thuoc biet duoc

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

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Lng, Ngh An. Thng 8/2010

ABOUT

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THUC VN A

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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

% bnh nhn trong Nghin cu c i chng*

Accupril Placebo

n = 1491 n = 394

(%) (%)

Nhc u 6,9 12,7

Chng mt 4,7 3,3

Vim mi 3 3,8

Ho 3,1 1,3

Nhim trng ng h hp trn 2,5 1,8

Mt mi 2,4 2

Nn, ma 2,3 3,3

Kh tiu 1,9 0,8

Nhim virus 1,7 2,3

au c 1,5 4,1

au ngc 1,5 1,8

au bng 1,5 1,5

Tiu chy 1,5 1,3

au lng 1,3 1,5

Vim xoang 1,2 1,3

Mt ng 1,2 1,3

D cm 1,2 0,5

Lo u, cu gt 1,1 1,3

Suy nhc 1,1 0,8

Vim hu 1,1 1,5

H huyt p 1 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



Actifed Compound Linctus :

cho 5 ml xir



Codein phosphate 10 mg

(Natri benzoate)

Actifed DM :

cho 5 ml xir



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 33 mg

(10 % nifedipine gi li lp bao ca vin

thuc)

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-methyl-

6-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 vt ng dng

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 1,5 mg

DC LC

Cm mu.

- 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.



THNH PHN

cho 100 mL Albutein 5%

Albumin ngi 5 g


Albumin ngi 20 g


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 Creutzfeldt-

Jakob (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

A L L E R G A N

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

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

K 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

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