gy ra tnh trng lo u :
- trn th vt, thuc c tc ng rt chn lc trong cc th nghim s dng cc th vt d xc
cm ;
- trong dc l{ lm sng, ngi ta chng minh rng thuc lm gim cc phn ng khc nhau
ca tnh trng stress (tnh kh d xc cm, tng huyt p, tng cc acide b o t do trong huyt
thanh, tng bi tit cortisol...).
V mt thc nghim, trn kh, etifoxine khng gy ra tnh trng l thuc thuc.
Trn lm sng c th iu tr ko di trong vng 6 thng v 12 thng m khng thy c hin
tng thiu thuc sau khi ngng thuc.
DC NG HC

Etifoxine chlorhydrate c hp thu tt bng ng ung, n khng gn vo thnh phn ca

mu, nng ca thuc trong mu gim t t theo 3 pha v thuc c o thi ch yu qua
nc tiu. Etifoxine chlorhydrate qua c nhau thai.
CH NH
Cc biu hin tm thn c th ca s lo lng nh lon trng lc thn kinh thc vt, nht l
biu hin tim mch.
CHNG CH NH
- Tnh trng chong.
- Suy gan v/hoc suy thn nng.
- Suy h hp nng.
CH PHNG v THN TRNG LC DNG
- Trong trng hp nhc c, do kh nng lm tng thm s mt mi ca c, Stresam ch c
dng di s theo di y khoa cht ch.
- Trong trng hp suy h hp va phi, nn iu chnh liu lng cho thch hp.
- Khng nn dng thuc cng lc vi cc thc ung c cht ru.
- Cn thn trng i vi ngi li xe v iu khin cc my mc do thuc c kh nng gy bun
ng.
LC C THAI v LC NUI CON B
Mc d khng thy c tc dng gy qui thai trong qu trnh thc nghim trn th vt th
nghim, khng nn ch nh thuc ny cho ph n c thai v ang cho con b m.
TNG TC THUC
Cn phi thn trng khi phi hp thuc vi cc thuc c ch thn kinh trung ng do kh nng
lm tng tim lc ca c hai.
TC DNG NGOI
Tnh trng bun ng c th xy ra khi bt u iu tr v mt i mt cch t nhin trong qu
trnh iu tr.
LIU LNG v CCH DNG
Trung bnh, ung 3 n 4 vin mi ngy trong 7 n 30 ngy.
QU LIU
Khng c thuc gii c c hiu.
Trng hp dng qu liu do v tnh hay c , vic x l{ c gii hn iu tr triu chng
(theo di cc chc nng tp trung, cnh gic, h hp v gan) bnh vin.

492.

STUGERON

JANSSEN PHARMACEUTICA
c/o JANSSEN-CILAG

c/o MEGA PRODUCTS

Vin nn 25 mg : v 10 vin, hp 25 v.
THNH PHN
cho 1 vin
Cinnarizine

25 mg

DC LC
Cc nghin cu trong ng nghim v trn c th sng cho thy cinnarizine gim co bp c trn
gy ra bi cc tc nhn hot mch khc nhau (histamine, angiotensine, bradykinine, nicotine,
actylcholine, adrnaline, noradrnaline, BaCl2) v gy ra bi s kh cc KCl. Hot tnh chng
co c c hiu c quan st thy trn c trn mch mu. Cinnarizine tc ng trn p ng
co c ca cc si c trn kh cc bng cch c ch chn lc lung ion calci i vo t bo b kh
cc nh gim thiu s hin din ca ion calci cn cho vic cm ng v duy tr co c.
Cinnarizine khng c hi v khng cn tr cc chc nng sinh l{ quan trng (h thn kinh trung
ng, chc nng tun hon, h hp).
DC NG HC
Trn chut cng th nghim, cinnarizine nh du ng v phng x c hp thu nhanh chng
t ng tiu ha v t nng nh trong vng 1 gi mu, gan, thn, tim, lch, phi v
no. Chuyn ha thuc mnh m xy ra trong vng 1/2 gi sau khi ung v sau 32 gi nng
thuc trong m l khng ng k. Thuc c chuyn ha c bit thng qua vic kh N-alkyl
ha. Khong 2/3 cht chuyn ha c thi ra phn v 1/3 nc tiu. Thi tr thuc hu
nh hon ton trong vng 5 ngy sau khi dng thuc.
CH NH
- Ri lon tin nh : iu tr duy tr cc triu chng ri lon m o bao gm chng mt, hoa
mt, chong vng, tai, rung git nhn cu, bun nn v nn.
- Phng nga say sng, say tu xe v phng nga chng au na u.
- iu tr duy tr cc triu chng bt ngun t mch mu no bao gm hoa mt, chong vng,
tai, nhc u nguyn nhn mch mu, ri lon kch thch v kh ha hp, mt tr nh, km tp
trung.
- iu tr duy tr cc triu chng ri lon tun hon ngoi bin bao gm bnh Raynaud, xanh tm
u chi, i khp khnh cch hi, ri lon dinh dng, lo t gin tnh mch, t rn, co tht c
bui ti, lnh u chi.
CHNG CH NH
Qu mn vi thuc.
THN TRNG LC DNG
Bnh nhn Parkinson ch nn dng Stugeron nu li ch dng thuc l cao hn nguy c kh d

lm nng thm bnh ny.

LC C THAI
Mc d trn sc vt nghin cu, Stugeron khng cho thy tc dng sinh qui thai, nn cn nhc
gia nguy c tim tng v li ch dng thuc trn ph n mang thai.
TNG TC THUC
Ru, thuc c ch h thn kinh trung ng, thuc chng trm cm 3 vng : dng ng thi
vi Stugeron c th tng tc dng gy bun ng ca cc thuc ny hoc ca Stugeron.
TC DNG NGOI
Bun ng nh, ri lon tiu ha c th xy ra liu cao. Trong hu ht cc trng hp cc tc
dng ny t bin mt sau mt vi ngy. bnh nhn nhy cm, nn bt u dng thuc vi
liu 1 vin, 3 ln/ngy v tng dn liu dng.
LIU LNG v CCH DNG
1-2 vin, 3 ln/ngy.

493.

STUGERON - RICHTER

GEDEON RICHTER
vin nn 25 mg : v 25 vin, hp 2 v.
THNH PHN
cho 1 vin
Cinnarizine

25 mg

M T
Cinnarizine l mt cht chn calcium chn lc, thuc nhm IV cc cht i khng calcium (theo
s phn loi ca WHO).
Cinnarizine l thuc khng histamine H1.
DC LC
Cinnarizine c ch s co tht cc t bo c trn ca mch mu bng cch chn cc dng
calcium. Ngoi s i khng trc tip calcium ny cinnarizine lm gim hot tnh gy co mch
ca cc cht gy co mch, nh serotonin v epinephrine, bng cch chn dng calcium. S
phong b dng calcium qua t bo c tnh chn lc m, v kt qu l lm cho cinnarizine c
c tnh chng co tht mch m khng nh hng n huyt p v nhp tim.
Hn na, cinnarizine cn c th ci thin s suy gim ca vi tun hon bng cch tng kh nng

bin dng ca hng cu v gim nht ca mu. Sc khng ca t bo vi tnh trng gim oxi
khng kh th vo tng ln.
Stugeron c ch s kch thch h thng tin nh, dn n kt qu ngn chn chng git nhn
cu v cc ri lon giao cm khc.
Cinnarizine c th lm chm dt hoc phng nga triu chng chng mt cp tnh.
DC NG HC
Nng huyt tng ti a ca cinnarizine t c t 1-3 gi sau khi dng thuc. Chu kz bn
hy ca cinnarizine l 4 gi. Cinnarizine c chuyn ha hon ton. N c loi thi 1/3 qua
nc tiu v 2/3 qua phn.
T l gn kt vi protein trong huyt thanh ca cinnarizine l 91%.
CH NH
Cc ri lon tun hon no :
- iu tr duy tr i vi cc triu chng ri lon m o, k c chng mt, chong vng, tai,
git cu mt, bun nn v nn ma.
- Phng say tu xe.
- Phng nhc na u.
- iu tr duy tr i vi cc triu chng c ngun gc t mch no, nh chong vng, tai,
nhc u c nguyn nhn mch, t cch khng ph hp vi x hi, d b kch thch, mt tr nh
v thiu tp trung.
- iu tr duy tr i vi cc ri lon tun hon ngoi bin, nh hin tng Raynaud, chng tp
tnh cch hi, chng xanh tm u chi, ri lon dinh dng, lo t do gin tnh mch v lot do
dinh dng, d cm, chng chut rt ban m, lnh cc chi.
CHNG CH NH
Stugeron chng ch nh i vi nhng bnh nhn nhy cm vi thuc.
Mang thai v cho con b. Mc d trong cc th nghim trn ng vt, Stugeron khng gy qui
thai, nhng cng nh vi tt c cc dc phm khc, Stugeron ch nn s dng trong thi kz c
thai khi li ch ca vic iu tr thuc ln hn c nguy c i vi bo thai.
Cha c s liu cho thy s bi tit ca Stugeron qua sa m : nn ngng cho b khi ngi m
s dng Stugeron.
CH PHNG v THN TRNG LC DNG
Ging nh nhng thuc khng histamine khc, Stugeron cng gy cc kh chu d dy, v th
tt nht l ung thuc sau ba n.
i vi nhng bnh nhn b bnh Parkinson, Stugeron ch nn dng nu nh li ch ca vic
dng thuc ln hn nhng nguy c lm trm trng thm bnh.
Trong thi kz u dng thuc, Stugeron c th gy bun ng, v th cn thn trng khi dng
cng lc vi ru hoc cc thuc c ch thn kinh trung ng.
nh hng i vi kh nng li xe v iu khin my mc : Do thuc c th gy bun ng, c

bit khi bt u dng, cn thn trng trong khi li xe v iu khin cc my mc.

TNG TC THUC
Khi dng ng thi vi :
- ru,
- thuc c ch thn kinh trung ng,
- thuc chng trm cm 3 vng,
tc dng an thn ca cc thuc ny hoc ca Stugeron c th tng.
Can thip vo chn on bnh : do tc dng khng histamin, Stugeron c th ngn nhng ch
th phn ng da dng tnh nu dng Stugeron 4 ngy trc th nghim.
TC DNG NGOI
Bun ng v ri lon tiu ha c th xy ra. Nhng ri lon ny thng ch l tm thi v
thng trnh c khi tng liu dn dn n liu ti u.
Trong mt s t trng hp c th thy au u, kh ming, tng cn, ra m hi v d ng.
Tng t, rt him khi xut hin liken phng v cc triu chng ging lupus.
i vi nhng ngi ln tui, khi iu tr lu di, mt s trng hp bnh ngoi b thp b
trm trng thm hoc bt u xut hin, thng km theo trm cm. Nn ngng iu tr trong
nhng trng hp nh vy.
LIU LNG v CCH DNG
Ri lon tun hon no : 3 x 1 vin/ngy
Ri lon tun hon ngoi bin : 3 x 2-3 vin/ngy
Chng mt : 1 x 3 vin/ngy
Say tu, xe :
- Ngi ln : ung 1 vin na gi trc chuyn i, sau nhc li c mi 6 gi mt ln.
- Tr em : dng na liu ca ngi ln.
Stugeron nn dng sau ba n.
Liu ti a hng ngy khng vt qu 225 mg (9 vin).
V tc dng ca Stugeron i vi bnh chng mt ph thuc vo liu lng thuc, nn liu c
th c nng ln mt cch t t.
QU LIU
Mt trng hp c bit, mt b 4 tui dng thuc qu liu cp tnh (2100 mg), ngi ta thy
cc biu hin sau y : nn ma, bun ng, hn m, run ry, gim huyt p. S hi phc yn
n.
Khng c thuc gii c c tr, nhng trong trng hp dng qu liu, nn ra d dy v dng
than hot.
BO QUN
ch kh, gi nhit khong 15-25oC. Trnh nh sng.

494.

SUBSYDE-CR

RAPTAKOS BRETT
Vin nang phng thch c kim sot 100 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Diclofenac sodium

100 mg

C TNH
Diclofenac sodium khng sinh khi u trn chut cho n liu ung 20 mg.kg-1 trong sut thi kz
c thai. Kh nng sinh sn ca chut cng trng, c ln ci, khng b nh hng, d vy mt s
tc dng c bo thai c ghi nhn liu hng ngy 2-4 mg.kg-1. iu ny c ngha l thuc
c kh nng gia tng hp thu vo trong t cung v/hoc c kh nng gim s lng con trong
mt la thng v gim cn con vt s sinh. Tuy nhin, s pht trin sau v kh nng
sng st ca chut con li tng ng vi l chng. Diclofenac cho n liu 10 mg.kg-1 trong
sut thai kz khng thy c tc dng sinh qui thai chut cng.
Trong cc nghin cu dng liu cao, nhiu sc vt cht v lot d dy v rut.
Trong cc nghin cu trn th, khng thy c tc dng sinh qui thai v s pht trin ca bo
thai vn tt liu 10 mg mi ngy vo ngy th 7-16 sau khi giao hp.
Nghin cu c cp din chng minh liu LD50 l 226-240 mg.kg-1. Nghin cu c trng
din cho thy c xut huyt, lo t v i khi thng tiu ha ty liu v khng thy c bin i
c hi no khc.
DC LC
Diclofenac l mt thuc chng vim khng phi steroid (NSAID) rt hiu lc km theo tc dng
gim au v h st. Thuc cng c mt cht tc dng tng uric niu.
Nghin cu trn cc h t bo thch hp cho thy diclofenac c ch hu hiu cyclo-oxygenase,
lm gim r nt s hnh thnh cc prostaglandin nh PgF2a v PgE2, prostacyclin v cc sn
phm thromboxane l cc cht trung gian c tnh cha kha ca hin tng vim. Hn na,
diclofenac sodium cn iu ha con ng lipoxygenase v lm bin i c { ngha s phng
thch v chuyn ha acid arachidonic. Diclofenac sodium lm gim lng acid arachidonic t do
trong t bo bng cch thc y s kt hp ca n vo cc triglycerid m sau dn n tnh
trng gim t l hnh thnh cc sn phm lipoxygenase. Trn m hnh gy vim khp tr gip,
diclofenac chng vim mnh hn aspirin v tng ng vi indomethacine.
Diclofenac n mn nim mc d dy v ko di thi gian mu chy.

DC NG HC
Subsyde-CR l mt ch phm a n v vi nhiu vin hon nh. Mi hon gm mt li vi
nhiu lp thuc v mng c bit xp xen k bao quanh c kh nng kim sot tc khuch
tn ca thuc bn trong. Sau khi ung vo, v nang gelatin tan ra nhanh chng v phng thch
cc vin hon nh vo trong d dy. Nc thm thu vo cc vin hon nh ngay t d dy v
ha tan diclofenac cho n khi bo ha. Cc vin hon nh sau c ri u dc theo ng
rut v mng thm tch m bo cho thuc khuch tn chm v u ra lng rut xung quanh,
c lp vi thnh phn cha trong rut. Tin trnh ny din ra u n, chm ri ht lp ny
n lp khc cho n khi thuc c khuch tn ra ht, cc vin hon nh xp i v c
o thi ra ngoi. Thuc c phng thch u dc sut ng tiu ha dn n s hp th thuc
u v nng diclofenac huyt tng c duy tr u trong sut 24 gi sau ch mt liu
ung.
Hp thu : Diclofenac trong Subsyde-CR c hp thu hon ton t ng tiu ha. Sau khi ung
100 mg Subsyde-CR, nng huyt tng nh trung bnh t n 1,39 mg/ ml sau khong thi
gian trung bnh l 4,83 gi. Din tin dc ng hc khng thay i sau khi dng lp li liu
thuc. Din tch vng di ng cong biu din nng (AUC) l 18,87 mg.h/ ml.
Phn phi : Hn 99% diclofenac c gn c th nh khi albumin huyt tng ngi. Cng
nh cc thuc chng vim khng phi steroid khc, diclofenac phn tn c vo trong v ra
khi hot dch khp. S phn tn vo trong khp xy ra khi lng thuc trong huyt tng cao
hn trong hot dch khp. C rt t d liu v s xuyn thm vo m ca ngi, nhng chut
nht nng thuc cao nht c tm thy gan, mt v thn nhng ch c mt lng nh
trong no v ty sng.
Chuyn ha v bi tit : Diclofenac c thi ra thng qua s chuyn ha v sau bi tit qua
nc tiu v mt di dng lin hp vi glucuronide v sulphat ca cc cht chuyn ha.
Khong 65% liu dng bi tit qua nc tiu v khong 35% qua mt.
Mt nghin cu trn su b m iu tr trong 1 tun l vi 100 mg diclofenac sodium mi ngy,
khng c mu no trong 59 mu sa c cha lng thuc nguyn dng m c th d ra c
(gii hn ca vic d ra l 10 mg.l-1).
DC L LM SNG
T khi diclofenac c gii thiu, c hn mt ngn bi bo c cng b bo co kt qu
ca vic dng thuc ny cho gn 100.000 bnh nhn.
Liu diclofenac ung hng ngy 75-150 mg c nghin cu l tt so vi liu iu tr ca cc
NSAID khc trong cc cng trnh nghin cu lm sng c i chng trn cc bnh nhn vim
khp dng thp, vim xng khp v vim ct sng dnh khp.
Diclofenac l mt thuc chng vim v gim au hu hiu trong thc tin lm sng v c s
dng rng ri trong iu tr vim khp dng thp v vim xng khp. Trong lm sng,
diclofenac c hiu lc tng t nh indomethacine hay aspirin v t tc dng ph hn hai loi

thuc ny. Diclofenac lm gim sng khp v gim au bnh nhn vim khp dng thp
nhng khng c tc dng lu di ln qu trnh din tin ca bnh. Diclfenac hu hiu trong vic
iu tr au sau m v c dng thuc tim. Diclofenac c ch s kt dnh ca tiu cu v ko
di thi gian mu chy. Bng vic c ch s tng hp prostaglandin trong t cung ph n mang
thai, thuc c th lm chm tr thi im bt u au .
Diclofenac khng nh hng trn chc nng thn ca ngi bnh thng nhng c th lm xu
thm chc nng thn ca bnh nhn c tnh trng lu lng tun hon qua thn ty thuc vo
s dn mch do prostaglandin E2 (nh tng huyt p, tiu ng, x gan v cc tnh trng
khc). Diclofenac c th n mn d dy, mt phn do trc tip kch ng nim mc d dy v
mt phn do c ch s tng hp cc prostaglandin bo v t bo.
CH NH
Cc bnh c xng (nh thn kinh ta, bong gn, dn c, v.v...) ; bnh thp ngoi khp (nh
vim gn, vim bao hot dch, vim m x) ; vim khp dng thp ; vim xng khp ; vim t
sng c ; vim ct sng dnh khp.
CHNG CH NH
Tng cm i vi diclofenac sodium. Vim lot tiu ha. Bnh nhn c c a hen suyn m c
th ln cn suyn, m ay hay vim mi cp do acid acetylsalicylic hay do cc thuc c ch s
tng hp prostaglandin khc gy nn.
THN TRNG LC DNG
Do dng bo ch p dng cng ngh DRCM, tc dng ph ti ch ln ton thn sau y ca
diclofenac dng bo ch thng thng l ti thiu : Lot d dy t trng, xut huyt tiu ha (c
th xy ra m khng c triu chng cnh bo hoc khng c tin s bnh, v thng ngi
cao tui b nng hn), vim lo t i trng, bnh Crohn hoc bt thng huyt hc.
Cng nh cc NSAIDs khc, bnh nhn suy gan, tim hay thn nng, bnh nhn ang dng thuc
li tiu hay ang phc hi sau gii phu ln hoc ngi cao tui cn c theo di st. Bnh
nhn dng di ngy cn c xt nghim theo di chc nng thn, chc nng gan (c th gia
tng cc men gan) v cng thc mu lng gi nguy c. Nu cc xt nghim chc nng gan
bt thng vn ko di hay nng ln, v c cc du chng hay triu chng lm sng cho thy
bnh gan pht trin hay nu xut hin cc bt thng khc (nh tng bch cu a eosin, ni
mn), cn phi ngng dng diclofenac sodium. nh hng trn chc nng thn thng c th
o ngc c nu ngng dng diclofenac sodium.
Diclofenac sodium c th lm bng pht bnh ca ngi b lon chuyn ha porphyrin gan.
Nh cc NSAIDs khc, diclofenac sodium c ch s kt tp tiu cu c th o ngc c.
Dng cho ph n mang thai v cho con b :
D thc nghim trn sc vt khng thy gy qui thai, vn khng nn dng diclofenac sodium
cho ph n mang thai tr trng hp c nhng l{ do xc ng phi dng. Nu s dng, nn vi
liu thp nht c hiu lc. Dng cc thuc c ch s tng hp prostaglandin c th lm cho

ng sm ng ng mch Botal (ductus arteriosus) hoc t cung (uterin inertia), do

khng nn k n thuc loi ny vo 3 thng cui ca thai kz.
Theo di vic ung diclofenac sodium liu 50 mg mi 8 gi, ngi ta nhn din c vt ca
thuc trong sa m nhng lng rt nh n mc khng mong c tc dng ngoi trn tr
s sinh.
TNG TC THUC
Kh nng tng tc nguy him :
- Digoxin : c bo co diclofenac lm gia tng nng digoxin trong huyt tng, nhng
khng thy du chng lm sng ca tnh trng qu liu.
- Thuc li tiu : Cc thuc NSAIDs khc nhau c bit l c ch hot tnh ca cc thuc li
tiu v c kh nng nh hng n cc thuc li tiu gi potassium, v vy cn theo di nng
potassium huyt thanh.
- Methotrexate : Cn theo di cn thn nu dng diclofenac chung vi methotrexate trong vng
24 gi, v cc NSAIDs c th lm gia tng nng methotrexate trong huyt tng v do lm
gia tng c tnh.
Tng tc khc :
- Diclofenac c bo co l lm gim nng salicylate v ngc li.
TC DNG NGOI
liu iu tr, Subsyde-CR ni chung c dung np tt. D vy, lc bt u iu tr, thnh
thong c th c bnh nhn than phin au xt thng v, bun nn, tiu chy, chng mt hay
nhc u. Cc tc dng khng mong muon ny thng nh. Ph ngoi vi v phn ng ngoi da
nh ni mn , m ay v chm cng c quan st thy.
Cc tc dng ph trn thn kinh trung ng nh mt mi, kh ng v kch ng sau khi dng
Subsyde-CR rt him khi c bo co mc d c quan st thy cc thuc chng vim
khng steroid khc. C mt vi bo co v vim lot d dy t trng, xut huyt, phn ng tng
cm (nh co tht ph qun, phn ng qu mn), men transaminase tng, vim gan, suy thn v
hi chng thn h bin. Cc trng hp c bit gim bch cu v gim tiu cu cng c quan
st thy.
LIU LNG v CCH DNG
Ung mt vin nang mi ngy trong khong 6 gi chiu n 8 gi ti.

495.

SUCCINIMIDE PHARBIOL

LABOMED - SERP
c/o GALIEN

bt pha hn dch ung : hp 30 gi.

THNH PHN
cho 1 gi
Succinimide

3g

DC LC
Gim oxalat-niu.
DC NG HC
Succinamide c hp thu nhanh. Dng 3 g succinamide mi 8 gi cho ngi c th trng nng
75 kg, sau 7 liu nng trong mu t c t 0,06 n 0,11 mg/l.
Succinamide c o thi ch yu di dng khng b bin i, v mt lng nh di dng
CO2 c o thi qua ng th.
CH NH
iu tr h tr si thn trong acide oxalique chim u th.
CHNG CH NH
Qu mn cm vi mt trong cc thnh phn ca thuc.
CH PHNG v THN TRNG LC DNG
Trong thi gian iu tr phi c ch n t calci (khng ung sa v cc sn phm t sa).
Phi tng cng bi niu bng cch ung nhiu nc c t cht khong trong thi gian iu tr.
LC C THAI v LC NUI CON B
Lc c thai :
Khng c s liu v kh nng gy qui thai trn ng vt. Trn lm sng, hin nay cha c s
liu xc ng nh gi kh nng gy d dng bo thai hay c phi khi dng trong thai kz.
Hn na, khng nn dng thuc iu tr si thn trong thi gian mang thai, do khng ch
nh thuc ny cho ph n c thai.
Lc nui con b :
Do thiu s liu v dc ng ca thuc, khng dng thuc ny trong thi gian cho con b.
TC DNG NGOI
Him khi c trng hp khng dung np ng tiu ha, ni ban da. Cc phn ng ny s t
khi khi ngng thuc.
LIU LNG v CCH DNG
Dng cho ngi ln.
Mi ln 1 gi, ngy 3 ln (tng ng 9 g/ngy).
Ha phn thuc trong gi vi 1 ly nhiu nc, c thm ng hoc khng, ung trc ba n.

496.

SULFARLEM 12,5 mg

SOLVAY
c/o KENI - OCA
vin bao : hp 60 vin.
THNH PHN
cho 1 vin
Antholtrithione

12,5 mg

DC LC
Thuc c tc ng hng gan, mt.
Sulfarlem l thuc gy kch thch chc nng mt.
DC NG HC
An tholtrithione c hp thu mt phn qua ng ung, sau c chuyn ha nhanh, ch
yu bng cch kh gc methyl bng oxy ha sau thnh lp nhng cht kt hp. ADT l cht
chuyn ha chnh, c bi tit nhanh qua nc tiu, mt phn di dng kt hp.
CH NH
- c ch nh iu tr cc ri lon tiu ha nh trng bng, chm tiu, , y hi, bun nn.
- c ch nh iu tr chng thiu nc bt do dng thuc, sau x tr, thiu nc bt ngi
ln tui.
CHNG CH NH
Tc nghn ng mt.
TC DNG NGOI
i khi lm mm phn v c khuynh hng gy lng.
Nc tiu nhum mu vng m l hin tng bnh thng.
LIU LNG v CCH DNG
Ung thuc na gi trc cc ba n.
Ngi ln : 1 n 2 vin, 3 ln/ngy.
Tr em :
- t 10 n 15 tui : 3 vin/ngy ;
- t 6 n 10 tui : 2 vin/ngy

497.

SULFARLEM CHOLINE

SOLVAY
c/o KENI - OCA
vin bao : hp 60 vin.
THNH PHN
cho 1 vin
Choline bitartrate

300 mg

Antholtrithione

5 mg

DC LC
Thuc li mt. An tholtrithione c tc ng trc tip ln t bo gan v choline bitartrate ngn
nga cc trng hp thoi ha m.
CH NH
- Cc ri lon kh tiu, trng bng thng v, chm tiu ha, , y hi, bun nn.
- H tr iu tr chng thoi ha m.
CHNG CH NH
- Tc mt.
- Suy t bo gan nng.
- Mn cm vi mt trong cc thnh phn ca thuc.
TC DNG NGOI
i khi lm mm phn v c khuynh hng gy lng.
Nc tiu nhum mu vng m l hin tng bnh thng.
LIU LNG v CCH DNG
Ung thuc na gi trc cc ba n.
Ngi ln : 2 n 4 vin/ln, 3 ln/ngy.
Tr em :
- t 5 n 10 tui : 1 n 3 vin/ngy.
- t 10 n 15 tui : 2 n 6 vin/ngy.

498.

SURGAM

HOECHST-MARION-ROUSSEL / ROUSSEL VIETNAM

[AVENTIS PHARMA]
Vin nn d b 100 mg : hp 30 vin.
THNH PHN

cho 1 vin
Acide tiaprofnique

100 mg

DC LC
Thuc khng vim khng stroide. C hot tnh khng vim, gim au, h nhit.
CH NH
iu tr di hn cc triu chng trong :
- Vim thp khp mn tnh, nht l vim a khp dng thp.
- Bnh thoi khp gy au v mt kh nng lm vic.
iu tr triu chng ngn hn cc cn au cp tnh ca :
- Bnh thoi khp,
- au tht lng, au r thn kinh nng.
Khoa chn thng: gy xng, gip, bong gn, hu phu.
iu tr triu chng au trong cc trng hp vim tai mi hng v rng ming. Trong ch nh
ny, phi cn nhc gia li ch v nguy c, c bit l nguy c lan rng cu s nhim trng kt
hp.
CHNG CH NH
- Qu mn vi acide tiaprofnique, khng vim khng stroide, aspirine.
- Tin s bnh suyn d do hoc khng do aspirine hoc nhng thuc khng vim khng
stroide gy ra.
- Lot d dy t trng ang tin trin hoc tin cn lo t d dy t trng.
- Suy gan hay suy thn nng.
- Ph n mang thai.
- Tr em di 3 tui.
CH PHNG v THN TRNG LC DNG
Ch { phng :
- C nguy c qu mn cho gia aspirine v thuc khng vim khng st roide. Khng c
dng acide tiaprofnique bnh nhn c tin s bnh suyn.
- Cn thn khi dng khng vim khng stroide trong cc bnh nhim trng hay c nguy c
nhim trng cho d c kim sot tt do thuc c kh nng lm gim sc khng t nhin
ca c th chng li nhim trng v/hay che khut cc du hiu thng thng ca s nhim
trng.
- Theo di cc triu chng ng tiu ha, ngng iu tr trong trng hp c xut huyt d
dy rut.
- Nu iu tr lu di, nn kim tra chc nng gan, thn v mu.
- Ngng iu tr khi c ban mn nc.

Thn trng lc dng :

- Khi bt u iu tr, phi theo di k vic bi niu v chc nng thn nhng bnh nhn suy
tim, suy gan v suy thn mn tnh, nhng bnh nhn c dng thuc li tiu, v c bit l ngi
c tui.
- Cc triu chng v niu v vim bng quang c ghi nhn vi acide tiaprofnique v cc
thuc khng vim khng stroide khc. Khi c bt kz mt triu chng no v tit niu xut hin,
phi chm dt ngay vic iu tr bng acide tiaprofnique.
- Cnh gic cc i tng iu khin phng tin giao thng v s dng my mc v nguy c b
chong vng.
LC C THAI v LC NUI CON B
Lc c thai :
Chng ch nh dng trong thi kz c thai.
Lc nui con b :
Trnh dng cho ph n nui con b.
TNG TC THUC
Khng nn phi hp :
- Cc thuc chng ng mu ng ung :do tng nguy c xut huyt.
- M thotrexate : do lm tng c tnh trn mu ca mthotrexate, nht l khi cht ny c s
dng liu cao.
- Cc thuc khng vim khng stroide khc (bao gm cc salicylate liu cao) : do tng nguy
c gy lo t v xut huyt ng tiu ha.
- H parine (ng ton thn) : do tng nguy c xut huyt.
- Lithium : do c nguy c tng lithium huyt c th t n cc gi tr gy c.
- Ticlopidine : do tng nguy c xut huyt.
Thn trng khi phi hp :
- Cc thuc li tiu : cho bnh nhn ung nhiu nc, theo di chc nng thn trong thi gian
u tr liu do c nguy c gy suy thn cp tnh bnh nhn mt nc hoc b gim lng mu.
- Thuc c ch men chuyn : gim tc dng h huyt p.
Lu { khi phi hp :
- Thuc c ch bta : gim tc dng h huyt p.
- Ciclosporine : tng tc dng c trn thn.
- Vng trnh thai : gim hiu lc ca vng trnh thai.
- Thuc tan huyt khi : tng nguy c xut huyt.
TC DNG NGOI
Ri lon d dy rut : thng gp : bun nn, nn, tiu chy, au thng v (khi bt u iu
tr) ; him khi : lot, xut huyt v thng ng tiu ha (sau khi iu tr ko di).
Phn ng qu mn :

- da : pht ban, ni my ay, nga, ban xut huyt. Him khi gy ban a dng v ban mn
nc (hi chng Stevens Johnson v hi chng Lyell).
- h hp : ln cn suyn, nht l nhng ngi c d ng vi aspirine v cc thuc khng
vim khng stroide khc.
- kh chu ton thn km h huyt p, ph Quincke, sc phn v.
Thn : suy thn, hi phc c.
Ri lon tit niu : au bng quang, tiu but, tiu lu, tiu ra mu. Cc ri lon ny s khi khi
ngng dng thuc.
Ri lon h thn kinh trung ng : him khi gy chng mt.
Ri lon mu : gim tiu cu, ban xut huyt.
LIU LNG v CCH DNG
Dng cho ngi ln v tr em trn 3 tui.
Ung thuc vi nhiu nc hoc ha tan thuc trong mt ly nc ln. Ung trong cc ba n.
Thi gian iu tr t 5 n 10 ngy.
Ngi ln :
Liu tn cng : 2 vin, 3 ln/ngy.
Liu duy tr : tnh t ngy th t : 3-4 vin/ngy.
Tr em trn 3 tui : 10 mg/kg/ngy, chia lm 3-4 ln.

THUC VN T

499.

TADENAN

DEBAT
[FOURNIER GROUP VIETNAM]
vin nang mm : hp 30 vin.
THNH PHN
cho 1 vin
Dch chit Pygeum africanum

50 mg

DC LC
Trn thc nghim, ngi ta xc nh c tc dng ca dch chit Pygeum africanum trn s
chng tng sinh nguyn bo si c kch thch bi b-FGF (yu t tng trng nguyn bo si
tnh kim), m vai tr trong bnh cn hc hin nay c gi ra. Mt khc, iu rt ng ch
l dch chit Pygeum africanum khng can thip vo hot ng kch thch t ca h sinh dc
nam.
CH NH
Ri lon ng tiu trung bnh lin quan n vic tng sinh lnh tnh tuyn tin lit.
Di chng ca phu thut ct b tuyn tin lit.
THN TRNG LC DNG
Tc ng ca Tadenan trn cc ri lon chc nng khng loi tr cc kim tra y t thng
thng, Tadenan khng th thay th c phu thut.
TC DNG NGOI
Him khi gy ri lon ng tiu ha : nn ma, to bn hoc tiu chy.
LIU LNG v CCH DNG
1 vin bui sng v ti, nn dng thuc trc cc ba n.
Thng thng, iu tr trong 6 tun, c th k o di n 8 tun.
C th lp li iu tr nu cn thit.

500.

TAGAMET

SMITHKLINE BEECHAM
vin bao 200 mg : hp 50 vin.
vin bao 400 mg : hp 30 vin.
vin bao 800 mg : hp 15 vin.
vin si 800 mg : ng 15 vin.
ng tim 200 mg/2 ml : hp 10 ng.
THNH PHN
cho 1 vin bao
Cimetidine

200 mg

cho 1 vin bao

Cimetidine

400 mg

cho 1 vin bao

Cimetidine

800 mg

cho 1 vin si
Cimetidine

800 mg

cho 1 ng tim
Cimetidine

200 mg

CH NH
iu tr lot t trng hoc lot d dy lnh tnh bao gm lot do cc thuc khng vim khng
steroid, lot ti pht v lot ch ni, tro ngc d dy - thc qun v cc bnh khc m tc
ng gim tit acid dch v ca Tagamet cho thy c hu ch.
CHNG CH NH
Qu mn vi cimetidine.
CH PHNG v THN TRNG LC DNG
bnh nhn suy thn, nn gim liu theo thanh thi creatinine. Tagamet c th lm ko di
s o thi ca thuc c chuyn ha qua con ng oxy ha gan. Tng tc dc l vi
cc thuc chng ng loi ung, phenytoin, theophylline v lignocaine loi tim tnh mch c
th c { ngha trn lm sng. iu tr vi Tagamet c th che y cc triu chng v cho php
lm lnh tm thi ung th d dy. Nn c bit lu { n kh nng lm chm tr chn on

bnh nhn trung nin v cao tui hn, mi b cc triu chng au d dy hay va mi thay i
triu chng au d dy. Nn thn trng theo di u n bnh nhn c tin s lot d dy, c
bit l ngi ln tui ang c iu tr vi Tagamet v mt thuc khng vim khng steroid.
bnh nhn ang iu tr bng thuc hay ang b cc bnh c th lm gim s lng t bo
mu, nn lu { n kh nng rng tc ng i khng th th H2 c th lm tng tc dng ny.
Nng cimetidine tun hon trong mu b gim qua lc mu v nn dng cimetidine sau khi
lc mu, tuy nhin, nng thuc khng thay i trong thm phn phc mc. Nn trnh tim
tnh mch nhanh cimetidine (di 5 pht).
LC C THAI v LC NUI CON B
Cng ging nh cc thuc khc, nn trnh dng thuc lc c thai ngoi tr c kin ca bc s
cho l cn thit. Cha c d liu nh gi y v s s dng thuc trong thi kz nui con b
ngi.
TC DNG NGOI
Trn 56 triu bnh nhn c iu tr vi Tagamet trn ton th gii v tc dng ngoi
c bo co khng thng xuyn. Tiu chy, chng mt, ni ban hay vim mch qu mn,
thng nh v thong qua, v chng mt mi cng c bo co. Chng to v nam gii
c ghi nhn v hu nh hi phc sau khi ngng thuc. i khi c cc bo co v gia tng
nng creatinine huyt tng, tng transaminase huyt thanh v mt vi trng hp vim
gan him gp. xut hin tnh trng l ln c hi phc, thng l ngi ln tui hay bnh
nhn c sn bnh nng nh bnh nhn b suy thn. Chng gim tiu cu v gim bch cu,
bao gm c mt bch cu ht, c tnh hi phc sau khi ngng thuc c bo co him khi
xut hin ; gim ton th huyt cu v thiu mu bt sn c bo co rt him. C rt t
bo co v vim thn k, vim ty cp, st, nhc u, au c, au khp, chm nhp xoang, nhp
tim nhanh v blc tim, tt c u c hi phc khi ngng iu tr. Cng ging nh cc thuc i
khng th th H2 khc, c rt him bo co v trng hp phn v.
LIU LNG v CCH DNG
Tagamet thng c dng theo ng ung, nhng c th dng theo ng tim hay qua
ng thng mi d dy thay th ton b hay mt phn liu ung c ngh khi khng th
dng theo ng ung hay ng ny c cn nhc cho l khng thch hp. Tng liu hng
ngy theo bt c mi ng dng thng khng vt qu 2,4 g. Nn gim liu bnh nhn
suy thn.
Ngi ln - dng theo ng ung : i vi nhng bnh nhn lot t trng hay lot d dy lnh
tnh, nn dng liu n hng ngy 800 mg vo lc i ng. C th dng 400 mg hai ln mi ngy
trong ba n sng v vo lc i ng.
Ngi ln - dng theo ng tim bp : Liu tim bp thng l 200 mg, c th lp li mi bn
n su gi.
Ngi ln - dng theo ng tim tnh mch : Liu tim tnh mch thng thng l 200 - 400

mg, c th lp li mi bn n su gi. Nu khng th trnh vic tim tnh mch trc tip, nn
tim chm 200 mg ti thiu 5 pht, v c th lp li mi bn n su gi. Tim tnh mch nhanh
c th gy lon nhp tim. Nu bnh nhn b suy tim mch, hay khi cn dng liu cao hn, nn
pha long liu v tim t nht 10 pht. Trong nhng trng hp ny tt hn nn dng theo
ng tim truyn.
Ngi ln tui : C th dng liu thng thng dnh cho ngi ln tr phi c suy thn r rt.
Tr em (trn 1 tui) : 25-30 mg/kg th trng mi ngy chia lm nhiu ln theo ng ung hay
ng tim.
Tr em (di 1 tui) : Cha c kho st y ; s dng liu 20 mg/kg th trng mi ngy,
chia lm nhiu ln.

501.

TAMIK

LAPHAL
c/o HYPHENS
Vin nang mm 3 mg : hp 60 vin - Bng A.
THNH PHN
cho 1 vin
Dihydroergotamine mesilate

3 mg

T dc : macrogol 400, nc tinh khit,

glycerol, acide ascorbique,
propyleneglycol, gelatine, dioxyde de
titane, oxyde st III.

DC LC
Thuc tr chng au na u (N : h thn kinh trung ng).
Dihydroergotamine c cc c tnh ch yu nh sau :
- Trn h thng ng mch cnh ngoi s no, thuc c tc ng ch vn tng phn (kch
thch), nht l trn cc th th serotoninergic.
- Thuc c tc ng ch vn tng phn trn cc th th a-adrenergic ca mch mu, tc ng
ny rt c ghi nhn trn tun hon tnh mch ; ngi ta chng minh rng tc dng gy co
mch c th c lin quan mt phn n s tng hp mt cht c gi l "prostaglandine-like"
Khi dng liu cao, dihydroergotamine c tc ng nh mt cht gy phong b cc th th aadrenergic v serotoninergic.

DC NG HC
Thuc c hp thu nhanh.
Thuc c i lc cao vi m.
Thuc c o thi ch yu qua mt v qua phn.
CH NH
- iu tr nn tng chng nhc na u v nhc u.
- Ci thin cc triu chng c lin quan n suy tnh mch bch huyt (chn nng, au, kh chu
khi mi bt u nm).
- c ngh trong iu tr chng h huyt p t th.
- Cc ri lon xy ra trong iu tr vi thuc an thn v hng phn.
CHNG CH NH
Tuyt i :
- bit b qu mn cm vi cc dn xut ca nm ca g.
- Nhm macrolide (ngoi tr spiramycine), sumatriptan : xem phn Tng tc thuc.
Tng i :
Bromocriptine (xem phn Tng tc thuc).
Ph n ang cho con b (xem phn Lc c thai v Lc nui con b).
CH PHNG v THN TRNG LC DNG
Khng nn ung thuc lc i.
Thn trng khi s dng trong trng hp bnh nhn b suy gan nng hay suy thn nng m
khng c lm thm tch.
Cn tng cng theo di trong trng hp bnh nhn c tin s bnh l{ ng mch.
LC C THAI v LC NUI CON B
Lc c thai :
Cc kt qu nghin cu c thc hin trn ng vt khng cho thy thuc c tc ng gy
qui thai, do thuc khng th gy d tt cho bo thai khi s dng cho ngi. Trn thc t,
cho n nay, cc cht gy d tt bo thai khi dng cho ngi u l nhng cht gy qui thai khi
s dng cho ng vt trong nhng cng trnh nghin cu c thc hin trn c hai loi.
Hin nay cn thiu cc s liu tha ng nh gi tc dng gy d tt bo thai hay c tnh
trn phi ca dihydroergotamine khi s dng trong thi gian mang thai. Tuy nhin, v mt l
thuyt nu dng liu cao c th gy tng co bp t cung.
Do nn thn trng trnh s dng dihydroergotamine trong thi gian mang thai.
Lc nui con b :
Do thiu s liu v s bi tit ca thuc qua sa m, khng s dng thuc ny nu mun cho
con b m.
TNG TC THUC
Chng ch nh phi hp :

- Nhm macrolide (tt c ngoi tr spiramycine) ; do suy t rythromycine, josamycine v

clarithromycine : c th gy cc triu chng ng c ergotine vi kh nng gy hoi t u chi
(do lm gim s o thi cc alcaloide ca nm ca g gan).
- Sumatriptan : trn l thuyt c th lm tng nguy c gy co tht mch vnh. Cn phi gi mt
thi hn l 24 gi t lc ngng dng dihydroergotamine cho ti lc dng sumatriptan. Tng
t, ch dng thuc ny cch 6 gi sau khi dng sumatriptan.
Khng nn phi hp :
- Bromocriptine : c th gy co mch v/hoc gy cn cao huyt p kch pht.
TC DNG NGOI
C th gy bun nn, nht l khi ung thuc lc i.
LIU LNG v CCH DNG
Ung thuc vi mt ly nc trong ba n, mi ln mt vin, 2 n 3 ln/ngy.
QU LIU
Trong trng hp xc nhn b ng c ergotine mch mu, cn phi cp cu bnh vin :
thng cn phi tin hnh truyn hparine phi hp vi mt cht gy gin mch, v ty tnh
hnh c th phi hp vi mt corticoide.

502.

TANAKAN

BEAUFOUR IPSEN
Dung dch ung 40 mg/ml : l 30 ml + dng c nh liu (1 liu = 1 ml).
Vin bao 40 mg : hp 30 vin, hp 500 vin.
THNH PHN
cho 1 liu
Chit xut t Ginkgo biloba c tiu chun ha (EGb 761)

40 mg

(Dung dch nc-cn chun khong 55deg)

cho 1 vin
Chit xut t Ginkgo biloba c tiu chun ha (EGb 761)
(Lactose)

40 mg

DC LC
Cc tnh cht ca Tanakan l hp lc ca cc hot tnh c chng minh trn chuyn ha t
bo, lu bin vi tun hon v vn mch cc mch mu ln. Chit xut ca Ginkgo biloba c tc
dng iu ha vn mch trn ton b mch mu : ng mch, mao mch, tnh mch. Tc dng
ph thuc vo liu lng v thay i ty theo tnh cht, ng knh v ngun gc m ca mch
mu v ty theo c trng lc c bn v tnh trng ca thnh mch, kch thch s tit EDRF t
ni m (Endothelium derived relaxing factor). EGb chng li s co tht ng mch, gy gin tiu
ng mch v ngc li lm co tnh mch, iu ha gin tnh mch p ng vi cc thay i
t th, gim tnh thm qu ca mao mch v tng cng sc bn mao mch. EGb chng ph
mnh no ln ngoi bin, che ch hng ro mu - no v mu - vng mc. Mt khc, Tanakan
c ch mnh s tng tnh thy phn proteine ca huyt thanh gy ra bi nhiu hin tng
bnh l. Nhng hiu qu v lu bin hc ca Tanakan c nghin cu in vitro v in vivo
trn s tng kt tp tiu cu v hng cu v cc qu trnh to huyt khi ca vi tun hon. Cc
tnh cht ny c v c chng minh bi tc dng n nh mng t bo, do can thip vo s
chuyn ha cc prostaglandine, do c ch tc dng ca vi loi autocoids (histamine,
bradykinine,...) v do tc dng c ch "yu t hot ha tiu cu" (PAF). Nhng cng trnh
nghin cu chng minh Tanakan c tnh bo v trn chuyn ha t bo v c bit l cc
nron no v cc t bo thn kinh cm gic. Trn cc ng vt th nghim, tc ng bo v
ca Tanakan th hin trn t l sng st, s ci thin no nng ATP v gim nng
lactate v mt s bt gi tt hn glucose v O2. V mt hnh vi, tc ng ny th hin bng s
ci thin thnh tch khi lm nhng test khc nhau. Tanakan c nh hng n s phng thch,
gi li v thoi bin nhng cht trung gian thn kinh (noradrenaline, dopamine,
acetylcholine,...) hoc can thip vo kh nng lin kt ca chng vi cc th th mng. Vi tc
dng dc l ca EGb c v c lin quan n tc ng i khng mnh vi s sn xut gc t
do v s peroxyde ha lipide ca mng t bo.
DC NG HC
ng vt, sau khi cho ung cht chit xut c nh du bng carbone 14, nghin cu v s
hp thu v phn phi ca sn phm cho thy s hp thu EGb nhanh v hon ton. S cn bng
phng x vo 72 gi sau cho thy s thi ra trong CO2 th ra v trong nc tiu. o phng x
trong mu theo thi gian lp nn nhng thng s dc ng hc v cho thy thi gian bn hy
sinh hc khong 4 gi 30. nh phng x trong mu t c sau 1 gi 30 cho thy s hp thu
xy ra phn trn ca ng tiu ha. Nghin cu v s phn phi vo m ca phng x cho
thy i lc i vi mt v vi loi m hch v thn kinh, c bit l vng di i, hi hi m v
th vn.
CH NH
Cc triu chng suy gim tr nng bnh l ca ngi ln tui (cc ri lon v ch , tr nh ...).
iu tr triu chng au cch hi ca bnh tc ng mch chi di mn tnh (giai on II).

Lu { : ch nh ny da vo nhng th nghim lm sng m i so vi gi dc cho thy tng

qung ng i c t nht 50 % 50-60 % bnh nhn c iu tr so vi 20-40 % bnh
nhn ch theo nhng quy tc v v sinh n ung.
Ci thin hi chng Raynaud.
c ngh trong vi hi chng chng mt v/hoc tai, vi loi gim thnh lc, c xem
nh do thiu mu cc b.
c ngh trong vi loi suy vng mc c th do nguyn nhn thiu mu cc b.
THN TRNG LC DNG
Thuc ny khng phi l mt thuc h p v khng th thay th hay trnh iu tr cao huyt p
bng nhng thuc c hiu.
LC C THAI
Cc kho st trn ng vt cho thy thuc khng c kh nng gy qui thai. ngi, cha c
kho st dch t hc. Tuy nhin, cha c trng hp gy qui thai do dng thuc c ghi
nhn.
TC DNG NGOI
Him thy gy cc ri lon tiu ha, ri lon da, nhc u.
LIU LNG v CCH DNG
Dung dch ung : 1 liu = 1 ml = 40 mg chit xut.
Liu thng thng : 3 liu (3 ml) mi ngy hoc 3 vin/ngy, pha long trong na ly nc, ung
trong ba n.

503.

TANATRIL 5 mg / 10 mg

TANABE SEIYAKU
[FOURNIER GROUP VIETNAM]
Vin nn 5 mg : v 10 vin, hp 10 v.
Vin nn 10 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Imidapril chlorhydrate
T dc : lactose, macrogol 6000, magi

5 mg

stearat.

cho 1 vin
Imidapril chlorhydrate

10 mg

T dc : lactose, macrogol 6000, magi

stearat.
M T
Imidapril hydrochloride c tn ha hc l (-)-(4S)-3-[(2S)-2-[[(1S)-1-ethoxycarbonyl-3phenylpropyl]amino]-propionyl]-1-methyl-2-oxoimidazolidine-4-carboxylic acid hydrochloride.
Cng thc phn t : C20H27N3O6.HCl.
Imidapril HCl dng tinh th trng. Thuc khng c mi hoc c mi c hiu nh. Thuc tan
d dng trong methanol, tan trong nc, tan t trong ethanol khan, hu nh khng tan trong
ethyl acetate, chloroform, ether v hexane.
DC LC
TANATRIL l mui hydrochloride ca Imidapril, ethyl esther ca cht c ch men chuyn tc
dng ko di, imidaprilat, khng cha nhm sulfhydryl. Imidapril l mt tin cht, sau khi ung,
c hot ha sinh hc do thy phn gc ethyl ester thnh imidaprilat. Imidaprilat l cht c
ch men chuyn mnh i vi angiotensin c thi gian bn hy di cho php mi ngy ung
mt ln.
DC L
Imidapril l mt tin cht c thy phn sau khi ung v to thnh Imidaprilat c hot tnh c
ch men chuyn angiotensin. Imidaprilat c ch tc dng ca men chuyn angiotensin c
phn b rng ri trong huyt tng v nhiu loi t bo ni m. Hiu qu chng tng huyt p
ca Imidapril l do c ch men chuyn angiotensin dn n gim angiotensin II, iu ny trc
tip hoc gin tip gy dn mch ngoi bin v gim sc bn mch mu.
c ch men chuyn angiotensin :
- Cht chuyn ha c hot tnh imidaprilat c ch cnh tranh vi hot ng ca men chuyn
angiotensin c ngun gc t v thn ca ln v huyt thanh ngi l ph thuc liu dng.
- chut cng, Imidapril v imidaprilat c ung c ch tc dng gy tng huyt p ca
angiotensin II ty thuc vo liu dng.
Tc dng chng tng huyt p :
- Imidapril ung c nhng tc dng chng tng huyt p ph thuc liu dng trn nhng chut
cng b tng huyt p t nhin (SHR) v chut cng b gy tng huyt p kiu goldblatt (2K-

1cRHR). Thuc c tc dng lm gim huyt p nh nhng chut cng c huyt p bnh
thng v khng c tc dng trn nhng chut cng b gy tng huyt p bng DOCA/mui.
- Cho chut SHR ung imidapril trong 2 tun c tc dng h huyp p n nh v khng tc dng
ln nhp tim.
- Ung nhc li 5 n 10 mg imidapril 1 ln mi ngy nhng bnh nhn tng huyt p v cn
c tc dng chng tng huyt p mt cch n nh v khng c tc dng ln s thay i huyt
p trong 24 gi.
Cc tc dng khc :
Lu lng mu thn v tc lc cu thn tng ln mt cch c { ngha trn ch sau khi s
dng Imidapril hoc Imidaprilat ng tnh mch hay t trng.
chut SHR, iu tr ko di Imidapril t 9 n 10 tun phng nga c tng huyt p di
truyn v ph i tim do tng huyt p.
DC L LM SNG
Nghin cu lm sng :
Hiu lc lm sng :
Tng huyt p v cn : Trong cc nghin cu lm sng bao gm mt nghin cu m i,
TANATRIL c hiu qu trn 80,8% (361/447) bnh nhn b tng huyt p v cn t nh n
trung bnh.
Bnh nhn b tng huyt p nng v tng huyt p km suy chc nng thn: Trong cc nghin
cu lm sng trn cc bnh nhn tng huyt p nng v bnh nhn tng huyt p km suy chc
nng thn, TANATRIL hiu qu 100% (19/19) vi bnh nhn tng huyt p nng v 84% (21/25)
vi bnh nhn tng huyt p km suy chc nng thn.
Tng huyt p do nhu m thn: Trong mt nghin cu lm sng trn cc bnh nhn c tng
huyt p do nhu m thn, TANATRIL c tc dng trn 80,6% (25/31) bnh nhn.
Cc phn ng ph v nhng bt thng v nhng xt nghim :
Trong nhng nghin cu lm sng trn tng s 832 bnh nhn dng Imidapril Nht c 48 ca
(5,8%) c bo co l c phn ng ph. Nhng bo co v phn ng ph ch yu l ho (2,8%),
kh chu hng (0,2%), nh trng ngc (0,2%), au u m (0,2%), kh chu d dy (0,5%),
v chm (0,2%). Nhng bt thng v kt qu xt nghim c nghi ng l do thuc quan st
c trn 47 bnh nhn (5,6%). Nhng bt thng hay gp c bo co l tng GPT (1,7%),
tng GOT (1,4%) v tng creatinin (0,7%).
NGHIN CU PHI LM SNG
c tnh :
c tnh cp LD50 (mg/kg) : xem bng
ng vt th nghim

Ung

Tnh mch

Di da

Chut nht, dng ddY

Chut cng, dng Wistar

Ch

> 5.000

> 500

> 1.000

3.846

> 500

> 1.000

ci

3.536
> 1.800

c tnh bn cp :
tin hnh nghin cu 3 thng v c tnh trn chut cng dng Wistar (100-3000 mg/kg,
ung), ch (6-150 mg/kg, ung) v kh (1,2-150 mg/kg, ung). Trong 3 nghin cu, du hiu
nhim c ch yu l vic gim pht trin trng lng c th, gim nh hng cu, v tng nh
BUN. Cc xt nghim tr v bnh thng sau khi ngng dng thuc Imidapril 1 thng. Liu
khng c chut cng, ch, kh tun t l 300 mg/kg/ngy, 6 mg/kg/ngy v 30 mg/kg/ngy.
Nhim c mn tnh :
thc hin nghin cu 12 thng v c tnh trn chut cng dng Wistar (12,5-200 mg/kg,
ung) v kh (1,2-30 mg/kg, ung). Du hiu c tnh ch yu l vic gim nh pht trin trng
lng c th, tng BUN chut cng; gim nh hng cu v tng BUN kh. Cc du hiu ny
tr v bnh thng mt thng sau khi ngng dng thuc Imidapril. Liu khng c chut
cng, kh tun t l 12,5 mg/kg/ngy, 6 mg/kg/ngy.
Nghin cu v s sinh sn :
Cho chut cng ung Imidapril trong thi kz trc khi c thai v trong giai on sm ca thi
kz mang thai, giai on hnh thnh c quan bo thai, thi kz chu sinh v cho con b; v nghin
cu trn th trong giai on hnh thnh c quan bo thai. Nghin cu trong giai on hnh
thnh c quan ca thai, nhim c trn m quan st c chut cng vi liu 1500 mg/kg, v
th vi liu 0,1 mg/kg hoc hn. Tuy nhin, thai khng ghi nhn thy cc du hiu gy cht,
gy qui thai hoc c ch s pht trin.
Nghin cu tnh khng nguyn :
S sn sinh khng th c nghin cu trn chut lang vi test phn v tng th, phn ng
Schultz-dale, test phn v da th ng ng dng, phn ng ta gel. Tt c cc test u m tnh
v s sn sinh khng th i vi imidapril khng c nhn thy.
Nghin cu v tnh gy t bin gen :
thc hin test o ngc trn vi khun, nhng test nhn nh chut nht, cc test sai lc
nhim sc th t bo ng vt c v c nui cy v cc test t bin gen. Khng thy c s
t bin gen trong cc nghin cu ny.
Nghin cu v tnh sinh ung th :
tin hnh cho chut nht v chut cng ung imidapril theo th t 18 v 24 thng. Vic ny
cho kt lun rng Imidapril khng gy ung th trn chut nht v chut cng.

DC NG HC
Imidapril c 4 cht chuyn ha v trong s Imidaprilat c hot tnh dc l hc.
Hp thu :
Sau khi ung 1 liu duy nht 10 mg Imidapril ngi khe mnh, nng imidapril trong huyt
tng t cao nht sau 2 gi dng v o thi khi huyt tng vi thi gian bn hy l 2 gi.
Imidaprilat t nh cao nng trong huyt tng vo khong 15 ng/mL sau khi dng t 6
n 8 gi v c o thi t t ra khi huyt tng vi thi gian bn hy l 8 gi.
Chuyn ha o thi :
Sau khi ung 1 liu duy nht 10 mg Imidapril ngi khe mnh, 25,5% liu imidapril c bi
tit trong nc tiu trong vng 24 gi.
Tch ly :
Nng Imidaprilat trong huyt tng n nh t 3 n 5 ngy sau khi bt u ung 10 mg
Imidapril 1 ln/ngy v lin tc trong 7 ngy nhng ngi khe mnh; khng thy du hiu
tch ly thuc. nhng bnh nhn c suy chc nng thn, nh nng Imidaprilat trong huyt
tng tng ln, v s o thi ra khi huyt tng c th b chm li.
CH NH
Tng huyt p.
Tng huyt p do nhu m thn.
CHNG CH NH
- Nhng bnh nhn c tin s nhy cm vi TANATRIL.
- Nhng bnh nhn c tin s do ph mch mu khi dng c ch men chuyn.
- Nhng bnh nhn c iu tr lm gim LDL bng s dng dextran cellulose sulfate.
- Nhng bnh nhn c thm phn vi mng acrylonitrile methallyl sulfonate sodium (AN 69).
THN TRNG LC DNG
Cn thn khi dng thuc :
- Nhng bnh nhn c bnh thn nng: Nu nng creatinin huyt thanh cao hn 3 mg/dl,
nn s dng TANATRIL mt cch cn thn bng cch gim liu hoc dng tha ra.
- Nhng bnh nhn b hp ng mch thn 2 bn.
Thn trng chung :
- Bnh nhn c th b h huyt p qu mc v thong qua khi bt u iu tr vi TANATRIL. Vi
nhng bnh nhn sau, cn bt u vi liu thp, sau da vo s theo di tnh trng bnh
nhn mt cch st sao, c th tng liu dn dn :
+ Bnh nhn tng huyt p nng.
+ Bnh nhn ang thm phn lc mu.
+ Bnh nhn ang iu tr li tiu, c bit l nhng ngi va bt u iu tr li tiu.
+ Bnh nhn cn phi n king mui tuyt i.
- TANATRIL c th gy hoa mt, chng mt, do gim huyt p.

S dng thn trng khi li xe, iu khin my hay lm cc cng vic khc i hi tinh thn sng
sut.
- Khng s dng thuc trong vng 24 gi trc khi phu thut.
- Him khi bnh nhn c biu hin ph do mch mu mt, li, thanh mn v thanh qun c
th nhanh chng gy ra kh th. Nu thy c nhng triu chng trn, cn ngng dng
TANATRIL v bt u ngay bin php iu tr thch hp.
- nhng bnh nhn ang dng thuc c ch men chuyn angiotensin c th b "shock" trong
khi lm gim LDL (apheresis) bng dextran cellulose sulfate nn khng c s dng TANATRIL
cc bnh nhn ny.
- nhng bnh nhn iu tr bng c ch men chuyn angiotensin c phn ng dng phn
v khi ang thm phn vi mng acrylonitrile methallyl sulfonate sodium (AN 69). TANATRIL
khng c dng cho cc bnh nhn ang dng AN 69 thm phn.
S dng thuc cho ngi ln tui :
TANATRIL c o thi ch yu qua thn, chnh v vy, c th c nng cao ko di trong
huyt tng ca bnh nhn ln tui bi v chc nng thn ca h thng b suy gim. iu ny
s lm tng kh nng xy ra cc phn ng ph v tng kh nng h p. Cng nh vy, nn trnh
h huyt p qu mc ngi gi v vic iu tr TANATRIL cn c bt u vi liu thp (2,5
mg chng hn) v phi c theo di cht ch.
S dng tr em :
S an ton tr em khng c xc nh.
LC C THAI v LC NUI CON B
Trong qu 2 v qu 3 ca thai kz, s dng thuc c ch men chuyn thy thiu i, h huyt
p, suy thn, tng kali mu v/hoc s km pht trin tr s sinh, v t vong cho tr s sinh
v thai. Km theo thiu i, cng thy co cng chi, bin dng s mt. Ch s dng TANATRIL
i vi ph n c thai hoc nghi ng c thai trong nhng trng hp tuyt i cn thit.
Nu dng TANATRIL cho ph n c thai hoc nghi ng c thai, th thi gian iu tr phi gim
xung ti thiu v cn theo di cn thn tnh trng thai nhi v th tch nc i.
TANATRIL khng nn s dng cho cc b m ang cho con b v nhng nghin cu trn sc vt
(chut) cho bit TANATRIL c bi tit trong sa. Nu TANATRIL cn phi s dng cho
nhng ngi m ang cho con b th phi ngng cho b trong qu trnh iu tr.
TNG TC THUC
C th lm tng nng Kali huyt thanh trong lc s dng kali hoc li tiu gi kali
(spironolactone, triamterene...) c bit nhng bnh nhn suy chc nng thn.
nhng bnh nhn iu tr thuc li niu, c th tng kh nng h huyt p trong nhng ngy
u iu tr bng TANATRIL ; nn cn thn bt u s dng TANATRIL liu thp.
Nhim c Lithium thy nc ngoi trn nhng bnh nhn c dng lithium song song
vi thuc c ch men chuyn angiotensin (captopril, enalapril, lisinopril). Nng lithium huyt

thanh phi thng xuyn c theo di khi dng cng lc vi TANATRIL.

TC DNG NGOI
Mu : Gim hng cu, huyt sc t, hematocrit v tiu cu hoc tng bch cu i toan c th
xy ra khng thng xuyn.
Thn : Thnh thong c th c albumin niu, tng BUN v creatinin.
Tm thn kinh : Khi dng thnh thong c th xut hin au u, hoa mt, chng mt khi ng.
Tim mch : Thnh thong xut hin nh trng ngc.
D dy-rut : i khi bun nn, nn, kh chu d dy v au bng.
Gan : C th tng GOT, GPT, Al-P, LDH, bilirubin ton phn mt cch khng thng xuyn.
Qu mn : C th him gp ph do huyt qun mt, li, thanh mn v thanh qun gy kh
th nhanh chng. Nu thy nhng du hiu trn, cn ngng TANATRIL v bt u ngay phng
php iu tr thch hp khc. i khi c th xut hin pht ban v nga, trong nhng trng
hp nh th cn gim liu hoc ngng dng TANATRIL.
Nhng phn ng ph khc : Ho, kh chu c hng, bc ha mt v tng kali huyt thanh c
th xy ra mt cch khng thng xuyn.
LIU LNG v CCH DNG
Liu dng ngi ln t 5 n 10 mg mi ngy ung 1 ln. Liu dng c iu chnh theo
tui bnh nhn v mc nng ca cc triu chng. nhng bnh nhn c bnh thn, tng
huyt p nng hoc tng huyt p do nhu m thn, liu iu tr bt u l 2,5 mg ung 1 ln
mi ngy.
BO QUN
Bo qun di 30oC. Trnh nh nng. Sau khi m gi thuc trnh ni m.

504.

TAXOL

BRISTOL-MYERS SQUIBB
dung dch dng pha tim truyn tnh mch 30 mg/5 ml : l n liu 5 ml, hp 1 l - Bng A.
dung dch dng pha tim truyn tnh mch 100 mg/17 ml : l 17 ml, hp 1 l - Bng A.
THNH PHN
cho 1 l
Paclitaxel
T dc : huile de ricin polyoxyethylene
(Crmophor EL), ethanol.

30 mg

cho 1 l
Paclitaxel

100 mg

T dc : huile de ricin polyoxyethylene

(Crmophor EL), ethanol.

DC LC
Chng ung th, iu chnh p ng min dch, km t bo : nhm Taxone.
Paclitaxel l mt tc nhn mi, c ch s phn r mng li vi th ca thoi nhim sc ; n kch
thch qu trnh ghp cc dimer ca vi ng thnh mng li vi th v n nh mng li vi th
bng cch ngn chn qu trnh tho xon ca chng. Tnh n nh ny c ch s ti t chc
nng lng bnh thng ca mng li vi th, mt hin tng ch yu ca chc nng sng ca
t bo trong tin trnh gian kz v gin phn.
Ngoi ra, paclitaxel cn gy s hnh thnh khng bnh thng cc nhm hay b ca mng li
vi th trong sut chu kz ca t bo, v t chc qu trnh phn chia th sao ca mng li vi th
trong s gin phn.
S dung np v hiu lc ca Taxol (135 mg/m2 trong 24 gi), sau dng cisplatine (75 mg/m2)
c nh gi trong mt nghin cu m i c kim sot (i chiu vi cyclophosphamide
750 mg/m2, cisplatine 75 mg/m2), nghin cu GOG 111/BMS CA 139-022. Nghin cu ny c
thc hin trn 400 bnh nhn b ung th bung trng nguyn pht vi bnh tin trin, c
bu tn lu > 1 cm) hay c di cn.
Kt qu ghi nhn nhm dng Taxol c hiu qu tt hn ng k v thi gian km khng cho
ung th pht trin (trn 3,5 thng) v thi gian ko di s sng (trn 11 thng). V dung np
thuc th tng t nhau gia hai nhm.
Taxol, vi liu 175 mg/m2, c truyn tip theo bng cisplatine 80 mg/m2 c nh gi
qua 2 cng trnh nghin cu giai on III nhng bnh nhn ung th phi khng phi t bo
nh giai on tin xa (367 bnh nhn iu tr bng Taxol); c hai u l th nghim ngu nhin,
trong mt c so snh vi iu tr bng cisplatine vi liu 100 mg/m2, mt s dng
tniposide liu 100 mg/m2 sau tip tc bng cisplatine liu 80 mg/m2 nh l cht i chiu
(c 376 bnh nhn c dng thuc i chiu). Kt qu tng ng nhau gia cc th
nghim. i vi tiu chun nh gi u tin v c lng t vong, gia nhm dng Taxol v
nhm dng thuc i chiu khng c s khc bit ng k (thi gian ko di s sng trung bnh
t 8,1 n 9,5 thng i vi nhm dng Taxol, 8,6 n 9,9 thng i vi nhm dng thuc i
chiu). Tng t, thi hn ko di cuc sng m ung th khng pht trin cng khng khc

nhau ng k gia cc nhm. C mt khc bit ng k trn phng din p ng lm sng.

Cc kt qu kho st trn cht lng sng cho thy dng Taxol c li do t lm mt cm gic
ngon ming v t gy cc bnh l thn kinh ngoi bin.
DC NG HC
Sau khi c truyn tnh mch, nng ca paclitaxel trong huyt tng gim dn theo mt
ng cong biu din gm hai pha.
Dc ng ca paclitaxel c nghin cu trong iu kin truyn tnh mch thi gian l 3 gi
v 24 gi, v liu 135 v 175 mg/m2. Thi gian bn hy trung bnh ca pha cui t 3 n 52,7
gi v gi tr trung bnh ca thanh thi ton phn t 11,6 n 24 l/gi/m2 S thanh thi ton
phn dng nh gim khi nng ca paclitaxel trong huyt tng cao. Th tch phn phi
trung bnh tnh trng cn bng dao ng t 198 n 688 l/m2iu ny cho thy c s khuch
tn ngoi mch v/hoc gn vo m ng k ca paclitaxel. Khi tng 30% liu, t 135 n 175
mg/m2, cc gi tr Cmax v din tch di ng cong tng tng ng t 75 n 81% khi truyn
trong 3 gi, nh vy vic tng liu khng c lin quan tuyn tnh vi vic tng cc thng s
dc ng.
S khc bit gia ngi ny v ngi khc khi dng paclitaxel ng ton thn rt t. Khng ghi
nhn c hin tng tch t paclitaxel khi dng nhiu t iu tr lin tip.
Cc nghin cu in vitro c thc hin trn proteine huyt thanh ngi cho thy t l gn vi
proteine trung bnh t 89 n 98%. Khi dng ng thi vi cimetidine, ranitidine,
dexamethasone hay diphenhydramine, t l gn vi proteine khng b thay i.
Th thc o thi ca paclitaxel ngi hin cha c bit r. T l o thi qua thn di
dng khng i t 1,3 n 12,6% liu dng, cho thy c s thanh thi ng k ngoi thn. Cc
cht chuyn ha chnh c tm thy di dng hydroxyl ha. S chuyn ha qua gan v o
thi qua mt dng nh l c ch o thi chnh ca paclitaxel. Cha c nghin cu v nh
hng trn s chuyn ha thuc khi dng cho bnh nhn b suy gan hay suy thn. Cc thng s
dc ng thu c bnh nhn chy thn c truyn Taxol 135 mg/m2 trong 3 gi th
tng t nh bnh nhn bnh thng.
AN TON TIN LM SNG
Kh nng gy ung th ca Taxol cha c nghin cu. Tuy nhin, paclitaxel l mt tc nhn
gy ung th v c tnh trn gen do c ch tc ng dc lc ca thuc. Taxol c ghi nhn
gy t bin in vitro v in vivo trong cc th nghim trn t bo ca ng vt hu nh.
CH NH
Ung th biu m bung trng :
- Tr liu u tay ung th bung trng tin xa hoc bu tn lu ( 1 cm) sau phu thut, dng
phi hp vi cisplatine.
- Trong tr liu th nh, ung th bung trng di cn, sau khi tht bi vi phng php iu tr
c in bng cc dn xut ca platine.

Ung th biu m v :
- Trong iu tr h tr ung th giai on sm, c hch dng tnh, dng lin tip sau phc c
cha doxorubicine.
- Trong iu tr ung th v di cn tht bi sau mt t ha tr - hoc ti pht sau khi iu tr
h tr. Thng cc iu tr trc c cha anthracycline, tr khi no c chng ch nh.
Ung th phi khng phi t bo nh :
- Taxol dng chung vi cisplatine, c c ch nh u tay iu tr bnh nhn ung th
phi khng phi t bo nh, giai on khng th phu thut v/hoc x tr c.
Ngoi ra, Taxol cn dng iu tr Ung th Kaposi c lin quan n bnh AIDS.
CHNG CH NH
- Chng ch nh Taxol cho nhng bnh nhn c phn ng qu mn cm nng vi paclitaxel
hoc vi bt c thnh phn no ca thuc, c bit l vi huile de ricin polyoxyethylene
(Crmophor EL).
- Khng c iu tr bng Taxol nhng bnh nhn c s lng bch cu trung tnh di
1.500/mm3.
- Ph n c thai hay cho con b : xem thm phn Lc c thai v Lc nui con b.
CH PHNG v THN TRNG LC DNG
- Vic iu tr bng Taxol phi do mt bc s chuyn khoa c kinh nghim quyt nh. Do c th
xy ra phn ng qu mn cm nng, cn phi trang b nhng phng tin cp cu thch hp.
Bnh nhn phi c cho dng mt thuc thuc nhm corticoide, khng histamine v i
khng th th H2 trc khi dng Taxol (xem thm phn Liu lng cc Cch dng).
- Taxol phi c cho dng trc cisplatine trong trng hp dng phi hp.
- Cc phn ng d ng nng, c c trng bng chng kh th v tt huyt p n mc cn
phi c iu tr, ph mch v pht ban ton thn, c ghi nhn trn 1% nhng bnh
nhn c iu tr bng Taxol mc du trc c dng nhng thuc d phng (corticoide,
khng histamine v i khng th th H2). Cc phn ng xy ra c lin quan n s phng thch
histamine.
Trng hp xy ra phn ng qu mn cm nng, cn phi ngng truyn ngay, iu tr triu
chng v khng dng tr li Taxol cho bnh nhn ny.
- Chng suy ty (ch yu l gim bch cu trung tnh) l mt c tnh ca thuc (gii hn liu
dng). Cn phi thng xuyn kim tra cng thc mu trong thi gian iu tr vi Taxol. Mt
t iu tr mi bng Taxol ch c thc hin khi m s lng bch cu trung tnh phi =
1.500 /mm3 v s lng tiu cu phi >= 100.000/mm3.
- Cc ri lon nng v dn truyn tim cng c ghi nhn. Nu c ri lon dn truyn ca
tim trong thi gian dng Taxol, phi dng mt bin php iu tr thch hp v theo di in tim
ca bnh nhn trong sut thi gian iu tr bng Taxol. C th xy ra h huyt p, tng huyt
p, chm nhp tim nhng khng biu hin bng triu chng. Nn thng xuyn theo di cc

chc nng sinh tn trong thi gian truyn Taxol, nht l trong gi u tin.
- Mc du cc bnh l thn kinh ngoi bin l mt trong nhng tc dng ngoi { thng xy ra,
nhng ch mc nh. Trng hp c nhng triu chng nng, nn gim liu 20% cho
nhng liu tip theo.
- nhng bnh nhn b ri lon chc nng gan nh, khng ghi nhn c tnh ca Taxol tng ln
khi truyn trong 3 gi. Hin khng c ti liu v dng thuc nhng bnh nhn b tc mt
nng. Nu thi gian truyn Taxol lu hn, nhng bnh nhn b suy gan va hoc nng, c th
tng nguy c suy ty.
- Khng khuyn co dng Taxol nhng bnh nhn b suy gan nng.
- Do trong thnh phn ca Taxol c cha 396 mg ethanol tuyt i/ml, cng nn lu { n
nhng tc dng trn thn kinh trung ng c th xy ra.
- Khng dng Taxol bng cch tim ng mch do ghi nhn c nhng phn ng nng trn
m trong nhng th nghim trn ng vt v kh nng dung np ti ch.
Li xe v vn hnh my mc :
Bn thn Taxol khng gy nh hng n s tp trung khi li xe hay thao tc my.
Tuy nhin, do thuc c cha alcool nn phi thn trng khng nn li xe hay thao tc my ngay
sau khi iu tr v c th gy bun ng.
Ngi li xe hay phi vn hnh my mc cn phi c lu { v iu ny.
LC C THAI v LC NUI CON B
Lc c thai :
Taxol c ghi nhn l c c tnh trn phi v bo thai th v lm gim kh nng sinh sn
chut cng.
Khng c s liu v s dng Taxol cho ph n c thai. Cng nh i vi tt c cc tc nhn c
t bo khc, Taxol c th c cho bo thai. Chng ch nh Taxol cho ph n c thai. Nn
khuyn bnh nhn khng nn c thai trong thi gian iu tr bng Taxol. Trng hp c thai,
bnh nhn phi bo ngay cho bc s iu tr bit.
Lc nui con b :
Khng bit Taxol c c bi tit qua sa m hay khng. Chng ch nh Taxol trong thi gian
cho con b. Phi ngng cho con b trong thi gian iu tr bng Taxol.
TNG TC THUC
S thanh thi ca paclitaxel khng b nh hng do vic dng cim tidine trc .
Trong iu tr u tay ung th bung trng, Taxol phi c dng trc cisplatine. Nh th, s
dung np thuc s tng t nh khi Taxol c dng trong n liu php. Nu Taxol c
dng sau cisplatine, tc dng gy suy ty s nng hn. S thanh thi ca paclitaxel c ghi
nhn gim 20% nu Taxol c dng sau cisplatine.
C th s chuyn ha ca Taxol b c ch bnh nhn c iu tr bng k toconazole. Do
phi thn trng khi dng Taxol cho bnh nhn c iu tr ng thi bng ktoconazole.

TC DNG NGOI
Tn sut xut hin v nng ca cc tc dng ngoi { u ging nhau i vi cc bnh nhn
c ung th bung trng hoc v hay phi khng phi t bo nh.
Cc s liu v dung np thuc m t di y c thu thp t 95 bnh nhn b ung th bung
trng v 289 bnh nhn b ung th v v c iu tr vi liu lng v phc truyn khuyn
co (175 mg/m2, truyn trong 3 gi) trong 3 th nghim lm sng giai on III.
S dung np ca thuc cng c nh gi trong mt th nghim i chiu qui m ln (GOG
111), v trong mt s th nghim quan trng giai on III trn ung th phi khng phi t bo
nh (truyn 3 gi): xem Dng lc hc. Tr trng hp c bit, phi hp Taxol v cisplatine
hay vic truyn Taxol trong 24 gi khng lm thay i s dung np ca Taxol.
Suy ty l mt tc dng ngoi { thng xy ra nht ca Taxol. Gim bch cu trung tnh nng
(di 500/mm3) c ghi nhn trn 28% bnh nhn khng km theo giai on st cao. Ch
1% bnh nhn b gim bch cu trung tnh nng trong 7 ngy hoc hn. 24% bnh nhn c giai
on b nhim trng. Trong cc th nghim lm sng giai on III, c hai trng hp t vong
do nhim trng c quan st liu lng v phc truyn khuyn co (175 mg/m2,
truyn trong 3 gi).
Gim tiu cu c ghi nhn trn 11% bnh nhn. 64% bnh nhn b thiu mu trong c
khong 6% c xem l nng (Hb < 8 g/dl). Mc nng nh v kh nng b thiu mu ty
thuc vo s lng hemoglobine trc khi iu tr.
Mt trng hp b bnh bch cu ty v mt trng hp b hi chng lon sn ty c ghi
nhn ngoi cc th nghim giai on III.
Chng suy ty t xy ra v t nghim trng hn nu thi gian truyn l 3 gi so vi 24 gi. Khi
phi hp Taxol v cisplatine c khuyn co trong iu tr u tay ung th bung trng, kh
nng gy suy ty s cao hn so vi dng ring Taxol 175 mg/m2, truyn trong 3 gi. Tuy nhin
khng li nhiu di chng lm sng hn.
Cc phn ng qu mn nng, i khi gy t vong (tt huyt p cn c iu tr, ph mch, suy
h hp cn phi iu tr bng thuc gin ph qun, ni ban ton thn) xy ra 2 bnh nhn
(di 1%). Cc phn ng qu mn nh (ch yu l gy cn bng vn mch, rash) khng cn phi
iu tr chuyn bit v cng khng cn phi ngng dng Taxol c ghi nhn 34% bnh nhn.
H huyt p ( 22% bnh nhn) v chm nhp tim (5% bnh nhn) cng c th xy ra trong qu
trnh truyn Taxol nhng thng va phi v khng cn phi iu tr chuyn bit.
Trong cc th nghim lm sng liu lng v phc truyn khuyn co, c 17% bnh nhn
c ghi nhn l c in tm bt thng. Trong a s trng hp, khng c mi lin h r
rng no gia vic dng Taxol v vic bt thng in tm . nh hng trn lm sng ca
nhng bt thng ny c nh gi l nh.
Mt bnh nhn (di 1%) b cao huyt p trong thi gian iu tr bng Taxol. Ngoi ra, c 2
bnh nhn (di 1%) c ghi nhn l c nhng biu hin b huyt khi nng, huyt khi cc

u ca chi trn v huyt khi tnh mch. C 1 bnh nhn c ghi nhn c hin tng tim
mch bao gm : h huyt p km theo sc nhim trng, bnh l{ c tim v nhp tim nhanh km
theo st. Trong cc th nghim u tin c thc hin liu v phc truyn khc nhau, c
4 bnh nhn (2%) c hin tng tim mch nng c th c lin quan n vic dng Taxol trong
gm nhp nhanh tht khng c triu chng, nhp nhanh vi nhp mch i, bloc nh-tht v
ngt.
Mt s him trng hp b nhi mu c tim c ghi nhn. Mt s trng hp suy tim sung
huyt cng c ghi nhn nhng bnh nhn c iu tr bng ha tr liu trc , c
bit l nhm anthracycline.
Bnh l thn kinh ngoi bin, c biu hin ch yu bng triu chng d cm, xy ra 66%
bnh nhn, trong ch 5% b nng. Cc triu chng thn kinh ngoi bin c th xy ra ngay sau
ln dng Taxol u tin v nng ln trong cc ln iu tr tip theo. C 3 trng hp phi ngng
iu tr. Cc ri lon v cm gic thng gim v khi vi thng sau khi ngng iu tr. Khng
cn phi chng ch nh dng Taxol nu bnh nhn c bnh l thn kinh do vic iu tr
trc . Trong nhng bnh nhn c iu tr bng Taxol ngoi nhm th nghim i chiu,
ghi nhn mt s trng hp b ng kinh, ri lon th gic, bnh l no, bnh l thn kinh
ca h thn kinh t ng dn n cc trng hp tc rut v tt huyt p t th. Mt s ri
lon thn kinh mt v/hoc th gic (m im lp le) cng c ghi nhn, c bit l nhng
bnh nhn c cho dng liu cao hn liu khuyn co. Cc tc dng ny thng phc hi
c.
au c v au khp xy ra 60% bnh nhn trong c 13% c xem l nng.
Rng tc xy ra hu ht tt c bnh nhn.
Mt s thay i tm thi v nh mng v da c ghi nhn.
Cc tc dng ngoi { trn ng tiu ha mc t nh n va c ghi nhn : bun nn
v nn (43%), tiu chy (28%) v vim ming (18%). Cc tc dng ngoi { c ghi nhn ngoi
th nghim c kim sot gm tc/thng rut v huyt khi mc treo rut k c vim rut kt
thiu mu cc b.
ghi nhn c tng nhiu (trn 5 ln gi tr bnh thng) men ASAT (SGOT) 5% bnh nhn,
phosphatase kim 4% bnh nhn hay bilirubine t nht 1% bnh nhn. Hoi t gan v bnh
no do gan c ghi nhn mt s bnh nhn c iu tr bng Taxol ngoi th nghim
giai on III.
Cc phn ng ti im tim c ghi nhn trong thi gian truyn tnh mch, c th gy ph ti
ch, cm gic au, hng ban v chai cng. Ty trng hp, tim thuc tro ra khi mch c th
gy vim t bo. Vng da ti ch tim c th mt mu. Phn ng da hi quy ti vng da trc
b tro thuc ra khi mch sau khi dng Taxol sang mt ni khc rt him khi c ghi
nhn. Hin nay cha c bin php iu tr chuyn bit cc phn ng do tro thuc ra khi
mch.

Cc bnh l phi b vim c ghi nhn nhng bnh nhn c iu tr phi hp vi x tr.
LIU LNG v CCH DNG
iu tr u tay ung th biu m bung trng :
Trong khi mt s phc iu tr khc ang c nh gi, phc c khuyn co l phi
hp Taxol 135 mg/m2, trong 24 gi, sau dng cisplatine 75 mg/m2, vi khong cch l 3 tun
gia 2 t iu tr (xem phn Tng tc thuc).
iu tr th nh ung th biu m bung trng v ung th biu m v :
Liu Taxol c khuyn co l 175 mg/m2, trong 3 gi, vi khong cch l 3 tun gia 2 t
iu tr. Sau ln dng Taxol u, cc liu sau nn c iu chnh ty theo mc dung np
ca tng bnh nhn.
iu tr ung th phi khng phi t bo nh :
Liu Taxol c khuyn co l 175 mg/m2 truyn tnh mch trong 3 gi, vi khong cch l 3
tun gia hai t iu tr. Sau liu u tin, phi iu chnh li liu lng ty theo s dung np
ca bnh nhn.
Cho tt c cc ch nh :
Ch dng Taxol khi s lng bch cu trung tnh >= 1.500/mm3 v s lng tiu cu >=
100.000/mm3. Nhng bnh nhn b gim bch cu trung tnh nng (s lng bch cu trung
tnh < 500/mm3 trong 7 ngy hoc hn) hoc b bnh l thn kinh ngoi bin nng, liu phi
c gim 20% trong cc ln iu tr tip theo (xem Ch { phng v Thn trng lc dng).
Trc khi dng Taxol, tt c bnh nhn phi c iu tr d phng bng corticoide, thuc
khng histamine v thuc i khng th th H2. Chng hn c th dng 130 mg prednisolone
ng ung hoc 20 mg dexamethasone ng ung khong t 12 n 6 gi trc khi truyn
Taxol, 5 mg dexchlorpheniramine IV v 300 mg cimetidine hoc 50 mg ranitidine IV 30 n 60
pht trc khi truyn Taxol (xem Ch { phng v Thn trng lc dng).
Taxol phi c truyn nh vo mt b phn lp ng ni vi mt mng vi lc c ng knh >=
0,22 mcm (xem Th thc thao tc)
TH THC THAO TC
Nh vi tt c cc thuc chng ung th, phi thn trng khi thao tc vi Taxol. Ngi pha thuc
phi c kinh nghim v phi pha thuc ni qui nh. Khi thao tc phi mang gng tay v trnh
khng thuc tip xc vi da hay nim mc. Nu thuc vy vo da th phi ra ngay vi nc
v x phng. Nu thuc vy vo nim mc th phi ra vi nhiu nc. C th b nng rt v
ti ni thuc vy vo v gim khi ra vi nc. Nu l ht thuc vo s c cm gic kh th, au
ngc, nng rt hng v bun nn.
Phi pha long Taxol trc khi truyn bng nhng k thut m bo v trng.
C th pha Taxol trong cc dung mi sau y :
- sodium chlorure 0,9%,
- glucose 5%,

- dung dch glucose 5% v sodium chlorure 0,9%,

- dung dch glucose v dung dch Ringer.
Dung mi phi c pha vi th tch t c nng cui cng ca Taxol t 0,3 n
1,2 mg/ml. Sau khi pha, cc dung dch c th s dng c trong vng 27 gi, nhit mi
trng (25oC) v c nh sng. Dung dch sau khi pha long khng c trong t lnh.
Mt s him trng hp thy c cn lng trong qu trnh truyn Taxol, thng vo cui giai
on truyn trong 24 gi. Mc du nguyn nhn gy ra hin tng ny cha c sng t, rt
c th l do hin tng qu bo ha ca dung dch. lm gim nguy c ny, phi s dng
Taxol cng sm cng tt sau khi pha v trong qu trnh truyn trnh lm lc hay rung chai dch
truyn. Phi quan st k chai dch truyn trong thi gian truyn v phi ngng truyn nu thy
xut hin cn lng.
Sau khi pha, dung dch c th hi b c do thnh phn t dc, khng th lc c.
Taxol phi c truyn nh vo mt b phn lp ng ni vi mt mng vi lc c ng knh <
0,22 mcm. Khng thy thuc b gim tc dng khi truyn bng b truyn c lp mng lc.
Cc ti hoc b phn lp ng c cht liu bng PVC c th gii phng cht di-(2-ethylhexyl)phtalate (DEHP) khi tip xc vi Taxol. trnh hin tng ny, khng c bo qun dung
dch Taxol trong cc dng c bng PVC, m phi dng chai bng thy tinh hoc polypropylene
hoc ti bng polypropylene hoc polyolefine, v khi truyn phi dng h thng truyn dch
c trng bng mt lp polyethylene. Vic ni mng lc bng PVC u v hay u ra ca b
phn lp ng khng lm gii phng ng k DEHP.
Hy rc : tt c cc vt liu tip xc vi Taxol phi c hy bnh vin theo qui nh i vi
nhng loi rc c vi t bo.
TNG K
Do trong thnh phn t dc ca thuc c cha huile de ricin polyoxyethylene, khng nn pha
long, bo qun hay cha thuc trong cc dng c plastic loi PVC (v c th phng thch DEHP).
BO QUN
L thuc cha m np phi c bo qun trong chnh bao b ca n, nhit t 15 n
25oC, trnh nh sng.
Trong trng hp bo qun trong t lnh (trc khi m np l), c th thy thuc b ng cn.
Bnh thng th khi pha thuc trong dung mi nhit phng th phn cn ny s c ha
tan tr li, c th phi lc hay khng cn phi lc, v cht lng thuc khng b thay i. Nu
sau khi lc m thuc vn khng tan hay thy vn cn nhng cn lng khng tan th phi hy,
khng c s dng.
C th bo qun thuc trong t ng.

505.

TEGRETOL / TEGRETOL CR

NOVARTIS
Vin nn 200 mg : hp 50 vin - Bng B.
Vin bao d b phng thch chm 200 mg : hp 50 vin - Bng B.
THNH PHN
cho 1 vin
Carbamazepine

200 mg

cho 1 vin phng thch chm

Carbamazepine

200 mg

DC LC
L thuc chng ng kinh, Tegretol c tc dng trn : ng kinh cc b (n gin hay phc tp)
c km hoc khng cn ng kinh ton th ha th pht, cn co cng ton th tonic-clonic
(grand mal), v hn hp ca cc loi trn.
Trong cc nghin cu lm sng, Tegretol c dng n tr liu cho bnh nhn ng kinh - c
bit tr em v tr v thnh nin - ghi nhn tc dng hng tm thn, bao gm kh nng
tp trung v nhn thc ; ti cc triu chng lo u v trm cm ; cng nh lm gim tnh kch
thch, hung hng. Khng phi mi nghin cu u xc nhn c nhng c tnh trn.
Vi tc dng hng thn kinh, Tegretol c hiu qu lm sng trong nhiu bnh l thn kinh. V
d tc dng ngn nga cn au dy thn kinh s V cp tnh t pht, h thp ngng co git v
lm gim cc triu chng (nh tnh d b kch thch, run, dng i khng vng) trong hi chng
cai nghin ru ; v lm gim s lng nc tiu v cm gic kht ngi i ng tim
tng.
C ch tc dng ca carbamazepine, hot cht chnh ca Tegretol mi c hiu r mt phn.
Carbamazepine lm n nh tnh trng qu kch thch ti mng thn kinh, km hm s phng lp
li cc xung thn kinh ; v lm gim s dn truyn xi np ca cc xung kch thch. S c ch cm
ng in dng natri c th l c ch hot ng chnh ca carbamazepine. Hot ng ch yu
ny dn n cc tc dng k trn, v nh carbamazepine c th c ch s chuyn vn
catecholamine v qu trnh gii phng glutamate. Trong khi vic lm gim glutamate v n nh
mng thn kinh c th l tc nhn chnh gy tc dng khng ng kinh th s c ch
dopamine v noradrenaline to ra tc dng chng hng cm.
DC NG HC

Hp thu :
Carbamazepine c hp thu tng i chm v gn nh hon ton. kh dng sinh hc ca
thuc gn nh 100% v khng b nh hng bi thc n.
Phn phi :
Dch no ty v nc bt : bng 20-30% nng c trong mu. Sa : bng 25-60% nng c
trong mu. Carbamazepine qua c nhau thai. Lng phn phi vo khong 0,8-1,9 l/kg.
Nng thuc trong mu :
Tmax sau khi dng liu duy nht : 24 gi. Nng thuc ti a sau khi dng liu duy nht 400
mg (vin nn) ; khong 4,5 mg/ml ; vin phng thch chm CR : gim ng k ch s bin v
nng thuc ti a giai on n nh, trong khi nng ti thiu khng gim nhiu. Nng
hiu dng giai on n nh khong 4-12 mg/ml. tng ng vi 17-50 mmol/l. Nng
ca carbamazepine-10,11-epoxide (hot cht chuyn ha) : khong 30% ca nng
carbamazepine. Nng carbamazepine n nh trong mu t c trong vng 1-2 tun, ty
thuc vo mc m ti chuyn ha c to ra nh carbamazepine (t cm ng) hay nh
cc thuc cm ng men khc (d cm ng ; v cng ph thuc vo tnh trng bnh nhn trc
khi iu tr, liu dng v thi gian iu tr.
Gn kt protein huyt thanh : 70-80%.
Chuyn ha
gan : carbamazepine c o thi ch yu di dng epoxide-diol. Hot cht chuyn ha l
carbamazepine-10,11-epoxide. Carbamazepine to ra h men gan mono-oxygenase.
o thi
Thi gian bn hy trung bnh sau khi dng liu duy nht : 36 gi ; sau cc liu nhc li (t cm
ng ca h enzyme gan mono-oxygenase) : 16-24 gi ; sau khi kt hp vi cc thuc cm ng
men gan khc (nh phenytoin, phenobarbital) : 9-10 gi. Bi tit : sau khi dng liu n 400
mg, 72% c bi tit qua nc tiu (2% dng khng i, 1% dng epoxide, khong 30% l
carbamazepine-10,11-transdiol, v phn cn li l cc sn phm chuyn ha bt hot) v 28%
c thi qua phn.
ng hc trong nhng trng hp lm sng c bit
Dc ng hc ca carbamazepine khng thay i ngi c tui. Hin cha c ti liu no
cp n bnh nhn suy chc nng gan hoc thn.
CH NH
ng kinh :
- ng kinh cc b :
- loi phc tp.
- loi n gin.
- ng kinh ton th nguyn pht hoc th pht km theo cn co cng - co git tonic - clonic.
- Hn hp ca cc loi trn.

Tegretol c th c dng n tr hay kt hp vi cc thuc chng co git khc.

Tegretol thng khng c hiu qu trong cn vng thc (petit mal).
iu tr hng cm v phng nga cn hng trm cm (lng cc).
Hi chng cai nghin ru.
au dy thn kinh s V (tam thoa) t pht v do bnh x cng ri rc. au dy thn kinh li
hu t pht.
CHNG CH NH
Qu mn cm vi carbamazepine v cc thuc c cu trc tng t (nh thuc chng trm cm
3 vng), bloc nh-tht, tin s b gim sn ty, tin s b ri lon chuyn ha porphyrine cp
tnh tng t. V l thuyt (da vo cu trc ging thuc chng trm cm 3 vng), khng nn
dng Tegretol km vi thuc c ch monoamine oxidase (IMAO). Phi ngng thuc IMAO ti
thiu (hoc hn nu iu kin lm sng cho ph p) trc khi dng Tegretol.
THN TRNG LC DNG
Tegretol phi c dng di s gim st y t. c bit lu { nhng bnh nhn c nhng cn
ng kinh hn hp bao gm cn vng thc khng in hnh, v nhng trng hp ny thng
i km vi s xut hin nhng cn ton th ha thng xuyn hn. Nu tnh trng ng kinh
tr nn nng hn cn ngng iu tr Tegretol.
Cn ng kinh c th xy ra khi bnh nhn chuyn t dng thuc ung sang dng vin t.
Nng calci trong mu nht thit phi c gim st 3-4 ngy sau khi bt u dng thuc
di dng vin t hoc khi cc cn ng kinh xy ra thng xuyn hn.
Bnh nhn nn c thng bo v nhng du hiu nhim c v cc triu chng v huyt hc,
cc biu hin v da hay phn ng gan, ngi bnh phi c khuyn ti gp bc s ngay khi
xut hin cc phn ng nh st, vim hng, ni ban, lot ming, ni vt thm tm, m xut
huyt hoc ban xut huyt gim tiu cu t pht. Vi nhng bnh nhn c tin s v tim mch,
gan hoc thn, hoc cc phn ng huyt hc vi cc loi thuc khc, hoc sau khi iu tr gin
on vi Tegretol, cn cn nhc gia li ch v nguy c v cn theo di bnh nhn cht ch.
Cc xt nghim chc nng gan c bn cn c xc nh trc khi bt u tr vi Tegretol, v
xt nghim chc nng gan cn phi c thc hin u n trong qu trnh iu tr, c bit
vi nhng bnh nhn c tin s bnh gan v ngi ln tui. Cn ngng iu tr ngay nu chc
nng gan b suy yu hoc xut hin vim gan tin trin trong qu trnh iu tr. nh gi y
cc thng s nc tiu v xc nh ur huyt BUN (Blood urea nitrogen) trc khi iu tr v
cch qung u n trong khi iu tr. Phn ng nh da, nh cc vt dt hoc sn ngoi ban
thng biu hin thong qua v v hi. Cc phn ng ny thng t ht trong vng vi ngy
hoc vi tun vi liu iu tr nh c hoc khi c gim liu. Tuy vy ngi bnh cn c
theo di cht ch. Tegretol c ghi nhn c lm mt bch cu ht v thiu mu bt sn,
nhng rt kh xc nh chnh xc do t l xut hin rt thp. Mt vi d on cho rng t l
mc vi Tegretol khng cao hn t l t pht trong dn s (4,7 trng hp/1 triu ngi/nm

vi bnh mt bch cu ht : 2,0 trng hp/1 triu ngi/nm vi thiu mu bt sn ty). S

gim tm thi hoc lu di tiu cu hay bch cu t mc him gp cho ti thng xuyn
hn trong iu tr Tegretol. Cc phn ng ny thng biu hin thong qua, tuy nhin khng
bo hiu s biu hin ca thiu mu bt sn ty hay mt bch cu ht. Vic nh lng t bo
mu bao gm c tiu cu v hng cu li v st huyt thanh cn c tin hnh trc khi bt
u iu tr. Tuy cn nhiu tranh lun v vic theo di cc thng s v mu, c nhiu ngh
c a ra v d nh x t nghim hng tun trong thng iu tr u tin, nh lng hng
thng cho 5 thng tip theo, v sau 2-4 ln/nm. Nu c biu hin gim bch cu hoc tiu
cu r rt, cn theo di cht ch cc xt nghim mu v tnh trng bnh nhn. Cn ngng tr
Tegretol nu xut hin cc du hiu c ch ty xng. Nu cc du hiu hay triu chng biu
hin phn ng da nng (nh hi chng Stevens-Johnson, hi chng Lyell), cn ngng tr
Tegretol ngay lp tc.
Tegretol c tc dng nh khng cholinergic. Bnh nhn vi du hiu tng nhn p cn c
theo di cht ch trong qu trnh iu tr. Cn lu { Tegretol c th lm biu hin cc ri lon
tm thn tim tng, v d gy l ln v kch ng ngi gi.
S ri lon kh nng sinh sn ph n v/hoc sinh tinh trng bt thng nam c ghi
nhn mt vi trng hp c bit. Mi lin quan vi Tegretol cha c xc nhn.
Ph n dng thuc trnh thai ung c th xut hin chy mu ; tin cy ca thuc trnh thai
ung c th b gim khi dng cng Tegretol.
Mc d s lin quan gia liu dng vi nng thuc trong mu, v gia nng thuc vi
hiu qu lm sng hay dung np kh t, s gim st lng carbamazepine trong mu c th
hu dng trong cc trng hp : khi c s tng t ngt s cn ng kinh ( kim tra s tun
tr ca bnh nhn), trong khi c thai, khi iu tr cho tr em hoc tr v thnh nin, nghi ng c
ri lon hp thu, nghi ng c du hiu nhim c khi kt hp thuc (xem phn Tng tc
thuc).
Khi phi ngng iu tr Tegretol t ngt, s chuyn sang mt thuc khng ng kinh khc phi
c che lp bng mt loi thuc thch hp (nh diazepam ng tnh mch hoc t trc
trng, phenytoin ng tnh mch).
nh hng trn kh nng li xe hay vn hnh my mc
Phn x ca bnh nhn c th b gim do tc dng lm chng mt, ng g ca Tegretol, c bit
khi bt u iu tr hoc khi ang chnh liu. Ngi bnh do vy cn thn trng khi li xe hay
vn hnh my mc.
LC C THAI v LC NUI CON B
C nguy c cho thai nhi, nhng li ch iu tr c th l quan trng hn i vi ngi m. Ph
n ng kinh c thai phi c theo di y t nghim ngt. Nn dng Tegretol n tr liu cho
ph n trong tui sinh nu c th c, v t l d dng bm sinh ph n dng phi hp
thuc (nh acid valproic vi carbamazepine v phenobarbital v/hoc phenytoin) cao hn

ngi dng n tr liu.

Cn s dng liu hiu dng ti thiu, v theo di nng thuc trong mu.
i vi bnh nhn n ang dng Tegretol m c thai, hoc mun dng Tegretol cho ph n
mang thai, cn cn nhc k lng gia li ch iu tr v cc yu t nguy c, c bit trong 3
thng u.
Cc ri lon pht trin bao gm c d tt c bit d xut hin hn i vi tr c m b ng
kinh. Carbamazepine cng nh cc thuc chng ng kinh ch yu khc c th lm tng cc
nguy c ny, d cho cha c bng chng kt lun no c rt ra t cc nghin cu lm sng
vi carbamazepine n tr liu. Mt s t ca c s ri lon pht trin v d tt (bao gm tt nt
t sng) c ghi nhn trn bnh nhn dng Tegretol. Ngi bnh cn c cho bit v nguy
c d tt v c ngh kim tra trc khi sinh.
Trong qu trnh mang thai c th c hin tng thiu acid folic. Thuc khng ng kinh c th
lm tng tnh trng thiu acid folic. S thiu ht ny c th lm tng t l d tt nhng tr c
m dng thuc khng ng kinh. Do vy cn b sung acid folic trc v trong qu trnh mang
thai.
phng bin chng chy mu tr s sinh, cn b sung vitamin K1 cho ngi m vi tun
cui trc khi sinh v cho tr s sinh.
Carbamazepine qua c sa m vi nng tng ng khong 25-60% nng trong
mu. Cn cn nhc gia li ch ca vic dng sa m v kh nng gy tc dng ngoi tr
nh. Ngi m dng thuc Tegretol c th cho con b min l tr nh c theo di k v cc
tc dng khng mong mun (nh ng li b). C mt bo co v phn ng qu mn nng da
mt tr b m.
TNG TC THUC
Do tc dng ti h enzyme gan mono-oxygenase, carbamazepine c th lm h thp nng
hoc lm mt tc dng ca mt s thuc chuyn ha qua h ny. Liu lng ca cc thuc ny
c th cn iu chnh ph hp vi cc yu cu lm sng : clobazam, clonazepam,
ethosuximide, primidone, acid valproic, alprazolam ; corticosteroid (nh prednisolone,
dexamethasone) ; cyclosporin, digoxin, doxycycline, felodipine, haloperidol, imipramine,
methadone ; thuc trnh thai ung (cn la chn cc phng thc trnh thai thch hp) ;
theophylline ; thuc chng ng ung (warfarin, phenprocoumone, dicoumarol).
Carbamazepine c ghi nhn lm tng v gim nng mephenytoin.
Cc thuc sau lm tng nng carbamazepine : erythromycine, troleandomycine, c th
josamycine, isoniazide, verapamil, diltiazem, dextropropoxyphene, viloxazine, fluoxetine,
cimetidine, acetazolamide, danazol, desipramine, v nicotinamide ( ngi ln, v ch vi liu
cao). Vic tng nng carbamazepine mu c th dn ti cc phn ng ph (nh chong
vng, ng g, mt iu ha, song th), cn chnh liu Tegretol cho ph hp v/hoc theo di
nng thuc trong mu. Vic tng kh nng nhim c gan do isoniazid c ghi nhn khi

dng kt hp vi thuc ny. Dng phi hp vi lithium hoc metoclopramide, hay vi cc thuc
an thn kinh (nh haloperidol, thioridazine) c th lm tng cc phn ng v thn kinh (vi
thuc an thn kinh ngay nng hiu dng).
Nng carbamazepine c th b gim do phenobarbital, phenytoin, primidone, progabide,
theophylline v c th (mc d c ti liu nhn x t ngc li) do clonazepam, acid valproic,
valpromide. Cng c trng hp ghi nhn acid valproic, valpromide v primidone lm tng
nng ca hot cht carbamazepine-10,11-epoxide. Liu dng Tegretol nn iu chnh nu
cn. Vic dng phi hp vi mt s thuc li tiu (nh hydrochlorothiazide, furosemide) c th
lm gim natri huyt. Carbamazepine c th c tc dng i khng vi cc thuc gin c khng
gy kh cc (nh pancuronium). Cc thuc ny do vy cn c dng vi liu cao hn, trong
khi theo di cht ch do vic loi b nhanh hn tc dng c ch thn kinh c. Isotretinoin c
ghi nhn lm thay i tnh kh dng sinh hc v/hoc s thanh thi ca carbamazepine v
carbamazepine-10,11-epoxide ; nng carbamazepine cn c theo di khi dng phi hp
thuc.
Nh cc thuc hng thn khc, Tegretol c th lm gim s dung np ru, v do vy ngi
bnh khng nn ung ru trong khi iu tr.
TC DNG NGOI
Mt s tc dng ph xut hin c th him gp hoc thng xuyn hn, c bit khi bt u
iu tr vi Tegretol, nu liu ban u qu cao, hay trong khi iu tr ngi ln tui. Cc tc
dng ny bao gm cc du hiu v thn kinh (nh chng mt, au u, mt iu ha, ng g,
mt mi, song th), hay cc ri lon tiu ha (nh bun nn, nn) v cc phn ng d ng da.
Cc phn ng lin quan n liu dng thng t gim trong vi ngy hay sau khi tm thi gim
liu. Cc phn ng v thn kinh c th l do dng qu liu nh hay do dao ng ln v nng
thuc trong mu. Nhng trng hp ny nn theo di nng thuc v gim liu hng ngy
hoc chia thnh 3-4 liu nh.
H thn kinh trung ng (v ngoi vi)
Phn ng thn kinh :
Hay gp : chng mt, mt iu ha, ng g, mt mi.
i khi : au u, song th, ri lon th trng (nh m mu).
Him gp : c ng v thc (nh run, lon gi t th, lon vn ng ming-mt, ma git, lon
trng lc c, my c) ; rung git nhn cu.
C bit : ri lon vn nhn, ri lon ngn t (lon vn ngn hay ni lp), vim dy thn kinh
ngoi vi, d cm
Tm thn :
C bit : o gic (th gic, thnh gic), trm cm, n mt ngon, bn chn, hnh vi kch thch, kch
ng, l ln, s kch hot cc ri lon tm thn.
Da v phn ph ca da

i khi hoc kh thng gp : phn ng d ng da, my ay (c th nng hn).

Him gp : vim da trc vy v da, hi chng Stevens-Johnson, hi chng lupus ban h
thng (SLE : systemic lupus erythematosus).
C bit : nhim c hoi t biu b, phn ng qu mn vi nh sng, hng ban a dng v ban
ni cc, thay i sc t da, ban xut huyt, nga, trng c, ra m hi, rng tc, rm lng (n).
Mu
i khi hoc kh thng gp : bnh gim bch cu, i khi tng bch cu a eosin, gim lng
tiu cu.
Him gp : chng tng bch cu, bnh hch bch huyt.
C bit : mt bch cu ht, thiu mu bt sn ty, thiu mu bt sn dng hng cu, thiu mu
nguyn hng cu khng l, cn ri lon chuyn ha porphyrin cp, chng tng hng cu, thiu
ht acid folic, thiu mu huyt tn.
Gan
Hay gp : tng lng g-GT (do gim enzyme gan), thng khng c { ngha ln v lm sng.
i khi : phosphatase kim tng.
Him gp : transaminase tng ; vng da, mt, vim nhu m (t bo gan), hoc vim gan hn
hp.
C bit : vim gan u ht.
Tiu ha
i khi hoc kh thng xuyn : bun nn, nn.
Thnh thong : kh ming.
Him gp : a chy hoc to bn.
C bit : au bng, vim li, vim ming.
Dng vin t i khi gy kch thch i trng.
Phn ng qu mn
Him gp : qu mn mun ca cc c quan biu hin st, ni ban, vim mch, bnh hch bch
huyt, ri lon ging u lympho, au khp, gim bch cu, tng bch cu a eosin, gan lch to,
xt nghim gan khng bnh thng, xut hin di nhiu dng khc nhau. Cc c quan khc
cng b nh hng (nh phi, thn, ty, c tim).
C bit : phn ng phn v, vim mng no v trng vi rung git c v tng bch cu a eosin
ngoi bin. Cn ngng iu tr nu cc triu chng qu mn trn xut hin.
Tim mch
Him gp : ri lon dn truyn nhp tim.
C bit : nhp tim chm, lon nhp, bloc nh-tht vi triu chng ngt, try mch, suy tim xung
huyt, tng huyt p hoc h huyt p, suy vnh, vim huyt khi tnh mch, bnh huyt khi
tc mch.
H ni tit v chuyn ha

i khi : ph, gi nc, tng cn , gim natri huyt v h nng dch do tc dng ging ADH,
dn ti c trng hp c bit nhim c nc cng cc triu chng ng lm, nn, au u, l
ln v cc ri lon thn kinh.
C bit : chng v to hoc tit sa nam ; xt nghim chc nng tuyn gip khng bnh thng
- gim L-thyroxine (FT4, T4, T3) v TSH tng - thng khng km theo biu hin lm sng ; ri
lon chuyn ha xng (gim calci mu v 25-OH-cholecalciferol), dn ti c bit c trng
hp nhuyn xng ; tng cholesterol, bao gm lipoprotein t trng cao v triglycerides.
Tit niu - Sinh dc
C bit : vim thn k v suy thn, hay cc du hiu gim chc nng thn (nh albumin niu,
i mu, thiu niu, tng ur mu BUN (blood urea nitrogen), i rt, b tiu, ri lon tnh
dc/bt lc.
Gic quan
C bit : ri lon v gic, c thy tinh th, vim kt mc, tai, h thp ngng nghe.
C xng
C bit : au khp, au c hay chut rt.
H hp
C bit : qu mn cm phi biu hin st, kh th, vim phi khu tr hoc vim phi.
LIU LNG v CCH DNG
C th ung thuc trong, sau hoc gia cc ba n.
Loi vin CR phng thch hot cht t t (c vin hay na vin ty thuc vo n thuc) phi
nut khi ung, khng nhai.
ng kinh :
Tegretol nn c ch nh n tr liu bt c khi no c th c.
iu tr phi c bt u vi liu thp, sau tng t t cho ti khi t c tc dng ti a.
Khi cn ng kinh c kim ch tt, c th gim dn ti liu tc dng thp nht.
C th hu ch nu xc nh c nng thuc trong mu khi gi mc liu ti u (xem phn
Thn trng lc dng).
Nu Tegretol c dng b sung cho mt thuc chng ng kinh khc, thuc phi c a
vo dn dn trong khi duy tr, hoc nu cn iu chnh li liu lng ca loi thuc kia (xem
phn Tng tc thuc).
Ngi ln : bt u iu tr vi liu 100-200 mg x 1-2 ln/ngy, tng liu dn dn ti khi t
c liu p ng ti a (thng vi liu 400 mg x 2-3 ln/ngy) ; 1600 mg hoc thm ch 2000
mg/ngy c th c ch nh cho mt vi bnh nhn.
Tr em : 10-20 mg/kg cn nng hng ngy.
- Tr nh <= 1 tui : 100-200 mg/ngy.
- 1-5 tui : 200-400 mg/ngy.
- 6-10 tui : 400-600 mg/ngy.

- 11-15 tui : 600-1000 mg/ngy.

tr nh 4 tui hoc thp hn nn bt u iu tr vi liu 20-60 mg/ngy, tng liu 20-60 mg
mi ngy. Vi tr hn 4 tui, iu tr bt u vi liu 100 mg/ngy, v tng liu 100 mg mi
tun. Nu iu tr thay th bng vin t, liu lng cn c tng 25% di mc ni
trn, liu ti a khng vt qu 1000 mg.
au dy thn kinh V :
Liu bt u 200-400 mg ngy. Phi tng liu t t cho ti khi ht triu chng au (thng vo
khong 200 mg x 3-4 ln/ngy). Sau nn gim liu dn dn cho ti liu duy tr thp nht c
th c. Liu bt u 100 mg x 2 ln/ngy c th p dng i vi ngi ln tui.
Hi chng cai nghin ru :
Liu trung bnh : 200 mg x 3-4 ln/ngy. Trong cc trng hp nng cn tng liu trong nhng
ngy u (v d ti 400 mg x 3 ln/ngy). Bt u iu tr trong cc ca nng cn phi hp
Tegretol vi thuc an thn/thuc ng (nh clomethiazol, chlordiazepoxide). Khi qua giai
on cp tnh. Tegretol c ch nh tip tc vi n tr liu.
Cn hng cm v phng nga trng thi hng-trm cm (lng cc) :
Liu dng khong 400-1600 mg/ngy ; liu dng 400-600 mg/ngy, chia 2-3 ln. Liu dng nn
tng nhanh trong cn hng cm cp tnh, trong khi tng liu t mt i vi iu tr phng nga
ri lon cm xc lng cc nhm t s dung np tt nht.
QU LIU
Du hiu v triu chng :
Thng l cc biu hin v thn kinh trung ng, h tim mch v ng h hp.
Thn kinh trung ng : c ch thn kinh, mt nh hng, bun ng, kch ng, o gic, hn m
; m mu, ni ngng, lon vn ngn, rung git nhn cu ; trc tng phn x, sau gim phn x
; co git, ri lon tm thn vn ng, rung git c, h thn nhit.
ng h hp : suy gim h hp, ph phi.
H tun hon : nhp tim nhanh, h p, i khi tng huyt p. Ri lon phc b QRS ; ngt km
theo ngng tim.
H tiu ha : nn, chm tit dch d dy, gim nhu ng rut.
Tit niu - Sinh dc : b tiu, thiu niu ; gi nc, ng c nc ging tc dng ca ADH.
Xt nghim : h natri mu, toan chuyn ha, c th tng ng huyt, tng creatinine
phosphokinase c.
X tr :
Cha c thuc gii c c hiu.
X tr ban u ty theo tnh trng ca bnh nhn ; chuyn ti bnh vin. Xc nh nng
thuc trong mu xc minh s ng c Carbamazepine v mc qu liu.
Ht, ra d dy v dng than hot. Bnh nhn cn c chm sc c bit, vi theo di cht
ch v tim mch v cn bng in gii.

Mt s hng dn c th :
H huyt p : dng dopamine hoc dobutamine ng tnh mch.
Lon nhp tim : x tr ty tng trng hp c th. Co git : dng benzodiazepine (nh
diazepam) hoc mt thuc chng ng kinh khc nh phenobarbital (thn trng c th lm
tng suy h hp) hay dng paraldehyde.
H natri mu (ng c nc) : hn ch a nc vo v truyn chm, thn trng dung dch
NaCl 0,9% ng tnh mch. Cc bin php trn c th hu ch trong phng nga tn thng
no. Truyn mu qua ct than, nhng cn tng bi niu, thm phn mu, v thm phn phc
mc c ghi nhn c kt qu.
Cn ch cc triu chng ti pht hoc nng thm c th xut hin ngy th 2 v 3 sau khi
dng qu liu do tc dng hp thu chm.

506.

TELFAST

HOECHST-MARION-ROUSSEL
[AVENTIS PHARMA]
Vin nang 60 mg : v 10 vin, hp 5 v - Bng B.
THNH PHN
Fexofenadine chlorhydrate

60 mg

T dc : croscarmellose sodium, gelatin,

lactose, cellulose vi tinh th, tinh bt
gelatin ha
DC LC
C ch tc dng
Fexofenadine, cht chuyn ha ca terfenadine, l mt cht khng histamine c tc dng i
khng chn lc th th H1 ngoi bin. Fexofenadine c ch s co ph qun gy nn do khng
nguyn chut lang nhy cm, v c ch s tit histamine t dng bo mng bng ca chut
cng. Trn ng vt th nghim, khng thy c tc dng khng cholinergic hoc c ch th th a
1-adrenergic.
Hn na, khng thy c tc dng an thn hoc cc tc dng khc trn h thn kinh trung ng.
Nghin cu trn loi chut cng v s phn b m ca fexofenadine c nh du, cho thy
thuc ny khng vt qua hng ro mu-no.
Dc lc
M ay v phn ng ban

Nghin cu m ay v phn ng ban do histamine gy nn da ngi sau khi ung liu duy
nht v liu 2 ln mi ngy 20 mg v 40 mg fexofenadine chlorhydrate, nhn thy thuc c tc
dng khng histamine sau 1 gi, t hiu lc cao nht sau 2-3 gi, v tc dng vn cn sau 12
gi. Khng thy c du hiu ln thuc sau 28 ngy dng thuc.
Tc dng trn khong QTc
loi ch (10 mg/kg/ngy, ung trong 5 ngy) v loi th (10 mg/kg tim tnh mch trong 1
gi), Fexofenadine khng ko di khong QTc vi nng trong huyt tng gp 28 ln ( ch)
v 63 ln ( th) so vi nng iu tr huyt tng ngi (da vo liu 60 mg 2 ln mi
ngy). Khng ghi nhn tc dng ca thuc ny trn dng in qua knh Ca2+ v knh K+, hoc
khng ghi nhn nh hng n s ko di hiu in th tc dng t bo c chut lang, hoc
ti dng Na+ t bo c ca chut cng mi sinh, hoc ti knh K+ tim ngi vi nng ti
1 x 10-5 M Fexofenadine. Nng ny t nht gp 32 ln nng trong huyt tng c tc dng
iu tr ngi (da vo liu fexofenadine chlorhydrate 60 mg, 2 ln mi ngy).
Nhn x t trn 714 ngi bnh vim mi d ng ung vin nang fexofenadine chlorhydrate vi
liu 60-240 mg, ung 2 ln mi ngy trong 2 tun lin, hoc trn 40 ngi khe mnh tnh
nguyn ung thuc ny (dng dung dch) vi liu ln ti 400 mg, 2 ln mi ngy, trong 6 ngy,
khng thy c s gia tng c { ngha thng k ca khong QTc so vi placebo.
Nghin cu lm sng
Trong 3 th nghim, ko di 2 tun l, a trung tm, theo phng php ngu nhin, m kp, c
kim sot placebo, ngi bnh 12-68 tui c vim mi d ng (n = 1634), thy fexofenadine
chlorhydrate, ung 60 mg 2 ln mi ngy, lm gim r rt tng s im ca cc triu chng
(tng s cc im ca mi triu chng ht hi, chy nc mi, nga mi, nga vm ming v
hng, mt nga , chy nc mt) so snh vi placebo.
C gim r rt c { ngha thng k im ca cc triu chng d ng sau khi ung liu u tin 60
mg, vi tc dng duy tr sut 12 ting. Ni chung, tng s im cc triu chng khng gim
thm nu c tng liu Fexofenadine ti 240 mg 2 ln mi ngy. Mc d s i tng trong mt
s phn nhm nghin cu cn t, khng c khc bit ng k v tc dng ca fexofenadine
chlorhydrate gia cc nhm nghin cu theo gii tnh, tui, chng tc.
Cho bnh nhn vim mi d ng tip xc vi phn c li ch ung liu duy nht 60 mg
fexofenadine chlorhydrate, thi gian bt u c tc dng lm gim tng s im cc triu
chng, tr triu chng nght mi, l 60 pht so vi placebo.
DC NG HC
nhng ngi n ng tnh nguyn khe mnh, sau khi ung liu duy nht 2 vin 60 mg,
fexofenadine chlorhydrate c hp thu nhanh vi thi gian trung bnh t nng ti a
trong huyt tng l 2,6 gi. nhng ngi khe mnh, sau khi ung liu duy nht dung dch
cha 60 mg, nng trung bnh trong huyt thanh l 209 ng/ml. Khi ngi tnh nguyn khe
mnh dng nhiu liu lin tip fexofenadine chlorhydrate (dung dch ung 60 mg, mi 12 gi,

v ung 10 liu nh vy), nng nh ca thuc trong huyt tng l 286 ng/ml. Ung liu
120 mg mi ln, dng 2 ln mi ngy, th Fexofenadine s c dc ng hc tuyn tnh. Mc d
sinh kh dng tuyt i ca vin nang fexofenadine chlorhydrate cha r, nhng vin nang
c sinh kh dng tng ng vi dung dch ung. Thi gian bn hy trung bnh ca
Fexofenadine l 14,4 gi sau khi ung 60 mg, 2 ln mi ngy, ngi tnh nguyn bnh thng.
Nhng nghin cu ngi cho thy sau khi ung fexofenadine chlorhydrate nh du bng
14
C, tm thy khong 80% trong phn v 11% trong nc tiu. Khong 5% tng liu c chuyn
ha. V cha xc nh c sinh kh dng tuyt i ca fexofenadine chlorhydrate, nn
cha r thnh phn thi tr qua phn l thuc khng c hp thu hay l do s thi qua mt.
Dc ng hc ca fexofenadine chlorhydrate ngi bnh vim mi d ng cng ging nh
ngi khe mnh. Nng nh ca Fexofenadine trong huyt tng ging nhau thiu nin
(12-16 tui) v ngi trng thnh.
60-70% Fexofenadine gn vo protein huyt tng, ch yu gn vo albumin v a1-acid
glycoprotein.
Nhng i tng c bit
Cho ung liu duy nht 80 mg fexofenadine chlorhydrate, v so snh dc ng hc ca thuc
ny nhng i tng c bit (v tui tc, suy gan, suy thn) vi nhng ngi bnh thng
khe mnh. Trong khi th trng tng i ng u gia cc nhm, th cc i tng c bit
li gi hn nhng ngi tnh nguyn tr, khe mnh nhiu. V l , tc ng ca tui tc c
th lm sai lch s khc bit v dc ng hc mt s i tng c bit.
nh hng ca tui tc
ngi cao tui (>= 65 tui), 99% c nng nh ca Fexofenadine trong huyt tng cao
hn ngi tnh nguyn bnh thng (< 65 tui). Thi gian bn hy trung bnh ging nh
ngi tnh nguyn khe mnh.
Ngi suy thn
nhng ngi suy thn nh ( thanh thi creatinine 41-80 ml/pht) ti nng ( thanh thi
creatinine 11-40 ml/pht) nng nh ca Fexofenadine trong huyt tng ln hn (87% v
111%) so vi ngi tnh nguyn khe mnh ; thi gian bn hy trung bnh nhng i tng
suy thn trn cng di hn (59% v 72%) so vi ngi khe mnh.
Nng nh ca Telfast trong huyt tng ngi thm phn ( thanh thi creatinine < 10
ml/pht) cao hn (82%) v thi gian bn hy di hn (31%) so vi ngi tnh nguyn khe
mnh. Da vo s tng kh dng sinh hc v thi gian bn hy, nn dng liu duy nht 60
mg/24 gi, lc khi u dng thuc ngi suy thn (xin c phn "Liu lng v cch dng").
Ngi suy gan
Dc ng hc ca fexofenadine chlorhydrate ngi suy gan khng khc nhiu so vi
ngi khe mnh.
nh hng ca gii tnh

Qua nhiu th nghim, khng c khc bit gia gii nam v n v dc ng hc ca

Fexofenadine.
CH NH
iu tr cc triu chng vim mi d ng ngi ln v tr em = 12 tui.
CHNG CH NH
bit c tng cm vi bt c thnh phn no ca thuc.
Tr em 12 tui.
THN TRNG LC DNG
Tc dng gy ung th, bin d, nh hng n s sinh sn
Tim nng gy ung th v c tnh trn s sinh sn ca fexofenadine chlorhydrate c nh
gi bng cch dng nhng nghin cu v terfenadine vi s tip xc Fexofenadine thch hp
(da vo gi tr "din tch di ng cong" (AUC) trong huyt tng). Khng thy c tc dng
gy ung th chut nht v chut cng ung liu hng ngy 50 v 150 mg/kg terfenadine trong
18 v 24 thng : nhng liu ny phn nh gi tr AUC trong huyt tng ca Fexofenadine gp 4
ln gi tr iu tr trn ngi (da vo liu fexofenadine chlorhydrate 60 mg, 2 ln mi ngy).
Th nghim in-vitro (dng test CHO/HGPRT gy t bin tri, hoc th nghim v s sai lc
nhim sc th ca lympho bo chut cng v th nghim in-vivo (th nghim vi nhn ca ty
xng chut nht), khng thy fexofenadine chlorhydrate gy bin d.
Trong nhng nghin cu trn kh nng sinh sn ca chut cng, s gim th tinh (ph thuc
liu lng) v tng tht thot sau khi th tinh c nhn thy qua liu ung >= 150 mg/kg
terfenadine ; nhng liu ny to gi tr AUC trong huyt tng ca Fexofenadine >= 3 ln so vi
gi tr iu tr ngi (da vo liu Fexofenadine mi ln 60 mg, dng 2 ln/24 gi).
C thai
Tc dng gy qui thai : Loi C. Khng thy terfenadine gy qui thai chut cng v th ung
liu ti 300 mg/kg. Liu ny to gi tr AUC ca Fexofenadine trong huyt tng gp 4 v 37 ln
gi tr iu tr ngi (da vo liu fexofenadine chlorhydrate 60 mg, 2 ln mi ngy).
Cha c nghin cu thch hp v c kim sot cht trn ph n mang thai. Khi mang thai ch
nn dng fexofenadine chlorhydrate nu li ch iu tr hn hn nhng nguy c c th gp i
vi thai.
Tc dng khng gy qui thai
Liu >= 150 mg/kg terfenadine lm gim s tng cn ch con, gim t l sng chut cng. Vi
liu ny, gi tr AUC ca Fexofenadine trong huyt tng >= 3 ln gi tr iu tr ngi (da
vo liu fexofenadine chlorhydrate 60 mg, 2 ln mi ngy).
Thi kz cho con b
Cha c nghin cu thch hp v c kim sot cht trn ph n cho con b. V c nhiu thuc
c bi tit qua sa ngi, nn cn thn trng khi dng fexofenadine chlorhydrate ph n
cho con b.

Dng cho tr em
Cha xc nh c an ton v hiu lc ca Telfast bnh nhi di 12 tui. Qua th nghim
lm sng c kim sot cht ch bnh nhn vim mi d ng, tng s 205 bnh nhn tui 1216, ung liu 20 mg-240 mg, 2 ln mi ngy trong 2 tun. Nhng tc dng ngoi nhm ny
cng tng ng vi nhm trn 16 tui.
Dng cho ngi cao tui
Th nghim so snh vi placebo, 42 bnh nhn, tui 60-68, ung liu 20 mg - 240 mg
Fexofenadine, 2 ln mi ngy, trong 2 tun lin. Nhng tc dng ngoi nhm ny tng
ng vi nhm di 60 tui.
TNG TC THUC
2 nghin cu ring r, ung fexofenadine chlorhydrate 120 mg 2 ln mi ngy (gp i liu
khuyn co) phi hp vi erythromycine 500 mg mi 8 gi hoc ketoconazole 400 mg liu duy
nht trong 24 gi iu kin n nh trn ngi tnh nguyn bnh thng khe mnh (n = 24
mi nghin cu). Kt qu khng nhn thy c s khc bit v tc dng c hi hoc v khong
QTc in tim ngi dng Fexofenadine n thun hoc phi hp vi erythromycin hoc
ketoconazole.
Bng sau y tm tt cc kt qu nghin cu k trn :
Tc dng trn dc ng hc ca Fexofenadine trng thi n nh sau 7 ngy dng phi
hp vi Fexofenadine Chlorhydrate 120 mg mi 12 gi (gp i liu khuyn co) trn ngi
tnh nguyn khe mnh (n = 24)
Thuc phi hp

Cmax (Nng nh
trong huyt tng)

Din tch di ng cong (0-12 gi)

(ni rng s tip xc tng th)

Erythromycin (500 mg
+82%
mi 8 gi)

+109%

Ketoconazole (400mg
+135%
mt ln mi ngy)

+164%

Cha r c ch ca nhng tng tc trn, v tim nng tng tc vi cc thuc chng nm

khc nhm azole hoc vi khng sinh nhm macrolid cha c nghin cu. Nhng thay i v
nng trong huyt tng ny u nm trong gii hn ca nng trong huyt tng t
c trong nhng th nghim lm sng thch hp v c kim sot tt.
Fexofenadine khng c nh hng trn dc ng hc ca erythromycin hoc ca

ketoconazole.
Thuc khng acid cha gel aluminium hay magnesium lm gim sinh kh dng ca
fexofenadine chlorhydrate.
Khng c tng tc gia Fexofenadine v omeprazole.
TC DNG NGOI
Th nghim trn lm sng c so snh vi placebo, gm 2461 bnh nhn ung fexofenadine
chlorhydrate vi liu 20 mg-240 mg, 2 ln mi ngy, thy nhng phn ng c hi tng ng
nhm ung thuc v nhm placebo. Nhng phn ng gp phi, k c bun ng, khng ph
thuc liu lng v cng tng t gia cc phn nhm c chia theo gii tnh, tui v dn
tc. T l phn trm bnh nhn b thuc sm v tc dng ngoi { l 2,2% i vi fexofenadine
chlorhydrate so vi 3,3% i vi placebo. Tt c nhng tc dng ngoi { c ghi nhn hn
1% bnh nhn ung fexofenadine chlorhydrate vi liu mi ngy c khuyn co (60 mg, 2 ln
mi ngy) v thung gp nhm dng Fexofenadine hn l nhm dng placebo ; nhng tc
dng ny c lit k bng sau :
Nhng tc dng ngoi ghi nhn trong nhng th nghim lm sng c kim sot dng
placebo bnh nhn vim mi d ng vi t l hn 1%
Tc dng ngoi

Fexofenadine 60 mg Ung 2 ln/24

gi (n=679)

Placebo Ung 2 ln/24 gi

(n=671)

Nhim virt (cm,

2,5%
cm)

1,5%

Bun nn

1,6%

1,5%

au bng kinh

1,5%

0,3%

Bun ng

1,3%

0,9%

Kh tiu

1,3%

0,6%

Mt mi

1,3%

0,9%

Hn 1% bnh nhn ung fexofenadine chlorhydrate (60 mg 2 ln mi ngy) c tc dng ph,

nhng thng gp hn nhm placebo, bao gm nhc u v nga hng.
Tn s v mc ca nhng bt thng trong xt nghim tng ng gia hai nhm bnh

nhn dng fexofenadine chlorhydrate v placebo.

LIU LNG v CCH DNG
Liu khuyn co cho Telfast l 60 mg mi ln, ung 2 ln mi ngy cho ngi ln v tr em >=
12 tui.
Liu khi u cho ngi suy thn l mt ln duy nht 60 mg/24 gi (xin c phn "Dc lc").
Khng cn gim liu ngi gi v bnh nhn suy gan.
Dng cch xa 2 gi i vi cc thuc khng acid c cha gel aluminium hay magnesium.
QU LIU
Thng tin v qu liu cp tnh ch c gii hn qua nhng kinh nghim t nhng th nghim
lm sng thc hin trong thi gian trin khai Telfast. Dng liu mt ln duy nht 800 mg
fexofenadine chlorhydrate ( 6 ngi tnh nguyn khe mnh) v liu 690 mg, 2 ln mi ngy,
dng 1 thng lin (3 ngi tnh nguyn khe mnh), khng thy tc dng ngoi { ng k
trong lm sng.
Trong trng hp qu liu, dng nhng bin php c bn loi phn thuc cha c hp
thu.
Cng cn iu tr triu chng v iu tr h tr.
Thm phn lc mu khng loi c tt Fexofenadine khi mu (ch loi khong 1,7%) sau khi
ung terfenadine.
Cho ung fexofenadine chlorhydrate vi liu ti 5000 mg/kg khng gy t vong cho chut nht
(gp 170 ln liu ung ti a hng ngy ngi, da vo mg/m2) v liu ti 5000 mg/kg
chut cng cng khng gy t vong (gp 330 ln liu ung ti a hng ngy ngi, da vo
mg/m2).
Hn na, khng gp du hiu lm sng v c tnh hoc nhng biu hin bnh l r rng. Trn
ch, khng thy du hiu lm sng v c tnh khi cho ung ti 2000 mg/kg (gp 450 ln liu
ung ti a hng ngy ngi, da vo mg/m2).
BO QUN
Bo qun nhit phng (15-30oC).

507.

TENOXITIC

O.P.V. (OVERSEAS)
vin nang 20 mg : hp 10 vin.
THNH PHN
cho 1 vin

Tenoxicam

20 mg

TNH CHT
Tenoxicam l mt thuc khng vim gim au khng steroid mi ca nhm oxicam. Do thi
gian bn hy ko di, tenoxicam c th dng ngy mt ln. Cc th nghim lm sng trn bnh
nhn vim khp dng thp, vim xng khp, vim dnh t sng, bnh gout v cc ri lon
dng thp ngoi khp chng minh tenoxicam 20 mg/ngy c tc dng khng vim, gim au
v thuc c dung np tt.
DC LC
Trong cc m hnh vim chun, tenoxicam c tc dng mnh nh piroxicam, indomethacin v
diclofenac, v mnh hn acetyl salicylic acid, mefenamic acid v naproxen. Trong th nghim
vim do kaolin, tenoxicam tng ngng au gp 3 ln. Ch s iu tr (l t s ca liu gy lot
v liu khng vim) ti u hn piroxicam, mefenamic acid, diclofenac, carprofen v salicylic
acid.
Cng nh cc thuc khng vim gim au khng steroid khc, tenoxicam c ch tng hp
prostaglandin. Thuc cng c hiu qu khng vim nh c ch sn sinh cc gc oxy hot ng,
ha hng ng bch cu v hin tng thc bo.
DC NG HC
Sau khi ung, nng nh trung bnh trong huyt tng t c sau 0,5-2 gi. kh dng
sinh hc ca tenoxitic l 100%. Sau khi ung liu n tenoxicam 20 mg v 40 mg, nng
tng ng t c trong huyt tng trung bnh l 2 v 4 mg/l. Thc n v antacid lm chm
hp thu nhng khng nh hng n mc hp thu ton phn ca thuc.
Nng cao n nh ca thuc trong huyt tng khong 11 mg/l t c 10-12 ngy sau khi
dng tenoxicam 20 mg/ngy. ngi khe mnh, th tch phn phi ca tenoxicam l 0,15
l/kg, thi gian bn hy trung bnh 60-75 gi v thanh thi trong huyt tng 0,1- 0,25 l/gi.
Tenoxicam d thm nhp vo bao hot dch ca bnh nhn vim xng khp hoc vim a
khp dng thp. Khong 2/3 liu tenoxicam c tm thy trong nc tiu v 1/3 liu c tm
thy trong phn.
CH NH
Tenoxitic c ch nh nh l mt thuc khng vim gim au trong iu tr vim khp dng
thp, vim xng khp, vim dnh t sng, gout v cc ri lon dng thp ngoi khp (vim
gn, vim bao hot dch, vim dy thn kinh, au lng) v sng sau chn thng.
CHNG CH NH
Khng nn dng tenoxicam cho nhng bnh nhn lot d dy t trng tin trin, xut huyt d
dy rut, vim d dy nng, ri lon chc nng gan thn nng v mn cm vi thuc.
LC C THAI v LC NUI CON B
Khng nn dng tenoxicam cho ph n c thai v cho con b.

TNG TC THUC
Tenoxicam c th gy tng hiu qu chng ng mu ca coumarins. Tenoxicam khng c
tng tc dc lc hc vi antacid, cimetidin v thuc h ng huyt (glibornuride hoc
glibenclamide). Nhng nn theo di hiu qu ca thuc khng ng v thuc h ng huyt
c bit khi bt u liu php tenoxicam. S dng ng thi probenecid lm gia tng t l o
thi tenoxicam.
TC DNG NGOI
Vi liu thng dng trong iu tr, tenoxicam dung np tt. Tc dng ph trn d dy rut gp
7% bnh nhn (au thng v, bun nn, kh tiu); v t hn l nhc u, chng mt. Nu
xut huyt ng tiu ha, nn ngng thuc.
Cng nh cc thuc khng vim khng steroid khc, c th tng men gan tm thi.
Tenoxitic c th c ch ngng tp tiu cu v ko di thi gian chy mu. Nn xem xt k khi
dng tenoxicam cho bnh nhn s c can thip phu thut.
LIU LNG v CCH DNG
Ngi ln : liu thng dng l 20 mg (1 vin nang), ngy mt ln.
Trong t cp ca vim khp do bnh gout, liu khuyt co l 40 mg mt ln/ngy trong 2 ngy
sau 20 mg mt ln/ngy trong 5 ngy.
Tr em : Tnh an ton ca thuc tr em cha c thit lp.
QU LIU
Trong trng hp qu liu, yu cu iu tr nng .

508.

TERGYNAN

BOUCHARA
c/o TEDIS
Vin t m o : hp 10 vin.
THNH PHN
cho 1 vin
Ternidazole

200 mg

N omycine sulfate 6500 n v hoc

100 mg

Nystatine

100 000 n v

Prednisolone mtasulfobenzoate sodique, tnh theo dng base

3 mg

(Lactose)

DC LC
iu tr a nng cc bnh ph khoa.
Tergynan c thnh phn cng thc phi hp nhiu hp cht, do c tc ng iu tr ti ch
vim m o do nhiu nguyn nhn khc nhau nh do nhim khun, nhim nm, nhim k sinh
trng hoc nhim nhiu mm bnh cng lc. Thuc c phi hp :
- ternidazole : dit trichomonas v Gardnerella vaginalis ;
- n omycine sulfate : khng sinh c tc ng trn nhiu mm bnh sinh m m o ;
- nystatine : khng nm ;
- prednisolone m tasulfobenzoate sodique : khng vim tan trong nc.
T l mc bnh vim m o do trichomonas hoc do Candida albicans tng ng k t vi nm
nay. Cc bnh ny thng phi hp vi nhiu mm bnh thng thng khc lm cho vic iu
tr tr nn kh khn hn. Do cn c mt phng thc iu tr phi hp cng lc dit
trichomonas, khng nm v khng khun ; Tergynan p ng c yu cu ny.
Thng cc bnh ng m o dai dng hoc ti pht, sau khi b vim nhim ti ch, s lm
cho nim mc tr nn mng manh v nhy cm ; s tham gia ca corticoide trong thnh phn
cng thc c li trong trng hp ny.
Tergynan c thnh phn t dc bo m cho thuc thm tt qua nim mc m o v n nh
pH sinh l.
CH NH
Vim m o do cc vi khun sinh m thng thng.
Vim m o do Gardnerella vaginalis.
Vim m o do Trichomonas.
Vim m o do nhim nm c bit l Candida albicans.
Vim m o do nhim ng thi Trichomonas v nm men.
Vim m o do cc tc nhn phi hp.
TC DNG NGOI
Ngoi l, c th b d ng nomycine vi cc triu chng da.
Cm gic b kim chm hoc kch ng ti ch trong vi ngy u iu tr nhng rt him.
Tc dng ton thn : nh vi tt c cc thuc iu tr ti ch, mt lng nh cc thnh phn
ca thuc c th c hp thu qua nim mc.
LIU LNG v CCH DNG
Trc khi t thuc, nn nhng ton b vin thuc trong nc trong khong 20 n 30 giy v

sau khi t thuc, bnh nhn nn t th nm trong khong 15 pht.

t 1 hoc 2 vin/ngy, trong 10 ngy lin tip ; trng hp bit r do nhim nm : trong 20
ngy.

509.

TERNEURINE H-5000

BRISTOL-MYERS SQUIBB
bt pha tim bp : hp 4 l bt ng kh + 4 ng dung mi 5 ml.
THNH PHN
cho 1 l
Thiamine

50 mg

Pyridoxine

250 mg

Hydroxocobalamine

5 mg

ng dung mi : Sodium actate : 60 mg ;

alcool benzylique : 50 mg ; nc ct pha
tim : lng va 5 ml
DC LC
Phi hp vitamine B12, l mt yu t to mu, vi vitamine B1, B6, c s dng vi mc ch
gim au.
CH NH
c ngh trong :
- mt vi chng au r thn kinh : au dy thn kinh hng, au thn kinh c-cnh tay, cc
chng au do thn kinh.
- vim a dy thn kinh ngi nghin ru kinh nin.
- mt s bnh vim thn kinh th gic sau nhn cu do ng c hoc do thuc.
CHNG CH NH
- Tin s d ng vi cobalamine (vitamine B12 v cc cht cng h).
- Khng dung np vitamine B1.
- Bu c tnh : do vitamine B12 c tc ng cao trn s tng trng ca m, do c nguy c
y mnh tc sinh sn ca t bo.
CH PHNG
Mt vi trng hp c phn ng min dch, i khi trm trng, thm ch c th gy t vong,

c ghi nhn sau khi tim ch phm c cha cobalamine ; do nn trnh dng thuc ny
nhng bnh nhn c c a d ng (suyn, chm).
THN TRNG LC DNG
Ch c dng ng tim bp tht.
Khng c dng thuc khi c hin tng khng dung np mt trong cc thnh phn ca
thuc qua cc ng dng thuc khc.
Nu c du hiu khng dung np thiamine (xem mc Tc dng ngoi ), phi ngng thuc ngay
v khng c dng tr li sau bng ng tim.
TNG TC THUC
Khng dng chung vi lvodopa (vitamine B6 lm gim tc ng ca lvodopa do kch thch
dopadcarboxylase ngoi bin)
TC DNG NGOI
- Phn ng phn v : nga, ni my ay, pht ban, sc (xem mc Ch { phng v Thn trng
lc dng).
- C th b mn trng c.
- Nc tiu c mu .
- Trng hp khng dung np thiamine : nn, cng c, cc biu hin da kiu b nga, h
huyt p (ch yu khi dng ng tim tnh mch).
- Nu hn hu c b sc, tr liu bao gm : adrnaline, corticoide dng tim, acide epsilon
aminocaproique.
Tim thuc khng au do c alcool benzylique trong thnh phn dung mi.
LIU LNG v CCH DNG
- Khng c tim thuc qua ng tim mch.
- Ch dng ng tim bp v tim bp su.
Hi chng au nhc : 1 ng/ngy hoc mi 2 ngy.
Nghin ru kinh nin : 2 ng/ngy.

510.

TTRACOQ

AVENTIS PASTEUR
Hn dch tim bp hoc di da : hp 20 ng bm tim cha 0,5 ml thuc.
THNH PHN
cho 1 ng tim
Bin c t bch hu tinh khit

1 liu

Bin c t un vn tinh khit

1 liu

Bordetella perturssis : ti thiu

4 UI

Vaccin st bi lit mt hot tnh loi 1, 2 v 3

1 liu

CH NH
D phng bnh bch hu, un vn, ho g v st bi lit.
CHNG CH NH
Bnh no ang tin trin c hoc khng km theo co git.
C phn ng qu mnh sau mi tim nga ho g trc : st cao >= 40oC, hi chng khc
tht dai dng, co git, tnh trng sc.
THN TRNG LC DNG
Cn di ngy chng nga i vi cc i tng b bnh nhim ang tin trin, ch yu dng
nhim trng.
Cc bnh nhn c tin s ng kinh nn dng thm thuc phng nga bnh co git v st cao
khi tim chng.
TC DNG NGOI
Phn ng gy au, ni cc cng ti im tim.
St 38oC-39oC ko di 24 gi.
Ngoi l c th gy st > 40oC, hi chng khc tht dai dng, co git, bnh no hoc tnh trng
sc (1 ca trong khong 100.000 ca tim chng).
LIU LNG v CCH DNG
ng tim di da hoc tim bp.
3 mi tim cch nhau 1 thng v 1 mi tim lp li 1 nm sau mi tim ln th 3.

511.

THERALENE

XNLD RHNE POULENC RORER

[AVENTIS PHARMA]
vin bao phim d b 5 mg : hp 50 vin.
xir 2,5 mg/5 ml : chai 90 ml v 125 ml.
THNH PHN

cho 1 vin
Alimmazine

5 mg

cho 1 mung caf xir

Alimmazine tartrate

2,5 mg

(Saccharose)

(3,55 g)

(Ethanol)

cho 1 mung canh xir

Alimmazine tartrate

7,5 mg

(Saccharose)

(10,65 g)

(Ethanol)
DC LC
Thuc khng histamine ng ung.
Alimmazine l mt thuc khng histamine H1 thuc nhm ph nothiazine, c cc c tnh nh
sau :
- tc dng an thn liu thng thng do tc ng khng histamine v c ch adrnaline
thn kinh trung ng ;
- tc dng khng cholinergic gy tc dng ngoi ngoi bin ;
- tc dng c ch adrnaline ngoi bin c th nh hng n ng lc mu (c th gy h
huyt p t th).
Cc thuc khng histamine c c tnh chung l i khng, do i khng tng tranh t nhiu
mang tnh thun nghch, vi tc dng ca histamine, ch yu trn da, mch mu v nim mc
kt mc, mi, ph qun v rut.
DC NG HC
Cc s liu v dc ng hc ca alimmazine hin cn cha c y .
Cc thuc khng histamine ni chung c nhng c tnh v dc ng nh sau :
- kh dng sinh hc mc trung bnh ;
- chuyn ha thuc tng i mnh to ra nhiu sn phm chuyn ha, iu ny gii thch ti

sao phn thuc khng b chuyn ha ch chim mt nng rt thp trong nc tiu ;
- thi gian bn hy dao ng, thng l ko di, cho php dng mt liu duy nht trong ngy ;
- cc phn t thuc tan trong lipid do th tch phn phi thuc cao.
CH NH
Mt ng (thnh thong hoc tm thi).
iu tr triu chng cc biu hin d ng khc nhau : vim mi theo ma hoc khng theo ma,
vim kt mc, m ay.
iu tr triu chng ho khan gy kh chu, nht l ho v m.
CHNG CH NH
Tuyt i :
- Qu mn cm vi thuc khng histamine.
- Tr em di 6 tui (i vi dng vin).
- C tin s b gim bch cu ht lin quan n dn xut phnothiazine.
- C nguy c b b tiu lin quan n ri lon niu o tuyn tin lit.
- C nguy c b glaucome gc ng.
Tng i :
- Sultopride (xem Tng tc thuc).
- Ph n c thai (3 thng u) hay cho con b (xem Lc c thai v Lc nui con b).
CH PHNG v THN TRNG LC DNG
Ch phng :
Lu { rng trong thnh phn ca dng xir c cha alcool.
Do hin nay ngi ta cn gi nh rng phnothiazine c th l mt yu t trong nhng trng
hp t t nh nhi, khng nn s dng thuc ny cho tr di 1 tui.
Trong iu tr chng mt ng :
Nu b mt ng, cn tm hiu nguyn nhn gy mt ng. Nu dng thuc trn 5 ngy m vn
cn b mt ng th nn nghi rng c mt bnh l tim n, v cn phi nh gi li vic iu tr.
Trong iu tr cc biu hin d ng :
Nu sau mt thi gian iu tr m cc triu chng d ng vn cn hoc nng ln (kh th, ph,
sang thng da...) hoc c nhng du hiu c lin quan n nhim virus, cn phi nh gi li
vic iu tr.
Trong iu tr chng ho :
Trng hp ho c m cn phi t nhin v l yu t c bn bo v phi-ph qun.
Trc khi k toa thuc chng ho, cn tm nguyn nhn gy ho c iu tr c hiu, nht l
hen ph qun, vim ph qun mn tnh, gin ph qun, tc nghn ph qun, ung th, nhim
trng ph qun-phi, suy tht tri, thuyn tc phi, trn dch mng phi.
Nu ho khng gim khi dng theo liu thng thng, khng nn tng liu m cn khm li tnh
trng lm sng ca bnh nhn.

Thn trng lc dng :

Dng vin c dnh cho ngi ln v tr em trn 6 tui.
Cn tng cng theo di (lm sng v in no ) bnh nhn b ng kinh do cc dn xut
phnothiazine c th lm gim ngng gy ng kinh.
Thn trng khi ch nh alimmazine cho :
- bnh nhn ln tui c kh nng cao b h huyt p t th, b chng mt, bun ng ; b to bn
kinh nin (do c nguy c b tc rut lit) ; b sng tuyn tin lit ;
- bnh nhn b bnh tim mch do cc dn xut phnothiazine c th gy nhp tim nhanh v h
huyt p mt s ngi ;
- bnh nhn b suy gan v/hay suy thn nng, do c nguy c tch t thuc.
Trng hp dng thuc cho tr em, cn phi bit chc l tr khng b hen ph qun hay b hi
lu d dy - thc qun trc khi k toa thuc ho.
Tuyt i trnh ung ru hay cc thuc c cha ru trong thi gian iu tr.
Do cc dn xut phnothiazine c th gy cm quang, trnh phi nng trong thi gian iu tr.
Trng hp bnh nhn b tiu ng hay phi theo ch n king t ng, nn lu { n
hm lng saccharose trong thnh phn ca dng xir.
Li xe v vn hnh my mc :
Cn thng bo cho ngi phi li xe hay vn hnh my mc v kh nng b bun ng khi dng
thuc, nht l trong thi gian u.
Hin tng ny cng r hn nu dng chung vi cc thc ung hay cc thuc khc c cha
ru.
Nn bt u iu tr cc biu hin d ng vo bui ti.
LC C THAI v LC NUI CON B
Lc c thai :
Kho st v tc dng gy d dng :
Khng c s liu ng tin cy v tc dng gy qui thai trn ng vt.
Hin nay cha c nhng s liu xc ng nh gi kh nng gy d dng hay c cho phi
thai ca alimmazine khi dng trong thai kz.
Kho st v c tnh trn phi thai :
tr s sinh c m c iu tr di hn vi liu cao cc thuc c c tnh khng cholinergic,
cc du hiu v tiu ha c lin quan n tc dng atropinic (cng bng, tc rut phn su, chm
i tiu phn su, nhp tim nhanh, ri lon thn kinh...) him khi c ghi nhn.
Da trn cc d liu trn, khng nn ung thuc ny trong 3 thng u ca thai kz, nhng
thng tip theo c th k toa nhng khi no tht cn thit v ch s dng ngn hn trong 3
thng cui thai kz.
Nu c ung thuc ny vo cui thai kz, cn phi theo di mt thi gian cc chc nng thn
kinh v tiu ha ca tr s sinh.

Lc nui con b :
Khng bit alim mazine c c bi tit qua sa m hay khng. Tuy nhin do thuc c tc
dng an thn hoc gy kch ng tr, hn na cc dn xut phnothiazine c th gy ngng
th cho tr, do khng nn dng thuc khi cho con b.
TNG TC THUC
Cho c dng vin v dng xir :
Khng nn phi hp :
- Alcool : ru lm tng tc dng an thn ca thuc khng histamine H1. Vic gim tp trung v
tnh to c th gy nguy him khi li xe hay vn hnh my mc. Trnh ung ru v cc thc
ung c cha ru trong thi gian dng thuc.
- Sultopride : c nguy c tng ri lon nhp tht, nht l nguy c gy xon nh, do phi hp cc
tc dng in sinh l.
Nn lu { khi phi hp :
- Cc thuc c ch thn kinh trung ng khc (thuc gim au v chng ho h morphine, thuc
chng trm cm c tc dng an thn, thuc ng nhm benzodiazpine, nhm barbiturate,
clonidine v cc thuc cng h, thuc ng, mthadone, thuc an thn kinh, thuc gii lo) : tng
c ch thn kinh trung ng. Vic gim tp trung v tnh to c th gy nguy him khi li xe hay
vn hnh my mc.
- Atropine v cc thuc c tc ng atropinic (thuc chng trm cm nhm imipramine, thuc
chng lit rung c tc ng khng cholinergic, thuc chng co tht c tc ng atropinic,
disopyramide, thuc an thn kinh nhm ph nothiazine) : tng cc tc dng ngoi atropinic
nh gy b tiu, to bn, kh ming.
Cho dng xir :
Khng nn phi hp :
- Disulfirame ; cfamandole, cfoprazone, latamoxef (khng sinh nhm cphalosporine) ;
chloramphnicol (khng sinh nhm phnicol) ; chlorpropamide, glibenclamide, glipizide,
tolbutamide (sulfamide h ng huyt) ; grisofulvine (khng nm) ; mtronidazole,
ornidazole, secnidazole, tinidazole (nitro-5-imidazole) ; ktoconazole (khng nm nhm azole) ;
procarbazine (km t bo) : cc thuc ny c th gy phn ng antabuse vi alcool (nng bng,
ngi, nn, nhp tim nhanh). Trnh ung ru v cc thc ung hay thuc c cha ru.
TC DNG NGOI
Cc c tnh dc l ca alim mazine cng l nguyn nhn ca mt s tc dng ngoi vi
nhiu mc khc nhau v c hay khng c lin quan n liu dng (xem Dc lc) :
Tc dng trn thn kinh thc vt :
- thiu thiu hoc bun ng, nht l vo thi gian iu tr u ;
- tc ng khng cholinergic lm kh nim mc, ri lon iu tit, gin ng t, tim p nhanh,
nguy c b tiu ;

- h huyt p t th ;
- ri lon cn bng, chng mt, gim tr nh hoc kh nng tp trung ;
- mt iu ha vn ng, rung ry, thng xy ra hn ngi ln tui ;
- ln, o gic ;
- him hn, ch yu nh nhi, c th gy kch ng, cu gt, mt ng.
Phn ng qu mn cm :
- ni ban, eczema, nga, ban xut huyt, m ay ;
- ph, him hn c th gy ph Quincke ;
- sc phn v ;
- cm quang.
Tc dng trn mu :
- gim bch cu, gim bch cu trung tnh ;
- gim tiu cu ;
- thiu mu huyt gii.
LIU LNG v CCH DNG
Vin nn : dnh cho ngi ln v tr em trn 6 tui.
Xir : dnh cho ngi ln v tr em trn 12 thng, khi dng nn s dng dng c lng c khc
vch 2,5 ml, 5 ml v 10 ml.
Khng histamine, tr ho :
iu tr triu chng ngn hn (vi ngy).
C th lp li liu dng nhng khng qu 4 ln trong ngy.
Trng hp iu tr ho, nn ung thuc vo thi im thng xy ra cn ho.
- Ngi ln : mi ln 5-10 mg, tng ng mi ln ung 1-2 vin hay 10-20 ml xir.
- Tr em trn 6 tui (khong 20 kg) : 0,125-0,250 mg/kg/ln, tng ng mi ln ung 1/2-1
vin.
- Tr em, nh nhi trn 12 thng tui : 0,125-0,250 mg/kg/ln, tng ng mi ln ung 0,250,5 ml xir/kg.
Nn u tin ung thuc vo bui chiu ti do alimmazine c th gy bun ng.
Tr chng mt ng :
Ung thuc trc khi i ng.
- Ngi ln : 5-20 mg, tng ng vi 1-4 vin hay 10-40 ml xir.
- Tr em trn 6 tui : 0,25-0,5 mg/kg, tng ng vi :
- tr t 20-40 kg (6-10 tui) : 1 vin ;
- tr t 40-50 kg (10-15 tui) : 2 vin.
- Tr em trn 3 tui : 0,25-0,5 mg/kg, tng ng vi 0,5-1 ml xir/kg
QU LIU
Du hiu qu liu alimmazine : co git (nht l nh nhi v tr em) ; ri lon nhn thc, hn

m.
iu tr triu chng bnh vin.

512.

TIDOCOL

TORRENT
Vin bao tan trong rut 400 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Mesalamine

400 mg

DC LC
Mesalamine l mt cht chuyn ha c hot tnh tr liu chnh ca sulfasalazine trong iu tr
vim lo t i trng. Sulfasalazine c chuyn i ng phn t thnh sulfapyridine v
mesalamine do tc ng ca vi khun i trng. Liu ung thng thng ca sulfasalazine
trong bnh vim lo t i trng tin trin l 3-4 g/ngy, chia lm nhiu ln, liu ny s cung cp
1,2-1,6 g mesalamine cho i trng.
C ch tc ng ca mesalamine (v sulfasalazine) hin cha c bit r, nhng dng nh l
n c tc ng ti ch hn l tc ng ton thn. S sn xut cht nhy ca cc cht chuyn
ha ca arachidonic acid, c qua con ng cyclooxygenase, nh prostanoid, v qua con ng
lipoxygenase, nh leukotrienes v hydroxyeicosatetraenoic acid, tng bnh nhn b vim rut
mn tnh, v c th mesalamine cng gim vim bng cch c ch cyclooxygenase v c ch to
prostaglandin i trng.
DC NG HC
Vin Tidocol c bao bng acrylic cho ph p mesalamine c phng thch ch khi thuc n
on t hi trng tr v sau. iu ny c chng minh qua cc th nghim ngi.
Khong 28% ca mesalamine trong vin Tidocol c hp thu sau khi ung, phn cn li cho tc
ng ti ch v c thi qua phn. S hp thu ca mesalamine ging nhau khi ung thuc lc
i hay khi c thc n. Phn mesalamine hp thu nhanh chng c acetyl ha nim mc ca
thnh rut v gan. N ch yu c bi tit qua thn di dng dn cht N-acetyl-5aminosalicylic acid.
Mesalamine dng ng ung di dng vin Tidocol dng nh c hp thu nhiu hn so
vi mesalamine c to ra t sulfasalazine. Nng ti a trong huyt tng ca
mesalamine v N-acetyl-5-aminosalicylic acid sau khi ung nhiu liu Tidocol cao gp 1,5-2 ln
so vi khi ung mesalamine cng vi liu tng t nhng di dng sulfasalazine. Din tch

di ng cong ca hn hp mesalamine v N-acetyl-5-aminosalicylic acid v nng ca

thuc trong nc tiu sau khi ung nhiu liu Tidocol cao gp 1,3-1,5 ln so vi khi ung
mesalamine cng vi liu tng t nhng di dng sulfasalazine.
Mesalamine v cc cht chuyn ha ca n, N-acetyl-5-aminosalicylic acid, c Tmax thng tr
do hot cht c phng thch chm, vo khong t 4 n 12 gi. Thi gian bn thi ca
mesalamine v N-acetyl-5-aminosalicylic acid vo khong 12 gi, nhng thng dao ng trong
khong t 2 n 15 gi. C s khc bit ln gia ngi ny v ngi khc v nng trong
huyt tng ca mesalamine v N-acetyl-5-aminosalicylic acid v v thi gian bn hy sau khi
ung vin Tidocol.
DC L LM SNG
Nghin cu lm sng :
Trong bnh vim lo t i trng tin trin t nh n va : Hai nghin cu c kim sot, i
chng vi placebo chng minh hiu lc ca vin Tidocol trn nhng bnh nhn b vim lot
i trng tin trin t nh n va. Trong mt nghin cu ngu nhin, m i, a trung tm,
thc hin trn 158 bnh nhn, Tidocol liu 1,6 g/ngy v 2,4 g/ngy c i chiu vi
placebo. liu 2,4 g/ngy, vin Tidocol lm gim cc triu chng bnh, vi 21 trn 43 (49%)
bnh nhn dng Tidocol cho thy c ci thin th hin trn soi i trng sigma, so vi 12 trn
44 (27%) bnh nhn dng placebo (p = 0,048). Ngoi ra, nhm dng Tidocol liu 2,4 g/ngy cn
cho thy c ci thin ng k trong chy mu trc trng v s ln i tiu.
Liu 1,6 g/ngy khng cho thy c hiu qu n nh.
Trong mt nghin cu ngu nhin th nh, m i, i chng vi placebo trong vng 6 tun
trn 87 bnh nhn b vim lo t i trng, vin Tidocol liu 4,8 g/ngy cho kt qu soi i trng
sigma c ci thin 28 trn 48 bnh nhn (74%), so vi 10 trn 38 bnh nhn (26%) bnh nhn
dng placebo (p = 0,001). Ngoi ra, nhm bnh nhn dng Tidocol liu 4,8 g/ngy cng cho kt
qu ci thin trn tt c cc triu chng nhiu hn so vi nhm dng placebo.
Duy tr s thuyn gim trong bnh vim lot i trng : Trong mt nghin cu ngu nhin, m
i, i chiu vi placebo, a trung tm, k o di trong 6 thng, thc hin trn 264 bnh nhn
c iu tr vi Tidocol liu 0,8 g/ngy (n = 90), liu 1,6 g/ngy (n = 87), hay c cho dng
placebo (n = 87). T l cc bnh nhn c iu tr vi liu 0,8 g/ngy khng cho kt qu thuyn
gim trn ni soi ng k v mt thng k so vi nhm dng placebo. Phn tch trn 174 bnh
nhn c iu tr vi Tidocol 1,6 g/ngy hay c cho dng placebo, Tidocol duy tr c s
thuyn gim vim lo t i trng 61 trn 87 bnh nhn (70,1%), so vi 42 trn 87 (48,3%) bnh
nhn c cho dng placebo (p = 0,005).
Phn tch 4 th nghim dng Tidocol, liu t 0,8 g/ngy n 2,8 g/ngy, i chiu vi
sulfasalazine, liu t 2 g/ngy n 4 g/ngy (n = 200). Vic iu tr cho kt qu thnh cng
59 trn 98 bnh nhn (59%) i vi Tidocol v 70 trn 102 bnh nhn (69%) i vi
sulfasalazine, khng c s khc bit ng k.

Nghin cu v nh hng trn kh nng sinh sn ca nam gii : Tc ng ca Tidocol

(mesalamine) trn kh nng sinh sn ca nam gii c nh gi qua mt nghin cu. Chn
bnh nhn (di 40 tui) b vim lo t i trng mn tnh c du hiu thuyn gim trn lm sng
khi iu tr vi sulfasalazine liu t 2 n 3 g/ngy, sau chuyn qua dng Tidocol liu tng
ng (0,8-1,2 g/ngy) trong vng 3 thng. C ci thin v s lng tinh trng (p < 0,02) v v
hnh thi (p < 0,02) tt c trng hp. Ci thin v tnh di ng ca tinh trng (p < 0,001) xy
ra 8 trn 9 bnh nhn.
CH NH
iu tr vim lo t i trng tin trin t nh n trung bnh.
Duy tr s thuyn gim trong bnh vim lo t i trng.
iu tr ngn hn bnh Crohn.
CHNG CH NH
Qu mn vi cc salicylate hay vi bt kz thnh phn no ca thuc.
Bnh nhn b hp mn v.
THN TRNG LC DNG
Nhng im thn trng chung :
bnh nhn b hp mn v, vin Tidocol c th b gi li lu d dy do c th chm gii
phng mesalanine i trng.
Cc triu chng ca vim i trng nng ln c ghi nhn 3% bnh nhn c iu tr vi
Tidocol trong mt kho st lm sng c kim sot. Phn ng cp tnh ny, c trng bi tng co
tht, au bng, tiu chy c mu, i khi c st, nhc u, bt n, nga, pht ban, v vim kt
mc, c ghi nhn sau khi khi u vi Tidocol cng nh vi cc bit dc khc ca
mesalamine. Cc triu chng thng s khi sau khi ngng dng Tidocol.
Mt vi bnh nhn tng b phn ng qu mn vi sulfasalazine cng c th b cc phn ng
tng t khi dng vin Tidocol hay cc thuc khc c cha sulfasalazine hay c chuyn
thnh mesalamine.
Thn :
Suy thn, k c suy thn nh, v vim thn k cp tnh v mn tnh, c bo co bnh
nhn c iu tr vi vin Tidocol cng nh vi cc thuc khc c cha sulfasalazine hay
c chuyn thnh mesalamine. Trong nhng nghin cu trn ng vt (chut cng, ch), thn
l i tng chnh m thuc th hin c tnh. liu xp x 750-1000 mg/kg (gp 15-20 ln liu
khuyn co s dng cho ngi c trng lng trong bnh 50 kg tnh theo mg/kg v gp 3-4 ln
nu tnh theo mg/m2), mesalamine gy hoi t nh thn. V th, cn thn trng khi s dng
Tidocol (hay cc thuc khc c cha sulfasalazine hay c chuyn thnh mesalamine)
bnh nhn bit b suy thn hay c tin s b cc bnh l thn. Nn nh gi chc nng thn
trc khi iu tr v nh kz trong thi gian iu tr vi Tidocol.
Thng tin cho bnh nhn :

Bnh nhn cn phi c hng dn nut nguyn vin Tidocol, cn thn khng lm b lp v
bn ngoi ca vin thuc. Lp v ny c nghin cu nhm bo v hot cht thuc bn
trong cn nguyn vn, mc ch cho mesalamine th hin hiu lc tc ng i trng. C 2
n 3% bnh nhn trong cc kho st lm sng, vin thuc cn nguyn vn trong phn. Nhc
nh bnh nhn thng bo cho bc s bit nu iu ny xy ra lp i lp li. Bnh nhn b vim
lo t i trng cn phi c thng bo rng him khi no bnh s khi hn hon ton v nn
ngn nga kh nng bnh ti pht bng cch dng lin tc vin Tidocol vi liu duy tr.
Tng tc thuc : khng c tng tc thuc no c ghi nhn.
Tc ng gy ung th, t bin, nh hng trn kh nng sinh sn :
Mesalamine khng gy ung th khi th nghim trn chut cng liu cao n 480 mg/kg/ngy,
hay trn chut nh liu 2000 mg/kg/ngy. Cc liu ny cao gp 2,4 n 5,1 ln liu duy tr ti
a khuyn co cho ngi ca Tidocol l 1,6 g/ngy (32 mg/kg/ngy cho ngi c th trng
trung bnh 50 kg hay 1184 mg/m2), tng ng, da trn din tch da. Mesalamine cho kt qu
m tnh th nghim Ames v kh nng gy t bin, khng cm ng s trao i gia cc cp
nhim sc th (SCE : sister chromatid exchanges) v bt thng nhim sc th trong th
nghim in vitro trn t bo bung trng ca chut Hamster Chinese, v cng khng cm ng vi
nhn trong hng cu a sc ty xng ca chut nh. Mesalamine, vi liu ung n 480
mg/kg/ngy, khng gy tc ng bt li no trn kh nng sinh sn ca c chut cng c v
ci.
C thai :
Cc th nghim trn s sinh sn chut cng v th vi liu n 480 mg/kg/ngy khng cho
thy c tc ng gy qui thai hay c tnh trn phi gy bi mesalamine. Du vy, vn cha c
nhng th nghim y v c kim sot trn ph n c thai. Do cc kt qu nghin cu trn
ng vt khng phi lc no cng tin on c cho cc p ng khi s dng trn ngi, ch
dng thuc ny trong thi kz mang thai khi tht s cn thit.
Cho con b :
Mesalamine c tm thy trong sa m vi mt nng thp v cht chuyn ha N-acetyl ca
n cng c tm thy trong sa m vi nng cao hn. Trong khi { ngha ca iu ny trn
lm sng cn cha c xc nh, nn thn trng khi dng mesalamine cho ph n nui con
bng sa m.
S dng trong nhi khoa :
Tnh an ton v hiu qu ca Tidocol khi s dng cho tr em cha c xc nhn.
S dng trong lo khoa :
Cc th nghim lm sng ca Tidocol bnh nhn t 65 tui tr ln c s lng khng
kt lun rng tui ny c cho p ng khc vi nhng bnh nhn tr tui hay khng. Ni
chung, ngi gi cc chc nng gan, thn hay tim thng b gim, v thng c nhng bnh
khc km theo hay dng ng thi vi nhng loi thuc khc, cn thn trng khi k toa Tidocol

cho ngi gi.

Thuc ny ch yu c bi tit qua thn, do nguy c xy ra cc phn ng ph ngi b
suy thn thng cao hn. Do ngi gi thng b suy thn, cn thn trng khi k toa thuc ny.
Bn trn cng c lu { rng cn phi nh gi chc nng thn trc khi iu tr v nh kz
trong thi gian iu tr vi Tidocol.
TC DNG NGOI
Mesalamine c nh gi trn 3685 bnh nhn b vim rut khng c hiu (a s b vim
lo t i trng) trong nhiu nghin cu m v c kim sot. Cc phn ng ph c ghi nhn
trn lm sng thng nh v t khi. Nhng tc dng ph nu di y c th xy ra khng
lin quan n vic iu tr v tng t nh nhng trng hp c ghi nhn trong cc
nghin cu ngn hn v di hn v nhng kho st tip theo sau khi tip th thuc ra th
trng.
Trong 2 nghin cu lm sng ngn hn (6 tun) c i chiu vi placebo thc hin trn 245
bnh nhn, trong 155 bnh nhn c chn ngu nhin cho dng vin mesalamine, 5 bnh
nhn (3,2%) thuc nhm dng mesalamine gin on vic iu tr do c nhng tc dng ph
so vi 2 bnh nhn (2,2%) trong nhm dng placebo. Cc phn ng bt li khin cho h ngng
khng dng vin mesalamine bao gm (mi nhm tc dng ph c ghi nhn mt bnh
nhn) : tiu chy v vim i trng nng ln ; chng mt, bun nn, au cc khp, v nhc
u ; pht ban, ng lm v to bn ; kh ming, bt n, au tht lng, mt nh hng nh, kh
tiu nh v tng co tht ; nhc u, bun nn, bt n, au n, nn ma, co tht c, nng u,
tai, v st.
Cc tc dng bt li xy ra nhng bnh nhn dng mesalamine chim t l 2% hay nhiu hn
trong 2 nghin cu ngn hn, m i, c i chiu vi placebo c nu trn bao gm nhc
u, au bng, hi, bun nn, chng mt, suy nhc, tiu chy, au lng, st, pht ban, kh
tiu... i vi cc tc dng bt li ny, ch c pht ban l chim tn xut xy ra cao khi tng liu
mesalamine trong cc nghin cu trn.
Cc bt thng kt qu xt nghim :
Tng AST (SGOT) hay ALT (SGPT), tng phosphatase kim, tng GGT, tng LDH, tng bilirubin,
tng creatinine huyt thanh v BUN.
LIU LNG v CCH DNG
iu tr vim lo t i trng tin trin t nh n trung bnh v bnh Crohn :
Liu thng thng cho ngi ln : mi ln 2 vin, ngy 3 ln (tng cng 2,4 g/ngy), trong vng
6 tun.
Duy tr s thuyn gim trong bnh vim lo t i trng :
Liu khuyn co cho ngi ln l 1,6 g/ngy, chia lm nhiu ln. Thi gian iu tr thng l 6
thng.
QU LIU

Lm dng thuc : khng c trng hp no c ghi nhn.

L thuc thuc : khng c trng hp no c ghi nhn sau khi iu tr di hn vi
mesalamine.
Qu liu :
Hai trng hp qu liu tr em c bo co. Mt b trai 3 tui ung 2 g mesalamine
c iu tr vi ipecac v than hot tnh ; khng c tc dng ph no xy ra. Mt b trai 3
tui khc, nng khong 16 kg, ung khng bit chnh xc l bao nhiu, ti a khong 24 g
mesalamine nghin trong cht lng (vin mesalamine b lp bao phim) ; em b ny c
iu tr bng cch cho ung nc cam v than hot tnh, v cng khng c tc dng ph no
xy ra. ch, cho dng liu n 6 g vin mesalamine tc ng chm s gy hoi t nh thn
nhng khng gy cht. Liu ny tng ng gp 12,5 ln liu khuyn co cho ngi. (da trn
liu 2,4 g/ngy cho ngi nng 50 kg). Nhng liu n ng ung ca vin mesalamine
mt lp bao phim cho dng trn chut nh v chut cng vi liu tng ng l 5000 mg/kg v
4595 mg/kg, hay liu 3000 mg/kg c cho dng trn kh cynomolgus, gy t vong ng k.

513.

TILCOTIL

HOFFMANN - LA ROCHE
Vin nn d b 20 mg : hp 30 vin.
Vin ta dc 20 mg : hp 10 vin.
L bt pha tim 20 mg : hp 1 l bt + 1 ng nc ct pha tim 2 ml - Bng B.
THNH PHN
cho 1 vin
Tnoxicam

20 mg

(Lactose)

cho 1 ta dc
Tnoxicam

20 mg

cho 1 n v thuc tim

Tnoxicam

20 mg

ng dung mi : Nc ct pha tim

2 ml

TNH CHT
Tnh cht dc l :
- Tnoxicam l mt thuc khng vim khng c nhn stroide thuc nhm oxicam.
- Hot tnh khng vim, gim au v h nhit.
- Hot tnh c ch s tng hp prostaglandine.
- Hot tnh c ch kt tp tiu cu
Tnh cht dc ng hc :
- Hp thu - Phn phi :
Sau khi ung, t noxicam c hp thu trong vng t 1 n 2 gi. Thuc c hp thu hon
ton. Thc n lm chm tc hp thu ca t noxicam nhng khng lm thay i lng kh
dng sinh hc. Sau khi tim bp, 90% nng cc i ca tnoxicam trong huyt tng s t
sau 25 pht
Tnoxicam gn kt vi protine huyt tng t l 99,2%.
Nng ca thuc trong huyt tng tng t l vi liu s dng cho n 40 mg.
Thi gian bn hy ca thuc khong 70 gi. Khi dng lu di liu 20 mg/ngy, nng ca
thuc trng thi cn bng s t c sau 15 ngy. Nng thuc trong huyt tng quan
st c sau mt nm iu tr cng tng ng vi nng sau ngy iu tr th 15.
- Chuyn ha - Bi tit :
Sau khi chuyn ha t noxicam c o thi gn nh hon ton : cht chuyn ha quan trng
nht l dn xut 5 hydroxyl ca nhn pyridine c o thi ch yu qua ng tiu (28% liu
dng). Mt phn nh cht chuyn ha ny c o thi sau khi lin hp vi acide
glucuronique. Cht chuyn ha th hai c bi tit qua mt v chim khong 17% liu
dng. Cht ny c lin kt vi acide glucuronique v tr C7 hoc C8 ca vng thienyl.
Suy thn v x gan khng lm thay i ng k tnh cht dc ng hc ca tnoxicam, ngoi
tr s gn kt vi protine huyt tng c th b gim xung.
Nhng d kin thu c v cc thng s dc ng hc ngi ln tui khng c khc bit g
so vi ngi tr.
CH NH
Ch nh ca t noxicam c da trn hot tnh khng vim ca thuc, mc quan trng ca
nhng biu hin bt dung np m thuc c th gy ra, v v tr ca thuc trong danh mc nhng

thuc khng vim hin ang lu hnh.

Nhng ch nh c gii hn trong :
iu tr triu chng trong thi gian lu :
- Cc bnh vim thp khp mn, nht l vim a khp dng thp, vim cng khp hoc nhng
hi chng tng t, v d nh hi chng Fiessinger-Leroy-Reiter.
- Vi trng hp thoi ha khp gy au v gim chc nng.
iu tr triu chng ngn hn trong cc cn cp tnh ca :
- Thp ngoi khp (cn au b vai cp, vim gn...).
- Cc bnh thoi ha khp.
CHNG CH NH
Tin cn d ng vi tnoxicam v cc cht c hot tnh tng t : Mt vi bnh nhn c th ln
cn suyn, nht l nhng ngi d ng vi aspirine.
Lot d dy t trng ang tin trin.
Suy gan nng.
Suy thn nng.
Vim i trng v i trng xch ma tin trin.
Thai kz ( ng vt, cc nghin cu thc nghim cha ghi nhn c thuc c nh hng n
s sinh sn hoc gy d dng trn phi thai, tuy nhin do cha nhng d kin lm sng,
nhng kt qu ny khng th em p dng cho ngi).
Tr em di 15 tui.
- Lu { :
Do nhng biu hin tiu ha trm trng c th xy ra, nht l nhng bnh nhn ang c
iu tr bng thuc khng ng cn c bit theo di s xut hin ca nhng triu chng v
tiu ha. Trong trng hp c xut huyt tiu ha, cn ngng ngay iu tr.
Nu c pht ban ngoi da trong khi ang dng thuc, cng cn ngng ngay iu tr. Tht vy,
tng t nh i vi nhng thuc khng vim khng c nhn stroide khc, phn ng trm
trng ngoi da kiu Stevens-Johnson hoc Lyell cng c th xy ra.
THN TRNG LC DNG
Tin cn lo t d dy t trng.
Lc bt u iu tr, cn theo di cht ch lng nc tiu v chc nng thn nhng bnh
nhn suy tim, x gan v b thn h, nhng bnh nhn ang dng thuc li tiu, nhng bnh
nhn suy thn mn v nht l ngi ln tui.
Vng trnh thai : c th b gim hiu qu trong khi ang iu tr bng cc thuc khng vim
khng c nhn stroide (AINS).
Do cha nghin cu y , t noxicam khng c ch nh cho ph n ang cho con b.
TNG TC THUC
Khi dng tnoxicam cng lc vi nhng thuc sau y, cn theo di cht ch tnh trng lm

sng v sinh hc ca bnh nhn :

Khng nn phi hp :
- Tnoxicam c th lm tng tc dng ca cc thuc khng ng ng ung v h parine (tng
nguy c xut huyt do c ch chc nng ca tiu cu v kch thch nim mc ng tiu ha).
Tuy nhin khi cn thit phi kt hp vi cc thuc khng vitamine K, nn theo di t l
prothrombine do nguy c c th lm tng tc dng khng ng ca thuc.
- Tnoxicam c th lm tng tc dng h ng huyt ca cc sulfamide (gii phng chng khi
s gn kt vi protine huyt tng).
- Tnoxicam c kh nng l mt tc nhn gy tng lithium/mu, c th t n ngng gy c
: tuy nhin nu s phi hp ny l cn thit, phi theo di lng lithium/mu iu chnh liu
lithium cho thch hp trong v sau khi phi hp thuc.
Thn trng khi phi hp :
- T noxicam cng c kh nng gy tng c tnh trn mu ca mthotrexate.
- Tnoxicam c th lm gim hot tnh ca cc thuc li tiu (tc dng li niu v h huyt p).
- T noxicam khng c dng chung vi triamterene do gy suy gim chc nng thn c
biu hin bng tnh trng tng nit/mu v cr atinine/mu.
- Tnoxicam c th tc dng cng lc vi :
Ticlopidine (tng tc dng chng kt tp tiu cu) : trong trng hp cn kt hp, phi theo di
thi gian mu chy.
Cc thuc khng vim khng c nhn st roide khc (tng nguy c gy lo t v xut huyt).
Khng nn s dng phi hp vi aspirine liu cao, v aspirine lm tng phn t do v tng s
o thi ca tnoxicam.
- Cc thuc bng d dy c hydroxyde aluminium lm chm s hp thu nhng khng lm thay
i kh dng sinh hc ca tnoxicam.
TC DNG NGOI
- H tiu ha : bun nn, nn, au thng v, ri lon nhu ng rut : tnoxicam c th gy
lot, thng, xut huyt tiu ha.
- Phn ng tng mn cm c th l :
Ngoi da (pht ban, ni mn, nga).
H hp (c th ln cn suyn, c bit nhng bnh nhn d ng vi aspirine v cc khng
vim khng nhn stroide khc).
- H thn kinh trung ng :
Rt him trng hp c ri lon thn kinh gic quan (chng mt nhc u).
- Thay i sinh hc :
Gan : c th tng SGOT - SGPT, phosphatase-kim hoc gamma GT.
Thn : tng va phi lng cratinine/mu (him gp).
H mu : gim tiu cu v bch cu va phi, c bit l gim bch cu ht.

LIU LNG v CCH DNG

Ngi ln - ng ung :
- 20 mg/ngy, mi ngy 1 ln, tc 1 vin.
- ngi ln tui hoc b nhiu bnh cng mt lc, nn bt u bng liu 10 mg/ngy m
bo l bnh nhn dung np thuc tt trc khi s dng liu thng thng.
- Vic iu chnh liu c th c thc hin ty theo p ng ban u ca iu tr bng cch
gim liu tenoxicam n 10 mg mi ngy trong trng hp c ci thin r trn lm sng.
Ngi ln - ng tim bp :
- ng tim bp ch s dng trong nhng ngy u tin ca vic iu tr. Sau c th tip
tc iu tr bng ng ung hoc qua hu mn.
- Tng liu mi ngy c ch nh cho t noxicam dng ng tim l 20 mg mi ngy, tim 1
ln mi ngy, tc 1 l.
Tilcotil 20 mg ng tim bp cn c dng khi ng ung v ng nht hu mn khng
th s dng c.
Vi nhng hiu bit hin nay v nhn chung cng khng thy c tng thm hiu qu khi tng
liu ca t noxicam, trong khi tn s ca cc tc dng ph li tng theo liu s dng. Do ,
thc t khng nn vt qu liu 20 mg/ngy.
QU LIU
Trong trng hp qu liu, ch iu tr triu chng

514.

TILDIEM

SANOFI SYNTHELABO VIETNAM

vin nn 60 mg : hp 30 vin.
THNH PHN
cho 1 vin
Diltiazem chlorhydrate

60 mg

(Lactose)
DC LC
Thuc c ch dng calci thuc dn xut ca benzothiazepine.
Diltiazem l cht c ch dng calci i qua mng t bo vo c tim v c trn mch mu v nh
th lm gim nng calci trong t bo :
- Diltiazem lm tng lu lng mch vnh do lm gim khng lc.

- C tc ng lm chm nhp tim va phi v lm gim va phi khng lc ca ng mch do

lm cho tim lm vic t li.
- Khng c tc dng inotrope m tnh ngay c khi phi hp vi cc thuc chn bta.
- Hiu lc trn lm sng ca diltiazem c chng minh qua cc nghin cu c kim sot
mi dng au tht ngc.
DC NG HC
Diltiazem c hp thu nhanh qua ng tiu ha. Thuc hin din trong mu sau khi ung 30
pht.
Nng nh trong huyt tng t c t gi th 3 n gi th 4. Thi gian bn hy trong
huyt tng t 4 n 8 gi. Diltiazem gn vi protein huyt tng vi t l 80-85%. Diltiazem
c chuyn ha mnh gan ; cht chuyn ha c hot tnh l desacetyl diltiazem. Thuc c
o thi qua mt 65% v qua nc tiu 35%.
Ch ghi nhn c t 0,2 n 0,4% diltiazem khng b bin i trong nc tiu.
C mi tng quan ng k gia liu dng v nng trong huyt tng. Tng liu s dn n
tng nng trong huyt tng nhng khng gy hin tng bo ha.
Khi dng liu n nh th nng trong huyt tng cng n nh.
C mi tng quan gia nng trong huyt tng v hiu lc ca thuc.
Nng trong huyt tng cn thit t c hiu qu iu tr mong mun l t 70 n
200 ng/ml. Nng trong huyt tng dng nh phi cao hn trong trng hp cn au tht
ngc nng hn.
Dc ng hc ca thuc khng b thay i trong trng hp suy thn.
Cc nng trong huyt tng ca thuc ngi gi, ngi b suy thn, suy gan thng cao
hn ngi tr.
Diltiazem v cc cht chuyn ha ca n rt t b thm tch.
CH NH
Phng nga cn au tht ngc ch yu trong au tht do gng sc, au tht t nhin, au tht
Prinzmetal.
CHNG CH NH
Ri lon hot ng nt xoang.
Bloc nh-tht 2 v 3 khng t my.
Suy tim tri vi ph phi.
CH PHNG v THN TRNG LC DNG
Tng cng theo di bnh nhn b chm nhp tim hoc bnh nhn b bloc nh-tht 1 (do
tng nguy c). Ngc li, khng cn phi c nhng lu { c bit trong trng hp ch b bloc
mt nhnh.
bnh nhn ln tui, b suy thn v suy gan, cc nng ca diltiazem trong huyt tng c
th s tng. Nn c bit lu { n nhng im chng ch nh v thn trng lc dng v phi

tng cng theo di, c bit l tn s tim v in tm , vo thi gian u iu tr.

Trng hp phi gy m trong phu thut, cn thng bo cho chuyn vin gy m v vic ang
dng thuc.
Diltiazem c th c dng khng b nguy him cho nhng bnh nhn b cc ri lon mn tnh
ng h hp.
LC C THAI
Cc th nghim trn ng vt cho thy thuc c tc dng gy qui thai. Hin cha c nhng s
liu thch ng kt lun v nguy c gy d tt khi dng cho ph n mang thai. Do khng
nn dng thuc ny trong thi gian mang thai. Tuy nhin khng cn phi ph thai khi pht hin
c thai trong thi gian dng thuc m phi ngng thuc v thn trng theo di.
LC NUI CON B
Diltiazem c bi tit qua sa m vi t l rt thp, tuy nhin khng nn cho con b trong
thi gian iu tr.
TNG TC THUC
Chng ch nh phi hp :
- Dantrolene (tim truyn), do thn trng : ng vt, mt s trng hp rung tht gy t
vong c ghi nhn khi dng chung verapamil v dantrolene ng tnh mch. Do vic
phi hp thuc c ch calci v dantrolene l c th gy nguy him. Tuy nhin, mt s bnh
nhn c iu tr ng thi bng nifedipine v dantrolene m khng b bt li g.
Khng nn phi hp :
- Esmolol (trng hp b hng chc nng ca tht tri) : ri lon tnh t ng (chm nhp tim
qu mc, ngng xoang), ri lon dn truyn nh-tht v suy tim (do hip ng tc dng).
- Thuc chng lon nhp : diltiazem c cc c tnh ca thuc chng lon nhp, v trn phng
din tng tc thuc n c xem nh l mt thuc thuc nhm ny. Do khng nn k toa
chung v c th lm tng cc tc dng ngoi do phi hp tc dng. Nu phi phi hp th cn
phi c bit thn trng, tng cng theo di lm sng v kim tra in tm .
Thn trng khi phi hp :
- Thuc chn a : tng tc dng h huyt p v c th gy h huyt p t th nng. Nu phi phi
hp th tng cng theo di cc du hiu ca h huyt p t th trong nhng gi u dng
thuc chn a v nht l trong thi gian u iu tr.
- Amiodarone : tng nguy c b chm nhp tim hoc bloc nh tht, nht l ngi ln tui. Theo
di lm sng v in tm .
- Thuc chn bta : ri lon tnh t ng, (chm nhp tim qu mc, ngng xoang), ri lon dn
truyn xoang-nh v nh-tht v suy tim (do hip ng tc dng). Nu phi phi hp th cn phi
tng cng theo di lm sng v kim tra in tm , nht l ngi ln tui v thi gian u
iu tr.
- Ciclosporine : tng nng ciclosporine trong mu do c ch s chuyn ha ca ciclosporine.

Cn phi gim liu ciclosporine, kim tra chc nng thn, nh lng nng ciclosporine trong
mu v chnh liu trong thi gian phi hp thuc v sau khi ngng phi hp.
- Carbamazepine : tng nng carbamazepine trong mu vi cc du hiu qu liu (do c ch
s chuyn ha gan). Cn theo di lm sng v ty tnh hnh, c th gim liu carbamazepine.
- Esmolol (trng hp chc nng tht tri bnh thng) : ri lon tnh t ng (chm nhp tim
qu mc, ngng xoang), ri lon dn truyn xoang nh, nh-tht v suy tim (do hip ng tc
dng). Cn theo di lm sng v in tm .
- Midazolam (ng tnh mch) : tng nng midazolam trong huyt tng (do gim chuyn
ha gan) vi tng cc du hiu an thn. Theo di lm sng v gim liu trong thi gian dng
phi hp vi diltiazem.
- Rifampicine : lm gim nng thuc i khng calci trong mu do tng chuyn ha gan.
Theo di lm sng v chnh liu thuc i khng calci trong thi gian iu tr chung vi
rifampicine v sau khi ngng thuc ny.
- Baclofene : tng tc dng h huyt p. Theo di huyt p ng mch v chnh liu thuc h
huyt p nu cn.
Nn lu { khi phi hp :
- Thuc tr trm cm nhm imipramine : tng tc dng h huyt p vi nguy c b h huyt p
t th (do hip ng tc dng).
- Thuc an thn kinh : tng tc dng h huyt p vi nguy c b h huyt p t th (do hip
ng tc dng).
TC DNG NGOI
Pht ban da, ph chi di.
Suy nhc, bun ng, nhc u, mt ng, chng mt, ri lon tiu ha, nhp tim chm, bloc
xoang-nh, bloc nh-tht.
Him khi tng lng transaminase, vim gan.
LIU LNG v CCH DNG
Ngi ln : mi ln ung 1 vin (60 mg), ngy 3 ln vo u ba n.
Trong nhng trng hp nng, c th tng liu n 4 vin (240 mg), thm ch 6 vin (360 mg)
mi ngy.
Ung thuc khng nhai, vi mt t nc.
QU LIU
Cc du hiu ng c cp tnh do qu liu c th i t h huyt p n try tim mch, chm
nhp xoang c km theo hoc khng gy phn ly ng nhp, cc ri lon dn truyn nh - tht.
Cp cu bnh vin, gm : ra rut, bi niu thm thu.
Cc thuc gii c c ngh : atropine, adrenaline, glutagon, c th dng calcium
gluconate.

515.

TOBRADEX

ALCON
huyn dch nh mt : l 5 ml - Bng B.
thuc m tra mt : tube 3,5 g - Bng B.
THNH PHN
cho 1 ml huyn dch
Tobramycine

3 mg

Dexamethasone

1 mg

Cht bo qun : benzalkonium chloride.

T dc : tyloxapol, edetate disodium,
sodium chloride, hydroxyethyl cellulose,
sodium sulfate, acid sulfuric v/hay
sodium hydroxide ( iu chnh pH) v
nc tinh khit.

cho 1 g thuc m
Tobramycine

3 mg

Dexamethasone

1 mg

Cht bo qun : chlorobutanol.

T dc : du khong cht v m
petrolatum trng.
M T
Thuc m v Huyn dch nh mt Tobradex (tobramycin v dexamethasone) l nhng dng
thuc kt hp khng sinh v steroid a liu v v trng dng ti ch mt.
DC L LM SNG
Corticoid lm gim p ng vim ca nhiu loi tc nhn khc nhau v chng c th tr hon

hay lm chm lin vt thng. V corticoid c th c ch c ch khng ca c th chng li

nhim trng cho nn c th s dng ng thi vi thuc khng khun khi thy rng tc dng c
ch c { ngha quan trng v mt lm sng. Dexamethasone l mt loi corticoid mnh.
Trong hn hp bao gm c thnh phn khng sinh (tobramycin) c tc dng chng li nhng
vi khun nhy cm. Nhng nghin cu in vitro cho thy rng tobramycin c tc dng chng li
nhng chng nhy cm ca cc loi vi khun sau y :
Cc Staphylococcus, bao gm S. aureus v S. epidermidis (coagulase dng tnh v coagulase
m tnh), k c nhng chng khng vi penicillin.
Cc Streptococcus, bao gm mt s loi lin cu tan mu nhm A, vi chng khng tan mu v
mt vi chng Streptococcus pneumoniae. Pseudomonas aeruginosa, Escherichia coli, Klebsiella
pneumoniae, Enterobacter aerogenes, Proteus mirabilis, Morganella morganii, hu ht cc
chng Proteus vulgaris, Hemophilus influenzae v mt vi loi Neisseria.
Nhng nghin cu v tnh nhy cm ca vi khun cho thy rng trong mt vi trng hp
nhng vi khun khng vi gentamicin vn cn nhy cm vi tobramycin. Hin nay cha xut
hin mt qun th vi khun ln khng vi tobramycin : tuy nhin s khng ca vi khun
c th pht trin khi s dng thuc ko di.
Cha c s liu v mc hp thu ton thn ca thuc m v huyn dch nh mt Tobradex :
tuy nhin, ngi ta bit rng c th c hp thu ton thn i vi cc thuc dng ti ch mt.
Nu cho huyn dch nh mt Tobradex vi liu lng ti a trong 48 gi u (nh hai git vo
mi mt mi 2 gi) v nu c hp thu ton thn hon ton (iu ny rt t kh nng xy ra) th
khi c liu lng dexamethasone hng ngy s l 2,4 mg. Liu thay th sinh l{ thng thng l
0,75 mg/ngy. Sau 48 gi u nu cho huyn dch nh mt Tobradex vi liu 2 git vo mi mt
mi 4 gi, khi liu dexamethasone cho s l 1,2 mg/ngy. Dng thuc m tra mt
Tobradex 4 ln mi ngy c hai mt th liu dexamethasone l 0,4 mg/ngy.
CH NH
Thuc m v Huyn dch Tobradex c ch nh cho nhng tnh trng vim mt c p ng
vi steroid v c ch nh dng corticosteroid v khi c nhim khun nng mt hay c nguy c
nhim khun mt. Cc loi steroid nh mt c ch nh trong nhng tnh trng vim kt mc
mi v kt mc nhn cu, vim kt mc v bn phn trc nhn cu khi ngi ta chp nhn nguy
c vn c ca vic s dng steroid nhm gim c ph n v tnh trng vim. Chng cng
c ch nh s dng trong trng hp vim mng b o trc mn tnh v tn thng gic
mc do ha cht, tia x hay bng nhit do d vt. Vic s dng mt loi thuc hn hp c thnh
phn chng nhim trng c ch nh khi nguy c nhim khun nng mt cao hay khi thy
c kh nng hin din mt s vi khun nguy him mt.
CHNG CH NH
Vim biu m gic mc do Herpes simplex (vim gic mc dng cnh cy), bnh u b, thy
u v nhiu bnh khc ca kt mc v gic mc do virus gy ra. Nhim Mycobacterium mt.

Bnh do nm gy ra cc b phn ca mt. Qu mn vi mt s thnh phn ca thuc.

Tuyt i chng ch nh s dng loi thuc phi hp ny sau khi m ly d vt gic mc khng
c bin chng.
CH PHNG
Khng dng tim vo mt. i vi mt s bnh nhn c th xy ra hin tng mn cm vi
cc loi aminoglycoside s dng ti ch. Ngng thuc nu xy ra phn ng mn cm.
S dng steroid ko di c th dn n glaucome, km theo tn thng thn kinh th gic,
khim khuyt th lc v th trng v cataract di bao sau. Nn theo di nhn p mt cch
thng quy mc d bin php ny kh thc hin tr em v nhng bnh nhn khng hp tc.
S dng thuc di ngy c th lm gim p ng ca c th v v vy tng nguy c nhim trng
th pht mt. Trong trng hp bnh lm mng gic mc hay cng mc, c trng hp
thng nhn cu khi s dng cc steroid ti ch. Trong nhng bnh nung m cp tnh mt, cc
steroid c th che lp du hiu nhim trng hay lm nng thm nhim trng hin c.
THN TRNG LC DNG
Nn phng kh nng nhim nm gic mc sau khi s dng steroid ko di. Cng nh cc ch
phm khng sinh khc, dng thuc ny ko di c th dn n bi tng vi sinh vt khng nhy
cm bao gm c nm. Nu xy ra bi nhim, nn bt u iu tr thch hp. Khi cn k toa
nhiu ln, hay bt c khi no khm lm sng thy cn nn khm bnh nhn vi s h tr ca
cc dng c phng i nh n khe v khi cn nn nhum huznh quang.
LC C THAI
Ch nn s dng Thuc m v Huyn dch nh mt Tobradex trong thi kz thai nghn nu thy
kh nng c li nhiu hn nguy c i vi thai.
LC NUI CON B
Khng bit c thuc c bi tit qua sa m hay khng. V c rt nhiu loi thuc bi tit qua
sa, do nn quyt nh tm thi ngng nui con b khi s dng Thuc m v Huyn dch
nh mt Tobradex.
TC DNG NGOI
xy ra nhng tc dng ngoi khi s dng nhng thuc phi hp steroid v khng khun,
nhng phn ng ny c th l do thnh phn steroid, thnh phn khng khun hay do c hn
hp. Cha c s liu chnh xc v tn sut cc tc dng ngoi . Nhng tc dng ngoi { thng
gp nht i vi tobramycin nh mt (Tobrex) l nhng phn ng c ti ch i vi mt v
qu mn, bao gm nga v ph mi mt, v kt mc. Nhng phn ng ny xy ra cha n
4% s bnh nhn. Nhng tc dng ngoi { khc cha c bo co ; tuy nhin, nu s dng
ng thi tobramycin ti ch mt v nhng khng sinh ton thn khc thuc nhm
aminoglycoside th nn thn trng theo di tng nng thuc trong huyt thanh. Nhng phn
ng do thnh phn steroid l : tng nhn p (IOP) c kh nng tin trin n glaucome, tn
thng thn kinh th khng thng xuyn ; cataract di bao sau ; v chm lin vt thng.

Nhim khun th pht : nhim khun th pht c xy ra sau khi s dng nhng thuc cha
steroid v khng sinh. Nhim nm gic mc c bit d xy ra sau khi s dng steroid di
ngy. Khi iu tr bng steroid phi xem xt kh nng nhim nm trong bt kz trng hp
no c lot gic mc ko di.
Nhim khun th pht cng xy ra do gim p ng ca c th.
LIU LNG v CCH DNG
Huyn dch : nh vo ti cng kt mc 1 hay 2 git mi 4-6 gi. Trong 24 n 48 gi u c th
tng liu ln n 1 hay 2 git mi 2 gi. Nn gim dn s ln nh thuc khi c ci thin cc du
hiu lm sng. Thn trng khng nn ngng iu tr qu sm.
Thuc m : tra mt lng nh (di khong 1/2 inch, khong 1 cm) vo ti cng kt mc 3-4
ln/ngy.
C th dng Thuc m tra mt Tobradex trc khi i ng kt hp vi huyn dch nh mt
Tobradex trong ngy. Ban u khng nn k toa qu 20 ml hay 8 g v khng nn k toa li m
khng c nh gi thm nh phc ha trn trong phn Thn trng lc dng.
BO QUN
Gi nhit 46 n 80oF (27oC).
Gi l huyn dch ng thng v lc k trc khi dng.
thuc xa tm tay tr em.

516.

TOBRAMICINA IBI

IBI
c/o GENESIS PHARMA
Dung dch tim bp, tnh mch 100 mg/2 ml : ng 2 ml, hp 1 ng.
Dung dch tim bp, tnh mch 150 mg/2 ml : ng 2 ml, hp 1 ng.
THNH PHN
cho 1 ng
Tobramycin sulfate

152,4 mg

tnh theo : Tobramycin

100 mg

T dc : phenol, sodium metabisulfite,

sodium edetate, nc ct

cho 1 ng
Tobramycin sulfate

228,6 mg

tnh theo : Tobramycin

150 mg

T dc : phenol, sodium metabisulfite,

sodium edetate, nc ct
DC LC
Khng khun nhm aminoglycosides.
CH NH
Tobramycin c ch nh c bit trong iu tr cc nhim khun ng tit niu, h tun
hon v mu (nhim trng mu), xng, da v cc m mm, b my tiu ha, h thn kinh
trung ng (vim mng no) v ng h hp di, gy bi cc vi khun nhy cm. Thuc
c ch nh trong la chn th hai iu tr cc nhim khun do E. coli v staphylococcus.
CHNG CH NH
- Qu mn cm vi tobramycin hay vi bt c thnh phn no ca thuc, hay vi nhm
aminoglycosides.
- Ph n c thai v cho con b.
THN TRNG LC DNG
Bnh nhn c iu tr vi tobramycin hay vi bt c cc khng sinh khc thuc nhm
aminoglycosides cn phi lu { tun th cc ch dn y khoa khi dng thuc, do cc khng sinh
thuc nhm ny tim tng c tnh trn thn v tai. nh hng trn dy thn kinh s 8 c th
gia tng, nht l bnh nhn b suy thn, hoc bnh nhn dng liu aminoglycosides cao hn
hay lu hn thi gian c khuyn co. Cc biu hin c thn kinh khc bao gm u oi, cm
gic kim chm, co c v co git. Nguy c b ic do dng aminoglycosides cng tng khi nng
nh hay nng cn ca aminoglycosides cng tng. Bnh nhn c th b tn thng c tai m
khng c cc triu chng bo trc trn thnh gic trong thi gian iu tr, nhng li xy ra v
tip tc gy nh hng khi kt thc iu tr. Cc biu hin c tnh trn thn him khi xy ra
trong nhng ngy u iu tr v thng s hi phc. Chc nng ca thn v dy thn kinh s 8
nn c theo di chc ch bnh nhn b suy thn hay nghi b suy thn v nhng bnh
nhn lc u c chc nng thn bnh thng nhng trong khi iu tr li c du hiu suy thn.
Trong qu trnh iu tr, nn kim tra nh kz nng nh v nng cn ca aminoglycosides
nhm trnh cho thuc t n nng gy c, ng thi cn m bo vic iu tr ch
nhng liu lng thch hp (xem Kim tra nng trong huyt thanh). Nn tin hnh xt
nghim nc tiu pht hin gim t trng, tng protein niu, t bo v tr niu. Nn o nh
kz BUN, creatinin huyt thanh v thanh thi creatinin. Nu c, nn o thnh lc nhiu

ln, nht l nhng bnh nhn c nguy c. Nn ngng iu tr khi c du hiu tn thng c
tai hay thn. Thn trng khi dng tobramycin tr sinh thiu thng hay tr s sinh do chc
nng thn cn cha hon chnh, c th dn n gia tng thi gian bn hy ca thuc.
Nn trnh dng ng thi hay tip theo cc khng sinh khc cng c c tnh trn thn kinh v
thn (nh amikacin, streptomycin, neomycin, kanamycin, gentamycin v paramomycin),
cephalosporin, viomycin, polymixin B, colistin, cisplatin v vancomycin. Khng nn dng chung
aminoglycosides vi cc thuc li tiu nh furosemide v ethacrinic acid. Mt s thuc li tiu
c c tnh trn tai v khi dng ng tim tnh mch c th lm tng c tnh ca
aminoglycosides, ng thi lm thay i nng ca khng sinh trong huyt thanh v trong
m.
Thuc c cha sodium metabisulfite, do c th gy phn ng d ng v hen ph qun nng
nhng bnh nhn b nhy cm, nht l bnh nhn b hen ph qun.
Tobramycin khng nh hng n kh nng tp trung khi li xe hay vn hnh my.
Kim tra nng trong huyt thanh :
Cn kim tra nng nh v nng cn trong thi gian iu tr. Nng nh trong huyt
thanh khng nn vt qu 12 mg/ml trong thi gian di. Nng cn tng cao (trn 2 mg/ml)
c th l du hiu tch ly thuc ti m. S tch ly thuc, nng nh qu cao, ln tui v
tng liu dng l nhng yu t gp phn gy c tnh trn tai v trn thn. Mt cch tng qut,
nn kim tra nng ca thuc trong huyt thanh sau liu th hai v liu th ba, sau mi 34 ngy trong sut thi gian iu tr, nu c du hiu suy thn th nn kim tra thng xuyn
hn. Bng cch ny, c th duy tr vic iu tr (xem Liu lng v Cch dng), nht l nhng
bnh nhn b bnh nng v suy thn, hay nhng bnh nhn b nhim bi cc vi khun t nhy
cm hay bnh nhn dng liu cao.
Bnh nhn b bng : bnh nhn b bng din rng, dc ng ca aminoglycosides b thay
i. nhng bnh nhn ny, nn kim tra nng ca tobramycin trong mu v tnh ton
cho liu thch hp.
Bnh nhn ang c gy v cm :
Kh nng ngng th ko di hay th pht c th xy ra khi dng tobramycin nhng bnh
c gy v cm bng cc tc nhn gy chn thn kinh c nh succinylcholine, tubocurarin,
decamethone hay bnh nhn c truyn mt lng ln mu c citrat. Nu xy ra nghn thn
kinh c, c th iu tr bng mui canxi.
LC C THAI v LC NUI CON B
Aminoglycosides c th gy tn thng bo thai khi dng trong thi gian mang thai. Chng ch
nh dng thuc trong thi gian mang thai hay cho con b, do c th gy c tnh trn cho tai
ca bo thai v tr s sinh.
TNG TC THUC
Trnh dng ng thi vi cc thuc li tiu mnh nh furosemide v ethacrinic acid, do chng

tim tng c tnh trn tai. Dng phi hp tobramycin vi cc thuc khc cng c c tnh trn
tai v trn thn nh streptomycin, kanamycin, gentamycin, cephalosporin, polymixin B v
cholistin c th gy hip ng tc ng.
TC DNG NGOI
Cc tc dng ph thng ch xy ra vi mt t l thp bnh nhn c chc nng thn bnh
thng khi khng vt qu liu lng v thi gian iu tr khuyn co. ngi gi, bnh nhn
b suy thn, vt qu liu lng v thi gian iu tr khuyn co th nguy c xy ra tc dng
ngoi s gia tng. Cc phn ng ph c trng ca khng sinh nhm aminoglycosides c
ghi nhn l c tnh trn c tai ca dy thn kinh s 8, nh chng mt, git nhn cu, c ting
vo vo trong tai v gim thnh lc. Tng BUN v tiu t cng c ghi nhn.
Tc tc dng ph khc :
Cc tc dng ph khc c th xy ra khi dng tobramycin gm thiu mu, mt bch cu ht,
gim tiu cu, st, pht ban, nga, m ay, bun nn, nn, tiu chy, nhc u, ng lm, hay
ln ln v mt kh nng nh hng, v au ti ni tim thuc. Cc bt thng c th xy ra khi
dng tobramycin gm tng transaminase huyt thanh (SGOT-SGPT) v lactic dehydrogenase,
gim canxi, magn, natri v kali trong huyt thanh, gim bch cu, tng bch cu v tng bch
cu i toan.
LIU LNG v CCH DNG
Tobramycin c th c dng bng ng tim IM hay IV.
Tim IM :
Ngi ln : bnh nhn c chc nng thn bnh thng, liu khuyn co ca tobramycin l 1
mg/kg mi 8 gi. Thi gian iu tr trung bnh l 7-10 ngy. C th tng liu n 5 mg/kg/ngy
bnh nhn b nhim trng nng. Liu ny nn c gim xung cn 3 mg/kg/ngy cng sm
cng tt.
Tr em : 3-5 mg/kg/ngy, chia lm cc liu bng nhau mi 8-12 gi.
Tr s sinh : 2 mg/kg mi 12 gi, i vi cc tr cn nng t 1,5 n 2,5 kg.
Truyn IV :
Ch nn dng ng truyn IV khi khng th dng ng tim IM. Nng tobramycin sau khi
pha khng vt qu 1 mg/ml (0,1%). Thi gian truyn t 1-2 gi. Liu khi dng ng IV tng
t nh i vi ng tim IM. Khng nn dng phi hp tobramycin vi cc thuc khc.
bnh nhn b suy thn, nn chnh liu ty theo mc suy thn.
Tng hp :
Tobramycin tng hp vi a s cc dch truyn ng tnh mch thng dng hin nay, nhng
khng tng hp vi dung dch heparin v c th tng tc ha hc vi b-lactam. Tobramycin
tng k vi cc dch truyn c cha alcohol, sargramostin v clyndamycin phosphate nu
c pha long trong dung dch glucose tim. Tobramycin tng k v mt vt l vi
carbenicillin. Khng c ha ln vi cc thuc khc trong cng mt bm tim hay cng mt

ng truyn tnh mch.

QU LIU
Nu xy ra qu liu hay phn ng c, tin hnh thm phn mu hay phc mc lm gim
nng ca thuc trong huyt thanh.

517.

TONICALCIUM

BOUCHARA
c/o TEDIS
Dung dch ung dng cho ngi ln : hp 20 ng thuc 10 ml.
Dung dch ung dng cho tr em : hp 20 ng thuc 5 ml.
THNH PHN
cho 1 ng thuc dng cho ngi ln
DL-lysine ascorbate

500 mg

Calcium ascorbate

500 mg

tng ng : Ca

47 mg

tng ng : Acide ascorbique

700 mg

(Saccharose)

(3,5 g)

cho 1 ng thuc dng cho tr em

DL-lysine ascorbate

250 mg

Calcium ascorbate

250 mg

tng ng : Ca

23,5 mg

tng ng : Acide ascorbique

350 mg

(Saccharose)

(1,75 g)

DC LC
Chng suy nhc : cung cp vitamine C, acide amine thit yu v calcium.
CH NH
Ri lon tng trng, ri lon to xng.
Ri lon tng trng : Nhc c, ci xng, chn n, mt mi, lao lc th cht v tinh thn, thi
kz phc hi bnh.
Mang thai, cho con b.
CHNG CH NH
- Si calcium.
- Si urate v oxalate.
CH PHNG v THN TRNG LC DNG
Trng hp bnh nhn b tiu ng, cn lu { rng thuc c cha saccharose (xem trong mc
Thnh phn).
TNG TC THUC
Do thuc c cha calcium, trng hp c phi hp vi ttracycline dng ung, nn ung cc
thuc ny cch nhau t nht 3 gi (v c th xy ra tng tc khi hp thu).
LIU LNG v CCH DNG
Nh vi tt c cc tr liu chng suy nhc, nn k toa ngn hn.
Ngi ln : mi ln ung 1 ng 10 ml, 2 hoc 3 ln/ngy.
Tr em (t 30 thng n 15 tui) : mi ln ung 1 ng 5 ml, 1 n 3 ln/ngy.
Thuc ung c mi thm d chu, pha vi 2 n 3 ln th tch nc, ung trc ba n.

518.

TOPLEXIL sirop

XNLD RHNE POULENC RORER

[AVENTIS PHARMA]
xir : chai 90 ml
THNH PHN
cho 1 mung caf
Oxommazine

1,65 mg

Guaifnsine

33,3 mg

T dc : glycerol, acide citrique

monohydrate, natri citrate, hng
caramel tng hp, caramel (E150), dung
dch saccharose, nc tinh khit va .
DC LC
- Oxommazine : khng histamine H1 thuc nhm phenothiazine, c tc dng c ch ho.
- Guaif n sine : st trng ng h hp.
CH NH
iu tr triu chng cc trng hp ho khan v ho do kch thch ni ngi ln v tr em trn 1
tui, nht l ho vo lc chiu ti v ban m.
CHNG CH NH
Tuyt i :
- D ng vi cc thnh phn ca thuc v nht l vi khng histamine.
- C tin s mt bch cu ht.
- Vi dng bnh tng nhn p.
- Tiu kh do bnh tin lit tuyn hoc do cc bnh khc.
Tng i :
- Khng dng chung vi sultopride.
- Trong 3 thng u thai kz hay trong thi kz cho con b.
CH PHNG
- Trng hp ho c m cn phi t nhin v l yu t c bn bo v phi-ph qun.
- Trc khi k toa thuc chng ho, cn tm nguyn nhn gy ho c iu tr c hiu.
- Nu ho khng vi 1 loi thuc ho dng theo liu thng thng, khng nn tng liu m cn
khm li tnh trng lm sng ca bnh nhn.
THN TRNG LC DNG
- V thuc c th gy bun ng nn ngi li xe v vn hnh my mc cn ch .
- Khng dng chung vi cc thc ung c ru hay thuc cha cn.
- Khng phi nng hay tip xc vi tia cc tm trong thi gian iu tr.
- Ngi bnh tiu ng hay king ng cn ch { lng ng saccharose trong thuc (3,7 g
ng trong 5 ml v 7,3 g trong 10 ml).
LC C THAI
Mc du khng c mt tc dng gy qui thai no c ghi nhn th vt cng nh ngi,
tuy nhin tnh v hi ca Toplexil cha c xc nhn trn ph n mang thai.
LC NUI CON B
Vi hm lng cha trong Toplexil, oxom mazine khng c tm thy trong sa m.
TNG TC THUC

Lin quan n oxommazine :

Khng nn phi hp :
- Alcool : alcool lm tng tc dng an thn ca thuc khng histamine H1, lm gim s tp trung
do c th gy nguy him cho ngi li xe cng nh ang vn hnh my mc. Trnh ung
ru cng nh cc thuc c cha alcool.
- Sultopride : nguy c phn ln l ri lon nhp tm tht, nht l cn lon nhp tht kch pht.
Mt s phi hp cng cn nn lu { :
- Thuc h huyt p : tng tc dng h huyt p v c th gy h huyt p th ng (hip ng
tc dng). i vi guanthidine, xem pha trn.
- Atropine v cc cht c tc ng atropinic (thuc chng trm cm nhm imipramine, a s cc
thuc khng histamine H1, thuc chng lit rung khng cholinergic, cc thuc chng co tht c
tc ng atropinic, disopyramide) : phi hp cc tc dng ngoi ca nhm atropine nh gy b
tiu, to bn, kh ming...
- Cc thuc khc gy trm cm h thn kinh trung ng (dn xut ca morphine c tc dng
gim au v chng ho, a s cc thuc khng histamine H1, barbiturate, benzodiazpine, cc
thuc gii lo khng thuc h benzodiazpine, clonidine v cc thuc cng h) : tng trm cm
c th gy hu qu nghim trng, nht l i vi ngi li xe v vn hnh my mc.
TC DNG NGOI
Thuc c th gy ra mt s ngi vi tc dng ph kh chu. Trong trng hp ngng
thuc ngay v n tham vn bc s :
- Bun ng, ngy ngt, nht l lc mi bt u iu tr.
- Ri lon tr nh hay tp trung, chng mt.
- Mt phi hp chc nng vn ng, run ry.
- Ln, o gic.
- Kh ming, ri lon th gic, b tiu, to bn, nh trng ngc, gim huyt p ng mch.
- Phn ng d ng : sn , chm, ban , m ay, ph Quincke, sc phn v, d ng da do
nng.
- Suy gim nng bch cu trong mu.
- Suy gim bt thng tiu cu.
LIU LNG v CCH DNG
Ngi ln v tr em trn 40 kg (hoc 12 tui) : ngy 4 ln, mi ln 10 ml.
Tr em : liu lng hng ngy ty trng lng c th :
- Tr em di 8 tui : theo ch nh ca bc s.
- Tr t 25 n 30 kg : 2 n 3 ln/ngy, mi ln 10 ml.
- Tr t 30 n 40 kg : 3 n 4 ln/ngy, mi ln 10 ml.
Nu cn, liu dng c th lp li cch nhau t nht 4 gi.
Vic iu tr ch nn ngn ngy v ch gii hn vo nhng lc ho.

QU LIU
Lin quan n oxommazine :
Du hiu tr em : cc du hiu thng gp nht l hng phn vi kch ng, o gic, mt iu
ha, khng phi hp c ng tc, ma vn v co git. Cc du hiu cui ch xy ra tng hi ;
run ry vi ng tc ma vn c th l cc du hiu tin triu. ng t c nh v gin ra, da
mt bng v st cao l cc du hiu thng xy ra khi ng c atropine. Sau cng c th xy
ra hn m nng vi try tim mch ; t vong c th xy ra trong 2 n 98 gi.
Du hiu ngi ln : cc triu chng xy ra khc hn : trm cm v hn m c th xy ra
trc giai on kch ng v co git. Him khi xy ra st v bng mt nh tr em.
iu tr : iu tr triu chng, c th tr h hp hoc h hp nhn to, dng thuc chng co
git.

519.

TORENTAL

HOECHST-MARION-ROUSSEL
[AVENTIS PHARMA]
Dung dch tim tim truyn tnh mch 100 mg/5 ml : hp 6 ng thuc 5 ml.
Vin bao tc ng ko di 400 mg : hp 20 vin.
THNH PHN
Torental 100 mg/5 ml :
cho 1 ng
Pentoxifylline

100 mg

Torental LP 400 mg :
cho 1 vin
Pentoxifylline

400 mg

DC LC
Pentoxifylline phc hi kh nng thay i hnh dng cho hng cu b suy gim trong vim
ng mch, h tr cho chng i qua cc mao mch c ng knh nh v do lm tng s
ti mu cho nhng m b thiu mu.
ngi, di nh hng ca pentoxifylline, kh nng thay i hnh dng ca hng cu tng, c
th o trc tip bng cch lc qua nhng l c ng knh nh hn ng knh ca hng cu

hay gin tip bng cch kho st nht ca mu ton phn. iu ny c nghin cu
ngi kho mnh v bnh nhn b suy tun hon ngoi bin.
Nh vy, pentoxifylline chng li s gim kh nng thay i hnh dng ca hng cu, mt ri
lon sinh l bnh m vai tr c chng minh trong nhiu qu trnh bnh l{ (c bit l
trong cc bnh ng mch chi di).
Kt qu l hng cu c ng knh t 7 n 8 microns c th i qua d dng cc mao mch c
ng knh t 3 n 5 microns. Vi tun hon c ci thin m khng lm tng lu lng ti
cc vng bnh thng, khng li cho cc vng b thiu mu.
- Pentoxifylline lm gim nng fibrinogne trong mu nhng vn cn trong gii hn bnh
thng ; theo s hiu bit cho n nay, khng th gn mt { ngha lm sng cho hin tng
gim khng ng k ny.
- Thm na, in vitro, pentoxifylline chng li tc dng ca Interleukine 1 v Tumor Necrosis
Factor trn bch cu a nhn trung tnh, gm lm chm s di chuyn, tng gn dnh v
phng thch qu mc ion superoxyd v hydrogen peroxyd. Li ch lm sng ca cc kt qu th
nghim ny phi c xc nh bi nhng cng trnh b sung.
- Pentoxifylline cng c tc dng lm dn c trn thnh mch mu.
DC NG HC
Pentoxifylline khng gn vo cc protine huyt tng. N c chuyn ha mnh. 7 cht
chuyn ha c xc nh trong mt s c hot tnh. Nhng bin i sinh ha xy ra ch
yu trn chui hexyle bn.
Thuc c thi ch yu trong nc tiu (trn 95% sau 24 gi) v di dng chuyn ha. Thi
gian bn hy khong 1 gi. Cc sn phm chuyn ha c th tch t trong suy thn nng.
ngi ln tui, vn tc thi chm hn l ngi tr.
Torental LP 400 mg c bo ch di dng vin bao gii phng hot cht chm. Sinh kh dng
gn 100%. Nng ti a trong mu t c khong 2 n 3 gi sau khi ung thuc, 2 gi
tip theo nng gim cn phn na v duy tr n nh trong vng 13 gi sau khi ung thuc.
Ung thuc 2 ln mi ngy, vo bui sng v bui ti, duy tr hiu lc ca thuc trong
vng 1 ngy m.
CH NH
- Bnh tc ng mch ngoi vi do x cng ng mch hoc tiu ng (au cch hi, au lc
ngh).
- Tn thng thuc dinh dng (lot v hoi th chn).
- Bnh l mch mu no.
- Ri lon tun hon mt do thoi ha mch mu.
CHNG CH NH
- Tng cm vi pentoxifylline, cc methylxanthines khc hay bt c thnh phn no ca thuc.
- Xut huyt nng.

- Xut huyt vng mc lan rng.

THN TRNG LC DNG
- Khng nn dng cho tr em, ph n c thai, ph n cho con b.
- Phi theo di cn thn khi dng cho bnh nhn lon nhp tim nng, nhi mu c tim, huyt p
thp, suy thn, suy gan nng, d xut huyt (ang dng thuc khng ng hay c ri lon ng
mu).
- i vi dng tim : phi cn thn theo di bnh nhn c bit c nguy c h huyt p (bnh
mch vnh nng hay hp mch mu nui no).
LC C THAI v LC NUI CON B
Lc c thai : th nghim trn sc vt khng cho thy tc dng gy qui thai. Vi ngi, khng
r nguy c v thiu d liu chnh xc. Khng nn dng trong thi gian mang thai.
TNG TC THUC
- C th lm tng tc dng h ng huyt ca insulin v cc thuc h ng huyt ung.
- C th lm tng tc dng h huyt p ca cc thuc h p v cc thuc c tim nng h p.
- C th lm gim nng theophylline trong huyt thanh.
TC DNG NGOI
- c bit khi dng liu cao hay truyn tnh mch qu nhanh, cc triu chng sau y c th xy
ra : thng gp : nng bng mt, tc bng, y bng, bun nn, nn hay tiu chy ; thnh
thong : nhp tim bt thng (th d nhp tim nhanh).
- Da : thnh thong c nga, da v ni m ay.
- H thn kinh trung ng : thnh thong c chng mt, nhc u, bt rt v ri lon gic ng.
- Phn v : trong vi trng hp ring l, phn ng phn v hay ging phn v th d nh ph
mch - thn kinh, c tht ph qun v i khi sc. Ngay khi va xut hin mt triu chng phn
v hay ging phn v, phi lp tc ngng ngay pentoxifylline v bo bc s.
- Gan : trong vi trng hp ring l, mt trong gan v tng men transaminase.
- Tim mch : him, au tht ngc, h huyt p v c bit bnh nhn d xut huyt, c th
xut huyt.
- Huyt hc : trong vi trng hp ring l, gim tiu cu.
LIU LNG v CCH DNG
Liu v ng dng ty thuc loi v mc nng ca ri lon tun hon v dung np ca
bnh nhn.
Thuc vin :
Liu thng thng l 400 mg x 2-3 ln/ngy hay 600 mg x 2 ln/ngy. Nut nguyn vin thuc
gia hoc ngay sau ba n vi na ly nc.
Thuc tim :
- Pha thuc vo trong mt dung dch thch hp truyn tnh mch. Truyn chm 100 mg
pentoxifylline trong t nht 60 pht.

- Bnh tc ng mch ngoi vi giai on II (au cch hi) v ri lon tun hon mt : 100-600
mg x truyn tnh mch 1-2 ln/ngy. Nu dng phi hp vi thuc vin pentoxifylline, tng liu
cho c hai dng thuc l 1200 mg/ngy.
- Bnh tc ng mch ngoi vi giai on III v IV : 1200 mg/ngy hoc truyn lin tc 24 gi
hoc chia ra 2 ln mi ln 600 mg truyn trong t nht 6 gi.
- Bnh nhn suy gim chc nng thn ( thanh thi creatinine <= 30 ml/pht) : gim 30-50%
liu.
- Bnh nhn suy gan nng : gim liu ty theo dung np ca bnh nhn.
- Bnh nhn c huyt p thp hay d b h huyt p (bnh mch vnh nng, hp mch mu nui
no) : khi u bng liu thp v tng dn dn.
QU LIU
Triu chng :
- Cc triu chng u tin ca qu liu cp pentoxifylline l bun nn, chng mt, tim p
nhanh hay h huyt p.
- Sau c th st, kch ng, nng bng mt, hn m, mt phn x, co git v i nu (xut
huyt tiu ha).
iu tr :
Khng c thuc gii c. Nu mi ung thuc, ra bao t v cho than hot. Dng cc bin php
tr liu tng qut v c hiu tch cc iu tr qu liu cp v phng nga bin chng.

520.

TOT'HEMA

INNOTECH
c/o ZUELLIG
dung dch ung : ng 10 ml, hp 20 ng.
THNH PHN
cho 1 ng
Gluconate ferreux tnh theo Fe

50 mg

Manganse gluconate tnh theo Mn

1,33 mg

Cuivre gluconate tnh theo Cu

0,70 mg

(Saccharose)
(Glucose)

DC LC
Cung cp cht st di dng mui ferreux (50 mg nguyn t st cho mi ng thuc).
DC NG HC
Mui ferreux thng c hp thu yu (10-20% liu ung vo). S hp thu ny tng ln khi m
ngun d tr cht st trong c th gim.
Qu trnh hp thu din ra phn ln t trng v phn gn hng trng.
CH NH
iu tr thiu mu thiu st.
D phng thiu cht st ph n c thai, tr cn b sinh thiu thng, tr sinh i hoc c m
b thiu cht st, khi ngun cung cp cht st t thc n khng m bo cung cp cht st.
CHNG CH NH
Qu ti cht st, c bit l trong thiu mu thng thng hoc tng cht st trong mu nh
trong bnh thiu mu vng bin (bnh Thalassmie), thiu mu do suy ty.
CH PHNG
- Dng thuc khng c hiu qu trng hp gim cht st trong mu c phi hp vi hi chng
vim.
- Trong chng mc c th, nn phi hp iu tr b sung cht st vi iu tr ngun gc bnh.
THN TRNG LC DNG
- Ung nhiu tr s gim hp thu cht st.
- Trng hp bnh nhn ang theo ch n king hydrate carbone, cn lu { rng mi ng
thuc c cha 3 g saccharose.
- trnh kh nng rng b nhum en (s t khi sau ), trnh ngm lu dung dch thuc
trong ming.
TNG TC THUC
Khng nn phi hp :
- St (dng mui ; ng tim) : xu, thm ch sc do gii phng nhanh st t dng phc hp v
do bo ha sidrophiline.
Thn trng khi phi hp :
- Ciprofloxacine : gim sinh kh dng ca ciprofloxacine do to chelate v do mt tc dng
khng chuyn bit trn kh nng hp thu ca ng tiu ha. Dng cc thuc ny cch xa nhau

(trn 2 gi nu c th).
- Cycline (ng ung) : gim hp thu ca cycline ng tiu ha (do hnh thnh phc cht).
Dng cc thuc ny cch xa nhau (2 gi chng hn).
- Mui, oxyde, hydroxyde ca Mg, Al v Ca (ph nim mc d dy-rut) : gim hp thu ng
tiu ha ca mui st. Dng cc thuc ny cch xa nhau (2 gi chng hn).
- Diphosphonate (ng ung) : gim hp thu cc diphosphonate. Dng cc thuc ny cch xa
nhau (2 gi chng hn).
TC DNG NGOI
Ri lon tiu ha : bun nn, nng rt d dy, to bn hoc tiu chy.
Phn c mu en l bnh thng.
LIU LNG v CCH DNG
Pha long ng thuc trong nc (c ng hoc khng), ung trc cc ba n, chia lm nhiu
ln trong ngy.
iu tr :
- Ngi ln : 100 n 200 mg Fe/ngy.
- Tr em/Tr nh nhi : 5 n 10 mg Fe/kg/ngy.
D phng :
- Ph n mang thai : 50 mg Fe/ngy, trong 2 qu sau ca thai kz (hoc t thng th t).
Thi gian iu tr :
Thi gian iu tr phi iu chnh s thiu mu v hi phc li ngun d tr cht st,
ngi ln l 600 mg ph n v 1200 mg nam gii.
Thiu mu thiu st : 3 n 6 thng ty theo mc hao ht ngun d tr, c th lu hn nu
nguyn nhn gy thiu mu khng c kim sot.
QU LIU
Sau khi ung mt lng ln thuc, nhng trng hp qu liu mui st c ghi nhn, c
bit tr di 2 tui : cc triu chng bao gm b kch ng v hoi t d dy-rut, a s trng
hp c km theo nn, ma v tnh trng sc.
Cn iu tr cng sm cng tt, tin hnh ra d dy vi dung dch natri bicarbonate 1%.
S dng cc cht to phc chelate rt c hiu qu, nht l khi dng dfroxamine, ch yu khi
nng cht st trong mu trn 5 mg/ml. Tnh trng sc, mt nc v bt thng acide-base
c iu tr bng cc phng php c in.

521.

TOZAAR

TORRENT
Vin nn 25 mg : v 10 vin.
Vin nn 50 mg : v 10 vin.
THNH PHN
cho 1 vin
Losartan potassium

25 mg

cho 1 vin
Losartan potassium

50 mg

DC LC
Losartan (Losartan potassium) l thuc hng u ca nhm thuc mi dng ung c tc ng
i khng chuyn bit th th angiotensin II (type AT1), c ch nh trong iu tr tng huyt
p.
Losartan l thuc hng u trong nhm thuc mi tr tng huyt p, l cht i khng chuyn
bit th th angiotensin II (type AT1). Angiotensin II l cht c hiu lc gy co mch v l
hormone c hot tnh nguyn pht ca h thng renin-angiotensin-aldosterone, ng vai tr
chnh trong sinh l bnh ca tng huyt p. Tc ng n nh ni mi tim mch ca angiotensin
II c th hin thng qua th th AT1. Losartan l mt hot cht tng hp c hiu lc, dng
ung, gn kt c chn lc vi cc th th AT1. Trn in vitro v in vivo, c losartan v cht
chuyn ha c hot tnh dc l ca n (E-3174) ngn chn tt c cc tc ng v mt sinh l c
lin quan n angiotensin II, bao gm tc ng gy co mch, gi mui-nc v kch thch giao
cm. iu ny dn n gim huyt p. Losartan khng c tc ng i khng v khng gn kt
hay chn cc th th ca cc hormone khc hay cc knh ion quan trng trong s iu ha tim
mch.
DC NG HC
Sau khi ung thuc, losartan c hp thu tt v chu s chuyn ha khi qua gan ln u ; sinh
kh dng ton thn xp x 33%. Khong 14% ca liu ung ca losartan c chuyn thnh cht
chuyn ha c hot tnh, E-3174. Nng nh trung bnh trong huyt tng ca losartan t
c sau 1 gi v ca cht chuyn ha E-3174 l 3-4 gi. Trong khi nng ti a trong huyt
tng ca E-3174 cao khong gp i so vi ca losartan, din tch di ng cong (AUC) ca
cht chuyn ha cng cao gp 4-8 ln nh ca losartan. C losartan v cht chuyn ha gn kt
cao vi protein huyt tng, ch yu l albumin, vi t l t do trong huyt tng i vi tng

cht l 1,3% v 0,2%. Gn kt vi protein huyt tng hng nh vi mi nng ca thuc

trong mu khi dng liu khuyn co. Khi losartan c dng ng ung, c khong 4% liu
dng c bi tit ra nc tiu di dng khng i v khong 6% di dng cht chuyn ha
c hot tnh. Losartan v cc cht chuyn ha ca n cng c chuyn ha ng k qua mt.
Losartan cng c ghi nhn c hiu qu tt trn huyt ng bnh nhn b suy tim. Gim p
lc mao mch phi bt v gim nhp tim cng c ghi nhn bnh nhn suy tim dng losartan.
CH NH
iu tr tng huyt p t nh n va, dng n hay phi hp vi mt thuc tr tng huyt p
khc.
CHNG CH NH
Qu mn cm vi mt trong cc thnh phn ca thuc. Losartan cng chng ch nh cho ph
n c thai, v nu pht hin c thai phi ngng losartan lp tc.
THN TRNG LC DNG
Gim th tch ni mch :
Bnh nhn b gim th tch ni mch (nh khi dng thuc li tiu liu cao), c th xy ra triu
chng tt huyt p. Trng hp ny cn c iu chnh u tin trc khi bt u dng
losartan, hay dng losartan khi u vi liu thp.
Suy gan :
Cc d liu v dc ng hc cho thy nng ca losartan trong huyt tng tng ng k
khi dng cho bnh nhn b x gan. Nn cn nhc dng liu thp bnh nhn c tin s b suy
gan.
Hp ng mch thn :
Cc thuc khc c tc ng ln h thng renin-angiotensin-aldosterone c th lm tng ur
mu v creatinine huyt thanh bnh nhn b hp ng mch thn hai bn hay hp ng
mch thn bnh nhn ch c mt thn cn hot ng. Trong khi ch xc nhn, iu ny cng
c th xy ra i vi cc thuc i khng th th angiotensin II.
LC C THAI v LC NUI CON B
Mc du kinh nghim dng losartan trn ph n c thai cn hn ch, cc th nghim trn ng
vt vi losartan cho thy thuc ny lm tn thng v cht phi v th con mi sinh, c ch
c hiu l do tc ng ca thuc trn h thng renin-angiotensin-aldosterone. ngi, s
ti mu n thn ca bo thai, c lp vi s pht trin ca h thng renin-angiotensinaldosterone, bt u trong 3 thng th nh. Nu dng thuc trong 3 thng th nh v 3 thng
cui ca thai kz, thuc gy tc ng trc tip ln h thng renin-angiotensin-aldosterone, c
th lm tn thng v thm ch lm cht bo thai trong tin trnh pht trin ca bo thai.
Losartan chng ch nh dng trong thai kz, v nu pht hin c thai trong khi ang iu tr,
phi ngng losartan ngay lp tc. Hin cha bit losartan c c bi tit qua sa m hay
khng. Do thuc c th gy nhng tc dng bt li cho tr b m, nn cn nhc hoc ngng

thuc hay ngng cho con b m da trn tm quan trng ca vic iu tr cho ngi m. Tnh
an ton v hiu lc ca thuc khi dng cho tr em cha c xc nhn.
TNG TC THUC
Khng c tng tc thuc no ng k trn lm sng c ghi nhn vi losartan. Cc cht
thuc c kho st trong cc th nghim lm sng v dc ng bao gm
hydrochlorothiazide, digoxin, warfarin, cimetidine v phenobarbitone.
TC DNG NGOI
Cc tc dng ph ca losartan thng nh v thong qua v khng cn phi ngng thuc. Ton
b cc tc dng ph c ghi nhn vi losartan cng tng ng vi ca placebo. Trong
nhng nghin cu lm sng c kim sot khi iu tr bnh tng huyt p v cn, triu chng
chng mt l tc dng ph duy nht c lin quan n thuc vi tn sut xy ra nhm dng
losartan cao hn khi i chiu vi placebo (1% hay hn). Pht ban hn hu cng c bo co,
mc du tn sut thp hn so vi nhm dng placebo trong cc nghin cu lm sng c kim
sot. Ngc li vi cc thuc c ch men chuyn, losartan khng gy tch t bradikinin v do
tc dng ph gy ho ca losartan thp hn ng k so vi cc thuc c ch men chuyn khc v
khng cao hn khi so snh vi placebo trong mt s nghin cu lm sng.
LIU LNG v CCH DNG
Liu khi u v liu duy tr ca losartan l 25 mg hay 50 mg, ngy 1 ln a s bnh nhn,
trong ba n hay xa ba n. Hiu lc h p ti a t c sau khi khi u iu tr t 3 n 6
tun. Mt s bnh nhn c th phi cn n liu cao 100 mg, ngy 1 ln.
Ngi gi :
- Di 75 tui : khng cn phi chnh liu khi u.
- Trn 75 tui : hin nay kinh nghim iu tr cn hn ch nhm tui ny ; nn dng liu khi
u thp hn 25 mg, ngy 1 ln.
Suy thn :
Khng cn phi chnh liu khi u bnh nhn b suy thn nh (thanh thi creatinine 20-50
ml/pht). Bnh nhn b suy thn t va n nng (thanh thi creatinine < 20 ml/pht) hay bnh
nhn chy thn nhn to, nn dng liu khi u thp hn 25 mg, ngy 1 ln.
Gim th tch ni mch :
bnh nhn b gim th tch ni mch (nh khi dng thuc li tiu liu cao), c th xy ra triu
chng tt huyt p. Trng hp ny cn c iu chnh u tin trc khi bt u dng
losartan, hay dng losartan khi u vi liu thp.
QU LIU
Cc s liu v qu liu ngi cn hn ch, cc biu hin thng l gy h huyt p v nhp tim
nhanh. C th lm chm nhp tim bng cch kch thch ph giao cm (ph v). Nu b h huyt
p, nn tin hnh cc bin php iu tr h tr. Khng th loi losartan cng nh cht chuyn
ha c hot tnh ca n l E-3174 bng cch thm phn mu.

522.

TRACRIUM

GLAXOWELLCOME
thuc tim 2,5 ml : hp 5 ng - Bng B.
THNH PHN
cho 1 ml
Atracurium besylate

10 mg

TNH CHT
Tracrium b bt hot bi s o thi Hofmann, mt qu trnh khng enzyme xy ra pH v
nhit sinh l, v bi s thy phn ester do cc men esterase khng c hiu.
S kt thc tc ng c ch thn kinh c ca Tracrium khng ph thuc vo s chuyn ha hay
o thi gan hay thn. Do , thi gian tc ng hu nh khng b nh hng khi chc nng
ca thn, gan hay h tun hon b suy gim.
Cc th nghim vi huyt tng ca nhng bnh nhn c nng pseudocholinesterase thp
cho thy rng qu trnh c hot ca Tracrium vn xc tin khng b nh hng.
Tracrium khng c tc dng trc tip trn nhn p v do thch hp cho vic s dng trong
phu thut nhn khoa.
S thay i pH mu v thn nhit ca bnh nhn trong gii hn sinh l khng nh hng ng
k thi gian tc ng ca Tracrium.
Tnh t bin : Atracurium c kho st trong ba th nghim v tnh t bin thc hin trong
thi gian ngn. Hot cht khng gy t bin trong th nghim in vitro Ames salmonella vi
nng ti a n 1000 mg/a hoc th nghim in vivo ty xng chut cng vi liu n
mc c th gy c ch thn kinh c. Trong th nghim th hai in vitro l th nghim u lympho
chut nht, khng quan st c tnh t bin vi liu n 60 mg/ml - vi nng ny c th
dit n 50% t bo c x l, tuy nhin hp cht cng gy t bin va phi nng 80
mg/ml khi khng c tc nhn chuyn ha v gy t bin yu nng rt cao (1200 mg/ml)
khi thm vo cc men chuyn ha. c hai nng ny, trn 80% t bo b tiu dit.
ng v mt bn cht s tip xc ca atracurium ngi, c th khng cn quan tm n nguy
c gy t bin cho bnh nhn chu gin c trong phu thut bng Tracrium.
Tnh gy ung th : Cc nghin cu v tnh cht gy ung th cha c thc hin.
Tnh sinh qui thai : Cc nghin cu trn th vt chng minh rng Tracrium khng gy tc
dng ng k trn s pht trin ca phi.

Kh nng sinh sn : Cc nghin cu v nh hng ln kh nng sinh sn cha c thc hin.

CH NH
Tracrium l mt tc nhn c ch thn kinh c cnh tranh khng kh cc c tnh chn lc cao
c s dng nh mt thuc h tr gy m tng qut thc hin vic t ni kh qun v lm
gin c vn trong qu trnh phu thut hay th my.
CHNG CH NH
Khng nn dng Tracrium cho bnh nhn bit c qu mn d ng vi thuc.
THN TRNG LC DNG
Ging nh cc tc nhn c ch thn kinh c khc, Tracrium gy lit c h hp cng nh cc c
vn khc nhng khng c nh hng ln tri gic. Ch nn dng Tracrium trong gy m ton b
khi c s gim st cht ch ca mt chuyn vin gy m cng vi y phng tin dng cho
vic t ng ni kh qun v my gip th.
Ging nh nhng thuc c ch thn kinh c khc, c kh nng phng thch histamine nhng
bnh nhn nhy cm trong qu trnh s dng Tracrium. Nn cn thn khi dng Tracrium cho
bnh nhn c tin s cho thy c qu mn gia tng vi tc dng ca histamine.
Tracrium khng c tc dng c ch hch hay thn kinh ph v khi dng liu lng theo khuyn
co. Do , Tracrium khng c tc dng c { ngha lm sng trn nhp tim khi dng liu khuyn
co v khng c tc dng chng tim chm gy ra do nhiu tc nhn gy m hay do kch thch
thn kinh ph v trong qu trnh phu thut. Ging nh nhng tc nhn c ch thn kinh c
khng kh cc khc, gia tng nhy cm vi atracurium c th gp nhng bnh nhn b nhc
c, nhng bnh v thn kinh c khc v ri lon in gii trm trng.
Nn tim chm Tracrium trong khong thi gian l 60 giy cho bnh nhn c th nhy cm bt
thng vi h huyt p ng mch, v d nhng ngi b gim th tch mu.
Cc nghin cu trn chng st cao c tnh th vt nhy cm (ln) v cc nghin cu lm sng
nhng bnh nhn nhy cm vi st cao c tnh cho thy rng Tracrium khng lm bng pht
triu chng ny.
Ging nh nhng tc nhn c ch thn kinh c khng kh cc khc, s khng c th xy ra
nhng bnh nhn b phng. Nhng bnh nhn ny c th cn tng liu ty vo thi gian tnh
t lc b bng v mc lan rng ca vt bng.
LC C THAI v LC NUI CON B
Ging nh nhng tc nhn c ch thn kinh c khc, ch nn dng Tracrium khi li ch cho
ngi m cao hn bt kz nguy c no c th xy ra cho thai nhi.
Tracrium thch hp duy tr s gin c trong qu trnh phu thut cesar do thuc khng i
qua nhau thai vi lng c { ngha trn lm sng khi dng liu khuyn co.
Khng bit c Tracrium c tit qua sa hay khng.
TNG TC THUC
S c ch thn kinh c to ra do Tracrium c th gia tng khi dng ng thi vi thuc gy m

bay hi, nh halothane, isoflurane v enflurane.

Ging nh tt c cc thuc c ch thn kinh c khng kh cc, su v/hoc thi gian c ch
thn kinh c c th tng do tng tc vi cc thuc sau :
Cc khng sinh, trong c aminoglycoside, polymyxine, spectinomycine, tetracycline,
lincomycine v clindamycine.
Cc thuc chng lon nhp : Propranolol, cc thuc c ch knh calcium, lignocaine,
procainamide v quinidine.
Cc thuc li tiu : Furosemide v c th l mannitol, thiazide v acetazolamide.
Magnesium sulfate.
Ketamine.
Mui lithium.
Cc thuc c ch hch : Trimetaphan, hexamethonium.
i khi, mt vi loi thuc c th lm nng thm hay lm l ra chng nhc c nng tim n
hay thc s gy ra hi chng nhc c ; gia tng nhy cm vi Tracrium c th l hu qu ca
cc thay i trn. Cc thuc ny bao gm nhiu loi khng sinh khc nhau, cc thuc c ch
beta (propranolol, oxprenolol), cc thuc chng lon nhp (procainamide, quinidine), cc thuc
vim khp (chloroquine, D-penicillamine), trimetaphan, chlorpromazine, steroide, phenytoine
v lithium.
Thi im khi pht ca c ch thn kinh c khng kh cc c th ko di v thi gian tc dng
ngn i nhng bnh nhn ang iu tr thuc chng co git mn tnh.
S kt hp cc thuc c ch thn kinh c khng kh cc v Tracrium c th gy c ch thn
kinh c qu mc mong i so vi khi dng mt liu Tracrium tng ng. Tc dng hip ng
c th thay i khi kt hp cc thuc khc nhau.
Khng nn dng mt thuc lm gin c kh cc, nh suxamethonium chloride lm ko di
tc dng c ch thn kinh c ca mt thuc khng kh cc nh atracurium do c th xy ra s
c ch phc tp v ko di kh ha gii vi cc thuc khng cholinesterase.
TC DNG NGOI
Cc tc dng ngoi khi s dng Tracrium c bo co gm c bng mt, h huyt p nh
thong qua hay co tht ph qun c quy cho s phng thch histamine. Rt him khi c phn
ng dng phn v c bo co trn bnh nhn dng Tracrium kt hp vi mt hay nhiu
thuc gy m.
LIU LNG v CCH DNG
Dng tim ngi ln : Tracrium c s dng theo ng tim truyn tnh mch.
Khong liu dng cho ngi ln : 0,3-0,6 mg/kg (ty theo thi gian c ch ton b cn thit) v
s gy gin c trong 15-35 pht.
t ni kh qun thng c th tin hnh 90 giy sau khi tim tnh mch 0,5-0,6 mg/kg.
Khi cn thit, s c ch hon ton c th duy tr khi b sung liu 0,1-0,2 mg/kg. Dng cc liu

duy tr lin tip khng lm tch t tc ng c ch thn kinh c.

Hi phc t pht vo cui giai on c ch xy ra khong 35 pht tnh theo s phc hi co c
n 95% chc nng thn kinh c bnh thng.
S c ch thn kinh c do Tracrium c th c nhanh chng ha gii vi liu chun cc thuc
khng cholinesterase, nh neostigmine v endrophonium, vi atropin km theo hay s dng
sn trc, m khng gy ti gin c.
Dng tim truyn ngi ln : Sau khi tim nhanh khi u mt lng 0,3-0,6 mg/kg/gi,
Tracrium c th dng duy tr s c ch thn kinh c trong qu trnh phu thut ko di bng
cch tim truyn lin tc vi tc 0,3-0,6mg/kg/gi.
Tracrium c th dng tim truyn trong phu thut bc cu tim phi vi tc tim truyn
c khuyn co. S h thp thn nhit n nhit 25-26oC lm gim tc bt hot ca
atracurium, do s c ch thn kinh c ton phn c th c duy tr vi tc vo khong
mt na tc tim truyn ban u khi h thn nhit.
Tracrium thch hp vi cc dung dch tim truyn sau trong khong thi gian s dng nu
bng di y :
Dung dch tim truyn

Khong thi gian

n nh

Dch truyn tnh mch Sodium chloride BP (0,9% khi lng/th

tch)

24

Dch truyn Glucose BP (5% khi lng/ th tch)

Dung dch Ringer USP

Dung dch sodium chloride(0,18% khi lng/th tch) v Glucose

8
(4% khi lng/th tch) BP
Dung dch hn hp Sodium Lactate BP (dch truyn Harmann)

Khi pha long vi nhng dch truyn ny c mt dung dch atracurium besylate c nng
0,5 mg/ml hay cao hn, dung dch thu c bn vng di nh sng ban ngy trong khong
thi gian ni trn nhit cho n 30oC.
S dng cho tr em : Liu lng tr em trn 1 thng tui cng ging nh liu cho ngi ln
tnh theo trong lng c th.
S dng cho ngi gi : Tracrium c th s dng liu chun cho bnh nhn cao tui. Tuy
nhin nn dng liu khi u thp nht trong khong liu s dng v tim tht chm.
S dng cho bnh nhn suy thn v/hoc suy gan : Tracrium c th c s dng liu chun

 tt c cc mc suy thn hoc suy gan, k c giai on cui.

S dng cho bnh nhn tim mch : bnh nhn mc bnh tim mch nng trn lm sng, nn
tim liu Tracrium khi u trong 60 giy.
Theo di : Thng cng ging nh cc tc nhn c ch thn kinh c, nn theo di chc nng
thn kinh c trong sut qu trnh s dng Tracrium chnh liu ring cho tng ngi.
Thn trng trong s dng : Tracrium b c hot mi trng pH cao v do khng nn trn
trong cng mt ng tim vi thiopentone hay bt kz cc cht kim ha. Khi chn tim qua tnh
mch nh, nn y Tracrium vo su trong tnh mch bng cch bm thm nc mui sinh l.
Khi cc thuc gy m khc c dng qua mt kim lun hay canule cng vi Tracrium, mi loi
thuc nn c bm su vo tnh mch vi mt lng nc mui sinh l.
QU LIU
Triu chng : Lit c k o di v cc hu qu ca n l du hiu ch yu ca vic qu liu.
iu tr : Cn duy tr ng th cng vi gip th p lc dng cho n khi c th t th c.
Cn thit cho an thn hon ton do tri gic khng b nh hng. C th lm hi phc nhanh hn
khi dng cc thuc khng cholinesterase sau dng thm atropine hay glycopyrrolate, khi c
du hiu hi phc.
BO QUN
Bo qun nhit trong khong 2-8oC. Trnh nh sng. Khng lm ng lnh thuc.
C th thuc trong mt thi gian ngn nhit cho n 30oC nhng ch trong trng hp
vn chuyn hay bo qun tm thi trong phng lnh. c lng khong 8% dc tnh b mt i
nu tn tr Tracrium 30oC trong vng mt thng.
Nn loi b Tracrium khng s dng sau khi m ng.

523.

TRANSAMIN

DAIICHI
c/o PHU THO PHARMA
c/o CT TNHH DP THIN THO
Vin nang 250 mg : hp 100 vin.
Vin nn 500 mg : hp 100 vin.
Dung dch tim tnh mch 5% : hp 10 ng thuc 5 ml.
Dung dch tim tnh mch 10% (Transamin S) : hp 10 ng thuc 2,5 ml, hp 10 ng thuc 10 ml
THNH PHN
cho 1 vin

Acide tranexamique

250 mg

cho 1 vin
Acide tranexamique

500 mg

cho 1 ng thuc 5 ml dung dch 5%

Acide tranexamique

250 mg

cho 1 ng thuc 2,5 ml Transamin S

Acide tranexamique

250 mg

cho 1 ng thuc 10 ml Transamin S

Acide tranexamique

1000 mg

DC LC
Transamin c hot cht l Trans-4-aminomethyl-cyclohexan carboxylique acide (Acide
tranexamique) l mt cht tng hp c hot lc mnh vi cc c tnh nh sau :
- Hot tnh chng plasmine tim n : Transamine c ch c hiu cc tc dng ca cht kch
hot plasminogne v plasmine l nhng cht c tc dng tiu fribine.
- Tc dng cm mu : Transamine c tc dng cm mu rt tt qua c ch ngn nga s tiu
fibrine, s gim chc nng tiu cu, kh nng v thnh mch v s phn hy cc yu t ng
mu.
- Hot tnh khng vim v chng d ng cao : Transamin c ch plasmine to ra cc kinine v
peptide hot tnh l cc cht gy sang thng d ng v vim. Ngi ta cng chng minh rng
Transamin lm gim tnh thm thnh mch v hin tng ph do cc tc nhn gy vim nh
carragenine v bradykinine.
DC NG HC
Hp thu :
- dng ng ung, thuc c hp thu nhanh v t nng ti a trong mu sau 2 n 3 gi

v gim sau 6 gi.

- dng ng tim tnh mch, thuc t nng ti a trong vng na gi v gim sau 6 gi.
Sau khi tim tnh mch, thuc c thi gian bn hy khong 2 gi.
Phn phi :
- n tt c cc m,
- n dch no ty, vi thi gian chm hn.
Th tch phn phi l 33% khi lng c th.
o thi :
- thi gian bn hy o thi khong 1 gi,
- 90% liu dng c bi tit qua nc tiu trong 24 gi u (c bi tit cu thn v khng
c s ti hp thu ng thn).
Thuc c o thi trong nc tiu di dng vn gi nguyn hot tnh.
CH NH
Khuynh hng xut huyt do tng s tiu si fibrine ton thn :
- bnh bch cu, thiu mu bt sn, ban xut huyt,
- xut huyt bt thng trong v sau khi phu thut.
Xut huyt bt thng do tng s tiu si fibrine ti ch :
- xut huyt phi, chy mu mi,
- xut huyt ng sinh dc, xut huyt thn,
- xut huyt bt thng trong v sau khi phu thut ph i tuyn tin lit.
Cc triu chng nh ban , sng nga trong cc bnh sau :
- eczma v cc triu chng tng t, ni m ay,
- ni ban do thuc, nhim c da.
Cc triu chng nh au hng, xut hin cc vng thng tn, sung huyt v sng trong cc
bnh sau :
- vim amian, vim hu hng,
- au ming v apht nim mc ming trong chng vim ming.
CHNG CH NH
- Bnh nhn c bnh huyt khi nh huyt khi no, nhi mu c tim, vim tnh mch huyt
khi v bnh nhn c khuynh hng b huyt khi.
- Bnh nhn ang iu tr bng liu php ng mu.
- Bnh nhn c tin s phn ng qu mn vi thuc.
- Suy thn nng (do c nguy c gy tch ly thuc).
THN TRNG LC DNG
- Suy thn c th gy nguy c tch ly thuc, do nn gim liu ca Transamin ty theo kt
qu nh lng cratinine huyt.
Nu cratinine huyt t 120 n 250 mmol/l, liu tim tnh mch nn c tnh ton da trn

c s 10 mg/kg, hai ln mi ngy.

Nu cratinine huyt t 250 n 500 mmol/l , liu Transamin s l 10 mg/kg, 1 ln mi 24 gi.
Nu cratinine huyt trn 500 mmol/l, liu 10 mg/kg ch c dng mi 48 gi.
- Trng hp tim tnh mch, phi tim tht chm.
- Khi tim tnh mch nhanh, cc tc dng ngoi { nh nhc u, kh chu ngc, nh trng
ngc v h huyt p c th xut hin nhng t gp..
- Trng hp i ra mu nguyn nhn do thn, dng thuc c th gy v niu c hc do hnh
thnh cc ng niu qun.
LC C THAI
Thuc qua c hng ro nhau thai nhng khng gy c tnh trong cc th nghim trn th
vt, trn ngi nguy c ny cha c nh gi.
LC NUI CON B
Mt lng nh c bi tit qua sa m, nng trong sa m chim khong 1% nng
trong huyt tng ; do thn trng, khng nn cho con b trong thi gian iu tr.
TC DNG NGOI
- C th gy qu mn ; ngng iu tr nu xy ra phn ng qu mn.
- Trn h tiu ha : mt s triu chng nh chn n, bun nn, tiu chy hay nng i khi c
th xy ra.
- Trn da : c xy ra nga v ni m ay.
- Mt s tc dng ngoi khc : c th gy bun ng.
LIU LNG v CCH DNG
Dng vin :
Liu ung hng ngy cho ngi ln l mi ln ung 250-500 mg (1 n 2 vin), 3 n 4
ln/ngy.
Liu ca Transamin c th c iu chnh theo tui tc v cc du hiu lm sng ca bnh
nhn.
Dng tim :
Liu thng thng cho ngi ln l 250 n 500 mg/ngy (1-2 ng) tim mch hoc tim bp
chia lm 1 n 2 ln/ngy.
Trong thi gian phu thut hay sau phu thut, nu cn c th dng 500-1 000 mg ngay lc
bng ng tnh mch hoc 500-2 500 mg bng cch truyn tnh mch nh git.
Liu ca Transamin c th c iu chnh theo tui tc v cc du hiu lm sng ca bnh
nhn.
Suy thn :
Cratinine huyt t 120 n 250 mmol/l : 10 mg/kg/12 gi.
Cratinine huyt t 250 n 500 mmol/l : 10 mg/kg/24 gi.
Cratinine huyt trn 500 mmol/l : 10 mg/kg/48 gi.

QU LIU
Transamin c gii hn an ton rt rng.

524.

TRI-REGOL

GEDEON RICHTER
vin nn : v 21 vin (gm 6 vin mu vng, 5 vin mu hng v 10 vin mu trng), hp 3 v
hoc 100 v.
THNH PHN
cho 1 vin mu vng
Levonorgestrel

0,05 mg

Ethinylestradiol

0,03 mg

cho 1 vin mu hng

Levonorgestrel

0,075 mg

Ethinylestradiol

0,04 mg

cho 1 vin mu trng

Levonorgestrel

0,125 mg

Ethinylestradiol

0,03 mg

CH NH
Thuc ung nga thai. Ri lon xut huyt chc nng, kinh nguyt tht thng, au kinh, iu
ha kinh nguyt v dng cho cc mc ch tr liu khc khi c hi chng tin kinh nguyt.
Tri-Regol l thuc c chn cho ph n c c a hormon gestagen cn bng hoc nh.
V trong qu trnh dng thuc, ni mc t cung vn duy tr kh nng bin dng, nn c th dng
thuc cho ngi mi ln, ngi cha sinh con, v ph n trung nin.
CHNG CH NH

Mang thai. Tnh trng sau vim gan, ri lon chc nng gan, c tin s bnh vng da t pht
trm trng khi mang thai, si ti mt, vim ti mt, vim rut kt mn tnh, c tin s bnh
nga nng khi mang thai, ri lon chuyn ha lipid.
Bnh tim thc th nng, cao huyt p trm trng, tiu ng trm trng, bnh v tuyn ni
tit, c nguy c huyt khi, c tin s ri lon mch no. Bnh c tnh, nht l ung th v v
ung th ng sinh dc. Thiu mu c tnh, chng vng da tan mu mn tnh, hi chng DubinJonhson v Rotor.
Thi kz cho con b v khng dung np thuc.
CH PHNG v THN TRNG LC DNG
Thn trng khi dng thuc trong cc trng hp gin tnh mch, ng kinh, tng huyt p, ri
lon tm thn km trm cm, tiu ng nh, u c t cung, bnh tuyn v v ngi trn 40
tui. Ht thuc l c th lm trm trng thm cc tc dng ph. Hng nm, nn kim tra t bo
hc. V loi thuc ny c hm lng hormon thp, trong trng hp tiu chy hoc nn ma
do lm gim hp thu - hiu qu trnh thai c th b mt tm thi. Do , cc bnh gian pht i
km tiu chy hoc nn ma phi c lu {. Trong trng hp b tiu chy hoc nn ko di,
th nn ngng thuc v nn dng phng php trnh thai khc.
bo v bo thai, nn ngng thuc 3 thng trc khi c k hoch mang thai v nn s dng
phng php trnh thai khng hormon khc.
Nn ngng thuc trong trng hp bnh mn tnh v trc khi i phu thut (6 tun trc k
hoch phu thut).
TNG TC THUC
Hiu qu thuc c th b gim (xut huyt bt thng) hoc mt tc dng hon ton, nu dng
ng thi vi mt s thuc gy cm ng enzyme, nh rifampicin, dn xut phenobarbital,
phenytoin, khng sinh ph rng, v dn xut pyrazolone, sulfonamide.
TC DNG NGOI
Khi bt u ung thuc, c th xut hin vi triu chng ng tiu ha, kh chu trong ngc
v bun nn, nhng triu chng ny thng chm dt hoc gim bt khi tip tc dng thuc.
C th gp tng hoc gim th trng. C th thay i dung np glucose. C th xut hin nhc
u, thay i xc cm, mt mi, ngoi ban, chut rt, thay i dc nng. Khi ra huyt lm tm
va phi trong thi gian dng thuc, khng nht thit phi ngng thuc. Khi xut huyt qu
nhiu, th nn ngng thuc v khm ph khoa. Nu kt qu kim tra khng c vn g, chu kz
mi 21 ngy c th c bt u vo ngy th 5 tnh t ngy c kinh. Xut huyt ngoi chu kz
kinh v xut huyt lm tm thng ngn hn v c khuynh hng chm dt hon ton khi dng
quen Tri-Regol.
Ngng thuc trong cc trng hp :
- Mang thai.
- Huyt khi, nghn mch, vim tnh mch huyt khi.

- Ri lon mch mu no.

- Nhi mu c tim.
- Huyt khi vng mc.
- Ri lon th gic, chng li mt, chng nhn i.
- Nhc u nng - ko di v ti pht.
- Mt vi bnh nng, mn tnh khc.
LIU LNG v CCH DNG
Nn bt u ung Tri-Regol t ngy th 5 ca chu kz kinh trong 21 ngy. Mi ngy ung 1 vin
vo gi ging nhau, tt nht l trc khi i ng ti. Sau l giai on 7 ngy ngh thuc, trong
thi gian ny, s gp xut huyt ging nh kinh nguyt.
Bt k biu hin v thi gian c kinh, chu kz dng thuc mi 21 ngy phi c bt u vo
ngy th 8. Phc ny c dng cho n khi vic trnh thai hoc iu ha kinh nguyt cn
cn thit. Trong trng hp dng thuc u, th hiu qu trnh thai t c c trong 7 ngy
ngh thuc.
Nhng vin thuc c mu khc nhau th c thnh phn khc nhau. Nhng vin mu vng dng
u tin, tip theo l nhng vin mu hng, sau l nhng vin mu trng. S th t c
ghi mt sau ca v.
Nu qun dng thuc v bt c l do g, phi ung thm vin qun cng sm cng tt.
S c ch rng trng khng th c xem l lin tc, nu thi gian ung gia 2 vin qu 36 gi.
Tri-Regol c th dng cho cc mc ch tr liu khc.

525.

TRIACANA

LAPHAL
c/o HYPHENS
Vin nn 0,35 mg : v 20 vin, hp 5 v.
THNH PHN
cho 1 vin
Tiratricol

0,35 mg

DC LC
Hormon tuyn gip.
Tiratricol l cht chuyn ha ph ca triiodothyronine, tng t nh triiodothyronine vi cc

c tnh dc lc ca cc hormon tuyn gip.

DC NG HC
Tiratricol c hp thu nhanh qua d dy rut v khuch tn d dng vo cc m. Thi gian bn
hy vo khong 6 gi.
Qu trnh chuyn ha ca tiratricol xy ra ngoi thn v c o thi di dng cc dn xut
sulfo v glucuro lin hp.
Cc iodid ch yu c o thi qua nc tiu.
CH NH
Cc trng hp cn km hm s bi tit ca TSH, nht l trong cc hi chng khng vi cc
hormon tuyn gip v cc trng hp ung th tuyn gip.
CHNG CH NH
Tuyt i :
- Bnh tim mt b.
- Suy mch vnh, lon nhp tim, rung nh, cung ng.
- u t nng.
- Cng gip.
Tng i :
Ph n c thai hay cho con b (xem Lc c thai v Lc nui con b).
CH PHNG v THN TRNG LC DNG
Ch { phng :
Khng dng cho bnh nhn bo ph khng b lon nng tuyn gip.
Thn trng lc dng :
Tiratricol c nh hng n kt qu nh lng T3, do khng th nh lng c hormon
ny khi ang dng tiratricol. iu ny lm cho kh nh gi vic iu chnh khi m s bi tit
TSH hon ton b ngng li do vic iu tr.
Thn trng khi dng trong trng hp bnh nhn b tiu ng, tng huyt p, c tin s b
bnh tim mch.
Cn theo di ng huyt bnh nhn b tiu ng.
LC C THAI v LC NUI CON B
Khng c s liu ng tin cy v tc ng gy qui thai khi s dng trn ng vt. Hin nay cng
cha c s liu thch ng hoc kho st trn mt s lng nhiu nh gi tc ng gy
d tt hay c phi ca tiratricol khi s dng trong thai kz.
Do thn trng, khng nn k toa cho ph n c thai.
TC DNG NGOI
Cc du hiu tng chuyn ha do cng gip (nhp tim nhanh, cu gt, mt ng, st cao, ra
nhiu m hi, gim cn nhanh, tiu chy). Nu xy ra cc triu chng nu trn, nn ngng
thuc trong vng 24 n 48 gi, sau dng li vi liu thp hn.

LIU LNG v CCH DNG

Dng cho ngi ln.
Trung bnh 2-5 vin/ngy, chia lm nhiu ln.
Thuc ny bt buc phi c chia lm 3 hay 4 ln trong ngy m bo s km hm TSH ko
di sut 24 gi.
Thuc ny c dng h tr cho liu php thay th bng L-Thyroxin, khi m tc dng km
hm TSH ca liu php L-Thyroxin khng m bo .
QU LIU
Cc du hiu tng chuyn ha c th xut hin khi dng qu liu. Gim liu hay ngng thuc s
lm thuyn gim cc triu chng.

526.

TRIHERPINE

NOVARTIS OPHTHALMICS
Thuc nh mt : l nh git 5 ml.
THNH PHN
cho 1 ml
Trifluridine

10 mg

(Methylhydroxypropylcellulose)
(Benzalkonium chlorure)

(0,1 mg)

DC LC
Hot cht chnh trifluridine l mt cht i khng chuyn ho trong qu trnh tng hp phn t
ADN. N c ch s tng hp protein cho virus v s pht trin (nhn i) ca virus Herpes
simplex. Trifluridine s c u tin kt hp vo ADN ca virus, lm bin i protein c tng
hp v gia tng s lng t bin. Hn na, trifluridine cn c ch men thymidylate synthetase
l men quan trng trong qu trnh tng hp ADN, lm cho virus ch tn ti bng nhng mnh
nh khng gy bnh.
DC NG HC
Thuc ngm d dng qua gic mc v nng hiu qu v mt iu tr cng t c trong
thy dch (5-6 mg/ml). Tn thng biu m do bnh cng lm tng tnh thm ca thuc (n 37
mg/ml sau 30 pht). Cha c s liu v phn b thuc v thi gian lu li ca thuc. Cng cha
c s liu v mc hp thu vo ton thn ca thuc.

Nu Trifluridine c hp thu vo ton thn, n s b ging ha nhanh chng v c thi ra ngoi

qua nc tiu.
CH NH
Vim gic mc hnh cnh cy mi do Herpes simplex cng nh cc trng hp khng IDU
(khng p ng iu tr vi idoxuridine) ; dng phng nga ti pht (trong trng hp gic mc
cn nguyn vn hay sau khi ghp gic mc xuyn) ; tnh trng vim hu herpes v vim gic
mc-mng mt do herpes.
CHNG CH NH
D ng vi cc thnh phn ca thuc.
THN TRNG LC DNG
Nn nh thuc vo nhng lc khng mang knh tip xc.
Nu bnh nhn b m mt sau khi nh Triherpine th khng nn li xe hay vn hnh my.
LC C THAI v LC NUI CON B
Th nghim trn ng vt cho thy phn ng ph rt thp trn thai nhi (khi dng liu cao hn 1
mg/kg/ngy). Cha c th nghim kim chng trn ph n c thai. Ch nn dng thuc cho i
tng ny khi li ch do thuc mang li cao gp nhiu ln nguy c cho thai. V cha bit r
Trifluridine sau khi nh vo mt c c tit vo sa m hay khng v nu c th nhiu hay t,
do vy khng nn dng thuc cho ph n ang cho con b.
Thai kz loi C.
TNG TC THUC
Cha c ghi nhn.
TC DNG NGOI
Cc th nghim lm sng cho thy Triherpine c dung np rt tt. Phn ng ph tng i
him. C th gp cm gic xt nh thong qua ngay sau khi nh thuc. Trong trng hp him,
c th xy ra vim gic mc chm khi dng ko di v s khi khi ngng thuc. Thnh thong c
th gp keratitis sicca, ph m, sung huyt v tng nhn p.
LIU LNG v CCH DNG
Nu khng c ch nh c bit th nh vo ti kt mc di 1 git x 5-7 ln/ngy cho n khi
gic mc lnh. Sau khi tn thng gic mc lnh (thng trong 6 ngy), tip tc nh thuc 23 ln/ngy trong khong 1 tun trnh ti pht.
QU LIU
Qu liu trong trng hp nh mt khng th xy ra. Khng c triu chng nhim c cp khi
ung nhm l thuc nh mt Triherpine. Suy ty xng c ghi nhn khi dng thuc
ng tnh mch nhiu ln.
BO QUN
thuc nh mt trong t lnh (2-8oC).
y np li sau khi dng.

Nu cha m np, thuc vn c tc dng cho n ngy ht hn ghi trn hp thuc.

Sau khi m np, ch nn dng chai thuc trong vng 1 thng.

527.

TRILEPTAL

NOVARTIS
Vin nn d b 300 mg : hp 50 vin.
THNH PHN
cho 1 vin
Oxcarbazepine

300 mg

DC LC
Trong nhng nghin cu dc l trn sc vt, oxcarbazepine v cht chuyn ha dn xut
monohydroxy (MHD) biu hin tc dng chng co git mnh v hu hiu, cho thy rng thuc
tr liu hu hiu ch yu trn ng kinh dng co cng cn ln hoc cn nh.
Mc d c ch chnh xc ca tc ng ca hu ht cc thuc chng ng kinh cha c hiu
bit mt cch chi tit, ngi ta cho rng cc thuc trong nhm ny tc ng bng cch thay i
hot tnh ca cht trung gian c bn ca kch thch thn kinh, c th l knh ion ca in th v
ca dn truyn thn kinh trong no. Theo nhng khm ph gn y, oxcarbazepine v MHD c
th c tc ng chng co git bng cch phong b knh natri ph thuc in th trong no.
nng iu tr, c hai hp cht lm gii hn dng chy lp i lp li vi tn sut cao ko di
ca hot ng ph thuc natri trn t bo thn kinh chut trong mu cy t bo, tc ng ny
c th gp phn vo c ch s lan truyn hot ng ng kinh t gy ng kinh. Thm vo
, bng chng t mt nghin cu in vitro nhng lt ct ca hi hi m chut cho thy rng
hot ng chng ng kinh ca ng phn racemic MHD, v c hai cu hnh ca n cng c
cn bng bi knh kali.
DC NG HC
Hp thu : Oxcarbazepine c hp thu nhanh chng v hon ton qua ng tiu ha. Thuc
c kh nhanh chng v hu nh hon ton thnh cht chuyn ha c hot tnh dc l 10,
11-dihydro-10-hydroxy-carbamazepine (dn xut monohydroxy, MHD), cht ny t n cc
nng cao hn vi ln trong huyt tng so vi thuc di dng khng i. Kh dng ton
thn ca MHD tng nh nhng ch c { ngha khi oxcarbazepine c dng chung vi thc n.
Phn phi : ch mt phn rt nh (40%) cht chuyn ha c hot tnh MHD gn vi protein
huyt thanh, ch yu vi albumin. Th tch phn phi l 0,7-0,8 l/kg (MHD).
Do b kh nhanh chng, nng trong huyt thanh ca oxcarbazepine c th c b qua v

ch yu x t n cht chuyn ha MHD. Dng cc liu duy nht 150 n 600 mg oxcarbazepine,
din tch di ng cong nng trung bnh trong huyt tng ca MHD c tng quan
tuyn tnh vi liu lng ; nng ti a trung bnh trong huyt tng sau cc liu 300 v 600
mg dng vin n n tng ng l 13,9 v 23,6 mmol/l. Nng ti a trong huyt tng t
c trong vng 4 gi.
Chuyn ha : oxcarbazepine c chuyn ha rng ri ngi, di 1% liu dng c o
thi trong nc tiu di dng khng i. Thuc b kh nhanh chng thnh MHD c hot tnh
dc l{ nh l cht chuyn ha ch yu. Cc cht chuyn ha ph l cc cht lin hp
glucuronic v sulfate trc tip ca oxcarbazepine v cht chuyn ha 10, 11-dihydro-10, 11dihydroxy.
o thi : thi gian bn hy o thi ca MHD trong huyt tng ngi trung bnh l 9 gi, sau
khi dng cc liu duy nht oxcarbazepine ; thanh thi ton phn trong huyt tng l 3,6 l/gi.
Khi ung nhiu liu lin tip oxcarbazepine, dc ng ca thuc dng nguyn vn v cht
chuyn ha c hot tnh ca n khng thay i, cho thy khng c tch t thuc. Oxcarbazepine
c o thi hon ton ; hn 95% liu dng, ch yu di dng cc cht chuyn ha, xut
hin trong nc tiu trong vng 10 ngy. Cc dng t do v lin hp ca MHD chim 60% lng
c o thi qua thn v phn cht chuyn ha lin hp ph chim khong 5-15% cho mi
cht.
c im ca bnh nhn : trn bnh nhn mc bnh ng kinh, liu hng ngy 600 n 1800
mg oxcarbazepine dng vin cho nhng nng trng thi n nh ca cht chuyn ha MHD
trong khong 8,3-107,3 mmol/l. Cc gi tr tng t cng t c vi liu hng ngy 1200 n
2100 mg oxcarbazepine dng hn dch. Mt vi bnh nhn c th cn liu cao hn. Nng
trng thi bn vng cao nht c tm thy l 177 mmol/l. bnh nhn dng duy nht mt
loi thuc l oxcarbazepine, ngi ta tm c mi lin h tuyn tnh gia liu hng ngy t
300 n 2700 mg v nng trong huyt tng ca MHD. Khng c mi lin h r rng tn ti
gia nng trong huyt tng v hiu qu iu tr.
Nng trng thi bn vng ca MHD trn tr em mc bnh ng kinh cng tng t nh
ngi ln.
ngi gi, nng ti a trong huyt tng v din tch di ng cong ca MHD cao hn
ng k so vi ngi tr tui, iu ny c th l do c s suy gim va phi chc nng thn.
Khng cn cc khuyn co c bit v liu lng trong nhng trng hp ny v liu iu tr
c iu chnh ty theo tng ngi. Cho n nay, dc ng ca oxcarbazepine v MHD
cha c nghin cu trn bnh nhn suy gan. Tnh trng suy thn trung bnh cng nh hng
mt t n MHD v oxcarbazepine trong huyt tng. Tuy nhin, do nng MHD lin hp
trong huyt tng gia tng c { ngha, iu ny c th lm tng cao hn nng ca MHD t
do, bnh nhn suy thn nng (thanh thi creatinin <= 30 ml/pht), nn gim khong mt na
liu oxcarbazepine.

CH NH
ng kinh ton th nguyn pht c km cn co cng-co git (tonic clonic).
ng kinh cc b, c hoc khng km theo cn ton th ha th pht.
CHNG CH NH
Qu mn bit vi oxcarbazepine.
Bloc nh tht.
CH PHNG v THN TRNG LC DNG
Ch nn dng Trileptal khi c s theo di y khoa.
Trong qu trnh iu tr vi Trileptal, c th b gim natri huyt. Do , nn kim tra natri huyt
trc khi bt u iu tr v sau trong nhng khong cch thi gian u n. Cn theo di
cn thn bnh nhn c nng natri trong huyt thanh thp v bnh nhn c iu tr vi
thuc li tiu.
Nu trong qu trnh iu tr m lng bch cu hay tiu cu thp hay gim xung, nn theo di
bnh nhn v cng thc mu cn thn. Nn ngng Trileptal nu c du hiu chn p ty ng
k.
Nu xut hin cc du hiu v triu chng gi cho phn ng trm trng trn da (nh hi
chng Stevens-Johnson), nn ngng ngay Trileptal. Nn cho bnh nhn bit cc du hiu ng
c sm ca nhng phn ng nu trn nh st, ni ban, sang thng trong ming, bm gip,
ban xut huyt. Khuyn h nn i khm bc s ngay nu xut hin nhng phn ng nh trn.
Nn theo di cn thn bnh nhn suy thn, suy gan hay suy tim, v ngi gi v nhm ngi ny
c nguy c b tc dng ngoi { cao hn (xem phn Dc lc).
Oxcarbazepine t c tc dng cm ng enzyme hn carbamazepine ; nu bnh nhn c tr
liu bng nhiu loi thuc, trong carbamaz pine hay nhng thuc chng ng kinh khc c
tc ng cm ng enzyme c ngng v thay th bi Trileptal, nn theo di cc nng trong
huyt thanh ca thuc chng ng kinh dng ng thi trnh kh nng gy c tnh ; c th
cn thit phi gim liu ca thuc dng phi hp (xem phn Tng tc thuc).
Nh nhng thuc chng ng kinh khc, nn trnh ngng t ngt Trileptal. Nn gim dn dn
liu gim kh nng thc y cn ng kinh, ngha l s tng cn ng kinh hay tnh trng
ng kinh lin tc khi ngng thuc.
Nu bt buc phi ngng Trileptal mt cch t ngt, nh trong trng hp b phn ng ph
trm trng, s chuyn i sang mt thuc chng ng kinh khc nn c thc hin di nh
hng ca mt thuc thch hp (nh diazepam tim tnh mch, t trc trng, phenytoin tim
tnh mch) v phi c theo di cht ch.
Khi bnh nhn c d ng vi carbamazepine c chuyn sang dng oxcarbazepine, nn cn
thn v c bo co v mt vi trng hp xy ra d ng ch o. iu ny c th do cu trc ca
hai hp cht tng t nhau.
Bnh nhn c iu tr vi Trileptal nn trnh ung ru do c th lm tng tc dng an thn

ca thuc.
Tc ng trn kh nng iu khin xe v my mc : kh nng phn x ca bnh nhn c th b
gim do chng chng mt v bun ng gy ra do Trileptal. Bnh nhn nn c bit cn thn khi
li xe hay vn hnh my mc.
LC C THAI v LC NUI CON B
chut, th nghim sinh sn bao gm kh nng sinh sn ca chut c v chut ci, qu trnh
mang thai v cho con b khng b nh hng bt li do oxcarbazepine cho n liu 150 mg/kg.
Khng c bng chng v kh nng gy qui thai chut nht v th. Tuy nhin, mt trong hai
nghin cu chut ln cho thy oxcarbazepine gy qui thai khi dng ti liu t 300 n 1000
mg/kg mi ngy, v km theo l gy c tnh trn m ln phi hoc bo thai. Cht chuyn ha
c hot tnh trn ngi l MHD, c em th nghim trn chut v th, hon ton khng
cho thy c kh nng gy qui thai. S pht trin trc v sau khi sinh ca th h sau loi gm
nhm b tr tr mt vi mc nht nh vi cc liu gy c cho th m. Cc liu gy c ln
m v phi ca oxcarbazepine hay MHD chut c lin kt vi nhng du hiu suy yu ca
s lm t ca trng.
Ph n mang thai mc bnh ng kinh nn c iu tr c bit cn thn. Nu ngi ph n
ang c iu tr bng Trileptal li c thai hay nu vn bt u iu tr vi Trileptal t ra
lc ang c thai, phi cn nhc cn thn gia li ch ca thuc vi nhng ri ro c th xy ra,
c bit trong ba thng u ca thai kz.
Oxcarbazepine v cht chuyn ha c hot tnh ca n i qua nhau thai. Cc nng MHD
trong huyt tng ngi m v a con s sinh th ging nhau.
Nu thuc tuyt i cn thit v khng cn phng cch thay th no an ton hn, nn dng
liu vi Trileptal thp nht c th c.
S thiu ht acid folic c bit l c xy ra trong thi kz c thai. Thuc chng ng kinh
c bo co lm nng thm s thiu ht acid folic. S thiu ht ny c th gp phn thm
vic gia tng tn sut khim khuyt ca a con c m c iu tr bng thuc chng ng
kinh. Do , nn cung cp acid folic cho ngi m trc v trong khi mang thai. S thiu ht
vitamin B12 c th b qua hay c iu tr.
Theo thng l, nn cn thn cn nhc gia li ch v nguy c ca vic ung thuc trong lc cho
con b.
Oxcarbazepine v cht chuyn ha c hot tnh ca n c bi tit qua sa m. t l nng
trong sa trn nng trong huyt tng l 0,5 c tm thy cho c hai loi hp cht.
Khng c kinh nghim da theo m x t on tnh an ton ca Trileptal trong lc cho con
b. Khng th loi tr kh nng xy ra tc dng ngoi { trn a tr. Do , nn cai sa cho tr
hay theo di phng k cng cc tc ng ngoi { nh ng qu nhiu.
TNG TC THUC
Trn c s l thuyt (s lin h v cu trc vi cc thuc chng trm cm tricyclique), vic s

dng Trileptal khng c khuyn co kt hp vi cc cht c ch monoamine-oxidase (IMAO)

; trc khi s dng Trileptal, nn ngng dng IMAO t nht 2 tun hay lu hn nu tnh trng
lm sng cho php.
Do cht chuyn ha c hot tnh l dn xut 10-monohydroxy (MHD) gn vi protine huyt
tng yu, nn rt t c nguy c tng tc thuc do s thay th khi v tr gn kt ca
oxcarbazepine.
Con ng chuyn ha chnh ca oxcarbazepine v cht chuyn ha c hot tnh (MHD) khng
l thuc vo h thng men cytochrome P-450. Do , s c ch hay thc y ca h thng men
ny hu nh khng c tc ng ln dc ng ca oxcarbazepine v cht chuyn ha c tc
dng ca n. Oxcarbazepine khng gy cm ng cc men kim sot cc hot ng ca chng
trn c th, v khng c nh hng trn tc o thi ca cht chuyn ha c hot tnh MHD
ca n. Hn na, trong nhng nghin cu lm sng v dc ng hc vi oxcarbazepine v
thuc h st, v oxcarbazepine v warfarine, cho thy c rng thuc c t gy cm ng men
so vi carbamazepine.
Tuy nhin, nng trong huyt tng ca estrogen v progestogen c th gim ph n ung
thuc nga thai ng thi vi Trileptal, iu ny c th dn n xut huyt t v c kh nng
mt hiu lc ca thuc nga thai. Nn cn nhc dng phng php trnh thai khc.
Hn na, tnh kh dng ton thn ca felodipine gim c { ngha trong mt nghin cu ngi
tnh nguyn khe mnh.
Cc nghin cu khc c thc hin trn mt s gii hn ngi tnh nguyn khe mnh hay
bnh nhn ng kinh dng ng thi Trileptal v nhng thuc c ch enzyme sau : cimtidine,
erythromycine, dextropropoxyphene, viloxazine, verapamil. Khng ghi nhn c tng tc thuc
c nh hng trn lm sng.
Cc nng trng thi n nh ca phenytoin v acid valproic gia tng khi thay th
carbamazepine bng oxcarbazepine (xem phn Ch { phng v Thn trng lc dng).
TC DNG NGOI
Cc tc dng ngoi ca Trileptal thng nh v thong qua v ch yu xy ra lc bt u iu
tr. Thng nhng tc dng ny gim khi tip tc iu tr. Tc dng ngoi { thng gp nht
c bo co l nhng phn ng trn h thn kinh trung ng nh mt mi, chng mt, bun
ng v nhc u.
- Thn kinh trung ng (v ngoi bin) : thng xuyn : mt mi ; i khi : chng mt/chong
vng, bun ng, nhc u, mt iu ha, run ry, ri loi tr nh/tp trung, ri lon gic ng, ri
lon th gic, d cm ; him : d xc cm tm thn, tai, trm cm, lo lng.
- Tiu ha : i khi : ri lon tiu ha, nh bun nn, nn ma, tiu chy.
- Phn ng qu mn : i khi : ni ban da ; trng hp ring bit : phn ng d ng trm trng
bao gm hi chng Stevens-Johnson.
- Phn ng huyt hc : i khi : gim s lng bch cu (tht thng v ch thong qua) ; him :

gim tiu cu, gim ton th cc dng t bo mu.

- Gan : him ; tng men gan nh transaminase, phosphatase kim.
- Tim mch : him : h huyt p.
- Cc phn ng ngoi { khc : i khi : tng cn, gim ham mun tnh dc, kinh nguyt bt
thng, ph, h natri huyt v gim tnh thm thu huyt tng do tc dng ging ADH dn
n trong mt vi trng hp him, chng nhim c nc i km theo l chng ng lm,
nn ma, nhc u, l ln thn kinh, bt thng thn kinh ; him : gim cn.
- Ring i vi tr em (dng a liu php) : tnh kh hung hng, st (khng r nguyn nhn).
LIU LNG v CCH DNG
Trileptal thch hp khi c dng iu tr duy nht hay phi hp vi nhng thuc chng
ng kinh khc. Trong c hai cch dng ny nn bt u bng liu thp v nng liu t t, cn
iu chnh liu thch hp vi nhu cu ca mi ngi bnh. Bnh nhn suy thn trm trng
nn gim bt mt na liu (xem phn Dc ng hc).
Ngi ln :
Dng mt loi thuc duy nht : liu khi u nn l 300 mg mi ngy. Hiu qu tr liu tt c
ghi nhn liu 600-1200 mg/ngy vi hu ht cc bnh nhn c p ng thun li liu 900
mg/ngy.
iu tr vi nhiu thuc : ( bnh nhn ng kinh nng v nhng trng hp ln thuc) : liu
bt u nn l 300 mg mi ngy, sau tng dn cho n khi t c p ng ti u. Liu
duy tr trong khong 900 v 3000 mg/ngy.
Trong c hai trng hp dng Trileptal ring r hay kt hp, nn bt u iu tr vi liu 10
mg/kg th trng mi ngy v tng t t. Liu khuyn co duy tr vo khong 30 mg/kg/ngy.
Nu vn cha kim sot c cc cn ng kinh, c th tng ln theo tng trng hp bng
cch thm 5-10 mg/kg th trng mi ngy.
Khi khng th t c mt liu chnh xc (mg/kg) vi cc dng vin nn c sn cho tr em v
nht thit phi iu tr vi Trileptal, nn quyt nh dng liu c lng theo tng trng hp.
Cch dng :
mt vi bnh nhn, c th p dng phc dng thuc mi ngy hai ln ; tuy nhin, thng
thng, nn dng thuc ba ln mi ngy.
Thuc vin nn nn ung vi nc trong ba n hoc sau ba n.
QU LIU
Trong cc kho st chuyn bit trn sc vt, oxcarbazepine v MHD dng ung c LD50 > 1000
mg/kg. ngi, c tnh vi oxcarbazepine hu nh him thy.
Cc biu hin lm sng c th ging nh khi b qu liu carbamazepine do hai cht ny c cu
trc phn t tng t nhau.
iu tr : khng c thuc gii c chuyn bit cho Trileptal. Bnh nhn c th c iu tr triu
chng, loi thuc bng cch ra d dy v/hoc hp ph thuc bng than hot tnh. Nn lu {

n cc du hiu sinh tn c bit l s dn truyn tim, cht in gii v s h hp. a bnh

nhn nhp vin v s dng cc bin php h tr y khoa trng hp b ng c nng.

528.

TRIMOVAX

AVENTIS PASTEUR
Bt pha tim : hp 1 l bt ng kh (1 liu) + ng tim cha dung mi 0,5 ml.
Bt pha tim : hp 10 l bt ng kh (1 liu) + 10 ng tim cha dung mi 0,5 ml.
THNH PHN
cho 1 liu tnh theo n v DICC 50
Virus sng gim c tnh ca bnh si (chng Schwarz)

>= 1000

Virus sng gim c tnh ca bnh quai b (chng Urabe AM9)

>= 5000

Virus sng gim c tnh ca bnh rubole (chng Wistar RA

27/3M)

>= 1000

(cht n nh, albumine ngi)

(c vt nomycine)
ng dung mi : nc ct pha tim

0,5 ml

CH NH
Nga cng mt lc 3 bnh : si, quai b, rubole, t 12 thng tui cho tr con trai v gi. i vi
tr sng tp th, c th dng t 9 thng tui.
CHNG CH NH
- Suy gim min dch bm sinh hay mc phi (k c nhim HIV). Trng hp c bit tr con c
m HIV dng tnh : khng th ca ngi m i qua nhau thai, nn khng th chn on c
a b c b nhim HIV hay khng. Phi ch xc nh bng phng php Western Blot n khi
no c phn ng m tnh mi c th cho rng a b khng b nhim.
Nu m tnh : c th chch nga theo lch trnh.
Nu dng tnh : phi hi kin ca chuyn khoa nhi.
- D ng vi protine ca trng.
- Mi tim nga immunoglobuline trong thi gian gn.
- Ph n mang thai : tuy nhin, nu chch nga trong thi gian c thai cha bit trc,

khng c ngha l phi ph thai.

THN TRNG LC DNG
Vaccin rubole : khng dng cho ph n mang thai v c thai 2 thng sau khi tim.
Dng cn thn nu d ng vi nomycine.
TNG TC THUC
trnh lm mt tc dng ca thuc, khng dng trong vng 6 tun (nu c th c th trong
vng 3 thng) sau khi tim immunoglobuline hay truyn mu.
Cng v vy, khng dng immunoglobuline trong vng 2 tun sau khi chch nga.
Phn ng th lao t c th m tnh tm thi sau khi tim.
TC DNG NGOI
C th c phn ng nh t ngy th 5 : st (c th trnh bng thuc h nhit), triu chng mi
hay h hp ngn hn, nga khp, . Rt t khi b st lm kinh.
Rt him khi thy ni hch, hay vim mang tai.
Rt t trng hp ghi nhn b bnh thn kinh nh vim mng no hay vim mng no th no,
ic mt bn. Vim mng no xut hin trong vng 30 ngy, khng c di chng, thnh thong
c pht hin virus bnh quai b trong dch no ty.
S xut hin bnh vim mng no v trng rt him gp. S hi phc thng hon ton. Rt t
trng hp b vim tinh hon.
LIU LNG v CCH DNG
Tim 1 ln t 12 thng tui. Tuy nhin i vi tr tim nga trc 12 thng tui, nn tim
ln th hai vo 6 thng sau.
Tim li 1 ln lc 4-12 tui.

529.

TRITANRIX-HB

SMITHKLINE BEECHAM
Hn dch tim bp 0,5 ml/liu : l 1 liu x 1 l, l 10 liu x 50 l.
THNH PHN
cho 1 liu 0,5 ml
Bin c t bch hu hp ph

30 IU

Bin c t un vn hp ph

60 IU

Vi khun ho g bt hot

4 IU

Protein HBsAg ti t hp

10 mg

TNH CHT
Tritanrix HB cha bin c t bch hu (D), bin c t un vn (T), vi khun ho g bt hot
(Pw) v khng nguyn b mt ch yu ca virus vim gan B (HBV) c tinh ch v hp ph
trn mui nhm.
Bin c t D v T c bo ch t c t vi khun bch hu (Corynebacterium diphtheriae) v
vi khun un vn (Clostridium tetani), kh hot bng formalin theo qui trnh cng ngh. Thnh
phn Pw thu c bng cch kh hot m cy vi khun ho g (Bordetella pertussis) giai on 1
bng nhit.
Khng nguyn b mt ch yu ca HBV (HBsAg) c sn xut nh vic nui cy t bo nm
men (Saccharomyces cerevisiae) theo cng ngh di truyn, cc t bo ny mang gien qui nh
khng nguyn b mt ch yu ca HBV. HBsAg c tinh ch qua mt s cng on l ha. Khi
cha qua qu trnh x l ho hc, HBsAg kt t mt cch t nhin thnh nhng tiu phn hnh
cu, ng knh trung bnh 20 nm, cha nhng polypeptid HBsAg khng glycosyl ha v mt
khun lipid ch yu gm phospholipid. Nhng th nghim trn phm vi rng chng minh
cc tiu phn ny c nhng tnh cht c trng ca HBsAg t nhin.
DC LC
3 lch tim chng khc nhau c nghin cu (2-4-6 thng, 3-4-5 thng v 3-4,5 -6 thng)
theo lch thc hnh tim chng thng qui cc nc khc nhau, vi 3 liu vaccin c s
dng cho tr trong 6 thng u i.
i vi 4 thnh phn ca vaccin, cc p ng min dch sau y c ghi nhn sau khi hon
thnh lch tim chng c bn c mt thng :
Khng th khng bch hu : 99,7% i tng c hiu gi khng th mc bo v
Khng th khng un vn :
100% i tng c hiu gi khng th mc bo v.
Khng th khng ho g : 97,7% i tng c xem l c p ng vi vaccin.
Khng th khng HBs : 99,2% i tng c hiu gi khng th mc bo v >= 10 mIU/ml.
CH NH
Tritanrix HB c ch nh cho tr t 6 tun tui tr ln to min dch ch ng chng li
cc bnh bch hu, un vn, ho g v vim gan B (HB).
CHNG CH NH
Khng c dng Tritanrix HB cho cc i tng c bit l qu mn cm (d ng) vi mt
thnh phn no ca vaccin, hoc cho cc i tng trc y c du hiu qu mn cm
sau khi tim vaccin bch hu, un vn, ho g hoc vaccin vim gan B. Nh cc vaccin khc, nn
hon tim Tritanrix HB cho bnh nhn ang c bnh st cao cp tnh.
Chng ch nh Tritanrix HB tr ang c bnh no cha r cn nguyn, xy ra trong 7 ngy sau

ln chng nga trc vi vaccin cha thnh phn ho g. Trong trng hp ny, nn tip tc
lch tim chng vi vaccin DT v HB.
CH PHNG v THN TRNG LC DNG
Cn xem xt li bnh s (c bit v ln tim vaccin trc v cc tc dng ngoi c th xy ra)
v khm nghim lm sng trc khi tim vaccin ny.
Nu mt trong cc s kin sau y xy ra trong khong thi gian lin quan n vic tim
Tritanrix HB, quyt nh tip tc tim cc liu vaccin k tip c cha thnh phn ho g cn phi
c xem xt k lng :
- Nhit >= 40oC trong vng 48 gi, khng do cc nguyn nhn khc bit.
- Ngt hoc tnh trng ging sc (giai on gim trng lc-gim p ng) trong vng 48 gi.
- Khc dai ng ko di >= 3 gi, xy ra trong vng 48 gi.
- Co git c hoc khng km st, xy ra trong vng 3 ngy.
Vic chng nga c th vn c tip tc, khi kh nng mang li li ch ca vic chng nga ln
hn nhiu so vi ri ro c th gp phi, v d : trng hp t l bnh ho g cao.
Bnh s st co git, tin cn gia nh c co git, tin cn gia nh c hi chng t t tr nh
(SIDS : Sudden Infant Death Syndrome) v tin cn gia nh c xy ra phn ng ph sau khi tim
Tritanrix HB khng phi l chng ch nh.
Nhim HIV khng c xem l chng ch nh dng vaccin bch hu, un vn, ho g v vim gan
B. p ng min dch mong mun c th khng t c sau khi tim vaccin bnh nhn b
suy gim min dch, v d: cc bnh nhn ang dng liu php c ch min dch.
Cng nh tt c cc vaccin tim khc, phng tin y t thch hp phi lun c chun b sn
e phng trng hp phn ng phn v xy ra sau khi tim vaccin. V l do ny, nn gi i
tng li sau khi tim 30 pht theo di.
Thn trng khi tim Tritanrix HB cho nhng i tng b gim tiu cu hoc c ri lon chy
mu, v c th xy ra chy mu sau khi s dng vaccin bng ng tim bp cho cc i tng
ny.
Trong bt c trng hp no cng khng c tim Tritanrix HB qua ng tnh mch.
LC C THAI v LC NUI CON B
Tritanrix HB khng nhm s dng cho ngi ln, do khng c ti liu v tnh an ton ca
vaccin khi dng cho ph n mang thai hoc ang cho con b.
TNG TC THUC
Trong thc t hin nay, tr em c chng nga nhiu vaccin khc nhau cng mt lc, cc
vaccin tim c tim ti nhng v tr khc nhau.
Tritanrix HB c th c trn chung trong cng mt bm tim vi vaccin Haemophylus
influenzae tp b (Hib) Hiberix.
Tritanrix HB cng c th c tim cng lc vi cc vaccin khc mt v tr ring, hoc bt c
lc no, trc hay sau khi tim nhng vaccin tr em khc, nu iu ny ph hp thun li vi

lch chng nga.

Trong cc nghin cu lm sng, Tritanrix HB c cho cng lc vi vaccin bi lit loi ung
(OPV) v vaccin Haemophilus influenzae tp b (Hib). Trong cc nghin cu ny, p ng min
dch i vi vaccin bi lit loi ung khng c nghin cu, tuy nhin, kinh nghim trc
khi dng chung cc vaccin bch hu (DTP), bi lit loi ung (OPV) v vim gan B (HBV) cho thy
khng c bt kz s tng tc no. Trong cc nghin cu lm sng, Tritanrix HB c dng
pha vaccin Hib ng kh (Hiberix), ngi ta nhn thy p ng min dch i vi cc khng
nguyn u khng b nh hng khi so snh vi p ng min dch sau khi tim ring bit hai
vaccin ny hai v tr khc nhau.
bnh nhn ang dng thuc c ch min dch hoc bnh nhn b suy gim min dch, p
ng min dch c th khng t c y .
TC DNG NGOI
Trong cc nghin cu lm sng gm 2.161 liu vaccin s dng, cc du hiu v triu chng ti
ch c kho st, (> 2 cm), sng (> 2 cm) ti ni tim xy ra trong 48 gi sau khi tim
c bo co vi tn sut tng ng ln lt l 5,0% v 9,2%. Cha m/ngi gim h tr nhn
thy ni tim nhy cm au 3,2% tr c tim.
Cc phn ng ton thn sau : khc bt thng, u oi (ng l m), cu knh, triu chng tiu
ha (d dy-rut) v nhng vn lin quan n vic n ung ca tr cng c theo di.
Nhng hin tng ny c bo co trong vng 48 gi < 5,0% tr c tim v c xem l
nhng trng hp c tc dng ngoi nghim trng. St c ghi nhn vi tn sut 40%,
nhng ch c 0,6% tr c tim c nhit trn 39,5oC.
Cc tc dng ngoi ny ch ko di vi ngy.
Trong sut giai on nghin cu, cc tc dng ton thn sau y c ghi nhn vi tn sut
di 3% : vim hng, vim phi, ri lon h hp, vim ph qun, vim tai gia. Cc bnh ny
c xem l bnh hay ti pht v khng c lin quan n vic tim vaccin Tritanrix HB.
Trong mt th nghim tin cu so snh vic s dng vaccin phi hp DTPw-HB cho 60 i
tng vi vic tim cc vaccin DTPw v HB cng lc ti nhng v tr ring cho 60 i tng khc,
t l (> 2 cm), sng (> 2 cm) c bo co sau khi tim vaccin vi t l tng ng ln lt l
: 9,1% (phi hp DTPw-HB) so vi 3,4 % (DTPw) v 0,6% (HB), 10,9% so vi 3,4% v 0,6%. au
nhiu v tr tim khng c ghi nhn nhm no. St c bo co 53,1% cc liu vaccin
phi hp DTPw-HB, nhng ch c 1,1% trng hp c nhit trn 39,5oC (so vi 35,0 % >=
38oC v 0,0% > 39,5% i vi trng hp dng cng lc vaccin DTPw v HB ti nhng v tr
ring). i vi c hai nhm chng nga, phn ln cc phn ng ch tn ti trong thi gian ngn.
Trong mt th nghim trn 120 i tng, mc d vaccin phi hp DTPw-HB c tnh gy phn
ng hi cao hn so vi khi dng ring hai vaccin DTPw v vim gan B ca SmithKline Beecham,
tnh sinh phn ng chung ca n vn nm trong phm vi ca nhng vaccin DTPw hin hnh.
LIU LNG v CCH DNG

Liu lng :
Phi dng liu vaccin ngh l 0,5 ml.
Lch chng c bn gm 3 liu trong vng 6 thng u i. nhng ni vaccin HB khng c
tim ngay khi sinh, vaccin phc hp c th bt u c tim ngay lc 8 tun tui. Ti vng c
tn sut HB cao, vic tim vaccin HB ngay khi sinh nn c duy tr. Trong cc trng hp ny,
nn bt u tim vaccin phc hp cho tr t lc 6 tun tui.
Phi tim ba liu vaccin, mi liu cch nhau t nht 4 tun.
Trng hp tr c sinh t m mang virus HB, khng nn thay i cc bin php d phng
min dch vim gan B. Nhng tr ny c th cn tim ring cc vaccin HB v DTPw, cng cn
tim HBIg ngay khi sinh.
Tritanrix HB c chng minh l c th c s dng mt cch an ton lm liu nhc li vo
nm hai tui.
Cch dng :
Tritanrix HB c dng tim bp su, u tin mt trc bn i.
bnh nhn b gim tiu cu hoc ri lon chy mu, vaccin c ngh tim di da (xem
phn Ch { phng v Thn trng lc dng).
Tng k :
Cho n khi c thm d liu v vn ny, khng nn pha trn vaccin Tritanrix-HB vi cc
vaccin khc trong cng mt bm tim, ngoi tr vaccin Hib ng kh (Hiberix).
Hng dn s dng/ X l :
S dng Tritanrix HB :
Tritanrix HB c trnh by dng hn dch. Trong qu trnh bo qun, c th thy mt lp cn
lng mu trng cng vi phn dch trong ni ln trn. Trc khi s dng, cn lc k l vaccin
thu c mt hn dch mu trng c thun nht, v phi quan st bng mt xem c cc tiu
phn l hoc cc bin i v mat vt l no khng. Nu c, phi loi b vaccin ngay.
Khi dng l vaccin a liu, mi liu phi c ly bng mt kim tim v bm tim v khun
ring. Cng nh cc loi vaccin khc, mt liu vaccin phi c ly trong nhng iu kin v
khun cht ch v cn thn trng trnh nhim cho phn cha trong l.
Trn chung Tritanrix HB v Hiberix :
Tritanrix HB c th c s dng hon nguyn vaccin Hiberix v tim chung mt ln. vaccin
Hiberix c trnh by dng vin Hib mu trng ng trong l, dung mi v khun, trong sut
v khng mu (nc mui) ng trong mt l th hai hoc ng sn trong mt bm tim. Loi
b phn dung mi.
Vaccin DTPw-HB-Hib phi c hon nguyn bng cch cho ton b phn cha trong mt l
Tritanrix HB n liu vo l n liu cha vin Hiberix mu trng. Sau khi thm Tritanrix HB vo
vin Hiberix, lc l hn hp cho n khi vin Hiberix tan hon ton trong hn dch Tritanrix HB.
Trc khi s dng, quan st bng mt thng vaccin phi hp hon nguyn xem c cc tiu

phn l v/ hoc bin i v mt vt l no khng. Nu c, phi loi b vaccin hon nguyn.

Nn dng mt kim tim mi tim vaccin. Sau khi hon nguyn, nn tim vaccin ngay.
BO QUN
Nn bo qun Tritanrix HB 2-8oC.
Khng c lm ng vaccin. Loi b vaccin b ng .

530.

TRIVASTAL RETARD 50 mg

LES LABORATOIRES SERVIER

vin bao phng thch chm 50 mg : hp 30 vin - Bng B.
THNH PHN
cho 1 vin
Piribdil

50 mg

(Saccharose)
DC LC
Thuc gy gin mch ngoi bin. Thuc chng lit rung (bnh Parkinson).
Piribdil l cht ch vn dopamine, c tc dng kch thch cc th th dopamine v cc ng
dn truyn dopamine lc no.
ngi : c ch tc ng kch thch dopamine ca pirib dil c chng minh qua cc nghin
cu dc l hc lm sng. Qua iu tr vi pirib dil, ngi ta ghi nhn : thuc gy kch thch
sinh in v no kiu "dopamine lc", lc thc cng nh lc ng ; thuc c tc ng lm sng
trn cc chc nng khc nhau c kim sot bi dopamine, tc ng ny c chng minh
nh s dng thang im nh gi hnh vi hay kh nng tm thn.
Mt khc, pirib dil lm tng lu lng mu i (s hin din ca cc th th dopamine trong
h thng mch mu i cho ph p gii thch tc ng ca piribdil trn tun hon ngoi bin).
DC NG HC
Pirib dil c hp thu nhanh chng.
Pirib dil t nng ti a trong mu sau khi ung thuc 1 gi.
Nng thuc trong mu gim theo hai pha : pha u tin c thi gian bn hy l 1,7 gi v
pha th hai chm hn c thi gian bn hy l 6,9 gi.
Pirib dil c chuyn ha mnh vi hai cht chuyn ha chnh (mt l dn xut hydroxyl v
mt l dn xut dihydroxyl).
Pirib dil c o thi ch yu theo nc tiu : 68% piribdil hp thu c bi tit qua thn

di dng cc cht chuyn ha v 25% c o thi qua mt.

Vin n n Trivastal Retard 50 mg c c tnh phng thch chm, do cho ph p hot cht c
gii phng v hp thu mt cch t t (in vivo) ; cc nghin cu dc ng thc hin trn ngi
cho thy rng hiu lc iu tr ca thuc ko di trn mt ngy m. Sau 24 gi, lng thuc
c o thi qua nc tiu l 50% v c o thi hon ton sau 48 gi.
CH NH
- iu tr b sung cc triu chng suy gim bnh l v nhn thc v thn kinh cm gic mn tnh
ngi ln tui (ngoi tr s sa st tr tu v bnh Alzheimer)
- iu tr b sung chng khp khnh cch hi trong bnh ng mch tc nghn mn tnh cc
chi di (giai on 2).
Ghi ch : ch nh ny da trn cc nghin cu chng t rng c s ci thin v chiu di
khong cch i b.
- iu tr bnh lit rung (Parkinson) :
+ hoc c ch nh dng n c (iu tr dng bnh c run l triu chng ch yu),
+ hoc c ch nh dng phi hp vi lvodopa, dng ngay t u hoc v sau, c bit trong
dng run ry.
- c ngh trong cc biu hin thiu mu cc b trong nhn khoa.
CHNG CH NH
Qu mn cm vi piribdil.
Shock do tim.
Nhi mu c tim cp.
CH PHNG v THN TRNG LC DNG
bnh nhn cao huyt p, vic dng piribdil khng th thay th c vic iu tr chuyn bit
bnh cao huyt p.
LC C THAI v LC NUI CON B
Thuc ny c dng cho ngi ln tui, nhng i tng ny khng c nguy c c thai. Do
cn thiu cc s liu thch ng, khng nn ch nh thuc ny cho ph n c thai hay ang cho
con b.
TNG TC THUC
Cc thuc i khng dopamine.
TC DNG NGOI
- Mt s ri lon nh ng tiu ha (bun nn, nn ma, y hi), cc ri lon ny c th t
khi sau khi iu chnh li liu cho thch hp vi tng bnh nhn.
- Him hn, c th xy ra mt s ri lon tm thn nh l ln hay d b kch ng, cc triu
chng ny s t khi khi ngng iu tr.
- Hn hu, c th xy ra ri lon v huyt p (h huyt p t th), hoc huyt p khng n nh.
LIU LNG v CCH DNG

Trong ri lon nhn thc v thn kinh gic quan do tui tc ; au cch hi hay thiu mu vng
mc cc b :
1 vin/ngy vo cui ba n chnh, hoc 2 vin/ngy, chia lm 2 ln (trng hp nng).
Bnh lit rung (Parkinson) :
- iu tr n c : 150-250 mg/ngy, chia lm 3-5 ln.
- b sung cho liu php lvodopa : 80-140 mg/ngy, chia lm 3-5 ln (theo t l 50 mg piribdil
cho 250 mg lvodopa).
Cch dng : Ung thuc vi na ly nc vo cui cc ba n, khng c nhai vin thuc.
QU LIU
liu rt cao, piribdil s gy nn ma do tc ng ln vng kch pht cc th th ha hc (CTZ
: Chemoreceptive Trigger Zone) : nh vy cht thuc cng nhanh chng c i ra, iu ny
gii thch c ti sao trn thc t li khng c mt d liu no v s qu liu ca thuc.

531.

TRYMO

RAPTAKOS BRETT
Vin nn bao phim : hp 14 v 8 vin.
THNH PHN
cho 1 vin
Colloidal bismuth subcitrate (Tripotassium dicitrato bismuthate) tnh theo Bi 2O3

120
mg

DC LC
i vi vt lot d dy t trng : Bismuth subcitrat th keo (CBS) rt tan trong nc. Trong mi
trng acide (pH < 5) d dy s kt ta thnh vi tinh th bismuth oxychloride v bismuth
citrate to ni chelate bn vng vi cc sn phm thoi ha ca protine vt lot hnh thnh
mng bo v ch ti vt lot m khng c vng nim mc lnh.
i vi cht nhy : CBS to phc hp glycoprotine bismuth khi gn vo cht nhy hnh thnh
ro cn s phn tn ngc ca ion H+ m khng nh hng n s trao i ion ca mng nhy.
CBS cng c kh nng bnh thng ha mc cao ca acide mucine mng nhy ca vt
lo t cha c cha tr.
i vi vi khun Helicobacter pylori : CBS c tc dng dit khun trc tip. Cc vi tinh th nu
trn kt t bn trong v ti vch t bo vi khun lm c c ton b cc thnh phn ca t
bo vi khun, hoc lm ha khng bo. Trong vng hai gi sau, vi khun mt kh nng bm dnh

nim mc v tri ln b mt. C nhiu bng chng cho vic tiu dit c vi khun ny lm
gim mnh m t l ti pht lot. Tc dng dit khun ca thuc c tng cng khi phi hp
vi khng sinh.
i vi pepsine : CBS lm gim kh nng kch hot pepsine ca pentagastrine khong 30%.
CBS kch thch tit PGE2 v c th y l c ch lm lnh lot ca thuc. Tc dng ny cng vi
tc dng trn vt lot gip xp loi thuc thuc nhm bo v t bo.
CBS khng lm gim acide ca dch v.
Tnh an ton : cho n nay cha c bo co no v bnh l no do CBS. CBS l mui bismuth
tan mnh trong nc, ch dng liu thp, khng dng ko di ; khng th so snh vi cc
mui bismuth khc (tan trong cht bo, dng liu rt cao v dng k o di) m trc kia b lm
dng v c lin quan n bnh l no. Tuy nhin, cn ngng dng cc ch phm bismuth nu
nng trong mu vt qu 100 ng/ml.
DC NG HC
Hp thu :
CBS tc ng ti ch l ch yu. Tuy nhin c mt lng bismuth rt nh c hp thu qua
ng tiu ha. Lng hp thu ny ty thuc vo liu ban u v t nh cao sau 4 tun s
dng. Vi liu iu tr 480 mg/ngy, nng bismuth trong mu trung bnh khong 7 ng/ml
(nng bo ng l 50-100 ng/ml).
Phn phi :
Trn sc vt thc nghim, hu ht bismuth hp thu u n thn, cc c quan khc ch l vt.
Trn ngi cha r.
Bi tit :
Hu ht bismuth trong CBS c bi tit qua phn di dng bismuth sulfite. Lng nh
bismuth hp thu c thi tr qua thn vi tc khong 2,6%/ngy v cn khong 2 thng
thi hon ton.
CH NH
- Lot t trng.
- Lot d dy lnh tnh.
- Vim d dy mn tnh hot ng.
- Chng kh tiu khng lot.
CHNG CH NH
Suy thn nng.
THN TRNG LC DNG
D khng c bo co no v bnh l no do bismuth sau khi dng colloidal bismuth subcitrate
liu iu tr, vn phi lun lun nh n nguy c ny v trnh dng qu liu. Cng vi l do
tng t, vic dng di ngy (liu php duy tr) khng c ch nh.
Thuc khng c ch nh dng cho tr em.

LC C THAI v LC NUI CON B

Khng dng cho ph n mang thai v cho con b.
TNG TC THUC
S hp th cht st, calcium hay ttracyline c th b gim nu dng chung. Cc thuc khng
acide hay sa dng chung vi thuc c th to ni chelate vi thuc v lm nh hng n tc
dng ca colloidal bismuth subcitrate. V vy, trnh dng thc n hay cc thuc khng acide
trong vng 30 pht trc hay sau khi dng thuc.
TC DNG NGOI
- Bun nn, i ma v tiu chy hoc nhc u, chng mt thnh thong c ghi nhn.
- Phn en do bi tit bismuth sulfite.
LIU LNG v CCH DNG
Mi ln hai vin, mi ngy hai ln, ung khi bng trng, na gi trc ba n. Nut nguyn
vin v khng nhai vin thuc. Nn dng trong bn tun v nu cn th n ti a 8 tun. Khng
nn dng Trymo nh l mt liu php duy tr sau khi qua thi gian ti a 8 tun iu tr. Nu
mun iu tr tip, nn cch t nht 8 tun trc khi tip tc t mi.

532.

TURINAL

GEDEON RICHTER
Vin nn 5 mg : hp 20 vin.
THNH PHN
cho 1 vin
Allylestrenol

5 mg

DC LC
- Nhm iu tr dc l : theo nhng nghin cu dc l hc, allylestrenol l mt gestagen
mnh cng l mt steroid bo v thai. N khng c tc dng androgen v estrogen, cng khng
c ch chc nng tuyn thng thn v sinh dc.
- C ch tc ng : trong bo v thai, Turinal ng vai tr thay th hormon m tc dng lm
sng ca n c bo m bng c tnh dng thai mnh. Theo nhng pht hin m hnh thi
hc, hot ng tit ca l nui v s sn xut oxytocinase tng. Di tc dng ca Turinal, s
tit nhng cht chuyn ha ca nhng steroid nhau thai tng, ngha l lm bnh thng ha
chc nng nhau thai. Turinal kch thch progesteron ni sinh, nn c hiu qu cao trong iu tr
e da sy thai v sy thai thng xuyn, nh xc nh bng nhiu quan st lm sng.
- Tc dng dc lc : nh c chng minh bng test Clauberg, tc dng dng thai ca

Turinal tng ng vi progesteron. Trong test Clauberg, Turinal cho thy hot tnh mnh
hn ethisteron 8 ln. Trong test u mng rng liu 2,5 mg cho nhng kt qu dng tnh 75%
sc vt, tr s ny vt xa nhng tc dng tng t ca norethisteron, dimethisteron,
methylpregnon v ethisteron. Turinal khng c tc dng estrogen v androgen, cng khng c
ch chc nng tuyn thng thn v sinh dc.
- Allylestrenol khng c tc dng c ch ln chc nng tuyn yn (mt khc, n c ch ng k
s tit hormon hng sinh dc ca tuyn yn, theo pht hin ca Sas v cs.)
- Allylestrenol c tc dng dng thai trn ni mc t cung, tng ng vi tc dng ca
progesteron.
DC NG HC
- Allylestrenol c hp thu hon ton ng tiu ha, nng huyt thanh nh thng t
c trong vng 2 gi. Tc dng ca thc n ln s hp thu cha c bit.
- S ti tun hon gan rut khng quan trng cho progestin, v khng th nh hng n nng
nh trong huyt thanh.
- S gn kt ca progestin ny trong huyt thanh ch yu xy ra vi albumin v SHBG. S gn
kt vi albumin tng i yu, nn s phn ly progestin din ra d dng; s gn kt vi SHBG
mnh hn nhiu v bin i, v s phn ly kh hn. Hm lng SHBG huyt thanh cho thy
thay i rng nhng i tng khng iu tr, v b nh hng bi nhiu yu t khc nhau.
Phn phi progestin gia 2 protein ny v tnh trng khng gn kt ph thuc vo yu t xc
nh trong huyt thanh nhng ph n trc khi bt u iu tr hoc sau vi thng dng
thuc, khi t c hm lng SHBG n nh. Ngoi ra, c s khc nhau ln gia cc i
tng trong p ng ca SHBG vi cng progestin.
- Allylestrenol c gan chuyn ha thnh pregnandiol bt hot.
- Nhng cht chuyn ha trong nc tiu ch yu lin hp vi acid glucuronic.
CH NH
Sy thai thng xuyn v e da sy thai. e da non.
CHNG CH NH
Ri lon chc nng gan. Hi chng Dubin Johnson v Rotor, c tin s nhim c huyt hoc
herpes thai kz.
CH PHNG v THN TRNG LC DNG
Nn kim tra mc glucose trong mu thng xuyn nhng ph n c thai b tiu ng v
thuc ny lm gim s dung np glucose.
LC C THAI v LC NUI CON B
Allylestrenol l mt cht c tc dng dng thai, khng c tc ng nam ha thai nhi.
Czeizel v Ruzicska chng minh rng Turinal khng nh hng ln s t bin nhim sc th.
Hungary c 30% ph n mang thai dng liu php h tr hormon c progestagen vo u
nhng nm 80, mt nghin cu c kim chng gi rng c mt mi lin h nhn qu gia

nhng liu php ni trn vi tt l tiu thp con chu.

TNG TC THUC
Nn cn thn khi dng ng thi vi nhng thuc cm ng enzyme (nhng thuc ny c th
lm gim hiu qu ca Turinal).
TC DNG NGOI
B i, bun nn, nhc u. Thay i duy nht thy c trong nghin cu c tnh mn vi
liu 25 mg/kg, vt xa liu iu tr, l gim nh chc nng sinh dc v tr s cholesterol huyt
tng.
LIU LNG v CCH DNG
e da sy thai : Ung mi ln mt vin nn, mi ngy ung 3 ln trong 5-7 ngy, tc l, cho
n khi chm dt triu chng. Nu cn, c th tng liu.
Xy thai thng xuyn : T nhng du hiu mang thai rt sm, ung 1-2 vin nn mi ngy lin
tc cho n t nht l mt thng sau giai on nguy c.
e da sinh non : Liu ty theo tng c th ; thng dng liu cao hn liu ni trn (5-20 mg
mi ngy).

533.

TYPHIM Vi

AVENTIS PASTEUR
Dung dch tim bp hoc di da : ng tim bm thuc 0,5 ml.
THNH PHN
cho 1 ng tim
Polyoside capsulaire Vi tinh khit chit t Salmonella typhi

0,025 mg

CH NH
D phng st thng hn ngi ln v tr em trn 5 tui.
CHNG CH NH
Mn cm vi mt trong cc thnh phn ca thuc.
Tr em di 2 tui : S p ng min dch ca tr em di 2 tui i vi vaccin polyoside
thng rt yu, sau tng dn. V th khng nn tim cho tr em di 2 tui.
THN TRNG LC DNG
Ch tim nga cho tr em t 2 n 5 tui trong trng hp c nguy c ly nhim nghim trng.
LC C THAI
Nguy c xy ra trong thai kz cha c kho st, nn ch tim nga sau khi cn nhc li hi.
TC DNG NGOI

au ti ch, , ha cng, st.

LIU LNG v CCH DNG
1 mi tim duy nht (tim bp hoc di da), bo v 3 nm.

THUC VN U-V-W

534.

ULFON

LAFON
c/o GALIEN
bt ung : hp 20 gi v 45 gi.
THNH PHN
cho 1 gi bt ung
Aldioxa (allantoinate de dihydroxyaluminium)

900 mg

Alcloxa (allantoinate de chlorhydroxyaluminium)

100 mg

Calcium carbonate

500 mg

1 gi cha 200 mg calcium v 123 mg aluminium.

Thnh phn chnh l 2 mui nhm nguyn cht.
Mi gi cha 123 mg nhm v 200 mg calci.
DC LC
Trung ha acid chlohydric
Tc dng nhanh : sau khi ung mt vi pht pH d dy c nng ln ng k (t khong 1
ln xp x 2) nh mt lng va phi calcicarbonate. Do thuc lm gim nhanh cc triu
chng.
Tc dng ko di : trong khong 3 gi v pH c nng dn ln ti gn 4 nh cc allantoinate
tc dng nh mt h m c dung tch ln.
Thuc c kh nng :
- iu chnh thi gian tng thc n t d dy xung t trng mt cch hp l do lm gim cc co
bp qu mc gy ra bi s tng tit acid, gip thc n li d dy lu hn to iu kin cho

thuc c thi gian trung ha dch v d tha.

- Ulfon bm dnh vo nim mc nn thuc lu li v tc dng ko di ti d dy.
Tc dng lm lin so lot v bo v nim mc
- Cc allantoinate gn mnh vo glucoprotein ca lp nhy nim mc c bit l gn vi protein
lot bng cc lin kt cng ha tr to thnh mt mng bo v gip lot lin so nhanh.
- Thuc c kh nng hp thu cc mui mt tro ngc t t trng vo d dy.
- Tng cng tc dng ca prostaglandin E2 lm gim tit pepsinogen v tng bi tit dch kim.
C th s dng iu tr ko di m khng gy tng nhm trong mu v nc tiu do thuc
khng hp thu qua ng tiu ha.
DC NG HC
- Dng ko di 4 gi/ngy cc trng hp thng thng khng gy ra nguy c tng nng
nhm trong mu.
- Ung 4 gi Ulfon trong 30 ngy iu tr triu chng au trong mt lot cc ri lon thc
qun, d dy, t trng m khng gy tng nng nhm trong mu v nc tiu. Xt nghim
c thc hin theo phng php tm c hiu v nhy theo cc tiu chun ca
Worldwide Interlaboratory Aluminium Control Programme cho thy khng c bt kz mt nguy
c no gy tch ly nhm khi dng thuc ko di.
- Nhng kt qu ny cng tng t kt qu thu c i vi Ulfon dng bt trong iu kin
tng t. Cc kt qu ny ngc li vi cc kt lun trong y vn vi cc mui nhm khc, nh
thuc khng acid c"hydroxide nhm" lm tng nng nhm trong mu v/hoc khng acid
c "phosphat nhm" lm tng nng nhm trong nc tiu. Vi Ulfon, nng nhm trong
mu cng nh trong nc tiu khng b tng ln, chng t khng c hp thu nhm ng
tiu ha t cc dng mui nhm c trong nh dch Ulfon (Weber v Berstad chng minh
rng theo di s bi tit ca nhm qua nc tiu l mt phng php nhy nht xc nh s
hp thu-thm ch l rt t-ca nhm qua lc cu thn.
- Nhng kt qu ny tr nn quan trng hn khi Salusky v cng s (1991) chng minh rng
thm ch vi mt liu nh nhm c xem mt cch r rng l khng gy c, cng dn n
gy tch ly dn hm lng nhm.
- Kt lun : Theo Eur. J. Clin. Chem. Biochem 1996, 34, 609-12 "khng c s hp thu ng
tiu ha hoc bi tit ra nc tiu ca nhm sau khi dng hai loi khng acid c cha hp cht
allantoinate cc bnh nhn c chc nng thn bnh thng". Chng t khng c s hp thu
nhm trn lm sng.
CH NH
- Tro ngc d dy - thc qun.
- Vim lot thc qun.
- Vim lot d dy.
- Vim lot t trng.

CHNG CH NH
- Vi cc trng hp tng calci mu.
CH PHNG v THN TRNG LC DNG
bnh nhn b suy thn v phi chy thn kinh nin, cn lu { n lng aluminium c trong
mi gi (do c kh nng gy bnh no) v theo di calci huyt.
LC C THAI v LC NUI CON B
Lc c thai :
Khng c nghin cu v kh nng gy qui thai ca thuc trn ng vt.
Trn lm sng, cc thuc khng acide cho thy c hiu qu iu tr tt v khng gy c tnh
trn phi thai hay c tc dng gy d dng. Do thuc khng acide c th c k toa cho ph
n c thai, nu cn.
TNG TC THUC
Thn trng khi phi hp :
- Khng khun (cc cyclines, fluoro-quinolones, thuc khng lao : thambutol, v isoniazide,
lincosamides), khng histamine H2, atenolol, propranolol, chloroquine, diflunisal, digoxine,
diphosphonates, mui st, fluorure de sodium, glucocorticoides (prednisolone v
dexamethasone), indometacine, kayexalate, ketoconazole, lansoprazole, thuc an thn kinh,
cc phnothiazines, cc pnicilline, phosphore (cung cp), thyroxine.
Ngi ta nhn thy rng khi dng ng thi cc thuc ny bng ng ung, s hp thu thuc
ng tiu ha s b gim i. phng, khi dng cc thuc khng acide phi cch khong
xa vi cc thuc khc ti thiu trn 2 gi, i vi fluoro-quinolones, thi gian l 4 gi.
Lu { khi phi hp :
- Salicylate : tng bi tit cc salicylate thn do s kim ha nc tiu.
TC DNG NGOI
- Liu cao c th gy to bn.
LIU LNG v CCH DNG
- iu tr triu chng : khi au, nng, rt bng, chua, ung mi ln 1 gi, ngy 3-4 ln.
- iu tr lot : ngy 4 ln, mi ln 1 gi sau mi ba n v trc khi i ng ung 1 gi. Dng
ko di trong 4-5 tun.
BO QUN
Thuc cn c bo qun nhit di 25oC.

535.

ULTRA-LEVURE

BIOCODEX
c/o TEDIS
vin nang : hp 20 vin v 50 vin.
THNH PHN
cho 1 vin
Saccharomyces boulardii ng kh

56,5 mg

DC LC
Thuc tiu chy c ngun gc vi sinh.
Tc ng dc l ca Saccharomyces boulardii ng vt ch yu bao gm :
- tng hp vitamine nhm B : vitamine B1, vitamine B2, acide pantothnique, vitamine B6, acide
nicotinique ;
- tc ng c ch in vitro v in vivo trn s tng trng ca cc vi sinh vt khc nhau : vi khun,
Candida albicans ;
- tc ng trn h thng min dch, c bit khi b nhim trng.
Chng Saccharomyces boulardii, hot cht chnh ca Ultra-Levure, c bo qun bng cc k
thut nhm bo m duy tr cc c tnh dc l nguyn gc. Saccharomyces boulardii c
ngun gc l mt men nm ch khng phi l vi khun do khng b nh hng tc ng ca
khng sinh v sulfamide.
Phng php ng kh c s dng bo ch Ultra-Levure cho php phc hi cc t bo
men nm trn mt mi trng ph hp m khng lm thay i hnh thi hoc chc nng.
DC NG HC
Cc th nghim trn ng vt cho thy sau khi dng mt liu duy nht, cc t bo sng xut hin
rt nhanh chng trong bao t, t trng v hng trng. Thuc chuyn vn nhanh qua t trng.
Ngc li, ti hng trng, mt lng ng k cc t bo sng c gi li sau gi u tin. Ti
hi trng, lng t bo t c ti a sau 1 gi. manh trng, lng t bo t ti a gi
th 6 ; 24 gi sau khi ung thuc, lng men rut vn cn tn ti ng k.
Saccharomyces boulardii khng b nh hng bi cc dch bi tit bao t, gan, ty v rut.
Mt khc, ngi ta cng ghi nhn rng nm men cng khng th t pht trin trong mi trng
rut.
ngi, cc k thut thng thng cho php tm thy cc t bo sng trong phn.
CH NH
Nn dng thuc trong cc trng hp sau :
iu tr v d phng cc bin chng ng tiu ha do s dng khng sinh.
D phng ngi ln b tiu chy lin quan n nui n bng ng thng qua ng tiu ha

lin tc.
iu tr tiu chy do nhim trng tr cn b, tr em, ngi ln v ngi gi.
Ghi ch : S tr liu cn phi phi hp vi vic bi hon nc nu cn. S c lng ca vic
bi hon nc v cch bi hon nc phi thch nghi vi nghim trng ca tiu chy, vi
tui v tnh trng ca ngi bnh.
CH PHNG v THN TRNG LC DNG
Nu cc triu chng k o di hn 2 ngy vi liu lng thng thng, cn phi xem xt li s tr
liu.
Khng nn trn thuc vo cc dung dch hoc thc phm qu nng (trn 50oC), hay qu lnh
(nc ) v Ultra-Levure c cha cc t bo men nm sng. Khng c pha vi cn.
Trnh gi thuc ni m v nng.
TNG TC THUC
Do c bn cht l mt nm, Saccharomyces boulardii khng c dng chung vi cc thuc
khng sinh khng nm ng ung v ton thn.
LIU LNG v CCH DNG
Liu thng thng l 4 vin mi ngy, chia lm 2 ln.
i vi tr em di 6 tui, khng nn cho ung trn vin nang m nn trt phn bt thuc
trong vin nang vo chai sa hoc thc phm khc ung.
BO QUN
Bo qun trnh m v nng.

536.

ULTRAVIST

SCHERING AG
c/o ZUELLIG
Ultravist 150 :
dung dch tim 0,31 g/ml : chai 50 ml.
Ultravist 240 :
dung dch tim 0,5 g/ml : chai 20 ml, 50 ml, 100 ml, 200 ml ; ng/l 10 ml.
Ultravist 300 :
dung dch tim 0,62 g/ml : chai 20 ml, 50 ml, 75 ml, 100 ml, 150 ml, 200 ml ; ng/l 5ml, 10 ml.
Ultravist 370 :
dung dch tim 0,77 g/ml : chai 100 ml, 150 ml, 200 ml ; ng/l 30 ml.
THNH PHN
Ultravist 150 :
cho 1 ml

Iopromide

0,31 g

Ultravist 240 :
cho 1 ml
Iopromide

0,5 g

Ultravist 300 :
cho 1 ml
Iopromide

0,62 g

Ultravist 370 :
cho 1 ml
Iopromide

0,77 g

CH NH
Ultravist 150 :
Tim ng mch trong th thut chp mch mu loi tr bng s (DSA), kim tra chc nng ca
shunt ni trong lc lm thm phn.
Ultravist 240 / 300 / 370 :
Thuc cn quang dng trong php chp ct lp in ton (CT), php chp ng mch loi tr
bng s (DSA), chp h niu ni tnh mch, chp tnh mch chi, chp cc khoang trong c th
(chp X quang khp, t cung - vi trng, chp ng r) ngoi tr chp ty sng, no tht, cc
xoang cha dch.
CHNG CH NH
Cng gip, ph n c thai.
THN TRNG LC DNG
Thn trng khi s dng trong nhng trng hp sau :
Bnh nhn qu mn cm vi thuc cm vi thuc cn quang c cha iodinate, suy chc nng
gan hoc thn nng, suy tim v suy tun hon, kh ph thng, tng trng suy kit, x va ng
mch no tin trin, tiu ng cn iu tr, tnh trng co git do no, cng gip tim n,
bu gip nhn th nh v a u ty.
Cc bnh nhn c tng d ng thng d b phn ng qu mn hn.
TC DNG NGOI
Bun nn, nn ma, hng ban, cm gic au v nng l cc phn ng thng gp nht khi tim

ni mch. Cn iu tr cp cu : phn ng tun hon i km vi gin mch ngoi bin v h

huyt p ; nhp tim nhanh phn x, kh th, kch thch, l ln, tm ti v c th dn n mt
thc.
LIU LNG v CCH DNG
Chp h niu ni tnh mch :
1 ml Ultravist 300 / kg cn nng.

537.

UNASYN

PFIZER
c/o ZUELLIG
vin nn bao phim 375 mg : hp 10 vin.
bt pha huyn dch ung : hp 1 l 30 ml.
bt pha tim bp, tnh mch 500 mg/1 g : hp 1 l bt.
THNH PHN
cho 1 vin
Sultamicilin tosylate, tnh theo sultamicilin

375 mg

cho 5 ml huyn dch

Sultamicilin base hon nguyn vi nc, tnh theo sultamicilin

250 mg

cho 1 l thuc tim 500 mg/1 g

Sulbactam sodium, tnh theo sulbactam

500 mg

Ampicillin sodium, tnh theo ampicillin

1000 mg

DC LC
Sultamicilin l mt ester i, trong ampicillin v cht c ch bta-lactamase sulbactam c
gn qua nhm methylen. V mt ha hc, sultamicilin l ester sulphone oxymethylpenicillinate

ca ampicillin v c trng lng phn t l 594,7.

ngi trong qu trnh hp thu sultamicilline s thy phn cho ra sulbactam v ampicillin t l
phn t 1:1 lu hnh trong h tun hon. Sinh kh dng khi s dng ng ung t ti 80%
so vi dng ng tnh mch liu tng ng ca sulbactam v ampicillin.
Nhng nghin cu sinh ha hc vi cc h vi khun khng t bo (cell-free bacterial systems)
chng minh sulbactam c kh nng lm bt hot khng hi phc phn ln cc men btalactamase quan trng ca cc vi khun khng penicillin. Sulbactam c hot tnh khng khun
ng k i vi Neisseriaceae, Acinetobacter calcoaceticus, Bacteroides spp., Branhamella
catarrhalis v Pseudomonas cepacia. Nhng nghin cu vi sinh hc trn cc dng vi khun
khng thuc xc nhn sulbactam c kh nng bo v penicillin v cephalosporin khng b vi
khun ph hy v c tc dng ng vn r rt vi penicillin v cephalosporin. Do sulbactam
cng gn vi mt s protein gn kt penicillin, cho nn i vi mt s dng vi khun nhy cm,
s dng kt hp sulbactam-ampicillin s hiu qu hn l ch dng mt loi bta-lactam.
Thnh phn kt hp vi sulbactam trong Unasyn l ampicillin c tnh nng dit nhng dng vi
khun nhy vi thuc bng cch c ch sinh tng hp mucopeptide ca vch t bo.
Unasyn c ph khng khun rng i vi c vi khun Gram dng v Gram m, gm c
Staphylococcus aureus v S. epidermidis (gm c nhng vi khun khng penicillin v mt s
vi khun khng methicillin), Streptococcus pneumoniae, Streptococcus faecalis v cc chng
Streptococcus khc, Haemophilus influenzae v parainfluenzae (c hai dng vi khun sinh btalactamase v khng sinh bta-lactamase), Branhamella catarrhalis, vi khun ym kh gm c
Bacteroides fragilis v nhng vi khun cng h, Escherichia coli, Klebsiella, Proteus gm c hai
loi indole (+) v indole (-), Morganella morganii, Citrobacter, Enterobacter, Neisseria
meningitidis v Neisseria gonorrhoeae.
DC NG HC
Ung sultamicillin sau khi n khng lm nh hng sinh kh dng ton thn. Nng nh
trong huyt tng ca ampicillin sau khi ung sultamicillin t cao gp hai ln so vi dng liu
tng ng ampicillin ung. ngi tnh nguyn khe mnh, thi gian bn thi (elimination
half-life) ca sulbactam l 0,75 gi v ca ampicillin l 1 gi, vi u im l c t 50% ti 75%
lng thuc thi tr nguyn vn qua nc tiu. Thi gian bn thi tng ln ngi gi v
ngi b suy thn. Probenecid lm gim kh nng bi tit qua ng thn ca c ampicillin v
sulbactam. Do , s dng ng thi probenecid v sultamicillin lm tng v k o di nng
ampicillin v sulbactam trong mu.
Sulbactam/ampicillin khuch tn d dng vo hu ht cc m v dch c th. Thuc t thm
nhp vo no v dch no ty tr khi c vim mng no. Nng ca sulbactam v ampicillin
cao trong mu sau khi tim tnh mch hoc tim bp v c sulbactam ln ampicillin u c thi
gian bn hy khong mt gi. Hu ht sulbactam/ampicillin c thi tr nguyn vn qua nc
tiu.

CH NH
Ch nh s dng Unasyn ung trong nhng trng hp nhim khun do vi khun nhy vi
thuc. Ch nh in hnh l nhim khun ng h hp trn gm vim xoang, vim tai gia v
vim amian ; nhim khun ng h hp di gm vim phi v vim ph qun do vi khun ;
nhim khun ng tiu v vim i b thn ; nhim khun da v phn mm ; nhim lu cu.
Sultamicillin cng c th dng nhng bnh nhn cn iu tr bng sulbactam/ampicillin sau
khi iu tr khi u bng Unasyn tim.
Ch nh s dng Unasyn tim trong nhng trng hp nhim khun do vi khun nhy vi
thuc. Ch nh in hnh l nhim khun ng h hp trn v ng h hp di gm vim
xoang, vim tai gia v vim tiu thit, vim phi do vi khun ; nhim khun ng tiu v
vim i b thn ; nhim khun trong bng gm vim phc mc, vim ti mt, vim ni mc
t cung, vim vng chu ; nhim khun huyt ; nhim khun da, phn mm, xng v khp v
nhim lu cu.
Unasyn tim cng c th c dng d phng nhng bnh nhn phu thut bng hoc
vng chu nhm mc ch trnh nhim khun vt thng hu phu do nhim khun phc mc.
Dng d phng nhim khun hu sn trong nhng trng hp chm dt thai kz ch ng hoc
m ly thai. Unasyn tim cng c dng phng nhim khun hu phu.
CHNG CH NH
Chng ch nh nhng ngi c tin cn d ng vi nhm penicillin.
CH PHNG v THN TRNG LC DNG
Ch { phng :
Nhng phn ng qu mn (phn v) trm trng i khi gy t vong c bo co nhng
bnh nhn dng penicillin. Cc phn ng ny thng xy ra ngi c tin cn d ng
pencicillin v/hoc nhy cm vi nhiu d ng nguyn. c nhng bo co v nhng ngi c
tin cn d ng vi penicillin c th b d ng khi dng cephalosporin. Trc khi dng pencicillin
phi hi k tin cn d ng trc , c bit l d ng vi pencillin, cephalosporin, v cc d
ng nguyn khc. Khi iu tr nu c d ng phi ngng thuc ngay v i sang loi thuc khc
thch hp .
Trong nhng trng hp phn ng phn v nng, cn cp cu ngay vi adrenaline. Nu cn
cho th oxy, tim steroid, lm thng ng th bao gm c vic t ni kh qun.
Thn trng lc dng :
Nh vi mi khng sinh khc, cn theo di lin tc cc du hiu ca tnh trng qu sn ca cc
vi sinh vt khng nhy vi thuc k c nm. Nu c du hiu bi nhim phi ngng thuc ngay
v iu tr vi loi thch hp hn.
Nh vi mi thuc c tc dng ton thn khc, nn kim tra nh kz chc nng thn, gan v cc
c quan to mu trong thi gian iu tr. iu ny rt quan trng tr s sinh c bit l tr
non thng, v nhng tr nh nhi khc.

S dng cho tr em :
ng thi tr ch yu ca sulbactam v ampicillin sau khi ung sultamicillin l qua nc tiu.
V chc nng thn tr s sinh cha hon chnh, cn lu { khi s dng sultamicillin tr s
sinh.
LC C THAI v LC NUI CON B
Nghin cu sinh sn trn th vt th nghim cho thy thuc khng c nh hng trn kh nng
sinh sn v khng tc hi cho thai. Tuy nhin, tnh an ton trong thi kz mang thai v cho con
b cha c xc nh.
Ampicillin v sultamicillin bi tit mt t qua sa. Do , nn lu { khi s dng ph n ang
cho con b.
TNG TC THUC
Khi s dng allopurinol v ampicillin cng lc d b ni mn hn l ch dng ampicillin n
thun. Cho n nay cha c d liu xc nh tng tc thuc gia sultamicillin v
allopurinol.
TC DNG NGOI
Dng ung :
Sultamicillin l thuc c dung np tt. a s cc tc dng ngoi nu c xy ra ch mc
nh hoc trung bnh v s dung np bnh thng khi dng tip tc.
ng tiu ha : tc dng ngoi { thng gp nht l tiu chy hoc i phn lng. Cng c th
bun i, nn ma, nng rt vng thng v, au bng/co tht c bng. Nh vi cc khng sinh
nhm ampicillin khc, vim i trng v vim i trng gi mc him khi xy ra.
Da v cu trc da : i khi gy mn v nga.
Tc dng ngoi khc : him khi xy ra nh l /bun ng, mt mi/kh chu v nhc u.
Tc dng ngoi ca ampicillin him khi xy ra.
V bnh nhim bch cu n nhn l do virus, khng nn s dng ampicillin iu tr. C mt
t l cao bnh nhn tng bch cu n nhn b ni mn khi s dng ampicillin iu tr.
Dng tim :
Ging nh nhng khng sinh ng tim khc, tc dng ngoi ch yu l au ti ch tim,
nht l khi tim bp. Mt s t bnh nhn c th b vim tnh mch.
ng tiu ha : thng gp l bun nn, nn ma v tiu chy.
Da v cu trc da : thng gp l ni mn , nga v cc phn ng da khc.
H to mu v bch huyt : c bo co v thiu mu, gim tiu cu, tng bch cu i toan v
gim s lng bch cu. Nhng phn ng ny c th hi phc khi ngng dng thuc, c cho
l do phn ng nhy cm.
Gan : tng tm thi men SGOT v SGPT.
Tc dng ngoi ca ampicillin i khi c th xy ra.
V bnh nhim bch cu n nhn l do virus, khng nn s dng ampicillin iu tr. C mt

t l cao bnh nhn tng bch cu n nhn b ni mn khi s dng ampicillin iu tr.
LIU LNG v CCH DNG
Dng ung :
Liu sultamicillin khuyn co ngi ln (gm c ngi gi) l 375 mg ti 750 mg hai ln mi
ngy.
Trong hu ht cc trng hp nhim khun tr em cn nng di 30 kg, liu sultamicillin l
25-50 mg/kg/ngy chia thnh hai ln ty thuc mc nhim khun v nh gi ca bc s. i
vi tr em cn nng 30 kg tr ln, dng liu nh ngi ln.
C ngi ln v tr em, sau khi ht st v nhng du hiu bt thng phi iu tr tip tc 48
gi na. Thi gian iu tr thng l t 5 ti 14 ngy, nhng c th ko di thm nu cn thit.
iu tr nhim lu cu khng triu chng, dng sultamicillin liu duy nht 2,25 g (6 vin 375
mg). C th kt hp vi probenecid 1 g ko di nng sulbactam v ampicillin trong huyt
tng.
Trng hp nhim lu cu m c tn thng nghi ng giang mai, nn xt nghim bng knh
hin vi nn en trc khi cho iu tr bng sultamicillin v phi xt nghim huyt thanh hc
hng thng t nht trong 4 thng lin tip.
Bt c trng hp nhim khun no do lin cu tan huyt (hemolytic streptococci) phi iu tr
t nht l 10 ngy ngn nga st thp hoc vim vi cu thn cp.
bnh nhn b ri lon chc nng thn nng ( thanh thi creatinine nh hn
30 ml/pht), kh nng thi tr sulbactam v ampicillin cng b nh hng nh nhau. Do , t
l nng ca hai thuc trong huyt tng khng thay i. Phi gim liu v s ln dng
sultamicillin nhng bnh nhn ny ging nh khi s dng ampicillin thng thng.
Hn dch ung sau khi pha nu mun li dng tip phi gi lnh v hy b nu lu qu
14 ngy.
Dng tim :
Unasyn tim c th c dng ng tnh mch hoc tim bp. C th pha thuc nh sau :
Tng liu Liu tng ng vi
(g)
Sulbactam-Ampicillin (g)

1,5

L 20
3,2
ml

0,5-1,0

Th tch ha
tan (ml)

Nng ti a sau khi

pha (mg/ml)
125-250

Khi tim truyn tnh mch, Unasyn tim nn c pha vi nc pha tim v khun hoc dung
dch thch hp sao cho hn dch s dng khng c cn v ha tan hon ton. Tim tnh mch
tht chm ti thiu l 3 pht hoc c th pha long tim tnh mch hay tim truyn tnh
mch trong 15-30 pht. Sulbactam/ampicillin sodium cng c th c s dng bng cch tim
bp su ; nu b au, c th pha thuc vi dung dch pha tim v khun lignocaine 0,5%.

Tng liu Unasyn tim thng dng t 1,5 g ti 12 g mi ngy, c chia ra mi 6 gi hoc 8
gi cho ti liu ti a mi ngy ca sulbactam l 4 g. Nhng trng hp nhim khun nh c
th chia liu mi 12 gi.
Mc nhim khun

Liu Unasyn tim mi ngy (g)

Nh

1,5-3 (0,5+1 n 1+2)

Trung bnh

ln n 6 (2+4)

Nng

ln n 12 (4+8)

Liu dng Unasyn tim cho hu ht nhim khun tr em, nh nhi v tr s sinh l 150
mg/kg/ngy (tng ng vi sulbactam l 50 mg/kg/ngy v ampicillin l 100 mg/kg/ngy). tr
em, nh nhi v tr s sinh liu thng c chia thnh mi 6 gi hoc 8 gi tng t nh dng
ampicillin thng thng. i vi tr s sinh mt tun tui (c bit l tr non thng) liu
thng c chia thnh mi 12 gi. S ln tim trong ngy ph thuc vo mc bnh v
chc nng thn ca bnh nhn.
Sau khi bnh nhn ht st v khng cn nhng du hiu bt thng phi tip tc dng thm 48
gi na. Thi gian iu tr thng t 5 n 14 ngy nhng c th ko di hoc dng thm
ampicillin trong nhng trng hp qu nng.
Bnh nhn b suy thn nng ( thanh thi creatinine nh hn 30 ml/pht), kh nng thi tr
sulbactam v ampicillin cng b nh hng nh nhau. Do , t l nng ca hai thuc trong
huyt tng khng thay i. Nn gim s ln tim ging nh khi s dng ampicillin nhng
bnh nhn ny. bnh nhn phi hn ch dng sodium, khi iu tr bng Unasyn tim phi lu
rng trong 1500 mg Unasyn tim c khong 115 mg (5 mmol) sodium.
d phng nhim khun phu thut, dng t 1,5 g n 3 g Unasyn tim lc tin m thuc
thi gian t nng hiu qu trong huyt tng v m khi tin hnh phu thut. C th
lp li liu trn mi 6 gi hoc 8 gi ; thng ngng thuc 24 gi sau phu thut tr khi c ch
nh dng thm. iu tr nhim lu cu khng bin chng, Unasyn tim c th dng liu duy
nht 1,5 g. C th ng thi ung thm 1 g Probenecid ko di nng sulbactam v
ampicillin trong huyt tng.
Tnh n nh v tng hp :
Sulbactam sodium tng hp vi hu ht dch truyn tnh mch nhng v ampicillin sodium (v
v vy Unasyn tim) t n nh trong dung dch dextrose hoc cc dung dch cha carbohydrate
khc, khng nn pha chung Unasyn vi nhng dung dch cha sn phm t mu hoc ly gii
m. Ampicillin (v v vy Unasyn tim) khng tng hp vi cc aminoglycoside v khng nn
pha trn trong cng mt vt cha. Dung dch m c tim bp, sau khi pha nn dng trong

vng mt gi. Thi gian s dng nu truyn tnh mch i vi nhng dung dch pha thuc khc
nhau nh sau :
Dung dch pha long

Nng sulbactam +
ampicillin

Thi gian
s dng
(gi)
25oC

Nc pha tim v khun

Sodium choloride ng trng

Dung dch sodium lactate M/6

n 45 mg/ml

45 mg/ml

48

n 30 mg/ml

72

n 45 mg/ml

45 mg/ml

48

n 30 mg/ml

72

n 45 mg/ml

n 45 mg/ml
Dung dch dextrose 5% trong nc

15 n 30 mg/ml

n 3 mg/ml

n 30 mg/ml
Dung dch dextrose 5% trong NaCl
0,45%

4oC

n 3 mg/ml

4
4

n 15 mg/ml

Dung dch ng nghch chuyn 10% n 3 mg/ml

trong nc
n 30 mg/ml

Dung dch Lactate Ringer

n 45 mg/ml

n 45 mg/ml

24

538.

UPSA C 1000 mg - UPSA C CALCIUM

UPSA
vin nn si bt d b 1 g : ng 10 vin.
vin nn si bt d b : ng 10 vin.
THNH PHN
cho 1 vin UPSA C
Acide ascorbique

1g

(Saccharose)

(628 mg)

cho 1 vin UPSA C Calcium

Acide ascorbique

1g

Calcium carbonate

0,6 g

(Sodium)

(201 mg)

DC LC
Cung cp vitamine C v calcium.
DC NG HC
Hp thu tt qua ng tiu ha. Trng hp dng qu nhu cu, thuc c o thi theo
nc tiu.
CH NH
- Phng nga tnh trng thiu calcium v vitamine C.
- iu tr suy nhc trong bnh cm, s mi, cm, nhim trng, thi kz dng bnh.
- iu tr triu chng trong bnh suy nhc chc nng.

CHNG CH NH
- Si thn khi dng liu trn 1 g/ngy.
- Suy chc nng thn, tng calci huyt, tng calci niu, bnh si do calcium.
THN TRNG LC DNG
- Lu { n lng ng trong vin UPSA C 1000 mg v lng Na trong vin UPSA C Calcium.
Do c tc dng kch thch nh, khng nn dng vitamine C vo cui ngy (bui ti).
TC DNG NGOI
Vitamine C dng liu cao (trn 1 g/ngy), c th gy ra :
- Ri lon tiu ha (nng rt d dy, tiu chy).
- Ri lon tit niu (kt ta si urate, cystine v/hoc oxalate).
- Tn huyt ngi thiu G6PD.
LIU LNG v CCH DNG
Ha tan vin thuc trong ly nc.
Vin UPSA C :
Liu thng dng 1 vin/ngy.
Vin UPSA C Calcium :
Ngi ln : 1 vin/ngy.
Tr em : na vin n 1 vin, ty theo tui.
- Ghi ch : mi vin UPSA C Calcium cha 201 mg sodium

539.

UROGRAFIN

SCHERING AG
c/o ZUELLIG
dung dch tim 60% : ng 20 ml ; l 50 ml.
dung dch tim 76% : ng 20 ml ; l 50 ml, 100 ml, 200 ml.
THNH PHN
cho 1 ml Urografin 60%
Sodium amidotrizoate

0,08 g

Meglumine amidotrizoate

0,52 g

cho 1 ml Urografin 76%

Sodium amidotrizoate

0,1 g

Meglumine amidotrizoate

0,66 g

CH NH
Chp tia X ng niu tim IV v chp tia X ng niu ngc dng. Chp tia X mch, chp tia
X khoang i, chp tia X khp, chp tia X ng mt trong khi phu thut, chp tia X ng r,
chp tia X t cung - vi trng, chp tia X lch - tnh mch ca, chp tia X ti tinh.
CHNG CH NH
- Cng gip r, suy tim mt b.
- Ph n c thai.
- Vim vng khung chu.
THN TRNG LC DNG
Thn trng khi s dng trong nhng trng hp :
Qu mn cm, suy chc nng gan v suy chc nng thn, suy tim v suy tun hon, kh ph
thng, sc khe k m, x cng ng mch no, tiu ng, tnh trng co git do no, cng
gip tim n, bu gip nhn th nh v a u ty.
TC DNG NGOI
Bun nn, nn, hng ban, cm gic au.
LIU LNG v CCH DNG
Thuc tim Urografin 76% :
Chp tia X ng niu tim IV :
- Ngi ln v tr em : 1 ml/kg th trng.
- Tr nh nhi : 2 ml/kg th trng.
Chp tia X mch :
200 ml c bit thch hp cho ch nh chp tia X tm tht - ng mch vnh.

540.

UROMITEXAN

ASTA MEDICA
c/o ZUELLIG
Dung dch tim 400 mg : ng 4 ml, hp 15 ng.
THNH PHN
cho 1 ng
Mesna

400 mg

T dc : sodium edetate, sodium

hydroxide, nc tim.
CH NH
Phng nga c tnh trn niu o do dng oxazaphosphorines (Holoxan, Endoxan, Ixoten).
Uromitexan lun c dng khi iu tr khi u, lun dng Uromitexan vi liu bm trc tip
(trn 10 mg/kg) ca cht c t bo v dng cho tt c bnh nhn c nguy c c bit. Cc yu
t nguy c ch yu l c x tr vng chu trc y, vim bng quang do trc y c dng
Holoxan, Endoxan hoc Ixoten hoc c tin s bnh l ng tit niu.
CHNG CH NH
Tng nhy cm vi mesna hoc cc phc hp khc c thiol.
CH PHNG
Xut hin cc phn ng tng nhy cm khi iu tr bng Uromitexan c ghi nhn bnh
nhn c ri lon v t min nhiu hn bnh nhn c khi u. Biu hin bng cc phn ng
da v nim mc (pht ban, ni m ay, ngoi ban, ni ban), tng men gan v cc triu chng
thng thng khng c hiu nh st, kit sc, bun nn v i ma. Cng c khi xut hin l t
nhng phn ng v tun hon nh h huyt p v nhp tim nhanh. Do dng Uromitexan
bo v ng tit niu ch c p dng cho bnh nhn sau khi phn tch k li ch v nguy
c v c gim st v y t.
V Uromitexan c dng nh Uroprotector khi iu tr km t bo bng oxazaphosphorines,
vic s dng thuc ny trong thai kz v lc cho con b phi tun theo cc tiu chun ca cch
iu tr km t bo ny. Nghin cu trn sc vt cho thy khng c chng c no v tc dng
c cho phi thai hoc gy qui thai ca Uromitexan.
Tc dng bo v ca Uromitexan ch p dng cho ng tit niu. Tt c cc thn trng khc
c ngh khi dng thuc u khng b nh hng v cc ngh lin quan n chng vn
cn hiu lc.
TNG TC THUC
In vitro : trong thc nghim Mesna c tng k vi cisplatin, carboplatin v nitrogen mustard.
TC DNG NGOI
Nhng trng hp ring bit c phn ng tng nhy cm lin quan vi c quan mt phn
(phn ng tng d ng), th d phn ng da v nim mc vi mc khc nhau (nga, da,
ni mn nc), sng m ti ch (ph, ni m ay), trng hp him c h huyt p v tng
nhp tim trn 100 ln/pht (nhp tim nhanh) do phn ng tng nhy cm cp tnh v trm trng
(phn ng phn v) v cng c s tng tm thi mt s th nghim chc nng gan (men gan).
Trng hp him gp c kch thch tnh mch v tr tim thuc. Trong nghin cu v kh nng
dung np thuc, dng mesna liu cao tim tnh mch v ung, liu duy nht 60 mg/kg cn
nng c th hoc hn th thy xut hin bun nn, i ma, tiu chy, nhc u, au tay chn,

h huyt p, nhp tim nhanh, phn ng da, kit sc v suy yu. Trong thi gian iu tr, khng
phi lc no cng c th phn bit mt cch r rng cc tc dng ph kiu trn vi cc tc dng
ph gy ra do dng oxazaphosphorines (Holoxan, Endoxan, Ixoten) hoc cc thuc khc dng
ng thi.
LIU LNG v CCH DNG
Tr phi c ghi trong toa thuc, Uromitexan thng c dng bng ng tnh mch
ngi ln vi liu bng 20% liu oxazaphosphorines vo thi im 0 (lc bt u dng
oxazaphosphorines) v vo lc 4 gi v 8 gi.
Th d v cch dng Uromitexan kt hp vi oxazaphosphorines tim
Thi im (gi)

0 (8 gi)

4 (12 gi)

Liu oxazaphosphorines 40 mg/kg th trng Liu Uromitexan

8 mg/kg th trng

8 (16 gi)
-

8 mg/kg th trng 8 mg/kg th trng

Kinh nghim lm sng khi dng tr em cho thy rng mt s trng hp cho Uromitexan
vi khong cch ngn hn gia cc ln dng th tt hn (th d cch khong mi 3 gi, tng liu
Uromitexan = 60% liu oxazaphosphorines).
iu tr km t bo vi liu rt cao oxazaphosphorines (th d trc khi ghp ty), tng liu
Uromitexan c th tng n 120 v 160% liu oxazaphosphorines. ngh dng nh sau : sau
khi cho 20% Uromitexan (tnh ton da trn tng liu oxazaphosphorines) vo thi im 0, liu
cn li s c cho lin tc trong 24 gi bng cch truyn tnh mch.
Tim tnh mch trc tip c th p dng :
Ngi ln 3 x40% (vo thi im 0, 4, 8 gi) hoc 4 x 40% (vo thi im 0, 3, 6, 9 gi) tng
ng. Tr em do thng i tiu hn nn lun cho tim tnh mch trc tip mi 3 gi (th d 20%
vo thi im 0, 1, 3, 6, 9, 12 gi). Thay v tim tnh mch trc tip, c th truyn tnh mch
trong thi gian ngn 15 pht.
Khi truyn tnh mch lin tc ifosfamide (Holoxan), s c li khi cho Uromitexan vo thi im 0
sau khi tim tnh mch trc tip 20% lc khi u (bt u truyn tnh mch, thi im 0),
sau truyn tnh mch cho 100% liu ifosfamide, v tip tc vi Uroprotector thm 6 n
12 gi sau khi kt thc truyn ifosfamide.
Th d v cch truyn Uromitexan kt hp vi truyn tnh mch ifosfamide
Thi im (gi) 0
5 g/m2 din tch c th (# 125 mg/kg th
Liu ifosfamide
trng)

24 30 36

Uromitexan liu
1 g/m2 din tch c th (# 125 mg/kg th
tim mch trc
trng)
tip
n 5 g/m2 din tch c th (# 125 mg/kg n 2,5 g/m2 din tch c
Uromitexan
th trng) Thm vo ifosfamide truyn
th (# 62,5 mg/kg th
truyn tnh mch
tnh mch
trng)
Ch :
Mesna ch c hiu qu bo v trn ng tit niu. Tt c cc cch phng nga khc c
ngh khi iu tr vi oxazaphosphorines khng b nh hng v nn tip tc s dng.
iu tr bng Uromitexan c th lm th nghim tm cetone dng tnh gi.
BO QUN
thuc ngoi tm tay tr em.
Khng dng Uromitexan khi qu hn s dng ghi trn hp thuc.

541.

UTROGESTAN

BESINS-ISCOVESCO
c/o TEDIS
vin nang dng ung hoc t m o 100 mg : hp 30 vin - Bng B.
THNH PHN
cho 1 vin
Progesterone t nhin dng vi tinh th

100 mg

DC LC
Progesterone (G : h tit niu-sinh dc v hormone sinh dc).
Thuc bao gm cc c tnh dc lc ca progesterone t nhin, gm : tr thai, khng
estrogene, khng nh androgene, khng aldosterone.
DC NG HC
ng ung :
- Hp thu :
Thuc c hp thu tt qua ng tiu ha.
Sau khi ung thuc, nng progesterone huyt tng bt u tng ngay trong gi u tin v
nng cao nht c ghi nhn sau khi ung thuc t 1 n 3 gi.
Cc nghin cu dc ng c thc hin ngi tnh nguyn cho thy rng sau khi ung
ng thi 2 vin, nng progesterone huyt tng tng trung bnh t 0,13 ng/ml n 4,25

ng/ml sau 1 gi, 11,75 ng/ml sau 2 gi, 8,37 ng/ml sau 4 gi, 2 ng/ml sau 6 gi v 1,64 ng/ml
sau 8 gi.
Do thuc c thi gian lu li trong m nn cn phi chia liu hng ngy lm 2 ln cch nhau 12
gi t tnh trng bo ha trong sut 24 gi.
S nhy cm i vi thuc c khc nhau gia ngi ny v ngi khc, tuy nhin cng mt
ngi th cc c tnh dc ng thng rt n nh, do khi k toa cn chnh liu thch hp
cho tng ngi v mt khi xc nh c liu thch hp th liu dng c duy tr n nh.
- Chuyn ha :
Trong huyt tng, cc cht chuyn ha chnh gm 20-a-hydroxy-d-4-a-pregnanolone v 5-adihydroprogesterone.
95% c o thi qua nc tiu di dng lin hp glucuronic trong ch yu l 3-a,5-bpregnanediol (pregnandiol). Cc cht chuyn ha trong huyt tng v nc tiu tng t vi
cc cht c tm thy trong qu trnh ch tit sinh l ca hong th bung trng.
ng m o :
- Hp thu :
Sau khi t vo m o, progesterone c hp thu nhanh qua nim mc m o, c chng
minh qua vic nng ca progesterone trong huyt tng tng cao ngay trong gi u tin
sau khi t thuc.
Nng ti a trong huyt tng ca progesterone t c sau khi t thuc t 2 n 6 gi
v duy tr trong 24 gi nng trung bnh l 9,7 ng/ml sau khi dng liu 100 mg vo bui sng
v bui ti. Vi liu trung bnh ny, progesterone t nng sinh l n nh trong huyt
tng, tng ng vi nng quan st c trong pha hong th ca chu kz kinh nguyt
rng trng bnh thng. S khc bit t gia ngi ny v ngi khc v nng progesterone
cho php d kin hiu lc ca thuc khi dng liu chun.
Vi liu cao hn 200 mg/ngy, nng progesterone thu c tng ng vi nng c
m t trong 3 thng u ca thai kz.
- Chuyn ha :
Trong huyt tng, nng ca 5-b-pregnanolone khng tng.
Thuc c o thi qua nc tiu ch yu di dng 3-a,5-b-pregnanediol (pregnandiol),
c chng minh qua nng cht ny trong nc tiu tng dn (cho n nng ti a l
142 ng/ml gi th 6).
CH NH
ng ung :
Cc ri lon c lin quan n s thiu progesterone, nht l trong cc trng hp :
- hi chng tin kinh nguyt,
- kinh nguyt khng u do ri lon rng trng hoc khng rng trng,
- bnh v lnh tnh,

- tin mn kinh,
- liu php thay th hormone trong giai on mn kinh (b sung cho liu php estrogene).
ng m o :
- thay th progesterone trong cc trng hp thiu progesterone hon ton ph n b ly
bung trng (chng trnh hin non bo),
- b sung cho pha hong th trong chu kz th tinh trong ng nghim (FIV),
- b sung cho pha hong th trong chu kz t pht hoc c to ra, trong trng hp kh nng
sinh sn km hoc v sinh nguyn pht hay th pht nht l do ri lon rng trng,
- trong trng hp b e da sy thai hoc phng nga trong trng hp b sy thai lin tip do
suy hong th, cho n tun th 12 sau khi tt kinh,
- trong tt c cc ch nh khc ca progesterone, ng m o c dng thay th cho
ng ung trong cc trng hp :
- c tc dng ngoi ca progesterone (b bun ng sau khi ung thuc),
- chng ch nh ng ung (b bnh gan)
CHNG CH NH
ng ung : ri lon chc nng gan nng.
CH PHNG v THN TRNG LC DNG
- Trn phn na s trng hp b sy thai sm t pht l do tai bin di truyn. Ngoi ra, cc
trng hp nhim trng v cc ri lon c hc c th l nguyn nhn gy sy thai sm. V vy,
dng progesterone c th lm chm vic tng phi cht (hoc gin on thai kz khng tin
trin).
- Ch nn dng progesterone cho nhng trng hp m s ch tit ca hong th b suy gim.
- Dng progesterone khng phi l mt liu php trnh thai.
- Nu dng Utrogestan trong thi gian mang thai th ch dng trong 3 thng u thai kz v dng
ng m o. Utrogestan khng phi l thuc iu tr da sanh non : dng progesterone
trong qu 2 v qu 3 ca thai kz c th d gy vng da mt trong thai kz hoc bnh t bo
gan.
Li xe v vn hnh my mc :
Khi li xe hay vn hnh my mc cn phi lu { rng ung thuc ny c th gy bun ng
v/hay cm gic chng mt.
LC C THAI v LC NUI CON B
Dng progesterone trong qu 2 v qu 3 ca thai kz c th d gy vng da mt hoc bnh t
bo gan.
TC DNG NGOI
ng ung :
- Bun ng hoc cm gic chng mt i khi xy ra mt vi bnh nhn sau khi ung thuc t 1
n 3 gi. Trong trng hp ny, c th gim liu hoc thay i cch dng thuc : ung 2 vin

vo bui ti lc i ng, 12 n 14 ngy cho mi chu kz iu tr, hoc chuyn sang ng m

o.
- Thu ngn chu kz kinh nguyt hoc gy xut huyt gia chu kz. Trong trng hp ny phi bt
u t iu tr chm hn trong chu kz (v d nh bt u vo ngy th 19 thay v ngy th
17).
Cc tc dng ngoi { ny thng xy ra khi qu liu.
ng m o :
- Khng c trng hp bt dung np thuc ti ch (nng, nga hoc chy cht nhn) no c
ghi nhn trong cc nghin cu lm sng.
- Khng c tc dng ph ton thn c bit l bun ng hay cm gic chng mt c ghi nhn
trong cc nghin cu lm sng liu khuyn co.
LIU LNG v CCH DNG
Cn chp hnh ng liu khuyn co.
ng ung :
Trung bnh trong cc trng hp thiu progesterone, liu dng l 200 n 300 mg
progesterone mi ngy, tng ng vi 2 n 3 vin, chia lm 2 ln, 1 vin vo bui sng v 1
n 2 vin vo bui ti. Nn ung thuc xa ba n, nn ung vo bui ti trc lc i ng.
- Trong suy hong th (hi chng tin kinh nguyt, bnh v lnh tnh, kinh nguyt khng u,
tin mn kinh) : 2 n 3 vin mi ngy, 10 ngy cho mi chu kz, thng bt u t ngy th 17
n ngy th 26.
- Trong liu php thay th hormone trong giai on mn kinh : liu php estrogene mt mnh
khng c khuyn co (do nguy c gy tng sn ni mc) : b sung progesterone, hoc 2 vin
mi ngy vo bui ti lc i ng, 12 n 14 ngy mi thng, hoc 2 tun l cui ca mi chu kz
iu tr, sau ngng ton b cc tr liu thay th trong khong 1 tun, trong thi gian ny c
th c xut huyt do thiu ht hormone.
i vi cc ch nh trn, c th dng ng m o vi liu tng t vi ng ung, trong
trng hp bnh nhn b bnh gan v/hoc c cc tc dng ngoi do progesterone (bun ng
sau khi ung thuc).
ng m o :
t vin nang su trong m o.
- Thay th progesterone trong cc trng hp thiu progesterone hon ton ph n b ly
bung trng (hin non bo) : B sung cho liu php estrogene : t 1 vin vo ngy th 13 v
ngy th 14 ca chu kz chuyn tip, sau t mi ln 1 vin vo bui sng v bui ti t ngy
th 15 n ngy th 25 ca chu kz. T ngy th 26 v trong trng hp bt u c thai, liu
c tng thm 1 vin/ngy mi tun cui cng t n liu ti a 6 vin mi ngy chia lm
3 ln. Duy tr liu ny cho n ngy th 60, v tr nht l cho n tun th 12 ca thai kz.
- B sung cho pha hong th trong chu kz th tinh trong ng nghim (FIV) : liu c khuyn

co l 4 n 6 vin mi ngy bt u t ngy tim hCG cho n tun th 12 ca thai kz.

- B sung cho pha hong th trong chu kz t pht hoc c to ra, trong trng hp kh nng
sinh sn km hoc v sinh nguyn pht hay th pht nht l do ri lon rng trng : liu c
khuyn co l 2 n 3 vin mi ngy, bt u t ngy th 17 ca chu kz, trong vng 10 ngy v
dng li cng nhanh cng tt trong trng hp tt kinh v c chn on l c thai.
- Da sy thai hoc phng nga trong trng hp b sy thai lin tip do suy hong th : liu
c khuyn co l 2 n 4 vin mi ngy, chia lm 2 ln.

542.

UVIMAG B6

LAPHAL
c/o HYPHENS
Dung dch ung : ng 10 ml, hp 20 ng.
THNH PHN
cho 1 ng
Magnsium (glycrophosphate acide)

0,5 g

Tng ng :
Magnsium (1,38 mmol)

33 mg

Pyridoxine chlorhydrate tnh theo dng base

125 mg

(Saccharose)

(4,25 g)

(V thm t nhin ca nho)

DC LC
Liu php iu tr bng Mg.
V mt sinh l :
- Mg l mt cation ch yu ni t bo. Mg lm gim kh nng b kch thch ca t bo thn
kinh v s dn truyn thn kinh c, v can thip vo nhiu phn ng cn xc tc enzyme. L
mt yu t ca c th, phn na lng Mg tp trung xng.
- Pyridoxine (vitamine B6) l mt yu t coenzyme, can thip vo rt nhiu tin trnh chuyn
ha, v lm d dng cho s thm nhp ca Mg vo trong t bo.
V mt lm sng, kt qu nh lng Mg trong huyt tng :
- t 12 n 17 mg/l : thiu ht Mg va phi.
- di 12 mg/l : thiu ht Mg trm trng.

Vic thiu Mg c th l nguyn pht do bt thng bm sinh trong s chuyn ha Mg hoc th

pht do gim cung cp (suy dinh dng nng, nghin ru, ch nui n bng ng tim), do
km hp thu ng tiu ha (tiu chy mn tnh, c l d ng tiu ha, suy tuyn cn gip),
do mt nhiu thn (bnh l ng thn, a niu, lm dng thuc li tiu, vim thn-b thn
mn tnh, tng aldost rone nguyn pht, iu tr bng cisplatine).
Mt s biu hin lm sng khng chuyn bit c th xut hin do thiu Mg nh : run, yu c,
cn co cng c, tht iu, tng phn x, ri lon tm thn (d kch thch, mt ng...), ri lon
nhp tim (ngoi tm thu, nhp tim nhanh), ri lon tiu ha (tiu chy).
DC NG HC
Mg l mt yu t ca c th, nng trung bnh 17 mmol/kg trong 99% nm trong t bo,
c hp thu mt cch chn lc trn nim mc rut non. Ti y, Mg c hp thu t 40 n
50% lng a vo.
Gn 2/3 Mg trong t bo c phn b vo cc m xng v 1/3 cn li phn b trong c trn
hoc c vn cng nh trong hng cu.
Mg c o thi qua ng tiu. thn, 70% Mg trong huyt tng c lc ti cu thn,
95-97% lng Mg ny c ti hp thu ng thn. Lng Mg c o thi qua nc tiu
chim khong 1/3 lng a vo.
Pyridoxine trong c th hoc b oxy ha thnh pyridoxal, hoc chuyn thnh pyridoxamine. Sau
khi c phosphoryl ha, s to thnh pyridoxal phosphate, y l dng c hot tnh ca
pyridoxine v mt chuyn ha.
CH NH
- c ngh trong cc trng hp thiu Mg c xc nhn, ring bit hoc phi hp.
Lu { : trng hp c phi hp vi thiu Ca, trong a s trng hp cn b sung Mg trc khi
dng liu php b sung Ca.
- c s dng, tc ng chuyn bit cha c chng minh mt cch c th, trong iu tr
cc biu hin chc nng ca cn lo u vi tng thng kh (chng co cng c do th tng hay cn
gi l bnh spasmophilie).
CHNG CH NH
Suy thn nng (h s thanh thi cratinine < 30 ml/pht/1,73 m2).
CH PHNG v THN TRNG LC DNG
bnh nhn tiu ng, cn lu { trong mi ng thuc c cha 4,25 g saccharose.
TNG TC THUC
Chng ch nh phi hp :
- L vodopa (i vi cc bit dc c cha pyridoxine hay vitamine B6) : c ch tc ng ca
l vodopa khi khng c s dng km theo cht c ch dopadcarboxylase ngoi bin.
Khng nn phi hp :
- Quinidine : gim bi tit quinidine thn do kim ha nc tiu.

Thn trng khi phi hp :

- Ttracycline : cc ln ung thuc nn cch nhau 3 gi (do c th lm gim hp thu
ttracycline).
- Calcium : cc ln ung thuc nn cch nhau 3 gi.
TC DNG NGOI
C th b tiu chy, au bng.
LIU LNG v CCH DNG
Ngi ln : 3 ng thuc/ngy chia lm 3 ln.
Tr em : 1 n 2 ng thuc/ngy, ty theo tui.

543.

V. ROHTO

CT TNHH ROHTO - MENTHOLATUM (VIT NAM)

Thuc nh mt : chai 15 ml.
THNH PHN
Panthenol

0,100%

Potassium L-Aspartate

1,000%

Pyridoxine HCl (vitamin B6)

0,050%

Dipotassium Glycyrrhizinate

0,100%

Naphazoline HCl

0,003%

Neostigmine Methylsulfate

0,005%

Chlorpheniramine Maleate

0,010%

DC LC
V. Rohto l thuc nhn khoa c bo ch theo cng thc mi, cha cc hot cht c tc dng
phng hoc cha chng mi mt. Ngoi Panthenol l mt vitamin thit yu cn cho hot ng
bnh thng ca mt, Potassium L-Aspartate v vitamin B6 c a vo lm tng hiu lc
ca thuc, gim nh hoc phng nga chng mi mt. Thuc c dng gim mi mt hoc
xung huyt mt ti ni lm vic hoc nh v phng bnh khi bi li.
Panthenol l mt trong cc Acid Pantothenic (vitamin nhm B), c coi l cn thit gi mt
tnh trng khe mnh.
Cc c im ca V. Rohto :
- Tc dng phc hi t mt mi tr v tnh trng bnh thng v phng nga mi mt : cng

thc PAB - Panthenol (P), Potassium L-Aspartate (A), vitamin B6 kch hot h hp m khc
phc v d phng mt mi.
- Ci thin nhanh chng s suy gim chc nng iu chnh th gic : Neostigmine Methylsulfate
tc dng trc tip ln thn kinh iu chnh mt, nh th mau chng phc hi chc nng iu
chnh tiu c suy yu.
- Lm mt chng nga v vim mt, loi tr xung huyt : Dipotassium Glycyrrhizinate c tc
dng khng vim mnh, hu hiu trong vic lm ht nga vim mt cng vi tc dng khng
histamine ca Chlorpheniramine Maleate, Naphazoline HCl c hiu lc rt tt loi tr xung
huyt.
- Thuc mang tnh n nh cao : dung dch c bo ch v ng l trong iu kin v khun,
cht lng c kim tra cht ch, ch phm c n nh nn t chu nh hng ca nh sng
v nhit .
- Cm gic d chu khi nh V-Rohto : to cm gic mt du, lm mt cm gic kh chu nh cng
thng v vim.
CH NH
Mt mi, xung huyt kt mc, bnh mt do tia cc tm hay cc tia sng khc (th d : m tuyt),
nhn m, mt nga, xn mt, phng cc bnh v mt khi bi li hoc do bi, m hi lt vo
mt, kh chu do dng knh tip xc cng.
THN TRNG LC DNG
Hi kin bc s hoc dc s trc khi dng trong trng hp :
- au mt nng.
- C tin cn d ng vi thuc nh mt.
- Tng nhn p.
- ang theo mt liu trnh tr liu.
Trc khi dng, cn lu { :
- Dng ng liu qui nh. Nu qu liu, c nguy c xung huyt.
- Tr em dng thuc di s hng dn ca ngi ln.
- Khng mi mt chm vo ming l, trnh nhim trng hoc lm c dung dch do cc
cht tit hoc cc vi sinh vt. Mt vi hot cht c th kt tinh ming l trong qu trnh bo
qun. Nu c kt tinh, lau ming l bng gc sch trc khi dng.
- Khng dng V- Rohto nh thuc mang knh tip xc mm, khng nh vo mt khi mang
knh tip xc mm.
- Ch dng thuc ny nh mt.
Trong v sau khi dng, cn lu { :
- Nu thuc gy xung huyt mt, nga, sng hoc cc triu chng khc, ngng dng thuc v
hi kin bc s hoc dc s.
- Nu khng khi m mt sau khi dng, ngng dng thuc v hi kin bc s hoc dc s.

- Sau khi dng nhiu ngy m bnh vn khng , ngng dng thuc v hi kin bc s hoc
dc s.
Lu { khi bo qun v s dng :
- thuc ngoi tm tay tr em.
- Vn cht nt l sau khi dng. Bo qun ti ni mt, trnh nh nng trc tip.
- trnh nhm ln v gim cht lng, khng ng thuc vo chai hoc l khc.
- Khng dng chung l thuc vi ngi khc trnh ly nhim.
- Khng dng thuc qu hn.
LIU LNG v CCH DNG
Nh mt mi ln 2-3 git, mi ngy 5 n 6 ln.

544.

VANCOCIN CP

ELI LILLY
Bt pha tim 500 mg : hp 1 l bt.
THNH PHN
cho 1 l
Vancomycine chlorhydrate

500 mg

DC LC
Vancomycin hydrochloride l khng sinh thuc nhm glycopeptide ba vng, c lm tinh khit
bng phng php sc k, chit xut t Amycolaptosis orientalis (trc y gi l Nocardia
orientalis) c cng thc ha hc l C66H75C12N9O24 . HCl. Phn t lng 1.486 ; 500 mg hot cht
tng ng 0,34 mmol.
Vancomycin hydrochloride cha trong l bt v khun c hm lng tng ng vi hot
tnh ca 500 mg vancomycin. Vancomycin hydrochloride dng bt ng kh mu trng ng.
Khi pha vi nc, c dng dung dch trong sut v pH t 2,5 n 4,5.
Vi sinh hc : tc dng dit khun ca vancomycin ch yu do c ch s sinh tng hp ca vch
t bo.
Hn na vancomycin cn lm thay i tnh thm ca mng t bo, lm thay i s tng hp
RNA ca vi khun. Khng c khng cho gia vancomycin v cc khng sinh khc.
Vancomycin c hot tnh chng : t cu, bao gm t cu vng v Staphylococcus epidermidis
(k c cc chng khng methicillin), lin cu bao gm Streptococcus pyogenes v Streptococcus
pneumoniae (k c cc chng khng penicilline), Streptococcus agalactiae, nhm viridans,
Streptococcus bovis, v cu khun rut (v d, Entercoccus faecalis *trc kia l Streptococcus
faecalis]), Clostridium difficile (v d, dng vi khun tit ra c t, nguyn nhn ca bnh vim

rut kt mng gi) v vi khun gy bnh bch hu. Cc vi khun khc nhy cm vi vancomycin
in vitro gm Listeria monocytogenes, cc dng Lactobacillus, Actinomyces, Clostridium, Bacillus.
Vancomycin khng c hiu qu "in vitro" i vi trc khun gram m, Mycobacteria, hoc vi
nm.
Tc dng hip ng : Phi hp vancomycin vi khng sinh nhm aminoglycoside c tc dng
hip ng in vitro chng li nhiu dng t cu vng, lin cu nhm D khng rut, cu khun
rut, dng Streptococcus (nhm viridans).
Khng sinh : Phng php dng a khng sinh chun mc th tnh nhy cm ca vi
khun i vi vancomycin c m t bi y Ban Quc Gia v cc chun mc phng th
nghim lm sng (NCCLS). Kt qu i vi a khng sinh tm 30 mg vancomycin hydrochloride
nn c bin lun theo tiu chun sau : Cc vi khun gi l nhy cm khi to vng ng knh
v khun >= 12 mm, cho thy vi khun c nghin cu c th p ng vi iu tr. Nu ng
knh vng v khun 10 hay 11 mm th l nhy cm trung gian, coi nh vi khun p ng vi s
tr liu nu nng khng sinh cao ti cc m hoc dch b nhim khun. Cc vi khun khng
to vng c ng knh <= 9 mm ; khi , phi chn khng sinh khc.
Nu dng phng php pha long, vi khun phn lp c coi l nhy cm khi MIC ca
vancomycin <= 4 mg/L. Nu MIC >= 16 mg/L, th vi khun xem nh khng vi vancomycin.
Nu MIC c tr s thp hn 16 mg/L nhng ln hn 4 mg/L th c gi l nhy cm trung gian.
Cc phng php chun mc i hi phi s dng cc vi khun chng phng th nghim. a
vancomycin 30 mg phi cho vng c ng knh t 15 n 19 mm i vi chng S.aureus ATCC
25923. Tng t, phng php pha long chun mc cng cn cc vi khun chng phng th
nghim. Bt vancomycin chun phi cho tr s MIC 0,5 mg/L - 2,0 mg/L i vi chng S. aureus
ATCC 29213. i vi E. faecalis ATCC 29212, th tr s MIC phi t 1,0 - 4,0 mg/L.
DC NG HC
Vancomycin hp thu km khi ung. Dng ng tnh mch cha nhim khun ton thn.
Tim bp gy au.
Khi truyn vancomycin nhiu liu 1 g (15 mg/kg th trng) lin tc trong 60 pht ngi bnh
c chc nng thn bnh thng, th nng trung bnh trong huyt tng t c 63 mg/L
ngay sau khi ngng truyn ; sau 2 gi, nng trung bnh trong huyt tng l 23 mg/L ; sau 11
gi, th nng l 8 mg/L Khi truyn nhiu liu 500 mg trong 30 pht, nng trung bnh trong
huyt tng khong 49 mg/L ngay sau khi kt thc truyn ; sau 2 gi, nng trung bnh trong
huyt tng l 19 mg/L ; sau 6 gi, th nng trung bnh trong huyt tng khong 10 mg/L.
Nng vancomycin trong huyt tng tim nhiu ln tng t nh khi tim liu duy nht.
Thi gian bn thi trung bnh ca vancomycin trong huyt tng l 4-6 gi ngi c chc
nng thn bnh thng. Trong 24 gi u tin, 75% liu vancomycin thi qua nc tiu do lc
cu thn. thanh thi trung bnh trong huyt tng khong 0,058 L/kg/gi v thanh thi
trung bnh ca thn khong 0,048 L/kg/gi. Khi chc nng thn suy gim, thi tr vancomycin

chm li. i vi ngi bnh suy thn nng, th thi gian bn thi khong 7,5 ngy. H s phn
phi t 0,3 n 0,43 L/kg. Khng thy c s chuyn ha thuc r rt. Khong 60% lng
vancomycin khi tim qua mng bng dng trong thm tch mng bng s c hp thu vo
mu sau 6 gi. Khi tim vancomycin qua mng bng vi liu 30 mg/kg, nng thuc trong
huyt tng khong 10 mg/L. Mc du vancomycin kh o thi qua ng thm tch lc mu
hoc thm tch mng bng, nhng nhng bo co cho thy thanh thi vancomycin c tng
ln khi truyn v lc mu.
H s thanh thi ton thn v thanh thi qua thn c th gim ngi bnh cao tui.
Khi nng vancomycin trong huyt thanh khong t 10 mg/L n 100 mg/L, th gn kt
vo protein huyt thanh khong 55%, o c bng phng php siu lc.
Sau khi truyn tnh mch vancomycin hydrochloride, th nng c ch vi khun s t c
ti dch mng phi, dch mng tim, dch bng, hot dch, trong nc tiu, trong dch thm tch
mng bng v trong m tiu nh. Vancomycin hydrochloride khng khuych tn qua mng no
bnh thng vo dch no ty, nhng khi mng no b vim th vancomycin thm c vo
dch no ty.
CH NH
Dng vancomycin trong cc bnh nhim khun nng do cc chng t cu khng methicillin
(khng vi b-lactam). Vancomycin cn c ch nh trong trng hp ngi bnh d ng vi
penicillin, hoc ngi khng p ng vi tr liu bng khng sinh khc bao gm cc penicillin v
cephalosporin, v trong cc nhim khun do vi khun nhy cm vi vancomycin, nhng
khng vi cc loi khng sinh khc. Cn dng vancomycin iu tr khi u khi nghi ng
nhim t cu khng methicillin, s iu chnh iu tr sau ny ty thuc kt qu vi sinh hc.
Vancomycin c hiu qu trong iu tr vim mng trong tim do t cu, ngoi ra tnh hiu qu
cn c chng minh trong cc nhim khun khc do t cu, bao gm : nhim khun huyt,
nhim khun xng, nhim khun ng h hp di, nhim khun da v cu trc da. Khi
nhim t cu khu tr v c m, cn phi hp khng sinh vi phng php phu thut thch
hp.
Vancomycin c bo co c hiu qu khi dng n c hoc phi hp vi aminoglycoside
trong trng hp vim mng trong tim do Streptococcus viridans hay S. bovis. Trng hp
vim mng trong tim do cu khun rut (th d E. faecalis), vancomycin c bo co ch c
hiu lc khi phi hp vi aminoglycoside. Vancomycin c hiu qu trong iu tr vim mng
trong tim do vi khun bch hu. Kt hp vancomycin vi rifampin, aminoglycoside hoc vi c
hai s cho hiu qu trong vim mng trong tim giai on sm ngi bnh c lp van gi phc
hnh gy ra do S. epidermidis hay do vi khun bch hu.
Cn ly bnh phm phn lp, nh danh vi khun v xc nh tnh nhy cm vi vancomycin.
Dng tim c th dng ng ung trong trng hp vim rut kt mng gi lin quan n
khng sinh gy ra bi C. difficile hay vim rut non-rut kt do t cu. Khng c hiu qu trong

ch nh ny, nu dng vancomycin ng tim. Ngoi ch nh trn, khng c hiu qu no

khc khi dng vancomycin ng ung.
Mc du khng c cc nghin cu c kim sot v hiu qu lm sng, Hip hi tim mch v
Hip hi nha khoa Hoa Kz ngh dng vancomycin nh mt khng sinh d phng bnh
vim mng trong tim do vi khun thay th penicillin khi ngi bnh b d ng vi penicillin v
c bnh tim bm sinh, thp tim, bnh van tim mc phi khi nhng ngi bnh cn c nhng
th thut v nha khoa hoc cc phu thut ng h hp trn.
Ch : Khi chn la khng sinh d phng bnh vim mng trong tim do vi khun, thy thuc v
nha s cn c k khuyn co ca Hip hi tim mch v Hip hi nha khoa Hoa Kz.
CHNG CH NH
Chng ch nh vancomycin vi ngi bnh c tin s mn cm vi thuc ny.
CH PHNG
Tim tnh mch nhanh trc tip (trong vi pht) c th gy tt huyt p mnh, chong, v him
khi gy ngng tim. Thuc nn c pha long, truyn chm khng di 60 pht trnh phn
ng do truyn nhanh. Khi ngng truyn, nhng phn ng trn thng ht ngay.
Vancomycin hydrochloride c vi thnh gic. c tnh ny c th thong qua hoc ko di,
thng thy ngi bnh dng qu liu, hoc trc c bnh v thnh gic, hoc trong ch
iu tr c dng ng thi mt loi thuc c vi thnh gic nh aminoglycoside. Thn trng
khi dng vancomycin cho ngi bnh suy thn, v nguy c gy c cng tng khi nng trong
mu cng cao v ko di. Cn iu chnh liu lng vancomycin trong trng hp suy thn (xin
c phn Thn trng lc dng v Liu lng).
THN TRNG LC DNG
Tng qut : Mt vi ngi bnh ung nhiu liu vancomycin cha vim rut kt c mng gi
do C. difficile c th c nng vancomycin trong huyt thanh c { ngha trn lm sng.
Dng vancomycin trong mt thi gian di c th lm pht trin qu mc cc vi khun khng
nhy cm. Cn theo di ngi bnh cn thn. Nu c bi nhim trong qu trnh iu tr, cn c
cc bin php iu tr thch hp. Trong mt s t trng hp, thy ngi bnh dng
vancomycin ng tnh mch b vim rut kt c mng gi do C. difficile.
gim bt nguy c c tnh trn thn ngi bnh c suy thn tim tng hoc c dng km
aminoglycoside, cn theo di chc nng thn lin tc v tun th cht ch ch liu lng
thch hp (xin c phn Liu lng).
Lm cc xt nghim v chc nng thnh gic nhiu ln c th gip pht hin bnh l nhm lm
gim nguy c c tnh vi thnh gic.
Gim bch cu trung tnh c hi phc c th xy ra ngi bnh dng vancomycin
hydrochloride. Ngi bnh no phi dng vancomycin di ngy hoc phi dng phi hp vi
nhng thuc gy gim bch cu trung tnh, th nn c theo di nh kz cng thc bch cu.
Vancomycin hydrochloride gy kch ng m, nn cn c truyn nhng tnh mch an ton.

Tim bp hoc khi truyn thuc trch khi ng truyn do s { s gy vim, au tc v hoi
t ni tim. Vim tc tnh mch c th xy ra, tn s v mc nghim trng c th c
gim nh bng cch truyn chm thuc, pha long dung dch (2,5 n 5 g/L) v lun thay i
ch tim truyn.
C nhng bo co cho thy rng t l tai bin lin quan n phn ng tim truyn (gm tt
huyt p, bng mt, ni ban, m ay v nga) tng ln khi dng chung vi cc thuc gy m.
Nhng phn ng ph ny c th c ngn nga bng cch tim truyn chm vancomycin
hydrochloride 60 pht trc khi khi m.
Cha nh gi c hiu qu v tnh an ton ca thuc khi tim vo dch no ty (qua ng
ty sng hoc no tht).
S dng trong nhi khoa : tr non v tr nh, cn xc nh nng iu tr ca vancomycin
trong huyt thanh.
S dng ngi cao tui : S suy gim t nhin v lc ca cu thn gia tng theo tui dn
n gia tng nng vancomycin trong huyt thanh, nu khng chnh liu vancomycin thch
hp. Nn iu chnh liu lng cho thch hp ngi cao tui (xin c phn Liu lng).
Tnh gy ung th, gy t bin v v sinh : Cha c nhng nghin cu di hn trn ng vt
nh gi tnh gy ung th, cng cha thy c bo co no v kh nng gy t bin trn ng
vt th nghim trong phng th nghim. Cha c nhng nghin cu xc nh nh hng trn
tnh sinh sn.
LC C THAI
Nhng nghin cu v tnh gy qui thai c thc hin trn chut vi liu gp 5 ln ngi v
trn th vi liu gp 3 ln ngi, khng thy c chng c g nguy hi cho bo thai do dng
vancomycin. Trong mt nghin cu lm sng c kim sot, c tnh vi thnh gic, vi thn ca
vancomycin tr em c nh gi khi dng thuc cho m b nhim t cu nng bin chng
do lm dng thuc ng tnh mch. Vancomycin c tm thy trong mu ca dy rn. Khng
ghi nhn thai c suy gim thnh gic do tn thng thn kinh hoc c tnh vi thn do
vancomycin. Mt sn ph c dng vancomycin trong 3 thng cui ca thai kz, sinh ra tr b
ic, nhng khng th quy kt l do s dng vancomycin. Do s lng ngi bnh trong cuc
nghin cu ny cn hn ch v ch dng vancomycin trong 6 thng cui ca thai kz, nn khng
th khng nh vancomycin c gy hi cho bo thai hay khng. V cc nghin cu v kh nng
sinh sn trn sc vt khng th lun lun suy din cho ngi, nn ch dng vancomycin cho
ngi mang thai khi tht cn thit.
LC NUI CON B
Vancomycin bi tit qua sa m. Cn thn trng khi dng vancomycin trong thi kz cho con b.
V c kh nng gy phn ng c hi, nn ty theo mc trm trng bnh ca ngi m m
quyt nh ngng thuc hoc ngng cho con b.
TNG TC THUC

- Phi hp vancomycin vi cc loi thuc gy m c th gy ban , chng bng mt ging

phn ng do histamin (xin c phn Thn trng lc dng) v phn ng dng chong phn v
(xin c phn Tc dng ngoi )
- Cn theo di cht khi dng ng thi vancomycin hoc lin tip vi cc loi thuc dng trong
hoc bi ngoi da m c c tnh trn h thn kinh v/hoc c vi thn nh amphotericin B,
aminoglycoside, bacitracin, polymyxin B, colistin, viomycin, cisplatin.
TC DNG NGOI
- Phn ng lin quan n tim truyn : Trong hoc sau khi tim truyn tnh mch nhanh
vancomycin hydrochloride, ngi bnh c th c phn ng ging chong phn v, bao gm tt
huyt p, th kh kh, kh th, ni m ay hoc nga. Truyn dch nhanh c th gy chng
bng phn trn ca c th ("c ") hoc au, co cng c ngc v lng. Nhng phn ng
trn thng ht trong vng 20 pht, nhng cng c th ko di trong vi gi. Cc th nghim
trn sc vt cho thy tt huyt p, nhp tim chm xy ra khi dng mt liu ln vancomycin vi
nng cao v truyn vi tc nhanh. Nhng hin tng trn t xy ra nu truyn chm, ko
di hn 60 pht. Trong cc nghin cu ngi khe mnh bnh thng, nhng phn ng lin
quan n tim truyn khng xy ra nu truyn vancomycin hydrochloride tc 10 mg/pht
hoc chm hn.
- c tnh trn thn : Rt him khi xy ra suy thn biu hin bng gia tng nng creatinine
hoc BUN trong huyt thanh, k c khi ngi bnh c truyn vancomycin liu cao. Him khi
thy vim thn k. Phn ln nhng trng hp ny l do ngi bnh c dng ng thi
aminoglycoside hoc c bnh thn km theo. Nit/huyt tr li bnh thng trong phn ln
trng hp khi ngng vancomycin.
- c tnh vi thnh gic : Mt s trng hp gim thnh gic c lin quan n vic dng
vancomycin. Phn ln trng hp l do ngi bnh c bnh thn t trc hoc c km theo
mt bnh v thnh gic hoc c dng ng thi thuc c c tnh vi thnh gic. Chng mt,
hoa mt, tai him khi xy ra.
- nh hng trn h to mu : Gim bch cu trung tnh c th hi phc xut hin trung bnh 1
tun hoc lu hn na sau khi dng thuc hoc sau tng liu qu 25 g, c ghi nhn trn
hn vi chc ngi bnh. Gim bch cu trung tnh hi phc nhanh chng ngay sau khi ngng
dng vancomycin. Him khi gim tiu cu. Chng gim bch cu ht (m di 500/mm3) him
khi xy ra, tuy nhin c th hi phc, mi lin quan gia thuc v chng ny cha c xc
nh r.
- Vim tnh mch : C thy vim ti ni tim.
- Cc phn ng khc : Rt him xy ra phn ng phn v, st do thuc, bun nn, lnh run, tng
bch cu a eosin, pht ban (bao gm vim da trc vy).
Hi chng Stevens-Johnson, hoi t biu b nhim c v him khi vim mch mu xy ra khi
dng vancomycin.

LIU LNG
Cc phn ng lin quan n tim truyn u lin quan n nng v tc truyn ca thuc.
i vi ngi ln, th nng thuc khng nn qu 5mg/mL v tc truyn khng nn qu
10 mg/pht. i vi nhng ngi bnh cn hn ch s dng nc, th c th dng nng cao
n 10 mg/mL. Nng ny s lm tng nguy c phn ng do dch truyn. Tuy nhin, cc phn
ng lin quan n dch truyn c th xy ra bt c nng v tc no.
ngi bnh c chc nng thn bnh thng
Ngi ln : Liu truyn tnh mch thng thng l 2 gam/24 gi, chia ra 500 mg cho mi 6 gi
hoc 1g mi 12 gi. Tc truyn mi liu khng qu 10 mg/pht hoc trong thi gian ti thiu
l 60 pht, c th k o di hn. Vi nhng yu t khc lin quan n ngi bnh nh tui tc,
bo ph, cn iu chnh li liu lng mi ngy.
Tr em : Liu truyn tnh mch thng thng l 10 mg/kg cho mi 6 gi. Mi liu nn truyn ti
thiu trong 60 pht.
Tr nh v tr s sinh : tr nh v tr s sinh, tng liu truyn tnh mch hng ngy c th
thp hn. Liu ngh khi u l 15 mg/kg, sau 10 mg/kg trong mi 12 gi cho tr s sinh
mt tun l tui, v mi 8 gi cho tr ln hn 1 tun n 1 thng tui. Mi liu nn truyn trn
60 pht. Cn theo di cht ch nng thuc trong huyt thanh nhng loi ngi bnh ny.
Ngi bnh suy thn v ngi bnh cao tui
Cn chnh liu ngi bnh c bnh v thn. tr sinh thiu thng v ngi cao tui, c th
cn phi gim liu nhiu hn, do chc nng thn gim. o nng vancomycin trong huyt
thanh rt cn c phng php iu tr ti u, c bit ngi bnh c bnh nng trm
trng v chc nng thn km. Nng vancomycin trong huyt thanh c th o c bng
phng php vi sinh hc, phng x min dch hc, min dch huznh quang phn cc, min dch
huznh quang, hoc sc k lng cao p.
Nu thanh thi creatinine c th o c hay c on chnh xc, th liu thuc i vi
ngi bnh suy thn c th tnh c da vo bng sau y. Liu lng vancomycin
hydrochloride (tnh theo mg) s dng hng ngy gp khong 15 ln tc lc cu thn tnh
bng mL/pht.
Bng liu dng vancomycin cho ngi bnh suy thn (Theo Moellering v cng s)
thanh thi creatinine

Liu lng

(mL/pht)

(mg/24 gi)

100

1545

90

1390

80

1235

70

1080

60

925

50

770

40

620

30

465

20

310

10

155

Liu khi u khng nn 15 mg/kg, ngay c ngi bnh suy thn nh hoc trung bnh.
Bng liu dng ny khng nn p dng cho ngi bnh thn cm chc nng. i vi nhng
ngi bnh ny, nn dng liu khi u 15 mg/kg t nng tr liu nhanh trong huyt
thanh. Liu dng i hi lun duy tr nng n nh l 1,9 mg/kg/24gi. i vi ngi bnh
suy thn nng, liu duy tr t 250 n 1 000 mg mi ln v cch nhiu ngy c l thun tin hn
cho thuc vi liu hng ngy. i vi ngi bnh v niu, nn dng liu 1 000 mg cch 7 n 10
ngy. Nu ch bit c nng creatinine trong huyt thanh, c th tnh c thanh thi
creatinine da theo cng thc sau y (cn c vo gii, th trng v tui ca ngi bnh).
thanh thi creatinine tnh c cng ch l s c lng. Cn o lng tr s chnh xc.
Cho nam gii :
Th trng (kg) x (140 - s tui) / 72 x nng creatinine trong huyt thanh (mg/dl)
Cho n gii : 0,85 x tr s trn
Nng creatinine trong huyt thanh phi th hin tnh trng n nh ca chc nng thn, nu
khng th tr s c lng thanh thi creatinine khng c gi tr. thanh thi creatinine
c lng theo cng thc trn y nu cao hn tr s tht ca ngi bnh, th l do nhng
nguyn nhn sau : (1) Tnh trng gim chc nng thn do nhng nguyn nhn nh chong, suy
tim nng, thiu niu ; (2) Khng c s tng quan bnh thng gia khi lng c v th trng,
th d nh ngi bo ph, c bnh v gan, ph n, c trng v (3) km suy dinh dng, suy
kit, nm bt ng lu ngy.
Hiu qu v tnh an ton khi dng vancomycin qua ng dch no ty (qua ty sng hoc no

tht) cha c xc nh. Nn dng thuc bng ng tim truyn tnh mch nh git cch
qung.
Cch pha thuc v tnh n nh
Khi s dng, pha long chai thuc cha 500 mg bt kh v khun vi 10 mL nc ct pha tim,
vi chai cha 1 g th pha vi 20 mL nc ct pha tim. Vi cch pha ny, s c dung dch c
nng 50 mg/mL. Sau , cn pha long thm na.
Sau khi pha xong, l thuc c th bo qun trong t lnh 14 ngy m khng mt hiu qu tc
dng. Dung dch cha 500 mg cn c pha long thm vi 100 mL dung mi hoc nu chai 1 g
cn pha thm 200 mL dch pha long. Sau , thuc c truyn nh git t nht trong thi gian
60 pht.
S tng hp vi cc dch tim truyn.
Dung dch c pha long vi dextrose 5% hoc nc mui sinh l 0,9% c th bo qun trong
t lnh 14 ngy m khng mt hiu qu tc dng. Thuc c th trong t lnh trong 96 gi,
khi pha long vi cc cht pha long sau y:
- Dextrose 5% v sodium chloride 0,9%
- Dung dch Lactate Ringer
- Dung dch Lactate Ringer v Dextrose 5%
- Normosol-M v Dextrose 5%
- Isolyte E
- Dung dch Acetate Ringer
Dung dch vancomycin c pH thp, c th khng n nh v mt vt l hoc ho hc khi trn ln
vi cc hp cht khc.
Trc khi dng, cc loi thuc tim cn c kim tra bng mt thng, xem dung dch c
b bin mu, vn c hoc c vt l khng.
Loi dng ung - Vancomycin dng ung c ch nh trong vim rut kt mng gi do C.
difficile v trong ch nh vim rut non - rut kt do t cu. Vancomycin dng ung khng c
hiu qu trong cc loi nhim khun khc. Liu ung tng cng trong 24 gi cho ngi ln l t
500 mg n 2 g, chia 3-4 ln ; dng trong 7-10 ngy. Liu tng cng trong 24 gi cho tr em l
40 mg/kg, chia 3-4 ln ; ung trong 7-10 ngy. Liu tng cng khng qu 2 gam trong 24 gi.
Thuc c th pha long vi 1 oz nc cho ngi bnh ung. Cht to mi c th trn thm
vo cho d ung. Dung dch pha long c th cho qua ng ng thng mi d dy.
QU LIU
Cn dng bin php h tr cho ngi bnh cng vi duy tr lc cu thn. Vancomycin c
thi tr rt t qua thm tch mng bng. Lc mu v truyn mu vi nha polysulfone lm tng
thanh thi ca vancomycin. Liu trung bnh gy cht qua ng tnh mch l 319 mg/kg
chut cng v 400 mg/kg chut nht. Khi x tr qu liu, cn quan tm n kh nng qu liu
ca nhiu loi thuc, tng tc gia cc thuc v dc ng hc bt thng ca ngi bnh.

BO QUN
Thuc dng bt kh, trc khi pha cn bo qun nhit 15deg-30oC.

545.

VANCOMYCIN HYDROCHLORIDE

ABBOTT
Bt pha tim 500 mg : hp 10 l.
Bt pha tim 1 g : hp 10 l.
THNH PHN
cho 1 l
Vancomycine HCl

500 mg

cho 1 l
Vancomycine HCl

1g

M T
Vancomycin hydrochloride v khun, USP l mt khng sinh glycopeptide ba vng dn xut t
Nocardia orientalis (trc y gi l Streptomyces orientalis) v c cng thc ha hc
C66H75Cl2N9O24.HCl. Trng lng phn t l 1.486 ; 500 mg cht c bn tng ng vi 0,34
mmol v 1 g cht c bn tng ng vi 0,67 mmol.
Nhng l v khun c cha 500 mg hoc 1 g cht c bn Vancomycin. Vancomycin
hydrochloride dng bt trng nh d ha tan. C th cha axit hydrochloric v/hoc hydroxide
natri iu chnh pH. Khi c ti t hp trong nc v khun tim, USP, thuc tr thnh
mt dung dch trong sut c pH khong 4,0 (2,5 n 4,5).
Dung dch Vancomycin hydrochloride c ti t hp vi nc v khun tim, USP khng c
cht km hm vi khun v ch dnh s dng nh l thuc tim liu duy nht. Khi cn liu nh
hn, phn khng dng nn b i. Trc khi dng cn pha long hn na.
DC LC
Vi sinh hc :
Tc dng dit khun ca Vancomycin ch yu l do kh nng c ch s sinh tng hp vch t
bo. Ngoi ra, Vancomycin lm thay i tnh thm mng t bo v s sinh tng hp RNA ca vi
khun. Khng c khng cho gia Vancomycin v nhng khng sinh khc. Vancomycin c
hot tnh chng Staphylococci, gm Staphylococcus aureus v Staphylococcus epidermidis (k
c nhng chng khng Methicillin khng ng nht) ; Streptococci, gm Streptococcus

pyogenes, Streptococcus pneumoniae (k c nhng chng khng penicillin), Streptococcus

agalactiae, nhm viridans, Streptococcus bovis, v Enterococci (v d Streptococcus faecalis) ;
Clostridium difficile (v d nhng chng sinh c t bao hm vim i trng gi mc) ; v
Diphtheroids. Nhng vi sinh vt khc nhy vi Vancomycin trn thc nghim gm Listeria
monocytogenes, Lactobacillus species, Actinomyceses species, Clostridium species, v Bacillus
species.
Trn thc nghim, Vancomycin khng c hot tnh chng nhng trc khun gram dng,
mycobacteria, hoc nm.
Tc dng hip lc : Vic phi hp Vancomycin v Aminoglycoside c tc dng hip lc chng li
nhiu chng S. aureus, Streptococci nonenterococcal nhm D, enterococci, v Streptococcus
species (nhm viridans) trn thc nghim.
Nhng th nghim tnh nhy cm bng a : Phng php chun c y ban Quc gia v
nhng chun mc phng xt nghim lm sng m t c ngh s dng a th
nghim tnh nhy cm ca Vancomycin. Nn bin lun nhng kt qu ca cc th nghim tnh
nhy cm liu chun duy nht vi a Vancomycin hydrochloride 30 g theo tiu chun sau.
Nhng vi khun nhy cm to ra nhng vng v khun c ng knh ln hn hoc bng 12
mm, cho bit vi khun th nghim chc chn p ng vi iu tr. Nhng vi khun to ra nhng
vng c ng knh 10 hoc 11 mm c xem l nhy cm trung gian. Nhng vi khun trong
phn loi ny chc chn p ng nu nhim trng hn ch trong m hoc dch m ni t
c nng khng sinh cao. Nhng vi khun khng to ra nhng vng c ng knh bng
hoc nh hn 9 mm, cho bit nn chn la tr liu khc.
Vi phng php pha long c chun ha, mt vi khun c lp c xem l nhy cm
nu gi tr MIC ca Vancomycin bng hoc nh hn 4 mg/l. Nhng vi khun c xem l
khng Vancomycin nu MIC bng hoc ln hn 16 mg/l. Nhng vi khun c gi tr MIC di 16
mg/l nhng ln hn 4 mg/l c xem l nhy cm trung gian.
Nhng phng thc c chun ha cn phi s dng nhng vi khun chng trong phng xt
nghim. Nhng a Vancomycin 30 mg phi cho nhng vng c ng knh t 15 n 19 mm
i vi S. aureus ATCC 25923. Cng vi nhng phng php pha long chun, nhng phng
thc pha long cn phi s dng nhng vi sinh vt chng trong phng xt nghim. Bt
Vancomycin chun phi cho nhng gi tr MIC trong gii hn t 0,5 mg/l n 2 mg/l i vi S.
aureus ATCC 25913. i vi S. faecalis ATCC 29212, gii hn MIC t 1,0 n 4,0 mg/l.
DC NG HC
Vancomycin hp thu k m khi dng ng ung ; thuc c dng tim mch iu tr nhim
trng ton thn. Tim bp rt au. nhng i tng c chc nng thn bnh thng, truyn
tnh mch nhiu ln liu 1 g Vancomycin (15 mg/kg) trong 60 pht to nn nng trung bnh
trong huyt tng khong 63 mg/l ngay khi ngng truyn, nng trung bnh trong huyt
tng khong 23 mg/l sau khi truyn 2 gi, v nng trung bnh trong huyt tng khong 8

mg/l sau khi ngng truyn 11 gi. Truyn nhiu ln liu 500 mg trong 30 pht to nn nng
trung bnh trong huyt tng khong 49 mg/l sau khi ngng truyn, nng trung bnh trong
huyt tng khong 19 mg/l sau khi truyn 2 gi, v nng trung bnh trong huyt tng
khong 10 mg/l sau khi truyn 6 gi. Nng Vancomycin trong huyt tng khi dng nhiu
ln cng tng t vi nng trong huyt tng khi dng liu duy nht.
Thi gian bn hy o thi trung bnh ca Vancomycin trong huyt tng t 4 n 6 gi
nhng i tng c chc nng thn bnh thng. Trong 24 gi u, khong 75% liu
Vancomycin dng c thi tr trong nc tiu do s lc cu thn. thanh thi trung bnh
trong huyt tng khong 0,058 l/kg/gi, v thanh thi trung bnh ca thn khong 0,048
l/kg/gi. Ri lon chc nng thn lm chm o thi Vancomycin. nhng bnh nhn suy thn
nng, thi gian bn hy o thi trung bnh l 7,5 ngy. H s phn khi t 0,3 n 0,43 l/kg.
Chuyn ha ca thuc khng r. Khong 60% liu Vancomycin trong mng bng khi dng qua
ng thm phn phc mc c hp thu ngm vo mu sau 6 gi. Khi tim Vancomycin vo
phc mc liu 30 mg/kg t c nng trong huyt thanh khong 10 mg/l. Vancomycin
khng d dng b loi b qua ng thm phn phc mc hoc lc mu : khng c bo co no
v thanh thi Vancomycin khi truyn mu. thanh thi Vancomycin ton thn v thn c
th gim nhng ngi ln tui.
Khong 55% Vancomycin kt hp protein huyt thanh, o bng phng php siu m lc
nng Vancomycin trong huyt thanh t 10 n 100 mg/l. Sau khi tim Vancomycin
hydrochloride tnh mch, nng c ch t c trong mng phi, mng tim, mng bng, v
hot dch ; trong nc tiu ; trong dch thm phn mng bng v trong m tiu nh.
Vancomycin hydrochloride thc s khng khuch tn qua mng no bnh thng vo dch
no ty ; nhng khi mng no b vim, s thm qua dch no ty xy ra.
CH NH
Vancomycin hydrochloride uc ch nh iu tr nhng trng hp nhim trng trm trng
gy ra do nhng chng Staphylococci khng methicillin nhy cm vi thuc ( khng blactam). Thuc c ch nh cho nhng bnh nhn d ng penicillin, cho nhng bnh nhn
khng th dng nhng thuc khc hoc khng p ng vi thuc khc, k c penicillin hoc
cephalosporin, v cho nhng trng hp nhim trng nhng vi khun nhy cm vi
Vancomycin nhng khng vi nhng khng sinh khc. Vancomycin hydrochloride c ch
nh iu tr khi u khi nghi ng Staphylococci khng methicillin, nhng sau khi c nhng
s liu v tnh nhy cm, nn iu chnh tr liu cho ph hp. Vancomycin hydrochloride c
hiu qu trong iu tr vim ni tm mc do t cu. Hiu lc ca thuc cn c ghi nhn trong
nhng nhim trng khc do Staphyloccoci, k c nhim trng huyt, nhim trng xng, nhim
trng ng h hp di, v nhim trng da v cu trc ca da. Khi nhim t cu khu tr v c
m, khng sinh c s dng h tr cho nhng phng php phu thut thch hp.
Vancomycin hydrochloride c bo co l hiu qu khi s dng n thun hoc phi hp vi

mt Aminoglycoside trong vim ni tm mc do S. viridans hoc S. bovis. i vi vim ni tm

mc do Enterococci (v d S. faecalis), Vancomycin hydrochloride c bo co l ch c hiu
qu khi phi hp vi mt Aminoglycoside.
Vancomycin hydrochloride c bo co l hu hiu trong iu tr vim ni tm mc do
diptheroid. Vancomyciin hydrochloride c s dng thnh cng khi phi hp vi rifampin,
mt aminoglycoside, hoc c hai trong vim ni tm mc c van gi phc hnh giai on sm do
S. epidermidis hoc diptheroid.
Nn ly nhng mu cy vi khun cch ly v nh danh vi khun gy bnh v xc nh tnh
nhy cm ca chng vi Vancomycin hydrochloride.
Vancomycin hydrochloride dng tim c th c s dng ng ung iu tr vim i
trng gi mc lin quan khng sinh do C. difficile. Cha chng minh c hiu qu ca vic s
dng n thun Vancomycin hydrochloride dng tim trong ch nh ny. Vancomycin
hydrochloride dng ng ung khng hiu qu i vi nhng loi nhim trng khc.
Mc d cha thc hin c nhng nghin cu c nhm chng v hiu qu lm sng, nhng
Vancomycin tim mch c Hip hi Tim mch Hoa Kz v Hip hi Nha khoa Hoa Kz ngh
s dng phng nga vim ni tm mc do vi khun nhng bnh nhn d ng penicillin v
bnh tim bm sinh hoc bnh van tim hu thp hoc bnh van tim mc phi khi nhng bnh
nhn ny cn tri qua nhng th thut v nha hoc nhng th thut ng h hp trn.
Lu { : Khi la chn khng sinh phng nga vim ni tm mc do vi khun, bc s hoc nha s
nn nghin cu ton b thng tin chung ca Hip hi Tim mch Hoa Kz v Hip hi Nha khoa
Hoa Kz.
CHNG CH NH
Vancomycin hydrochloride chng ch nh trn nhng bnh nhn c tin s mn cm vi khng
sinh ny.
CH PHNG
Tim thng tnh mch nhanh (v d trong khong vi pht) c th gy h huyt p qu mc v
him gp hn, ngng tim.
Nn s dng Vancomycin hydrochloride di dng dung dch pha long truyn trong khong
thi gian khng di 60 pht trnh nhng phn ng do truyn nhanh. Thng thng ngng
truyn, nhng phn ng ny s ngng ngay lp tc. c tnh trn tai c th xy ra trn nhng
bnh nhn dng Vancomycin hydrochloride. c tnh ny c th thong qua hoc lu di. Hu
ht uc bo co trn nhng bnh nhn c cho liu qu cao, tim tng mt kh nng nghe,
hoc dng ng thi vi mt khng sinh khc cng c tai, nh aminoglycoside. Vancomycin
nn c s dng thn trng nhng bnh nhn suy thn v nguy c c tnh tng ng k do
nng trong mu cao, ko di.
Phi iu chnh liu lng ca Vancomycin hydrochloride nhng bnh nhn ri lon chc
nng thn (xem phn Thn trng lc dng, Liu lng v Cch dng).

THN TRNG LC DNG

Chung :
Nng trong huyt thanh c { ngha lm sng c bo co trong mt s bnh nhn ang
c iu tr vim i trng gi mc do C. difficile sau khi ung nhiu liu Vancomycin.
gim n mc ti thiu nguy c c tnh trn thn khi iu tr nhng bnh nhn c bnh
thn tim tng hoc nhng bnh nhn s dng ng thi mt aminoglycoside, nn thc hin
vic theo di chc nng thn nhiu ln v c bit l cn thn khi p dng nhng ch liu
lng thch hp bn di (xem Liu lng v Cch dng).
Th nghim nhiu ln v chc nng thnh gic c th hu ch gim n mc ti thiu nguy
c c tnh trn tai.
Gim bch cu trung tnh c hi phc c bo co nhng bnh nhn dng Vancomycin
hydrochloride (xem Tc dng ngoi ). Nhng bnh nhn s dng Vancomycin hydrochloride
lu di hoc dng ng thi vi nhng thuc c th gy gim bch cu trung tnh nn theo di
nh kz s lng bch cu.
Vancomycin hydrochloride kch thch m v phi c cho bng cch s dng mt ng tnh
mch an ton. au, d nhy cm, v hoi t xy ra khi tim bp Vancomycin hydrochloride
hoc khi thot mch do s {. Vim tc tnh mch c th xy ra, tn sut v nng c th c
gim n mc ti thiu bng cch truyn thuc chm nh mt dung dch pha long (2,5 n 5
g/l) v thay i nhng v tr tim truyn.
C nhng bo co v tn sut nhng s kin lin quan n vic tim truyn (gm h huyt p,
mt, ban , m ay, v nga) tng khi s dng ng thi vi nhng thuc gy v cm khc.
C th gim n mc ti thiu nhng s kin lin quan n vic tim truyn bng cch s dng
Vancomycin hydrochloride truyn 60 pht trc khi gy v cm.
Tnh an ton v hiu qu ca vic s dng Vancomycin tim vo no tht (ng ct sng hoc
trong no tht) cha c nh gi. Cn phi theo di cn thn khi s dng ti ch hoc ton
thn ng thi vi/hoc theo sau nhng thuc c thn kinh v/hoc c thn khc, nh
amphotericin B, cc aminoglycoside, bacitracin, polymyxin B, colistin, viomycin, hoc cisplatin.
S dng tr em : Xc nh nng Vancomycin mong mun trong huyt thanh nhng tr
sinh non v tr nh c th cn thit. tr em, vic s dng ng thi Vancomycin vi nhng
thuc gy v cm c th gy ban v mt ging histamine (xem Tc dng ngoi ).
S dng ngi ln tui : S suy gim t nhin lc cu thn theo tui c th lm nng
Vancomycin trong huyt thanh tng nu khng iu chnh liu. Nn iu chnh ch liu
lng Vancomycin nhng bnh nhn ln tui (xem Liu lng v Cch dng).
LC C THAI v LC NUI CON B
Lc c thai :
Nhng cng trnh nghin cu v kh nng sinh sn ca sc vt vi Vancomycin hydrochloride
cha c thc hin. Ngi ta cng khng bit Vancomycin hydrochloride c gy nguy him

cho thai hay khng khi c s dng cho ngi ph n c thai hoc c th nh hng n kh
nng sinh sn hay khng. Ch nn s dng Vancomycin hydrochloride cho ph n c thai khi
tht s cn thit.
Lc nui con b :
Ngi ta khng bit thuc c c tit ra qua sa m hay khng. V nhiu thuc c tit qua
sa m, nn thn trng khi s dng Vancomycin hydrochloride cho ph n cho con b. Ngi
ta khng chc rng tr b sa m c th hp thu mt lng Vancomycin ng k qua ng
tiu ha bnh thng.
TC DNG NGOI
Nhng s kin lin quan n tim truyn : Trong lc hoc ngay sau khi truyn nhanh
Vancomycin hydrochloride, bnh nhn c th b nhng phn ng dng phn v, gm h huyt
p, th rt, kh th, m ay, hoc nga. Truyn nhanh c th gy da na trn c th ("c
") hoc au v co tht c ngc v lng. Nhng phn ng ny thng ht trong vng 20 pht
nhng c th ko di nhiu gi. Nhng s kin nh th him xy ra nu Vancomycin
hydrochloride c cho truyn chm khong 60 pht. Trong nhng nghin cu nhng ngi
tnh nguyn bnh thng, nhng s kin lin quan n tim truyn khng xy ra khi
Vancomycin hydrochloride c cho vi tc bng hoc t hn 10 mg/pht.
c thn : Nhiu trng hp nng creatinine mu hoc BUN trong huyt thanh tng
nhng bnh nhn dng Vancomycin hydrochloride c bo co. a s nhng trng hp
ny xy ra nhng bnh nhn c cho ng thi vi aminoglycoside hoc nhng ngi c
ri lon chc nng thn tn ti t trc. Khi ngng Vancomycin hydrochloride, a s bnh
nhn s ht tng azot mu.
c tai : Nhiu trng hp mt thnh gic lin quan n vic s dng Vancomycin
hydrochloride c bo co. Hu ht nhng bnh nhn ny b ri lon chc nng thn, mt
thnh gic tn ti t trc, hoc tr liu ng thi vi nhng thuc c tai. Chng mt, chong
vng v tai c bo co him gp.
To mu : Gim bch cu trung tnh c hi phc, thng bt u xut hin mt hoc nhiu tun
sau t iu tr vi Vancomycin hydrochloride hoc sau tng liu ln hn 25 g, c bo
co trn nhiu bnh nhn. Gim bch cu trung tnh phc hi nhanh chng ngay khi ngng
Vancomycin hydrochloride. Gim tiu cu him gp.
Cc phn ng ph khc : Him khi xy ra, nhng bnh nhn b phn v, st do thuc, run, v
pht ban c bo co do dng Vancomycin hydrochloride.
LIU LNG v CCH DNG
Nhng bnh nhn c chc nng thn bnh thng :
Ngi ln : Liu tim mch thng dng hng ngy l 2 g chia thnh 500 mg mi 6 gi hoc 1 g
mi 12 gi. Mi liu nn c cho trong khong thi gian t nht l 60 pht. Nhng yu t c
a khc, nh tui hoc bo ph, c th cn phi iu chnh liu thng dng mi ngy.

Tr em : Tng liu Vancomycin hydrochloride tim mch mi ngy oc tnh trn c s 40 mg

cho mi kg cn nng, c th chia hoc pha vo nhu cu dch trong 24 gi ca tr. Mi liu nn
c cho trong mt khong thi gian t nht 60 pht.
Tr nh v tr s sinh : tr nh v s sinh, tng liu tim mch mi ngy c th thp hn.
c hai trng hp tr nh v tr s sinh, liu khi u c ngh l 15 mg/kg, sau l 10
mg/kg mi 12 gi cho tr sinh mt tun tui v mi 8 gi cho tr trn mt thng tui. Theo di
cht ch nng Vancomycin trong huyt thanh nhng bnh nhn ny.
Tnh an ton v hiu qu ca vic s dng Vancomycin tim vo no tht (ng ct sng hoc
trong no tht) cha c nh gi.
Nhng bnh nhn suy chc nng thn v ln tui : Vic iu chnh liu phi oc thc hin
nhng bnh nhn suy chc nng thn. nhng bnh nhn ln tui, vic gim liu c th cn
phi nhiu hn mong i v chc nng thn gim. o nng Vancomycin trong huyt thanh
c th hu ch iu tr tt, nht l nhng bnh nhn bnh nng km theo chc nng thn
thay i. Nng Vancomycin trong huyt thanh c th c xc nh bng phng php nh
lng vi sinh hc, nh lng min dch phng x, nh lng min dch huznh quang phn cc,
nh lng min dch huznh quang, hoc php ghi sc k lng cao p.
Nu c th o hoc c lng thanh lc creatinin mt cch chnh xc, liu lng cho hu
ht nhng bnh nhn suy thn c th c tnh ton theo bng di y. Liu lng
Vancomycin hydrochloride tnh bng mg mi ngy khong 15 ln lc cu thn tnh bng
ml/pht :
Bng Liu lng Vancomycin cho nhng
bnh nhn suy chc nng thn (Phng
theo Moellering et al)
thanh lc creatinin (ml/pht)

Liu Vancomycin (mg/24 gi)

100

1.545

90

1.390

80

1.235

70

1.080

60

925

50

770

40

620

30

465

20

310

10

155

Nn dng liu khi u di 15 mg/kg ngay c nhng bnh nhn suy thn t nh n trung
bnh.
Bng ny khng c gi tr i vi nhng bnh nhn suy thn chc nng. i vi nhng bnh
nhn nh th, nn cho liu khi u 15 mg/kg cn nng t c nng tr liu trong
huyt thanh ngay lp tc. Liu cn duy tr nng hng nh l 1,9 mg/kg/ngy. V liu duy
tr thch hp cho tng ngi l t 250 n 1.000 mg, nn mt liu c th cho cch khong
nhiu ngy tt hn l dng thuc mi ngy nhng bnh nhn c suy thn r. nhng bnh
nhn v niu, mt liu 1.000 mg c ngh cho mi 7 n 10 ngy.
Ch khi bit nng creatinin trong huyt thanh, c th s dng cng thc sau tnh thanh
lc creatinin (da trn gii, cn nng, v tui bnh nhn). thanh lc creatinin c tnh
(ml/pht) ch l gi tr c lng. Nn o thanh lc creatinin ngay sau .
Nam :
Cn nng (kg) x (140 - tui tnh theo nm) / 72 x nng creatinin huyt thanh (mg/dl)
N : 0,85 x gi tr trn.
Creatinin huyt thanh phi th hin tnh trng chc nng thn n nh. Nu khng th tr s c
lng ca thanh lc creatinin khng c gi tr. Nh th thanh lc c tnh ton cao hn
thanh lc thc s nhng bnh nhn c nhng iu kin : (1) c trng bi chc nng thn
gim, nh chong, suy tim nng, hoc thiu niu ; (2) khng c mi tng quan bnh thng
gia khi lng c v ton b trng lng c th, nh nhng bnh nhn bo ph hoc nhng
bnh nhn c bnh gan, ph, bng bng ; v (3) i km tnh trng suy nhc, suy dinh dng,
hoc khng hot ng.
Tnh an ton v hiu qu ca vic s dng Vancomycin tim vo no tht (ng ct sng hoc
trong no tht) cha c nh gi.
Truyn ngt qung l phng php dng c ngh.
Pha ch v Tnh bn :
Ngay khi s dng, ti t hp bng cch thm hoc 10 ml nc v khun vo l 500 mg hoc 20
ml nc v khun vo l 1 g bt Vancomycin kh, v khun. Pha long hn na l cn thit.
Sau khi ti t hp, nhng l ny c th gi trong t lnh 14 ngy m khng mt hiu lc ng
k.
Dung dch c ti t hp c 500 mg Vancomycin phi c pha long vi t nht 100 ml dung

mi. Dung dch c ti t hp c 1 g Vancomycin phi c pha long vi t nht 200 ml dung
mi. Liu lng mong mun c pha long theo cch ny nn c s dng truyn tnh mch
trong mt thi gian t nht l 60 pht.
Tng hp vi nhng thuc khc v nhng dch truyn tnh mch khc : nhng dung dch c
pha long vi Dextrose 5 % hoc Sodium Chloride 0,9% c th bo qun trong t lnh 14 ngy
m khng mt hiu lc ng k. Nhng dung dch c pha long vi nhng dch sau c th
bo qun trong t lnh 96 gi :
- Dch truyn Dextrose 5% v Sodium Chloride 0,9% USP
- Lactated Ringer, USP
- Lactated Ringer v Dextrose 5%, USP
- Normosol *- M v Dextrose 5%
- Isolyte * E
Dung dch Vancomycin c pH thp v c th khng n nh v mt vt l khi trn vi nhng hp
cht khc.
Nhng sn phm thuc ang tim nn kim tra k bng mt xem c cn v mt mu trc khi
dng, vo bt c lc no c th c.
Vic s dng thuc ng ung :
Tng liu thng dng hng ngy ngi ln trong vim i trng gi mc do C. difficile l 500
mg n 2 g chia 3 hoc 4 ln trong 7 n 14 ngy. Tng liu thng dng hng ngy tr em l
40 mg/kg cn nng chia 3 hoc 4 ln. Tng liu hng ngy khng nn qu 2 g. Liu thch hp c
th c pha vi 1 oz nc v cho bnh nhn ung. Thuc c pha long c th cho qua
ng thng mi d dy. C th thm sir c mi thm thng dng cho d ung.
QU LIU
Nn iu tr nng cng vi duy tr lc cu thn. Vancomycin thi tr rt t qua thm phn.
Lc mu vi Amberlite XAD-4 resin c ghi nhn c hiu qu hn ch.

546.

VARILRIX

SMITHKLINE BEECHAM
vaccine : l n liu (cha 1 vin vaccine ng kh) + ng dung mi n liu.
THNH PHN
cho 1 liu 0,5 ml vaccine hon nguyn

Khng di 103,3 n v plaque-forming (PFU) virus varicella-zoster 2.000 UI

TNH CHT
Varilrix l ch phm ng kh dng Oka sng gim c lc ca virus varicella-zoster, thu c
bng vic sinh si ca virus trong mi trng nui cy t bo lng bi MRC5 ca ngi.
Varilrix t nhng yu cu ca T Chc Y T Th Gii i vi sinh phm v vaccine thy u.
Dung mi v khun cha nc pha tim trong sut v khng mu.
DC L LM SNG
Varilrix gy nhim varicella gim c lc khng c biu hin r trn lm sng cc i tng
nhy cm. 72 gi sau khi chng nga, c th c s bo v khi tip xc vi virus thy u t
nhin. S hin din ca khng th c chp nhn nh du hiu bo v chng li bnh.
i tng lnh mnh : Trong cc nghin cu lm sng, bao gm > 1.500 i tng (9 thng-12
tui), t l c p ng khng th > 98% t c 6 tun sau khi tim.
T l p ng khng th gim theo tui. cc i tng >=13 tui, cn tim 2 liu (cch nhau
t 6-10 tun) t t l 100% c p ng khng th.
Bnh nhn nguy c cao : nhng bnh nhn nguy c cao, t l p ng khng th ton phn l
80%, tuy nhin bnh nhn b bnh bch cu, t l p ng khng th l khong 90%.
nhng bnh nhn nguy c cao, c th nh lng thng kz khng th varicella sau khi tim
nhm xc nh nhng i tng cn phi c tim nhc li.
Trong 1 nghin cu, t l b herpes zoster bnh nhn b bnh bch cu c chng thp hn
so vi bnh nhn khng c chng nga v b nhim bnh mt cch t nhin.
CH NH
i tng lnh mnh : Varilrix c ch nh to min dch ch ng chng li varicella cho
cc i tng khe mnh t 12 thng tui tr ln.
Bnh nhn c nguy c cao v nhng i tng khe mnh c tip xc gn gi vi h : Varilrix
cng c ch nh to min dch ch ng chng li varicella nhng bnh nhn c nguy
c cao nhy cm v cc i tng tip xc thn mt vi h.
Bnh nhn bch cu cp : Nhng bnh nhn c bnh bch cu cp c xem l c nguy c c
bit khi b thy u, v nn chng nga nu cha mc bnh hoc c xt nghim huyt thanh
m tnh.
Khi chng nga cho nhng bnh nhn ang giai on cp ca bnh bch cu, nn ngng ha
tr liu trc v sau mt tun tim nga. Thng thng, bnh nhn ang x tr cng khng nn
chng nga trong t tr liu.
Bnh nhn trong khi iu tr bng thuc c ch min dch : Bnh nhn iu tr bng thuc c
ch min dch (bao gm tr liu bng corticosteroid) cho khi u c c tnh hoc cc bnh mn
tnh nng (nh suy thn mn, cc bnh t min, bnh collagen, hen ph qun nng) d mc
bnh thy u trm trng.

Ni chung, bnh nhn c chng nga khi h hon ton thuyn gim v mt huyt hc, vi t
bo lympho tng cng ti thiu l < 1200/mm3 hoc khng c chng c cho thy c s gim
min dch t bo.
Bnh nhn c k hoch gh p c quan ni tng : Nu vic gh p c quan (nh gh p thn) ang
c xem xt, th nn tin hnh chng nga mt vi tun trc khi s dng thuc c ch min
dch.
Bnh nhn vi cc bnh mn tnh : Bnh nhn b cc bnh mn tnh nh ri lon chuyn ha v
ni tit, cc bnh tim mch v phi mn, bnh nhy nht v nhng bt thng v thn kinh c
cng c th mc bnh thy u trm trng.
Ngi khe mnh tip xc gn gi vi ngun bnh : Nhng ngi c tip xc gn gi nn c
chng nga nhm gim nguy c ly truyn virus t nhng bnh nhn nguy c cao. Nhng
ngi ny gm cha m v anh em ca bnh nhn c nguy c cao, nhn vin y t hoc nhng
ngi c tip xc thn mt vi bnh nhn b thy u hoc bnh nhn c nguy c cao.
CHNG CH NH
Cng nh cc vaccine khc, vic tim nga Varilrix nn c hon li nhng bnh nhn b
bnh st cao cp tnh. Tuy nhin, khng chng ch nh nhng i tng khe mnh c
nhim trng nh.
Chng ch nh tim Varilrix nhng i tng c s lng t bo lympho tng cng
1200/mm3 hoc c chng c cho thy thiu kh nng min dch t bo. Vaccine cng chng ch
nh nhng i tng c bit c mn cm ton thn vi neomycin, nhng bnh s vim
da tip xc do neomycin th khng phi l trng hp chng ch nh.
THN TRNG LC DNG
Khng nn tim Varilrix trong da.
Khng c tim tnh mch Varilrix trong bt c hon cnh no.
Sau khi hon nguyn, Varilrix nn c s dng ngay. Cn v cc cht st trng khc phi c
cho bay hi ht khi da trc khi tim vaccine v cc cht ny c th bt hot virus.
Nh tt c cc vaccine tim khc, lun lun cn sn cc phng tin iu tr thch hp phng
khi phn ng phn v xy ra, d him, sau khi chng nga vaccine. Vi l{ do ny, ngi c
chng nga nn c lu li theo di trong 30 pht sau khi tim.
LC C THAI v LC NUI CON B
Chng ch nh s dng Varilrix trn ph n mang thai. Ngoi ra, khng nn c thai trong vng 3
thng sau khi tim chng.
Khng c d liu lin quan n vic s dng ph n cho con b.
TNG TC THUC
nhng i tng c s dng immuno globulin hoc truyn mu, nn hon tim chng li
t nht 3 thng v c kh nng tht bi do cc khng th varicella thu nhn mt cch th ng.
i tng lnh mnh :

Varilrix c th c s dng cng lc vi nhng vaccine khc. Cc vaccine khc nhau phi lun
c tim nhng v tr khc nhau.
Cc vaccine bt hot c th c s dng m khng cn tnh n khong cch thi gian vi
Varilrix. Vaccine si khng nn tim cng lc vi Varilrix, m c ngh l cch t nht 1
thng do vic tim vaccine si c th dn n s c ch p ng min dch qua trung gian t
bo trong mt thi gian ngn.
Bnh nhn nguy c cao : Khng s dng Varilrix cng lc vi cc vaccine sng gim c lc
khc. Cc vaccine bt hot c th c s dng bt c thi im no lin quan n Varilrix,
min rng khng c chng ch nh c bit no. Cc vaccine tim khc nhau lun phi tim
nhng v tr khc nhau.
Tnh tng k : Khng nn trn ln Varilrix vi cc vaccine khc trong cng mt bm tim.
TC DNG NGOI
i tng lnh mnh : Varilrix l mt vaccine c tnh sinh phn ng ph ton thn rt thp tt
c cc nhm tui. Phn ng ti ch tim Varilrix thng nh v ngn.
Trong cc th nghim lm sng, vi hn 1500 i tng (9 thng-12 tui), di 4% i tng
c chng nga c bo co l c ni sn mn nc, hu ht xut hin trong 3 tun u sau
khi tim chng v s sang thng thng di 10. Nhit trn 37,5oC (nch)/38oC (hu mn)
c ghi nhn khong 5% i tng c chng nga trong 6 tun theo di.
Trong nghin cu m i s dng vaccine v gi dc c theo di trong 4 tun, bao gm 513
tr tui t 12-30 thng, khng c s khc bit ng k v bn cht hoc t l cc triu chng
cc i tng tim vaccine hay gi dc.
Trong cc nghin cu lm sng (vi phc 2 liu) thiu nin, khng c bo co no cho thy
c ni sn mn nc sau khi tim.
Triu chng tng qut nh nhc u, st, d cm v mt mi xut hin vi t l <=2,5% sau mi
liu. Phn ng ph sau liu th 2 khng nhiu hn liu th 1 v khng c s khc bit gia i
tng c huyt thanh dng tnh v m tnh lc ban u.
Bnh nhn nguy c cao : Phn ng ti ni tim Varilrix thng nh.
Sn mn nc, him khi phi hp vi st nh hoc trung bnh, xut hin vi ngy n vi tun
sau khi tim. Di 1/4 bnh nhn b bnh bch cu c nhng phn ng ny. Nhng sn ny
thng nh v tn ti khng lu.
Sn mn nc c khuynh hng gp nhiu hn nhng bnh nhn b bnh bch cu ang
dng thuc c ch min dch, nh ngi ang iu tr duy tr bng ha tr liu. S xut hin
cc sn ny khng nh hng n vic iu tr lm sng ca bnh nhn. Khng c bng chng
cho thy vic tim nga c tc dng bt li trn din tin ca bnh.
cc bnh nhn suy gim min dch nng, bnh thy u biu hin r rt trn lm sng xy
ra sau khi chng nga v ngi ta phn lp c virus dng vaccine t cc mn nc. S ly
lan virus vaccine dng Oka c chng minh qua s phn lp v nhn din virus trong 4

trng hp anh ch em rut ca nhng i tng c chng nga b suy gim min dch,
nhng i tng ny b sn mn nc. Khi nhng anh ch em ca i tng suy gim min
dch c chng nga ny b pht trin ban sau khi nhim, mc thng l rt nh.
LIU LNG v CCH DNG
Varilrix ch c dng tim di da.
0,5 ml vaccine hon nguyn cha mt liu tim chng.
>=13 tui : 2 liu cch nhau t 6 n 10 tun ; T 12 thng n 12 tui : 1 liu.
Lch tim tng t nh dng cho i tng khe mnh cng c p dng cho nhng bnh
nhn nguy c cao. nhng bnh nhn ny, vic o thng kz lng khng th sau khi tim c
th c ch nh nhm xc nh cc i tng cn c tim nhc li.
Hon nguyn vaccine : Varilrix phi c hon nguyn bng cch thm phn cha trong dung
mi c cung cp vo l vaccine. Vin vaccine phi hon ton ha tan trong cht pha long.
Phi tim ht ton b phn cha trong l.
Lu { khi s dng : Do s thay i nh v pH, mu ca vaccine c pha c th thay i t
hng ti trc khi s dng, nn quan st vaccine pht hin cc cht l v/hoc s thay
i v phng din vt l. Trong trng hp pht hin c mt trong hai hin tng nu
trn, vaccine phi c loi b.
BO QUN
Vaccine ng kh nn c bo qun trong t lnh nhit t +2oC n +8oC v trnh nh
sng. Dung mi c th c bo qun trong t lnh hoc nhit mi trng ngoi. Vaccine
ng kh khng b nh hng bi s ng lnh.
Khi Varilrix c phn phi i t trung tm bo qun lnh, cn chun b cho vic chuyn ch
di iu kin t lnh.

547.

VASOBRAL

JACQUES LOGEAIS
c/o HYPHENS
Dung dch ung : l 50 ml + ng nh chun (40 git = 2 ml).
THNH PHN
cho 1 ng nh chun
Dihydroergocryptine A msilate

2 mg

Cafine

20 mg

(thanol 95deg)
DC LC
Gy gin mch ngoi bin v chn alpha trung tm/kch thch tm thn.
ng vt : dihydroergocryptine c i lc rt mnh i vi cc th th alpha adrnergique ca
tt c cc m (mch mu, c tim, t cung, h thn kinh, tiu cu) v gy tc dng trn s tun
hon ca mu v trn s chuyn ha no.
Ung dihydroergocryptine A msilate (DHEC) v cafine s lm tng s tun hon ca mu
trong mao mch, gim s kt tp tiu cu v hng cu. Tng kh nng chng chi ca no i
vi chng gim oxy huyt hoc thiu mu cc b : cc chc nng ca no v s chuyn ha
no c ci thin tt hn c ghi nhn sau khi s dng phi hp DHEC v cafine.
iu tr trn ng vt bng DHEC + caf ine lm tng kh nng chu ng v gim tnh thm ca
thnh mao mch.
chut cng, DHEC c tc ng chng thiu mu cc b da.
Cc dn xut ca nm ca g c chui polypeptique t c hp thu qua ng tiu ha, cng t
hn na nu chng b hydro ha v tr 9 v 10. ng thi, vic hnh thnh phc hp c vng
xanthine c th lm thay i c tnh sinh ha ca cc cht ny, trong chiu hng to mt h
s phn b nc/du tt hn v do ci thin s hp thu ca cc cht ny qua ng tiu
ha.
Cc kho st in vivo (c thc hin trn chut cng, ch) cho thy rng sau khi s dng cht
3
H-DHEC, hm lng ca cht phng x ny trong huyt tng tng cao nu c phi hp s
dng vi trimthylxanthine (cafine).
Thc t v s tng cng kh nng hp thu ca dihydroergocryptine bi caf ine c khng
nh qua nhiu kho st trn ng vt : caf ine lm tng 26% kh nng hp thu ca 3H-DHEC
t trng chut cng.
DC NG HC
ngi, vi s hin din ca cafine, phn DHEC khng b bin i c hp thu nhanh chng
sau khi ung thuc (Tmax : 0,5 gi). Nng ti a thp (Cmax : 227 pg/ml sau khi ung 8 mg
DHEC di dng vin nn).
Thi gian bn hy trong huyt tng ca DHEC khng b bin i di 2 gi.
Mt nghin cu v s cn bng sinh hc c thc hin trn ngi cho thy rng Vasobral
dng vin v dng dung dch ung c dc ng hc nh nhau.
CH NH
c ngh trong tr liu iu chnh cc triu chng suy gim tr tu v bnh l ca ngi ln
tui (cc ri lon s ch , tr nh ...).

iu tr h tr trong hin tng Raynaud.

THN TRNG LC DNG
Lu { vn ng vin th thao do thuc cho kt qu dng tnh cc test v s dng cht kch
thch (doping).
Vasobral khng c tc dng h huyt p do khng th c dng iu tr bnh cao huyt
p.
LC C THAI
Cc kho st trn ng vt khng cho kt lun rng thuc khng c kh nng gy qui thai.
ngi, do thiu s liu, do thn trng nn trnh k toa cho ph n mang thai.
TNG TC THUC
+ Khng sinh nhm macrolide (ngoi tr spiramycine) : Chng ch nh (Ng c ergotine km
theo c th b hoi t u chi)
+ Sumatriptan : Chng ch nh (Nguy c tng huyt p ng mch, co tht ng mch vnh do
phi hp tc dng gy co mch trong ca phi hp ng thi cn au na u)
+ Bromocriptine : Chng ch nh (Nguy c gy co mch v/hoc cn cao huyt p)
TC DNG NGOI
Bun nn (trong trng hp dng lc i), sung huyt mi.
LIU LNG v CCH DNG
2-4 ml, 2 ln/ngy, trong cc ba n.

548.

VASTAREL

LES LABORATOIRES SERVIER

vin bao 20 mg : hp 60 vin.
THNH PHN
cho 1 vin
Trimtazidine chlorhydrate

20 mg

DC LC
Thuc tr au tht ngc, bo v t bo c tim.
Trimtazidine, bng cch gi cho s chuyn ha nng lng ca t bo n nh trc tnh trng
thiu oxy hoc thiu mu, trnh cho hm lng ATP trong t bo gim.
Trim tazidine nh th m bo cho chc nng bm ion v lung natri v kali i qua mng t
bo c n nh v duy tr tnh bt bin ni mi trong t bo.
Trn th vt : trim tazidine c tc ng :
- duy tr s chuyn ha nng lng tim v cc c quan thn kinh cm gic trong trng hp

thiu mu v thiu oxy ;

- gim nhim toan trong t bo v cc ri lon lung ion qua mng t bo gy bi tnh trng
thiu mu ;
- gim s di chuyn v s ngm ca bch cu a nhn hng thn kinh trong m tim b thiu
mu ; ng thi gim mc ca nhi mu trong thc nghim ;
- tc ng ny ca thuc khng km theo bt kz thay i huyt ng no.
Trn ngi : cc nghin cu c kim sot trn bnh nhn b au tht ngc cho thy
trim tazidine c tc ng :
- lm tng d tr mch vnh ;
- lm gim nguy c b cao huyt p khi phi gng sc, khng lm thay i ng k tn s tim ;
- lm gim ng k tn s xut hin au tht ngc ;
- lm gim ng k liu trinitrine cn dng trong d phng v iu tr au tht ngc.
DC NG HC
- Dng ng ung, trim tazidine c hp thu nhanh v t nng ti a trong mu trc 2
gi sau khi ung thuc.
- Nng ti a trong huyt tng t c sau khi dng liu duy nht 20 mg trimtazidine
vo khong 55 ng/ml.
- Tnh trng cn bng, t c t 24 n 36 gi sau khi dng cc liu lp li, rt n nh trong
qu trnh iu tr.
- Th tch phn phi l 4,8 l/kg, m bo mt s phn phi tt n m ; gn kt vi protine
huyt tng thp, trong khong 16%.
- Trimtazidine ch yu c o thi qua nc tiu di dng khng b bin i.
Thi gian bn hy o thi trung bnh l 6 gi.
CH NH
- Trong tim mch : iu tr d phng cn au tht ngc.
- iu tr h tr cc triu chng chng mt v tai.
LC C THAI v LC NUI CON B
Lc c thai :
Cc nghin cu trn th vt cho thy thuc khng c tc dng gy qui thai ; do thiu cc s
liu lm sng, khng th loi tr nguy c gy d dng ; do , nn thn trng trnh k toa cho
ph n ang mang thai.
Lc nui con b :
Do thiu s liu v s bi tit qua sa m, khng nn cho con b m trong thi gian iu tr.
TC DNG NGOI
Him khi gy mt s ri lon nh ng tiu ha (bun nn, ma).
LIU LNG v CCH DNG
40 n 60 mg/24 gi, tng ng 2 n 3 vin/ngy, chia lm 2 hoc 3 ln trong cc ba n.

549.

VAXEM HIB

CHIRON VACCINES
c/o HONG LAN PHARMA
Hn dch tim 10 mg : l hay bm tim cha 1 liu 0,5 ml.
THNH PHN
cho 1 liu
Haemophilus influenzae type b

10 mg

M T
Mi liu 0,5 ml cha 10 mg oligosaccharide chit t v ca vi khun Haemophilus influenzae
type b c lin hp vi khong 25 mg Cross Reacting Material 197 (CMR 197) protein, mt
dng bin i ca c t bch hu khng cn c tnh. Ngoi ra cn c cc t dc : aluminium
hydroxide 1 mg v thimerosal 0,05 mg.
CH NH
Min dch ch ng cho tr t 2 thng n 5 tui chng li vi khun Haemophilus influenzae
type b.
CHNG CH NH
bit c qu mn vi cc thnh phn caVaxem Hib v trong bt kz bnh l st cp tnh no.
THN TRNG LC DNG
Thn trng khng kim tim m vo mch mu.
Tim chng cho tr em b nhim Haemophilus influenzae bm sinh v/hoc b suy gim min
dch v cc tr ang c iu tr bng corticoid c th lm hn ch p ng min dch. Mc d
vaccin anti-Hib c th gy ra khng th bch hu, khng th dng vaccin ny thay th cho
vic tim chng bch hu. Do l mt sn phm sinh hc nn khng th loi tr nguy c gy
phn ng qu mn : nn d phng adrenalin t l 1:1000 hay corticoid s dng ngay lp tc
trong trng hp xy ra phn ng qu mn.
Khng tim IV.
LC C THAI v LC NUI CON B
Khng nn tim chng trong thi gian mang thai v cho con b.
TNG TC THUC
Vaccin anti-Hib c th dng ng thi vi cc vaccin bch hu/un vn, bch hu/un vn/ho
g, bi lit hay vim gan B.
TC DNG NGOI
Mc d c dung np rt tt, vic tim chng cng c th gy mt s phn ng.
Ti ch : au, sng, .

Ton thn : st, kch ng, n khng ngon, nn, tiu chy.
Vic dng bt kz dng vaccin no cng c th gy ra phn ng qu mn, hn hu c th gy sc
phn v vi cc triu chng : h huyt p, tim p nhanh hay chm, mt mi, lo u, mt ng,
mt nhn thc, th kh, nut kh, nga (nht l lng bn tay, lng bn chn), ni m ay c
hay khng km theo ph mch, ban (nht l xung quanh tai), bun nn, nn, au bng, tiu
chy. Tham kho kin bc s hay dc s nu c nhng triu chng khc.
LIU LNG v CCH DNG
Ti , phc tim chng cho tr di 12 thng gm 3 liu, bt u khi tr c 8 tun (2
thng tui). Liu th nh phi c tim trong vng thng th 5, v phi hon tt mi th 3
trong vng thng th 11 hay thng th 12. i vi tr nhn 3 liu trong nm u tin,
khng cn phi tim chng tng cng vo cc nm sau .
Tr t 13 n 48 thng m khng c tim chng trong nm u, ch cn tim chng 1 liu
duy nht Vaxem Hib cho tc ng min dch bo v.
Mt s phc tim chng khc khuyn co tim vaccin vo thng th 2, thng th 3 v thng
th 4 hay vo thng th 2, thng th 4 v thng th 6. Cc phc ny u cho tc ng min
dch bo v tt.
Vaxem Hib phi c dng bng ng tim IM :
- Tr n 2 tui, nn tim vo trc i.
- Tr trn 2 tui, nn tim vo c delta.
Lc trc khi tim.
QU LIU
Khng c trng hp qu liu no c bo co.
BO QUN
Bo qun +2oC n +8oC

550.

VENTOLIN

GLAXOWELLCOME
vin nang xoay (rotacaps) dng ht 200 mg : 10.
xir long m 2 mg/5 ml : chai 100 ml.
kh dung (arosol) 100 mg/liu : bnh xt 200 liu.
dung dch h hp (respirator solution) 5 mg/ml : chai 20 ml.
kh dung (nebules) : ng 2,5 mg x 2,5 ml.
kh dung (nebules) : ng 5 mg x 2,5 ml.
THNH PHN
cho 1 vin

Salbutamol sulfate

200 mg

cho 1 mung lng 5 ml

Salbutamol sulfate

2 mg

cho 1 liu kh dung

Salbutamol sulfate

100 mg

cho 1 ml dung dch h hp

Salbutamol sulfate

5 mg

cho 1 nebule
Salbutamol sulfate

2,5 mg

cho 1 nebule
Salbutamol sulfate

5 mg

DC LC
Salbutamol sulfate l mt cht kch thch b-adr nergique c tc ng chn lc ln th th trn
c ph qun v c rt t hay khng c tc ng ln cc th th tim vi liu iu tr.
Do tc ng chn lc trn ph qun v khng nh hng ln h tim mch, dng thuc ung
Ventolin thch hp cho vic iu tr co tht ph qun bnh nhn mc ng thi bnh tim hay
cao huyt p.
Thuc cng c hot tnh cao trong vic ngn nga s phng thch histamine gy ra t khng
nguyn v nhng cht to thnh trong phn ng phn v c tc dng chm, SRS (A), t nhng
dng bo phi nhy cm vi IgE. Mt cch tng qut, nhng phn ng qu mn loi I nh
trn c xem nh l phn ng khi pht u tin ca hi chng suyn d ng.

CH NH
Dng rotacaps dng cho s phng thch histamine gy ra bi khng nguyn v nhng cht to
thnh trong phn ng phn v c tc dng chm, SRS(A), t dng bo phi nhy cm vi
khng th IgE. Nhng phn ng mn cm loi I nh trn, mt cch tng qut, c xem nh l
phn ng khi pht u tin ca hi chng suyn d ng.
iu tr v d phng hen ph qun v cng iu tr cc bnh khc nh vim ph qun, kh
thng phi km theo s tt nghn c hi phc ng h hp. Salbutamol ht c tc ng ko
di. Tr liu duy tr v d phng trong bnh suyn mn tnh, lm gim co tht ph qun ko
di v bt i p ng d ng trong phi. Kim sot co tht ph qun ko di trong vim ph
qun mn.
Ventolin rotacaps c th c dng khi cn thit gim cn kh th cp ; Rotacaps cng c
th dng ngn nga trc cn suyn do gng sc hay trc khi vo nhng mi trng
khng nguyn bit trc nhng khng th trnh c.
Xir long m : dng cho chng co tht ph qun trong cc dng hen ph qun, vim ph qun
mn v kh thng phi. Tr liu ng ung ny thch hp cho tr em v ngi ln thch dng
thuc dng lng.
Kh dung : iu tr v d phng hen ph qun v cng iu tr cc bnh khc nh vim ph qun
v kh thng phi km theo thuyn tc ng h hp c hi phc. Thuc c tc dng ko di v
thch hp cho iu tr duy tr thng ngy bnh phi mn tnh v vim ph qun mn tnh. H
thng phn phi thuc qua ng ht vo khi dng salbutamol vi liu lng nh tnh bng mg
trnh c s rung c vn thng gp vi dng ung. Thuc tc ng nhanh chng v c th
dng khi cn thit gim cn kh th cp.
C th dng thuc ngn chn cn suyn do gng sc. Do tc ng chn lc trn ph qun v
khng nh hng ln h tim mch, thuc ht Ventolin dng ph hp cho bnh nhn mc ng
thi bnh tim hay cao huyt p, bao gm c nhng ngi dng thuc chn bta - cc loi thuc
ny thng lm suy h hp.
Dung dch h hp (respirator solution) : dng iu tr suyn cp nng v nhng dng co tht
ph qun khc.
Nebules : dng kim sot cn co tht ph qun cp v iu tr suyn cp nng.
CHNG CH NH
Mc d dung dch tim tnh mch salbutamol v i khi vin n n salbutamol c dng trong
nhng trng hp khng c bin chng, nh nhau tin o, xut huyt trc khi sanh hay
nhim c mu lc c thai, ch phm Ventolin dng ht khng thch hp kim sot sanh non.
Cc dng bo ch Ventolin khng c dng cho cc trng hp da sy thai trong 6 thng u
ca thai kz.
Ventolin c chng ch nh cho bnh nhn c tin s mn cm vi bt kz cht no c trong
thnh phn.

Khng chng ch nh cho bnh nhn ang c iu tr vi IMAO .

THN TRNG LC DNG
Chung cho cc dng rotacaps/xir long m/a rosol/dung dch h hp/nebules : Trong trng
hp m liu hu hiu ca Ventolin trc y khng lm gim cn trong t nht 3 gi, bnh
nhn cn hi kin bc s xem nn thc hin cc bin php h tr cn thit tip theo nh th
no. Nn cn thn khi dng Ventolin cho bnh nhn b nhim c do tuyn gip.
Dng cn thn cho bnh nhn khi bit h dng mt liu ln thuc ging giao cm.
Dung dch h hp : ch dng vi mt my xng (respirator) hay my kh dung (nebulizer) di s
hng dn ca cc bc s. Khng c tim hay ung.
TNG TC THUC
Khng nn dng cc ch phm Ventolin ng ung cng vi cc thuc chn bta nh
propranolol.
LIU LNG v CCH DNG
n Rotacaps : ch dng ht vi mt ng ht Ventolin rotahaler.
Ngi ln :
p Co tht ph qun cp v kim sot cn suyn : 200 hay 400 mg, c th dng mt liu duy
nht.
p Liu d phng hay duy tr bnh mn tnh : 400 mg, 3 hay 4 ln mi ngy.
p Liu ngn nga cn co tht ph qun do vn ng qu : 400 mg, dng trc khi vn ng.
Tr em :
p Co tht ph qun cp, kim sot cn suyn c chu kz hay trc khi vn ng : 200 mg.
p Liu d phng hay duy tr hng ngy : 200 mg, dng 3 hay 4 ln mi ngy. t c kt
qu ti a, cho hu ht cc bnh nhn, nn dng Ventolin rotacaps u n thng xuyn.
Tc dng gin ph qun ca mi ln ht ko di ti thiu 4 gi, ngoi l bnh nhn c chng
suyn ngy cng nng. Nhng bnh nhn ny nn c lu { khng c tng liu dng dng
rotacaps, tuy nhin nn hi kin bc s trong trng hp c ch nh iu tr bng
glucocorticoide dng ht hay ng ton thn.
n Xir :
Ngi ln : 10 ml, 3 hay 4 ln mi ngy.
Tr em di 6 tui-12 tui : 5 ml, 3 hay 4 ln mi ngy.
Tr em 6-2 tui : 2,5-5 ml, 3 n 4 ln mi ngy.
n Arosol :
Ngi ln :
p gim bt co tht ph qun cp v kim sot cc cn suyn khng lin tc : c th dng
liu duy nht 1 hay 2 ln ht.
p Liu khuyn co dng d phng hay duy tr bnh mn tnh : 2 ln ht vo dng 3 hay 4 ln mi
ngy.

p ngn nga co tht ph qun do gng sc : nn dng 2 ln ht trc khi vn ng.

Tr em : liu lng 1 ln ht c khuyn co s dng gim cn co tht ph qun cp, kim
sot cn suyn v trc khi vn ng gng sc.
p Liu d phng hay duy tr hng ngy : 1 ln ht, 3 hay 4 ln mi ngy. C th tng ln 2 ln ht
nu cn thit.
c kt qu ti ho, hu ht cc bnh nhn, nn dng ng ht Ventolin u n.
Tc dng gin ph qun ca mi ln ht Ventolin ko di ti thiu 4 gi tr ngoi l nhng
bnh nhn c chng suyn ngy cng nng. Nhng bnh nhn ny nn c lu { khng c
tng liu ht, tuy nhin nn hi kin ca bc s trong trng hp c ch nh dng
glucocorticoide dng ht hay dng ton thn.
n Dng thuc khng lin tc :
Ngi ln : 0,5-1 ml (2,5-5 mg salbutamol) nn pha long vi dung dch mui thng thng
dng tim t c th tch 2-4 ml. Dung dch thu c c ht vo qua mt my kh
dung thch hp cho n khi hi thuc ngng sinh ra. Khi dng mt my kh dung v ngun bm
thch hp, qu trnh ny c th ko di khong 10 pht.
Trong trng hp dng thuc khng lin tc, Ventolin dng dung dch h hp c th dng c,
khng pha long. 2ml dung dch ny (10 mg salbutamol) c t trong my kh dung v bnh
nhn ht kh dung c phun ln khi t c tc dng gin ph qun. Qu trnh ny c th ko
di 3- 5 pht.
mt vi bnh nhn ngi ln, c th cn tng liu salbutamol cao hn n 10 mg. Trong
trng hp ny, qu trnh dng kh dung vi dung dch c khng pha long c th tip tc cho
n khi hi thuc ngng sinh ra.
Tr em : khi dng thuc khng lin tc c th p dng cng mt cch thc nh trn.
p Liu lng thng thng :
Di 12 tui : 0,5 ml (2,5 mg salbutamol) ha long vi 2- 4 ml dung dch mui ng trng
dng tim. Mt vi trng hp c th cn dng liu cao hn n 5 mg.
Liu php dng thuc khng lin tc c th lp li 4 ln mi ngy.
n Dng thuc lin tc : Ventolin dng dung dch h hp c ha tan vi dung dch mui ng
trng dng tim t c nng 50-100 mg salbutamol/ ml (1-2 ml dung dch pha
thnh 100ml). Dung dch pha long thu c dng di dng kh dung vi mt my kh dung
thch hp. Tc dng bnh thng l 1-2 mg/gi.
C th dng thuc bng mt n, ng hnh ch T hay qua ng ni kh qun. C th dng mt ng
thng kh p lc dng khng lin tc nhng thng him khi cn thit. Khi c nguy c thiu
oxy do gim thng kh, nn thm oxy vo trong khng kh c ht vo. Nn thay dung dch
trong my kh dung hng ngy.
n Nebules :
Ngi ln v tr em : liu bt u thch hp dng ht salbutamol m l 2,5 mg. Liu ny c

th tng ln 5 mg v c th lp li 4 ln mi ngy.
Ventolin nebules c dng di dng c khng pha. Tuy nhin, nu cn thit mun ko di
thi gian dng thuc (lu hn 10 pht), c th pha long vi dung dch mui ng trng dng
tim.
Ventolin nebules phi dng vi mt my kh dung, di s hng dn ca bc s.
Dung dch khng c dng tim.
Tnh hu hiu trn lm sng ca salbutamol dng kh dung tr s sinh di 18 thng khng
chc chn. Khi chng gim oxy mu c th xy ra, cn xem xt liu php b sung oxy.
Pha long : Ventolin nebules c th c pha long vi dung dch tim NaCl BP. Phi loi b
mi dung dch khng dng n trong bung kh dung.
Lu { khi dng thuc : Ha long : xir Ventolin khng cha ng. Thuc c th ha tan vi
nc ct. Hn hp thu c nn c bo v trnh nh sng v dng trong vng 28 ngy. Hn
hp pha long 50% th tch xir Ventolin cho thy c bo qun thch hp chng li s nhim
vi trng. Tuy nhin, trnh kh nng a n nhim vi trng qu mc, nn dng nc ct va
mi ct hay phi un si v lm lnh ngay trc khi dng pha long. Khng nn pha long
xir Ventolin vi xir BP hay dung dch sorbitol v c th lm kt ta cellulose. Cng khng nn
pha long xir Ventolin vi cc ch phm lng khc.
QU LIU
Mi du hiu qu liu thng c th i ph bng cch ngng thuc.
Thuc gii c thng dng cho Ventolin l cc tc nhn c ch bta chn lc ln tim. Tuy
nhin cc thuc chn bta nn dng cn thn cho bnh nhn c tin s co tht ph qun.
BO QUN
Rotacaps : Bo qun ni kh nhit bnh thng.
Xir : bo qun nhit khng qu 30oC. Xir Ventolin nn trnh nh sng.
Dung dch h hp/Kh dung : bo qun nhit di 25oC. Trnh nh sng. Khi l thuc b
m, thuc cha bn trong nn c b i sau mt thng. Bo qun ni mt, trnh sng v
nh sng mt tri trc tip. ng dng bm thuc phi khng b v, thng hay b t chy, ngay
c khi hon ton trng rng

551.

VERGETURINE

BAILLEUL
c/o GALIEN
Kem thoa ngoi da : tube 125 ml.
THNH PHN
cho 100 g

b-carotne

4 mg

Vitamine A (rtinol)

158 mg

Vitamine C

92 mg

Cholestrol

340 mg

Lcithine

1,380 g

Du gan c tuyt

0,850 g

Du mm la m

1,5 g

Tinh du Lavande

350 mg

Tinh du Romarin

150 mg

E 216
E 218
TNH CHT
Khi cc lp biu b pha bn ngoi b cng ra (khi c thai, dy th v.v.) th lp m n hi s ph
v v xy ra cc vt rn nt trn da.
Cc vt rn nt, cc vt so khng xa c t nhiu b cng ra, thng xy ra bng, hng v
v, l kt qu ca vic cc si n hi v m ca biu b b t.
Vergeturine l mt kem c phi hp lcithine, cc du thin nhin v cc vitamine, khi c
thoa ln b mt da s mang li cho da s mm mi, ti mt v cc yu t dinh dng cn thit
ngn nga cc trng hp rn nt da.
CH NH
Ngn nga cc trng hp rn nt da do thay i th trng v thai nghn, lm cho da mm mi
v ti mt.
LIU LNG v CCH DNG
T thng th 4 ca thai kz, nn thoa kem Vergeturine mi ngy vo bui ti sau khi ra da
bng dung dch x phng m, lau kh. Khi thoa kem, cn xoa u cho n khi kem ngm ht vo
da.
Hng dn :
- Massage bng : massage u theo ng trn ng thi hi n nh tay cho n khi kem thm
ht vo da.

- Massage hng : lm tng t v nh thoa kem ln c phn trn ca i.

- Massage v : massage tht nh tay ng thi nng v ln kem thm c vo phn k di
ca v.

552.

VERGETURINE

BAILLEUL
c/o GALIEN
Kem thoa ngoi da : tube 125 ml.
THNH PHN
cho 100 g
b-carotne

4 mg

Vitamine A (rtinol)

158 mg

Vitamine C

92 mg

Cholestrol

340 mg

Lcithine

1,380 g

Du gan c tuyt

0,850 g

Du mm la m

1,5 g

Tinh du Lavande

350 mg

Tinh du Romarin

150 mg

E 216
E 218
TNH CHT
Khi cc lp biu b pha bn ngoi b cng ra (khi c thai, dy th v.v.) th lp m n hi s ph
v v xy ra cc vt rn nt trn da.
Cc vt rn nt, cc vt so khng xa c t nhiu b cng ra, thng xy ra bng, hng v
v, l kt qu ca vic cc si n hi v m ca biu b b t.
Vergeturine l mt kem c phi hp lcithine, cc du thin nhin v cc vitamine, khi c
thoa ln b mt da s mang li cho da s mm mi, ti mt v cc yu t dinh dng cn thit

 ngn nga cc trng hp rn nt da.

CH NH
Ngn nga cc trng hp rn nt da do thay i th trng v thai nghn, lm cho da mm mi
v ti mt.
LIU LNG v CCH DNG
T thng th 4 ca thai kz, nn thoa kem Vergeturine mi ngy vo bui ti sau khi ra da
bng dung dch x phng m, lau kh. Khi thoa kem, cn xoa u cho n khi kem ngm ht vo
da.
Hng dn :
- Massage bng : massage u theo ng trn ng thi hi n nh tay cho n khi kem thm
ht vo da.
- Massage hng : lm tng t v nh thoa kem ln c phn trn ca i.
- Massage v : massage tht nh tay ng thi nng v ln kem thm c vo phn k di
ca v.

553.

VERORAB

AVENTIS PASTEUR
Bt pha tim bp : hp 1 l bt ng kh (1 liu) + ng tim cha dung mi 0,5 ml.
THNH PHN
cho 1 n v
Virus bnh di (chng Wistar rabies PM/WI 38-15031 liu
3 M)
ng dung mi : Sodium chlorure 2 mg, nc ct pha
tim va 0,5 ml

CH NH
- D phng bnh di trc khi tip xc :
- nhm ngh nghip : bc s th y, sinh vin ph t, nhn vin phng th nghim v l st sinh,
ngi nhi bng th, ha s hay iu khc gia chuyn v sc vt.
- ti cc vng c dch di sc vt : nng gia, lnh tun sn, th sn, tr em, khch du lch (Phi
chu, chu, Nam M).
- D phng bnh di sau khi chc chn hay nghi ng c tip xc virus.
Vic tim chng phi c khi s ngay lp tc khi c bt c nguy c ly nhim di no v bt

buc phi c thc hin ti mt trung tm chng di.

CHNG CH NH
Trng hp iu tr sau khi b ly nhim, hon ton khng c chng ch nh tim chng.
Trng hp tim chng d phng ngi c nguy c cao, nn hon tim nga khi c bnh l
st tin trin.
CH PHNG
Nu i tng tim chng b mt con vt cn hay b ly nhim bi mt vt phm kh nghi,
bt buc phi i khm ti mt trung tm chng di, c mang theo th chng nhn tim nga.
THN TRNG LC DNG
Thn trng khi dng trong trng hp d ng vi Streptomycine, Nomycine v/hoc
Polymyxine B d chng ch hin din dng vt trong vaccin.
LC C THAI
Khng chng ch nh tim chng khi c thai, tr trng hp tim chng d phng (trc khi c
tip xc) ngi c nguy c ly nhim cao.
TC DNG NGOI
Ti ni tim, him gp ban v ni cc cng nh tn ti t 24 n 48 gi, vi trng hp c
km tng thn nhit v suy nhc tm thi.
LIU LNG v CCH DNG
ng tim bp hoc tim di da.
Ngi ln : tim vng c en-ta.
Tr em : tim khu vc hai bn pha trc ngoi ca bp i.
n Tim chng d phng :
p Ln chng nga u tin : 1 mi tim vo cc ngy 0, ngy 7 v ngy th 28.
p Chng nga lp li : 1 mi tim sau 1 nm, sau mi 5 nm.
n Chng nga c coi nh l iu tr :
i tng cha c min dch : 1 mi tim vo cc ngy 0, 3, 7, 14, 30. Trong ca nguy c b
bnh di cao, tim ngy 0 liu 40 UI/kg huyt thanh khng bnh di hoc 20 UI/kg globuline
min dch ngi khng bnh di ; cho huyt thanh ngm su vo vt thng cng nhiu cng
tt, phn cn li tim bp mt ni cch xa ni tim vaccin.
i tng c min dch (c tim nga v tim nhc y ) :
p < 3 nm : tim 1 mi vo ngy 0 v ngy 3 khng cn dng huyt thanh.
p > 3 nm hoc khng tnh c : tim chng iu tr v huyt thanh liu php vi liu y
nu cn thit

554.

VEROSPIRON

GEDEON RICHTER
vin nn 25 mg : hp 100 vin.
vin nang 50 mg : hp 30 vin.
vin nang 100 mg : hp 30 vin - Bng B.
THNH PHN
cho 1 vin
Spironolactone

25 mg

ho 1 vin
Spironolactone

50 mg

cho 1 vin
Spironolactone

100 mg

DC LC
Hot cht ca thuc ny, spironolactone, l thuc li tiu gi kali, mt cht i khng c cnh
tranh vi aldosterone. Thuc c tc dng ln ng ln xa ca thn, c ch tc dng gi nc v
Na+ v c ch tc dng thi tr K+ ca aldosterone. Verospiron khng nhng lm tng thi tr
Na+ v Cl- v lm gim thi tr K+, m cn c ch thi tr H+ vo nc tiu.
Kt qu ca tc dng trn l verospiron cng lm h huyt p.
DC NG HC
Spironolactone c hp thu nhanh v mnh qua ng tiu ha. Spironolactone lin kt mnh
vi protein huyt tng (khong 90%).
Spironolactone c chuyn ha nhanh. Cht chuyn ha c hot tnh dc l ca n l 7athiomethylspironolactone v canrenone. Cc cht chuyn ha ny c thi tr ch yu qua
nc tiu, mt lng nh thi qua phn. Spironolactone v cc cht chuyn ha ca n vt
qua c hng ro mu - no v bi tit vo sa m.
CH NH
iu tr ngn hn, iu tr trc phu thut trong bnh cng aldosterone tin pht ; iu tr
lu di, nu ngi bnh khng th phu thut hoc t chi phu thut.
Ph do cc nguyn nhn khc nhau. Nn phi hp spironolactone vi cc thuc li tiu khc,
hn ch dng mui v nc v nu cn, phi ngh ngi trn ging.

Ph n, i km suy tim xung huyt, nu ngi bnh khng p ng, hoc nu cc liu php
khc khng c dung np hoc mun c tc dng hip ng vi cc thuc li tiu khc.
Ph v/hay c trng km theo x gan.
Hi chng thn h : nu iu tr bnh gc hay hn ch dng nc v mui, v dng cc thuc
li tiu khc khng t hiu qu mong mun.
Cao huyt p v cn : dng kt hp vi cc thuc chng cao huyt p khc, c bit trong
trng hp gim kali huyt.
Gim kali huyt, nu nhng liu php khc khng th p dng c.
Verospiron cn dng phng nga gim kali huyt ngi bnh iu tr vi digitalis, nu
khng cn kh nng iu tr khc.
CHNG CH NH
V niu, suy thn cp, suy chc nng thn nghim trng (tc lc cu thn < 10 ml/pht),
tng kali huyt, gim natri huyt, mang thai, thi kz cho con b.
Qu mn cm vi bt kz thnh phn no ca thuc.
CH PHNG v THN TRNG LC DNG
Trong trng hp suy thn v tng thong qua chng tng kali huyt, th c th pht trin hm
lng nitrogen trong nc tiu v chng toan huyt chuyn ha tng clorid huyt kh hi.
V th, ngi bnh c ri lon chc nng gan v thn v ngi cao tui, cn phi kim tra
thng xuyn cht in gii trong huyt thanh v chc nng thn.
Verospiron lm xo trn s xc nh digoxin trong huyt thanh, cortisol v epinephrine trong
huyt tng.
Mc du Verospiron khng tc ng trc tip ln chuyn ha carbohydrate, nhng cng phi
dng thuc ny cn thn ngi bnh tiu ng, c bit khi c bnh thn do tiu ng, v
chng tng kali huyt c th xut hin nhng ngi bnh ny.
Khi u iu tr, nn trnh li xe v vn hnh my mc nguy him trong mt thi gian c
xc nh ty theo tng c th. Sau bc s s quyt nh gii hn ny.
Trong khi iu tr, trnh dng cc thc ung c cn.
ng vt, khi dng liu cao gp nhiu ln liu dng cho ngi trong mt thi gian di, ngi
ta thy xut hin ng vt cc khi u v bnh bch cu ty bo, v vy nn trnh dng lu di.
TNG TC THUC
- Salicylate (lm gim tc dng li tiu).
- Cc thuc li tiu khc (tng li tiu).
- Kali v cc thuc li tiu gi kali khc (nguy c tng kali huyt).
- Thuc chng cao huyt p (tng tc dng h huyt p).
- Thuc chng vim khng steroid NSAID (nguy c tng kali huyt).
- Thuc c ch enzyme chuyn dng angiotensin (nguy c tng kali huyt).
- Amoni clorid (tng nguy c toan huyt).

- Flucocortisone (tng thi tr kali mt cch nghch thng).

- Digoxin (tng thi gian bn thi ca digitalis, tng nguy c nhim c digoxin).
- Mitotane (gim tc dng ca mitotane).
- Cc dn xut coumarine (gim tc dng ca cc thuc ny).
- Triptoreline, busereline, gonadoreline (tng tc dng ca cc thuc ny).
TC DNG NGOI
Dng Verospiron lu di c th gy tng kali huyt, gim natri huyt, v to n ng, bt lc
n ng, ri lon kinh nguyt, nhn v n b, thay i ging ni c hai gii.
Him khi ban sn hoc ban , ri lon tiu ha (nn, bun nn, tiu chy, chy mu d dy,
lot d dy, vim d dy), ri lon h thn kinh trung ng (tht iu, bun ng, nhc u),
mt bch cu ht.
Nhng tc dng ngoi { ny thng mt i khi ngng thuc.
LIU LNG v CCH DNG
Cng aldosterone :
Mi ngy c th ung 100-400 mg trc phu thut.
Nu ngi bnh khng thch hp cho phu thut, th tin hnh iu tr duy tr di ngy vi liu
ti thiu c hiu qu c xc nh cho tng c th. Trong trng hp ny, liu khi u c th
gim c mi 14 ngy mt ln cho n khi t liu ti thiu c hiu qu. Trong thi gian iu tr
lu di, tt nht l dng kt hp Verospiron vi cc thuc li tiu khc gim cc tc dng
khng mong mun.
Ph (suy tim sung huyt, x gan, hi chng thn h) :
Ngi ln :
- Liu khi u thng thng l 100 mg/ngy, chia lm hai ln, nhng c th dng t 25-200
mg/ngy.
- Vi liu cao hn, Verospiron nn dng kt hp vi mt thuc li tiu khc, tt nht l vi
thuc li tiu c tc dng ng ln gn. Trong trng hp ny, liu Verospiron vn khng
i.
Tr em : 3,0 mg/kg th trng/ngy, chia lm hai ln, hoc ung lm mt ln.
Cao huyt p :
Liu khi u l 50-100 mg/ngy, chia lm hai ln, v kt hp vi cc thuc chng cao huyt p
khc. iu tr Verospiron lin tc t nht trong 2 tun, bi v hiu qu chng cao huyt p ti a
ch c th t c sau 2 tun iu tr.
Sau iu chnh liu ty tng c th.
Gim kali huyt :
Liu hng ngy thay i t 25-100 mg, nu khng th cung cp K+ c bng ng ung hoc
khng th dng c phng php gi kali khc.
QU LIU

Khng c thuc gii c c hiu. B nc v cht in gii : dng thuc li tiu thi kali, tim
glucose + insulin ; trong cc trng hp trm trng th tin hnh thm phn.
BO QUN
Bo qun nhit 15-30oC

555.

VEYBIROL-TYROTHRICINE

VEYRON FROMENT
c/o MARKETING SANPROMEX
Dung dch sc ming : hp 1 b gm 2 l 10 ml vi np phn liu.
THNH PHN
L 10 ml :
cho 100 ml
Formaldehyde, dung dch 35%

6,16 g

T dc : ethanol 59% th tch/th tch

(chun cn 50% th tch/th tch).
L 10 ml :
cho 100 ml
Tyrothricine

2g

T dc : ethanol 90% th tch/th tch

(chun cn 89% th tch/th tch).
DC LC
Khoa ming (A : h tiu ha v chuyn ha).
iu tr ti ch c tc ng st khun.
CH NH
iu tr h tr ti ch trong cc bnh khoang ming.
CHNG CH NH
Tr em di 6 tui.
C tin s d ng vi formaldehyde hay vi tyrothricine.
CH PHNG v THN TRNG LC DNG
Khng ch nh iu tr ko di do c th lm thay i cn bng h vi khun t nhin ming v
hng.

Trng hp cc triu chng nng thm hay khng thy ci thin sau 10 ngy iu tr v/hay b
st, nn xem xt li vic iu tr.
TNG TC THUC
Nn trnh dng ng thi hay tip theo cc thuc st khun khc do c th xy ra tng tc v
mt tc ng (i khng, mt tc ng...).
LIU LNG v CCH DNG
Sc ming.
Ha 2 liu mi chai vo na ly nc.
Ngi ln : sc ming 3-4 ln/ngy. Ngm trong vi giy.
Tr em 6-12 tui : sc ming 2-3 ln/ngy

556.

VIARTRIL-S

ROTTA
c/o EBEWE - HEALTHCARE PHARMACEUTICAL PRODUCTS LTD.
thuc vin 250 mg : l 80 vin v 500 vin.
bt pha ung 1,5 g : hp 30 gi.
thuc tim : 400 mg/3 ml : ng 3 ml, hp 6 ng.
THNH PHN
cho 1 vin
Glucosamine sulfate tinh th

314 mg

tng ng : Glucosamine sulfate

250 mg

cho 1 gi
Glucosamine sulfate tinh th

1884 mg

tng ng : Glucosamine sulfate

1500 mg

cho 1 ng

Glucosamine sulfate tinh th

502,5 mg

tng ng : Glucosamine sulfate

400 mg

Lidocain

10 mg

DC LC
Dc l :
Glucosamine tham gia qu trnh chuyn ha tng hp nn thnh phn ca sn khp. N l mt
amino-monosaccharide, nguyn liu tng hp proteoglycan, khi vo trong c th n kch
thch t bo sn khp tng tng hp v trng hp nn cu trc proteoglycan bnh thng.
Kt qu ca qu trnh trng hp l muco-polysaccharide, thnh phn c bn cu to nn u
sn khp. Glusamine sulfate ng thi c ch cc enzym ph hy sn khp nh collagenase,
phospholinase A2 v gim cc gc t do superoxide ph hy cc t bo sinh sn. Glucosamine
cn kch thch sinh sn m lin kt ca xng, gim qu trnh mt calci ca xng.
Do glucosamine lm tng sn xut cht nhy dch khp nn tng nht, tng kh nng bi
trn ca dch khp. V th glucosamine khng nhng gim triu chng ca thoi khp (au, kh
vn ng) m cn ngn chn qu trnh thoi ha khp, ngn chn bnh tin trin.
l thuc tc dng vo c ch bnh sinh ca thoi khp, iu tr cc bnh thoi ha xng
khp c cp v mn tnh, c au hay khng c au, ci thin chc nng khp v ngn chn
bnh tin trin, phc hi cu trc sn khp.
CH NH
Tt c cc bnh thoi ha xng khp, thoi khp nguyn pht v th pht nh thoi khp gi,
hng tay, ct sng, vai, vim quanh khp, long xng, gy xng teo khp, vim khp mn v
cp.
CHNG CH NH
D ng vi glucosamine sulfate.
THN TRNG LC DNG
Viartril-S khng gy ri lon d dy rut nn c th iu tr lu di. iu tr nn nhc li 6 thng
hoc ngn hn ty theo tnh trng bnh.
Thuc dng trong thi kz c thai cn thn trng v theo di ca bc s.
Viartril-S l thuc iu tr nguyn nhn nn tc dng ca thuc c th bt u sau 1 tun, v vy
nu au nhiu c th dng thuc gim au chng vim trong nhng ngy u.
TC DNG NGOI

Him gp, nhn chung rt nh, thong qua.

LIU LNG v CCH DNG
Hi chng thoi khp nh v trung bnh : 2 vin hoc 1 gi (ha vi 1 cc nc) 1 ln/24 gi
trong vng 4-12 tun hoc lu hn ty tnh trng bnh, c th nhc li 2-3 ln 1 nm.
Bnh nng : iu tr ban u trong vng 8 tun vi 1 ng Viartril-S hng ngy v 2 vin 2 ln
hng ngy trong vng 2 tun u, sau duy tr 2 vin 2 ln/ngy trong 6 tun tip theo. Nu
khng dng c ng tim th 3 vin/ngy trong 8 tun.
iu tr duy tr : trong vng 3-4 thng sau : 2 vin 2 ln/ngy. Ung thuc 15 pht trc ba n.

557.

VINCARUTINE

LABOMED - SERP
c/o GALIEN
vin nang : hp 45 vin.
THNH PHN
cho 1 vin
Vincamine

20 mg

Rutoside

40 mg

DC LC
Vincarutine c tc ng trn s chuyn ha ca t bo thn kinh do lm tng sc tiu th oxy
v gim t l lactate/pyruvate.
Ngoi ra cn lm tng lu lng mu v cc ni b thiu mu cc b.
Cc c tnh ny c xc nhn ngi v c a vo cc y vn.
Rutoside c tc ng bo v thnh mch mu.
DC NG HC
Thuc c hp thu nhanh v t nng ti a trong mu sau 2 gi. Thuc c o thi qua
thn gm 5 cht chuyn ha v vicamine khng b bin i.
CH NH
c ngh ci thin cc triu chng suy gim tr tu do bnh l ngi gi (gim kh
nng ch { v tr nh).
CHNG CH NH
Tn sinh m no vi tng p lc ni s.
Phi hp vi thuc chng lon nhp hoc gy xon nh (xem Tng tc thuc).
CH PHNG v THN TRNG LC DNG

Trong di chng ca nhi mu c tim v trong cc ri lon thc th ca nhp tim, liu phi c
tng t t v trong thi gian iu tr phi theo di in tm .
Khi ngi bnh, tnh hng phn thay i do gim kali huyt, ch nn bt u iu tr sau khi
n nh tr li kali huyt.
Vincamine khng c tc dng h huyt p lu di v khng min tr cho mt iu tr c hiu
cao huyt p.
TNG TC THUC
Chng ch nh phi hp :
- Cc thuc gy xon nh (amiodarone, bbridil, brtylium, disopyramide, rythromycine
ng tnh mch, nhm quinidine, sotalol, sultopride) : tng nguy c gy xon nh.
Khng nn phi hp :
- Cc thuc gy h kali huyt : amphot ricine B (ng tnh mch), gluco-, minralocorticoide
(ng ton thn), ttracosactide, thuc li tiu h kali huyt, thuc nhun trng kch thch :
nguy c gy xon nh (h kali huyt l mt yu t to thun li, cng nh nu bnh nhn ang
b chm nhp tim hay QT di).
i vi amphotricine B, thuc li tiu, corticoide v ttracosactide : d phng h kali huyt v
iu chnh nu cn ; theo di QT ; trng hp b xon nh, khng dng thuc chng lon nhp
(gy in tm thu).
i vi cc thuc nhun trng kch thch : thay bng nhm thuc nhun trng khng kch
thch.
- Cc thuc gy xon nh (astmizole, halofandrine, pentamidine, sparfloxacine, terfnadine) :
tng nguy c gy xon nh. Nu cn thit phi phi hp, nn tng cng theo di lm sng v
in tm .
LIU LNG v CCH DNG
Liu thng dng l mi ln 1 vin, 3 ln/ngy vo mi ba n.

558.

VINCRISTIN RICHTER

GEDEON RICHTER
bt pha tim 1 mg : hp 10 l bt ng kh + 10 ng dung mi 10 ml - Bng A.
THNH PHN
cho 1 l thuc tim
Vincristine sulfate

1 mg

ng dung mi pha tim : dung dch NaCl 0,9%

10 ml

DC LC
Vincristine l alcaloid ngun gc thc vt (cy da cn). N ngn chn nhng c th phc hi
c s phn chia gin phn giai on trung kz. Nh s lin kt ca thuc vi cc vi cu trc
hnh ng khi gin phn, Vincristine c ch c s to thnh thoi gin phn. Trong t bo ung
th, Vincristine c ch mt cch chn lc c ch sa i ADN ; v bng cch c ch ARNpolymerase ph thuc ADN, Vincristine c ch c s tng hp ARN.
CH NH
Bnh bch cu nguyn bo lymph cp, bnh Hodgkin, tt c cc dng m bnh hc in hnh
v cc giai on lm sng ca bnh lymph khng-Hodgkin, sarcm c vn, sarcm Ewing,
bu nguyn bo thn kinh, bu Wilms. Phn ln cc bu rn trng thnh, khi phi hp
vi thuc khc km t bo.
CHNG CH NH
Qu mn cm vi hot cht v vi cc thnh phn khc ca ch phm, suy ty, bnh thn kinh,
nhim vi khun v virus.
CH PHNG v THN TRNG LC DNG
Ni chung, c th dng cho ngi mang thai, nhng phi lu { nh vi cc thuc km t bo
khc. Thy thuc nn cn nhc gia li v hi ca vic dng thuc.
Trong qu trnh dng thuc, khng c cho con b.
C th dng thuc mt cch rt thn trng khi dng ng thi hoc dng trc cc thuc
km t bo hoc x tr, vi ngi cao tui, trong trng hp gim bch cu, gim tiu cu v suy
gan.
Nn kim tra cng thc mu thng xuyn, nu s lng bch cu xung di 3000, th ngng
iu tr v dng khng sinh d phng.
Dng Vincristine c th dn n s pht trin ca bnh thn acid uric cp tnh (v th mc acid
uric trong huyt thanh nn c kim tra thng xuyn, cng nh nn dng nc v cc thuc
li tiu y , nn dng cht c ch men xanthine-oxydase (nh Allopurinol).
Tim ngoi tnh mch c th gy au ti ch v hoi t. Nn ngng tim ngay lp tc, phn cn
li ca liu thuc nn tim vo tnh mch khc. Tim ti ch hyaluronidase gim nhng kh
chu ny.
Nn s dng phng php trnh thai khng hormon trong thi gian iu tr.
TNG TC THUC
Chng ch nh phi hp :
Thuc ny cm dng ng thi vi cc thuc c thn kinh (nh asparaginase, isoniazide...).
Thn trng khi phi hp :
- Mitomycin-C (c th xut hin kh th cp v co tht ph qun).
- Phenytoin (nng trong huyt thanh ca phenytoin c th gim, do c th tng nguy c

co git).
TC DNG NGOI
Ph bin nht : c thn kinh (th hin r rng trong cc chc nng cm gic, vn ng, hoc
thn kinh thc vt, tng acid uric huyt, bnh thn tng acid uric huyt, rng tc).
t ph bin hn : c h thn kinh trung ng, gim natri huyt, hi chng do tit hormon
khng niu khng thch hp, to bn, st cn, bun nn, nn, ni m ay.
Him : gim bch cu, gim tiu cu, vim ming.
Sau khi kt hp ha tr liu vi Vincristine, c th xut hin v kinh v v tinh trng.
Ngng thuc nu c triu chng c thn kinh.
LIU LNG v CCH DNG
Thuc ny ch dng tim tnh mch (ch trnh tim ra ngoi mch), nu tim trong mng cng
s gy nguy him n tnh mng.
Cn c bit thn trng khi tnh ton liu dng chnh xc cho tng c th, ty theo tnh trng
lm sng ca ngi bnh.
Ngi ln :
Theo nguyn tc, c th dng 1,0-1,4 mg (nhiu nht l 2 mg)/m2 din tch b mt c th cho
mt liu n, mi tun dng mt ln. Tng liu khng c vt qu 10-12 mg/m2 trong mt
t iu tr.
Tr em :
C th dng 1,5 mg/m2 din tch b mt c th cho mt liu n, mi tun dng mt ln.
Thi gian iu tr l 4-6 tun.
Nu c ri lon chc nng gan, nn dng liu thp hn.
Pha hot cht ng kh trong l vi ng dung mi km theo. Sau pha long vi nc mui
sinh l, dung dch Vincristine va pha ny c th c tim tnh mch hoc truyn dch, trong
vng 1 pht.
QU LIU
iu tr h tr bao gm vic dng thuc chng co git (phenobarbital), tht ra ( chng tc
rut), kim tra thng xuyn chc nng tim mch v kim sot cng thc mu ca ngi bnh.
BO QUN
Trnh nh sng, gi trong t lnh (2-8oC).

559.

VISINE ORIGINAL

PFIZER
c/o ZUELLIG
Thuc nh mt 0,05% : l 15 ml.
THNH PHN

cho 100 ml
Tetrahydrozolin hydrochloride

0,05 g

DC LC
Visine l tn thng mi ca tetrahydrozolin hydrochloride, l dung dch m, v khun, ng
trng, dng nh mt cha tetrahydrozolin HCl 0,05%, boric acid, sodium borate, sodium
chloride v nc. Cht bo qun l benzalkonium chloride 0,01% v edetate sodium 0,1%.
Visine c tc dng giao cm chng sung huyt do tc ng co mch. Visine s lm ht mt
nhanh chng do lm co cc mch mu nh hn ch phn ng mch mu ti ch. Tc dng co
mch bt u xut hin trong vng vi pht v ko di. Visine khng gy ra tnh trng n ng
t hay sung huyt phn ng nh cc thuc co mch khc.
CH NH
Visine l dung dch nh mt chng sung huyt kt mc, lm gim triu chng ca ph kt mc
v sung huyt th pht do d ng v cc kch thch nh do bi, khi, sng khi, li xe ban m,
c sch, xem ti-vi nhiu ; do nc, gi, nh nng chi chang hay do eo knh st trng.
CHNG CH NH
Khng nn s dng Visine nhng bnh nhn b tng nhn p tr khi bc s ch nh v theo
di.
CH PHNG v THN TRNG LC DNG
Ch nn s dng Visine cho nhng kch thch nh mt. Nu thy cc triu chng kch thch hay
mt vn cn hay tng thm sau 72 gi, hy ngng s dng v i khm bc s. Trong nhng
trng hp kch thch mt hay mt do nhng tnh trng trm trng mt nh nhim khun,
vt l trong mt, hay chn thng gic mc do ha cht cn thit phi i khm bc s. Nu au
mt trm trng, nhc u, thay i th gic nhanh, xut hin t ngt cc vt di ng, mt
cp, au mt khi tip xc vi nh sng, hay b nhn i, nn i khm bc s.
TC DNG NGOI
Dng qu nhiu thuc ny c th lm gia tng chng mt.
LIU LNG v CCH DNG
Nh mt hoc hai git vo mi mt n 4 ln mi ngy. trnh ly nhim l thuc, khng
c chm u l vo mi b mt khc. y np sau khi s dng. Tho knh st trng trc khi
s dng. thuc trnh xa tm tay tr em.

560.

VITABACT

CIBA VISION OPHTHALMICS

c/o KENI - OCA

thuc nh mt : l 10 ml.
THNH PHN
cho 1 l
Picloxydine dichlorhydrate

5 mg

DC LC
Picloxydine l mt cht st khun c tc ng km khun ph rng.
CH NH
Thuc nh mt st trng, c dng trong iu tr mt s bnh nhim mt, k c mt ht.
CHNG CH NH
C tin s d ng vi thuc.
CH PHNG v THN TRNG LC DNG
Thi gian iu tr thng khng qu 10 ngy. Qu thi gian ny cn phi nh gi li vic tr
liu.
KHNG DUNG NP THUC
X phng, cc cht din hot anionic.
TC DNG NGOI
C th xy ra phn ng khng dung np ti ch (kch ng hay c cm gic kh chu).
LIU LNG v CCH DNG
Mi ln nh 1 git, 2-6 ln/ngy.
BO QUN
Sau khi m np : 15 ngy.

561.

VITACIC

CIBA VISION OPHTHALMICS

c/o KENI - OCA
thuc nh mt : l 5 ml.
THNH PHN
cho 1 l
Adnosine

10 mg

Thymidine

10 mg

Cytidine

30 mg

Uridine

35 mg

Guanilate 5' disodique

60 mg

DC LC
Thuc c s dng mt, c tc dng gip mau lin so (S : c quan cm gic).
CH NH
c dng trong iu tr vim gic mc, vt thng v phng gic mc, lot chn thng v
trong trng hp do mang knh st trng, sau phu thut to hnh gic mc.
CHNG CH NH
Qu mn cm vi mt trong cc thnh phn ca thuc.
CH PHNG v THN TRNG LC DNG
- Khng c dng thuc nh mt tim xung quanh hoc trong mt.
- Nn trnh mang cc trng knh tip xc mm (loi thn nc) trong thi gian iu tr v cc
trng ny c th hp ph cht bo qun c trong thnh phn ca thuc nh mt
(mercurothiolate sodique).
- Trng hp cc triu chng nng ln, cn phi xem xt li vic tr liu.
- Nu iu tr ng thi vi mt thuc nh mt loi khc, nn nh cc loi thuc cch nhau t
nht 15 pht.
TNG TC THUC
Hiu lc ca thuc nh mt c th b nh hng nu nh cng lc vi mt thuc nh mt loi
khc.
LIU LNG v CCH DNG
Liu lng :
Mi ln nh 1 hoc 2 git, 3-6 ln/ngy.
Cch dng :
Nh 1 git Vitacic vo trong ti kt mc pha di ca bn mt (hoc 2 mt) b bnh, khi nh
mt phi nhn hng ln trn v dng tay ko nh mi mt pha di v pha di.
Khng phn u ca l thuc chm vo mt hay mi mt.
y np li sau mi ln s dng.
BO QUN
Sau khi m np : 15 ngy.

562.

VITAMINE D3 BON

DOMS-RECORDATI
c/o MARKETING SANPROMEX

dung dch du, chch hoc ung : hp 1 ng 1 ml.

THNH PHN
cho 1 ng 1 ml
Colcalcifrol (vitamine D3)
200.000 UI

5 mg

(Du olive trung ha v v trng)

DC LC
Chng ci xng, tng s hp thu calci rut, tc dng ln s bin dng v hp thu
phosphocalci ca xng.
DC NG HC
Vitamine D3 c hp thu rut non, tch ly gan, c o thi ch yu qua ng mt
mt phn nh.
CH NH
Ci xng.
Chng co git, co git do thiu calci.
Bnh nhuyn xng.
CHNG CH NH
Nhng bnh km hi chng tng calci trong mu, tng calci trong nc tiu, si calci, qu mn
vi vitamine D, nhng bnh nhn nm bt ng (i vi liu cao).
CH PHNG v THN TRNG LC DNG
Trnh qu liu, c bit tr em, khng dng qu 10-15 mg/nm.
Trong nhng ch nh liu cao v ko di, phi thng xuyn theo di lng calci trong mu,
nc tiu trnh trng hp qu liu.
LC C THAI
Khng nn ch nh liu cao cho ph n c thai.
LIU LNG v CCH DNG
Thuc dng du, dng ng tim bp. Tuy nhin i vi tr nh nhi v ngi ln khng dung
np vi thuc chch dng du, c th dng thuc bng ng ung.
Ci xng : phng bnh ci xng phi c tin hnh sm v lin tc n ht 5 tui. Mi 6
thng dng 1 liu 5 mg (200.000 UI), liu dng s l 10 mg (400.000 UI) nu tr t ra nng hoc
da sm mu.
Liu iu tr : 1 ng mi tun, trong 2 tun.
Tng co git, co git do thiu calci : iu tr bng vitamine D ging nh liu c ch nh

nga ci xng v cn kt hp vi mui calci.

Nhuyn xng : c 15 ngy dng 1 ng, trong vng 3 thng.
QU LIU
- Triu chng lm sng : bing n, kht nc, tiu nhiu, to bn, cao huyt p.
- Triu chng cn lm sng : tng calci huyt, tng calci niu, ri lon quan trng cc chc nng
thn.

563.

VITREOLENT

NOVARTIS OPHTHALMICS
Thuc nh mt : l nh git 10 ml.
THNH PHN
cho 1 ml
Potassium iodide

3 mg

Sodium iodide

3 mg

(Chlorhexidine acetate)

(0,1 mg)

(Methylhydroxypropylcellulose)

DC LC
Iodide dng ton thn hay ti ch u lm tng chuyn ha trong pha l th v c th lm trong
pha l th b vn c.
Hiu qu ca iodide i vi c thy tinh th lo suy giai on sm cha c xc nh. Tuy
nhin, iodide c kh nng lm chm tin trin c thy tinh th v n nh th lc.
DC NG HC
Ti ch :
Potassium iodide khuch tn nhanh vo pha l th (th nghim trn mt th). Trong vng 60
pht sau khi nh, nng potassium iodide trong thy dch l 0,25 mmol/ml. 6,4% lng iodide
c tm thy trong thy tinh th, v 3,7% trong pha l th.
Ton thn :
Hp thu ton thn sau khi nh mt cha c nghin cu.
CH NH
- Vn c pha l th.
- Xut huyt pha l th do bt c nguyn nhn g (ngi gi, cn th, tiu ng, vim quanh

tnh mch).
- c thy tinh th bt u v tin trin.
CHNG CH NH
- Nhy cm vi iodine.
- Nhy cm vi cc thnh phn ca thuc.
- Ri lon chc nng tuyn gip hay bu nhn gip trng.
THN TRNG LC DNG
Nu c dng knh tip xc, nn nh thuc vo nhng lc khng mang knh. C th mang knh
tip xc li sau t nht 30 pht. gim thiu hp thu ton thn, bnh nhn nn n nh
vng ti l t 1-2 pht sau khi nh thuc.
LC C THAI v LC NUI CON B
Cha c nghin cu i chng trn ng vt hay ph n mang thai. Do , ch nn dng thuc
cho i tng ny khi cc li ch do thuc mang li nhiu hn nguy c cho thai. Cha c nghin
cu v vic dng Vitreolent i vi ph n cho con b.
TC DNG NGOI
Ti ch :
Cm gic xt nh thong qua sau khi nh thuc.
Him gp : tng tit nc mt.
Ton thn :
Vitreolent cha iodide nn c th gy cng gip v ni mn kiu trng c nhng bnh nhn
c yu t thun li.
LIU LNG v CCH DNG
Nh mt 1-3 ln mi ngy, mi ln 1 git.
BO QUN
ng np li sau mi ln nh thuc. Mi chai thuc m ch nn dng trong thi gian 1 thng.
Ch nn dng thuc khi cn thi hn s dng c ghi trn hp thuc.

564.

VOLTAMICIN

NOVARTIS OPHTHALMICS
Thuc nh mt : l 5 ml.
THNH PHN
cho 1 ml
Diclofenac sodium

1,0 mg

Gentamicin sulfate, tnh theo gentamicin

3,0 mg

Cht bo qun : Benzalkonium chloride

0,1 mg

DC LC
Voltamicin l s kt hp gia diclofenac, mt cht c tnh khng vim, gim au non-steroid vi
gentamicin, mt khng sinh nhm aminoglycoside. Hai hot cht ny c dng iu tr ti ch
cho mt vi tc dng ring bit :
Diclofenac :
Diclofenac c ch men cyclo-oxygenase v t c ch qu trnh tng hp prostaglandin ngay
t giai on u tin. Diclofenac cng nh hng ti s sn xut leukotrienes thng qua phn
ng lipoxygenase. Prostaglandin v leukotrienes ng vai tr quan trng trong c ch bnh sinh
ca phn ng vim v au mt.
Gentamicin :
Gentamicin l mt khng sinh dit khun thuc nhm aminoglycoside. Ph khng khun ca
gentamicin bao gm cc vi khun a kh gram m, gram dng k c Pseudomonas aeruginosa,
Staphylococci, Haemophilus influenzae v aegyptus, Klebsiella, Enterobacter, Proteus,
Escherichia coli, Shigella v Salmonella.
Cc vi khun h Streptococci, Meningococci, cc vi khun k kh, nm v virus ni chung l
khng vi gentamicin.
Phn ln cc vi khun gy nn nhim trng phn trc ca mt p ng tt i vi gentamicin
dng ti ch. Tc dng ca gentamicin thng qua s tng hp protein ca cc vi khun nhy
cm. Trn in vitro, ph khng khun ca gentamicin c m t nh sau :
(MIC < 4 mg/ml : nhy cm ; 4-8 mg/ml : nhy cm trung bnh ; > 8 mg/ml : khng)
Vi khun gram dng

MIC90 (mg/ml) Vi khun gram m

MIC90 (mg/ml)

Staph. aureus

Haemophilus infl.

3,4

Staph. epidermidis

32

Neisseria gonorrh.

thay i

Other Staph. ssp.

E. coli

0,5

Strep. pneumoniae

Enterobacter

0,5

Strep. pyogenes

Klebsiella

0,25

Strep. faecalis

16

K. pneumoniae

64

a-, b-haemolytic Strep.

Listeria monocyg.

resistant

0,5

Serratia marcescens

> 128

Shigella

P. aeruginosa

Salmonella ssp.

0,25-1

Proteus

S kt hp :
S kt hp gia diclofenac v gentamicin to nn ph khng khun chng li cc vi khun gram
m, gram dng tng ng vi ph khng khun ca gentamicin khi dng n thun.
Cc nghin cu trn ng vt cho thy s kt hp gia diclofenac v gentamicin c hiu qu tt
hn nhiu so vi dng gentamicin n thun i vi vim kt mc cng nh lin gic mc sau
p-xe.
DC NG HC
ng vt, nng c tc dng iu tr ca diclofenac v gentamicin c xc nh phn
trc mt, kt mc v gic mc khi dng nhc li Voltamicin (1 git/ln x 4 ln/ngy). Nng
ti a t c trong vng 5-60 pht. Nng gn vi mc ti thiu cn c th pht hin c
tm thy trong mu v huyt tng.
Sau phu thut ly thy tinh th c, nng diclofenac trong thy dch cng c xc
nh. Cc kt qu cho thy diclofenac cng thm qua gic mc. Nngh ti a trong thy dch
khong 201+/-116 ng/ml o c 60 pht sau khi dng thuc ln cui cng. S ngm thuc ny
c coi l tng ng so vi khi dng diclofenac m khng c gentamicin.
CH NH
Cc trng hp vim phn trc ca mt c nguy c gy nhim khun nhn cu (v d nh sau
m).
CHNG CH NH
- Nhim nm, virus.
- Chn thng, lo t gic mc.
- Ging nh cc thuc khng vim non-steroid khc, khng c dng Voltamicin cho cc bnh
nhn hen, m ay hay vim mi cp tnh sau khi ung acetylsalicylic acid hay bt kz thuc no
c ch s tng hp prostaglandin.
THN TRNG LC DNG
Vi nng cao, gentamicin c th lm chm qu trnh hi phc biu m gic mc. Trong cc
trng hp m cn phi iu tr thm ti mt, th nn dng cc thuc cch nhau t nht l 5
pht (xem phn Tng tc thuc).

Khi c bi nhim, cn phi ngng iu tr ngay iu tr Voltamicin v cn phi iu tr vi khng

sinh khc.
Sau khi nh mt c th thy m mt. V vy, cn thn trng trong trng hp phi li xe hay
vn hnh my ngay sau khi nh thuc.
Lu { vi bnh nhn eo knh tip xc :
Ni chung khng nn eo knh tip xc khi c nhim khun mt v nguy c lan rng nhim
khun. Nu thc t bt buc cn phi eo knh tip xc th nn b knh ra trc khi nh thuc
v eo li sau t nht l 5 pht.
LC C THAI v LC NUI CON B
Lc c thai :
3 thng u v 3 thng gia : loi B.
Cc nghin cu trn ng vt cho thy khng c nguy c cho bo thai nhng cha c nghin
cu kim chng trn ph n c thai.
3 thng cui : Thai kz loi D.
Khng nn dng diclofenac v c th c nguy c ng sm ng ng mch (ng Botal) hay c
ch co hi t cung.
Lc nui con b :
Cha r gentamicin c bi tit qua sa m hay khng, cho nn khng dng Voltamicin cho b
m trong thi kz cho con b. Diclofenac ch bi tit qua sa m vi mt lng ng k ch khi
dng liu cao gp nhiu ln lng hot cht c cha trong l thuc a liu.
TNG TC THUC
Trnh dng phi hp cng lc vi cc khng sinh km khun. Khi cn dng nhiu loi thuc dng
ti ch cho mt, nn dng cc thuc cch nhau 5 pht.
TC DNG NGOI
C th xy ra kt mc c hoc khng c cht tit ging nh vim gic mc chm nng. Cm
gic xt nh i khi xy ra khi nh mt trc tip vi Voltamicin.
Rt him khi xy ra phn ng qu mn.
LIU LNG v CCH DNG
Ngi ln v bnh nhn ln tui :
Nh thuc vo ti kt mc 1 git/ln x 4 ln/ngy trong vng 2 tun. Khng nn dng thuc qu
2 tun. Thuc cha c kim nghim i vi tr em.
QU LIU
ngi ln, khi v tnh ung c l thuc th c th thy nng ti a ca diclofenac cng ch
bng 3% liu diclofenac hng ngy dng ng ung. Cn lng gentamicin 15 mg c cha
trong l thuc Voltamicin 5 ml gn xp x bng liu khi im cao nht khi dng ng ung (56 mg/kg).
Tuy nhin, cng ging nh cc khng sinh nhm aminoglycoside khc, gentamicin rt kh hp

thu t ng tiu ha.

BO QUN
ng np l thuc sau khi dng. Khng dng thuc qu mt thng sau khi m np. Bo qun
nhit phng (15-25oC). Khi cha m np, thuc c th c dng ti hn ghi trn v hp.
thuc ngoi tm tay tr em.

565.

VOLTAREN

NOVARTIS
Vin tan trong rut 25 mg : hp 10 vin, 1000 vin.
Vin tan trong rut 50 mg : hp 100 vin, 500 vin.
Vin phng thch chm 75 mg : hp 100 vin.
Vin phng thch chm 100 mg : hp 30 vin.
Dung dch tim bp 75 mg/3 ml : hp 50 ng thuc 3 ml.
THNH PHN
cho 1 vin
Diclofenac sodium

25 mg

(Lactose, saccharose)

cho 1 vin
Diclofenac sodium

50 mg

(Lactose, saccharose)

cho 1 vin phng thch chm

Diclofenac sodium
(Saccharose)

cho 1 vin phng thch chm

75 mg

Diclofenac sodium

100 mg

(Saccharose)

cho 1 ng thuc
Diclofenac sodium

75 mg

(Alcool benzylique, sulfite)

DC LC
Voltaren cha mui natri diclofenac l mt cht khng steroid c tc dng chng thp khp,
gim au, chng vim v h nhit.
Qua cc th nghim, ngi ta thy rng c ch tc dng ch yu ca diclofenac l gy c ch
qu trnh sinh tng hp prostaglandine. Prostaglandine ng vai tr chnh trong vic gy vim
nhim, au v st.
Trong bnh thp khp, cc c tnh chng vim, gim au ca Voltaren c chng minh
qua cc th nghim lm sng, thuc c tc dng gim au trong cc triu chng nh : au khi
ngh, au khi di chuyn, co cng vo bui sng, hay trng hp sng ty cc khp, cng nh ci
thin cc chc nng ca khp.
Trong vim sau chn thng v sau phu thut, Voltaren lm gim nhanh cc cn au t pht
hay khi vn ng, v gim sng do vim v chn thng.
Khi dng chung vi phin trong gim au sau m, Voltaren lm gim ng k nhu cu s dng
phin.
Cc kho st lm sng cng cho thy rng thuc c tc ng gim au tt trong cc cn au
va phi v nng, khng do thp khp. Nghin cu lm sng cng cho thy tc dng tt trn
au bng kinh nguyn pht. Ngoi ra, Voltaren cng chng t c tc dng tt iu tr cc cn
au na u. Thuc tim Voltaren c bit thch hp cho vic iu tr ban u cc bnh thp
khp do vim v thoi ha, cng nh trong cc tnh trng vim au c ngun gc khng do
thp khp.
nhng nng tng ng nng t ngi, in vitro, Voltaren khng c ch qu trnh
sinh tng hp proteoglycan trong sn.
Voltaren phng thch chm SR 75 v 100 lm gim s ln ung thuc trong ngy, ci thin vic
tun th liu iu tr ca bnh nhn.
Voltaren Emulgel l mt thuc chng vim v gim au c hiu qu, c s dng ngoi da.
Thuc c thnh phn hot cht tng ng vi 1% diclofnac sodique. Dng bo ch tng

t nh mt cht kem mu trng, khng gy nhn. Thuc thm nhanh qua da, ngoi ra cn lm
du nh vo thnh phn t dc c nc v alcool.
DC NG HC
Hp thu
Dng ung :
Diclofenac dng vin bao tan trong rut c hp thu nhanh v hon ton.
Diclofenac dng vin phng thch chm c hp thu hon ton. Do hot cht c phng
thch chm nn nng ti a trong huyt tng thp hn so vi liu lng dng nhng nng
diclofenac huyt tng c th duy tr trong nhiu gi sau khi ung.
S hp thu thuc xy ra chm hn nu ung Voltaren trong ba n hay sau ba n so vi ung
lc i nhng khng nh hng g n lng hot cht hp thu.
Dng tim :
Nng ti a trong huyt tng trung bnh l 2,5 mg/ml (8 mmol/l) t c khong 20 pht
sau khi tim bp 75 mg diclofenac. Nng trong huyt tng c lin quan tuyn tnh vi liu
dng.
Phn phi
Dng ung :
Nng ti a trong huyt tng trung bnh l 1,5 mg/ml (5 mmol/l), t c khong 2 gi
sau khi ung vin bao 50 mg. Cc nng trong huyt tng c lin quan tuyn tnh vi liu
dng.
Nng trung bnh trong huyt tng ln lt l 0,4 mg/ml (1,25 mmol/l) hay 0,43 g/ml (1,35
mol) t c trung bnh khong 5 gi sau khi ung 1 vin Voltaren SR 75 mg hay 1 vin
Voltaren SR 100 mg
Nng trong huyt tng o c tr em nhn liu tng ng (tnh theo mg/kg th
trng) tng t cc gi tr o c ngi ln.
Dc ng hc ca thuc khng b bin i khi dng cc liu lp li. Khng c hin tng lch
ly thuc nu tun theo khong cch dng thuc.
Diclofenac lin kt vi protein huyt tng 99,7%, ch yu l vi albumin (99,4%).
Diclofenac i vo hot dch v c nng ti a t 2-4 gi sau khi t nng ti a trong
huyt tng. Thi gian bn hy hot dch l 3-6 gi. iu ny c ngha l nng hot cht
trong hot dch cao hn nng trong huyt tng sau t 4-6 gi dng thuc, v chng tn
ti cho n 12 gi.
Dng tim :
Sau khi tim, din tch di ng cong nng khong gp i so vi din tch ghi nhn sau
khi dng ng ung hoc ng trc trng vi liu tng t do khi dng nhng ng ny,
phn na hot cht phi chu s chuyn ha khi qua gan ln u.
99,7% diclofenac lin kt vi protein huyt tng, ch yu l vi albumin (99,4%).

Dc ng hc khng thay i khi dng nhng liu lp li.

Khng tch t trong huyt tng sau khi dng nhiu liu nu tun theo khong cch dng
thuc. Diclofenac i vo hot dch v c nng ti a t 2-4 gi sau khi t nng ti a
trong huyt tng.
Chuyn ha
Dng ung :
Khong mt na hot cht c chuyn ha giai on th nht qua gan, iu c ngha
rng din tch di ng cong nng ch bng mt na khi ung hay dng thuc qua ng
trc trng so vi ng tim vi cng liu.
S chuyn ha sinh hc mt phn do s glucuronic ha ca phn t nguyn vn, nhng ch
yu do s glucuronic ha sau khi hydroxyl ha mt hay nhiu ln.
Dng tim :
S chuyn ha sinh hc mt phn do s glucuronic ha ca phn t nguyn vn, nhng ch
yu do s glucuronic ha sau khi hydroxyl ha mt hay nhiu ln.
Thi tr
Dng ung :
Hot cht c thi tr khi huyt tng vi h s thanh thi ton thn l 263 +/- 56 ml/pht.
Thi gian bn hy cui l 1-2 gi.
Khong 60% liu dng c bi tit qua thn di dng cc cht chuyn ha, di 1% c bi
tit di dng cha chuyn ha. Phn cn li c thi tr di dng cc cht chuyn ha qua
mt theo ng phn.
Dng tim :
Hot cht c thi tr khi huyt tng vi h s thanh thi ton thn l 263 +/- 56 ml/pht.
Thi gian bn hy cui l 1-2 gi.
Khong 60% liu dng c bi tit qua thn di dng cc cht chuyn ha, di 1% c bi
tit di dng cha chuyn ha. Phn cn li c thi tr di dng cc cht chuyn ha qua
mt theo ng phn.
Thi gian bn hy hot dch l 3-6 gi. iu ny c ngha l nng hot cht trong hot dch
cao hn nng trong huyt tng sau t 4-6 gi dng thuc, v chng tn ti cho n 12
gi.
ng hc trong nhng trng hp lm sng c bit :
Ngi ta thy rng khng c s khc nhau ca la tui v mc hp thu, chuyn ha hay thi
tr ca thuc.
bnh nhn suy thn, khng c s tch ly hot cht cha b chuyn ha khi dng liu n vi
phc bnh thng. Vi h s thanh thi < 10 ml/pht th nng trong huyt tng ca cc
cht chuyn ha theo l thuyt th cao gp 4 ln so vi bnh nhn c chc nng thn bnh
thng. Mc du vy, cui cng cc cht chuyn ha vn b thi tr qua mt.

 bnh nhn suy gan (vim gan mn tnh, x gan khng mt b) th ng hc v chuyn ha
diclofenac tng t nh bnh nhn khng b cc bnh v gan.
CH NH
iu tr di hn cc triu chng trong :
- vim thp khp mn tnh, nht l vim a khp dng thp, vim xng khp v vim cng
khp ct sng hay trong nhng hi chng lin kt nh hi chng Fiessiger-Leroy-Reiter v thp
khp trong bnh vy nn.
- bnh cng khp gy au v tn ph.
iu tr triu chng ngn hn cc cn cp tnh ca :
- bnh thp khp v tn thng cp tnh sau chn thng ca h vn ng nh vim quanh
khp vai cng tay, vim gn, vim bao hot dch, vim mng hot dch, vim gn bao hot dch.
- vim khp vi tinh th.
- bnh khp.
- au tht lng, au r thn kinh nng.
- cn thng phong cp tnh.
Hi chng au ct sng. Bnh thp ngoi khp.
Gim au sau m.
Cn migrain.
Cn au qun thn, qun mt.
Gim au sau phu thut hoc chn thng nh phu thut nha khoa hay chnh hnh.
Cc tnh trng au v/hoc vim trong ph khoa, nh au bng kinh hay vim phn ph. L
thuc h tr trong bnh vim nhim tai, mi, hng, nh vim hng amian, vim tai. Theo
nguyn tc tr liu chung, nn p dng nhng bin php thch hp iu tr bnh gc. St n
thun khng phi l mt ch nh iu tr.
CHNG CH NH
Lot d dy, qu mn cm vi hot cht. Ging nh vi tt c cc thuc khng vim khng
steroid khc, chng ch nh Voltaren cho bnh nhn bit l b hen ph qun, ni m ay,
vim mi cp khi dng acid acetylsalicylic hoc cc cht c ch tng hp prostaglandine khc.
THN TRNG LC DNG
Ch dng Voltaren khi c ch nh v phi c theo di y khoa cht ch nhng bnh nhn c
triu chng ri lon tiu ha, c tin s lot d dy, vim lot kt trng, bnh Crohn v bnh
nhn b ri lon chc nng gan.
Chy mu hay lot/thng d dy thng gy hu qu nng c bit ngi gi, c th xy ra
bt c lc no trong thi gian iu tr, v khng cn phi c cc du hiu bo trc hay c tin
s. Mt s him trng hp xy ra lot hay xut huyt tiu ha trong thi gian iu tr bng
Voltaren, cn phi ngng thuc. Do tnh cht quan trng ca prostaglandine trong vic duy tr
s ti mu thn, cn phi c bit thn trng khi dng Voltaren bnh nhn b tn thng

chc nng tim hoc thn, ngi gi, bnh nhn ang dng thuc li tiu v bnh nhn b gim
th tch dch ngoi bo cho d do nguyn nhn g, v d trong giai on phu thut hoc sau cc
phu thut ln. Do cn phi thn trng theo di chc nng thn trong cc trng hp ny.
Bnh thng th sau khi ngng iu tr th tnh trng s n nh li nh trc.
Cng theo nhng nguyn tc chung, cn phi thn trng khi dng cho nhng ngi cao tui.
c bit nn khuyn co dng liu ti thiu hu hiu cho ngi ln tui v yu t hoc nh
cn.
Nh vi tt c cc thuc khng vim khng stroide, Voltaren c th gy tng mt hoc nhiu
men gan. Do nn thn trng kim tra chc nng gan trong trng hp dng thuc ko di.
Khi cc kt qu kim tra chc nng gan cho thy c s bt thng dai dng hoc nng ln, hay
khi c cc du hiu hoc triu chng lm sng ca bnh gan hoc c cc biu hin khc (nh
tng bch cu a osine, pht ban da), cn phi ngng dng Voltaren. Vim gan c th xy ra
m khng c du hiu bo trc. Cn phi thn trng khi dng cho bnh nhn b ri lon
chuyn ha porphyrin gan do Voltaren c th pht ng bnh l ny.
Nh vi tt c cc thuc khng vim khng steroid, cn phi kim tra cng thc mu nu iu
tr ko di bng Voltaren. Nh vi tt c cc thuc khng vim khng steroid, cc phn ng d
ng k c phn v/ging phn v c th xy ra, ngay c khi bnh nhn dng thuc ny ln u
tin.
Lu { c bit
Nu bnh nhn cm thy chng mt hoc c ri lon thn kinh trung ng, khng c li xe
hay iu khin my mc.
LC C THAI
Do thn trng, khng dng Voltaren ng ton thn trong 3 thng u ca thai kz.
Khng dng Voltaren ng ton thn hay bi ngoi da trong 3 thng cui ca thai kz (do c
nguy c nhim c tim, phi v thn trn thai nhi, nguy c k o di thi gian mu chy m v
con).
LC NUI CON B
Sau khi ung liu 50 mg trong khong thi gian 8 gi, hot cht ca Voltaren qua c sa m
vi s lng nh, tuy nhin khng c tc dng khng mong mun no c ghi nhn tr nh
nhi.
TNG TC THUC
Trng hp k toa ng thi, diclofenac c th lm tng nng ca lithium v digoxine.
Nhiu thuc khng vim khng steroid c th c ch tc ng ca thuc li tiu. iu tr ng
thi vi thuc li tiu gi kali i khi s gy tng kali huyt, do cn phi theo di. Dng ng
thi nhiu thuc khng vim khng steroid hoc glucocorticoid s lm tng cc tc dng khng
mong mun. Mc d kt qu ca cc nghin cu lm sng cho thy rng diclofenac khng nh
hng ln tc dng ca thuc khng ng, mt vi bo co dng ng thi diclofenac v thuc

khng ng s tng nguy c xut huyt ; do cn phi tng cng theo di nhng bnh
nhn ny.
Nh nhng thuc khng vim khng steroid, diclofenac liu cao (200 mg) c th tm thi gy
c ch kt tp tiu cu. Cc th nghim lm sng cho thy rng c th dng ng thi diclofenac
vi thuc ung tr tiu ng m khng gy thay i hiu qu lm sng. Tuy nhin, mt vi
trng hp c phn ng h ng huyt hoc tng ng huyt sau khi dng diclofenac
c bo co ; nhng trng hp ny cn phi iu chnh liu ca thuc h ng huyt.
Thn trng khi dng thuc khng vim khng steroid di 24 gi trc hoc sau khi iu tr
bng methotrexate do nng trong mu v c tnh ca cht ny c th tng.
c tnh trn thn ca cyclosporin tng khi dng chung vi khng vim khng steroid do tc
ng ca khng vim khng steroid trn cc prostaglandine thn.
TC DNG NGOI
ng tiu ha
i khi : au thng v, c nhng ri lon tiu ha nh nn, ma, tiu chy, au bng, kh
tiu, y hi, chn n.
Him : xut huyt tiu ha, nn ra mu, tiu ra mu, lo t ng tiu ha vi xut huyt hay
thng, tiu chy ra mu.
Trng hp ngoi l : bnh bng di nh vim kt trng xut huyt khng chuyn bit, cn
kch pht vim lot kt trng hay bnh Crohn, vim ming apht, vim li, sang thng
thc qun, to bn, vim rut dng biu , vim ty.
H thn kinh trung ng (v ngoi bin)
i khi : nhc u, chong vng, chng mt.
Him : mt mi.
Trng hp ngoi l : ri lon cm gic k c d cm, ri lon tr nh, mt nh hng, ri lon
th gic (gim th lc, song th), gim thnh lc, tai, mt ng, d b kch thch, co git, trm
cm, lo u, c mng, run ry, phn ng tm thn, ri lon v gic.
Da
i khi : pht ban da.
Him : m ay.
Trng hp ngoi l : pht ban c bng nc, chm, hng ban a dng, hi chng StevensJohnson, hi chng Lyell, (chng da bng trc biu b), da (vim da trc mnh), rng tc,
phn ng cm quang, ban xut huyt, k c ban xut huyt do d ng.
Thn
Trng hp ngoi l : suy thn cp, tiu ra mu, protein niu, vim thn k, hi chng thn h,
hoi t nh thn.
Gan
Trng hp ngoi l : tng transaminase trong huyt thanh (SGOT, SGPT).

Him : vim gan vi vng da hay khng, c th xy ra t ngt trong mt vi trng hp.
Mu
Trng hp ngoi l : gim tiu cu, gim bch cu, mt bch cu ht, thiu mu tn huyt,
thiu mu bt sn.
Qu mn cm
Him : phn ng qu mn cm nh hen suyn, phn ng phn v/ging phn v, k c h huyt
p.
Trng hp ngoi l : vim mch, vim phi.
H tim mch
Trng hp ngoi l : nh trng ngc, au ngc, cao huyt p, suy tim.
Ch ring Voltaren tim :
Him : au v cng vng tim bp.
Trng hp ngoi l : p xe hoc hoi t ti vng tim bp.
LIU LNG v CCH DNG
Ngi ln :
ng ung :
Ung thuc trong cc ba n.
- Bnh thp khp :
Liu tn cng : 150 mg/ngy, chia lm 3 ln nu s dng vin tan trong rut, chia lm 2 ln nu
s dng vin phng thch chm 75 mg..
Liu duy tr : 75-100 mg/ngy, chia lm 1-3 ln.
- au bng kinh : 100 mg/ngy, chia lm 2 ln.
ng tim bp su v chm : tim 1 ln hoc 2 ln 75 mg/ngy, trong 2 ngy ; b sung dng
ung 50 mg/ngy, nu cn thit. Sau , nn iu tr tip tc bng dng ung.
Tr em trn 1 tui : 0,5-2 mg/kg/ngy, chia lm 2 n 3 ln.
QU LIU
iu tr ng c cp thuc khng vim khng steroid ch yu bao gm cc bin php h tr v
iu tr triu chng. Qu liu diclofenac khng gy ra cc du hiu lm sng in hnh.
Cc bin php iu tr khi qu liu bao gm : loi cht thuc nut vo cng sm cng tt bng
cch ra d dy v dng than hot tnh.
Cc triu chng nh h huyt p, suy thn, co git, kch ng d dy-rut, suy h hp c th x
l bng cc bin php h tr v iu tr triu chng. Dng nh khng cn thit phi dng n
cc bin php iu tr chuyn bit nh tng cng bi niu, thm tch hay truyn mu loi
thuc khng vim khng steroid do chng lin kt vi protein cao v chuyn ha mnh.

566.

WELLFERON

GLAXOWELLCOME
dung dch tim 3 MU : l 1 ml - Bng A.
dung dch tim 5 MU : l 1 ml - Bng A.
dung dch tim 10 MU : l 1 ml - Bng A.
THNH PHN
cho 1 l
Interferon alfa-n1 tinh ch

3 MU

cho 1 l
Interferon alfa-n1 tinh ch

5 MU

cho 1 l
Interferon alfa-n1 tinh ch

10 MU

CH NH
Wellferon c ch nh trong iu tr cc bnh sau :
- bnh bch cu mn tnh dng ty giai on mn tnh.
- nhim vim gan siu vi mn tnh th tn cng vi du hiu tng sinh r rt ca virus.
- nhim vim gan siu vi C (khngA - khng-B).
- bnh bch cu t bo tc.
CHNG CH NH
Qu mn bit vi Wellferon hay bt kz thnh phn no khc ca thuc. Trong nhim vim
gan siu vi B v C, Wellferon cng b chng ch nh bnh nhn c sn bnh tim, suy thn hay
suy gan nng, ng kinh v/hoc suy gim hot ng chc nng h thn kinh trung ng, vim
gan mn tnh vi x gan mt b tin trin, bnh nhn vim gan mn tnh ang hay va mi tr
liu vi tc nhn lm suy yu min dch ngoi tr trng hp ngng corticoid dng ngn hn.
CH PHNG v THN TRNG LC DNG
Alpha interferon c th lm suy ty v do cn phi theo di cc thng s huyt hc cn thn
v thng xuyn tt c cc bnh nhn, c bit trong vi tun l iu tr u tin, sau khi thay

i liu lng v khi dng ng thi vi cc thuc c t bo, c bit l busulphan v

vinblastine.
Nn c bit thn trng khi iu tr cho bnh nhn mc ng thi bnh gan, thn, tim mch
hay h thn kinh trung ng hoc c tin s ri lon tm thn.
Do h thn kinh trung ng c th b nh hng, nn lu { bnh nhn khng li xe hay thao tc
my mc cho n khi bit r c kh nng dung np thuc ca bn thn. Nn cn thn bnh
nhn b suyn hay bnh t min nh bnh tuyn gip do c bo co v cc cn tng nng
thm tnh trng bnh d him khi xy ra.
LC C THAI v LC NUI CON B
Hai nhm kh ci mang yu t Rh c cho dng interferon vi liu hng ngy ln n 2,5
MU/kg, mt nhm c cho dng t ngy th 21 n ngy th 50 ca thai kz, v nhm cn li
c cho dng t ngy th 51 n ngy th 130 ca thai kz. Khng c trng hp qui thai hay
tc dng ngoi { no khc c ghi nhn cc kh con ra i, nhng t l sinh non v sy thai
tng cao nhng kh m c cho dng liu ti a.
Hin cha c kinh nghim no trong vic s dng Wellferon trong thi gian mang thai. Do c s
chuyn ha rt r ngi, Wellferon phi c xem nh l mt tc nhn c c tnh trn phi
; nn thng bo cho bnh nhn v iu ny v khuyn bnh nhn nn c bin php trnh thai
hiu qu khi ngi chng ang c iu tr bng Wellferon.
Do nhng l do trn, Wellferon ch c dng khi li ch iu tr cao hn nhng nguy c c th
xy ra cho bo thai.
Do tnh cht lu di ca bnh vim gan B mn tnh v do kh nng min dch c th xy ra tr
s sinh i vi bnh ny, khng nn s dng Wellferon iu tr vim gan B trong thi gian c
thai.
Do thn trng, khng nn s dng Wellferon trong thi gian cho con b m.
TNG TC THUC
Thuc lm gim hot tnh ca cytochrome P-450. S dng ng thi vi cc thuc c tc ng
trn h thn kinh trung ng i khi gy cc thay i trm trng khng lng trc c trn
tnh trng tm thn.
TC DNG NGOI
Hi chng dng cm nh st, n lnh, run ry, nhc u, kh v au c. Cc tc dng ny c
khuynh hng gim bt i khi tip tc dng thuc hay c loi tr vi s s dng
paracetamol. Vic dng thuc tip tc c th dn n chng ng lm, yu t, au c, mt mi,
chn n v st cn.
Nhiu tc dng ngoi trn tim mch trong c mt vi tc dng trm trng, c bo
co. Suy ty. Cc tc dng ngoi { ng k trn h thn kinh trung ng bao gm trm cm
nng, l ln, ng kinh c th xut hin. Cc tc dng ngoi khc bao gm phn ng ti ch
ni tim, bun nn, nn ma, tiu chy, tng men gan, rng tc.

LIU LNG v CCH DNG

Thuc c th dng tim di da hay tim bp.
Bnh bch cu mn tnh dng ty : nn bt u iu tr vi Wellferon khi bt u kim sot
c s lng bch cu mc t 4 n 20 x 109/l trong khong thi gian t nht 4 tun khi
s dng liu ha tr liu c t bo thng thng nh busulphan hay hydroxyurea. Vic nn
hon iu tr vi Wellferon cho n khi s lng bch cu v tiu cu c n nh sau khi
ngng busulphan (t nht 4 tun). Trong ba tun l u tin, liu khuyn co l tim di da 3
MU mi ngy. Sau ba tun, c th iu chnh liu t c s lng bch cu vo khong 2
n 5 x 109/l. C th cn phi p dng thm mt giai on s dng ha tr liu c t bo nu
lng bch cu ln cao trn 30 x 109/l ti xc lp li kim sot s lng bch cu. Nn gim
tng liu mi tun nu lng bch cu di 2 x 109/l hay lng tiu cu di 50 x 109/l ; nn
ngng iu tr vi Wellferon nu cc lng t bo ni trn h xung n cc gi tr tng ng
di 1 x 109/l hay 25 x 109/l, v ti iu tr khi cc gi tr ny trn 2 x 109/l hay 50 x 109/l. Nn
tip tc dng Wellferon cho n khi khng cn kim sot c s lng bch cu, hay c bng
chng gia tng hoc chuyn i nguyn bo.
Nhim vim gan siu vi B mn tnh : 10-15 MU/m2 (cho n 7,5 MU/m2 din tch c th) ba ln
mi tun trong 12 tun. thun li, nn nng liu tng bc qua mi 5 ngy. Mt cch khc, 510 MU (cho n 5 MU/m2) ba ln mi tun cho n 6 thng c th thch hp hn cho nhng
bnh nhn khng dung np c liu cao hn.
Nhim vim gan siu vi C (khng A-khng B) : nn iu tr mt t 48 tun vi 5 MU ba ln
mi tun. Mt vi bnh nhn c th c p ng tt vi liu thp hn bng 3 MU ba ln mi
tun trong 48 tun. Phc 3 MU ba ln mi tun cng c th thch hp cho bnh nhn nghi
ng l km dung np vi liu cao hn.
Bnh bch cu t bo tc : tim bp hay tim di da 3 MU mi ngy. Sau khi bt u c ci
thin cc ch s huyt hc ngoi vi (thng l 12 n 16 tun), c th dng ba ln mi tun.
S dng thuc cho tr em : Hin cha c s liu v vic s dng Wellferon trong iu tr bnh
bch cu t bo tc tr em.
S dng thuc cho ngi ln tui : Bnh nhn ln tui c th chu ng km tc dng ngoi
ca interferon ; nn gim liu Wellferon hay thm ch ngng thuc nu bnh nhn nhy cm
qu vi tc dng ngoi .
Trong khi cn phi cnh gic trong iu tr bnh bch cu dng ty mn tnh bnh nhn trn
65 tui, kinh nghim lm sng cho thy rng nhng ngi ny c kh nng sng cn tng t
cng vi dung np iu tr ging nh bnh nhn tr tui.

THUC VN X-Y-Z

567.

XATRAL SR 5 mg

SANOFI SYNTHELABO VIETNAM

vin bao c tc ng ko di 5 mg : hp 56 vin - Bng B.
THNH PHN
cho 1 vin
Alfuzosine chlorhydrate

5 mg

DC LC
Alfuzosine l mt dn xut ca quinazoline, c hot tnh khi dng ng ung.
y l cht i khng chn lc trn cc th th a1-adrnergique hu sinap.
Kt qu cc nghin cu dc l{ in vitro khng nh tnh chuyn bit ca alfuzosine i vi
cc th th ti tam gic bng quang, niu o v tuyn tin lit.
Cc nghin cu in vivo ng vt cho thy rng alfuzosine lm gim p lc niu o v do
gim lc cn dng nc tiu.
Trn lm sng, trong tng sinh lnh tnh tuyn tin lit, s xut hin v mc trm trng ca
cc biu hin chc nng ng niu khng ch lin quan n th tch ca tuyn tin lit m cn
lin quan n trng lc thn kinh giao cm gy tng trng lc ca si c trn ng tiu
di, ni chung, v m cht m ca tuyn tin lit, ni ring, do kch thch cc th th a1adrnergique hu ni.
Trn tim mch, alfuzosine c tc ng chng cao huyt p.
DC NG HC
Dng tc ng ko di (phng thch chm) :
- Nng ti a trong huyt tng t c sau khi ung thuc khong 3 gi.
- Thi gian bn hy o thi l 8 gi.
- Sinh kh dng gim trung bnh khong 15% so vi vin Xatral 2,5 mg. S gim ny c b
bng cch tng liu hng ngy ca vin Xatral SR 5 mg (xem Liu lng v Cch dng).
Alfuzosine :
- Lng alfuzosine gn vi protine huyt tng l 90%. Cht ny c chuyn ha mnh v
bi tit ch yu qua mt v phn.
- Khng c cht chuyn ha c hot tnh no c tm thy ngi.
- ngi gi, s hp thu alfuzosine nhanh hn v nng ti a cao hn. Sinh kh dng c th
tng v mt vi bnh nhn c b gim th tch phn phi c ghi nhn. Thi gian bn hy
o thi khng thay i.

- bnh nhn suy thn c lm thm phn hay khng, th tch phn phi v thanh thi
alfuzosine tng do tng phn on t do.
- Suy thn mn tnh ngay c khi suy thn nng (thanh thi cratinine t 15 n 40 ml/pht)
khng b alfuzosine lm trm trng hn.
- Trng hp suy tim mn tnh, cc c tnh dc ng ca alfuzosine khng b thay i.
CH NH
iu tr mt vi biu hin chc nng ca tng sinh lnh tnh tuyn tin lit khi cn phi tr hon
phu thut v trong cc t tin trin.
CHNG CH NH
Qu mn vi thuc c ch a1.
C tin s b h huyt p th ng.
Phi hp vi cc thuc c ch a1 khc (xem Tng tc thuc).
CH PHNG
mt vi ngi, trong c cc bnh nhn cao huyt p c iu tr bng cc thuc h
huyt p (ch yu l cc thuc i khng calci), chng h huyt p t th c th xy ra trong vi
gi sau khi ung thuc, c th phi hp vi mt vi triu chng nh cm gic chng mt, mt
mi, v m hi.
Trong trng hp ny, bnh nhn phi c t nm cho n khi mt hn cc triu chng.
Hin tng ny ch tm thi v thng khng cn phi ngng thuc.
Bnh nhn cn c thng bo v nguy c h huyt p t th.
THN TRNG LC DNG
bnh nhn bnh mch vnh, tip tc iu tr c hiu suy mch vnh. Trng hp cn au
tht ngc ti xut hin hoc nng thm th ngng iu tr bng thuc c ch a.
ngi gi, khng nn dng qu 10 mg/ngy.
TNG TC THUC
Khng nn phi hp :
- Cc thuc chn alpha khc : tng nguy c b h huyt p t th.
- Cc thuc c ch dng calci : tng nguy c b h huyt p t th.
Nn lu { khi phi hp :
- Cc thuc gy m : c th lm cho huyt p khng n nh, cn thng bo cho chuyn vin gy
m v vic ang dng thuc.
C th phi hp vi : warfarine, digoxine, hydrochlorothiazide, at nolol (trn ngi khe mnh
n nay cha thy xut hin mt tc dng ph no).
TC DNG NGOI
Bun nn, au d dy, tiu chy.
Chong vng, chng mt, kh chu, nhc u.
Him gp : kh ming, nhp nhanh, au ngc, suy nhc, bun ng, ni mn ngoi da, nga,

da.
nhng ngi cao huyt p : hi hp, h huyt p t th, ph.
LIU LNG v CCH DNG
Ung thuc khng nhai.
Liu thng thng l 1 vin bui sng v 1 vin bui ti, tng ng 10 mg/ngy, bt u iu
tr nn ung vo bui ti.
Ngi ln tui v bnh nhn cao huyt p ang c iu tr :
- bt u bng vin Xatral 2,5 mg, 2 ln/ngy (tng ng 5 mg/ngy) ;
- sau , tng liu theo dung np v p ng lm sng, ti a khng qu 1 vin Xatral SR 5 mg, 2
ln/ngy vo bui sng v ti (tng ng 10 mg/ngy).
QU LIU
Cho bnh nhn nhp vin.
Tin hnh iu tr kinh in cho hin tng h huyt p (bng cch nng mch).
Cht i khng thch hp nht dng nh l cht co mch c tc dng trc tip ln si c
mch. Kh tch mi lin kt alfuzosine vi protine.

568.

ZANOCIN

RANBAXY
vin nn d b 200 mg : hp 100 vin.
dung dch tim truyn tnh mch 200 mg/100 ml : chai 100 ml.
thuc nh mt 3 mg/ml : l 10 ml.
THNH PHN
cho 1 vin
Ofloxacine

200 mg

cho 1 chai
Ofloxacine

200 mg

cho 1 ml thuc nh mt
Ofloxacine

3 mg

TNH CHT
Ofloxacin l mt Carboxyquinolone gn Fluor tc dng dit khun hot ph rng . Cng thc
ho hc ca n l (+)-9-Fluoro-2,3-dihydro-3-methyl-10-(4-methyl-1-piperazinyl)-7-oxo-7Hpyrido[1,2,3-de]-1,4-benzoxazin-6-carboxylic acid.
C ch tc dng :
Fluoroquinolone tc dng dit khun bng cch c ch enzym Topoisomerase II (ADN gyrase)
ca vi khun. Topoisomerase c vai tr tho xon cho ADN. y l mt phn ng ph thuc ATP
i hi c 2 chui ca ADN b ct ra cho ph p a vo mt on ADN on ct, sau
on ct ny c hn gn li. Fluoroquinolone lm gim vic tho xon cho ADN v lm ngng
nhanh chng s tng hp ADN do can thip vo s nhn i ADN.
Hot tnh khng khun :
In vitro, Ofloxacin c ph khng khun rng bao gm cc vi khun gram dng, vi khun gram
m v vi khun k kh nh l : Staphylococcus aureus, Staphylococcus epidermidis, (k c nhng
dng khng Methicillin), Staphylococcus saprophyticus, Streptococcus pneumoniae,
Streptococcus pyogenes, Streptococcus agalactiae, Enterococcus faecalis, Enterobacter
aerogenes, E. coli, H. influenza, Klebsiella pneumoniae, Neisserria gonorrhoeae, Proteus
mirabilis, Proteus vulgaris, Pseudomonas aeruginosa, Pseudomonas fluorescens, Acinetobacter
species, Aeromonoas hydrophilia, Campylobacter jejuni, Citrobacter diversus, Citrobacter
freundii, Enterobacter cloacae, Haemophilus parainfluenza, Klebsiella oxytoca, Moraxella
(Branhamella), Morganella morganii, Neisseria meningitidis, Plesiomonas shigelloides,
Providencia rettgeri, Providencia stuartii, Salmonella species, Serratia marcescens, Shigella
species, Vibrio cholerea, Xanthomonas (Pseudomonas) maltophilia, Yersinia enterocolitica,
Bacteroides fragilis, Bacteroides intermedius, Clostridium perfringens, Peptococcus niger,
Peptostreptococcus species, Chlamydia pneumonia, Chlamydia trachomatis, Legionella
pneumoniae, Mycobacterium tuberculosis, Mycoplasma pneumoniae v Ureaplasma
urealyticum.
Dc ng hc :
Ofloxacin c hp thu tt sau khi ung vi kh dng sinh hc hu nh 100%. Trung bnh
nng nh trong huyt tng t c sau khi ung 1 liu duy nht 200mg Ofloxacin l 220
mg/ml v t c trong vng 6 gi sau khi ung. Thc n c th lm chm s hp thu thuc
nhng khng nh hng ng k n mc hp thu thuc.
Khong 25% thuc gn kt vi protein huyt tng. Ofloxacin c phn b rng ri trong cc
m v dch ca c th nh l phi, da, mn nc, c t cung , bung trng, m v dch tit tin
lit tuyn, m.
Ofloxacin o thi ch yu qua ng thn. Khong 75-80% liu ung c bi xut qua nc
tiu di dng khng chuyn ha, di 5% c bi xut di dng cht chuyn ha kh
methyl hay N-oxid.

Thi gian bn hy o thi trong huyt tng thay i t 5-8 gi. Thi gian bn hy c th ko
di trong trng hp suy thn nng.
CH NH
Zanocin c ch nh iu tr nhng trng hp nhim khun sau :
- Nhim trng ng tiu c bin chng v khng c bin chng.
- Nhim trng da v m mm.
- Vim tuyn tin lit.
- Bnh ly truyn qua ng sinh dc nh l : nhim lu cu cp niu o v c t cung khng
bin chng, vim niu o v c t cung khng do lu cu.
- Vim phi do H. influenza hay Streptococcus pneumoniae.
- Vim ph qun mn tnh t cp.
Dng thuc nh mt :
Cc nhim trng phn ngoi mt (vim kt mc, vim gic mc) hoc nhng b phn ph
(vim mi mt, vim ti l) do nhng chng vi khun nhy cm vi ofloxacin.
CHNG CH NH
Chng ch nh dng Ofloxacin bnh nhn nhy cm vi Ofloxacin hay bt kz mt dn xut
ca Quinolone.
THN TRNG LC DNG
Tng qut :
Nn xem xt cn thn gia li ch v yu t nguy c tim tng khi s dng Ofloxacin trong
nhng trng hp c bnh l h thng thn kinh trung ng k c ng kinh v x cng
ng mch no.
Phn ng nhy cm vi nh sng c nhn thy mt s bnh nhn ang dng
fluoroquinolone. Nn trnh tip xc vi nh sng mt tri. Nu xy ra phn ng nhy cm nh
sng th phi ngng dng thuc. Bnh nhn c chc nng thn suy gim cn phi thay i ch
iu tr.
Khuyn co :
Tnh an ton v hiu qu ca Ofloxacin tr em , tr ang ln (tr di 18 tui), ph n c thai
v cho con b th cha c bit r. Cng nh nhng Quinolone khc, Ofloxacin c th kch
thch thn kinh trung ng gy ra triu chng run ry, bn chn, cm gic nh lng lng, l ln
v o gic. Nu nhng triu chng ny xut hin, nn ngng thuc v tin hnh nhng bin
php iu tr thch hp.
Khi c du hiu au gn, cn ngng dng ngay tc khc nhng khng sinh thuc nhm
fluoroquinolone.
Tnh nhy cm cho :
Nhng bnh nhn c tnh trng mn cm vi mt Fluoroquinolone hay vi nhng dn xut ca
Quinolone c cu trc ha hc tng t cng c th mn cm vi Ofloxacin.

S dng thuc cho tr em :

Fluoroquinolone khng c khuyn dng tr em v tr s sinh.
Ngi gi :
Nhng cng trnh nghin cu c thc hin cho thy khng c nhng bin chng c hiu
ring ngi gi khin cho phi hn ch s s dng fluoroquinolone nhm ngi ny. Tuy
nhin ngi gi thng c tnh trng suy gim chc nng thn theo tui tc nn cn phi iu
chnh liu khi s dng fluoroquinolone.
Tnh t bin-Tnh sinh ung :
Hin nay nhng cng trnh nghin cu lu di v tnh sinh ung ca ofloxacin chut th cha
c thc hin. Ngi ta khng thy ofloxacin sinh t bin trong cc test vi khun Ames,
trong cc th nghim sinh t bo in vitro v in vivo, th nghim trao i nhim sc t ch em,
th nghim phc hi ADN hay th nghim gy cht tnh tri.
Thn trng khi s dng dng thuc nh mt :
Khng c dng thuc iu tr d phng (do nguy c chn lc chng khng).
Trng hp bnh khng c ci thin nhanh, hoc trong tr liu lu di cn theo di kim tra
vi trng hc v tnh nhy cm ca cc chng vi khun, pht hin chng no khng thuc c
bin php iu tr thch hp.
Trng hp tr liu cng vi mt thuc nh mt cha hot cht khc, phi dng cch khong 15
pht.
Khng c tim thuc nh mt vo xung quanh hoc trong mt.
LC C THAI
Ofloxacin qua c mng nhau. Cho n nay cha c mt cng trnh nghin cu y v c
kim sot ngi. Tuy nhin ngi ta nhn thy ofloxacin gy ra bnh khp trong cc cng
trnh nghin cu th vt. Thuc khng c khuyn dng ph n c thai.
LC NUI CON B
Ofloxacin hin din trong sa m. V th vt fluoroquinolone c biu hin gy tn thng
vnh vin sn khp nhng khp chu ng sc nng, nn nu cn phi dng fluoroquinolone
khng th dng khng sinh khc thay th ngi ta khuyn khng nn cho con b.
TNG TC THUC
Theophylline : Vic s dng ng thi ofloxacin v theophylline c th dn n tng nng
theophylline trong mu. Nu buc phi s dng ng thi 2 thuc trn th cn phi theo di
nng theophylline trong mu v iu chnh liu cho thch hp.
Thuc khng acid cha magnesium hydroxide hay aluminium hydroxide : Thuc khng acid lm
gim s hp thu ofloxacin, nn trnh dng ofloxacin chung vi nhng thuc ny.
Probenecid : Khi dng phi hp vi probenecid, s bi xut ofloxacin qua ng tiu s gim.
Thuc gim au : c bo co vic s dng thuc khng vim non-steroid lm tng tc dng
ph ca quinolone trn h thng thn kinh trung ng.

Sucralfate : Sucralfate gii phng nhng ion aluminium trong d dy, do lm gim s hp thu
ofloxacin.
Warfarin : S dng chung vi ciprofloxacin hay norfloxacin s lm tng tc dng chng ng
mu ca warfarin, do phi theo di cn thn thi gian prothrombin bnh nhn ang dng
fluoroquinolone
Thay i gi tr cc xt nghim cn lm sng :
Gi tr phosphatase kim, SGOT, SGPT v lactate dehydrogenase trong mu c th gia tng
trong thi gian dng ofloxacin.
TC DNG NGOI
ng tiu ho : bun nn, i ma, tiu chy, au bng.
Da : nga, phn ng da nhy cm nh sng, vim mch mu, pht ban v mn da.
H thng thn kinh trung ng : chng mt, cm gic lng lng, hay qun, run ry, co git, d
cm, tng kch thch.
Thn : suy thn cp th pht sau vim thn m k.
C quan khc : nhn m, tng bch cu a acid, gim bch cu a nhn trung tnh, gim tiu
cu, au c, chng v to.
Dng thuc nh mt :
- C th gy kch thch tm thi.
- C th gy phn ng qu mn.
- C th gy chn lc cc chng vi khun khng.
- C th gy cc phn ng d ng cho.
LIU LNG v CCH DNG
Dng ung :
Ngi ln :
Nhim khun ng tiu :
Vim bng quang do E. coli hay K. pneumoniae : 200 mg mi 12 gi trong 3 ngy.
Vim bng quang do nhim cc loi vi khun khc : 200 mg mi 12 gi trong 7 ngy.
Nhim khun ng tiu c bin chng : 200 mg mi 12 gi trong 10 ngy.
Nhim khun da v m mm mc trung bnh hoc nh : 400 mg mi 12 gi trong 10 ngy.
Vim phi hay vim ph qun mn tnh t cp : 400 mg mi 12 gi trong 10 ngy.
Bnh ly truyn qua ng sinh dc :
Nhim lu cu khng bin chng : 400 mg mt liu duy nht.
Vim niu o hay vim c t cung do C. trachomatis : 300 mg mi 12 gi trong 7 ngy.
Vim tuyn tin lit : 300 mg mi 12 gi trong 6 tun.
iu chnh liu bnh nhn suy thn : bnh nhn c chc nng thn suy gim c th gim
liu nh sau :

 thanh lc creatinin (ml/pht)

Khong cch dng thuc (gi)

> 50

Dng liu thng thng

10-50

Liu thng thng dng mi 24 gi

< 10

Gim 50% liu v dng mi 24 gi

Khi ch bit nng creatinin trong huyt tng, ta c th p dng cng thc sau c lng
thanh lc creatinin :
Nam : thanh lc creatinin ml/pht = Cn nng (kg) x (140 - Tui) / 72 x Creatinin huyt
tng(mg/dl)
N : 0,85 x Gi tr c tnh cho nam
Dng tim :
Tim truyn tnh mch trong 30 pht.
Ngi ln : 400 mg/24 gi, chia lm hai ln tim truyn. Trng hp nng : 400 mg mi 12 gi.
Ngi gi/Ngi suy thn :
thanh lc creatinin (ml/pht)

Liu lng

20-50

200 mg/24 gi

< 20

200 mg/48 gi

Dng thuc nh mt : Liu lng ty thuc vo mc nhim trng v c bc s chuyn

khoa mt quyt nh.
QU LIU
Bi v khng c antidote c hiu cho ofloxacin nn trong trng hp dng thuc qu liu ch
iu tr nng v iu tr triu chng v bao gm nhng bc sau :
1. Ra d dy hoc gy i.
2. B nc y .
3. iu tr nng .
BO QUN
Bo qun nhit khng qu 25oC, trnh m t.
Trnh xa tm tay vi ca tr em.

569.

ZANTAC

GLAXOWELLCOME
vin nn 150 mg : hp 60 vin.

vin nn si bt 150 mg : hp 30 vin.

vin nn si bt 300 mg : hp 30 vin.
dung dch tim 50 mg/2 ml : hp 5 ng thuc 2 ml.
THNH PHN
cho 1 vin nn 150 mg
Ranitidine chlorhydrate tnh theo dng base

150 mg

cho 1 vin si bt 150 mg

Ranitidine chlorhydrate tnh theo dng base

150 mg

cho 1 vin si bt 300 mg

Ranitidine chlorhydrate tnh theo dng base

300 mg

cho 1 ng thuc
Ranitidine chlorhydrate tnh theo dng base

50 mg

DC LC
Vin nn/ng tim : ranitidine chlorhydrate l mt cht i khng ln th th histamine H2, c
tc ng nhanh v c hiu. Thuc c ch s tit acide d dy ca cht nn v do b kch
thch, lm gim dung tch v acide cng nh pepsine trong cht tit d dy.
Vin nn : thuc c tc ng tng i k o di, do mt liu duy nht 150 mg lm gim hu
hiu s tit acide d dy trong vng 12 gi.
DC NG HC
Ranitidine c hp thu nhanh chng sau khi ung. Nng ti a trong huyt tng thng
t c trong vng 2 gi. S hp thu khng b gim ng k bi thc n hay cc thuc khng
acide. Thi gian bn hy trung bnh ca ranitidine vo khong 2 gi. Ranitidine c o thi
qua thn ch yu di dng t do v mt lng nh di dng cc cht chuyn ha. Cht
chuyn ha chnh l N-oxyde v cn mt phn nh hn l S-oxyde v dmthyl ranitidine. S
thu hi trong nc tiu sau 24 gi ca ranitidine t do v cht chuyn ha chnh ca n l vo
khong 40% vi dng thuc ung.

Ranitidine c hp thu nhanh chng sau khi tim. Nng ti a trong huyt tng thng
t c trong vng 15 pht sau. Ranitidine c o thi qua thn ch yu di dng t do
v mt lng nh di dng cc cht chuyn ha. Cht chuyn ha chnh l N-oxyde v cn
mt phn nh hn l S-oxyde v dmthyl ranitidine. S thu hi trong nc tiu sau 24 gi ca
ranitidine t do v cht chuyn ha chnh ca n l vo khong 75% sau khi tim tnh mch.
CH NH
Lot t trng, lot d dy lnh tnh, lot sau phu thut, vim thc qun do hi lu, hi chng
Zollinger-Ellison v cc chng bnh cn gim s tit dch v v acide tit ra nh sau : d phng
xut huyt d dy t s lot do b stress bnh nhn bnh nng, d phng xut huyt ti pht
bnh nhn c lot xut huyt d dy v trc khi gy m ton thn bnh nhn c xem
nh c nguy c ht acide trong hi chng hi lu, c bit bnh nhn sn vo lc sinh n (hi
chng Mendelson). Bnh nhn ghp thn.
CHNG CH NH
Qu mn bit vi ranitidine.
CH PHNG
Vic iu tr vi cht i khng H2 histamine c th che giu cc triu chng i km vi
carcinome d dy v do , c th tr hon chn on bnh ny. Theo , khi nghi ng lot d
dy nn loi tr kh nng c tnh trc khi bt u iu tr vi Zantac.
Ranitidine c o thi qua thn v khi c s hin din ca suy thn trm trng, nng ca
ranitidine trong huyt tng gia tng. V vy, khuyn co dng Zantac vi liu 25 mg cho nhng
bnh nhn ny.
C cc bo co rng s s dng cao hn liu khuyn co thuc tim tnh mch thuc khng
histamine H2 c th gy tng men gan khi k o di iu tr ny trn 5 ngy.
LC C THAI v LC NUI CON B
Zantac i qua nhau thai nhng liu iu tr c dng cho bnh nhn c thai lc sinh hay chu
phu thut csar, khng gy tc dng ngoi trn s sinh hay s pht trin v sau ca tr s
sinh. ngi, Zantac cng i qua sa m . Ging nh nhng thuc khc, ch nn dng Zantac
trong lc c thai v khi cho con b nu xt thy cn thit.
TNG TC THUC
Ranitidine khng c ch h thng men oxygnase c chc nng phi hp lin kt vi
cytochrome P450 ca gan. V vy, ranitidine khng lm tng tc dng ca cc thuc b oxy ha
hay lm bt hot bi men ny ; cc thuc ny bao gm diazpam, lignocaine, phnytoine,
propranolol, thophylline v warfarine.
Thuc tim Zantac tng thch vi cc dch truyn tnh mch sau : NaCl 0,9%, dextrose 5%, NaCl
0,18% v dextrose 4%, sodium bicarbonate 4,2% v dung dch Hartmann. Mc d cc nghin
cu v tnh tng hp ch c thc hin vi cc ti dung dch tim truyn polyvinyl chlorure
(trong bao b thy tinh cho sodium bicarbonate) v b dy tim truyn polyvinyl chlorure, nn

ch rng tnh tng hp y cng c th dng tham kho khi s dng ti tim truyn
polythylne. Tt c hn hp Zantac v dch truyn khng dng n nn c loi b 24 gi
sau khi pha ch.
TC DNG NGOI
Cc tc dng ngoi { sau c bo co nh cc tai bin trong cc th nghim lm sng hay
trong vic kim sot thng thng cc bnh nhn c iu tr vi ranitidine. Mi lin quan
trong nhiu trng hp vi vic iu tr bng ranitidine khng c xc nh. Cc thay i
thong qua v c hi phc trn cc xt nghim chc nng gan c th xy ra. i khi c nhng
bo co v chng vim gan c hi phc (vim t bo gan, vim ng mt trong gan hay phi
hp c hai) c hay khng c vng da.
Chng gim bch cu v gim tiu cu him khi xy ra v hi phc tr li khi ngng thuc.
Cc trng hp him gy mt bch cu ht, hay gim ton th huyt cu, i khi c bt sn ty
c bo co.
Cc phn ng qu mn (my ay, ph mch thn kinh, co tht ph qun, h huyt p) c
quan st thy him khi xut hin sau khi dng ranitidine theo ng tim v ng ung. Cc
phn ng ny i khi cng xy ra vi mt liu duy nht.
Tim chm cng c bo co xut hin rt him.
Chng nhc u, i khi trm trng v chng mt c bo co xy ra mt phn rt nh
bnh nhn. C mt vi bo co v cc triu chng trn v (sng v/hoc kh chu) ngi n
ng dng ranitidine ; mt vi trng hp c gii quyt khi tip tc dng thuc. Vic tr
liu c th cn gin on xc nh nguyn nhn gy bnh.
LIU LNG v CCH DNG
Vin nn :
Ngi ln : Liu thng thng : mt vin 150 mg hai ln mi ngy, ung vo bui sng v
chiu. Mt cch khc, bnh nhn lot d dy hay t trng c th c iu tr vi mt liu duy
nht 300 mg trc khi ng. Khng cn thit tnh thi gian dng thuc lin quan n ba n.
Trong hu ht cc trng hp lot t trng, lot d dy lnh tnh v lot sau phu thut, s lm
lnh xy ra trong 4 tun. Thng vic lnh vt lot xut hin sau 4 tun iu tr cho bnh nhn
c vt lot khng lnh hon ton sau ln tr liu khi u. iu tr duy tr vi liu c gim
thnh mt vin 150 mg trc khi ng c khuyn co cho bnh nhn p ng vi iu tr
ngn hn, c bit ngi c tin s lot ti pht. Trong vic kim sot vim thc qun hi lu,
qu trnh iu tr c khuyn co l mt vin 150 mg hai ln mi ngy n ti a 8 tun.
bnh nhn mc hi chng Zollinger-Ellison, liu bt u l 150 mg ba ln mi ngy v c th
tng nu cn thit. Bnh nhn b hi chng ny c cho cc liu gia tng ln n 6 g/ngy
v c dung np rt tt.
Trong vic d phng xut huyt bi lot do stress bnh nhn mc bnh nng hay d phng
xut huyt ti pht trn bnh nhn b chy mu t vt lot d dy, vic iu tr vi vin nn

Zantac 150 mg hai ln mi ngy c th thay th cho thuc tim Zantac khi bt u cho n bng
ming trn nhng bnh nhn vn cn b xem l cn trong nguy c do cc bnh ny.
Trn cc bnh nhn c xem l c nguy c b hi chng ht acide trong hi chng hi lu, c
th dng mt liu ung 150 mg 2 gi trc khi gy m ton thn v tt hn na l thm mt
vin 150 mg vo ti hm trc. Mt cch khc, cng c th dng thuc tim Zantac theo
ng tnh mch v tim bp.
nhng bnh nhn sn lc bt u sinh, c th dng mt liu ung 150 mg theo sau liu 150
mg mi 6 gi. Khuyn co rng do vic lm trng d dy v hp thu thuc b tr hon lc sinh,
nn dng thm trn mi bnh nhn cn gy m ton thn cp cu mt thuc khng acide
khng chuyn bit (nh sodium citrate) trc khi gy m. Cn cn thn trnh chng ht acide
do hi lu.
Tr em : kinh nghim vi vin nn Zantac tr em cn gii hn v s s dng ny khng c
kho st u trn cc nghin cu lm sng. Tuy nhin, thuc c dng thnh cng cho
tr t 8-18 tui vi liu ln n 150 mg hai ln mi ngy.
Thuc tim :
Ngi ln : c th c dng hoc bng cch tim tnh mch chm dng 50 mg (trong t nht 2
pht), sau khi pha long trong mt th tch 20 ml cho 50 mg, lp li vi khong cch 6-8 gi ;
hoc tim truyn tnh mch khng lin tc vi tc 25 mg/gi trong 2 gi ; c th lp li tim
truyn cch khong 6-8 gi ; hoc tim bp 50 mg (2 ml) mi 6-8 gi.
Trong d phng xut huyt bi lot do stress bnh nhn mc bnh trm trng hay d phng
xut huyt ti pht bnh nhn chy mu t s lot d dy, c th tip tc tim thuc cho n
khi bt u cho n bng ng ming. Cc bnh nhn c xem nh cn trong nguy c c th
c iu tr vi vin nn Zantac 150 mg hai ln mi ngy.
bnh nhn c xem nh cn trong nguy c pht trin ht acide trong hi chng hi lu, c
th cho thuc tim Zantac 50 mg tim bp hay tim tnh mch chm 45-60 pht trc khi gy
m ton thn.
Tr em : s s dng thuc tim Zantac tr em cha c kho st.
QU LIU
Zantac rt c hiu trn tc ng ca n v do , khng c vn g c bit trong vic qu
liu. Nn p dng cc tr liu triu chng v h tr thch hp. Nu cn, c th loi b thuc ra
khi huyt thanh bng lc mu.
BO QUN
Vin nn : khng cn thit c bin php bo qun c bit.
ng thuc tim : bo qun nhit di 25oC. Trnh nh sng. Khng nn b thuc tim
Zantac vo ni hp.

570.

ZEFFIX

GLAXOWELLCOME
vin nn 100 mg : hp 28 vin, 84 vin - Bng A.
THNH PHN
cho 1 vin
Lamivudine

100 mg

TNH CHT
Zeffix l cht ng ng nucleoside (-)-2,3-dideoxy-3-thiacytidine c hot tnh khng virus c
hiu trn virus vim gan B (HBV). Thuc lm gim s sao chp HBV mt cch nhanh chng v
mnh m qua s c ch tng hp DNA virus.
DC LC
Zeffix l mt cht ng ng deoxycytidine dng (-)-enantiomere tinh khit, ngha l n hin
din dng cu hnh ngc li vi nucleoside t nhin. Cc protein ngi tng tc vi cc
nucleoside thng c tnh chn lc cao i vi cu hnh (+) v do c th khng tng tc vi
Zeffix. y l c im quan trng do n lm gim kh nng gy c ca Zeffix.
C ch tc ng : C ch tc ng ch yu ca Zeffix bao gm s c ch tng hp DNA virus.
Tc ng ny xy ra ch yu qua s kt hp vo HBV DNA va mi tng hp, gy kt thc chui
tin trnh tng hp. S c ch tng tranh trn DNA polymerase m ha DHBV cng c
chng minh. Zeffix l mt cht c ch cnh tranh yu trn DNA polymerase ca t bo ngi
bnh v khng lm kt thc chui tng hp DNA ca t bo ngi bnh. Zeffix khng c ch
trc tip s tng hp protein ca virus, tuy nhin vic gim tng hp protein virus l hu qu
ca s c ch tng hp DNA virus. Nht qun vi c ch ny, vic gim HBeAg v HBsAg trong
huyt thanh bnh nhn xy ra chm hn nhiu so vi gim virus trong mu.
Zeffix cn c s phosphoryl ha ni bo th hin tc ng khng virus. V vy, kh nng
khng virus ca n lin h cht ch vi hm lng Zeffix triphosphate sn sinh trong t bo
nhim HBV. Khi trong cc lympho bo mu ngoi vi, Zeffix c phosphoryl ha thnh dn
xut 5'-triphosphate cc t bo 2.2.15.
Virus hc : In vitro Zeffix c hot tnh khng virus mnh trn HBV v virus gy suy gim min
dch ngi (HIV). Zeffix khng c hot tnh trn cc tc nhn gy bnh khc ngi bao gm
cc virus gy vim gan khc, virus gy bnh ng h hp, herpes virus, vi khun v nm. Tnh
chn lc ny ca Zeffix c th do phng thc tc ng ch yu ca n l tng tc vi men
DNA polymerase ph thuc RNA m ha virus (reverse transcriptase - men sao m ngc).

Reverse transcriptase cn thit cho s nhn i ca c HBV v HIV nhng khng cn thit cho
cc vi sinh vt gy nhim khc hay cho ngi.
Hot tnh khng HBV ca Zeffix in vitro : Zeffix c ch mnh s sao chp HBV in vitro, cho gi tr
IC50 (IC50 l nng thuc lm gim 50% s nhn i) l 0,008 - 0,032 mM trong t bo khi u
gan b HBV (t bo 2.2.15). Trong cc th nghim ny, lamivudine mnh hn nhiu so vi cc
cht ng ng nucleoside c tm thy trc nh ara-AMP hay ganciclovir. Zeffix cng c
tnh chn lc cao : S c ch phn chia t bo trong mu cy m ch c quan st nng
cao hn t nht 10 000 ln gi tr IC50 trn virus.
Hot tnh khng HBV ca Zeffix in vivo : Ngoi loi ngi, HBV ch nhim trn tinh tinh v mt
vi loi linh trng cao cp hn. Do , tinh tinh c s dng nh mt phng tin nh gi
hot tnh khng virus in vivo ca Zeffix trn HBV ngi. Hin nay ngi ta bit c rt t bin
th ca HBV trn th, nh virus vim gan siu vi B vt (DHBV). Ging nh HBV ngi, cc
virus ny c tnh c hiu loi cao nhng mt khc li tng t v mt sinh hc vi virus
ngi. Hai nghin cu tinh tinh b nhim virus mn tnh xc nh rng Zeffix c hot tnh
khng virus mnh trn HBV in vivo. Tng t, cc nghin cu cho thy rng Zeffix lm gim
DHBV vt Bc kinh b nhim virus mn tnh. Tuy nhin, trong tt c cc nghin cu ny, hm
lng HBV DNA huyt thanh tr v tnh trng nh trc khi iu tr vi tun sau khi chm
dt tr liu.
iu tr kt hp : Zeffix vi IFN-a : Hai nghin cu lm sng pha III (B3010, AB3011) kho st
hiu qu ca Zeffix dng kt hp vi IFN-a trong iu tr vim gan siu vi B. C s hp l cho
cc nghin cu ny da trn cc phng thc tc ng khc nhau ca IFN-a v Zeffix v kh
nng tng tc hip ng ca chng. Cc nghin cu ny c thit k nh gi nh hng
ca vic cng thm Zeffix vo mt t iu tr tiu chun vi IFN-a.
Nghin cu B3010 so snh n tr liu Zeffix vi n tr liu IFN-a vi tr liu kt hp Zeffix/IFNa nhng bnh nhn cha c iu tr vi interferon trc . Nghin cu AB3011 so snh
n tr liu Zeffix v tr liu kt hp Zeffix/IFN-a vi placebo bnh nhn khng c p ng vi
IFN-a trc .
p ng khng th HbeAg trong huyt thanh : iu tr Zeffix trong 1 nm dn n vic bin mt
HBeAg v t l p ng khng th HBeAg cng tng t nh t l thu c vi iu tr tiu
chun vi IFN-a (B3010) v cao hn so vi t l thu c t iu tr placebo (AB3011). T l p
ng khng th trong huyt thanh cho iu tr kt hp Zeffix/IFN-a cao hn so vi n tr liu
Zeffix hoc IFN-a bnh nhn cha c iu tr trc (B3010). Tuy nhin, s khc bit ny
khng c { ngha thng k trong phn tch ban u. iu tr kt hp khng c ch li g hn so
vi n tr liu Zeffix nhng ngi khng c p ng vi interferon (AB3011).
Trong cc th nghim lm sng vi Zeffix, n tr liu vi Zeffix hay IFN-a lm bin mt HBeAg
v t l p ng khng th cng tng t nh t l c bo co trong phn tch meta thng
k t cc s liu ca 15 nghin cu c lp vi nhau v tc dng ca IFN-a trn vim gan B.

Trong nghin cu A3010, HBeAg bin mt xy ra vi t l 32% v 11% bnh nhn c iu tr

tng ng vi Zeffix hay placebo. Trong nghin cu B3010, HBeAg bin mt xy ra vi t l 22%
trong c hai nhm dng Zeffix v IFN-a. Trong mt phn tch meta, s bin mt HBeAg xy ra
33% bnh nhn dng IFN-a v 12% bnh nhn khng c iu tr.
M hc ca gan : nhng ngi khng p ng vi IFN-a (AB3011), bnh nhn dng Zeffix cho
thy c kt qu xt nghim m hc ca gan c ci thin nhiu hn so vi placebo (p=0,002).
nhng bnh nhn cha c iu tr (B3010), c mt t l hi cao hn bnh nhn s dng
Zeffix cho ci thin m hc ca gan vo tun th 52 so vi bnh nhn s dng IFN-a hay kt
hp Zeffix/IFN-a. Zeffix cng cho thy t l p ng v m hc cao hn nhng bnh nhn ny
so vi iu tr kt hp Zeffix/IFN-a ; tuy nhin, cc sai bit sau cng ny khng c { ngha thng
k.
Trong xp loi khng phn bit cc mu sinh thit gan trc v sau iu tr, chng x ho tin
trin nng hn xut hin t hn bnh nhn dng Zeffix so vi bnh nhn dng IFN-a (B3010 :
p=0,051) hay iu tr kt hp Zeffix/IFN-a (AB3011 : p=0,027).
Bnh thng ha ALT : S bnh thng ha ALT trong huyt thanh ko di xy ra bnh nhn
dng Zeffix nhiu hn ng k so vi IFN-a, kt hp Zeffix/IFN-a hay placebo.
Ti pht HBV sau khi gh p gan : Khi khng iu tr, vim gan siu vi B nhng ngi c ghp
gan c lin quan n mt t l cao o thi phn ghp v c kh nng e da n tnh mng.
Vic s dng Zeffix iu tr hay d phng ti pht sau khi gh p c kho st trong cc
nghin cu m. Nhn chung, nhng bnh nhn ny cho p ng virus hc tng t nh nhng
p ng quan st c cc bnh nhn mc bnh nh hn, v ni chung n nh bnh v thi
gian sng c th k o di hn.
p ng vi Zeffix c kho st nhng bnh nhn ti pht HBV sau ghp gan. Phn tch
52 bnh nhn tham gia nghin cu hon tt iu tr 52 tun vi Zeffix cho thy rng 60% c
DNA HBV khng th pht hin c qua s lai ging phn tn (solution hybridisation), 31%
bnh nhn c xt nghim dng tnh ban u khng cn HBeAg v ALT huyt thanh tr v
bnh thng 29% bnh nhn. Sau 6 thng iu tr u tin, 52% bnh nhn c nh gi l
c hot tnh hoi t vim ca gan c ci thin qua nh gi xp loi m, v im s HAI ci
thin t tr trung bnh l 10 xung n 6,5 (p=0,003).
Mt nghin cu th nh (A2006) kho st xem iu tr vi Zeffix c ngn nga c ti pht
HBV sau khi cy ghp hay khng. Mt phn tch trung gian xem x t cc p ng ca 78 bnh
nhn c HBsAg dng tnh ang ch cy gh p gan dng Zeffix trc phu thut vi 38 ngi
chun b ghp gan. 38 ngi c gh p dng Zeffix 100 mg mi ngy mt ln trong khong
thi gian trung bnh l 32 ngy trc khi ghp v t nht 6 thng sau khi gh p. Zeffix c dung
np tt vi rt t tc dng ngoi { c xem l c th hay c kh nng lin quan n thuc
nghin cu.
Su thng sau phu thut, t l dng tnh HBeAg gim t 49% n 6% ; v t l dng tnh

HBV DNA (bng cch lai ging phn tn) gim t 29% n 0%. Yu t nh du virus gim trn
hu ht cc bnh nhn c s liu trong 1 nm sau khi phu thut. Thm vo , bilirubin huyt
thanh trung bnh, c gi tr l 4,8 mg/dl vo lc xt nghim, ci thin n 0,9 mg/dl 6 thng
sau khi cy ghp v vn duy tr thp trong mt nm sau.
Zeffix dng kt hp vi globulin min dch vim gan B (HBIg) cng cho thy lm ngn nga hay
lm chm ti pht HBV sau khi ghp gan trong mt nghin cu trn 14 bnh nhn c iu tr
c trc v sau khi gh p gan, HBV khng c pht hin bng PCR 13 bnh nhn cn sng st
(1 bnh nhn cht do cc nguyn nhn khng c lin quan) trong khong thi gian trung
bnh l 346 ngy sau khi ghp. Trung bnh 394 ngy sau khi ghp, cc gi tr AST, ALT, bilirubin
v alkaline phosphatase vn trong mc gii hn bnh thng cho 13 ngi sng st.
Khng phi tt c bnh nhn b bnh gan tin trin u c li trong vic iu tr vi Zeffix.
Trong mt vi trng hp bnh tin trin trc khi iu tr, bnh gan tin trin khng hi phc
n tnh trng cui cng hay cc bnh mc ng thi khc ngn chn khng cho ci thin trn
lm sng.
Cc nhim virus ng thi : iu tr lamivudine bnh nhn bnh nhn nhim ng thi HIV
v HBV c nghin cu trong cc th nghim iu tr HIV. Cc th nghim ny nghin
cu nh hng ca Epivir (lamivudine 150 mg hai ln mi ngy cho iu tr HIV) hn l ca
Zeffix (lamivudine 100 mg mi ngy mt ln cho iu tr vim gan B).
Mt nhm bnh nhn nhim ng thi HIV/HBV dng Epivir hai ln mi ngy (97 bnh nhn)
hay placebo (25 bnh nhn) trong 52 tun. Mt vi bnh nhn trong nhm iu tr Epivir cng
dng loviride, mt cht c ch reverse transcriptase non-nucleotide ; tuy nhin, cc s liu t
tt c cc bnh nhn dng Epivir u c tn tr so snh vi placebo, do loviride khng
c hot tnh trn HBV in vitro.
Vo cui giai on iu tr 52 tun, cc bnh nhn c iu tr vi Epivir gim 2,7 log trn
nng HBV DNA huyt thanh trung bnh, so vi khng thay i g nhm dng placebo. Nng
ALT huyt thanh trung bnh c ci thin t 74,7 n 54,7 n v/l trong nhm Epivir, v c
rt t thay i trong nhm placebo (68,2 - 74,9 n v/l). Thm vo , 22% bnh nhn trong
nhm Epivir v khng c ngi no trong nhm dng placebo khng cn pht hin c
HBeAg.
Cc kt qu ny cng tng t nh kt qu c bo co ni khc v gi rng hot tnh
khng HBV ca lamivudine bnh nhn nhim ng thi HIV cng tng t nh bnh nhn
ch nhim HBV. Tuy nhin, cn c nghin cu su hn xc nh xem vic gim virus c dn
n s ci thin bnh gan do HBV hay khng.
Cha xc nh c hiu qu ca Zeffix trong iu tr bnh nhn vim gan siu vi B mn tnh
nhim ng thi HCV hay HDV.
DC NG HC
Trong cc t bo 2.2.15, Zeffix triphosphate c thi gian bn hy l 17 - 19 gi, lu hn khong

3 gi so vi thi gian bn hy trong huyt thanh ca Zeffix t do ngi. S hin din lu

trong t bo ny ca Zeffix l do qu trnh phosphoryl ha ngn chn s lan ta t do ca thuc
ra ngoi t bo, v c th c lin quan n tc dng khng virus mnh tng t thy c
ngi sau liu mi ngy mt ln so vi mi ngy hai ln.
Zeffix c hp thu tt v c kh dng sinh hc tuyt i cho tt c cc dng ung khong
80 - 85%. iu chnh liu ch cn thit cho bnh nhi v nhng bnh nhn b suy thn trung bnh
n nng.
c tnh : Zeffix c dung np tt trong tt c cc nhm bnh nhn c nghin cu. Trong
th nghim lm sng pha II v III, khng c s gia tng t l hay thay i v bn cht cc tc
dng ngoi { do gia tng liu lng hay thi gian iu tr. Trong cc th nghim lm sng, rt
him khi phi ngng iu tr Zeffix do tc dng ngoi .
Tnh an ton tin lm sng : S liu tin lm sng thu c t mt dy cc test in vitro v trn
th xc nh tnh an ton tt ca Zeffix trc khi s dng trn ngi. Zeffix c dung np
tt trong cc nghin cu c tnh cp v c tnh vi liu lp li loi gm nhm, ch v kh
ui sc, nng trong huyt tng cao hn ng k so vi cc liu c s dng sau
trn lm sng. Trong cc nghin cu th vt ny, cc tc dng c lin quan n iu tr c
gii hn nhng thay i v huyt hc (gim s lng hng cu v bch cu trung tnh), ha
hc lm sng v phn tch nc tiu.
Zeffix khng cho thy bng chng kch ng mt v da, hay kh nng nhy cm do tip xc trong
cc kho st v tnh an ton th vt. Hn na, vi cc liu cao hn nhiu so vi liu cn thit
cho hot tnh khng virus trn lm sng, Zeffix khng nh hng ng k n h thng thn
kinh trung ng hay thn kinh t ng cng nh h tim mch hay h hp chut cng, mo
hoc ch.
Tnh an ton trn lm sng : Trong cc nghin cu pha I, tnh an ton v dung np cp tnh
c kho st sau khi dng thuc theo ng ung v tim tnh mch liu n Zeffix (n 4
mg/kg) hay liu lp li (n 8 mg/kg/ngy). Ch quan st c cc tc dng ngoi nh nh
nhc u v bun nn, v kh xc nh c mi lin quan nhn qu i vi thuc do khng c
s liu trn placebo. Khng c tc dng huyt ng hc no c { ngha trn lm sng (huyt p,
nhp tim), thay i trn in tm (EKG), hay thay i trn cc s liu v tnh an ton trong
phng th nghim. Cc liu n Zeffix c dung np rt tt nhng bnh nhn suy gan hay
suy thn.
Trong cc nghin cu lm sng pha III, t l tc dng ngoi { trong qu trnh iu tr cng tng
t nhau cho cc bnh nhn dng Zeffix v placebo, v hu ht u nh v khng c xem l
c lin quan n Zeffix. Phn tch cc phn nhm tc dng ngoi { c xem l c th lin quan
n thuc nghin cu hay do mi lin h khng xc nh c thy rng tn s xut hin cc
tc dng ny l tng t nh nhau bnh nhn dng Zeffix v placebo.
T l tc dng ngoi { trong qu trnh iu tr cc nghin cu pha III cao hn ng k trn cc

nhm iu tr c dng IFN-a. Tc dng ngoi cc bnh nhn dng IFN-a so vi iu tr kt

hp Zeffix/IFN-a cng tng t nhau.
Cc bt thng xt nghim : Bng sau cho thy t l bnh nhn c cc bt thng xt nghim
c hiu tng ng vi im c tnh 3 v 4, theo tiu chun b sung ca T Chc Y T Th
Gii. Trong qu trnh iu tr, t l bnh nhn b cc tc dng ngoi { ny l tng t nhau cho
c hai nhm Zeffix v placebo.
Tc dng ngoi trong cc nghin cu lm sng Pha III ca Zeffix : Cc tc dng c t l >=10%
trong qu trnh iu tr trong mi nhm iu tr*.
Tc dng ngoi

T l tc
dng ngoi
(% bnh
nhn)
Placebo
(n=200)

Zeffix
(n=416)

IFN-a
(n=70)

Zeffix + IFN-a
(n=139)

Kh v mt mi

28

26

70

66

Nhc u

21

22

47

63

Nhim virus ng h hp

17

19

37

29

Bun nn v nn ma

17

16

34

35

Kh chu v au bng

17

15

23

13

Nhim khun tai mi hng

12

14

Tiu chy

12

14

16

16

Nhim virus tai mi hng

11

11

au hng v amian

11

Ho

10

13

au c xng

10

11

17

au c

40

34

St

43

54

Chng mt

19

Ri lon gic ng

11

Nng enzyme bt thng

13

Bt thng xt nghim chc

nng gan

14

au c v thp khp

23

14

Ni ban da

10

Ri lon trm cm

13

11

C vn v n ung

33

27

Rng lng tc

23

29

C vn v th trng

16

Gim bch cu

<1

26

17

Thiu ht lng tiu cu

<1

<1

13

* S liu ca IFN-a v kt hp IFN-a/Zeffix ly t nghin cu 24 tun B3010 v AB3011 trong

thi gian iu tr kt thc cho cc nhm ny.S liu ca Zeffix v placebo ly t giai on
52 n 68 tun iu tr Zeffix ca nghin cu B3009, A3010, B3010 v AB3011.
Gia tng ALT sau iu tr : S sao chp HBV v ALT trong huyt thanh thng tr v mc
trc khi iu tr nu ngng dng Zeffix trc khi c p ng khng th HBeAg. t khi bnh
nhn ngng Zeffix b tng ALT huyt thanh sau iu tr vi mc vt qu nng trc khi
iu tr.
T l gia tng ALT sau khi iu tr >=2 x gi tr bt u cng tng t nhau trong s nhng bnh
nhn dng Zeffix, IFN-a hay kt hp IFN-a/Zeffix v ch hi cao hn so vi nhng bnh nhn
dng placebo. iu ny gi rng nhiu s gia tng nh ALT sau iu tr thy c trong cc
nghin cu ny c th lin quan n tnh trng dao ng bnh t nhin hn l do iu tr c
nhn.
So vi nhng bnh nhn c iu tr placebo, nhng bnh nhn dng Zeffix c t l hi cao
hn v tng ALT =3 x gi tr bt u (tng ng vi 3 im c tnh) v cc trng hp tng ALT

=2 x gi tr bt u, gn lin vi gi tr ALT tuyt i > 500 IU/l. Tuy nhin, c cc t l thp hn

tng t bnh nhn dng Zeffix hay placebo b tng ALT sau iu tr i km vi cc tc dng
ngoi lm sng trm trng, tng bilirubin hay cc du hiu khc ca suy gan. Trong thc t,
vic kim sot ALT c th gip pht hin d dng hn cc phn ng ny nu Zeffix c ngng
dng trc khi c p ng khng th HBeAg ; vic kim tra ny c th c bit c gi tr i vi
nhng bnh nhn b vim gan tin trin c d tr gan gim.
Cc dn s bnh nhn c bit : Tnh an ton ca Zeffix c xem xt trn vi tiu nhm dn
s bnh nhn b vim gan siu vi B mn tnh, bao gm nhng bnh nhi v nhng ngi b x
gan, bnh gan mt b v nhim HBV t bin. T l ton phn tc dng ngoi c th quy cho
Zeffix cng tng t nhau cho tt c cc nhm. Do , khng c bng chng lo ngi v tnh an
ton ca Zeffix c hiu cho cc phn nhm bnh nhn ny.
CH NH
iu tr vim gan siu vi B mn tnh bnh nhn c bng chng sao chp HBV.
CHNG CH NH
Qu mn vi thuc.
THN TRNG LC DNG
Sau khi ngng dng lamivudine, bnh nhn c th b ti pht vim gan siu vi B mn tnh, iu
ny c th gy hu qu nghim trng hn bnh nhn b bnh gan mt b. Nn theo di nh
kz trn lm sng v nh gi th nghim chc nng gan trong huyt thanh (nng ALT v
bilirubin) trong ti thiu 4 thng tm bng chng vim gan siu vi ti pht. Nn duy tr liu
lamivudine 150 mg x 2 ln/ngy bnh nhn nhim HIV ng thi, ang dng hay c k hoch
dng Epivir (lamivudine) hay Combivir (lamivudine/zidovudine). Nn thn trng cho ph n c
thai v nui con b.
TNG TC THUC
Zeffix c o thi qua thn bi s tit cation hu c hot ng. Cc thuc c o thi qua
ng ny, c bit l nhng trng hp c ch s iu tr thp, c th b tng tc thuc vi
Zeffix.
Trimethoprime, mt thnh phn ca cotrimoxazole lm tng 40% nng lamivudine huyt
tng. Tuy nhin, iu ny c xem l khng c { ngha trn lm sng v khng cn phi chnh
liu tr phi bnh nhn c suy thn.
Khng quan st c tng tc dc ng ng k no vi zidovudine hay IFN-a.
TC DNG NGOI
Kh , mt mi, nhim trng ng h hp, nhc u, kh chu v au bng, bun nn, nn,
tiu chy. Cc trng hp nhim acid lactic thng lin quan n chng gan to v thoi ha
m ti gan c bo co l c lin quan n vic dng phi hp iu tr nucleoside ng ng
bnh nhn nhim HIV.
LIU LNG v CCH DNG

Ngi ln v tr em trn 12 tui :

Liu khuyn co : 100 mg, mi ngy mt ln. Nn ngng dng Zeffix bnh nhn c p ng
min dch bnh thng khi xy ra p ng chuyn huyt thanh HBeAg v/hoc HBsAg
(seroconvertion).
Tr em di 12 tui :
3 mg/kg, mi ngy mt ln (ti a 100 mg/ngy).
Bnh nhn suy thn < 50 ml/pht : gim liu.

571.

ZENTEL

SMITHKLINE BEECHAM
vin nn 200 mg : v 2 vin, hp 1 v.
vin nn 400 mg : v 1 vin, hp 1 v.
hn dch ung 4% (w/v) : l 10 ml.
THNH PHN
cho 1 vin
Albendazole

200 mg

cho 1 vin
Albendazole

400 mg

cho 100 ml
Albendazole

4g

TNH CHT
Zentel c tc ng dit giun, trng v u trng nh c ch phn ng trng hp tubulin. Tc
ng ny ph v s chuyn ha ca giun, sn lm suy kit nng lng, t bt ng v tiu
dit cc giun nhy cm.
CH NH

Zentel l mt benzimidazole carbamate c hot tnh dit giun sn v ng vt n bo tc ng

trn cc k sinh trng ti m v ng rut :
Giun a (Ascaris lumbricoides), giun kim (Enterobius vermicularis), giun mc (Necator
americanus, Ancylostoma duodenale), giun tc (Trichuris trichiura), giun ln/giun ch
(Strongyloides stercoralis), sn di (Taenia spp v Hymenolepsis nana, ch trong trng hp
nhim k sinh phi hp), bnh sn l gan nh (Clonorchis sinensis), bnh sn Opisthorchis gan
(Opisthorchis viverrini) v bnh u trng da di chuyn ; bnh Giardia (G. gamblia, G. duodenalis,
G. intestinalis, Lamblia intestinalis) tr em.
CHNG CH NH
Khng nn dng trong thai kz hoc ph n nghi c thai.
Bnh nhn c tin s qu mn vi thuc (albendazole hoc cc t dc).
LC C THAI v LC NUI CON B
trnh s dng Zentel trong lc mi c thai, i vi ph n tui sinh sn nn bt u
dng thuc trong tun l u tin ca chu kz kinh nguyt hoc sau khi xt nghim thai m tnh.
Hin nay vic albendazole hoc cc cht chuyn ha ca n c tit ra trong sa m ngi vn
cha c bit r. Do , khng nn dng Zentel lc ang nui con b tr khi nhn nh li
ch iu tr nhiu hn nguy c c th gp phi khi dng thuc.
TNG TC THUC
Praziquantel c ghi nhn lm tng nng trong huyt tng ca cht chuyn ha c hot
tnh ca albendazole.
TC DNG NGOI
Cng nh cc benzimidazole khc, him khi xy ra cc triu chng ng tiu ha trn (nh
au thng v hoc au bng, bun nn, nn) v tiu chy khi dng thuc. Nhc u v chng
mt cng him gp. Cc tc dng ny cng xy ra khi b nhim giun, sn.
Cc phn ng d ng bao gm pht ban, nga v ni m ay cng c ghi nhn nhng rt
him.
Khng thy cc tc dng bt li nh hng ln kh nng li xe hoc vn hnh my.
LIU LNG v CCH DNG
Liu lng :
Liu dng

Thi gian
iu tr

Ch nh

Tui

- Giun a.
- Giun kim*.
- Giun mc.

Ngi ln v tr 400 mg (2 vin 200 mg hoc Liu duy nht

em > 2 tui
10 ml hn dch 4%)
Tr em t 1-2 tui 200 mg (1 vin 200 mg hoc Liu duy nht

- Giun tc

5 ml hn dch 4%)

- Bnh giun ln.

Ngi ln v tr 400 mg (nh trn)
- Bnh sn di Taenia. em > 2 tui
- Bnh sn
Hymenolepis**

1 liu/ngy x
3 ngy

- Bnh sn l gan nh Ngi ln v tr 400 mg (nh trn)

do Clonorchis.
em 2 tui
- Bnh sn Opisthorchis
gan

2 liu/ ngy x
3 ngy

- Bnh Giardia

1 liu/ ngy x
5 ngy

Ch tr 2-12 tui 400 mg (nh trn)

* khi bnh hon ton trong trng hp nhim giun kim, cn thc hin nhng bin php
gi v sinh trit v ng thi cng phi iu tr cho thn nhn v nhng ngi sng chung
nh.
** Trng hp xc nh nhim bnh sn Hymenolepis, cn ti iu tr sau 10- 21 ngy.
Cch dng :
Nu bnh nhn khng khi bnh sau 3 tun, ch nh liu iu tr th hai.
Khng cn p dng nhng bin php c bit nh nhn i hoc dng thuc x khi dng thuc.
Vin nn : c th c nhai hoc ung vi nc.
Hn dch : lc k chai trc khi dng.
QU LIU
Trong trng hp qu liu, nn iu tr triu chng (ra d dy) v cc bin php nng tng
trng.
BO QUN
Vin nn : bo qun < 30oC.
Hn dch : bo qun < 30oC v trnh nh sng mt tri trc tip.
Dng trc hn s dng c nu r trn nhn thuc

572.

ZEROCID

SUN PHARMA
Vin nang 20 mg : v 10 vin, hp 10 v.
THNH PHN
cho 1 vin
Omprazole

20 mg

T dc : Ht omeprazol IH.

DC LC
Omeprazole thuc nhm mi nhng hp cht chng s tit dch - nhng dn xut
benzimidazoly - khng biu hin tnh khng tit acetylcholine v khng H2 Histamine, nhng
ngn chn s tit Acid d dy bng tnh cht c ch c th ca h Enzyme H+K+Atpase b
mt tit dch ca nhng t bo thnh d dy. H enzym ny c xem nh mt bm acid
(proton) trong mng nhy d dy, nn Omeprazole l cht c ch bm acid, m d dy n
ngn chn bc cui cng trong qu trnh sn xut Acid, tc dng ny lin quan n liu lng
v dn n c ch c s tit Acid c bn ln kch thch m khng quan tm n tc nhn kch
thch.
DC NG HC
Cc nghin cu ch ra Omeprazole o thi nhanh khi huyt tng v c th tm thy trong
mng nhy d dy trong vng 1 ngy thm ch hn.
Sau khi ung thuc, Omeprazole bt u c tc dng chng tit dch trong vng mt gi v tc
dng ti a t c trong khong hai gi.Sau 24 gi, tc dng c ch tit dch cn khong 50%
mc ti a v thi c ch c th k o di hn mong i trong khi thi gian bn hy huyt
tng rt ngn (cha n mt gi ), r rng gy bi thi gian lin kt lu di gia Enzyme
H+/K+/ATPASE vi vch d dy. Khi ngng thuc, hot tnh tit dch tr li bnh thng sau 3
n 5 ngy. Tc dng c ch tit acid ca Omeprazole tng dn khi bt u ung liu n mi
ngy, t mc n nh sau 4 ngy. Vin n n Omeprazole c bc nang v hp th nhanh, mc
cao im trong huyt tng tng trong vng t 0.5 n 3.5 gi. Nng cao im trong huyt
tng l din tch di ng cong xp x t l vi liu lng cho ti 40mg, nhng do tc dng
vng chuyn th nht (first pass) bo ha nn nng cao im huyt tng v AUC cao hn
p ng tuyn tnh trong vng liu lng t 20 - 40 mg phn ln gy bi chuyn ha tin h
thng. nhng c th khe mnh, thi gian bn hy huyt tng t 0,5-1 gi, thanh thi trn
ton c th l 500 - 600 ml/pht. Lin kt protein xp x 95%. Kh dng sinh hc ca
Omeprazole tng nh khi liu lng tng nhanh. Phn ln liu lng (khong 77%) bi tit qua
nc tiu. Omeprazole c t nht 6 dng chuyn ha. Hai dng c bit l hydroxy-

omeprazole v acid carboxylic tng ng. Phn cn li ca liu thuc c th thu hi t phn.
Nh vy c s thi mt ng k ca cc chuyn ha trong huyt tng- dn cht Sulphide,
Sulphone ca Omeprazole v Hydroxy-omeprazole. Nhng dng chuyn ha ny khng c hoc
hot tnh rt thp.
nhng bnh nhn gan mn tnh, kh dng sinh hc c th tng ti 100% phn nh suy gim
tc dng vng chuyn th nht (first pass) v thi gian bn hy huyt tng tng ti gn 3
gi so vi ngi bnh thng ch t 0,5-1gi. Tc thanh thi huyt tng trung bnh 70
ml/pht trong khi ngi bnh thng l 500-600 ml/pht. Vi bnh nhn suy nng thn mn
tnh m thanh thi Creatinine t 10-62 ml/pht /1,73m2. Omeprazole c khuynh hng tng
t nh nhng ngi tnh nguyn khe mnh tuy nhin kh dng sinh hc c tng cht t.
Do bi tit qua nc tiu l con ng o thi c bn cc chuyn ha ca Omeprazole nn s
o thi Omeprazole t l vi tc thanh thi creatinine. i vi ngi gi, tc o thi
Omeprazole gim cht t trong khi tc dng sinh hc tng.
C TNH
Cc trng hp gy ung th, bin i gen di truyn v suy gim kh nng sinh sn :
Trong 2 th nghim 24 thng v kh nng gy ung th trn chut, liu lng Omeprazole ung
hng ngy l 1.7, 3.4, 12.8, 44.0 v 140.8 mg/kg/ngy sinh ra nhng t bo Calciroid ECL d
dy ph thuc vo liu lng c chut c ln chut ci, t l mc phi l cao hn ng k
chut ci, l gii c mc trong mu cao hn Calciroid ECL d dy him khi xy ra chut khng
iu tr Omeprazole xy ra s tng sn lng t bo ECL tt c cc nhm iu tr ca 2 gii
tnh.
Omeprazole khng gy t bin th nghim Ames Salmoella Typhimurium trong ng nghim,
th nghim t bo u lympho trong ng nghim, th nghim sai lc nhim sc th ty xng trn
c th sng. Kt qu nghin cu vi nhn mc 2000 ln liu lng cho ngi vi nhng ln ly
mu khc nhau (trong iu kin tt nht) vn cho kt qu m tnh.
th nghim v kh nng v qu trnh sinh sn chut, Omeprazole trong vng liu lng t
13,8-138 mg/kg/ngy l khng c v khng c hi n qu trnh sinh sn ca b m.
CH NH
iu tr ngn hn vi lot t trng hot ng.
Vin nang Omeprazole c ch nh iu tr ngn hn cho lot t trng hot ng. a s cc
bnh nhn iu tr trong 4 tun. Mt s bnh nhn i hi iu tr thm khong 4 tun.
Khng nn s dng Omeprazole nh mt tr liu thng xuyn diu tr bnh nhn lot t
trng.
Bnh vim thc qun d dy tro ngc (GERD) v vim lot thc qun nng.
Vin nang Omeprazole ch nh iu tr ngn hn (t 4 -8 tun). Bnh vim thc qun d dy
tro ngc hin tng (GERD) m nhng iu tr y t thng thng km hiu qu thng gm
1 qu trnh tch hp iu tr khng histamine th cm H2.

Cha xc nh tnh hiu qu ca vic iu tr Omeprazole lu hn 8 tun nhng bnh nhn

ny, trong s t trng hp m sau 8 tun iu tr bnh nhn khng p ng thuc th c th
iu tr thm 4 tun. Nu li xy ra hin tng GERD hoc nng m iu tr y t thng thng
km hiu qu th nn cn nhc iu tr ph thm t 4 -8 tun.Thuc ny khng c s dng
nh mt iu tr thng xuyn tnh trnh tng tit bnh l{. Vin nang Omeprazole c ch
nh cho iu tr di hn tnh trnh tng tit bnh hc (hi chng Zollinger - Ellison, u tuyn a
ni tit v u t bo bn h thng (Systemic Mastocytosis).
CHNG CH NH
Chng ch nh Omeprazole cho nhng bnh nhn c bit v qu nhy cm vi bt kz thnh
phn no ca cng thc ny.
THN TRNG LC DNG
Trong nghin cu di hn (2 nm) trn chut ch ra liu lng Omeprazole s dng lm tng
nguy c ung th d dy. Vi nhng ng gi ni soi c th v kim tra m nhng mu sinh
thit t d dy ngi th khng thy s nguy him no khi tip xc ngn hn vi Omeprazole.
Cn thm nhng s liu v con ngi lin quan n tc dng gim acid hydrocloric dch v v
tng tit dich v loi b kh nng tng nguy c ung th ngi iu tr di hn vi
Omeprazole.
i vi tr em : Cha xc lp c tnh an ton v hiu qu ca Omeprazole i vi tr em.
LC C THAI v LC NUI CON B
Lc c thai :
Cha c nhng nghin cu y ph n c thai. Ch s dng Omeprazole trong thi kz
mang thai khi m tc dng ca vic iu tr ln hn nhng nguy himtim tng cho thai nhi.
Lc nui con b :
Cha c kt lun Omeprazole c thi qua sa m hay khng. Song do nhiu loi thuc c
thi qua sa m v do kh nng gy ung th qua th nghim ca Omeprazole trn chut, nn
phi quyt nh hoc l ung thuc hoc l cho con b. C quan tm n tm quan trng ca
thuc i vi ngi m.
TNG TC THUC
Omeprazole ko di qu trnh o thi Diazepam Warfarin v Phenytoin l nhng thuc chuyn
ha bng con ng oxy ha gan. Thng thng khng thy c tng tc vi Theophylline
hay Propranaolol, nhng cng c mt s bo co v tng tc vi nhng thuc m chuyn
hathng qua h sc t t bo P-450 (Cyclosporin, Disulfiram). Nn theo di bnh nhn xc
nh c cn thit phi iu chnh liu lng ca nhng loi thuc ny khi ung cng vi
Omeprazole. Do tnh cht c ch su v ko di s tit acid d dy nn Omeprazole c th
gy nhiu cho s hp th nhng thuc m pH d dy l mt thng s quan trng trong kh
dng sinh hc ca chng (v d nh Ketoconazole, Ampicillin Ester v nhng mui st).
TC DNG NGOI

Ni chung, Omeprazole c dung np tt. C xy ra nhng tc dng ngoi sau khong 1%

bnh nhn iu tr vi Omeprazole : nhc u, tiu chy, au bng, bun nn, chng mt, i
ma, ni ban, bn ut, ho, suy nhc, au lng, y hi.
Mt s tc dng ph khc :
Mt s tc dng ph khc xy ra i vi 1% bnh nhn v i tng dng thuc trong v ngoi
nc, hoc xy ra t khi thuc c em ra th trng, c trnh by di y theo tng h.
Trong nhiu trng hp, mi lin h vi Omeprazole l khng r rng.
Ton thn : St, au nhc, mt mi, kh chu, trng bng.
Tim mch : au ngc hoc au tht, tng gim nhp tim, nh trng ngc, tng huyt p, ph
ngoi bin.
Tiu ha : Nhng bnh v gan bao gm vim gan, suy gan (him gp), tng ALT (SGPT), tng
lng AST (SGOT), tng lng cc cht nh g-Glutamyl Transpeptidase, Alkaline Phosphate,
chng vng da, bing n, kch thch i trng (rut kt), y hi, bin mu phn, bnh nm
Candidia thc qun, teo mng nhy li, kh ming.
Chuyn ha cht / dinh dng : H ng huyt, tng trng.
C bp: Chut rt, au c au khp, au chn.
H thn kinh : Ri lon tm l bao gm trm ut, nng ny, o gic, ln thn, mt ng, bn
chn, run ry, m mng, lo lng, mng m bt thng, d cm, lon cm.
H hp : chy mu cam, au hng.
Da : Vim da, ni ban, ph mch m ai, nga ngy, rng lng tc, da kh, lon tng tit m
hi.
Nhng cm gic khc : tai, l ming.
Tit niu - sinh dc : nhim ng tit niu, m niu vi m, tiu thng xuyn, huyt thanh
Creatinine tng, Protein niu, tiu ng, au tinh hon, v to ni bnh nhn nam.
Huyt hc : Quan st thy chng gim bch cu ht nam bnh nhn trn 65 tui b bnh tiu
ng dng nhiu th thuc cng Omeprazole. Mi quan h gia Omeprazole v chng mt
bch cu ht l cha r rng. Gim ton th huyt cu, gim lng tiu cu, gim bch cu
trung tnh, chng tng bch cu, thiu mu do tan mu.
T l mc hin tng y t ngoi bnh nhn trn 60 tui l tng t nh bnh nhn 65
tui v t hn.
LIU LNG v CCH DNG
Dng ung
iu tr ngn hn vi lot t trng hot ng: Ung 20 mg mt ln mi ngy. Hu ht cc bnh
nhn lnh bnh sau 4 tun. Mt s bnh nhn c th cn thm 4 tun tr liu.
iu tr vim thc qun d dy tro ngc (GERD) v vim lot thc qun nng: Ung hng
ngy t 4-8 tun, 20 mg / ngy.
Tnh trng tng tit bnh hc : Liu lng Omeprazole cho nhng bnh nhn tng tit bnh hc

thay i theo tng ngi. Liu khi u ngh l 60 mg mt ln mt ngy. iu chnh liu
lng theo nhu cu ca tng bnh nhn v nn tip tc nh ch nh y t. Liu ti 120 mg 3 ln
/ngy c k. Vi nhng liu hn 80 mg mt ngy nn chia ra ung. iu tr
Omeprazole vi mt s bnh nhn c hi chng Zollinger-Ellison lin tc hn 5 nm. Khng cn
thit iu chnh liu dng vi bnh nhn suy thn, suy gan hoc ngi ln tui.
Omeprazole nn ung trc khi n.
QU LIU
Cho ti nay, cha xy ra qu liu do c . Liu lng n 360 mg / ngy vn chp nhn c.
Cha c thuc gii c c tr. Omeprazole lin kt vi Protein mt cch ph bin do khng
th thm lc. Trng hp dng qu liu, nn s dng nhng iu tr triu chng v h tr.
BO QUN
Bo qun ni kh mt, trnh nh sng

573.

ZINACEF

GLAXOWELLCOME
bt pha tim bp, tnh mch 750 mg : hp 1 l bt.
bt pha tim bp, tnh mch 1,5 g : hp 1 l bt.
THNH PHN
cho 1 l
Cfuroxime sodique tnh theo cfuroxime

750 mg

(Na)

(38,62 mg)

cho 1 l
Cfuroxime sodique tnh theo cfuroxime

1,5 g

(Na)

(77,25 mg)

DC LC
Cfuroxime sodique l mt khng sinh c phalosporine c tc ng dit khun khng vi hu
ht cc b-lactamase v c hot tnh chng li nhiu vi khun gram dng v gram m. Thuc
c ch nh cho vic iu tr cc nhim trng trc khi nhn din c vi khun gy nhim

hay cc nhim trng do cc vi khun nhy cm. Thm vo , y l mt thuc d phng hu

hiu chng li cc nhim trng hu phu trong nhiu loi phu thut. Thng cefuroxime hu
hiu khi dng ring r, nhng khi thch hp, thuc c dng kt hp vi mt khng sinh
aminoglycoside hay lin kt vi mtronidazole (dng ung hay ta dc hay thuc tim), c
bit d phng trong phu thut kt trng (xem Ch { phng).
Vi sinh hc : cfuroxime sodique c hot tnh cao vi Staphylococcus aureus, bao gm cc
chng khng vi p nicilline (nhng khng gm cc chng khng mticilline him gp), S.
epidermidis, Haemophilus influenzae, Klebsiella sp, Enterobacter sp, Streptococcus pyogenes,
Escherichia coli, Streptococcus mitis (nhm viridans), Clostridium sp, Proteus mirabilis, Proteus
rettgeri, Salmonella typhi, S. typhimurium v cc Salmonella sp khc, Shigella sp, Neisseria sp
(bao gm cc chng N. gonorrhoeae sn xut b-lactamase) v Bordetella pertussis. Thuc cng
c hot tnh trung bnh ln cc chng Proteus vulgaris, Proteus morganii v Bacteroides fragilis.
DC NG HC
Nng ti a ca c furoxime t c trong vng 30-45 pht sau khi tim bp. Thi gian bn
hy trong huyt thanh sau khi tim bp hoc tim tnh mch l vo khong 70 pht. S dng
thuc ng thi vi probncide lm ko di s o thi ca khng sinh ny v to nn mt
nng ti a gia tng trong huyt thanh. C furoxime c thu hi gn nh hon ton di
dng khng i trong nc tiu trong vng 24 gi sau khi dng, phn ln c o thi trong 6
gi u. Khong 50% c o thi qua ng thn v khong 50% qua s lc cu thn. Nng
c furoxime vt qu mc c ch ti thiu i vi cc tc nhn gy bnh thng thng c
th t c xng, hot dch v thy dch. C furoxime i qua hng ro mu no khi mng
no b vim.
CH NH
Nhim trng ng h hp : vim ph qun cp v mn, dn ph qun bi nhim, vim phi do
vi trng, abcs phi v nhim trng phi hu phu.
Nhim trng tai mi hng : vim xoang, vim amygdale v vim hng.
Nhim trng ng tiu : vim thn-b thn cp v mn, vim bng quang v nhim trng niu
khng c triu chng.
Nhim trng m mm nh vim t bo, vim qung, vim phc mc v nhim trng vt
thng.
Nhim trng xng v khp : vim c xng v vim khp nhim khun.
Nhim trng sn ph khoa : cc bnh vim vng chu.
Bnh lu, c bit khi pnicilline khng thch hp.
Cc nhim trng khc bao gm nhim trng huyt v vim mng no.
D phng nhim trng trong phu thut bng, vng chu, chnh hnh, tim, phi, thc qun v
mch mu khi c nguy c tng nhim trng.
CHNG CH NH

Qu mn vi nhm cphalosporine.
THN TRNG LC DNG
Ni chung cc khng sinh cphalosporine c th dng mt cch an ton cho bnh nhn qu
mn vi pnicilline, mc d cc phn ng ch o c bo co. Nn thn trng khi ch nh
cho bnh nhn b phn ng phn v vi pnicilline.
Nn cn thn khi s dng cc khng sinh cphalosporine vi liu cao cho bnh nhn ang dng
ng thi thuc li tiu mnh nh furos mide, do s kt hp ny b nghi ng l gy nh hng
c hi ln chc nng thn. Kinh nghim lm sng vi Zinacef cho thy rng hu nh khng c
vn g khi dng thuc cc liu khuyn co. Zinacef khng can thip vo cc test da trn
men tm glucose niu. C th quan st c mt s can thip nh trong cc phng php
kh ng (test dng dung dch Benedict, Fehling, Clinitest). Tuy nhin, iu ny c th khng
dn n kt qu dng tnh gi to nh c th gp mt vi cphalosporine khc.
Phng php glucose oxydase hoc hexokinase c khuyn co xc nh nng glucose
trong mu/huyt tng trn bnh nhn dng Zinacef. Khng sinh ny khng can thip vo th
nghim picrate kim tm cratinine.
LC C THAI v LC NUI CON B
Khng c bng chng thc nghim v c tnh trn thai hay kh nng gy qui thai c quy
cho Zinacef, tuy nhin, ging nh mi thuc khc, nn dng thuc cn thn trong nhng thng
u tin ca thai kz.
TNG TC THUC
In vitro, tc ng ca cfuroxime sodique v cc khng sinh aminoglycoside dng kt hp cho
thy t nht cng c tc ng h tr vi mt vi bng chng thnh thong xy ra ca s hip
ng.
TC DNG NGOI
Tc dng ngoi ca Zinacef xy ra tng i khng thng xuyn v ni chung c tnh cht
thong qua v nh.
Cc phn ng d ng c bo co bao gm ni ban da (dt sn v my ay); st do thuc
v rt him khi phn ng phn v. Ging nh nhng khng sinh khc, s s dng ko di c th
a n tng sinh cc vi khun khng nhy cm nh Candida. C th xy ra ri lon ng tiu
ha bao gm nhng trng hp rt him cc triu chng vim kt trng gi mc xy ra trong
hay sau khi iu tr. Cc thay i ch yu trn nhng thng s huyt hc quan st trn mt vi
bnh nhn bao gm gim nng h moglobine v tng bch cu a osine, gim bch cu,
bch cu trung tnh v tiu cu. Kt qu dng tnh trong test Coombs c tm thy trn
mt vi bnh nhn c iu tr vi cfuroxime ; hin tng ny c th can thip vo s nh
du cho ca mu. Mc d i khi c s gia tng men gan trong huyt thanh hay bilirubine
huyt thanh thang qua, c bit bnh nhn c sn bnh gan t trc, nhng khng c
bng chng no v nh hng ln gan.

C th c mt vi thay i trong kt qu xt nghim sinh ha ca chc nng thn, nhng cc

thay i ny khng cho thy c tm quan trng v mt lm sng. Do cn thn, nn kim tra
chc nng thn nu c suy thn.
C th b au thong qua ti ni tim bp. iu ny ch xy ra khi dng cc liu cao. Tuy nhin,
y khng phi l mt l{ do ngng iu tr.
i khi chng vim tnh mch huyt khi c th i km vi tim tnh mch.
LIU LNG v CCH DNG
Liu khuyn co tng qut :
Ngi ln : nhiu nhim trng p ng vi liu tim tnh mch hay tim bp 750 mg ba ln
mt ngy. i vi nhng nhim trng nng hn, nn gia tng liu n 1,5 g tim tnh mch ba
ln mt ngy. Khong cch thi gian tim tnh mch hay tim bp c th gia tng thnh mi 6
gi nu cn thit, cho tng liu l 3-6 g mi ngy.
Tr em v tr cn rt nh : 30-100 mg/kg/ngy, chia lm 3 hay 4 ln. i vi hu ht cc trng
hp, liu 60 mg/kg/ngy l thch hp.
Tr s sinh : 30-100 mg/kg/ngy, chia lm 2 hay 3 ln. Trong tun tui u tin, thi gian bn
hy trong huyt thanh ca cfuroxime c th di hn 3-5 ln so vi ngi ln.
Lu : nn dng liu duy nht 1,5 g. C th chia lm hai mi tim 750 mg vo cc v tr khc nhau,
v d vo hai mng.
Vim mng no : Zinacef thch hp cho vic dng n c iu tr vim mng no nhim
khun do cc chng nhy cm. Cc liu lng sau c khuyn co dng :
Tr em v tr cn rt nh : tim tnh mch 200-240 mg/kg/ngy, chia lm 3 hay 4 ln. C th
gim liu xung tim tnh mch 100 mg/kg/ngy sau 3 ngy hay khi c ci thin.
Tr s sinh : liu khi u nn dng tim tnh mch 100 mg/kg/ngy. C th gim xung thnh
tim tnh mch 50 mg/kg/ngy khi c ch nh lm sng.
Ngi ln : tim tnh mch 3 g mi 8 gi. Cha c y s liu khuyn co liu lng cho
vic tim vo ng sng.
D phng : liu thng thng l tim tnh mch 1,5 g khi gy m cho phu thut bng, vng
chu v chnh hnh, nhng c th b sung thm hai liu tim bp tht 750 mg, vo lc 8 v 16
gi sau. Trong phu thut tim, phi, thc qun v mch mu, liu thng thng l tim tnh
mch 1,5 g cng vi gy m sau tip tc vi tim bp 750 mg ba ln mt ngy cho 24-48 gi
sau.
Trong thay khp ton b, c th trn 1,5 g bt cfuroxime vi mi gi polymer xi mng m thyl
m thacrylate trc khi thm monomer lng.
Liu lng dng trong trng hp suy thn : c furoxime c o thi qua thn. Do , ging
nh nhng khng sinh tng t, khuyn co nn gim liu Zinacef trn nhng bnh nhn suy
thn b vo s o thi chm ca n. Tuy nhin, khng cn thit phi gim liu khi thanh
thi cr atinine cao hn 20 ml/pht. ngi ln b suy thn ng k (thanh thi cratinine l

10-20 ml/pht), khuyn co dng liu 750 mg hai ln mi ngy ; vi suy thn nng (thanh thi
cr atinine di 10 ml/pht) 750 mg mt ln mi ngy l va . Bnh nhn ang lm thm
phn, nn dng thm 750 mg sau khi thm phn. Khi dng thm phn phc mc lin tc, liu
thch hp thng l 750 mg hai ln mi ngy.
Cch dng :
Tim bp : thm 3 ml nc ct pha tim vo 750 mg Zinacef. Lc nh s cho ra huyn dch trng
c.
Tim tnh mch : ha tan Zinacef trong nc ct pha tim t nht 6 ml cho 750 mg. Lc nh s
cho ra dung dch mu vng nht. Nhng s thay i v m ca mu sc khng c nh
hng n hiu qu v tnh an ton ca thuc. i vi truyn tnh mch ngn (nh ti a 30
pht), c th ha tan 1,5 g trong 50 ml nc ct pha tim. Cc dung dch ny c th tim thng
vo tnh mch hay qua ng ca b dy tim truyn nu bnh nhn ang c truyn dch.
Zinacef tng hp vi cc dnh tim truyn thng dng.
Ch khi s dng : khng nn trn ln Zinacef trong bm tim vi cc khng sinh
aminoglycoside.
QU LIU
Nng cfuroxime trong huyt thanh c th c lm gim bng thm phm.
BO QUN
Trnh nh sng.
Huyn dch Zinacef dng tim bp v dung dch tim tnh mch trc tip bo tn dc tnh
trong 5 gi nu c gi nhit di 25oC v trong 48 gi nu trong t lnh. Cc dung
dch ha long hn, ngha l 1,5 g thm 50 ml nc ct pha tim nc ct pha tim, vn bo
tn hot tnh tha ng trong 24 gi nu c gi di 25oC v trong 72 gi nu c gi
trong t lnh.
Dung dch v hn dch c pha c th b sm mu trong qu trnh bo qun.
1,5 g Zinacef c pha vi 15 ml nc ct pha tim c th cng thm vo thuc tim
mtronidazole (500 mg/100 ml) v c hai thuc bo tn hot tnh ca n cho n 24 gi nhit
di 25oC. 1,5 g Zinacef tng hp vi azlocilline 1 g (trong 15 ml) hay 5 g (trong 50 ml) cho
n 24 gi nhit 4oC hay 6 gi nhit di 25oC. Zinacef (5 mg/ml) trong thuc tim
xylitol 5% hay 10% trng lng/th tch c th c tn tr n 24 gi nhit di 25oC.
Zinacef tng hp vi cc dch truyn thng dng.
Thuc bo ton dc tnh n 24 gi nhit phng trong dung dch thuc tim NaCl 0,9%
trng lng/th tch, thuc tim 5% dextrose, 0,18% NaCl trng lng/th tch v 4% dextrose,
v hp cht sodium lactate (dung dch Hartmann). pH ca dung dch thuc tim sodium
bicarbonate 2,74% trng lng/th tch nh hng ng k n mu ca dung dch v do
khng khuyn co dng dung dch ny pha Zinacef. Tuy nhin, nu cn thit, c th cho
Zinacef qua ng ca b tim truyn bnh nhn ang c tim truyn sodium bicarbonate.

Tnh n nh ca Zinacef trong thuc tim NaCl 0,9% trng lng/th tch v trong 5% dextrose
khng b nh hng bi s hin din ca hydrocortisone sodium phosphate. Zinacef cng
tng hp vi dung dch nc cha 1% lignocaine chlorhydrate.

574.

ZINNAT

GLAXOWELLCOME
vin nn 125 mg : hp 10 vin.
vin nn 250 mg : hp 10 vin.
vin nn 500 mg : hp 10 vin.
bt pha hn dch ung 125 mg/5 ml : chai 50 ml.
bt pha hn dch ung dng gi 125 mg : hp 10 gi.
THNH PHN
cho 1 vin
Cfuroxime axetil tnh theo cfuroxime

125 mg

cho 1 vin
Cfuroxime axetil tnh theo cfuroxime

250 mg

cho 1 vin
Cfuroxime axetil tnh theo cfuroxime

500 mg

cho 1 mung lng 5 ml

Cfuroxime axetil tnh theo cfuroxime

cho 1 gi

125 mg

Cfuroxime axetil tnh theo cfuroxime

125 mg

PH KHNG KHUN
Cfuroxime axetil l tin cht ca mt khng sinh dit khun nhm cphalosporine l
c furoxime, khng vi hu ht cc b-lactamase v c hot tnh trn phn ln vi khun gram
dng v gram m.
Cfuroxime axetil c hot tnh dit khun in vivo ging hp cht gc ca n l cfuroxime.
Thuc c nhiu c tnh ch li v hu hiu vi tc ng dit khun chng li nhiu tc nhn gy
bnh thng thng, bao gm cc chng sn xut c b-lactamase.
Cfuroxime rt n nh vi cc b-lactamase ca vi khun, v do c tc ng ln nhiu chng
khng ampicilline hay amoxicilline. Tc ng dit khun ny t c l do c ch s tng
hp mng t bo bng cch gn kt vo cc prot ine ch thit yu.
- In vitro, c furoxime thng c hot tnh vi nhng vi khun sau :
Hiu kh gram m : Escherichia coli, Klebsiella sp, Proteus mirabilis, Providencia sp, Proteus
rettgeri, Haemophilus influenzae (bao gm cc chng khng ampicilline), Haemophilus
parainfluenzae, Branhamella catarrhalis, Neisseria gonorrhoeae (gm cc chng c sn xut
pnicillinase v khng sn xut pnicillinase)
Hiu kh Gram dng : Staphylococcus aureus v Staphylococcus epidermidis (bao gm cc
chng sn xut pnicillinase tr cc chng khng methicilline) Streptococcus pyogenes (v
nhng streptococci tn huyt beta), Streptococcus pneumoniae, Streptococcus nhm B
(Streptococcus agalactiae).
K kh : cu khun gram dng v gram m (gm Peptococcus v Peptostreptococcus spp). Trc
khun gram dng (bao gm Clostridium sp) v trc khun gram m (bao gm Bacteroides v
Fusobacterium spp), Propionibacterium sp.
- Nhng vi khun sau khng nhy cm vi cfuroxime : Clostridium difficile, Pseudomonas sp,
Campylobacter sp, Acinetobacter calcoacetinus, cc chng khng methicilline ca
Staphylococcus aureus v Staphylococcus epidermidis.
- Mt vi chng sau thng khng nhy cm vi cfuroxime : Streptococcus faecalis,
Morganella morganii, Proteus vulgaris, Enterobacter sp, Citrobacter sp, Serratia sp, Bacteroides
fragilis.
DC NG HC
Sau khi ung thuc, c furoxime axetil c hp thu qua ng tiu ha v nhanh chng b thy
phn nim mc rut v trong mu phng thch cfuroxime vo h tun hon.
Thuc hp thu tt nht khi c ung trong ba n.
Nng ti a trong huyt thanh (2-3 mg/l cho liu 125 mg, 4-6 mg/l cho liu 250 mg, 5-8 mg/l
cho liu 500 mg v 9-14 mg/l cho liu 1 g) t c vo khong 2-3 gi sau khi ung trong ba
n. Thi gian bn hy trong huyt thanh t 1 n 1,5 gi. Mc gn kt vi protine th hin

khc nhau t 33-50% ty theo phng php c dng.

Cfuroxime khng b chuyn ha v c o thi bi qu trnh lc cu thn v s thi ng
thn.
Dng prob n cide ng thi s lm tng din tch di ng cong n 50%.
Nng trong huyt thanh ca cfuroxime b gim bng thm phn.
CH NH
Nhim khun ng h hp di nh vim phi v vim ph khun cp.
Nhim khun ng h hp trn nh nhim khun tai, mi, hng v d nh vim tai gia,
vim xoang, vim amygdale v vim hng.
Nhim khun niu-sinh dc nh vim b thn, vim bng quang, vim niu o.
Nhim khun da v m mm nh bnh nht, m da, chc l.
Bnh lu, nh vim b thn v vim c t cung cp khng bin chng do lu cu.
CHNG CH NH
Mn cm bit vi cc khng sinh cphalosporine.
THN TRNG LC DNG
Thng thng, cc khng sinh nhm cphalosporine c th c dng mt cch an ton cho
bnh nhn mn cm vi pnicilline, mc d cng c mt s bo co v phn ng cho. Cn
ch { c bit khi dng cho bnh nhn b sc phn v vi cc pnicilline.
Ging nh nhng khng sinh khc, dng cfuroxime axetil di ngy c th a n tng sinh
cc vi khun khng nhy cm (Candida, Enterococci, Clostridium difficile), trng hp ny c
th phi ngng thuc.
Chng vim i trng gi mc c bo co khi dng khng sinh ph rng ; do , iu quan
trng l cn phi cn nhc khi chn on bnh bnh nhn b tiu chy trm trng trong hoc
sau qu trnh s dng khng sinh.
Cc phng php glucose oxidase hay hexokinase c khuyn co dng xc nh nng
glucose trong mu hay trong huyt tng cho bnh nhn dng cfuroxime axetil. Khng sinh
ny khng nh hng n xt nghim picrate kim cho cratinine.
LC C THAI v LC NUI CON B
Khng c bng chng th nghim no cho thy cfuroxime axetil c tc dng gy bnh phi hay
sinh qui thai. Tuy nhin, cng nh vi tt c cc thuc khc, nn cn thn khi dng trong
nhng thng u ca thai kz. C furoxime c bi tit qua sa m v do cn cn trng khi
dng c furoxime axetil cho ngi m cho con b.
TC DNG NGOI
Nhn chung, cc tc dng ngoi { do c furoxime axetil thng nh v ch ko di trong mt thi
gian ngn. Mt s t bnh nhn dng c furoxime axetil b ri lon tiu ha, bao gm tiu
chy, bun nn v nn ma. Cng nh vi cc khng sinh ph rng, cng c mt vi bo co
(rt him) v vim i trng gi mc. Nhc u cng c bo co.

Tng bch cu a osine v s gia tng thong qua ca cc enzyme gan [ALT(SGPT) v AST
(SGOT)+ c ghi nhn trong qu trnh iu tr bng Zinnat. Mt phn ng Coombs dng
tnh c bo co trong qu trnh iu tr bng cphalosporine ; hin tng ny c th can
thip vo th nghim cho ca mu.
LIU LNG v CCH DNG
Ngi ln : trong bnh vim ph qun v vim phi, nn dng 500 mg hai ln mi ngy. a s
cc nhim trng v tr khc s p ng vi liu 250 mg hai ln mi ngy. Trong nhim trng
ng niu, dng 125 mg hai ln mi ngy. Liu duy nht 1 g c khuyn co dng cho iu
tr bnh lu khng bin chng.
Tr em : liu thng thng l 125 mg hai ln mi ngy hay 10 mg/kg hai ln mi ngy ti ti a
250 mg/ngy. tr em 2 tui hay ln hn mc bnh vim tai gia, c th dng 250 mg hai ln
mi ngy hay 15 mg/kg hai ln mi ngy ti ti a 500 mg/ngy. Do c furoxime axetil c v
ng, khng nn nghin nt v do , dng vin khng thch hp cho bnh nhn khng th
nut vin thuc nh tr nh di 2 tui.
QU LIU
Qu liu cphalosporine c th gy kch thch no dn n co git.
Nng cfuroxime c th c gim bng cch thm phn mu hay thm phn phc mc.
BO QUN
Bo qun di 25oC. Khi nhit thp hn 30oC trong vng ti a hai thng cng khng
nh hng c hi n thuc.

575.

ZITHROMAX

PFIZER
c/o ZUELLIG
vin nn bao phim 500 mg : hp 3 vin.
bt pha hn dch ung 200 mg/5 ml : l 15 ml, tng ng 600 mg.
gi bt pha hn dch ung 100 mg : hp 6 gi.
THNH PHN
cho 1 vin
Azithromycine dihydrate

524,01 mg

ng vi : Azithromycine base

500 mg

cho 5 ml hn dch
Azithromycine dihydrate

209,64 mg

ng vi : Azithromycine base

200 mg

cho 1 gi
Azithromycine dihydrate

104,82 mg

ng vi : Azithromycine base

100 mg

DC LC
Azithromycin l khng sinh u tin nhm azalide. V mt ha hc, hp cht l dn xut do
thm mt nguyn t nitrogen vo vng lactone ca erythromycine A. Tn ha hc ca
azithromycin l 9-deoxy-9a-aza-9a-methyl-9a-homoerythromycine A. Trng lng phn t l
749,0.
C ch tc dng ca azithromycin l c ch tng hp protein vi khun bng cch gn vo tiu
n v ribosome 50s v ngn chn s chuyn v ca cc peptide.
In vitro, azithromycin cho thy c hot tnh chng li cc vi khun sau :
Vi khun Gram dng hiu kh : Staphylococcus aureus, Streptococcus pyogenes (streptococcus
huyt gii bta nhm A), Streptococcus pneumoniae, cc Streptococcus huyt gii alpha (nhm
viridans) v cc Streptococcus khc, v Corynebacterium diphtheriae. Azithromycin cho thy c
khng cho vi cc chng Gram dng khng vi erythromycine bao gm Streptococcus
faecalis (Enterococcus) v hu ht cc chng Staphylococcus khng methicilline.
Vi khun Gram m hiu kh : Haemophilus influenzae, Haemophilus para-influenzae, Moraxella
catarrhalis, Acinetobacter spp., Yersinia spp., Legionella pneumophila, Bordetella pertussis,
Bordetella parapertussis, Shigella spp., Pasteurella spp., Vibrio cholera v parahaemolyticus,
Plesiomonas shigelloides.
Tc ng ca azithromycin chng li Escherichia coli, Salmonella enteritidis, Salmonella typhi,
Enterobacter spp., Aeromonas hydrophila v Klebsiella spp. thay i nn cn phi thc hin
khng sinh . Proteus spp., Serratia spp., Morganella spp., v Pseudomonas aeruginosa
thng khng vi thuc.
Vi khun k kh : Bacteroides fragilis v Bacteroides spp., Clostridium perfringens, Peptococcus
spp., v Peptostreptococcus spp., Fusobacterium necrophorum v Propionibacterium acnes.
Cc vi khun ly nhim qua ng sinh dc : Azithromycin c tc ng trn Chlamydia
trachomatis v cng cho thy tc ng tt trn Treponema pallidum, Neisseria gonorrhoea v

Haemophilus ducreyi.
Cc vi khun khc : Borrelia burgdorferi (gy bnh Lyme), Chlamydia pneumoniae, Toxoplasma
gondii, Mycoplasma pneumoniae, Mycoplasma hominis, Ureaplasma urealyticum,
Pneumocystis carinii, Mycobacterium avium-intracellulare, Campylobacter spp. v Listeria
monocytogenes.
DC NG HC
ngi, sau khi ung, azithromycin c phn phi rng ri trong c th vi sinh kh dng
khong 37%. Nu dng thuc dng vin nang, thc n c th lm gim sinh kh dng n ti
thiu l 50%. Nng nh trong huyt tng t c sau 2-3 gi. Thi gian bn thi cui
cng trong huyt tng phn nh gn ng vi thi gian bn hy trong m l khong 2 n 4
ngy. ngi tnh nguyn ln tui (> 65 tui) sau khi dng thuc trong 5 ngy, phn din tch
di ng cong (AUC) hi cao hn so vi nhng ngi tr (< 40 tui), nhng iu ny
khng c { ngha lm sng v do khng cn thit phi chnh liu.
bnh nhn suy thn nh (thanh thi creatinine > 40 ml/pht), khng c bng chng thay i
ng k trn dc ng hc trong huyt thanh ca azithromycin khi so snh vi ngi c chc
nng thn bnh thng. Khng c s liu dc ng hc v s s dng azithromycin bnh
nhn c mc suy thn nng hn.
Trn nhng bnh nhn suy gan nh (nhm A) n trung bnh (nhm B), khng c bng chng
thay i ng k v dc ng hc huyt thanh ca azithromycin khi so snh vi ngi c chc
nng gan bnh thng. nhng ngi ny, mc tm thy azithromycin trong nc tiu hi
cao hn, c l l do b tr li vi s gim thanh thi gan.
Cc nghin cu dc ng hc chng minh c nng azithromycin cao hn ng k
trong m so vi trong huyt tng (gp 50 ln nng ti a quan st c trong huyt
tng), cho thy thuc c i lc cao vi cc m. Sau liu duy nht 500 mg, nng
azithromycin trong cc m ch nh phi, amian v tin lit tuyn vt qu MIC90 cho hu ht
cc vi khun gy bnh.
Khong 12% liu tim tnh mch c o thi trong nc tiu trong vng 3 ngy di dng
khng i ban u, phn ln c tm thy trong 24 gi u tin. Nng rt cao thuc di
dng khng i c tm thy mt cng vi 10 cht chuyn ha hnh thnh do s N-v Odemethyl ha, hydroxyl ha desosamine v vng aglycone, v bi s phn chia lin hp
cladinose. So snh kt qu sc k lng cao p v vi sinh hc cc m cho thy cc cht chuyn
ha khng c vai tr g trong hot tnh vi sinh ca azithromycin.
Trong cc nghin cu thc hin trn th vt, nng cao azithromycin c tm thy trong cc
thc bo. Trong cc mu thc nghim, nng cao azithromycin cng c phng thch khi c
thc bo ch ng nhiu hn so vi thc bo khng c kch thch. Trong cc mu th vt th
nghim, cc kt qu ny cho thy nng azithromycin cao ti v tr nhim khun.
AN TON TIN LM SNG

Trong cc nghin cu liu cao trn th vt, khi dng liu cao vi nng gp 40 ln so vi thc
nghim lm sng, azithromycin c ghi nhn gy chng nhim phospholipide c hi phc,
ni chung khng c di chng c tnh. Khng c bng chng no cho thy iu ny lin quan
vi vic s dng azithromycin liu bnh thng ngi.
CH NH
Zithromax c ch nh cho cc nhim khun do cc vi khun nhy cm; nhim khun ng
h hp di bao gm vim ph qun v vim phi, nhim khun da v m mm, vim tai gia
v nhim khun ng h hp trn bao gm vim xoang v vim hng/vim amian (Penicillin
thng l thuc c la chn trong iu tr vim hng do Streptococcus pyogenes, bao gm
c d phng st thp khp. Azithromycin ni chung c hiu lc lm sch vi khun
Streptococccus hu hng, tuy nhin, hin ti vn cha c s liu xc nh hiu lc ca
azithromycin trong ngn nga st thp).
i vi cc bnh ly truyn qua ng sinh dc nam v n, Zithromax c ch nh trong :
Nhim khun sinh dc khng bin chng do Chlamydia trachomatis.
Nhim khun sinh dc khng bin chng do Neisseria gonorrhoea khng a khng thuc (sau
khi loi tr nhim ng thi Treponema pallidum).
H cam mm do Haemophilus ducreyi.
D phng nhim Mycobacterium avium - intracellulare (MAC) bnh nhn nhim HIV dng
n c hay phi hp vi rifabutin.
Zithromax c ch nh trong vim kt mc do Chlamydia trachomatis (bnh mt ht).
CHNG CH NH
Chng ch nh s dng Zithromax nhng bnh nhn c tin s b qu mn vi azithromycin
hoc mi khng sinh macrolide khc.
CH PHNG v THN TRNG LC DNG
Ging nh erythromycin v cc macrolide khc, c bo co v cc phn ng d ng trm
trng him khi xy ra, bao gm ph mch v phn v (him khi gy t vong). Mt vi phn ng
vi azthromycin ny gy ra tnh trng ti pht nn cn phi theo di v iu tr trong thi gian
di hn.
Khng c s liu v s s dng azithromycin bnh nhn suy thn vi thanh thi creatinine
> 40 ml/pht., do nn cn thn khi k n Zithromax cho nhng bnh nhn ny.
Do gan l ng o thi chnh ca azithromycin, nn dng thuc cn thn cho bnh nhn suy
gan nng.
bnh nhn dng cc dn xut nm ca g, kh nng ng c nm ca g gia tng khi dng
chung vi mt vi khng sinh nhm macrolide. Khng c s liu v kh nng tng tc gia
nm ca g v azithromycin. Tuy nhin, do kh nng ng c nm ca g trn l thuyt, khng
nn dng ng thi hai thuc ny.
Ging nh cc khng sinh khc, nn quan st pht hin kp thi cc du hiu bi nhim do

cc vi khun khng nhy cm k c nm.

Tc dng ln kh nng li xe v vn hnh my mc :
Khng c bng chng rng Zithromax c tc ng ln kh nng li xe v vn hnh my mc ca
bnh nhn.
LC C THAI v LC NUI CON B
Cc nghin cu v sinh sn ng vt cho thy azithromycin qua c nhau thai nhng khng
c bng chng tc dng gy hi cho thai nhi. Khng c s liu v s bi tit qua sa m. Tnh an
ton khi s dng trong lc mang thai v nui con b ngi cha c xc nh. Do , ch
nn s dng Zithromax cho ph n c thai hay ang nui con b khi khng c thuc khc thch
hp hn.
TNG TC THUC
- Cc thuc khng acid : Nghin cu dc ng hc v hiu lc ca thuc khng acid dng ng
thi vi azithromycin khng cho thy nh hng ln sinh kh dng ton phn mc du nng
nh trong huyt thanh gim n 30%. bnh nhn cn dng c Zithromax v thuc khng
acid, khng nn dng hai thuc ny ng thi.
- Carbamazepine : Trong nghin cu tng tc dc ng ngi tnh nguyn khe mnh,
khng quan st thy tc dng ng k no trn nng trong huyt thanh ca carbamazepine
v cc cht chuyn ha c hot tnh ca n bnh nhn dng ng thi vi Zithromax.
- Cimetidine : Trong nghin cu dc ng v tc dng ca liu n cimetidine s dng 2 gi
trc khi dng azithromycin cho thy khng c thay i g trn dc ng hc ca
azithromycin.
- Cyclosporin : Khng c s liu v co git t cc nghin cu lm sng hay dc ng hc v kh
nng tng tc thuc gia azithromycin v cyclosporin, nn cn thn trng khi dng ng thi
hai thuc ny. Nu cn phi phi hp hai thuc, nn kim tra nng cyclosporin v iu chnh
liu cho thch hp.
- Digoxin : Mt vi khng sinh macrolide c bo co l lm gim chuyn ha vi sinh ca
digoxin trong rut ca mt vi bnh nhn. nhng bnh nhn dng ng thi Zithromax, mt
khng sinh azalide, v digoxin nn lu { n kh nng tng cao nng digoxin.
- Nm ca g : Kh nng ng c nm ca g trn l thuyt t ra vn chng ch nh s
dng ng thi Zithromax vi cc dn xut nm ca g (xem Thn trng lc dng)
- Methylprednisolone : Trong nghin cu tng tc dc ng hc ngi tnh nguyn khe
mnh, Zithromax khng nh hng ln dc ng hc ca methylprednisolone.
- Theophylline : Khng c bng chng v tng tc dc ng hc gia Zithromax v
theophylline khi s dng ng thi ngi tnh nguyn khe mnh.
- Thuc chng ng loi coumarin : Trong cc nghin cu tng tc dc ng hc,
azithromycin khng lm thay i tc dng khng ng ca warfarin khi dng liu duy nht 15
mg warfarin nhng ngi tnh nguyn khe mnh. S dng ng thi Zithromax v thuc

chng ng loi coumarin gy tng hin tng chng ng c bo co, do cn kim

tra thng xuyn thi gian prothrombine.
- Zidovudine : Liu duy nht 1000 mg v a liu 1200 mg hay 600 mg azithromycin khng nh
hng c ng hc huyt tng hay s bi tit qua ng tiu ca zidovudine hoc cht
chuyn ha glucuronide ca n. Tuy nhin, dng azithromycin lm gia tng nng zidovudine
phosphoryl ha, cht chuyn ha hot ng trn lm sng, trong cc t bo n nhn mu
ngoi bin. ngha lm sng ca iu ny khng r rng, nhng c th c li cho bnh nhn.
- Didanosin : Cho 6 ngi dng liu 1200 mg azithromycin mi ngy cng vi didanosin khng
thy nh hng dc ng hc ca didanosin khi so snh vi gi dc.
- Rifabutin : Dng chung azithromycin vi rifabutin khng nh hng nng huyt thanh ca
cc thuc.
Gim bch cu trung tnh c nhn thy trn bnh nhn c iu tr phi hp
azithromycin v rifabutin. Mc d gim bch cu ht i km vi vic s dng rifabutin, nhng
mi lin h nhn qu vi vic phi hp cng azithromycin vn cha c xc nh (xem phn
Tc dng ngoi ).
TC DNG NGOI
Zithromax c dung np tt, tc dng ngoi c tn sut thp.
Tc dng ngoi ch yu xy ra ng tiu ha nh chn n, bun nn, i ma/tiu chy
(him khi dn n s mt nc), tiu phn lng, kh tiu, kh chu bng (au/co tht), to
bn v y bng thnh thong xy ra.
Gim thnh lc c bo co xut hin vi cc khng sinh macrolide, bao gm nghe kh,
ic hay tai mt vi bnh nhn dng azithromycin. Nhiu trng hp trong nhng bnh
nhn ny suy gim thnh lc l do s dng thuc ko di vi liu cao trong cc nghin cu.
Trong cc trng hp ny, thng thy cc tc dng ngoi { c hi phc sau .
C nhng bo co cc trng hp him v ri lon v gic.
Cc trng hp bt thng chc nng gan bao gm vim gan v vng da mt c bo
co. Him c hoi t v suy gan gy t vong nhng mi lin quan nhn qu vn cha c xc
nh.
Chong vng/chng mt, co git (nh quan st c vi cc macrolide khc), nhc u v
bun ng c bo co.
Cn gim bch cu trung tnh nh, thong qua i khi xut hin trong cc th nghim lm sng
mc d cha xc nh c mi lin quan nhn qu vi Zithromax.
Cc phn ng d ng bao gm ni ban, nhy cm vi nh sng, au khp, ph n, my ay, ph
mch v phn v (him khi gy t vong) (xem Thn trng lc dng).
Him khi c phn ng da trm trng bao gm ban a dng, hi chng Stevens-Johnson v
hoi t thng b nhim c.
nh trng ngc v ri lon nhp tim bao gm nhp nhanh tht ( thy vi cc macrolide khc)

 c bo co mc d cha xc nh c mi lin quan nhn qu vi azithromycin.

Chng suy nhc c bo co mc d cha xc nh c mi lin quan nhn qu.
Vim thn m k v suy thn cp. au khp. Kch ng, lo u. Vim m o.
LIU LNG v CCH DNG
Liu lng :
Zithromax nn dng liu duy nht trong ngy. Thi gian dng ty thuc vo nhim khun nh
hng dn di y.Vin nn, bt pha hn dch ung Zithromax c th s dng cng vi thc
n.
Ngi ln :
i vi bnh ly truyn qua ng sinh dc do Chlamydia trachomatis, Haemophilus ducreyi
hay Neisseria gonorrhoea nhy cm, dng 1 g liu duy nht.
iu tr mt ht do Chlamydia trachomatis :
Ngi ln : 1 g liu duy nht.
Tr em : 20 mg/kg/liu duy nht.
Cc ch nh khc, tng liu 1,5 g c cho 500 mg/ngy, trong 3 ngy.
Ngi gi :
S dng liu ging nh liu dnh cho ngi ln.
Bnh nhn suy thn :
C th dng liu dnh cho bnh nhn c chc nng thn bnh thng ngi suy thn nh
(thanh thi creatinine > 40 ml/pht). Khng c s liu v s s dng azithromycin trn bnh
nhn c mc suy thn nng hn (xem Thn trng lc dng).
Bnh nhn suy gan :
C th dng liu dnh cho bnh nhn c chc nng gan bnh thng ngi suy gan (xem
Thn trng lc dng).
Tr em :
Tng liu tr em l 30 mg/kg, c cho liu duy nht mi ngy l 10 mg/kg/ngy trong 3
ngy.
i vi tr em cn nng di 15 kg, nn dng hn dch ung Zithromax vi liu lng c tnh
tht k bng cch dng ng bm lng c sn trong hp. i vi tr cn nng 15 kg hay hn, c
th dng hn dch ung Zithromax (s dng mung lng c sn) hay dng gi bt ung cho tr
em Zithromax theo hng dn nh sau :
Dng hn dch ung Zithromax :
Trng lng
(kg)

Phc trong 3 ngy

L bt 600 mg

Gi 100 mg

< 15

10 mg/kg/mt ln mi ngy x 3 ngy

10 mg/kg/mt ln mi ngy x 3
ngy

15-25

200 mg (5 ml)/mt ln mi ngy x 3

ngy

2 gi/mt ln mi ngy x 3
ngy

26-35

300 mg (7,5 ml)/mt ln mi ngy x 3 3 gi/mt ln mi ngy x 3

ngy
ngy

36-45

400 mg (10 ml)/mt ln mi ngy x 3 4 gi/mt ln mi ngy x 3

ngy
ngy

> 45

Dng liu nh ngi ln

Ch nn dng vin nn Zithromax cho tr em cn nng hn 45 kg.

Cch dng :
Bt pha hn dch ung : M np l bt ra. i vi l 600 mg, thm 9 ml nc ; l 900 mg, thm
12 ml nc ; l 1200 mg, thm 15 ml nc. Lc k. Lc trc khi s dng.
i vi tr em c cn nng trn 15 kg, hn dch Zithromax nn c o lng cn thn bng
ng lng liu ung v i vi tr em c cn nng bng hay hn 15 kg, hn dch Zithromax nn
c o bng cch dng mung thch hp.
Gi bt pha hn dch ung : Ha tan bt thuc trong mt ly va nc, khuy u ri ung.
Vin nn : Nn nut trn vin nn Zithromax.
QU LIU
Tc dng ngoi khi dng liu cao tng t nh khi dng liu bnh thng. Trong trng hp
qu liu, p dng cc bin php h tr tng qut v iu tr triu chng.
BO QUN
Hn dng :
- Bt pha hn dch ung : 2 nm vi bt kh v 5 ngy vi bt pha.
- Vin n n : 2 nm
Thn trng c bit khi bo qun :
- Bt pha hn dch ung : Bo qun bt v hn dch sau khi ha tan di 30oC.
- Vin nn : Bo qun di 30oC.

576.

ZOVIRAX

GLAXOWELLCOME
vin nn 200 mg : hp 25 vin - Bng B.
vin nn 800 mg : hp 35 vin - Bng B.
hn dch ung 200 mg/5 ml : chai 125 ml - Bng B.
bt pha dung dch tim truyn tnh mch 250 mg : hp 5 l - Bng B.
kem 5% : ng 2 g.
thuc m tra mt 3% : ng 4,5 g - Bng B.
THNH PHN
cho 1 vin
Acyclovir

200 mg

cho 1 vin
Acyclovir

800 mg

cho 5 ml hn dch
Acyclovir

200 mg

cho 1 l
Acyclovir

250 mg

cho 100 g kem

Acyclovir

5g

cho 100 g thuc m

Acyclovir

3g

DC LC
Acyclovir l mt ng ng purine nucleoside tng hp vi cc tc ng c ch in vitro v in
vivo chng li virus gy bnh herpes ngi, bao gm virus Herpes simplex (HSV) loi 1 v 2,
Varicella zoster (VZV), Epstein Barr (EBV), v Cytomegalovirus (CMV). Trong mu cy t bo,
acyclovir c tc ng khng virus mnh nht vi HSV-1, sau l HSV-2, VZV, EBV v CMV (theo
th t gim dn v hiu nng tc ng).
Tc ng c ch ca acyclovir i vi HSV-1, HSV-2, VZV, EBV v CMV l tc ng c ch c tnh
chn lc cao. Men thymidine kinase (TK) ca cc t bo bnh thng, khng b nhim virus
khng dng aciclovir mt cch hu hiu nh mt cht c s, do c tnh nh hng ln t
bo k ch l ng vt c v thp ; tuy nhin, TK m ha bi HSV, VZV v EBV chuyn i
acyclovir thnh acyclovir monophosphate, mt ng ng nucleoside, cht ny sau chuyn
thnh dng diphosphate v cui cng thnh triphosphate di tc dng ca cc men t bo.
Acyclovir triphosphate tng tc vi men AND polymerase ca virus v c ch s sao chp ADN
virus v kt thc chui phn ng tng hp sau khi gn kt vo ADN ca virus.
iu tr ko di hay lp i lp li vi acyclovir bnh nhn b suy gim min dch trm trng c
th dn n s la chn cc dng virus gim tnh nhy cm, c th khng p ng vi iu tr
bng acyclovir. Hu ht cc virus c lp c trn lm sng c tnh nhy cm gim bt u
tng i thiu TK virus ; tuy nhin, cc dng c TK virus hay AND polymerase thay i cng
c bo co xut hin. In vitro, s x l cc virus HSV c lp bng acyclovir cng c th a
n s xut hin cc dng km nhy cm. Mi lin quan gia tnh nhy cm c xc nh in
vitro ca HSV c lp v p ng lm sng vi acyclovir khng r rng.
DC NG HC
Acyclovir ch c hp thu mt phn rut. Nng ti a trong huyt tng lc trng thi
n nh trung bnh (Cmax) sau cc liu 200 mg dng mi 4 gi l 3,1 mmol (0,7 mg/ml) v nng
ti thiu (Cmin) l 1,8 mmol (0,4 mg/ml). Cc nng Cmax tng ng sau cc liu 400 mg
v 800 mg dng mi 4 gi l 5,3 mmol (1,2 mg/ml) v 8 mmol (1,8 mg/ml), v Cmin tng ng
l 2,7 mmol (0,6 mg/ml) v 4 mmol (0,9 mg/ml).
ngi ln, thi gian bn hy cui cng trong huyt tng ca acyclovir sau khi tim tnh
mch vo khong 2,9 gi. Phn ln thuc c o thi thn di dng khng i. S
thanh thi thn ln hn nhiu so vi thanh thi cr atinine, iu ny cho thy rng s tit ra
ng thn cng vi qu trnh lc cu thn gp phn vo vic o thi thuc thn. 9carboxymthylguanine l cht chuyn ha duy nht c tc dng ca acyclovir v chim khong
10-15% liu dng c tm thy trong nc tiu. Khi acyclovir c ch nh dng 1 gi sau khi
ung 1 g probncide, thi gian bn hy cui cng v din tch di ng cong tng thm cc
gi tr tng ng l 18% v 40%.
ngi ln, nng Cmax sau khi tim truyn trong vng 1 gi cc liu 2,5 mg/kg, 5 mg/kg, v
10 mg/kg tng ng l 22,7 mmol (5,1 mg/ml), 43,6 mmol (9,8 mg/ml) v 92 mmol (20,7

mg/ml). Cc nng tng ng Cmin sau 7 gi l 2,2 mmol (0,5 mg/ml), 3,1 mmol (0,7 mg/ml)
v 10,2 mmol (2,3 mg/ml). tr trn 1 tui, cc nng trung bnh Cmax, Cmin cng c tm
thy khi cho liu 250 mg/m2 c dng thay v cho 5 mg/kg v liu 500 mg/m2 c dng th
cho 10 mg/kg. tr s sinh di 3 thng tui c iu tr vi cc liu 10 mg/kg qua ng
tim truyn trong vng 1 gi mi 8 gi, Cmax tm thy l 61,2 mmol (13,8 mg/ml) v Cmin l
10,1 mmol (2,3 mg/ml). Thi gian bn hy cui cng trn nhng bnh nhn ny l 3,9 gi.
ngi gi, thanh thi ton phn ca c th gim xung theo tui tc i km vi gim thanh
thi cratinine mc d c rt t thay i trong thi gian bn hy cui cng trong huyt tng.
bnh nhn suy thn mn tnh, thi gian bn hy cui cng trung bnh trong huyt tng l
19,5 gi. Thi gian bn hy trong thm phn mu ca acyclovir l 5,7 gi. Cc nng acyclovir
trong huyt tng gim xung khong 60% trong qu trnh thm phn. Nng trong dch no
ty t c vo khong 50% nng tng ng trong huyt tng. Lin kt ca thuc vi
protine huyt tng tng i thp (9- 33%) v tng tc thuc lin quan n s i ch ti
v tr gn khng c d on trc.
Acyclovir di dng thuc m tra mt nhanh chng c hp thu qua biu m gic mc v cc
m b mt ca mt cho h qu l nng gy c i vi virus t c trong thy dch.
Ngi ta khng th tm thy acyclovir trong mu bng nhng phng php hin hnh sau khi
dng ti ch thuc m tra mt Zovirax, tuy nhin cc du vt nh lng ca thuc c th
tm thy trong nc tiu. Tuy nhin, nhng nng trn khng c { ngha v mt tr liu.
Tnh gy qui thai : dng acyclovir ng ton thn trong nhng xt nghim theo tiu chun
c quc t chp nhn khng gy ra c tnh trn thai nhi v khng gy qui thai th, chut
ln v chut nht.
Tc ng trn kh nng sinh sn : cc tc ng ngoi c hi phc rng ri trn s sinh tinh bo
lin kt vi c tnh ton phn chut v ch c bo co xut hin ch khi dng cc lng
acyclovir vt qu rt nhiu nhng liu lng dng iu tr.
Cc nghin cu trn hai th h chut khng cho thy nh hng no ca acyclovir dng
ng ung ln kh nng sinh sn.
loi ngi, cha thy nh hng no trn kh nng sinh sn ca Zovirax ln ph n. Vin nn
Zovirax cho thy khng c tc dng xc nh no ln s lng, hnh thi v s vn ng ca tinh
trng ngi.
CH NH
Vin nn/Hn dch : Nhim virus herpes simplex da v nim mc, bao gm herpes sinh dc khi
pht v ti pht. Ngn chn vic ti nhim herpes simplex trn ngi c min dch bnh thng.
D phng herpes simplex bnh nhn suy gim min dch. Bnh zona (herpes zoster). Cc
nghin cu cho thy vic iu tr zona vi Zovirax trong giai on sm c nh hng c li trn
cm gic au v c th lm gim tn sut au dy thn kinh sau zona (au lin quan n zona).
Tim truyn tnh mch : Nhim herpes simplex virus, varicella zoster virus, d phng nhim

herpes simplex bnh nhn suy gim min dch, nhim herpes simplex tr s sinh.
Dng kem : Nhim virus herpes simplex da bao gm herpes mi v herpes sinh dc, khi pht
v ti pht.
Thuc m tra mt : vim gic mc do herpes simplex.
CHNG CH NH
Bnh nhn c bit l c qu mn vi acyclovir.
Dng kem : Qu mn vi propylenglycol.
THN TRNG LC DNG
Liu lng ca thuc tim truyn tnh mch Zovirax phi c iu chnh cho bnh nhn suy
thn trnh s tch t ca acyclovir trong c th (xem phn liu lng dng trong suy thn
trong phn Liu lng v Cch dng). bnh nhn dng Zovirax tim truyn tnh mch vi liu
cao hn (v d nh cho trng hp vim no do herpes), nn p dng cc bin php sn sc
c bit, nht l trong khi bnh nhn b mt nc hay suy thn.
Zovirax tim truyn tnh mch sau khi pha c pH vo khong 11 v khng nn dng ung.
Kem Zovirax khng c khuyn co dng cho nim mc, nh dng bn trong ming, mt, hay
m o. Nn c bit cn trng trnh trng hp v tnh a thuc vo trong mt.
Thuc m tra mt Zovirax : bnh nhn nn c thng bo rng c th b xt nh thong qua
ngay sau khi tra vo mt.
Tnh gy t bin gen : cc kt qu ca nhiu phng php nghin cu kh nng gy t bin
gen in vitro v in vivo cho thy rng acyclovir khng gy ra nguy c v di truyn cho ngi.
Tnh gy ung th : Acyclovir khng c tm thy c gy ung th trong nhng nghin cu lu
di trn chut ln v chut nht.
LC C THAI v LC NUI CON B
Cc s liu hin c v s s dng acyclovir trn ph n c thai vn cn hn ch. Do nn cn
trng cn nhc gia li ch iu tr v cc ngu nhin c th xy ra cho thai nhi.
Sau khi ung 200 mg Zovirax 5 ln mi ngy, acyclovir c tm thy trong sa cc nng t
0,6-4,1 ln nng tng ng trong huyt tng. Nng ny c th a vo cho tr b sa
m cc liu c th ln n 0,3 mg/kg/ngy. Do nn cn trng khi phi dng Zovirax cho ph
n cho con b.
TNG TC THUC
Prob n cide lm gia tng thi gian bn hy trung bnh v din tch di ng cong ca
acyclovir dng ton thn. Cc thuc gy nh hng n sinh l hc ca thn c kh nng lm
xo ng dc ng hc ca acyclovir. Tuy nhin, cc kinh nghim lm sng vn cha cho thy
thm nhng tng tc thuc khc vi acyclovir.
TC DNG NGOI
Vin nn/Hn dch : ni ban da c bo co xut hin trn mt vi bnh nhn s dng vin
nn v t khi khi ngng thuc. Cc tc dng trn ng tiu ha nh bun nn, nn ma, tiu

chy v au bng c bo co xut hin bnh nhn dng thuc vin nn. Trong nhng
th nghim m i dng gi dc c kim sot, tn sut cc biu hin ri lon trn ng
tiu ha tm thy khng khc bit nhau lm gia nhm dng gi dc v nhm dng acyclovir.
Cc phn ng thn kinh c hi phc, ng ch { l chng mt, tnh trng ln ln, o gic v
bun ng c bo co xut hin i lc, thng l vi bnh nhn suy thn hay c nhng
yu t to khuynh hng mc bnh.
Mt vi bo co v chng gia tng rng tc lan ta. Do loi chng bnh ny thng lin kt vi
nhiu loi thuc v cc tin trin bnh khc nhau, mi lin h gia biu hin ny vi liu php
acyclovir khng c chc chn.
Cn c nhng trng hp rt him c bo co xy ra vi ngi ung Zovirax bao gm vic
tng nh v thong qua bilirubine v cc men gan, tng nh urea v cratinine mu, gim nh
cc ch s huyt hc, nhc u, c nhng phn ng thn kinh nh c hi phc v mt mi.
Thuc tim truyn tnh mch : i khi c tng nhanh urea v cr atinine mu bnh nhn c
tim tnh mch Zovirax. S kin ny c cho rng l c lin quan n nng ti a trong
huyt tng v tnh trng thiu nc ca bnh nhn. trnh iu ny, thuc khng nn tim
tnh mch trc tip m phi tim truyn tnh mch chm hn mt gi. Nn gi cn bng nc
cho bnh nhn. Chng suy thn tng trong qu trnh tr liu vi Zovirax thng p ng nhanh
chng vi s b nc v/hoc gim liu hay ngng thuc.
Tuy nhin, tin trin dn n suy thn cp c th xy ra trong mt vi trng hp ngoi l.
Phn ng vim ti ch trm trng, i khi dn n s hy hoi da, xy ra khi Zovirax tim
tnh mch b tim truyn mt cch thiu thn trng vo m ngoi tnh mch.
Cc phn ng thn kinh c hi phc, v d nh ln ln, o gic, kch ng, run ry, bun ng,
lon tm thn, co git v hn m lin quan vi vic s dng Zovirax thuc tim tnh mch dng
tim truyn, thng xy ra trong nhng trng hp phc tp v mt y hc.
Bun nn v nn ma c bo co bnh nhn c tr liu bng Zovirax tim tnh mch.
Cc tc dng ngoi { khc c bo co bao gm tng men gan, gim cc ch s huyt hc
(thiu mu, gim tiu cu v gim bch cu).
Dng kem : cm gic rt bng v xt c th xy ra vi mt s bnh nhn khi bi thuc. Ni ban
hay nga cng c bo co xy ra trong mt s t bnh nhn.
Thuc m tra mt : mt s nh bnh nhn c th xut hin cm gic xt nh thong qua ngay
sau khi tra thuc vo mt. Bnh gic mc m nh nng cng c bo co. Du hiu ny
khng cn thit phi ngng thuc sm v s lnh khng c bin chng r rt.
Kch ng v vim ti ch, nh vim mi mt v vim gic mc c bo co xy ra bnh
nhn dng thuc m tra mt Zovirax.
LIU LNG v CCH DNG
1. Vin nn/Hn dch :
iu tr herpes simplex ngi ln : iu tr nhim herpes simplex, nn dng 200 mg

Zovirax 5 ln mi ngy cch khong 4 gi khi phi ung vo ban m. C th iu tr trong

vng 5 ngy, nhng c th phi k o di hn cho nhng nhin virus khi pht trm trng.
Trn nhng bnh nhn suy gim min dch trm trng (nh sau khi gh p ty) hay nhng bnh
nhn b gim hp thu rut, liu lng c th tng gp i thnh 400 mg hay c th thay i
bng cch xem x t dng ng tnh mch.
Nn bt u tr liu cng sm cng tt ngay khi nhim bnh ; cho nhng giai on ti pht, tr
liu nn p dng trong giai on tin triu hay ngay lc bt u xut hin sang thng.
Ngn chn herpes simplex ngi ln : ngn chn nhim herpes simplex bnh nhn c
kh nng min dch bnh thng, nn dng 200 mg Zovirax 4 ln mi ngy, cch khong 6 gi.
Nhiu bnh nhn thy tin li khi dng liu 400 mg 2 ln mi ngy cch khong 12 gi.
Gim liu xung cn 200 mg 3 ln mi ngy cch khong 8 gi hay thm ch 2 ln mi ngy cch
khong 12 gi cng c th cho kt qu hu hiu.
Mt vi bnh nhn c th b nhim t pht vi liu tng cng hng ngy l 800 mg.
iu tr nn dng li sau mi 6-12 thng quan st nhng thay i c th xy ra trong tin
trnh t nhin ca bnh.
Phng nga herpes simplex ngi ln : phng nga herpes simplex nhng bnh nhn b
tn hi v min dch, nn dng 200 mg Zovirax 4 ln mi ngy cch khong 6 gi.
nhng bnh nhn b suy gim min dch nghim trng (nh sau khi gh p ty) hay b gim hp
thu thuc rut, c th gp i liu ln 400 mg hay c th xem x t thay i bng phng php
tim tnh mch.
Thi gian dng thuc phng nga ty thuc vo thi kz c nguy c di hay ngn.
iu tr bnh zona (herpes zoster) ngi ln : iu tr bnh zona (herpes zoster), nn dng
800 mg Zovirax 5 ln mi ngy cch khong 4 gi, khi phi ung vo ban m. Nn iu tr
trong vng 7 ngy.
i vi nhng bnh nhn suy gim min dch nghim trng (nh sau khi gh p ty) hay b gim
hp thu rut, nn xem x t phng php dng tim tnh mch.
Nn bt u cng sm cng tt ngay sau khi nhim bnh ; iu tr c kt qu cng tt nu bt
u ngay khi khi pht ni ban.
Liu lng dnh cho tr em : i vi vic iu tr herpes simplex trng hp b suy gim min
dch, tr em trn 2 tui nn dng vi liu dng cho ngi ln v tr di 2 tui nn dng liu
bng mt na liu cho ngi ln. Cha c s liu c hiu v ngn chn nhim herpes simplex
hay iu tr bnh zona (herpes zoster) tr em c kh nng min dch.
Ngi gi : ngi gi, thanh thi ton phn acyclovir ca c th st gim song song vi
thanh thi cratinine. Nn duy tr b sung nc cho bnh nhn dng Zovirax vi liu cao. Nn
c bit ch gim liu bnh nhn suy thn.
Suy thn : trong vic kim sot nhim herpes simplex bnh nhn suy thn, liu khuyn co
dng ung khng a n s tch t acyclovir trn mc c xc nh l an ton khi tim tnh

mch. Tuy nhin, nhng ngi suy thn trm trng ( thanh thi cr atinine di 10
ml/pht) nn iu chnh liu thnh 200 mg 2 ln mi ngy, cch khong 12 gi. Trong iu tr
bnh zona (herpes zoster), nn dng 800 mg 2 ln mi ngy, cch khong 12 gi i vi bnh
nhn suy thn trm trng (thanh thi cr atinine di 10 ml/pht) v 800 mg 3 ln mi ngy,
cch khong 8 gi cho bnh nhn suy thn trung bnh (thanh thi cratinine trong khong 10-25
ml/pht).
2. Zovirax tim truyn tnh mch :
Liu lng dnh cho ngi ln : bnh nhn nhim herpes simplex virus (ngoi tr vim no
herpes) hay Varicella zoster virus (gy bnh thy u, zona) nn c cho thuc tim tnh mch
Zovirax dng tim truyn vi liu 5 mg/kg th trng mi 8 gi.
Bnh nhn suy gim min dch b nhim Varicella zoster virus hay bnh nhn vim no herpes
nn tim truyn tnh mch Zovirax vi liu 10 mg/kg th trng mi 8 gi nu khng b suy yu
chc nng thn.
Liu lng dnh cho tr em : liu Zovirax tim truyn tnh mch cho tr t 3 thng tui n 12
tui c tnh ton da trn c s din tch b mt c th.
Tr em nhim herpes simplex virus (tr vim no herpes) hay varicella zoster virus (gy bnh
thy u, zona) nn c tim truyn tnh mch Zovirax vi liu 250 mg/m2 c th mi 8 gi.
tr suy gim min dch b nhim Varicella zoster virus hay tr em b vim no herpes, nn
tim truyn tnh mch vi liu 500 mg/m2 c th mi 8 gi, nu chc nng thn khng b suy
gim.
Tr em b suy thn cn c dng liu c iu chnh thch hp tuz theo mc suy thn.
Liu lng cho tr s sinh : liu Zovirax tim truyn tnh mch tr s sinh c tnh ton da
trn c s trng lng c th. Tr s sinh nhim herpes simplex nn c tim truyn tnh
mch vi liu 10 mg/kg th trng mi 8 gi.
Liu lng dnh cho ngi gi : ngi gi, thanh thi acyclovir ton phn ca c th gim
song song vi thanh thi cr atinine. Nn c bit ch gim liu bnh nhn ln tui c suy
gim thanh thi cratinine.
Liu lng dnh cho trng hp suy thn : nn cn thn khi tim truyn tnh mch Zovirax cho
bnh nhn suy thn. Cc iu chnh sau c ngh p dng trong trng hp suy thn :
Bng 1
Thanh thi
cratinine Liu lng
(ml/pht)
20-50

Liu khuyn co nh trn (5 hay 10 mg/kg th trng), dng cch mi 12

gi.
10-25

Liu khuyn co nh trn (5 hay 10 mg/kg th trng) dng mi 24 gi.

bnh nhn b thm phn phc mc lin tc (CAPD), liu khuyn co

nh trn (5 hay 10 mg/kg th trng) nn chia phn na v dng cch
6 (v niu)khong 24 gi. bnh nhn c thm phn mu liu khuyn co nh trn
10
(5 hay 10 mg/kg th trng) nn chia phn na v dng mi 24 gi v sau
khi thm phn.
Thi gian iu tr vi phng php tim truyn tnh mch thng k o di trong 5 ngy, nhng
thi gian ny c th c iu chnh ty theo tnh trng v p ng ca bnh nhn vi tr liu.
iu tr vim no herpes v herpes simplex tr s sinh thng ko di 10 ngy.
Thi gian dng Zovirax tim truyn tnh mch trong phng nga c xc nh bi thi kz c
nguy c di hay ngn.
Pha ch : Thuc tim tnh mch Zovirax dng tim truyn nn c pha ch vi nc pha tim
theo tiu chun dc in Anh BP hay thuc tim tnh mch NaCl BP (0,9 % khi lng/th
tch) vi nhng th tch sau cho mt dung dch cha 25 mg acyclovir/ml :
Bng 2
Trnh by

Th tch dch dng pha

l 250 mg

10 ml

T liu lng c tnh ton, xc nh s lng v c l thuc thch hp phi dng. pha mi
l, thm th tch dung dch tim truyn vo v lc nh cho n khi ha tan hon ton.
Cch dng : Liu lng cn thit Zovirax tim tnh mch dng tim truyn nn c tim tnh
mch chm trn 1 gi.
Sau khi pha xong, thuc tim Zovirax dng tim truyn c th c dng bng mt bm tim
truyn c th kim tra tc .
Mt cch khc, dung dch pha xong c th pha long hn t c nng acyclovir khng
vt qu 5 mg/ml (0,5% khi lng/th tch) dng tim truyn.
Thm th tch dung dch pha cn thit vo dung dch tim truyn chn, theo nh khuyn
co di y, v lc k bo m phn tn hon ton.
i vi tr em v tr s sinh, cho cc trng hp ny nn gi th tch dch truyn mc ti
thiu c th, khuyn co dng dch pha long trn c s 4 ml dung dch pha (100 mg acyclovir)
c thm vo 20 ml dch truyn.
i vi ngi ln, nn dng ti dch truyn 100 ml, ngay c khi iu ny c th cho nng
acyclovir thp hn ng k so vi nng 0,5% khi lng/th tch. Do mt ti dch truyn

100 ml c th dng cho bt kz liu lng no trong khong 250 v 500 mg acyclovir (10 v 20
ml dung dch pha), tuy nhin phi dng thm ti dch truyn th hai cho cc liu trong khong
500 mg v 1000 mg.
Khi ha tan da theo cc cch khuyn co trn, thuc tim Zovirax dng tim truyn c bit
c tng hp vi nhng dung dch tim truyn sau v n nh n 12 gi nhit phng :
Dung dch tim truyn tnh mch NaCl BP (4,5% v 0,9 % khi lng/th tch) ; dung dch tim
truyn tnh mch NaCl (0,18% khi lng/th tch) v glucose (4 % khi lng/th tch) BP ;
dung dch tim truyn tnh mch NaCl (0,45% khi lng/th tch) v glucose (2,5% khi
lng/th tch) BP ; dung dch tim truyn kp Natri lactate BP (dung dch Hartmann).
Thuc tim tnh mch Zovirax dng tim truyn khi pha long vi phng cch nu trn s
cho mt nng acyclovir khng vt qu 0,5 % khi lng/th tch.
Do khng c cht bo qun khng li vi khun, s pha v ha long thuc phi c thc hin
trong mi trng hon ton v khun, ngay trc khi dng, v nn loi b mi dung dch khng
dng n. Nu dung dch b c hay xut hin tinh th trc hay trong khi tim truyn, nn loi
b ch phm ny.
3. Zovirax kem :
Cho ngi ln v tr em, nn bi 5 ln mi ngy cch khong 4 gi, khi dng vo ban m.
Kem Zovirax nn bi vo sang thng hay ni sang thng sp xy ra cng sm cng tt ngay
sau khi nhim. Vic iu tr cc giai on ti pht c bit quan trng cn bt u ngay trong
giai on tin triu hay ngay khi sang thng bt u xut hin.
Nn lin tc iu tr trong vng 5 ngy. Nu cha lnh, c th ko di tr liu thm n 10 ngy.
4. Thuc m tra mt Zovirax :
Cho ngi ln v tr em, tra vo ti cng kt mc mt lng thuc bp ra khong 10 mm, 5 ln
mi ngy cch khong 4 gi. Nn tip tc iu tr t nht 3 ngy sau khi lnh.
QU LIU
- Vin nn /Hn dch :
Acyclovir ch c hp thu mt phn qua ng tiu ha. Hu nh rt t khi tc dng gy c
trm trng xy ra khi dng mt liu ln n 5 g trong mt ln dng.
Cha c s liu v hu qu xy ra sau khi ung cc liu cao hn.
Cn theo di k cng bnh nhn trong trng hp ung vt qu 5 g acyclovir.
- Thuc tim tnh mch :
c trng hp cc liu tim tnh mch ln n 80 mg/kg th trng c dng mt cch bt
cn khng gy tc dng ngoi . Acyclovir c th thm phn c.
- Kem :
Khng c tc ng bt li no c thy khi mt ng thuc 10 g cha 500 mg acyclovir c n
ht. Cc liu 800 mg mi ngy (4 g/ngy) c dng trong 7 ngy m khng gy tc dng
ngoi .

BO QUN
Vin nn : Bo qun di 25oC v gi kh.
Hn dch : Bo qun di 25oC.
Kem : Bo qun di 25oC.
Thuc m tra mt : Bo qun di 25oC.
Hn dch Zovirax 200 mg/5 ml nn c pha long trong mt th tch tng ng xir hay
dung dch sorbitol 70% (khng tinh th ha). Sn phm ha tan n nh trong 4 tun 25oC,
nhng khuyn co nn dng cc dung dch va mi pha.
Thuc tim Zovirax dng tim truyn tnh mch khng cha cht bo qun chng vi khun. Do
, s pha v ha long thuc nn thc hin trong cc iu kin hon ton v trng hay ngay
trc khi dng v phi loi b mi dung dch khng dng n.
Cc dung dch pha hay ha long nn trong t lnh.
Kem Zovirax cha mt cht kim c bo ch c bit v khng nn ha long hay dng nh
mt cht nn phi hp vi cc thuc khc.
ng thuc m tra mt Zovirax b m qu 1 thng nn b i.

577.

ZYMOPLEX

LAPHAL
c/o HYPHENS
Vin nang : hp 30 vin, 90 vin.
THNH PHN
cho 1 vin
Phi hp cc enzyme tiu ha*

186,5 mg

Dimethicone 500 cSt

255,5 mg

* Thnh phn ca phi hp cc enzyme tiu ha :

- Amylase tuyn ty ngun gc heo.
- Enzyme c ngun gc vi nm (cellulase, amylase, protease t Aspergillus).
- Lipase c ngun gc vi nm (t Rhizopus).
- Glycine.
Bao gm cc tc ng :

- Tiu gii tinh bt : 30,80 mckatal (1850 U FIP).

- Tiu gii t bo : 0,86 mckatal (1120 U cellulasic).
- Tiu gii lipid : 21,70 mckatal (1300 U FIP).
- Tiu gii protid : 2,80 mckatal (170 U FIP).
Vin nang khng tan d dy do tc ng ca dung dch acetonic formaldehyd.
DC LC
Dimethicone : mng bo v chng y hi. Phi hp cc enzyme tiu ha c ngun gc vi nm
v ty tng.
CH NH
iu tr triu chng cc ri lon kh tiu.
LIU LNG v CCH DNG
4-6 vin/ngy, chia lm 2-3 ln, ung trc ba n.
Vin nang phi c ung, khng nhai, vi nc hay thc ung.

578.

ZYPREXA

ELI LILLY
Vin nn 5 mg : v 7 vin, hp 4 v.
Vin nn 10 mg : v 7 vin, hp 4 v.
THNH PHN
cho 1 vin
Olanzapine
T dc : sp carnauba, hp cht mu
trng (titanium dioxide E171, macrogol,
polysorbate 80), crospovidone, mc xanh
n c (c cha mu indigo carmine
E132), hydroxypropyl cellulose, lactose
monohydrate, magnesium stearate,
methylhydroxypropylcellulose,
microcrystalline cellulose.

cho 1 vin

5 mg

Olanzapine

10 mg

T dc : sp carnauba, hp cht mu
trng (titanium dioxide E171, macrogol,
polysorbate 80), crospovidone, mc xanh
n c (c cha mu indigo carmine
E132), hydroxypropyl cellulose, lactose
monohydrate, magnesium stearate,
methylhydroxypropylcellulose,
microcrystalline cellulose.

DC LC
Olanzapine l thuc chng lon thn c hot tnh dc l hc rng trn mt s h receptor.
Trong cc nghin cu tin lm sng, olanzapine c i lc (Ki ; < 100 nM) vi cc receptor ca
serotonin 5 HT2A/2C, 5 HT3, 5 HT6 ; dopamine D1, D2, D3, D4, D5 ; muscarinic M1-M5 ; adrenergic
a1; v histamine H1. Cc nghin cu v hnh vi ng vt cho thy olanzapine c tc dng i
khng vi 5HT, vi dopamine, v khng cholinergic, ph hp vi kh nng gn kt vo cc
receptor. Olanzapine c i lc mnh hn vi receptor ca serotonin 5HT2 in vitro so vi D2 v
hot tnh 5HT2 in vivo mnh hn so vi hot tnh D2. Cc nghin cu in sinh l{ chng minh
olanzapine gy gim mt cch chn lc s kch hot cc t bo thn kinh dopaminergic
mesolimbic (A10), nhng t c tc dng n th vn (A9) trong chc nng vn ng. Olanzapine
lm gim p ng n trnh c iu kin, l mt th nghim xc nh tc dng chng lon thn
khi dng liu thp hn liu gy ra chng gi nguyn th, l mt tc dng ph trn chc nng
vn ng. Khng ging nh mt s thuc chng lon thn khc, olanzapine gy tng p ng
trong mt th nghim "lm gim lo u".
Trong mt nghin cu liu ung duy nht (10 mg) dng phng php chp rngen ct lp pht
positron (Positron Emission Tomography, PET) nhng ngi tnh nguyn khe mnh,
olanzapine chim gi receptor 5HT2A nhiu hn so vi receptor dopamin D2. Hn na, mt
nghin cu hnh nh dng phng php chp rngen ct lp pht photon n in ton (Single
Photon Emission Computerised Tomography, SPECT) nhng ngi bnh tm thn phn lit
cho thy nhng ngi bnh p ng vi olanzapine chim gi D2 ca th vn t hn so vi
nhng nhng ngi bnh p ng vi risperidone v mt s thuc chng lon thn khc,
nhng tng ng vi nhng nhng ngi bnh p ng vi clozapine.
C hai trong hai th nghim c kim chng bng placebo v hai trong ba th nghim c kim
chng bng cht so snh trn 2.900 bnh nhn tm thn phn lit vi c hai triu chng dng
tnh v m tnh, thy olanzapine ci thin nhiu hn c { ngha thng k cc triu chng

dng tnh cng nh m tnh.

DC NG HC
Olanzapine hp thu tt khi ung, t nng nh trong huyt tng trong vng 5 n 8 gi.
Thc n khng nh hng n s hp thu. Cha xc nh sinh kh dng tuyt i ng ung
so vi ng dng tnh mch. Nng olanzapine trong huyt tng l tuyn tnh v t l vi
liu dng trong cc th nghim nghin cu c liu dng t 1 n 20 mg.
Olanzapine c chuyn ha ti gan qua c ch lin hp v oxy ha. Cht chuyn ha lu
thng chnh l 10-N-glucuronide, v khng qua c hng ro mu no. Cc cytochrom P450CYP1A2 v P450-CYP2D6 tham gia vo vic to ra cc cht chuyn ha N-desmethyl v 2hydroxymethyl. C hai cht chuyn ha ny u c hot tnh dc l hc in vivo thp hn nhiu
so vi olanzapine trong cc nghin cu trn ng vt. Tc dng dc l ch yu l do cht
olanzapine m. Sau khi dng ng ung, thi gian bn thi trung bnh ngi khe mnh
thay i ph thuc vo tui v gii tnh. Sau khi dng ng ung ngi khe mnh, thi
gian bn thi trung bnh l 33 gi (21 n 54 gi cho bch phn v th 5 n 95) v thanh
thi huyt tng trung bnh ca olanzapine l 26 L/gi (12 n 47 L/gi cho bch phn v th 5
n 95).
nhng ngi cao tui (65 v cao hn) khe mnh so vi nhng ngi tr tui, thi gian bn
thi trung bnh l ko di (51,8 so vi 33,8 gi) v thanh thi gim i (17,5 so vi 18,2 L/gi).
Cc thay i dc ng hc ngi cao tui vn nm trong phm vi thay i ca ngi tr
tui. 44 ngi bnh tm thn phn lit (65 tui), liu dng t 5 n 20 mg/ngy khng c s
khc bit no v cc tc dng ph.
ph n so vi nam gii, thi gian bn thi trung bnh l ko di (36,7 so vi 32,3 gi) v
thanh thi gim i (18,9 so vi 27,3 L/gi). Tuy nhin, an ton ca olanzapine (5-20 mg)
tng ng nhau nhng bnh nhn n (n=467) v nam (n=869).
Khng c s khc nhau ng k v thi gian bn thi trung bnh (37,7 so vi 32,4) hoc
thanh thi (21,2 so vi 25,0 L/gi) ca olanzapine gia ngi suy thn ( thanh thi creatinin <
10 mL/pht) vi ngi khe mnh. Khong 57% olanzapine c nh du bng cht phng x
c thi qua nc tiu, ch yu di dng cc cht chuyn ha.
ngi bnh ht thuc m c ri lon nh chc nng gan, thi gian bn thi trung bnh (39,3
gi) l k o di v thanh thi (18,0 L/gi) gim tng t nh i vi nhng ngi khe mnh
khng ht thuc (tng ng l 48,8 gi v 14,1 L/gi).
nhng ngi khng ht thuc so vi ht thuc (nam gii v n gii), thi gian bn thi trung
bnh l ko di (38,6 so vi 30,4 gi) v thanh thi gim (18,6 so vi 27,7 L/gi).
thanh thi huyt tng ca olanzapine thp hn ngi cao tui so vi ngi tr tui, n
gii so vi nam gii, v ngi khng ht thuc so vi ngi ht thuc. Tuy nhin, mc nh
hng ca tui tc, gii tnh, hoc ht thuc n thanh thi v thi gian bn thi ca
olanzapine l nh khi so snh vi s khc nhau chung gia cc c th.

Trong mt nghin cu ngi Caucasian, Nht Bn v Trung Quc, khng c s khc nhau v
cc thng s dc ng hc gia ba nhm ngi ny.
Khong 93% olanzapine gn kt vi protein huyt tng khi nng t 7 n 1000 ng/mL.
Olanzapine gn kt ch yu vi albumin v a1-acid-glycoprotein.
AN TON TIN LM SNG
c tnh cp (Liu duy nht) :
Nhng du hiu c tnh ng ung nhng ng vt gm nhm l c im ca nhng hp
cht chng lon thn mnh : gim hot ng, hn m, run ry, co git rung, chy nc bt, v
gim tng trng lng. Liu gy t vong 50% l khong 175 mg/kg chut cng v 210 mg/kg
chut nht. Ch dung np c liu ung duy nht n 100 mg/kg m khng c t vong.
Nhng du hiu lm sng bao gm an thn, mt iu ha c, run ry, tng nhp tim, th kh
khn, co ng t, v bing n. kh, nhng liu ung duy nht n 100 mg/kg gy mt l, v
liu cao hn lm mt mt phn thc.
c tnh ca liu lp li :
Trong nhng nghin cu thi gian n 3 thng chut nht v n 1 nm chut cng v ch,
nhng tc dng ch yu l c ch h thn kinh trung ng, nhng tc dng khng cholinergic,
v nhng ri lon mu ngoi bin. C xut hin dung np i vi tc dng c ch h thn kinh
trung ng. Nhng thng s pht trin b gim xung khi dng liu cao. Nhng nh hng c
hi phc, ph hp vi s tng prolactin chut cng, bao gm gim khi lng bung trng v
t cung v nhng thay i hnh thi biu m m o v tuyn v.
c tnh trn h huyt hc :
Nhng tc dng trn nhng thng s huyt hc c mi loi, bao gm gim bch cu ph
thuc vo liu dng olanzapine chut nht, gim bch cu khng c hiu chut cng ; tuy
nhin, khng c bng chng v c tnh trn t bo ty xng. C gim bch cu trung tnh,
gim tiu cu, hoc thiu mu c hi phc mt s ch dng liu 8 hoc 10 mg/kg/ngy (liu
tc dng tng cng ca olanzapine [AUC] gp 12 n 15 ln ngi dng liu 12 mg). nhng
con ch c gim t bo mu, khng c nhng tc dng ngoi trn nhng t bo gc v nhng
t bo ang tng sinh ty xng.
c tnh trn h sinh sn :
Olanzapine khng gy qui thai. Tc dng an thn lm nh hng n kt qu giao phi ca
chut cng c. Chu kz ng dc b nh hng vi liu 1,1 mg/kg (gp 3 ln liu ti a ngi)
v cc thng s sinh sn chut cng b nh hng khi dng liu 3 mg/kg (gp 9 ln liu ti a
ngi). th h sau ca chut cng dng olanzapine, c ghi nhn bo thai chm pht trin
v gim thong qua mc hot ng.
Kh nng gy t bin :
Olanzapine khng gy t bin hoc ph v cc nhim sc th khi th nghim hng lot cc xt
nghim tiu chun, bao gm cc xt nghim t bin vi khun v cc xt nghim in vitro, in vivo

 ng vt c v.
Kh nng gy ung th :
Da trn cc kt qu nghin cu chut nht v chut cng, c th kt lun l olanzapine
khng gy ung th.
CH NH
Olanzapine dng iu tr tn cng v iu tr duy tr bnh tm thn phn lit, cng nh cc
bnh lon thn khc m c nhng biu hin r rt ca cc triu chng dng tnh (v d nh
hoang tng, o gic, ri lon suy ngh, th ch v nghi ng) v/hoc cc triu chng m tnh
(v d nh cm xc phng lng, lnh m, thu mnh li, ngn ng ngho nn). Olanzapine cng
c hiu qu i vi cc triu chng ca cm xc th pht thng i km vi bnh tm thn
phn lit v cc ri lon tng t. Olanzapine c hiu qu duy tr tnh trng lm sng ci
thin khi tip tc iu tr bng olanzapine nhng ngi bnh c p ng vi ln iu tr
u tin.
CHNG CH NH
Chng ch nh dng olanzapine ngi bnh c tin s mn cm vi bt c thnh phn
no ca thuc. Olanzapine cng chng ch nh ngi bnh c nguy c bnh glcm gc
hp.
CH PHNG v THN TRNG LC DNG
Nhng bnh km theo : Olanzapine c hot tnh khng cholinergic in vitro, nhng trong cc th
nghim lm sng, cc triu chng lin quan xut hin vi t l thp. Do kinh nghim lm sng
dng olanzapine nhng ngi bnh c cc bnh km theo cn t, nn cn thn khi k toa
olanzapine cho bnh nhn ph i tuyn tin lit, tc rut lit, hoc cc tnh trng lin quan.
Lactose : Vin olanzapine c cha lactose.
Cc enzym gan transaminase, ALT, AST i khi tng thong qua, khng c biu hin triu chng,
c bit giai on u ca t iu tr. Cn cn thn theo di cc bnh nhn c tng ALT
hoc/v AST, bnh nhn c cc du hiu v triu chng suy gan, bnh nhn c sn cc tnh
trng chc nng gan hn ch v bnh nhn ang dng cc thuc c c tnh trn gan. Trong
trng hp tng ALT v/hoc AST khi ang iu tr, cn theo di v cn nhc gim liu.
Cng nh vi cc thuc chng lon thn khc, cn cn thn khi dng olanzapine nhng ngi
bnh c s lng bch cu v/hoc bch cu trung tnh thp do bt c nguyn nhn no, ngi
bnh c tin s c ch/ng c ty xng do thuc, ngi bnh c c ch ty xng do bnh
km theo, x tr liu hoc ha tr liu, v ngi bnh c cc tnh trng tng bch cu a eosin
hoc bnh tng sinh ty xng. 32 bnh nhn c tin s mt bch cu ht hoc gim bch cu
trung tnh do clozapine, nhng khng c gim s lng bch cu trung tnh sau khi dng
olanzapine.
Hi chng an thn kinh c tnh (Neuroleptic Malignant Syndrome) : Hi chng an thn kinh c
tnh l tnh trng c kh nng e da tnh mng ngi bnh, lin quan n iu tr bng thuc

chng lon thn. Him c bo co v trng hp hi chng an thn kinh c tnh lin quan n
olanzapine. Nhng biu hin lm sng ca hi chng an thn kinh c tnh l st cao, cng c,
trng thi tm thn thay i, v c biu hin khng n nh ca h thn kinh thc vt (mch
hoc huyt p khng u, nhp tim nhanh, tot m hi, lon nhp tim). Nhng du hiu khc
gm tng creatinine phosphokinase, myoglobin niu (tiu c vn), v suy thn cp. Cn ngng
ngay tt c cc loi thuc chng lon thn, k c olanzapine, khi bnh nhn c cc biu hin v
triu chng ca hi chng an thn kinh c tnh hoc khi c st cao khng r nguyn nhn m
khng c cc biu hin lm sng ca hi chng an thn kinh c tnh.
Cn cn thn khi dng olanzapine ngi bnh c tin s ng kinh hoc c nhng yu t lm
gim ngng ng kinh. ng kinh him khi xy ra nhng ngi bnh khi iu tr bng
olanzapine. Phn ln nhng ngi bnh ny c tin s ng kinh hoc c nhng yu t nguy c
ca bnh ng kinh.
Lon vn ng mun : Trong cc nghin cu so snh trong thi gian 1 nm hoc t hn, t l tai
bin chng lon vn ng bnh nhn khi iu tr olanzapine thp hn c { ngha thng k.
Tuy nhin, nguy c lon vn ng mun tng ln khi dng thuc chng lon thn trong thi
gian di, nn cn gim liu hoc ngng thuc khi xut hin cc du hiu hoc cc triu chng
ny. Nhng triu chng lon vn ng mun c th nng ln theo thi gian hoc thm ch xut
hin sau khi ngng iu tr.
V olanzapine c tc dng ch yu trn h thn kinh trung ng, nn phi cn thn khi dng kt
hp vi cc thuc khc cng tc dng trn h thn kinh trung ng v ru. V olanzapine th
hin tnh i khng vi dopamine in vitro, nn olanzapine c th i khng vi tc dng ca cc
cht ch vn dopamine gin tip v trc tip.
H huyt p t th t khi xy ra nhng ngi ln tui trong nhng th{ nghim lm sng
olanzapine. Cng nh i vi nhng thuc chng lon thn khc, nn o huyt p nh kz
nhng ngi bnh trn 65 tui.
Trong nhng th nghim lm sng, olanzapine khng lin quan n tng k o di khong QT
tuyt i. Ch c 8 trong s 1685 i tng c tng khong QT trong nhiu trng hp. Tuy
nhin, cng nh i vi nhng thuc chng lon thn khc, nn cn thn khi cho toa
olanzapine cng vi nhng thuc bit l lm tng khong QT, c bit ngi cao tui.
Li xe v vn hnh my mc :
Ngi bnh nn dng cn thn thuc ny khi li xe hoc ang iu khin my mc nguy him v
olanzapine c th gy ng.
LC C THAI v LC NUI CON B
Lc c thai :
Khng c cc nghin cu kim sot cht ch v y ngi mang thai. Ph n c khuyn
nn bo cho thy thuc nu h c thai hoc c { nh mang thai khi ang dng olanzapine. Do
kinh nghim cn hn ch ngi, ch nn dng thuc ny ngi mang thai khi li ch em li

hn hn mi nguy hi cho bo thai.

Lc nui con b :
chut cng cho con b, olanzapine c tit vo sa. Cha r olanzapine c c tit vo sa
m hoc khng. Ngi bnh khng nn cho con b trong thi kz ang dng olanzapine.
TNG TC THUC
Kh nng nhng thuc khc nh hng n Olanzapine : Thuc khng acid (magnesi, nhm)
hoc cimetidine liu duy nht khng nh hng n sinh kh dng ca olanzapine dng ng
ung. Tuy nhin, dng ng thi than hot s lm gim sinh kh dng ca olanzapine ng
ung t 50 n 60%. Chuyn ha ca olanzapine c th b cm ng do ht thuc ( thanh thi
ca olanzapine thp hn 33% v thi gian bn thi di hn 21% nhng ngi khng ht thuc
so vi nhng ngi ht thuc) hoc iu tr bng carbamazepin ( thanh thi tng 44% v thi
gian bn thi gim 20% khi iu tr bng carbamazepin). Ht thuc v iu tr bng
carbamazepin gy cm ng hot tnh P450-1A2. Dc ng hc ca theophylline, mt thuc
chuyn ha nh P450-1A2, khng thay i khi dng olanzapine. Cha c nghin cu v tc
dng ca nhng cht c ch mnh hot tnh P450-1A2 trn dc ng hc ca olanzapine.
Kh nng olanzapine nh hng n nhng thuc khc : Trong cc th nghim lm sng dng
liu duy nht olanzapine, khng c s c ch chuyn ha ca imipramine/desipramine (P4502D6 hoc P450-P3A/1A2), warfarin (P450-2C9), theophylline (P450-1A2), hoc diazepam (P4503A4, v P450-2C19). Olanzapine cng khng c tng tc khi dng chung vi lithium hoc
biperiden. nghin cu kh nng ca olanzapine lm c ch chuyn ha thng qua 5
cytochrom ch yu in vitro. Nhng nghin cu ny cho thy hng s c ch i vi 3A4 (491
mM), 2C9 (751 mM), 1A2 (36 mM), 2C19 (920 mM), 2D6 (89 mM), m khi so snh vi nng
huyt tng olanzapine l 0,2 mM, c ngha l s c ch ti a ca nhng h thng P450 do
olanzapine thp hn 0,7%. Cha r s lin quan n lm sng ca nhng kt qu ny.
Nng olanzapine lc n nh khng c nh hng n dc ng hc ca ethanol. Tuy
nhin, tc dng hip ng v dc l hc nh gy tng an thn c th xy ra khi dng ethanol
cng vi olanzapine.
TC DNG NGOI
Cc tc dng khng mong mun thng gp (> 10%) :
Nhng tc dng khng mong mun thng gp lin quan n dng olanzapine trong cc th
nghim lm sng ch l bun ng v tng trng. Tng trng khi c gim ch s trng lng c
th (Body Mass Index) trc khi iu tr v vi liu khi u l 15 mg hoc cao hn.
Cc tc dng khng mong mun t gp (1-10%) :
Nhng tc dng khng mong mun t gp lin quan n dng olanzapine trong cc th nghim
lm sng bao gm chng mt, tng cm gic ngon ming, ph ngoi bin, h huyt p t th
ng, v nhng tc dng khng cholinergic nh, thong qua gm kh ming v to bn.
i khi c tng bch cu a eosin khng triu chng.

i khi c tng thong qua v khng triu chng cc enzym transaminase gan, ALT v AST, c
bit giai on u ca t iu tr (xem thm phn Ch { phng v Thn trng lc dng).
Trong nhng nghin cu c kim tra bng hot cht, nhng ngi bnh khi iu tr bng
olanzapine c t l xut hin bnh Parkinson, chng ng ngi khng yn v lon trng lc c
thp hn so vi nhng liu haloperidol chun . V khng c thng tin chi tit v tin s
ca nhng ri lon vn ng ngoi thp cp tnh v mun, nn hin nay khng th kt lun l
olanzapine gy ra t hn chng lon vn ng mun v/hoc nhng triu chng ngoi thp
mun khc.
Cc tc dng khng mong mun him gp (< 1%) :
Him c bo co v phn ng nhy cm vi nh sng v ni ban. Cng him c bo co v vim
gan.
ng kinh him khi xy ra nhng ngi bnh iu tr bng olanzapine. Phn ln nhng ngi
bnh ny c tin s ng kinh hoc c nhng yu t nguy c ca bnh ng kinh.
Cc tc dng khc :
i khi c tng nng prolactin huyt tng, nhng cc biu hin lm sng lin quan (v d
nh to v nam gii, chy sa, to v n gii) him khi c. phn ln bnh nhn, nng
prolactin tr v phm vi bnh thng m khng cn ngng iu tr.
Him c bo co v trng hp hi chng an thn kinh c tnh (NMS) lin quan n olanzapine
(xem thm phn Ch { phng v Thn trng lc dng).
Him khi c nhng trng hp nng creatinin phosphokinase cao.
i khi c nhng thay i trong huyt hc nh gim bch cu v gim tiu cu.
LIU LNG v CCH DNG
Liu khuyn dng khi u ca olanzapine l 10 mg, dng mt ln trong 24 gi m khng cn
ch { n ba n. Sau ny c th iu chnh liu hng ngy ty theo tnh trng lm sng, thay
i t 5 mg n 20 mg trong 24 gi. Ch c tng liu cao hn liu thng thng 10 mg trong
24 gi, ngha l dng liu 15 mg trong 24 gi hoc cao hn, sau khi c nh gi lm sng
thch hp.
Tr em : Olanzapine cha c nghin cu ngi di 18 tui.
Ngi bnh cao tui : Khng nn dng thng quy liu khi u thp l 5 mg, nhng nn cn
nhc i vi ngi bnh hn 65 tui khi c km cc yu t lm sng khng thun li.
Ngi bnh suy thn v/hoc suy gan : Nn cn nhc dng liu khi u thp l 5 mg
nhng ngi bnh ny. Trong trng hp suy gan trung bnh (x gan, loi A hoc B Child-Pugh),
nn dng liu khi u 5 mg v cn thn khi tng liu.
Ngi bnh n so vi ngi bnh nam : Khng c khc nhau v liu khi u v phm vi liu
thng thng ngi bnh nam v ngi bnh n.
Ngi bnh khng ht thuc so vi ngi bnh c ht thuc : Khng c khc nhau v liu khi
u v phm vi liu thng thng ngi bnh khng ht thuc v ngi bnh c ht thuc.

Khi c nhiu hn mt yu t lm chm qu trnh chuyn ha ca olanzapine (n gii, tui gi,

khng ht thuc), nn cn nhc dng liu khi u thp. Nn cn thn khi c ch nh tng
liu nhng ngi bnh ny (xem thm phn Tng tc v Dc ng hc).
QU LIU
Kinh nghim khi dng qu liu olanzapine cn hn ch. Trong cc th nghim lm sng, c 67
bnh nhn dng qu liu olanzapine cp tnh do v hoc c tnh. bnh nhn dng liu cao
nht c pht hin l 300 mg, c triu chng chng mt v ni nhu. Vi s lng bnh nhn
hn ch c nh gi ti bnh vin, k c bnh nhn dng 300 mg, khng thy c cc du hiu
c hi cc cht c xt nghim v in tm . Cc du hiu sinh tn vn trong mc gii
hn bnh thng nhng bnh nhn dng qu liu.
Da vo cc d liu trn ng vt, cc triu chng qu liu l nhng triu chng ca s tng
qu mc nhng tc dng dc l{ bit ca thuc. Cc triu chng ny bao gm bun ng,
gin ng t, mt m, c ch h hp, h huyt p, v c th c cc ri lon ngoi thp.
Khng c thuc gii c c hiu cho olanzapine. V vy, cn bt u vi cc bin php iu tr
h tr thch hp. Cn xem xt kh nng qu liu ca nhiu loi thuc khc nhau.
Trong trng hp ng c cp tnh, cn thit lp v gi thng ng h hp, m bo qu
trnh oxy ha v thng kh y . Nn xem xt dng than hot, v than hot lm gim sinh kh
dng ca olanzapine dng ng ung t 50 n 60%. Nu cn, nn ra d dy (sau khi t
ng thng vo kh qun, nu bnh nhn hn m). Thm phn lc mu khng tch b c
nhiu olanzapine.
H huyt p v try mch nn iu tr bng cc bin php thch hp nh truyn dch v/hoc
thuc kch thch giao cm nh norepinephrine (khng dng epinephrine, dopamine, hoc cc
thuc kch thch giao cm khc c hot tnh ch vn bta, v kch thch bta c th lm nng
thm tnh trng h huyt p trong hon cnh receptor a b phong b do olanzapine). Cn theo
di tim mch pht hin nhng chng lon nhp tim. Tip tc theo di k, cho n khi ngi
bnh hi phc.
BO QUN
Bo qun nhit 15-30oC. Thuc nhy cm vi nh sng. Bo qun cc vin trong bao b gc
v ni kh ro.

579.

ZYRTEC

UCB PHARMA
Vin nn d b 10 mg : hp 10 vin, hp 15 vin.
Dung dch ung 1 mg/1 ml : l 75 ml.
Dung dch ung 10 mg/1 ml : l 10 ml.
THNH PHN
cho 1 vin
Ctirizine dichlorhydrate

10 mg

cho 1 ml
Ctirizine dichlorhydrate

1 mg

cho 1 ml
Ctirizine dichlorhydrate

10 mg

DC LC
Zyrtec c tc ng i khng mnh, k o di, v c bit chn lc trn cc th th H1.
Zyrtec lm gim ng k p ng hen suyn i vi histamine. Zyrtec c ch s di chuyn m
ca cc t bo vim i osine trong mt vi chng ni m ay.
Trong cc nghin cu lm sng, tc dng ca Zyrtec trn h thn kinh trung ng khng khc so
vi plac bo. iu ny cng c ghi nhn trong cc kho st in no , cc test tm thn v
cc test trn s tp trung.
Mt khc, Zyrtec khng gy tc ng khng cholinergique cng nh tc ng khng
srotoninergique.
Thuc khng gy bun ng v khng b hng hot tnh gy bi ru.
DC NG HC
- Sau khi ung vi liu 10 mg Zyrtec, nng ti a trong huyt tng t c sau khong 1
gi.
- Thi gian bn hy trong huyt tng khong 11 gi.
- Thuc c o thi ch yu qua thn.
- Zyrtec gn kt mnh vi protine huyt tng.

CH NH
iu tr triu chng cc biu hin d ng :
Trn ng h hp :
- vim mi d ng khng theo ma, s mi cn khng theo ma,
- vim mi theo ma v bnh phn hoa, s mi ma ;
Ngoi da :
- cc bnh da gy nga do d ng,
- ni m ay mn tnh,
- bnh da v ni do lnh ;
Mt :
- vim kt mc d ng,
- vim mi-kt mc vi nga mt ;
- ph Quincke (sau khi iu tr sc).
CHNG CH NH
Qu mn vi thuc.
Suy thn.
LC C THAI
ng vt : khng c tc dng gy qui thai no c ghi nhn.
ph n : cc s liu trn ng vt cho thy thuc khng gy d dng, tuy nhin, do thn trng,
khng nn dng thuc trong thi gian mang thai.
LC NUI CON B
C tirizine c bi tit qua sa m di dng vt.
Khng nn dng thuc trong thi gian cho con b.
TC DNG NGOI
Cc ri lon nh ng tiu ha, kh ming, chng mt, bun ng ch xy ra trong nhng
trng hp ngoi l vi mc tng ng vi cc tc dng c ghi nhn nhm dng gi
dc.
LIU LNG v CCH DNG
Dng vin 10 mg : dng cho ngi ln v tr em trn 12 tui.
Trong a s trng hp, liu hng ngy c ngh l 10 mg, ung mt ln duy nht.
Dng dung dch ung : dng cho tr 12 tui tr xung.
< 6 tui : 5 mg mi ngy.
6-12 tui : 10 mg mi ngy.
QU LIU
Nu bnh nhn khng t nn c, cn p dng cc bin php gy nn, cng c th tin hnh
ra rut. iu tr triu chng trong mi trng chuyn khoa. Khng c thuc gii c chuyn
bit. Cng cn ngh n kh nng b ng c nhiu loi thuc.

580.

ZYTEE RB

RAPTAKOS BRETT
Gel r ming : tup 10 g.
THNH PHN
Choline salicylate

9% tl/tt

Benzalkonium chloride

0,02% tl/tt

DC LC
Choline salicylate l mt thuc gim au mnh v c tc dng nhanh dng bi ti ch. Thuc
lm gim au trong vng 3-4 pht v tc dng ko di trong 3-4 gi.
Benzalkonium chloride c dng rng ri nh l mt thuc khng khun ph rng ty u,
kh trng v bo qun dc phm. Benzalkonium chloride pht huy tc dng khng khun
thng qua vic tc ng khng c hiu ti mng bo tng ca vi khun. Tc ng ny lm gia
tng tnh thm thu ca mng i vi cc cht trong bo tng nh cc acid amin v nucleotid
cui cng lm tiu t bo vi khun.
CH NH
Dng lm gim au rng. Vim li, vim ming, lot ming v cc tn thng vim khc
ming.
CHNG CH NH
Tng cm vi benzalkonium chloride hay choline salicylate.
THN TRNG LC DNG
Khng nut s lng ln.
TNG TC THUC
Khng c bo co.
LIU LNG v CCH DNG
Nh mt hay hai git keo thuc ln u ngn tay tr v chm xoa nh ln vng b tn thng.
C th lp li mi 3-4 gi mt ln nu cn, hay theo ch dn ca thy thuc.