{"id":10919,"date":"2019-06-12T01:50:53","date_gmt":"2019-06-11T18:50:53","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=10919"},"modified":"2019-06-16T23:11:37","modified_gmt":"2019-06-16T16:11:37","slug":"nebivolol-nebilet-trong-dieu-tri-suy-tim-man-tinh","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/nebivolol-nebilet-trong-dieu-tri-suy-tim-man-tinh\/","title":{"rendered":"Nebivolol (Nebilet) trong \u0111i\u1ec1u tr\u1ecb suy tim m\u1ea1n t\u00ednh"},"content":{"rendered":"<h2>T\u00f3m t\u1eaft<\/h2>\n<ul>\n<li><strong>Nebivolol<\/strong> l\u00e0 thu\u1ed1c ch\u1eb9n \u00a0\u00a0th\u1ee5 th\u1ec3 beta 1 ch\u1ecdn l\u1ecdc m\u1edbi \u0111\u01b0\u1ee3c d\u00f9ng trong \u0111i\u1ec1u tr\u1ecb suy tim m\u1ea1n t\u00ednh.<\/li>\n<li>Nebivolol \u0111\u01b0\u1ee3c d\u00f9ng thay th\u1ebf cho bisoprolol, carvedilol v\u00e0 metoprolol d\u1ea1ng b\u00e0o ch\u1ebf ph\u00f3ng th\u00edch c\u00f3 ki\u1ec3m so\u00e1t nh\u01b0ng c\u00f3 b\u1eb1ng ch\u1ee9ng \u00edt m\u1ea1nh m\u1ebd h\u01a1n v\u1ec1 \u00a0t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t.<\/li>\n<li>M\u1eb7c d\u00f9 th\u1eed nghi\u1ec7m ch\u00ednh \u00a0\u00a0v\u1edbi nebivolol \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i (70 tu\u1ed5i), nh\u01b0ng kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng n\u00e0o cho th\u1ea5y nebivolol c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n \u1edf b\u1ea5t k\u1ef3 nh\u00f3m tu\u1ed5i n\u00e0o so v\u1edbi c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00e1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong suy tim.<\/li>\n<li>Nebivolol ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ecb suy gan v\u00e0 n\u00ean tr\u00e1nh trong suy th\u1eadn n\u1eb7ng.<\/li>\n<li>Li\u1ec1u kh\u1edfi \u0111\u1ea7u c\u1ee7a nebivolol 1,25mgx 1l\u1ea7n\/ng\u00e0y v\u00e0 t\u0103ng t\u1eeb t\u1eeb \u0111\u1ebfn li\u1ec1u dung n\u1ea1p t\u1ed1i \u0111a (t\u1ed1i \u0111a 10mgx 1l\u1ea7n\/ng\u00e0y).<\/li>\n<li>C\u0169ng nh\u01b0 c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00e1c, Nebivolol l\u00e0m suy tim n\u1eb7ng h\u01a1n, nh\u1ecbp tim ch\u1eadm v\u00e0 ch\u00f3ng m\u1eb7t khi b\u1eaft \u0111\u1ea7u d\u00f9ng thu\u1ed1c.<\/li>\n<li>Tr\u00e1nh ng\u1eebng nebivolol \u0111\u1ed9t ng\u1ed9t v\u00ec c\u00f3 th\u1ec3 l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam b\u1ec7nh suy tim, ho\u1eb7c g\u00e2y ra c\u01a1n \u00a0\u0111au th\u1eaft ng\u1ef1c, nh\u1ed3i m\u00e1u c\u01a1 tim ho\u1eb7c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t \u1edf b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh thi\u1ebfu m\u00e1u c\u01a1 tim.<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-10921 aligncenter\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/06\/Nebivolol_1.jpg\" alt=\"Nebivolol \" width=\"450\" height=\"450\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/06\/Nebivolol_1.jpg 450w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/06\/Nebivolol_1-280x280.jpg 280w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/06\/Nebivolol_1-400x400.jpg 400w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/06\/Nebivolol_1-350x350.jpg 350w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/06\/Nebivolol_1-100x100.jpg 100w\" sizes=\"auto, (max-width: 450px) 100vw, 450px\" \/><\/p>\n<h2><strong>PBS listing\u00a0<\/strong><\/h2>\n<p>\u0110\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n suy tim m\u1ee9c \u0111\u1ed9 trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u1ed5n \u0111\u1ecbnh b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n (ACEi) ho\u1eb7c thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 angiotensin II (ARB) n\u1ebfu dung n\u1ea1p t\u1ed1t.<\/p>\n<h2><strong>L\u00fd do d\u00f9ng PBS listing<\/strong><\/h2>\n<p>\u1ee6y ban T\u01b0 v\u1ea5n L\u1ee3i \u00edch D\u01b0\u1ee3c ph\u1ea9m (PBAC) khuy\u1ebfn c\u00e1o li\u1ec7t k\u00ea nebivolol tr\u00ean c\u01a1 s\u1edf gi\u1ea3m thi\u1ec3u chi ph\u00ed ngh\u0129a l\u00e0 hi\u1ec7u qu\u1ea3 v\u00e0 chi ph\u00ed t\u01b0\u01a1ng t\u1ef1 so v\u1edbi bisoprolol, carvedilol v\u00e0 metoprolol.<\/p>\n<p>Quy\u1ebft \u0111\u1ecbnh n\u00e0y d\u1ef1a tr\u00ean ba th\u1eed nghi\u1ec7m tr\u1ef1c ti\u1ebfp v\u1edbi carvedilol trong vi\u1ec7c so s\u00e1nh hi\u1ec7u qu\u1ea3 c\u1ee7a c\u00e1c bi\u1ec7n ph\u00e1p thay th\u1ebf suy tim. PBAC ch\u1ea5p nh\u1eadn nebivolol g\u00e2y ra nh\u1eefng c\u1ea3i thi\u1ec7n t\u01b0\u01a1ng t\u1ef1 trong c\u00e1c bi\u1ec7n ph\u00e1p thay th\u1ebf (thay \u0111\u1ed5i ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i [LVEF], thay \u0111\u1ed5i th\u1eed nghi\u1ec7m \u0111i b\u1ed9 6 ph\u00fat v\u00e0 c\u1ea3i thi\u1ec7n ph\u00e2n lo\u1ea1i H\u1ed9i Tim m\u1ea1ch New York [NYHA]) v\u00e0 c\u00f3 h\u1ed3 s\u01a1 an to\u00e0n t\u01b0\u01a1ng \u0111\u01b0\u01a1ng. PBAC c\u0169ng xem x\u00e9t so s\u00e1nh gi\u00e1n ti\u1ebfp v\u1edbi c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00e1c (bisoprolol, carvedilol v\u00e0 metoprolol) so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c v\u1ec1 b\u1eb1ng ch\u1ee9ng v\u1ec1 k\u1ebft qu\u1ea3 li\u00ean quan \u0111\u1ebfn b\u1ec7nh nh\u00e2n trong suy tim.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-10920 aligncenter\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/06\/Nebivolol_2.jpg\" alt=\"Nebivolol \" width=\"450\" height=\"450\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/06\/Nebivolol_2.jpg 450w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/06\/Nebivolol_2-280x280.jpg 280w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/06\/Nebivolol_2-400x400.jpg 400w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/06\/Nebivolol_2-350x350.jpg 350w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/06\/Nebivolol_2-100x100.jpg 100w\" sizes=\"auto, (max-width: 450px) 100vw, 450px\" \/><\/p>\n<h2><strong>Vai tr\u00f2 trong \u0111i\u1ec1u tr\u1ecb<\/strong><\/h2>\n<p>Nebivolol l\u00e0 thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 beta1 ch\u1ecdn l\u1ecdc. Thu\u1ed1c c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb suy tim m\u1ea1n t\u00ednh khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 m\u1ed9t thu\u1ed1c ph\u1ed1i h\u1ee3p c\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n (ho\u1eb7c thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 angiotensin II) v\u00e0\/ho\u1eb7c thu\u1ed1c l\u1ee3i ti\u1ec3u. Nebivolol c\u0169ng \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn cho \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p nh\u01b0ng kh\u00f4ng \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea trong PBS cho ch\u1ec9 \u0111\u1ecbnh n\u00e0y.<\/p>\n<p>Nebivolol \u0111\u00e3 \u0111\u01b0\u1ee3c d\u00f9ng \u1edf ch\u00e2u \u00c2u \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p trong h\u01a1n 10 n\u0103m v\u00e0 cho b\u1ec7nh suy tim trong kho\u1ea3ng 2 n\u0103m. Thu\u1ed1c \u0111\u00e3 \u0111\u01b0\u1ee3c d\u00f9ng \u1edf M\u1ef9 cho \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p trong 2 n\u0103m. H\u1ed9i \u0111\u1ed3ng t\u01b0 v\u1ea5n c\u1ee7a C\u1ee5c Qu\u1ea3n l\u00fd Th\u1ef1c ph\u1ea9m v\u00e0 D\u01b0\u1ee3c ph\u1ea9m Hoa K\u1ef3 g\u1ea7n \u0111\u00e2y \u0111\u00e3 b\u00e1c b\u1ecf ph\u00ea duy\u1ec7t \u0111\u0103ng k\u00fd nebivolol cho b\u1ec7nh suy tim \u1edf Hoa K\u1ef3 d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng kh\u00f4ng \u0111\u1ee7 v\u1ec1 hi\u1ec7u qu\u1ea3.<\/p>\n<p>B\u1eb1ng ch\u1ee9ng cho s\u1ef1 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng trong suy tim c\u00f3 th\u1ec3 so s\u00e1nh v\u1edbi c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00e1c, nh\u01b0ng nebivolol c\u00f3 b\u1eb1ng ch\u1ee9ng \u00edt m\u1ea1nh m\u1ebd h\u01a1n v\u1ec1 l\u1ee3i \u00edch s\u1ed1ng s\u00f3t. M\u1eb7c d\u00f9 th\u1eed nghi\u1ec7m \u0111i\u1ec1u tra c\u00e1c k\u1ebft qu\u1ea3 li\u00ean quan \u0111\u1ebfn b\u1ec7nh nh\u00e2n v\u1edbi nebivolol \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i h\u01a1n so v\u1edbi c\u00e1c th\u1eed nghi\u1ec7m thu\u1ed1c \u1ee9c ch\u1ebf beta kh\u00e1c, nh\u01b0ng kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng n\u00e0o cho th\u1ea5y nebivolol hi\u1ec7u qu\u1ea3 h\u01a1n \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i so v\u1edbi c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00e1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong suy tim<\/p>\n<p><strong>Nebivolol l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn thay th\u1ebf cho c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00e1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong suy tim nh\u01b0ng c\u00f3 b\u1eb1ng ch\u1ee9ng \u00edt m\u1ea1nh m\u1ebd h\u01a1n v\u1ec1 l\u1ee3i \u00edch s\u1ed1ng s\u00f3t<\/strong><\/p>\n<p>C\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng cho th\u1ea5y nebivolol c\u00f3 t\u00e1c d\u1ee5ng t\u01b0\u01a1ng t\u1ef1 trong thay th\u1ebf \u0111i\u1ec1u tr\u1ecb suy tim so v\u1edbi bisoprolol, carvedilol ho\u1eb7c metoprolol. Nebivolol gi\u00fap c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng\u00a0 (c\u1ea3i thi\u1ec7n LVEF% v\u00e0 qu\u00e3ng \u0111\u01b0\u1eddng \u0111i b\u1ed9 h\u01a1n 6 ph\u00fat) v\u00e0 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a tri\u1ec7u ch\u1ee9ng (c\u1ea3i thi\u1ec7n \u1edf m\u1ee9c ph\u00e2n lo\u1ea1i NYHA) c\u00f3 th\u1ec3 so s\u00e1nh v\u1edbi carvedilol, kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t l\u1edbn v\u1ec1 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a hai lo\u1ea1i thu\u1ed1c.<\/p>\n<p>Tuy nhi\u00ean, b\u1eb1ng ch\u1ee9ng v\u1ec1 t\u00e1c d\u1ee5ng c\u1ee7a nebivolol \u0111\u1ed1i v\u1edbi t\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n ho\u1eb7c t\u1eed vong \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ecb suy tim k\u00e9m h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00e1c. Trong th\u1eed nghi\u1ec7m duy nh\u1ea5t \u0111\u1ec3 t\u00ecm ki\u1ebfm nh\u1eefng \u1ea3nh h\u01b0\u1edfng c\u1ee7a n\u00f3 \u0111\u1ed1i v\u1edbi t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh v\u00e0 kh\u1ea3 n\u0103ng s\u1ed1ng s\u00f3t (SENIORS), nebivolol l\u00e0m gi\u1ea3m nh\u1eb9 nguy c\u01a1 d\u1eabn \u0111\u1ebfn t\u1eed vong ho\u1eb7c nh\u1eadp vi\u1ec7n v\u00ec b\u1ec7nh tim m\u1ea1ch so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. Tuy nhi\u00ean, kh\u00f4ng gi\u1ed1ng nh\u01b0 c\u00e1c th\u1eed nghi\u1ec7m t\u01b0\u01a1ng t\u1ef1 v\u1edbi c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00e1c, nebivolol kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng \u0111\u1ed1i v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong \u0111\u01a1n thu\u1ea7n ho\u1eb7c t\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n tim m\u1ea1ch \u0111\u01a1n thu\u1ea7n. Kh\u00f4ng c\u00f3 th\u1eed nghi\u1ec7m n\u00e0o so s\u00e1nh tr\u1ef1c ti\u1ebfp gi\u1eefa t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh v\u00e0 t\u1eed vong trong suy tim gi\u1eefa nebivolol v\u00e0 c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00e1c.<\/p>\n<h2><strong>Vi\u1ec7c c\u00e2n nh\u1eafc c\u00e1c l\u1ee3i \u00edch c\u1ee7a nebivolol so v\u1edbi c\u00e1c beta-blocker kh\u00e1c b\u1ecb c\u1ea3n tr\u1edf b\u1edfi s\u1ef1 kh\u00e1c bi\u1ec7t trong \u00a0qu\u1ea7n th\u1ec3 nghi\u00ean c\u1ee9u<\/strong><\/h2>\n<p>Qu\u1ea7n th\u1ec3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u trong th\u1eed nghi\u1ec7mch\u00ednh v\u1ec1 nebivolol nh\u1eb1m \u0111\u1ea1i di\u1ec7n cho ng\u01b0\u1eddi gi\u00e0 b\u1ecb suy tim trong c\u1ed9ng \u0111\u1ed3ng, m\u1ed9t nh\u00f3m kh\u00f4ng \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u k\u1ef9 trong c\u00e1c th\u1eed nghi\u1ec7m \u1ee9c ch\u1ebf beta kh\u00e1c. Ng\u01b0\u1eddi tham gia trong th\u1eed nghi\u1ec7m SENIORS, trung b\u00ecnh l\u00e0 nhi\u1ec1u tu\u1ed5i h\u01a1n v\u00e0 ph\u1ee5 n\u1eef nhi\u1ec1u h\u01a1n trong c\u00e1c th\u1eed nghi\u1ec7m beta-blocker kh\u00e1c. \u0110\u1ed3ng th\u1eddi kh\u00f4ng gi\u1ed1ng nh\u01b0 nh\u1eefng \u00a0qu\u1ea7n th\u1ec3 trong c\u00e1c th\u1eed nghi\u1ec7m \u00a0ch\u00ednh \u00a0so v\u1edbi c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf beta kh\u00e1c v\u1ec1 t\u1ef7 l\u1ec7 c\u00f3 ch\u1ee9c n\u0103ng t\u00e2m thu b\u1ea3o t\u1ed3n (b\u1ea3ng 1).<\/p>\n<p>B\u1ea3ng 1. \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a b\u1ec7nh nh\u00e2n trong c\u00e1c th\u1eed nghi\u1ec7m ch\u00ednh v\u1ec1 thu\u1ed1c ch\u1eb9n beta trong suy tim<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"156\">Thu\u1ed1c v\u00e0\u00a0th\u1eed nghi\u1ec7m<\/td>\n<td width=\"156\">Tu\u1ed5i trung b\u00ecnh (tu\u1ed5i)<\/td>\n<td width=\"156\">T\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n n\u1eef (%)<\/td>\n<td width=\"156\">LVEF trung b\u00ecnh (%)<\/td>\n<\/tr>\n<tr>\n<td width=\"156\">Nebivolol<\/p>\n<p>SENIORS<\/p>\n<p>n = 2128<\/td>\n<td width=\"156\">76<\/td>\n<td width=\"156\">38<\/td>\n<td width=\"156\">36<\/td>\n<\/tr>\n<tr>\n<td width=\"156\">Carvedilol<\/p>\n<p>COPERNICUS<\/p>\n<p>n = 2289<\/td>\n<td width=\"156\">63<\/td>\n<td width=\"156\">21<\/td>\n<td width=\"156\">20<\/td>\n<\/tr>\n<tr>\n<td width=\"156\">Bisoprolol<\/p>\n<p>CIBIS\u2013II<\/p>\n<p>n = 2647<\/td>\n<td width=\"156\">61<\/td>\n<td width=\"156\">19<\/td>\n<td width=\"156\">28<\/td>\n<\/tr>\n<tr>\n<td width=\"156\">Metoprolol \u2013 CR<\/p>\n<p>MERIT-HF<\/p>\n<p>n = 3991<\/td>\n<td width=\"156\">64<\/td>\n<td width=\"156\">23<\/td>\n<td width=\"156\">28<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>Th\u1eed nghi\u1ec7m \u00a0\u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 v\u00e0 \u0111\u1ed9 an to\u00e0n c\u1ee7a nebivolol so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c \u1edf nh\u1eefng ng\u01b0\u1eddi t\u1eeb \u00a0\u00a070 tu\u1ed5i tr\u1edf l\u00ean c\u00f3 ti\u1ec1n s\u1eed \u00a0\u00a0v\u1ec1 b\u1ec7nh suy tim (xu\u1ea5t vi\u1ec7n trong 12 th\u00e1ng tr\u01b0\u1edbc v\u1edbi ch\u1ea9n \u0111o\u00e1n suy tim sung huy\u1ebft ho\u1eb7c v\u1edbi LVEF \u2264 35% trong 6 th\u00e1ng tr\u01b0\u1edbc). Nebivolol \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u \u1edf m\u1ee9c 1,25 mg m\u1ed7i ng\u00e0y v\u00e0 hi\u1ec7u ch\u1ec9nh \u0111\u1ebfn l\u01b0\u1ee3ng dung n\u1ea1p t\u1ed1i \u0111a 10 mg 1 l\u1ea7n\/ng\u00e0y v\u1edbi th\u1eddi gian theo d\u00f5i trung b\u00ecnh l\u00e0 21 th\u00e1ng.<\/p>\n<p>So v\u1edbi gi\u1ea3 d\u01b0\u1ee3c, nebivolol gi\u1ea3m nh\u1eb9 t\u1ef7 l\u1ec7 \u00a0ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 ph\u1ed1i h\u1ee3p (composite endpoint) \u00a0v\u1ec1 t\u1eed vong ho\u1eb7c nh\u1eadp vi\u1ec7n v\u00ec b\u00eanh tim m\u1ea1ch (hazard ratio [HR] 0,86, kho\u1ea3ng tin c\u1eady 95% 0,74 \u0111\u1ebfn 0,99). Tuy nhi\u00ean, kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa nebivolol v\u00e0 gi\u1ea3 d\u01b0\u1ee3c v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong \u0111\u01a1n \u0111\u1ed9c. Ng\u01b0\u1ee3c l\u1ea1i, c\u00e1c th\u1eed nghi\u1ec7m \u00a0ch\u00ednh kh\u00e1c v\u1ec1 thu\u1ed1c ch\u1eb9n beta kh\u00e1c v\u1eabn h\u1eb1ng \u0111\u1ecbnh gi\u1ea3m h\u01a1n 30% t\u1ef7 l\u1ec7 t\u1eed vong sau 1 n\u0103m \u0111i\u1ec1u tr\u1ecb (xem B\u1ea3ng 2).<\/p>\n<p>S\u1ef1 kh\u00e1c bi\u1ec7t trong \u00a0qu\u1ea7n th\u1ec3 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch cho s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 \u00a0t\u1ef7 l\u1ec7 s\u1ed1ng gi\u1eefa nebivolol v\u00e0 c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00e1c. M\u1ed9t ph\u00e2n t\u00edch h\u1eadu \u0111\u1ecbnh (a post hoc analysis) t\u1eeb ph\u00e2n nh\u00f3m c\u1ee7a SENIORS, ph\u00f9 h\u1ee3p h\u01a1n v\u1edbi c\u00e1c qu\u1ea7n th\u1ec3 th\u1eed nghi\u1ec7m kh\u00e1c (&lt;75,2 tu\u1ed5i v\u1edbi ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u \u2264 35%, n = 684), \u0111\u00e3 cho th\u1ea5y l\u1ee3i \u00edch gi\u1ea3m t\u1ec9 l\u1ec7 t\u1eed vong t\u01b0\u01a1ng t\u1ef1 c\u1ee7a nebivolol so v\u1edbi c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00e1c ( t\u1ec9 s\u1ed1 nguy c\u01a1 (Hazardous ratio) 0,62 , kho\u1ea3ng tin c\u1eady 95% t\u1eeb 0,43 \u0111\u1ebfn 0,89). Tuy nhi\u00ean, k\u1ebft qu\u1ea3 c\u1ee7a ph\u00e2n t\u00edch kh\u00f4ng d\u1ef1a theo k\u1ebf ho\u1ea1ch n\u00e0y n\u00ean \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng. Nghi\u00ean c\u1ee9u s\u00e2u h\u01a1n r\u1ea5t c\u1ea7n thi\u1ebft \u0111\u1ec3 x\u00e1c nh\u1eadn \u00a0t\u1ef7 l\u1ec7 s\u1ed1ng c\u1ee7a nebivolol.<\/p>\n<p>B\u1ea3ng 2. Hi\u1ec7u qu\u1ea3 c\u1ee7a c\u00e1c beta blocker tr\u00ean t\u1ea5t c\u1ea3 c\u00e1c nguy\u00ean nh\u00e2n t\u1eed vong trong suy tim<\/p>\n<table width=\"587\">\n<tbody>\n<tr>\n<td width=\"196\">Th\u1eed nghi\u1ec7m<\/td>\n<td width=\"196\">Thu\u1ed1c<\/td>\n<td width=\"196\">Hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb* (kho\u1ea3ng tin c\u1eady 95%)<\/td>\n<\/tr>\n<tr>\n<td width=\"196\">SENIORS<\/td>\n<td width=\"196\">Nebivolol<\/td>\n<td width=\"196\">0,88 (0,71 \u2013 1,08)<sup>\u253c<\/sup><\/td>\n<\/tr>\n<tr>\n<td width=\"196\">COPERNICUS<\/td>\n<td width=\"196\">Carvedilol<\/td>\n<td width=\"196\">0,65 (0,52 \u2013 0,81)<\/td>\n<\/tr>\n<tr>\n<td width=\"196\">CIBIS-II<\/td>\n<td width=\"196\">Bisoprolol<\/td>\n<td width=\"196\">0,66 (0,54 \u2013 0,81)<\/td>\n<\/tr>\n<tr>\n<td width=\"196\">MERIT-HF<\/td>\n<td width=\"196\">Metoprolol-CR<\/td>\n<td width=\"196\">0,66 (0,53 \u2013 0,81)<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" width=\"587\">* T\u1ec9 s\u1ed1 nguy c\u01a1 v\u1edbi kho\u1ea3ng tin c\u1eady 95%, ngo\u1ea1i tr\u1eeb MERIT \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u1edbi nguy c\u01a1 t\u01b0\u01a1ng \u0111\u1ed1i\u253c\u00a0Kh\u00f4ng c\u00f3 \u00fd ngh\u0129a<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2><strong>\u00a0<\/strong><strong>Nebivolol kh\u00f4ng hi\u1ec7u qu\u1ea3 h\u01a1n c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00e1c \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i<\/strong><\/h2>\n<p>M\u1eb7c d\u00f9 nh\u1eefng ng\u01b0\u1eddi trong th\u1eed nghi\u1ec7m SENIORS gi\u00e0 h\u01a1n so v\u1edbi nh\u1eefng ng\u01b0\u1eddi trong c\u00e1c th\u1eed nghi\u1ec7m c\u1ee7a c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf beta kh\u00e1c, nh\u01b0ng kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng n\u00e0o cho th\u1ea5y nebivolol c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n \u1edf nh\u00f3m tu\u1ed5i n\u00e0y so v\u1edbi c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00e1c. Trong qu\u1ea7n th\u1ec3 c\u1ee7a nghi\u00ean c\u1ee9u SENIORS, t\u00e1c d\u1ee5ng c\u1ee7a nebivolol d\u01b0\u1eddng nh\u01b0 kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o tu\u1ed5i t\u00e1c, gi\u1edbi t\u00ednh, ho\u1eb7c LVEF. \u0110\u1eb7c t\u00ednh gi\u00e3n m\u1ea1ch c\u1ee7a Nebivolol (\u0111\u01b0\u1ee3c cho l\u00e0 do oxid nitric) kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n<p>V\u1ea5n \u0111\u1ec1 an to\u00e0n<\/p>\n<p>Nh\u1eefng t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a nebivolol t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00e1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong suy tim. C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 ph\u1ed5 bi\u1ebfn nh\u1ea5t \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong th\u1eed nghi\u1ec7m SENIORS c\u1ee7a nebivolol v\u00e0 gi\u1ea3 d\u01b0\u1ee3c, t\u01b0\u01a1ng \u1ee9ng l\u00e0:<\/p>\n<ul>\n<li>Ch\u1eadm nh\u1ecbp tim (11% so v\u1edbi 2%)<\/li>\n<li>Ch\u00f3ng m\u1eb7t (14% so v\u1edbi 13%)<\/li>\n<li>H\u1ea1 huy\u1ebft \u00e1p (7% so v\u1edbi 7%)<\/li>\n<li>M\u1ec7t m\u1ecfi (6% so v\u1edbi 5%).<\/li>\n<\/ul>\n<p>Suy tim n\u1eb7ng h\u01a1n \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf kho\u1ea3ng 20% \u200b\u200bb\u1ec7nh nh\u00e2n trong m\u1ed7i nh\u00f3m. H\u1ea7u h\u1ebft c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 v\u1edbi nebivolol \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong giai \u0111o\u1ea1n ch\u1ec9nh li\u1ec1u (xem b\u00ean d\u01b0\u1edbi).<\/p>\n<p>Nebivolol ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ecb suy gan, v\u00ec h\u1ea1n ch\u1ebf kinh nghi\u1ec7m \u0111i\u1ec1u tr\u1ecb trong nh\u00f3m \u0111\u1ed1i t\u01b0\u1ee3ng n\u00e0y. B\u1ec7nh nh\u00e2n c\u00f3 n\u1ed3ng \u0111\u1ed9 men gan t\u0103ng \u2265 3 l\u1ea7n gi\u1edbi h\u1ea1n tr\u00ean c\u1ee7a m\u1ee9c b\u00ecnh th\u01b0\u1eddng \u0111\u00e3 \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb kh\u1ecfi th\u1eed nghi\u1ec7m SENIORS. Tr\u00e1nh s\u1eed d\u1ee5ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb suy th\u1eadn n\u1eb7ng (n\u1ed3ng \u0111\u1ed9 creatinine huy\u1ebft thanh \u2265 250 \u00b5mol\/L) v\u00ec ch\u01b0a c\u00f3 kinh nghi\u1ec7m \u0111i\u1ec1u tr\u1ecb \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n<p>B\u00e1o c\u00e1o nghi ng\u1edd ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i c\u1ee7a TGA (Therapeutic Goods Administration) tr\u1ef1c tuy\u1ebfn ho\u1eb7c b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng \u201cth\u1ebb xanh\u201d \u0111\u01b0\u1ee3c cung c\u1ea5p 3 l\u1ea7n m\u1ed9t n\u0103m v\u1edbi ng\u01b0\u1eddi k\u00ea toa \u1edf \u00dac. \u0110\u1ec3 bi\u1ebft th\u00f4ng tin v\u1ec1 b\u00e1o c\u00e1o ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i, xem trang web TGA.<\/p>\n<h2><strong>Gi\u00e1m s\u00e1t c\u00e1c d\u1ea5u hi\u1ec7u sinh t\u1ed3n ch\u1eb7t ch\u1ebd khi b\u1eaft \u0111\u1ea7u ho\u1eb7c ch\u1ec9nh li\u1ec1u nebivolol<\/strong><\/h2>\n<p>Kh\u00f4ng b\u1eaft \u0111\u1ea7u d\u00f9ng nebivolol \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb suy tim c\u1ea5p trong v\u00f2ng 6 tu\u1ea7n qua. \u0110\u00e1nh gi\u00e1 nh\u1ecbp tim, huy\u1ebft \u00e1p v\u00e0 t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u d\u00f9ng nebivolol v\u00e0 tr\u01b0\u1edbc khi t\u0103ng li\u1ec1u. Kh\u00f4ng t\u0103ng li\u1ec1u tr\u1eeb khi b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh (xem b\u00ean d\u01b0\u1edbi). Th\u1ea3o lu\u1eadn v\u1ec1 t\u1eebng t\u00e1c d\u1ee5ng ph\u1ee5 ph\u1ed5 bi\u1ebfn c\u1ee7a nebivolol v\u1edbi b\u1ec7nh nh\u00e2n v\u00e0 ph\u1ea3i l\u00e0m g\u00ec n\u1ebfu g\u1eb7p ph\u1ea3i ch\u00fang (xem Th\u00f4ng tin cho b\u1ec7nh nh\u00e2n).<\/p>\n<p>Nh\u00e0 s\u1ea3n xu\u1ea5t khuy\u1ebfn c\u00e1o nh\u1eefng ng\u01b0\u1eddi b\u1eaft \u0111\u1ea7u d\u00f9ng nebivolol ho\u1eb7c t\u0103ng li\u1ec1u \u0111\u01b0\u1ee3c theo d\u00f5i d\u01b0\u1edbi s\u1ef1 gi\u00e1m s\u00e1t c\u1ee7a b\u00e1c s\u0129 c\u00f3 kinh nghi\u1ec7m trong \u00edt nh\u1ea5t 2 gi\u1edd \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o r\u1eb1ng t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng \u1ed5n \u0111\u1ecbnh, ph\u00f9 h\u1ee3p v\u1edbi quy tr\u00ecnh c\u1ee7a SENIORS. M\u1ed9t khuy\u1ebfn ngh\u1ecb t\u01b0\u01a1ng t\u1ef1 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o th\u00f4ng tin s\u1ea3n ph\u1ea9m cho c\u00e1c thu\u1ed1c ch\u1eb9n beta kh\u00e1c khi l\u1ea7n \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn cho b\u1ec7nh suy tim, nh\u01b0ng sau \u0111\u00f3 \u0111\u00e3 b\u1ecb lo\u1ea1i b\u1ecf. D\u01b0\u1eddng nh\u01b0 kh\u00f4ng c\u00f3 l\u00fd do d\u01b0\u1ee3c l\u00fd n\u00e0o trong vi\u1ec7c l\u00ed gi\u1ea3i theo d\u00f5i qu\u00e1 tr\u00ecnh hi\u1ec1u ch\u1ec9nh li\u1ec1u c\u1ee7a nebivolol n\u00ean kh\u00e1c v\u1edbi \u00a0\u00a0thu\u1ed1c ch\u1eb9n beta kh\u00e1c d\u00f9ng trong suy tim.<\/p>\n<h2><strong>Suy tim n\u1eb7ng h\u01a1n, ch\u1eadm nh\u1ecbp tim v\u00e0 ch\u00f3ng m\u1eb7t \u0111\u00f4i khi c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t m\u00e0 kh\u00f4ng c\u1ea7n ng\u1eebng nebivolol<\/strong><\/h2>\n<p>N\u1ebfu suy tim n\u1eb7ng h\u01a1n ho\u1eb7c kh\u00f4ng dung n\u1ea1p (v\u00ed d\u1ee5 nh\u01b0 nh\u1ecbp tim ch\u1eadm, h\u1ea1 huy\u1ebft \u00e1p, ch\u00f3ng m\u1eb7t) \u0111\u00e3 tr\u1ea3i qua trong qu\u00e1 tr\u00ecnh ch\u1ec9nh li\u1ec1u, h\u00e3y c\u00e2n nh\u1eafc gi\u1ea3m li\u1ec1u t\u1eebng b\u01b0\u1edbc v\u00e0 k\u00e9o d\u00e0i kho\u1ea3ng th\u1eddi gian ch\u1ec9nh li\u1ec1u (xem c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 li\u1ec1u) . Tr\u01b0\u1edbc ti\u00ean h\u00e3y \u0111i\u1ec1u ch\u1ec9nh \u0111\u1ed3ng th\u1eddi li\u1ec1u thu\u1ed1c l\u1ee3i ti\u1ec3u ho\u1eb7c thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n \u0111\u1ec3 c\u00f3 th\u1ec3 ph\u00f9 h\u1ee3p h\u01a1n v\u1edbi m\u1ed9t s\u1ed1 tri\u1ec7u ch\u1ee9ng (v\u00ed d\u1ee5 ph\u00f9 ph\u1ed5i). C\u1ed1 g\u1eafng kh\u00f4ng ng\u1eebng nebivolol \u0111\u1ed9t ng\u1ed9t, v\u00ec \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 l\u00e0m n\u1eb7ng h\u01a1n t\u00ecnh tr\u1ea1ng suy tim ho\u1eb7c \u0111au th\u1eaft ng\u1ef1c, nh\u1ed3i m\u00e1u c\u01a1 tim ho\u1eb7c r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t \u1edf nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh thi\u1ebfu m\u00e1u c\u01a1 tim. \u0110\u1ec3 ng\u01b0ng d\u00f9ng Nebivolol, gi\u1ea3m d\u1ea7n li\u1ec1u b\u1eb1ng c\u00e1ch gi\u1ea3m m\u1ed9t n\u1eeda h\u00e0m l\u01b0\u1ee3ng m\u1ed7i tu\u1ea7n.<\/p>\n<p>Tuy nhi\u00ean, n\u1ebfu c\u00e1c tri\u1ec7u ch\u1ee9ng nghi\u00eam tr\u1ecdng (v\u00ed d\u1ee5 h\u1ea1 huy\u1ebft \u00e1p n\u1eb7ng, suy tim n\u1eb7ng h\u01a1n v\u1edbi ph\u00f9 ph\u1ed5i c\u1ea5p, s\u1ed1c tim, nh\u1ecbp tim ch\u1eadm ho\u1eb7c block nh\u0129 nh\u1ea5t), h\u00e3y c\u00e2n nh\u1eafc ng\u1eebng nebivolol v\u00e0 theo d\u00f5i ch\u1eb7t ch\u1ebd b\u1ec7nh nh\u00e2n. Nh\u1eadp vi\u1ec7n n\u00ean\u00a0 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nh\u01b0 v\u1eady.<\/p>\n<h2><strong>Kinh nghi\u1ec7m h\u1ea1n ch\u1ebf trong suy tim n\u1eb7ng<\/strong><\/h2>\n<p>H\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng nebivolol trong th\u1eed nghi\u1ec7m SENIORS l\u00e0 NYHA \u0111\u1ed9 II ho\u1eb7c III (94%) v\u00e0 ch\u1ec9 c\u00f3 kho\u1ea3ng 2% b\u1ecb suy tim n\u1eb7ng (NYHA \u0111\u1ed9 IV). M\u1ed9t nghi\u00ean c\u1ee9u ki\u1ec3m so\u00e1t gi\u1ea3 d\u01b0\u1ee3c kh\u00e1c v\u1edbi nebivolol c\u00f3 t\u1ef7 l\u1ec7 t\u01b0\u01a1ng t\u1ef1 nh\u1eefng ng\u01b0\u1eddi b\u1ecb suy tim \u0111\u1ed9 IV NYHA. Th\u1eed nghi\u1ec7m tr\u1ef1c ti\u1ebfp v\u1edbi nebivolol \u0111\u00e3 lo\u1ea1i tr\u1eeb nh\u1eefng ng\u01b0\u1eddi b\u1ecb suy tim n\u1eb7ng.<\/p>\n<h2><strong>M\u1ed9t s\u1ed1 SSRI c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 t\u00e1c d\u1ee5ng ph\u1ee5 v\u1edbi nebivolol<\/strong><\/h2>\n<p>C\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf cytochrom P450 2D6 nh\u01b0 paroxetin v\u00e0 fluoxetin c\u00f3 th\u1ec3 l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 nebivolol trong huy\u1ebft t\u01b0\u01a1ng. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 ch\u1eadm nh\u1ecbp tim v\u00e0 c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00e1c, \u0111\u1eb7c bi\u1ec7t n\u1ebfu thu\u1ed1c \u1ee9c ch\u1ebf cytochrom P450 2D6 \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u sau khi ch\u1ec9nh li\u1ec1u nebivolol.<\/p>\n<p>Li\u1ec1u<\/p>\n<p>B\u1eaft \u0111\u1ea7u v\u1edbi 1,25 mg x 1l\u1ea7n\/ng\u00e0y trong 1-2 tu\u1ea7n. Ch\u1ec9nh li\u1ec1u theo c\u00e1ch t\u0103ng d\u1ea7n \u0111\u1ebfn li\u1ec1u dung n\u1ea1p t\u1ed1i \u0111a (t\u1ed1i \u0111a 10 mg m\u1ed7i ng\u00e0y). Nebivolol kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi th\u1ee9c \u0103n.<\/p>\n<h2><strong>Ch\u1ec9nh li\u1ec1u t\u1eeb t\u1eeb theo kh\u1ea3 n\u0103ng dung n\u1ea1p c\u1ee7a b\u1ec7nh nh\u00e2n<\/strong><\/h2>\n<p>N\u1ebfu li\u1ec1u kh\u1edfi \u0111\u1ea7u \u0111\u01b0\u1ee3c dung n\u1ea1p v\u00e0 b\u1ec7nh nh\u00e2n \u0111\u00e3 \u1ed5n \u0111\u1ecbnh, t\u0103ng li\u1ec1u l\u00ean 2,5 mg l\u1ea7n\/ng\u00e0y trong 1-2 tu\u1ea7n, sau \u0111\u00f3, khi \u0111\u01b0\u1ee3c dung n\u1ea1p, t\u0103ng \u0111\u1ebfn 5 mg l\u1ea7n\/ng\u00e0y trong 1-2 tu\u1ea7n, v\u00e0 ti\u1ebfp t\u1ee5c t\u0103ng \u0111\u1ebfn li\u1ec1u t\u1ed1i \u0111a 10 mg 1 l\u1ea7n\/ng\u00e0y.<\/p>\n<p>L\u01b0u \u00fd nebivolol c\u0169ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho t\u0103ng huy\u1ebft \u00e1p, nh\u01b0ng c\u00f3 li\u1ec1u d\u00f9ng thu\u1ed1c kh\u00e1c cho ch\u1ec9 \u0111\u1ecbnh n\u00e0y.<\/p>\n<p>H\u01b0\u1edbng d\u1eabn c\u1ee7a NICE v\u1ec1 \u0111i\u1ec1u tr\u1ecb suy tim g\u1ee3i \u00fd t\u0103ng g\u1ea5p \u0111\u00f4i li\u1ec1u thu\u1ed1c ch\u1eb9n beta trong kho\u1ea3ng th\u1eddi gian kh\u00f4ng d\u01b0\u1edbi 2 tu\u1ea7n.<\/p>\n<h2><strong>Kh\u1ea3 n\u0103ng dung n\u1ea1p c\u1ee7a m\u1ed7i c\u00e1 nh\u00e2n c\u00f3 th\u1ec3 kh\u00e1c nhau<\/strong><\/h2>\n<p>Trong th\u1eed nghi\u1ec7m SENIORS, 68% b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng nebivolol \u0111\u1ea1t li\u1ec1u 10 mg m\u1ed7i ng\u00e0y v\u00e0 th\u00eam 12% \u0111\u1ea1t 5 mg m\u1ed7i ng\u00e0y. Kh\u00f4ng c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i, \u1edf b\u1ec7nh nh\u00e2n b\u1ecb suy th\u1eadn nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh, ho\u1eb7c kh\u1ea3 n\u0103ng chuy\u1ec3n h\u00f3a nebivolol k\u00e9m. Li\u1ec1u nebivolol ph\u1ea3i lu\u00f4n \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh \u0111\u1ebfn li\u1ec1u dung n\u1ea1p t\u1ed1i \u0111a (kh\u00f4ng qu\u00e1 10 mg 1 l\u1ea7n\/ng\u00e0y) cho t\u1eebng c\u00e1 nh\u00e2n. Ng\u01b0\u1eddi chuy\u1ec3n h\u00f3a k\u00e9m, c\u00f3 n\u1ed3ng \u0111\u1ed9 nebivolol trong huy\u1ebft t\u01b0\u01a1ng kho\u1ea3ng 1,4 l\u1ea7n v\u00e0 c\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f3 ho\u1ea1t t\u00ednh nh\u01b0 c\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a r\u1ed9ng r\u00e3i, c\u0169ng c\u00f3 th\u1ec3 kh\u00f4ng dung n\u1ea1p \u0111\u01b0\u1ee3c nebivolol v\u00e0 c\u00f3 th\u1ec3 c\u1ea7n li\u1ec1u cu\u1ed1i c\u00f9ng th\u1ea5p h\u01a1n.<\/p>\n<p>Chuy\u1ec3n h\u00f3a c\u1ee7a nebivolol ph\u1ee5 thu\u1ed9c v\u00e0o cytochrom P450 2D6 \u2013 lo\u1ea1i \u0111a h\u00ecnh di truy\u1ec1n.<\/p>\n<p>Th\u00f4ng tin cho b\u1ec7nh nh\u00e2n<\/p>\n<p>T\u01b0 v\u1ea5n cho b\u1ec7nh nh\u00e2n:<\/p>\n<ul>\n<li>Nebivolol c\u1ea3i thi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng suy tim v\u00e0 gi\u1ea3m nguy c\u01a1 t\u1eed vong ho\u1eb7c nh\u1eadp vi\u1ec7n li\u00ean quan \u0111\u1ebfn c\u00e1c v\u1ea5n \u0111\u1ec1 tim m\u1ea1ch.<\/li>\n<li>C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a suy tim ban \u0111\u1ea7u n\u1eb7ng \u0111i l\u00e0 ph\u1ed5 bi\u1ebfn. B\u1ec7nh nh\u00e2n n\u00ean nhanh ch\u00f3ng \u0111i kh\u00e1m b\u00e1c s\u0129 n\u1ebfu c\u1ea3m th\u1ea5y kh\u00f3 th\u1edf, m\u1ec7t m\u1ecfi ho\u1eb7c t\u0103ng s\u01b0ng \u1edf ch\u00e2n ho\u1eb7c d\u1ea1 d\u00e0y.<\/li>\n<li>C\u1ea7n c\u1ea5p c\u1ee9u ngay t\u1ea1i b\u1ec7nh vi\u1ec7n \u0111\u1ecba ph\u01b0\u01a1ng n\u1ebfu b\u1ec7nh nh\u00e2n b\u1ecbch\u00f3ng m\u1eb7t n\u1eb7ng ho\u1eb7c ng\u1ea5t x\u1ec9u.<\/li>\n<li>B\u1ec7nh nh\u00e2n s\u1ebd b\u1eaft \u0111\u1ea7u v\u1edbi li\u1ec1u th\u1ea5p v\u00e0 t\u0103ng d\u1ea7n trong m\u1ed9t s\u1ed1 tu\u1ea7n t\u1edbi li\u1ec1u t\u1ed1t nh\u1ea5t cho h\u1ecd.<\/li>\n<li>\u0110\u1ee9ng d\u1eady t\u1eeb t\u1eeb khi ra kh\u1ecfi gi\u01b0\u1eddng ho\u1eb7c \u0111\u1ee9ng d\u1eady kh\u1ecfi gh\u1ebf, \u0111\u1ec3 gi\u1ea3m b\u1edbt ch\u00f3ng m\u1eb7t.<\/li>\n<li>Ph\u1ea3i u\u1ed1ng \u0111\u1ee7 n\u01b0\u1edbc khi t\u1eadp th\u1ec3 d\u1ee5c v\u00e0 trong th\u1eddi ti\u1ebft n\u00f3ng,\u0111\u1ec3 tr\u00e1nh huy\u1ebft \u00e1p gi\u1ea3m \u0111\u1ed9t ng\u1ed9t (ch\u00f3ng m\u1eb7t).<\/li>\n<li>Kh\u00f4ng \u0111\u01b0\u1ee3c ng\u1eebng d\u00f9ng nebivolol m\u00e0 kh\u00f4ng trao \u0111\u1ed5i v\u1edbi b\u00e1c s\u0129, v\u00ec vi\u1ec7c d\u1eebng \u0111\u1ed9t ng\u1ed9t c\u00f3 th\u1ec3 l\u00e0m cho t\u00ecnh tr\u1ea1ng c\u1ee7a h\u1ecd tr\u1edf n\u00ean t\u1ed3i t\u1ec7 h\u01a1n.<\/li>\n<\/ul>\n<p>Ng\u01b0\u1eddi d\u1ecbch:\u00a0Nguy\u1ec5n Minh \u0110\u1ea1t \u2013 SV D\u01b0\u1ee3c 4 \u2013 Khoa D\u01b0\u1ee3c, \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh.<\/p>\n<p>Ng\u01b0\u1eddi hi\u1ec7u \u0111\u00ednh:\u00a0Nguy\u1ec5n Th\u1ecb Th\u1ea3o \u2013 Khoa D\u01b0\u1ee3c b\u1ec7nh vi\u1ec7n Nhi Thanh H\u00f3a<\/p>\n<p>Ngu\u1ed3n:\u00a0NPS Medicinewise (01\/03\/2010). Nebivolol (Nebilet) for chronic heart failure.\u00a0<a href=\"https:\/\/www.nps.org.au\/radar\/articles\/nebivolol-nebilet-for-chronic-heart-failure?fbclid=IwAR1LxGPglg9TuT7gKf_G6rRD6tVP4LV-wJfjnrkX8HGEOFgzTWMbL5Rm45I#key-points\" rel=\"noopener\">Link<\/a><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>T\u00f3m t\u1eaft Nebivolol l\u00e0 thu\u1ed1c ch\u1eb9n \u00a0\u00a0th\u1ee5 th\u1ec3 beta 1 ch\u1ecdn l\u1ecdc m\u1edbi \u0111\u01b0\u1ee3c d\u00f9ng trong \u0111i\u1ec1u tr\u1ecb suy tim m\u1ea1n t\u00ednh. Nebivolol \u0111\u01b0\u1ee3c d\u00f9ng thay th\u1ebf cho bisoprolol, carvedilol v\u00e0 metoprolol d\u1ea1ng b\u00e0o ch\u1ebf ph\u00f3ng th\u00edch c\u00f3 ki\u1ec3m so\u00e1t nh\u01b0ng c\u00f3 b\u1eb1ng ch\u1ee9ng \u00edt m\u1ea1nh m\u1ebd h\u01a1n v\u1ec1 \u00a0t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t. M\u1eb7c d\u00f9 [&#8230;]\n","protected":false},"author":1,"featured_media":10922,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-10919","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/10919","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=10919"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/10919\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/10922"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=10919"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=10919"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=10919"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}