{"id":6755,"date":"2019-04-01T01:30:38","date_gmt":"2019-03-31T18:30:38","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=6755"},"modified":"2019-04-11T01:39:59","modified_gmt":"2019-04-10T18:39:59","slug":"celecoxib-nhung-dieu-can-biet-de-su-dung-thuoc-hop-ly-an-toan","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/celecoxib-nhung-dieu-can-biet-de-su-dung-thuoc-hop-ly-an-toan\/","title":{"rendered":"Celecoxib: Nh\u1eefng \u0111i\u1ec1u c\u1ea7n bi\u1ebft \u0111\u1ec3 s\u1eed d\u1ee5ng thu\u1ed1c h\u1ee3p l\u00fd, an to\u00e0n"},"content":{"rendered":"<p>Ng\u01b0\u1eddi d\u1ecbch: T\u01b0\u0300 Pha\u0323m Hi\u00ea\u0300n Trang, L\u01b0\u01a1ng Anh T\u00f9ng<\/p>\n<h2>T\u00f3m t\u1eaft<\/h2>\n<p><strong>Celecoxib<\/strong> l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc cyclo-oxygenase-2 (COX-2) \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111i\u1ec1u tr\u1ecb \u0111au c\u1ea5p t\u00ednh, c\u00e1c b\u1ec7nh l\u00fd n\u1ec1n c\u1ee7a kh\u1edbp ho\u1eb7c \u0111au b\u1ee5ng kinh nguy\u00ean ph\u00e1t nh\u01b0 l\u00e0 l\u1ef1a ch\u1ecdn thay th\u1ebf cho c\u00e1c thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid (NSAID) nh\u01b0 naproxen hay ibuprofen. \u01afu \u0111i\u1ec3m c\u1ee7a celecoxib l\u00e0 nguy c\u01a1 g\u00e2y xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a th\u1ea5p h\u01a1n c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc. Vi\u1ec7c s\u1eed d\u1ee5ng celecoxib c\u00f3 li\u00ean quan \u0111\u1ebfn gia t\u0103ng c\u00e1c nguy c\u01a1 v\u1ec1 tim m\u1ea1ch, tuy nhi\u00ean nguy c\u01a1 n\u00e0y t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi nguy c\u01a1 c\u1ee7a c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc.<\/p>\n<figure id=\"attachment_6756\" aria-describedby=\"caption-attachment-6756\" style=\"width: 450px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-6756\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/04\/Celecoxib.jpg\" alt=\"Celecoxib\" width=\"450\" height=\"450\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/Celecoxib.jpg 450w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/Celecoxib-350x350.jpg 350w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/Celecoxib-150x150.jpg 150w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/Celecoxib-300x300.jpg 300w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/Celecoxib-100x100.jpg 100w\" sizes=\"auto, (max-width: 450px) 100vw, 450px\" \/><figcaption id=\"caption-attachment-6756\" class=\"wp-caption-text\">H\u00ecnh \u1ea3nh: thu\u1ed1c Celecoxib<\/figcaption><\/figure>\n<h2>N\u1ed9i dung b\u00e0i<\/h2>\n<p>T\u1ea1i New Zealand, celecoxib d\u1ea1ng vi\u00ean nang (100 v\u00e0 200 mg) \u0111\u00e3 \u0111\u01b0\u1ee3c b\u1ea3o hi\u1ec3m chi tr\u1ea3 ho\u00e0n to\u00e0n t\u1eeb ng\u00e0y 01\/6\/2017. Nh\u00ecn chung, celecoxib c\u00f3 hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi naproxen, ibuprofen v\u00e0 diclofenac v\u1ec1 t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au v\u00e0 ch\u1ed1ng vi\u00eam.<\/p>\n<p>Celecoxib c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p:<\/p>\n<p>&#8211; \u0110au c\u1ea5p t\u00ednh;<\/p>\n<p>&#8211; Vi\u00eam x\u01b0\u01a1ng kh\u1edbp;<\/p>\n<p>&#8211; Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p;<\/p>\n<p>&#8211; Vi\u00eam \u0111\u1ed1t s\u1ed1ng c\u1ee9ng kh\u1edbp;<\/p>\n<p>&#8211; \u0110au b\u1ee5ng kinh nguy\u00ean ph\u00e1t.<\/p>\n<p>T\u01b0\u01a1ng t\u1ef1 c\u00e1c NSAID kh\u00e1c, celecoxib b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n qu\u00e1 m\u1eabn v\u1edbi NSAID, bao g\u1ed3m b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed hen, m\u00e0y \u0111ay c\u01a1 \u0111\u1ecba, ph\u00f9 m\u1ea1ch ho\u1eb7c vi\u00eam m\u0169i li\u00ean quan \u0111\u1ebfn s\u1eed d\u1ee5ng NSAID hay aspirin. Celecoxib v\u00e0 c\u00e1c NSAID kh\u00e1c c\u0169ng b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, b\u1ec7nh m\u1ea1ch n\u00e3o, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i vi, suy tim c\u00e1c m\u1ee9c \u0111\u1ed9 t\u1eeb nh\u1eb9 \u0111\u1ebfn n\u1eb7ng, c\u00f3 lo\u00e9t ho\u1eb7c xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a ti\u1ebfn tri\u1ec3n ho\u1eb7c trong b\u1ec7nh l\u00fd \u0111\u1ea1i tr\u00e0ng do vi\u00eam. C\u1ea7n th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng celecoxib cho b\u1ec7nh nh\u00e2n cao tu\u1ed5i, c\u00f3 suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn, c\u00f3 nguy c\u01a1 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a v\u00e0 b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c c\u00f3 th\u1ec3 t\u01b0\u01a1ng t\u00e1c v\u1edbi NSAID, bao g\u1ed3m thu\u1ed1c l\u1ee3i ti\u1ec3u v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n angiotensin. S\u1eed d\u1ee5ng celecoxib c\u00f3 li\u00ean quan \u0111\u1ebfn gia t\u0103ng c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch, tuy nhi\u00ean, nguy c\u01a1 n\u00e0y t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc.<\/p>\n<h3>L\u1ee3i \u00edch v\u00e0 nguy c\u01a1 c\u1ee7a celecoxib do t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf COX<\/h3>\n<p>T\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb v\u00e0 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a NSAID li\u00ean quan \u0111\u1ebfn kh\u1ea3 n\u0103ng \u1ee9c ch\u1ebf c\u00e1c enzym COX-1 v\u00e0\/ho\u1eb7c COX-2. \u00c1i l\u1ef1c kh\u00e1c nhau c\u1ee7a c\u00e1c thu\u1ed1c trong nh\u00f3m v\u1edbi COX-1 v\u00e0 COX-2 l\u00e0 nguy\u00ean nh\u00e2n d\u1eabn \u0111\u1ebfn kh\u00e1c bi\u1ec7t v\u1ec1 \u0111\u1ed9c t\u00ednh tr\u00ean ti\u00eau h\u00f3a v\u00e0 nguy c\u01a1 tim m\u1ea1ch c\u1ee7a c\u00e1c thu\u1ed1c n\u00e0y. \u1ee8c ch\u1ebf COX-1 l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng b\u1ea3o v\u1ec7 ni\u00eam m\u1ea1c \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n nh\u01b0 lo\u00e9t v\u00e0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a. \u1ee8c ch\u1ebf COX-2 l\u00e0m gi\u1ea3m s\u1ea3n sinh prostaglandin, l\u00e0 ch\u1ea5t trung gian h\u00f3a h\u1ecdc trong qu\u00e1 tr\u00ecnh \u0111au, vi\u00eam v\u00e0 s\u1ed1t. Tuy nhi\u00ean, khi t\u00ednh ch\u1ecdn l\u1ecdc trong \u1ee9c ch\u1ebf COX-2 t\u0103ng l\u00ean, nguy c\u01a1 xu\u1ea5t hi\u1ec7n c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch c\u0169ng t\u0103ng theo.<\/p>\n<h3>T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a celecoxib<\/h3>\n<p>Celecoxib l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc COX-2, c\u00f3 nguy c\u01a1 g\u00e2y t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n nghi\u00eam tr\u1ecdng tr\u00ean ti\u00eau h\u00f3a th\u1ea5p h\u01a1n so v\u1edbi c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc, nh\u01b0 naproxen hay ibuprofen. Tuy nhi\u00ean, celecoxib v\u1eabn c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf COX-1 khi d\u00f9ng li\u1ec1u cao. Do \u0111\u00f3, c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a celecoxib n\u00f3i chung t\u01b0\u01a1ng t\u1ef1 v\u1edbi c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc, nh\u01b0ng t\u1ea7n su\u1ea5t xu\u1ea5t hi\u1ec7n c\u00e1c ph\u1ea3n \u1ee9ng n\u00e0y c\u00f3 th\u1ec3 kh\u00e1c nhau.<\/p>\n<p>C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a celecoxib bao g\u1ed3m:<\/p>\n<ul>\n<li>C\u00e1c tri\u1ec7u ch\u1ee9ng tr\u00ean ti\u00eau h\u00f3a \u1edf c\u00e1c m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau t\u1eeb kh\u00f3 ti\u00eau \u0111\u1ebfn xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a.<\/li>\n<li>T\u0103ng huy\u1ebft \u00e1p.<\/li>\n<li>\u0110au \u0111\u1ea7u.<\/li>\n<li>Ch\u00f3ng m\u1eb7t.<\/li>\n<li>Gi\u1eef natri v\u00e0 n\u01b0\u1edbc.<\/li>\n<\/ul>\n<h3>KHI N\u00c0O N\u00caN C\u00c2N NH\u1eaeC K\u00ca \u0110\u01a0N CELECOXIB<\/h3>\n<p>\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh, c\u00e1c thu\u1ed1c d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u00e0 \u0111\u1eb7c t\u00ednh d\u01b0\u1ee3c l\u00fd c\u1ee7a NSAID l\u00e0 c\u00e1c y\u1ebfu t\u1ed1 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 vi\u1ec7c s\u1eed d\u1ee5ng NSAID c\u00f3 ph\u00f9 h\u1ee3p hay kh\u00f4ng v\u00e0 n\u00ean l\u1ef1a ch\u1ecdn NSAID n\u00e0o. C\u00e1c y\u1ebfu t\u1ed1 c\u1ea7n xem x\u00e9t khi \u0111\u00e1nh gi\u00e1 ng\u01b0\u1eddi b\u1ec7nh bao g\u1ed3m c\u00e1c nguy c\u01a1 v\u1ec1:<\/p>\n<p>&#8211; B\u1ec7nh tim m\u1ea1ch;<\/p>\n<p>&#8211; Bi\u1ebfn ch\u1ee9ng ti\u00eau h\u00f3a;<\/p>\n<p>&#8211; B\u1ec7nh th\u1eadn m\u1ea1n;<\/p>\n<p>&#8211; Ti\u1ec1n s\u1eed qu\u00e1 m\u1eabn v\u1edbi NSAID;<\/p>\n<p>&#8211; T\u01b0\u01a1ng t\u00e1c thu\u1ed1c, v\u00ed d\u1ee5 tr\u00e1nh s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 angiotensin II k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u v\u00e0 NSAID (triple whammy).<\/p>\n<h3>Nguy c\u01a1 tim m\u1ea1ch c\u1ee7a celecoxib t\u01b0\u01a1ng \u0111\u01b0\u01a1ng c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc<\/h3>\n<p>T\u1ea5t c\u1ea3 NSAID, bao g\u1ed3m c\u1ea3 naproxen, c\u1ea7n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u1eadn tr\u1ecdng tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 m\u1eafc c\u00e1c b\u1ec7nh tim m\u1ea1ch. Nguy\u00ean nh\u00e2n do t\u1ea5t c\u1ea3 c\u00e1c NSAID (tr\u1eeb aspirin) \u0111\u1ec1u li\u00ean quan \u0111\u1ebfn gia t\u0103ng nguy c\u01a1 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch, ph\u1ee5 thu\u1ed9c li\u1ec1u, c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong nh\u1eefng tu\u1ea7n \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb. Vi\u1ec7c s\u1eed d\u1ee5ng NSAID li\u1ec1u cao h\u00e0ng ng\u00e0y trong th\u1eddi gian t\u1eeb 8-30 ng\u00e0y \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 nguy c\u01a1 cao nh\u1ea5t, v\u00ed d\u1ee5 s\u1eed d\u1ee5ng celecoxib &gt;200 mg, diclofenac &gt;100 mg, ibuprofen &gt;1200 mg v\u00e0 naproxen &gt;750 mg. Ng\u01b0\u1eddi b\u1ec7nh m\u1eafc b\u1ec7nh tim m\u1ea1ch, \u0111\u1eb7c bi\u1ec7t l\u00e0 ng\u01b0\u1eddi m\u1edbi b\u1ecb nh\u1ed3i m\u00e1u c\u01a1 tim ho\u1eb7c \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u n\u1ed1i ch\u1ee7 &#8211; v\u00e0nh, c\u00f3 nguy c\u01a1 cao nh\u1ea5t g\u1eb7p c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch li\u00ean quan \u0111\u1ebfn NSAID. C\u0169ng n\u00ean l\u01b0u \u00fd, nguy c\u01a1 n\u00e0y c\u0169ng c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 b\u1ec7nh l\u00fd tim m\u1ea1ch.<\/p>\n<p>L\u01b0u \u00fd chung v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng NSAID li\u00ean quan \u0111\u1ebfn nguy c\u01a1 tim m\u1ea1ch \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1eadp nh\u1eadt so v\u1edbi c\u00e1c h\u01b0\u1edbng d\u1eabn tr\u01b0\u1edbc \u0111\u00e2y. Tr\u01b0\u1edbc \u0111\u00f3, naproxen ho\u1eb7c ibuprofen s\u1eed d\u1ee5ng \u1edf li\u1ec1u t\u01b0\u01a1ng \u0111\u1ed1i th\u1ea5p \u0111\u01b0\u1ee3c coi l\u00e0 kh\u00f4ng li\u00ean quan \u0111\u1ebfn gia t\u0103ng nguy c\u01a1 tim m\u1ea1ch. Tuy nhi\u00ean, b\u1eb1ng ch\u1ee9ng t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y cho th\u1ea5y vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c NSAID n\u00e0y c\u0169ng c\u00f3 nguy c\u01a1 tim m\u1ea1ch t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi celecoxib.<\/p>\n<p>G\u1ea7n \u0111\u00e2y, m\u1ed9t nghi\u00ean c\u1ee9u t\u1eeb d\u1eef li\u1ec7u th\u1ef1c t\u1ebf tr\u00ean h\u01a1n 440.000 b\u1ec7nh nh\u00e2n, trong \u0111\u00f3 c\u00f3 h\u01a1n 61.000 ca nh\u1ed3i m\u00e1u c\u01a1 tim \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng vi\u1ec7c s\u1eed d\u1ee5ng t\u1ea5t c\u1ea3 c\u00e1c NSAID \u0111\u1ec1u li\u00ean quan \u0111\u1ebfn t\u0103ng nguy c\u01a1 nh\u1ed3i m\u00e1u c\u01a1 tim. Nguy c\u01a1 nh\u1ed3i m\u00e1u c\u01a1 tim tr\u00ean b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng celecoxib t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n d\u00f9ng c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc v\u00e0 th\u1ea5p h\u01a1n \u1edf b\u1ec7nh nh\u00e2n d\u00f9ng rofecoxib.<\/p>\n<h3>T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean ti\u00eau h\u00f3a c\u1ee7a celecoxib th\u1ea5p h\u01a1n c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc<\/h3>\n<p>Celecoxib \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n c\u00f3 t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a c\u00f3 ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng NSAID, do c\u00f3 nguy c\u01a1 g\u00e2y xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a th\u1ea5p h\u01a1n c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc. Tuy nhi\u00ean, do thu\u1ed1c c\u0169ng c\u00f3 kh\u1ea3 n\u0103ng \u1ee9c ch\u1ebf COX-1, vi\u1ec7c s\u1eed d\u1ee5ng celecoxib \u1edf b\u1ec7nh nh\u00e2n c\u00f3 t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a c\u0169ng c\u00f3 nguy c\u01a1 g\u00e2y ra ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i tr\u00ean h\u1ec7 c\u01a1 quan n\u00e0y. Th\u00eam v\u00e0o \u0111\u00f3, enzym COX-2 c\u00f3 th\u1ec3 tham gia v\u00e0o qu\u00e1 tr\u00ecnh l\u00e0m l\u00e0nh t\u1ed5n th\u01b0\u01a1ng \u1edf d\u1ea1 d\u00e0y. V\u00ec v\u1eady, celecoxib c\u00f3 th\u1ec3 ng\u0103n c\u1ea3n qu\u00e1 tr\u00ecnh h\u1ed3i ph\u1ee5c t\u1ed5n th\u01b0\u01a1ng lo\u00e9t \u0111\u00e3 c\u00f3 tr\u01b0\u1edbc \u0111\u00f3. \u1ede b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao g\u1eb7p c\u00e1c bi\u1ebfn ch\u1ee9ng tr\u00ean ti\u00eau h\u00f3a, nh\u01b0 c\u00f3 ti\u1ec1n s\u1eed xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a do NSAID, n\u00ean k\u00ea \u0111\u01a1n k\u00e8m theo thu\u1ed1c \u1ee9c ch\u1ebf b\u01a1m proton (PPI). C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 li\u00ean quan \u0111\u1ebfn t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean ti\u00eau h\u00f3a c\u1ee7a NSAID bao g\u1ed3m:<\/p>\n<ul>\n<li>Ng\u01b0\u1eddi b\u1ec7nh tr\u00ean 65 tu\u1ed5i;<\/li>\n<li>C\u00f3 ti\u1ec1n s\u1eed xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a;<\/li>\n<li>S\u1eed d\u1ee5ng thu\u1ed1c l\u00e0m t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft, nh\u01b0 aspirin, warfarin, dabigatran, c\u00e1c thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m \u1ee9c ch\u1ebf t\u00e1i thu h\u1ed3i ch\u1ecdn l\u1ecdc serotonin v\u00e0 corticosteroid;<\/li>\n<li>B\u1ec7nh gan;<\/li>\n<li>B\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh;<\/li>\n<li>S\u1eed d\u1ee5ng qu\u00e1 nhi\u1ec1u \u0111\u1ed3 u\u1ed1ng ch\u1ee9a c\u1ed3n.<\/li>\n<\/ul>\n<p>B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c c\u1ea5p c\u1ee9u n\u1ebfu c\u00f3 bi\u1ec3u hi\u1ec7n n\u00f4n ra m\u00e1u, \u0111\u1ea1i ti\u1ec7n ph\u00e2n \u0111en ho\u1eb7c c\u00e1c tri\u1ec7u ch\u1ee9ng thi\u1ebfu m\u00e1u. B\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a cao n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u1ea1i trong th\u00e1ng \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u ti\u00ean, bao g\u1ed3m x\u00e9t ghi\u1ec7m hemoglobin.<\/p>\n<p>\u1ede b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a li\u00ean quan \u0111\u1ebfn NSAID, d\u00f9ng k\u00e8m m\u1ed9t PPI v\u1edbi celecoxib gi\u00fap l\u00e0m gi\u1ea3m nguy c\u01a1 g\u1eb7p xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a. Trong 441 b\u1ec7nh nh\u00e2n vi\u00eam kh\u1edbp c\u00f3 ti\u1ec1n s\u1eed xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a tr\u00ean, kh\u00f4ng ghi nh\u1eadn tr\u01b0\u1eddng h\u1ee3p xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a n\u00e0o trong v\u00f2ng 13 th\u00e1ng \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n \u0111\u1ed3ng th\u1eddi celecoxib (200 mg, 2 l\u1ea7n\/ng\u00e0y) v\u1edbi esomeprazol li\u1ec1u cao (t\u01b0\u01a1ng \u0111\u01b0\u01a1ng 20 mg omeprazol, 2 l\u1ea7n\/ng\u00e0y), trong khi c\u00f3 12 ca xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a x\u1ea3y ra trong nh\u00f3m b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng celecoxib v\u00e0 placebo.<\/p>\n<h3>Celecoxib c\u00f3 nguy c\u01a1 g\u00e2y bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i tr\u00ean th\u1eadn t\u01b0\u01a1ng \u0111\u01b0\u01a1ng c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc<\/h3>\n<p>Prostaglandin \u0111\u01b0\u1ee3c t\u1ed5ng h\u1ee3p nh\u1edd x\u00fac t\u00e1c c\u1ee7a c\u00e1c enzym COX c\u00f3 t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn ch\u1ee9c n\u0103ng c\u1ee7a th\u1eadn th\u00f4ng qua \u0111i\u1ec1u h\u00f2a s\u1ef1 co m\u1ea1ch v\u00e0 l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u0111\u1ebfn th\u1eadn. \u1ee8c ch\u1ebf COX-1 l\u00e0m gi\u1ea3m m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn, trong khi vi\u1ec7c \u1ee9c ch\u1ebf COX-2 li\u00ean quan \u0111\u1ebfn gi\u1eef natri. S\u1eed d\u1ee5ng NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc ho\u1eb7c thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc COX-2 l\u00e0m t\u0103ng kho\u1ea3ng 2 l\u1ea7n nguy c\u01a1 xu\u1ea5t hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p.<\/p>\n<h3>Celecoxib c\u00f3 nguy c\u01a1 ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn v\u1edbi NSAID th\u1ea5p h\u01a1n c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc<\/h3>\n<p>M\u1ed9t s\u1ed1 \u00edt b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng NSAID s\u1ebd g\u1eb7p ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn, v\u00ed d\u1ee5 l\u00e0m x\u1ea5u \u0111i c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh l\u00fd h\u00f4 h\u1ea5p khi d\u00f9ng asprin v\u00e0 m\u00e0y \u0111ay. Co th\u1eaft ph\u1ebf qu\u1ea3n do NSAID li\u00ean quan \u0111\u1ebfn \u1ee9c ch\u1ebf COX-1, l\u00e0m m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa c\u00e1c ch\u1ea5t trung gian ti\u1ec1n vi\u00eam v\u00e0 kh\u00e1ng vi\u00eam. Celecoxib kh\u00f4ng \u1ee9c ch\u1ebf COX-1 m\u1ea1nh nh\u01b0 c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc, do \u0111\u00f3 \u00edt c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn h\u01a1n. Tuy nhi\u00ean, c\u1ea7n l\u01b0u \u00fd thu\u1ed1c v\u1eabn b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh cho ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ti\u1ec1n s\u1eed qu\u00e1 m\u1eabn v\u1edbi NSAID. C\u1ea7n h\u1ed9i ch\u1ea9n d\u1ecb \u1ee9ng n\u1ebfu c\u00f3 \u00fd \u0111\u1ecbnh s\u1eed d\u1ee5ng celecoxib cho c\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n<h2>T\u00d3M T\u1eaeT L\u00c2M S\u00c0NG: CELECOXIB \u0110\u01af\u1ee2C \u01afU TI\u00caN S\u1eec D\u1ee4NG TR\u00caN NG\u01af\u1edcI B\u1ec6NH C\u00d3 NGUY C\u01a0 XU\u1ea4T HUY\u1ebeT TI\u00caU H\u00d3A<\/h2>\n<p>Celecoxib l\u00e0 NSAID \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng cho c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a. Thu\u1ed1c c\u0169ng c\u00f3 nguy c\u01a1 g\u00e2y ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn v\u1edbi NSAID gi\u00e1n ti\u1ebfp th\u00f4ng qua \u1ee9c ch\u1ebf COX-1 th\u1ea5p h\u01a1n so v\u1edbi c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc (b\u1ea3ng 1). Kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng gi\u1eefa celecoxib v\u00e0 c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc v\u1ec1 t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au. Nguy c\u01a1 xu\u1ea5t hi\u1ec7n c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i tr\u00ean tim m\u1ea1ch v\u00e0 th\u1eadn l\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau gi\u1eefa c\u00e1c thu\u1ed1c n\u00e0y. T\u01b0\u01a1ng t\u1ef1 c\u00e1c NSAID kh\u00e1c, c\u00f3 th\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 xu\u1ea5t hi\u1ec7n t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng celecoxib \u1edf m\u1ee9c li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3, trong th\u1eddi gian ng\u1eafn nh\u1ea5t c\u00f3 th\u1ec3 v\u00e0 lu\u00f4n \u0111\u00e1nh gi\u00e1 s\u1ef1 c\u1ea7n thi\u1ebft ti\u1ebfp t\u1ee5c d\u00f9ng thu\u1ed1c trong m\u1ed7i l\u1ea7n t\u00e1i kh\u00e1m.<\/p>\n<table dir=\"ltr\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td colspan=\"4\" valign=\"Top\" bgcolor=\"#E6B8B8\" width=\"546\" height=\"22\">B\u1ea3ng 1: So s\u00e1nh l\u1ee3i \u00edch v\u00e0 nguy c\u01a1 gi\u1eefa celecoxib v\u00e0 c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc<\/td>\n<\/tr>\n<tr>\n<td valign=\"Top\" bgcolor=\"#FFCCCC\" width=\"212\" height=\"17\">T\u00e1c d\u1ee5ng l\u00e2m s\u00e0ng<\/td>\n<td valign=\"Top\" bgcolor=\"#FF9999\" width=\"65\" height=\"17\">Celecoxib<\/td>\n<td valign=\"Top\" bgcolor=\"#FFCCCC\" width=\"148\" height=\"17\">C\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc<\/td>\n<td valign=\"Top\" bgcolor=\"#E6B8B8\" width=\"121\" height=\"17\">Ghi ch\u00fa<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"white\" width=\"212\" height=\"21\">Gi\u1ea3m \u0111au<\/td>\n<td bgcolor=\"white\" width=\"65\" height=\"21\">=<\/td>\n<td bgcolor=\"white\" width=\"148\" height=\"21\">=<\/td>\n<td rowspan=\"5\" bgcolor=\"#E6B8B8\" width=\"121\" height=\"110\">\u2193: Nguy c\u01a1 th\u1ea5p h\u01a1n; \u2191: Nguy c\u01a1 cao h\u01a1n; =: Nguy c\u01a1 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng (ho\u1eb7c l\u1ee3i \u00edch t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au).<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"white\" width=\"212\" height=\"22\">Nguy c\u01a1 tim m\u1ea1ch<\/td>\n<td bgcolor=\"white\" width=\"65\" height=\"22\">=<\/td>\n<td bgcolor=\"white\" width=\"148\" height=\"22\">=<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"white\" width=\"212\" height=\"22\">Bi\u1ebfn ch\u1ee9ng tr\u00ean ti\u00eau h\u00f3a<\/td>\n<td bgcolor=\"white\" width=\"65\" height=\"22\">\u2193<\/td>\n<td bgcolor=\"white\" width=\"148\" height=\"22\">\u2191<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"white\" width=\"212\" height=\"23\">T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean th\u1eadn<\/td>\n<td bgcolor=\"white\" width=\"65\" height=\"23\">=<\/td>\n<td bgcolor=\"white\" width=\"148\" height=\"23\">=<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"white\" width=\"212\" height=\"22\">Co th\u1eaft ph\u1ebf qu\u1ea3n do NSAID<\/td>\n<td bgcolor=\"white\" width=\"65\" height=\"22\">\u2193<\/td>\n<td bgcolor=\"white\" width=\"148\" height=\"22\">\u2191<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"<p>Ng\u01b0\u1eddi d\u1ecbch: T\u01b0\u0300 Pha\u0323m Hi\u00ea\u0300n Trang, L\u01b0\u01a1ng Anh T\u00f9ng T\u00f3m t\u1eaft Celecoxib l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc cyclo-oxygenase-2 (COX-2) \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111i\u1ec1u tr\u1ecb \u0111au c\u1ea5p t\u00ednh, c\u00e1c b\u1ec7nh l\u00fd n\u1ec1n c\u1ee7a kh\u1edbp ho\u1eb7c \u0111au b\u1ee5ng kinh nguy\u00ean ph\u00e1t nh\u01b0 l\u00e0 l\u1ef1a ch\u1ecdn thay th\u1ebf cho c\u00e1c thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid (NSAID) nh\u01b0 [&#8230;]\n","protected":false},"author":1,"featured_media":6203,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-6755","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\/6755","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=6755"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/6755\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/6203"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=6755"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=6755"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=6755"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}