M\u1ed7i vi\u00ean n\u00e9n bao phim thu\u1ed1c METOVANCE<\/strong><\/a> ch\u1ee9a:<\/p>\n D\u1ea0NG B\u00c0O CH\u1ebe: Vi\u00ean n\u00e9n bao phim.<\/p>\n QUY C\u00c1CH \u0110\u00d3NG G\u00d3I: V\u1ec9 10 vi\u00ean; h\u1ed9p 3 v\u1ec9.<\/p>\n Xem th\u00eam:<\/p>\n K\u1ebft h\u1ee3p gi\u1eefa biguanide (metformin hydroclorid) v\u00e0 sulphonamide (glibenclamid). Metformin k\u00edch th\u00edch s\u1ef1 t\u1ed5ng h\u1ee3p glycogen \u1edf t\u1ebf b\u00e0o b\u1eb1ng c\u00e1ch t\u00e1c \u0111\u1ed9ng l\u00ean glycogen synthase. Metformin gia t\u0103ng kh\u1ea3 n\u0103ng v\u1eadn chuy\u1ec3n c\u1ee7a c\u00e1c lo\u1ea1i v\u1eadn chuy\u1ec3n giycose qua m\u00e0ng (GLUT), \u1edf ng\u01b0\u1eddi, ngo\u00e0i t\u00e1c \u0111\u1ed9ng tr\u00ean \u0111\u01b0\u1eddng huy\u1ebft, metformin c\u00f2n t\u00e1c \u0111\u1ed9ng c\u00f3 l\u1ee3i cho s\u1ef1 chuy\u1ec3n h\u00f3a l\u1ec9pid. \u0110i\u1ec1u n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh qua c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng c\u00f3 nh\u00f3m ch\u1ee9ng trung v\u00e0 d\u00e0i h\u1ea1n, \u1edf c\u00e1c li\u1ec1u \u0111i\u1ec1u tr\u1ecb: metformin l\u00e0m gi\u1ea3m m\u1ee9c cholesterol to\u00e0n ph\u1ea7n, m\u1ee9c cholesterol t\u1ec9 tr\u1ecdng th\u1ea5p (LDL cholesterol) v\u00e0 m\u1ee9c triglyceride. Cho \u0111\u1ebfn nay, c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u1edbi li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p gi\u1eefa metformin v\u00e0 glibendamid kh\u00f4ng cho th\u1ea5y t\u00e1c d\u1ee5ng c\u00f3 l\u1ee3i n\u00e0y tr\u00ean chuy\u1ec3n h\u00f3a lipid. Glibenc\u0129amid l\u00e0 sulphonylurea th\u00ea’ h\u1ec7 th\u1ee9 2 c\u00f3 th\u1eddi gian b\u00e1n th\u1ea3i trung b\u00ecnh: g\u00e2y h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft c\u1ea5p b\u1eb1ng c\u00e1ch k\u00edch th\u00edch gi\u1ea3i ph\u00f3ng insulin \u1edf tuy\u1ebfn t\u1ee5y, t\u00e1c d\u1ee5ng n\u00e0y ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a t\u1ebf b\u00e0o beta ch\u1ee9c n\u0103ng \u1edf \u0111\u1ea3o Langerhans.<\/p>\n S\u1ef1 k\u00edch th\u00edch b\u00e0i ti\u1ebft insulin c\u1ee7a glibenclamid nh\u1eb1m \u0111\u00e1p \u1ee9ng v\u1edbi b\u1eefa \u0103n c\u00f3 t\u1ea7m quan tr\u1ecdng l\u1edbn.Vi\u1ec7c s\u1eed d\u1ee5ng glibenclamid trong b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng g\u00e2y ra s\u1ef1 gia t\u0103ng \u0111\u00e1p \u1ee9ng k\u00edch th\u00edch insulin sau b\u1eefa \u0103n. S\u1ef1 gia t\u0103ng \u0111\u00e1p \u1ee9ng insulin sau b\u1eefa \u0103n v\u00e0 s\u1ef1 b\u00e0i ti\u1ebft C-peptide t\u1ed3n t\u1ea1i sau khi \u0111i\u1ec1u tr\u1ecb \u00edt nh\u1ea5t 6 th\u00e1ng. Metformin v\u00e0 glibenclamid c\u00f3 c\u01a1 ch\u00ea’ v\u00e0 v\u1ecb tr\u00ed t\u00e1c d\u1ee5ng kh\u00e1c nhau, nh\u01b0ng t\u00e1c d\u1ee5ng c\u1ee7a ch\u00fang b\u1ed5 sung cho nhau. Glibenclamid k\u00edch th\u00edch tuy\u1ebfn t\u1ee5y b\u00e0i ti\u1ebft insulin, trong khi metformin l\u00e0m gi\u1ea3m s\u1ef1 \u0111\u1ec1 kh\u00e1ng c\u1ee7a t\u1ebf b\u00e0o \u0111\u1ed1i v\u1edbi insulin b\u1eb1ng c\u00e1ch t\u00e1c \u0111\u1ed9ng l\u00ean s\u1ef1 nh\u1ea1y c\u1ea3m insulin ngo\u1ea1i bi\u00ean (c\u01a1 x\u01b0\u01a1ng v\u00e0 \u1edf gan).<\/p>\n K\u1ebft qu\u1ea3 thu \u0111\u01b0\u1ee3c t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng m\u00f9 \u0111\u00f4i, c\u00f3 nh\u00f3m ch\u1ee9ng v\u1edbi c\u00e1c thu\u1ed1c tham kh\u1ea3o trong \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng tu\u00fdp 2 kh\u00f4ng \u0111\u00e1p \u1ee9ng b\u1eb1ng \u0111\u01a1n tr\u1ecb li\u1ec7u v\u1edbi metformin ho\u1eb7c glibencla- mid k\u1ebft h\u1ee3p v\u1edbi ch\u00ea’ \u0111\u1ed9 \u0103n v\u00e0 t\u1eadp th\u1ec3 d\u1ee5c, \u0111\u00e3 ch\u1ee9ng t\u1ecf r\u1eb1ng s\u1ef1 k\u1ebft h\u1ee3p c\u00f3 t\u00e1c d\u1ee5ng hi\u1ec7p l\u1ef1c trong vi\u1ec7c \u0111i\u1ec1u h\u00f2a glucose. Li\u00ean quan \u0111\u1ebfn s\u1ef1 k\u1ebft h\u1ee3p:<\/p>\n H\u1ea5p thu:<\/p>\n Chuy\u1ec3n h\u00f3a: Metformin \u0111\u01b0\u1ee3c \u0111\u00e0o th\u1ea3i d\u01b0\u1edbi d\u1ea1ng kh\u00f4ng \u0111\u1ed5i trong n\u01b0\u1edbc ti\u1ec3u. Kh\u1ed5ng c\u00f3 ch\u1ea5t chuy\u1ec3n h\u00f3a n\u00e0o \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y \u1edf ng\u01b0\u1eddi.<\/p>\n \u0110\u00e0o th\u1ea3i:<\/p>\n H\u1ea5p thu: Glibenclamid \u0111\u01b0\u1ee3c h\u1ea5p thu \u0111\u00e1ng k\u1ec3 (>95%) sau khi u\u1ed1ng. N\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh trong huy\u1ebft t\u01b0\u01a1ng \u0111\u1ea1t \u0111\u01b0\u1ee3c sau kho\u1ea3ng 4 gi\u1edd.<\/p>\n Ph\u00e2n b\u1ed1: Glibenclamid li\u00ean k\u1ebft m\u1ea1nh v\u1edbi albumin huy\u1ebft t\u01b0\u01a1ng (99%), \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch cho v\u00e0i t\u01b0\u01a1ng t\u00e1c thu\u1ed1c.<\/p>\n Chuy\u1ec3n h\u00f3a: Glibendamid \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a ho\u00e0n to\u00e0n \u1edf gan th\u00e0nh 2 ch\u1ea5t chuy\u1ec3n h\u00f3a. Suy t\u1ebf b\u00e0o gan l\u00e0m gi\u1ea3m s\u1ef1 chuy\u1ec3n h\u00f3a c\u1ee7a glibenclamid v\u00e0 l\u00e0m ch\u1eadm s\u1ef1 \u0111\u00e0o th\u1ea3i \u0111\u00e1ng k\u1ec3.<\/p>\n \u0110\u00e0o th\u1ea3i: Glibenclamid \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft \u1edf d\u1ea1ng ch\u1ea5t chuy\u1ec3n h\u00f3a qua m\u1eadt (60%) v\u00e0 n\u01b0\u1edbc ti\u1ec3u (40%), s\u1ef1 \u0111\u00e0o th\u1ea3i ho\u00e0n to\u00e0n trong v\u00f2ng 45 t\u1edbi 72 gi\u1edd. Th\u1eddi gian b\u00e1n th\u1ea3i kh\u1ea3 ki\u1ebfn t\u1eeb 4 \u0111\u1ebfn 11 gi\u1edd.<\/p>\n S\u1ef1 b\u00e0i ti\u1ebft c\u1ee7a ch\u1ea5t chuy\u1ec3n hoa \u1edf m\u1eadt gia t\u0103ng tr\u1ed1ng tr\u01b0\u1eddng h\u1ee3p suy th\u1eadn, theo m\u1ee9c \u0111\u1ed9 suy th\u1eadn cho \u0111\u1ebfn khi \u0111\u1ed9 thanh th\u1ea3i c\u1ee7a creatinine l\u00e0 30ml\/ph\u00fat. V\u00ec v\u1eady, s\u1ef1 \u0111\u00e0o th\u1ea3i glibenclamid kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi suy th\u1eadn mi\u1ec5n sao s\u1ef1 thanh th\u1ea3i creatinine v\u1eabn c\u00f2n gi\u1eef tr\u00ean 30ml\/ph\u00fat.<\/p>\n B\u1ec7nh nhi: Kh\u00f4ng c\u00f3 S\u1ecaTkh\u00e1c bi\u1ec7t v\u1ec1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a glibenclamid v\u00e0 metformin gi\u1eefa b\u1ec7nh nh\u00e2n tr\u1ebbem v\u00e0 ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh kh\u1ecfe m\u1ea1nh ph\u00f9 h\u1ee3p v\u1ec1 gi\u1edbi t\u00ednh v\u00e0 c\u00e2n n\u1eb7ng.<\/p>\n Metovance \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng tu\u00fdp II gi\u00fap ki\u1ec3m so\u00e1t h\u00e0m l\u01b0\u1ee3ng \u0111\u01b0\u1eddng huy\u1ebft. Thu\u1ed1c \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh k\u1ebft h\u1ee3p v\u1edbi ch\u1ebf \u0111\u1ed9 \u0103n ki\u00eang v\u00e0 luy\u1ec7n t\u1eadp th\u1ec3 d\u1ee5c \u0111\u1ec3 gia t\u0103ng s\u1ef1 ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft t\u1ed1t h\u01a1n trong su\u1ed1t c\u1ea3 ng\u00e0y.<\/p>\n \u0110\u01b0\u1eddng u\u1ed1ng. Ch\u1ec9 d\u00f9ng cho ng\u01b0\u1eddi l\u1edbn. S\u1ed5 l\u1ea9n d\u00f9ng thu\u1ed1c: S\u1ed1 l\u1ea9n d\u00f9ng thu\u1ed1c ph\u1ee5 thu\u1ecdc v\u00e0o li\u1ec1u l\u01b0\u1ee3ng c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n:<\/p>\n N\u00ean u\u1ed1ng thuoc v\u00e0o b\u1eefa \u0103n. So l\u1ea7n d\u00f9ng thu\u1ed1c n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh d\u1ef1a tr\u00ean th\u00f3i quen \u0103n u\u1ed1ng c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n. Tuy nhi\u00ean, sau m\u1ed7i khi u\u1ed1ng thu\u1ed1c, ph\u1ea3i d\u00f9ng k\u00e8m m\u1ed9t b\u1eefa \u0103n ch\u1ee9a carbohy\u00acdrate \u0111\u1ee7 \u0111\u1ec3 ng\u0103n ng\u1eeba s\u1ef1 kh\u1edfi ph\u00e1t c\u01a1n h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.<\/p>\n N\u1ebfu Metovance \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c lie ch\u1ebf acid m\u1eadt, Metovance n\u00ean \u0111\u01b0\u1ee3c u\u1ed1ng tr\u01b0\u1edbc thu\u1ed1c \u1ee9c ch\u00ea’ acid m\u1eadt \u00edt nh\u1ea5t 4 gi\u1edd \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 gi\u1ea3m h\u1ea5p thu.<\/p>\n Ng\u01b0\u1eddi l\u1edfn tu\u1ed5i: Li\u1ec1u d\u00f9ng c\u1ee7a Metovance n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh d\u1ef1a tr\u00ean c\u00e1c th\u00f4ng s\u1ed1 ch\u1ee9c n\u0103ng th\u1eadn; c\u1ea7n th\u01b0\u1eddng xuy\u00ean ki\u1ec3m tra ch\u1ee9c n\u0103ng th\u1eadn.<\/p>\n \u0110\u1ed1i t\u01b0\u1ee3ng t\u1eeb 65 tu\u1ed5i tr\u1edf l\u00ean: li\u1ec1u l\u01b0\u1ee3ng ban \u0111\u1ea9u v\u00e0 li\u1ec1u duy tr\u00ec glibenclamid n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh c\u1ea9n th\u1eadn \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft. \u0110i\u1ec1u tr\u1ecb v\u1edbi li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 th\u1ec3 v\u00e0 t\u0103ng d\u1ea7n n\u1ebfu c\u1ea9n thi\u1ebft. Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng thu\u1ed1c tr\u00ean b\u1ec7nh nh\u00e2n suy th\u1eadn:<\/p>\n \u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u1eb3ng th\u1eadn tr\u01b0\u1edbc klii kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi metformin v\u00e0 \u0111\u00e1nh gi\u00e1 \u0111\u1ecbnh k\u1ef3 sau \u0111\u00f3 \u00edt nh\u1ea5t m\u1ed7i n\u0103m m\u1ed9t l\u1ea9n. \u1edf b\u1ec7nh nh\u00e2n suy ch\u1ee9c n\u0103ng th\u1eadn ti\u1ebfn tri\u1ec3n v\u00e0 ng\u01b0\u1eddi gi\u00e0 c\u1ea9n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn th\u01b0\u1eddng xuy\u00ean h\u01a1n, n\u00ean \u0111\u00e1nh gi\u00e1 sau m\u1ed7i 3 \u0111\u1ebfn 6 th\u00e1ng.<\/p>\n C\u00e1c y\u1ebfu to l\u00e0m t\u0103ng nguy c\u01a1 nhi\u1ec5m toan lactic c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng metformin \u1edf b\u1ec7nh nh\u00e2n c\u00f3 GFR <60 mL \/ ph\u00fat.<\/p>\n Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh metformin tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 eGFR d\u01b0\u1edbi 30 m\u01afph\u00fat\/1,73 m2.<\/p>\n Kh\u00f4ng khuy\u1ebfn c\u00e1o kh\u1edfi \u0111\u1ea9u \u0111i\u1ec1u tr\u1ecb v\u1edbi metformin \u1edf b\u1ec7nh nh\u00e2n c\u00f3 eGFR n\u1eb1m trong kho\u1ea3ng 30-45 \u1ede\u00a0b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng metformin v\u00e0 c\u00f3 eGFR gi\u1ea3m xu\u1ed1ng d\u01b0\u1edbi 45m\u01b0ph\u00fat\/1,73 m2, \u0111\u00e1nh gi\u00e1 nguy c\u01a1 – l\u1ee3i \u00edch khi ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb.<\/p>\n Ng\u1eebng s\u1eed d\u1ee5ng metformin n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 eGFR gi\u1ea3m xu\u1ed1ng d\u01b0\u1edbi 30 mL\/ph\u00fat\/1,73 m2 [xem m\u1ee5c Ch\u1ed1ng ch\u1ec9 \u0111inh, m\u1ee5c<\/p>\n N\u1ebfu kh\u00f4ng c\u00f3 li\u1ec1u Metov\u00e0nce th\u00edch h\u1ee3p, c\u00e1c th\u00e0nh ph\u1ea9n ri\u00eang l\u1ebb n\u00ean \u0111\u01b0\u1ee3c s\u1eedd\u1ee5ng thay cho ph\u1ed1i h\u1ee3p c\u1ed1 \u0111\u1ecbnh.<\/p>\n Gi\u1ea3m li\u1ec1u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t t\u00f9y thu\u1ed9c v\u00e0o s\u1ef1 suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn.<\/td>\n Li\u1ec1u kh\u1edfi \u0111\u1ea9u kh\u00f4ng \u0111\u01b0\u1ee3c v\u01b0\u1ee3t qu\u00e1 m\u1ed9t n\u1eeda so v\u1edbi li\u1ec1u t\u1ed1i \u0111a.<\/td>\n Li\u1ec1u kh\u1edfi \u0111\u1ea7u khong \u0111\u01b0\u1ee3c v\u01b0\u1ee3t qu\u00e1 m\u1ed9t n\u1eeda so v\u1edbi li\u1ec1u t\u1ed1i \u0111a.<\/td>\n Ng\u1eebng s\u1eed d\u1ee5ng metformin khi th\u1ef1c hi\u1ec7n x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh c\u00f3 s\u1eed d\u1ee5ng thu\u1ed1c c\u1ea3n quang ch\u1ee9a iod.<\/p>\n Tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 eGFR n\u1eb1m trong kho\u1ea3ng t\u1eeb 30 \u2014 60 mL\/ph\u00fat\/1,73 m2, tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh l\u00fd v\u1ec1 gan, nghi\u1ec7n r\u01b0\u1ee3u ho\u1eb7c suy tim, ho\u1eb7c tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n s\u1ebd s\u1eed d\u1ee5ng thu\u1ed1c c\u1ea3n quang ch\u1ee9a iod qua \u0111\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch, ng\u1eebng metformin tr\u01b0\u1edbc ho\u1eb7c t\u1ea1i th\u1eddi \u0111i\u1ec3m th\u1ef1c hi\u1ec7n x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh c\u00f3 s\u1eed d\u1ee5ng thu\u1ed1c c\u1ea3n quang ch\u1ee9a iod. \u0110\u00e1nh gi\u00e1 l\u1ea1i ch\u1ec9 s\u1ed1 eGFR sau khi chi\u1ebfu ch\u1ee5p 48 gi\u1edd, s\u1eed d\u1ee5ng l\u1ea1i metformin n\u1ebfu ch\u1ee9c n\u0103ng th\u1eadn \u1ed5n \u0111\u1ecbnh [xem m\u1ee5c C\u1ea3nh b\u00e1o v\u00e0 th\u1eadn tr\u1ecdng].<\/p>\n Tr\u1ebb em: Kh\u00f4ng khuy\u00ean d\u00f9ng Metovance cho tr\u1ebb em.<\/p>\n Kh\u00f4ng \u0111\u01b0\u1ee3c dung thu\u1ed1c n\u00e0y trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p:<\/p>\n Nhi\u1ec5m acid lactic:<\/p>\n Tr\u01b0\u1edbc khi kh\u1edfi \u0111au \u0111i\u1ec3u tr\u1ecb v\u1edbi metformin c\u1ea7n \u01b0\u1edbc t\u00ednh m\u1ee9c \u0111\u1ed9 l\u1ecdc c\u1ea9u th\u1eadn (eGFR) c\u1ee7a b\u1ec7nh nh\u00e2n. -Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh metformin tr\u00ean b\u1ec7nh nh\u00e2nc\u00f3eGFRd\u01b0\u1edbi30mL\/ph\u00fat\/1,73 m2 [xem m\u1ee5c Ch\u1ed5ng ch\u1ec9 \u0111\u1ecbnh].<\/p>\n Kh\u00f4ng khuy\u1ebfn c\u00e1o kh\u1edfi \u0111\u1ea9u \u0111i\u1ec1u tr\u1ecb v\u1edbi metformin \u1edf b\u1ec7nh nh\u00e2n c\u00f3 eGFR n\u1eb1m trong kho\u1ea3ng 30 – 45 mL\/ph\u00fat\/1,73 m2<\/p>\n Thu th\u1eadp d\u1eef li\u1ec7u v\u1ec1 eGFR \u00edt nh\u1ea5t 1 l\u1ea9n\/n\u0103m \u1edf t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng metformin, \u1edf b\u1ec7nh nh\u00e2n c\u00f3 kh\u1ea3 n\u0103ng t\u0103ng nguy c\u01a1 suy th\u1eadn (v\u00ed d\u1ee5 nh\u01b0 ng\u01b0\u1eddi cao tu\u1ed5i), ch\u1ee9c n\u0103ng th\u1eadn n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 th\u01b0\u1eddng xuy\u00ean h\u01a1n.<\/p>\n \u1ede b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng metformin v\u00e0 c\u00f3 eGFR gi\u1ea3m xu\u1ed1ng d\u01b0\u1edbi 45 m\u01afph\u00fat\/1,73 m2 , \u0111\u00e1nh gi\u00e1 nguy c\u01a1 – l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c ti\u1ebfp t\u1ee5c ph\u00e1c \u0111\u1ed3.<\/p>\n T\u01b0\u01a1ng t\u00e1c thu\u1ed1c: S\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi metformin v\u1edbi m\u1ed9t s\u1ed1 thu\u1ed1c c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 nhi\u1ec5m toan lactic li\u00ean quan \u0111\u1ebfn metformin: b\u1ec7nh nh\u00e2n suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn d\u1eabn t\u1edbi nh\u1eefng thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3 v\u1ec1 m\u1eb7t huy\u1ebft \u0111\u1ed9ng, \u1ea3nh h\u01b0\u1edfng t\u1edbi c\u00e2n b\u1eb1ng acid-base ho\u1eb7c l\u00e0m t\u0103ng t\u00edch l\u0169y metformin [xem m\u1ee5c T\u01b0\u01a1ng t\u00e1c thu\u1ed1c].V\\ v\u1eady, c\u00e2n nh\u1eafc theo d\u00f5i b\u1ec7nh nh\u00e2n th\u01b0\u1eddng xuy\u00ean h\u01a1n.<\/p>\n B\u1ec7nh nh\u00e2n t\u1eeb 65 tu\u1ed5i tr\u1edf l\u00ean: Nguy c\u01a1 toan lactic li\u00ean quan \u0111\u1ebfn metformin t\u0103ng l\u00ean theo tu\u1ed5i c\u1ee7a b\u1ec7nh nh\u00e2n b\u1edfi b\u1ec7nh nh\u00e2n cao tu\u1ed5i c\u00f3 kh\u1ea3 n\u0103ng b\u1ecb suy gan, suy th\u1eadn, suy tim l\u1edbn h\u01a1n nh\u1eefng b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i h\u01a1n. C\u1ea9n \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn th\u01b0\u1eddng xuy\u00ean h\u01a1n \u0111\u1ed1i v\u1edbi nh\u0169ng b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i.<\/p>\n Th\u1ef1c hi\u1ec7n c\u00e1c x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n c\u00f3 s\u1eed d\u1ee5ng thu\u1ed1c c\u1ea3n quang: Ti\u00eam thu\u1ed1c c\u1ea3n quang v\u00e0o n\u1ed9i m\u1ea1ch \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb metformin c\u00f3 th\u1ec3 d\u1eabn t\u1edbi suy gi\u1ea3m c\u1ea5p t\u00ednh ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 g\u00e2y ra toan lactic. Ng\u1eebng s\u1eed d\u1ee5ng metformin tr\u01b0\u1edbc ho\u1eb7c t\u1ea1i th\u1eddi \u0111i\u1ec3m th\u1ef1c hi\u1ec7n chi\u1ebfu ch\u1ee5p c\u00f3 s\u1eed d\u1ee5ng thu\u1ed1c c\u1ea3n quang c\u00f3 ch\u1ee9a iod \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 eGFR n\u1eb1m trong kho\u1ea3ng 30 – 60 mL\/ph\u00fat\/1,73 m2, nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed suy gan, nghi\u1ec7n r\u01b0\u1ee3u, suy tim ho\u1eb7c nh\u1eefng b\u1ec7nh nh\u00e2n s\u1ebd s\u1eed d\u1ee5ng thu\u1ed1c c\u1ea3n quang ch\u1ee9a iod theo \u0111\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch. \u0110\u00e1nh gi\u00e1 l\u1ea1i eGFR 48h sau khi chi\u1ebfu ch\u1ee5p v\u00e0 s\u1eed d\u1ee5ng l\u1ea1i metformin n\u1ebfu ch\u1ee9c n\u0103ng th\u1eadn \u1ed5n \u0111\u1ecbnh.<\/p>\n Ph\u1eabu thu\u1eadt ho\u1eb7c c\u00e1c th\u1ee7 thu\u1eadt kh\u00e1c: S\u1ef1 l\u01b0u gi\u1eef th\u1ee9c \u0103n v\u00e0 d\u1ecbch trong qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt ho\u1eb7c th\u1ef1c hi\u1ec7n c\u00e1c th\u1ee7 thu\u1eadt kh\u00e1c c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 gi\u1ea3m th\u1ec3 t\u00edch, t\u1ee5t huy\u1ebft \u00e1p v\u00e0 suy th\u1eadn. N\u00ean t\u1ea1m th\u1eddi ng\u1eebng s\u1eed d\u1ee5ng metformin khi b\u1ec7nh nh\u00e2n b\u1ecb gi\u1edbi h\u1ea1n l\u01b0\u1ee3ng th\u1ee9c \u0103n v\u00e0 d\u1ecbch n\u1ea1p v\u00e0o.<\/p>\n Tinh tr\u1ea1ng gi\u1ea3m oxyh\u00edtv\u00e0o: Qu\u00e1 tr\u00ecnh theo d\u00f5i h\u1eadu m\u00e3i \u0111\u00e3 ghi nh\u1eadn m\u1ed9t s\u1ed1 ca nhi\u1ec5m toan lactic li\u00ean quan \u0111\u1ebfn metformin x\u1ea3y ra trong b\u1ec7nh c\u1ea3nh suy tim sung huy\u1ebft c\u1ea5p (\u0111\u1eb7c bi\u1ec7t khi c\u00f3 k\u00e8m theo gi\u1ea3m t\u01b0\u1edbi m\u00e1u v\u00e0 gi\u1ea3m oxy huy\u1ebft). Tr\u1ee5y tim m\u1ea1ch (s\u1ed1c), nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p, nhi\u1ec5m khu\u1ea9n huy\u1ebft v\u00e0 c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c li\u00ean quan \u0111\u1ebfn gi\u1ea3m oxy huy\u1ebft c\u00f3 m\u1ed1i li\u00ean quan v\u1edbi toan lactic v\u00e0 c\u0169ng c\u00f3 th\u1ec3 g\u00e2y nit\u01a1 huy\u1ebft tr\u01b0\u1edbc th\u1eadn. Khi nh\u1eefng bi\u1ebfn c\u1ed1 n\u00e0y x\u1ea3y ra, ng\u1eebng metformin. H\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft: V\u00ec th\u00e0nh ph\u1ea7n c\u00f3 ch\u1ee9a sulphonylurea, Metovance c\u00f3 nguy c\u01a1 g\u00e2y kh\u1edfi ph\u00e1t c\u01a1n h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft. Sau khi b\u1eaft \u0111\u1ea9u \u0111i\u1ec1u tr\u1ecb, m\u1ed9t s\u1ef1 ch\u1ec9nh li\u1ec1u l\u0169y ti\u1ebfn c\u00f3 th\u1ec3 ng\u0103n ng\u1eeba s\u1ef1 kh\u1edfi ph\u00e1t c\u01a1n h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft. Ch\u1ec9 n\u00ean ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb n\u1ebfu b\u1ec7nh nh\u00e2n tu\u00e2n th\u1ee7 m\u1ed9t l\u1ecbch tr\u00ecnh b\u1eefa \u0103n \u0111\u1ec1u \u0111\u1eb7n (bao g\u1ed3m \u0103n s\u00e1ng). \u0110i\u1ec1u quan tr\u1ecdng l\u00e0 l\u01b0\u1ee3ng carbohydrate \u0111\u01b0a v\u00e0o ph\u1ea3i \u0111\u1ec1u \u0111\u1eb7n v\u00ec nguy c\u01a1 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft t\u0103ng l\u00ean khi \u0103n mu\u1ed9n, kh\u1ea9u ph\u1ea9n carbohydrate kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 ho\u1eb7c kh\u00f4ng c\u00e2n \u0111\u1ed1i. H\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng x\u1ea3y ra trong tr\u01b0\u1eddng h\u1ee3p ch\u00ea’ \u0111\u1ed9 \u0103n h\u1ea1n ch\u1ebf n\u0103ng l\u01b0\u1ee3ng, sau khi luy\u1ec7n t\u1eadp th\u1ec3 d\u1ee5c c\u01b0\u1eddng \u0111\u1ed9 cao ho\u1eb7c k\u00e9o d\u00e0i, khi u\u1ed1ng r\u01b0\u1ee3u ho\u1eb7c trong qu\u00e1 tr\u00ecnh s\u1eed d\u1ee5ng m\u1ed9t ph\u1ed1i h\u1ee3p c\u1ee7a c\u00e1c t\u00e1c nh\u00e2n h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.<\/p>\n X\u1eed l\u00fd khi h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft<\/p>\n C\u00e1c tri\u1ec7u ch\u1ee9ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft trung b\u00ecnh kh\u00f4ng g\u00e2y m\u1ea5t \u00fd th\u1ee9c ho\u1eb7c kh\u00f4ng c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n th\u1ea7n kinh n\u00ean \u0111\u01b0\u1ee3c x\u1eed l\u00fd b\u1eb1ng c\u00e1ch u\u1ed1ng \u0111\u01b0\u1eddng ngay. Ph\u1ea3i \u0111\u1ea3m b\u1ea3o ch\u1ec9nh li\u1ec1u v\u00e0\/ho\u1eb7c thay \u0111\u1ed5i ki\u1ec3u b\u1eefa \u0103n. Nh\u1eefng ph\u1ea3n \u1ee9ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft nghi\u00eam tr\u1ecdng v\u1edbi h\u00f4n m\u00ea, co gi\u1eadt ho\u1eb7c c\u00f3 d\u1ea5u hi\u1ec7u th\u1ea7n kinh kh\u00e1c c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra v\u00e0 c\u1ea7n \u0111i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u y t\u1ebf ngay b\u1eb1ng c\u00e1ch ti\u00eam t\u0129nh m\u1ea1ch glucose m\u1ed9t khi nguy\u00ean nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n ho\u1eb7c nghi ng\u1edd, tr\u01b0\u1edbc khi nhanh ch\u00f3ng \u0111\u01b0a b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n.<\/p>\n Vi\u1ec7c l\u1ef1a ch\u1ecdn c\u1ea9n th\u1eadn b\u1eb9nh nh\u00e2n, li\u1ec1u l\u01b0\u1ee3ng v\u00e0 h\u01b0\u1edbng d\u1eabn \u0111\u1ea9y \u0111\u1ee7 cho b\u1ec7nh nh\u00e2n l\u00e0 quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 c\u01a1n h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft. N\u1ebfu b\u1ec7nh nh\u00e2n g\u1eb7p ph\u1ea3i c\u01a1n h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft l\u1eb7p l\u1ea1i, nghi\u00eam tr\u1ecdng ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi s\u1ef1 kh\u00f4ng c\u00f3 \u00fd th\u1ee9c v\u1ec1 tr\u1ea1ng th\u00e1i, n\u00ean xem x\u00e9t l\u1ef1a ch\u1ecdn ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng kh\u00e1c h\u01a1n l\u00e0 Metovance C\u00e1c yeu t\u1ed1 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft:<\/p>\n Suy gan v\u00e0 suy th\u1eadn: D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc v\u00e0\/ho\u1eb7c d\u01b0\u1ee3c l\u1ef1c h\u1ecdc c\u1ee7a Metovance c\u00f3 th\u1ec3 thay \u0111\u1ed5i \u1edf b\u1ec7nh nh\u00e2n suy gan ho\u1eb7c suy th\u1eadn n\u1eb7ng. N\u1ebfu h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y, n\u00f3 c\u00f3 th\u1ec3 k\u00e9o d\u00e0i, v\u00e0 ph\u1ea3i ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p.<\/p>\n M\u1ea5t c\u00e2n b\u1eb1ng \u0111\u01b0\u1eddng huy\u1ebdt: Trong tr\u01b0\u1eddng h\u1ee3p ph\u1eabu thu\u1eadt ho\u1eb7c b\u1ea5t c\u1ee9 nguy\u00ean nh\u00e2n n\u00e0o g\u00e2y m\u1ea5t b\u00f9 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, li\u1ec7u ph\u00e1p insulin t\u1ea1m th\u1eddi n\u00ean \u0111\u01b0\u1ee3c d\u1ef1 ki\u1ebfn thay cho \u0111i\u1ec1u tr\u1ecb n\u00e0y.<\/p>\n C\u00e1c tri\u1ec7u ch\u1ee9ng cua t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft l\u00e0: \u0111i ti\u1ec3u t\u1eafng, kh\u00e1t n\u01b0\u1edbc d\u1eef d\u1ed9i, kh\u00f4 da.<\/p>\n Ch\u1ee9c n\u0103ng th\u1ea1n: V\u00ec metformin \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft qua th\u1eadn, khuy\u1ebfn c\u00e1o x\u00e1c \u0111\u1ecbnh \u0111\u1ed9 thanh th\u1ea3i creatinine v\u00e0\/ho\u1eb7c creatinine huy\u1ebft thanh tr\u01b0\u1edbc khi b\u1eaft \u0111\u1eabu \u0111i\u1ec1u tr\u1ecb v\u00e0 th\u01b0\u1eddng xuy\u00ean sau \u0111\u00f3:<\/p>\n N\u00ean th\u1eadn tr\u1ecdng \u0111\u1eb7c bi\u1ec7t trong tr\u01b0\u1eddng h\u1ee3p ch\u1ee9c n\u0103ng th\u1eadn c\u00f3 th\u1ec3 tr\u1edf n\u00ean suy y\u1ebfu, v\u00ed d\u1ee5 nh\u01b0 kh\u1ec9 b\u1eaft \u0111\u1ea9u \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p ho\u1eb7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c l\u1ee3i ti\u1ec3u, v\u00e0 khi b\u1eaft \u0111\u1ea9u tr\u1ecb li\u1ec7u v\u1edbi m\u1ed9t lo\u1ea1i thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng steroid (NSAID). Ph\u1eabu thu\u1eadt: V\u00ec Metovance ch\u1ee9a metformin hydrochlorid, ph\u1ea3i ng\u01b0ng Metovance 48 gi\u1edd tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt theo ch\u01b0\u01a1ng tr\u00ecnh, g\u00e2y t\u00ea ngo\u00e0i m\u00e0ng c\u1ee9ng ho\u1eb7c t\u1ee7y s\u1ed1ng v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u1ea1i s\u1edbm h\u01a1n 48 gi\u1edd sau ph\u1eabu thu\u1eadt ho\u1eb7c sau khi b\u1eaft \u0111\u1ea9u l\u1ea1i s\u1ef1 nu\u00f4i d\u01b0\u1ee1ng qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u00e0 ch\u1ec9 sau khi ch\u1ee9c n\u0103ng th\u1eadn \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u1ea1i v\u00e0 cho th\u1ea5y \u0111\u00e3 tr\u1edf l\u1ea1i b\u00ecnh th\u01b0\u1eddng.<\/p>\n Nh\u1eefng l\u01b0u \u00fd kh\u00e1c<\/p>\n Metovance kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u00ean d\u00f9ng khi c\u00f3 thai. Khi c\u00f3 thai, \u0111i\u1ec1u tr\u1ecb b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng c\u1ea7n ph\u1ea3i d\u00f9ng insulin. N\u1ebfu bi\u1ebft \u0111ang c\u00f3 thai ho\u1eb7c d\u1ef1 \u0111\u1ecbnh c\u00f3 thai, b\u00e1c s\u0129 \u0111i\u1ec1u ch\u1ec9nh \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n.<\/p>\n Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh Metovance trong th\u1eddi gian cho con b\u00fa.<\/p>\n B\u1ec7nh nh\u00e2n c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c c\u1ea3nh b\u00e1o v\u1ec1 nh\u1eefng tri\u1ec7u ch\u1ee9ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 c\u1ea7n ph\u1ea3i th\u1eadn tr\u1ecdng khi l\u00e1i xe ho\u1eb7c v\u1eadn h\u00e0nh m\u00e1y m\u00f3c.<\/p>\n S\u1ef1 k\u1ebft h\u1ee3p ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/p>\n Li\u00ean quan \u0111\u1ebfn glibenclamid Miconazole (dung to\u00e0n th\u00e2n, gel nh\u1ea9y \u0111\u01b0\u1eddng mi\u1ec7ng): t\u0103ng t\u00e1c d\u1ee5ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t c\u00e1c bi\u1ec3u hi\u1ec7n h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, ho\u1eb7c ngay c\u1ea3 h\u00f4n m\u00ea S\u1ef1 k\u1ebft h\u1ee3p kh\u1ed5ng khuy\u00ean dung<\/p>\n Li\u00ean quan \u0111\u1ebfn sulfonylurea<\/p>\n – R\u01b0\u1ee3u:T\u00e1c d\u1ee5ng chong nghi\u1ec7n r\u01b0\u1ee3u (kh\u00f4ng dung n\u1ea1p r\u01b0\u1ee3u), \u0111\u1eb7c bi\u1ec7t \u0111\u1ed1i v\u1edbi chlorpropamide, glibencla- mid, glipizide, tolbutamide Li\u00ean quan \u0111\u1ebfn t\u1ea5t c\u1ea3 c\u00e1c t\u00e1c nh\u00e2n tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/p>\n – Chlorpromazine: \u1edf li\u1ec1u cao (100mg chlorpromazine m\u1ed7i ng\u00e0y), l\u00e0m t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft (l\u00e0m gi\u1ea3m s\u1ef1 ph\u00f3ng th\u00edch insulin) Li\u00ean quan \u0111\u1ebfn metformin<\/p>\n -Thuoc l\u1ee3i ti\u1ec3u: Nhi\u1ec5m acid lactic do metformin \u0111\u01b0\u1ee3c kh\u1edfi ph\u00e1t b\u1edfi b\u1ea5t k\u1ef3 t\u00ecnh tr\u1ea1ng suy ch\u1ee9c n\u0103ng th\u1eadn, li\u00ean quan \u0111\u1ebfn thu\u1ed1c l\u1ee3i ti\u1ec3u v\u00e0 \u0111\u1eb7c bi\u1ec7t l\u00e0 l\u1ee3i ti\u1ec3u quai C\u1ea3nh b\u00e1o b\u1ec7nh nh\u00e2n v\u00e0 t\u0103ng c\u01b0\u1eddng ki\u1ec3m tra \u0111\u01b0\u1eddng huy\u1ebft, c\u00f3 th\u1ec3 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u l\u01b0\u1ee3ng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb > \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng trong th\u1eddi gian \u0111i\u1ec3u tr\u1ecb v\u1edbi fluconazole v\u00e0 sau khi ng\u1eebng s\u1eed d\u1ee5ng thu\u1ed1c n\u00e0y. Li\u00ean quan t\u1edbi glibeclamid x<\/p>\n – Desmopressin: l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng ch\u1ed1ng l\u1ee3i ti\u1ec3u c\u1ee7a thu\u1ed1c T\u00c1C D\u1ee4NG KH\u00d4NG MONG MU\u1ed4N (ADR): C\u00e1c x\u00e9t nghi\u1ec7m:<\/p>\n Kh\u00f4ng th\u01b0\u1eddng:\u0129\u1ea3r\\g t\u1eeb nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh n\u1ed3ng \u0111\u1ed9 creatinine v\u00e0 ur\u00ea huy\u1ebft thanh R\u1ea5t hi\u1ebfm: G’\\\u00e3m n\u00e2tri huy\u1ebft <\/p>\n <\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" Th\u00e0nh ph\u1ea7n: M\u1ed7i vi\u00ean n\u00e9n bao phim thu\u1ed1c METOVANCE ch\u1ee9a: Metformin h\u1ef5droclorid 500 mg. Glibenclamid 5 mg. T\u00e1 d\u01b0\u1ee3c v\u0111 1 vi\u00ean. T\u00e1 d\u01b0\u1ee3c g\u1ed3m c\u00f3: Polyvinyl pyrolidon (PVP K30), hydroxy propyl methyl cellulose E15 (HPMC E15), polyethylen glycol 6000 (PEG 6000), talc, titan dioxyd, magnesi stearat, disolcel, s\u1eaft v\u00e0ng oxyd. D\u1ea0NG B\u00c0O CH\u1ebe: Vi\u00ean […]\n","protected":false},"author":1,"featured_media":57251,"comment_status":"open","ping_status":"closed","template":"","meta":{"_acf_changed":false},"product_cat":[89],"product_tag":[],"class_list":{"0":"post-3003","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-thuoc","8":"first","9":"instock","10":"shipping-taxable","11":"purchasable","12":"product-type-simple"},"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/product\/3003","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/product"}],"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=3003"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/57251"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=3003"}],"wp:term":[{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/product_cat?post=3003"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/product_tag?post=3003"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
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Nh\u00f3m d\u01b0\u1ee3c l\u00fd:<\/h2>\n
\nM\u00e3 ACT: A10BD02
\nMetformin l\u00e0 m\u1ed9t biguanide c\u00f3 t\u00e1c d\u1ee5ng ch\u1ed1ng t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft, l\u00e0m gi\u1ea3m c\u1ea3 glucose huy\u1ebft t\u01b0\u01a1ng c\u01a1 b\u1ea3n v\u00e0 sau khi \u0103n. N\u00f3 kh\u00f4ng k\u00edch th\u00edch s\u1ef1 ti\u1ebft insulin v\u00e0 v\u00ec th\u1ebf kh\u00f4ng g\u00e2y h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft. Metformin c\u00f3 th\u1ec3 t\u00e1c d\u1ee5ng qua 3 c\u01a1 ch\u1ebf:<\/p>\n\n
\nB\u1eb9nh nhi: Nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng, m\u00f9 \u0111\u00f4i, c\u00f3 nh\u00f3m ch\u1ee9ng trong 26 tu\u1ea7n th\u1ef1c hi\u1ec7n tr\u00ean 167 b\u1ec7nh nhi t\u1eeb 9 -16 tu\u1ed5i b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng tu\u00fdp 2 kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi ch\u00ea’ \u0111\u1ed9 \u0103n v\u00e0 t\u1eadp th\u1ec3 d\u1ee5c, c\u00f3 ho\u1eb7c kh\u00f4ng \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng u\u1ed1ng, d\u1ea1ng ph\u1ed1i h\u1ee3p c\u1ed1 \u0111\u1ecbnh gi\u1eefa 250mg metformin h\u1ef5drochlorid v\u00e0 1,25mg glibenclamid kh\u00f4ng cho hi\u1ec7u qu\u1ea3 h\u01a1n metformin hydrochlorid ho\u1eb7c glibendamid trong vi\u1ec7c gi\u1ea3m HbA1 c c\u01a1 b\u1ea3n. V\u00ec th\u1ebf, kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng Metovance cho b\u1ec7nh nhi.<\/p>\nD\u01af\u1ee2C \u0110\u1ed8NG H\u1eccC:<\/h2>\n
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Li\u00ean quan \u0111\u1ebfn metformin:<\/h3>\n
\n
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Thu\u1ed1c Metovance c\u00f3 t\u00e1c d\u1ee5ng g\u00ec?<\/h2>\n
Li\u1ec1u d\u00f9ng, c\u00e1ch d\u00f9ng thu\u1ed1c Metovance:<\/h2>\n
\nT\u1ed5ng qu\u00e1t: C\u0169ng nh\u01b0 t\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, li\u1ec1u d\u00f9ng cho m\u1ed7i b\u1ec7nh nh\u00e2n ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ef1 \u0111\u00e1p \u1ee9ng chuy\u1ec3n h\u00f3a c\u1ee7a t\u1eebng c\u00e1 th\u1ec3 (\u0111\u01b0\u1eddng huy\u1ebft, HbA1 c).
\nNg\u01b0\u1eddi l\u1edbn v\u1edbi ch\u1ee9c n\u00e2ng th\u1eadn b\u00ecnh th\u01b0\u1eddng (GFR >90ml\/ph\u00fat):
\nKh\u1edfi \u0111\u1ea9u \u0111i\u1ec1u tri: C\u0169ng nh\u01b0 t\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, li\u1ec1u d\u00f9ng cho m\u1ed7i b\u1ec7nh nh\u00e2n ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ef1 \u0111\u00e1p \u1ee9ng chuy\u1ec3n h\u00f3a c\u1ee7a t\u1eebng ng\u01b0\u1eddi. Li\u1ec1u kh\u1edfi \u0111\u1ea7u \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n \u0111ang kh\u00f4ng s\u1eed d\u1ee5ng metformin l\u00e0 1 vi\u00ean Metovance, m\u1ed9t l\u1ea9n\/ng\u00e0y, d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng.
\n\u0110i\u1ec1u ch\u1ec9nh li\u1ec1u: N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng g\u1eb7p ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i \u0111\u01b0\u1eddng tieu h\u00f3a v\u00e0 c\u1ea9n ph\u1ea3i t\u0103ng li\u1ec1u thi c\u00f3 th\u1ec3 d\u00f9ng th\u00eam 1 vi\u00ean Metovance sau m\u1ed7i kho\u1ea3ng th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1eeb 1 \u0111\u1ebfn 2 tu\u1ea7n. Li\u1ec1u d\u00f9ng c\u1ee7a metformin c\u1ea9n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u0111i\u1ec1u ch\u1ec9nh tr\u00ean t\u1eebng b\u1ec7nh nh\u00e2n c\u1ee5 th\u1ec3 d\u1ef1a tr\u00ean hi\u1ec7u qu\u1ea3 v\u00e0 \u0111\u1ed9 dung n\u1ea1p c\u1ee7a b\u1ec7nh nh\u00e2n.
\nLi\u1ec1u t\u1ed1i \u0111a h\u00e0ng ng\u00e0v: Li\u1ec1u t\u1ed1i \u0111a l\u00e0 3 vi\u00ean Metovance m\u1ed7i ng\u00e0y. Tr\u01b0\u1eddng h\u1ee3p ngo\u1ea1i l\u1ec7, c\u00f3 th\u1ec3 t\u0103ng li\u1ec1u l\u00ean 4 vi\u00ean Metovance m\u1ed7i ng\u00e0y.
\nK\u1ebft h\u01a1p v\u1edbi li\u00eau ph\u00e1p insulin:
\nKh\u00f4ng c\u00f3 d\u1eef li\u1ec7u l\u00e2m s\u00e0ng v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng c\u00f9ng l\u00fac s\u1ea3n ph\u1ea9m n\u00e0y v\u1edbi li\u1ec7u ph\u00e1p insulin.<\/p>\n\n
\nmL\/ph\u00fat\/1,73 m2.<\/p>\nC\u1ea3nh b\u00e1o v\u00e0 th\u1eadn tr\u1ecdng.<\/h2>\n
\n\n
\n DFG ml\/ph\u00fat<\/td>\n Metformin<\/td>\n Glibenclamid<\/td>\n<\/tr>\n \n 60-89<\/td>\n Li\u1ec1u t\u1ed1i \u0111a h\u00e0ng ng\u00e0y l\u00e0 3000 mg.<\/p>\n Kh\u00f4ng c\u1ea7n gi\u1ea3m li\u1ec1u.<\/td>\n<\/tr>\n \n 45-59<\/td>\n Li\u1ec1u t\u1ed1i \u0111a h\u00e0ng ng\u00e0y l\u00e0 2000 mg.<\/p>\n Li\u1ec1u t\u1ed1i \u0111a h\u00e0ng ng\u00e0y l\u00e0 10,5 mg.<\/td>\n<\/tr>\n \n 30-44<\/td>\n Li\u1ec1u t\u1ed1i \u0111a h\u00e0ng ng\u00e0y l\u00e0 1000 mg.<\/p>\n Li\u1ec1u t\u1ed1i \u0111a h\u00e0ng ng\u00e0y l\u00e0 10,5 mg. Kh\u00f4ng n\u00ean b\u1eaft \u0111\u1ea9u \u0111i\u1ec1u tr\u1ecb v\u00ec nguy c\u01a1 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.<\/td>\n<\/tr>\n \n <30<\/td>\n Metformin l\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n CH\u1ed0NG CH\u1ec8 \u0110\u1ecaNH:<\/h2>\n
\n
\nho\u1eb7c v\u1edbi b\u1ea5t c\u1ee9 t\u00e1 d\u01b0\u1ee3c n\u00e0o.<\/li>\n
\nth\u00e1o \u0111\u01b0\u1eddng.<\/li>\n
\nn\u1eb7ng, s\u1ed1c, s\u1eed d\u1ee5ng b\u1eb1ng \u0111\u01b0\u1eddng ti\u00eam t\u0129nh m\u1ea1ch c\u00e1c ch\u1ea5t c\u1ea3n quang c\u00f3 iod.<\/li>\n
\ntim, nh\u1ed3i m\u00e1u c\u01a1 tim g\u1ea7n \u0111\u00e2y, s\u1ed1c.<\/li>\nTH\u1eacN TR\u1eccNG KHI s\u1eed D\u1ee4NG THU\u1ed0C:<\/h2>\n
\n
\nU\u1ed1ng r\u01b0\u1ee3u: R\u01b0\u1ee3u c\u00f3 kh\u1ea3 n\u0103ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u00e1c \u0111\u1ed9ng c\u1ee7a metformin l\u00ean chuy\u1ec3n h\u00f3a lactat v\u00e0 t\u1eeb \u0111\u00f3 c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 nhi\u1ec5m toan lactic li\u00ean quan \u0111\u1ebfn metformin. C\u1ea3nh b\u00e1o b\u1ec7nh nh\u00e2n kh\u00f4ng u\u1ed1ng r\u01b0\u1ee3u khi s\u1eed d\u1ee5ng metformin.
\nSuy gan: B\u1ec7nh nh\u00e2n suy gan c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n th\u00e0nh toan lactic li\u00ean quan \u0111\u1ebfn metformin do suy gi\u1ea3m th\u1ea3i tr\u1eeblactat d\u1eabn t\u1edbi t\u0103ng n\u1ed3ng \u0111\u1ed9 lactat trong m\u00e1u. V\u00ec v\u1eady, tr\u00e1nh s\u1eed d\u1ee5ng metformin tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n b\u1ec7nh gan th\u00f4ng qua b\u1eb1ng ch\u1ee9ng x\u00e9t nghi\u1ec7m ho\u1eb7c l\u00e2m s\u00e0ng.<\/p>\n\n
\n
\nS\u1eed d\u1ee5ng cac ch\u1ea5t c\u1ea3n quang c\u00f3 ch\u1ee9a iod: S\u1eed d\u1ee5ng c\u00e1c ch\u1ea5t c\u1ea3n quang c\u00f3 ch\u1ee9a iod b\u1eb1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch trong c\u00e1c x\u00e9t nghi\u1ec7m x-quang c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy th\u1eadn. T\u00f9y thu\u1ed9c v\u00e0o ch\u1ee9c n\u0103ng th\u1eadn, ph\u1ea3i ng\u01b0ng s\u1eed d\u1ee5ng Metovance 48 gi\u1edd tr\u01b0\u1edbc ho\u1eb7c ngay t\u1ea1i th\u1eddi \u0111i\u1ec3m x\u00e9t nghi\u1ec7m v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u1ea1i cho t\u1edbi 48 gi\u1edd sau \u0111\u00f3, v\u00e0 ch\u1ec9 sau khi ch\u1ee9c n\u0103ng th\u1eadn \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u1ea1i v\u00e0 cho th\u1ea5y \u0111\u00e3 tr\u1edf l\u1ea1i b\u00ecnh th\u01b0\u1eddng. S\u1eedd\u1ee5ng \u0111\u1ed3ng th\u1eddi giibenclam\u1ec9d V\u1edaI c\u00e1c thu\u1ed1c kh\u00e1c: Kh\u1ed5ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng \u0111\u1ed5ng th\u1eddi glibencla- mid v\u1edbi r\u01b0\u1ee3u, phenylbutazone ho\u1eb7c danazol. C\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng: H\u1ecfi b\u1ec7nh nh\u00e2n c\u00f3 \u0111ang m\u1eafc c\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng nh\u01b0 c\u1ea3m c\u00fam, nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p ho\u1eb7c nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ec3u.<\/p>\n\n
C\u00d3 THAI V\u00c0 TH\u1edcI K\u1ef2 CHO CON B\u00da:<\/h2>\n
\u1ea2NH H\u01af\u1edeNG C\u1ee6A THU\u1ed0C KHI V\u1eacN HANH M\u00c1Y M\u00d3C T\u00c0U XE:<\/h2>\n
T\u01af\u01a0NG T\u00c0C THU\u1ed0C:<\/h2>\n
\nT\u0103ng phan \u1ee9ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft (\u1ee9c ch\u1ebf ph\u1ea3n \u1ee9ng b\u1ed3i h\u00f3\u00e0n), c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng kh\u1edfi ph\u00e1t h\u00f4n m\u00ea h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft. Tr\u00e1nh s\u1eed d\u1ee5ng r\u01b0\u1ee3u ho\u1eb7c c\u00e1c thu\u1ed1c ch\u1ee9a c\u1ed3n
\n– Phenylbutazone (d\u00f9ng to\u00e0n th\u00e2n): l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft c\u1ee7a sulfonylureas (thay th\u1ebf sulfonylurea t\u1ea1i v\u1ecb tr\u00ed li\u00ean k\u1ebft v\u1edbi protein v\u00e0\/ho\u1eb7c l\u00e0m gi\u1ea3m s\u1ef1 th\u1ea3i tr\u1eeb c\u1ee7a n\u00f3). T\u1ed1t h\u01a1n n\u00ean d\u00f9ng c\u00e1c thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00e1c c\u00f3 t\u01b0\u01a1ng t\u00e1c \u00edt h\u01a1n, ho\u1eb7c c\u1ea3nh b\u00e1o cho b\u1ec7nh nh\u00e2n v\u00e0 t\u0103ng c\u01b0\u1eddng t\u1ef1 ki\u1ec3m tra; n\u1ebfu c\u1ea9n thi\u1ebft, \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c kh\u00e1ng vi\u00eam v\u00e0 sau khi ng\u1eebng s\u1eed d\u1ee5ng. Li\u00ean quan \u0111\u1ebfn t\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c \u0111i\u1ec3u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng
\n– Danazol: N\u1ebfu s\u1ef1 k\u1ebft h\u1ee3p kh\u00f4ng th\u1ec3 tr\u00e1nh kh\u1ecfi, c\u1ea3nh b\u00e1o cho b\u1ec7nh nh\u00e2n v\u00e0 t\u0103ng c\u01b0\u1eddng t\u1ef1 ki\u1ec3m tra \u0111\u01b0\u1eddng huy\u1ebft. C\u00f3 th\u1ec3 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u1edbi danazol v\u00e0 sau khi ng\u1eebng s\u1eed d\u1ee5ng
\nLi\u00ean quan \u0111\u1ebfn metformin
\n– R\u01b0\u1ee3u: t\u0103ng nguy c\u01a1 nhi\u1ec5m toan acid lactic khi ng\u1ed9 \u0111\u1ed9c r\u01b0\u1ee3u c\u1ea5p t\u00ednh, \u0111\u1eb7c bi\u1ec7t trong tr\u01b0\u1eddng h\u1ee3p nh\u1ecbn \u0111\u00f3i ho\u1eb7c suy dinh d\u01b0\u1ee1ng, suy t\u1ebf b\u00e0o gan.
\nTr\u00e1nh d\u00f9ng c\u00e1c th\u1ee9c u\u1ed1ng va thu\u1ed1c co ch\u1ee9a c\u1ed5n.
\nNh\u1eefng k\u1ebft h\u1ee3p c\u1ea9n th\u1eadn tr\u1ecdng<\/p>\n
\nTh\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng: c\u1ea3nh b\u00e1o cho b\u1ec7nh nh\u00e2n v\u00e0 t\u0103ng c\u01b0\u1eddng ki\u1ec3m tra \u0111\u01b0\u1eddng huy\u1ebft C\u00f3 th\u1ec3 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng khi \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c an th\u1ea7n v\u00e0 sau khi ng\u1eebng s\u1eed d\u1ee5ng.
\n– Corticosteroids (glucocorticoid) v\u00e0 tetracosactide d\u00f9ng (\u0111\u01b0\u1eddng to\u00e0n th\u00e2n v\u00e0 t\u1ea1i ch\u1ed7): l\u00e0m t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft, th\u1ec9nh tho\u1ea3ng \u0111i k\u00e8m v\u1edbi ch\u1ee9ng \u0111a ceton (gi\u1ea3m s\u1ef1 dung n\u1ea1p carbohydrate v\u1edbi corticosteroid) Th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng: c\u1ea3nh b\u00e1o b\u1ec7nh nh\u00e2n v\u00e0 t\u0103ng c\u01b0\u1eddng ki\u1ec3m tra \u0111\u01b0\u1eddng huy\u1ebft. C\u00f3 th\u1ec3 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u thu\u1ed1c \u0111i\u1ec3u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng khi \u0111i\u1ec1u tr\u1ecb v\u1edbi corticosteroid v\u00e0 sau khi ng\u1eebng s\u1eed d\u1ee5ng.
\n– Ch\u1ea5t ch\u1ee7 v\u1eadn beta-2: l\u00e0m t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft do ch\u1ea5t ch\u1ee7 v\u1eadn beta-2
\nTh\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng: c\u1ea3nh b\u00e1o b\u1ec7nh nh\u00e2n, t\u0103ng c\u01b0\u1eddng ki\u1ec3m tra \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 c\u00f3 th\u1ec3 chuy\u1ec3n qua \u0111i\u1ec1u tr\u1ecb b\u1eb1ng insulin.
\nC\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n (captopril, enalapril): C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n c\u00f3 th\u1ec3 g\u00e2y h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft. N\u1ebfu c\u1ea9n thi\u1ebft, \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u l\u01b0\u1ee3ng Metovance trong su\u1ed1t th\u1eddi gian \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 cho t\u1edbi khi ng\u01b0ng s\u1eed d\u1ee5ng.<\/p>\n
\n– Ch\u1ea5t c\u1ea3n quang c\u00f3 iod: S\u1eed d\u1ee5ng ch\u1ea5t c\u1ea3n quang c\u00f3 ch\u1ee9a iod b\u1eb1ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy th\u1eadn. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn vi\u1ec7c t\u00edch t\u1ee5 metformin v\u00e0 nguy c\u01a1 nhi\u1ec5m toan acid lactic. D\u1ef1a tr\u00ean ch\u1ee9c n\u0103ng th\u1eadn, ph\u1ea3i ng\u1eebng s\u1eed d\u1ee5ng Metovance 48 gi\u1edd tr\u01b0\u1edbc khi x\u00e9t nghi\u1ec7m ho\u1eb7c t\u1ea1i th\u1eddi \u0111i\u1ec3m x\u00e9t nghi\u1ec7m v\u00e0 ch\u1ec9 d\u00f9ng tr\u1edf l\u1ea1i 48 gi\u1edd sau \u0111\u00f3, v\u00e0 ch\u1ec9 sau khi ch\u1ee9c n\u0103ng th\u1eadn \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 l\u1ea1i v\u00e0 cho th\u1ea5y b\u00ecnh th\u01b0\u1eddng Li\u00ean quan \u0111\u1ebfn g\u00edibenc\u00edamid
\n– Chat ch\u1eb9n beta: T\u1ea5t c\u1ea3 c\u00e1c ch\u1ea5t ch\u1eb9n beta che d\u1ea5u v\u00e0i tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft: h\u1ed5i h\u1ed9p v\u00e0 ch\u1ee9ng tim \u0111\u1eadp nhanh; h\u1ea7u h\u1ebft c\u00e1c ch\u1ea5t ch\u1eb9n beta kh\u00f4ng ch\u1ecdn l\u1ecdc tr\u00ean tim l\u00e0m gia t\u0103ng t\u1ec9 l\u1ec7 m\u1eafc ph\u1ea3i v\u00e0 m\u1ee9c \u0111\u1ed9 tr\u1ea7m tr\u1ecdng c\u1ee7a h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.
\nC\u1ea3nh b\u00e1o b\u1ec7nh nh\u00e2n, t\u0103ng c\u01b0\u1eddng t\u1ef1 ki\u1ec3m tra \u0111\u01b0\u1eddng huy\u1ebft, \u0111\u1eb7c bi\u1ec7t l\u00fac b\u1eaft \u0111\u1ea9u \u0111i\u1ec1u tr\u1ecb.
\n– Fluconazole: Gia t\u0103ng th\u1eddi gian b\u00e1n th\u1ea3i c\u1ee7a sulfonylurea, c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t nh\u1eefng bi\u1ec3u hi\u1ec7n h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.<\/p>\n
\nBosentan: Nguy c\u01a1 l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft c\u1ee7a glibehclamid v\u00ec bosentan l\u00e0m gi\u1ea3m n\u1ed3ng \u0111\u1ed9 huy\u1ebft t\u01b0\u01a1ng c\u1ee7a glibendamid. Gia t\u0103ng nguy c\u01a1 t\u0103ng men gan \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf b\u1ec7nh nh\u00e2n d\u00f9ng \u0111\u1ed3ng th\u1eddi glibendamid v\u1edbi bosentan.
\nC\u1ea3nh b\u00e1o b\u1ec7nh nh\u00e2n, b\u1eaft \u0111\u1ea7u theo d\u00f5i \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 c\u00e1c men gan v\u00e0 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u l\u01b0\u1ee3ng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng n\u1ebfu c\u1ea9n thi\u1ebft.
\nC\u00e1c t\u01b0\u01a1ng t\u00e1c kh\u00e1c: K\u1ebft h\u1ee3p c\u1ea7n ph\u1ea3i c\u00e2n nh\u1eafc<\/p>\n
\nC\u00e1c t\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd sau c\u00f3 th\u1ec3 x\u1ea3y ra khi \u0111i\u1ec1u tr\u1ecb v\u1edbi Metovance. C\u00e1c t\u1ea7n s\u1ed1 \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a nh\u01b0 sau: r\u1ea5t th\u01b0\u1eddng: > 1\/10; th\u01b0\u1eddng: > 1\/100 v\u00e0 < 1\/10; kh\u00f4ng th\u01b0\u1eddng: > 1\/1000 v\u00e0 < 1\/100; hi\u1ebfm: > 1\/10000 v\u00e0 < 1\/1000; r\u1ea5t hi\u1ebfm: < 1\/10000 v\u00e0 kh\u00f4ng bi\u1ebft (kh\u00f4ng th\u1ec3 \u01b0\u1edbc l\u01b0\u1ee3ng t\u1eeb c\u00e1c d\u1eef li\u1ec7u hi\u1ec7n c\u00f3)<\/p>\n
\nR\u1ed1i lo\u1ea1n m\u00e1u v\u00e0 h\u1ec7 b\u1ea1ch huy\u1ebft: C\u00e1c r\u1ed1i lo\u1ea1n n\u00e0y \u0111\u1ec3u m\u1ea5t \u0111i khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb Hi\u1ebfm: gi\u1ea3m b\u1ea1ch c\u1ea9u, gi\u1ea3m ti\u1ec3u c\u1ea7u
\nR\u1ea5t hi\u1ebfm: Ch\u1ee9ng m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t, thi\u1ebfu m\u00e1u tan huy\u1ebft, b\u1ea5t s\u1ea3n t\u1ee7y x\u01b0\u01a1ng v\u00e0 gi\u1ea3m to\u00e0n th\u1ec3 huy\u1ebft c\u1ea9u. R\u1ed1i lo\u1ea1n h\u1ec7 th\u1ed1ng th\u1ea7n kinh: Th\u01b0\u1eddng: R\u1ed1i lo\u1ea1n v\u1ecb gi\u00e1c
\nR\u1ed1i lo\u1ea1n m\u1eaft: C\u00e1c r\u1ed1i lo\u1ea1n th\u1ecb gi\u00e1c tho\u00e1ng qua c\u00f3 th\u1ec3 x\u1ea3y ra l\u00fac b\u1eaft \u0111\u1ea9u \u0111i\u1ec1u tr\u1ecb do gi\u1ea3m m\u1ee9c \u0111\u01b0\u1eddng huy\u1ebft. R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a:
\nR\u1ea5t th\u01b0\u1eddng: C\u00e1c r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a nh\u01b0 n\u00f4n, bu\u1ed3n n\u00f4n, ti\u00eau ch\u1ea3y, \u0111au b\u1ee5ng v\u00e0 ch\u00e1n \u0103n. C\u00e1c t\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd n\u00e0y x\u1ea3y ra th\u01b0\u1eddng xuy\u00ean h\u01a1n trong giai \u0111o\u1ea1n b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u00e0 t\u1ef1 h\u1ed3i ph\u1ee5c trong h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p. \u0110\u1ec3 ng\u0103n ng\u1eeba, Metovance \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng m\u1ed7i ng\u00e0y 2 ho\u1eb7c 3 l\u1ea7n. S\u1ef1t\u0103ng li\u1ec1u ch\u1eadm c\u0169ng c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n dung n\u1ea1p \u1edf \u0111\u01b0\u1eddng ti\u00eau h\u00f3a.
\nR\u1ed1i lo\u1ea1n da v\u00e0 m\u00f4 d\u01b0\u1edbi da:
\nHi\u1ebfm: c\u00e1c ph\u1ea3n \u1ee9ng tr\u00ean da nh\u01b0 ng\u1ee9a, m\u00e0y \u0111ay, ban s\u1ea9n.
\nR\u1ea5t hi\u1ebfm: vi\u00eam m\u1ea1ch d\u1ecb \u1ee9ng da ho\u1ea1c n\u1ed9i t\u1ea1ng, ban \u0111\u1ecf \u0111a h\u00ecnh, vi\u00eam da tr\u00f3c m\u1ea3nh, ch\u1ee9ng nh\u1ea1y v\u1edbi \u00e1nh s\u00e1ng, m\u00e0y \u0111ay ti\u1ebfn tri\u1ec3n th\u00e0nh n\u1eb7ng.
\nC\u00f3 th\u1ec3 x\u1ea3y ra t\u01b0\u01a1ng t\u00e1c ch\u00e9o gi\u1eefa sulphonamide v\u00e0 c\u00e1c d\u1eabn xu\u1ea5t c\u1ee7a n\u00f3 R\u1ed1i lo\u1ea1n chuy\u1ec3n hoa v\u00e0 dinh d\u01b0\u1ee1ng:
\nH\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.
\nKh\u00f4ng th\u01b0\u1eddng: c\u00e1c c\u01a1n r\u1ed1i lo\u1ea1n chuy\u1ebfn h\u00f3a porphyrin gan v\u00e0 lo\u1ea1n chuy\u1ec3n h\u00f3a porphyrin bi\u1ec3u hi\u1ec7n \u1edf da. R\u1ecb\u1ea5th\u0129\u1ebfm: nh\u1ec9ern toan acid lactic
\nG i\u1ea3m h\u1ea5p thu vitamin B12 k\u00e8m theo s\u1ef1 gi\u1ea3m n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft thanh khi d\u00f9ng metformin l\u00e2u d\u00e0i. K\u1ecahuy\u1ebfn c\u00e1o xem x\u00e9t \u0111\u1ebfn nguy\u00ean nh\u00e2n n\u00e0y n\u1ebfu b\u1ec7nh nh\u00e2n b\u1ecb thi\u1ebfu m\u00e1u h\u1ed3ng c\u1ea9u kh\u1ed5ng l\u1ed5. p!h\u1ea3n \u1ee9ng t\u01b0\u01a1ng t\u1ef1 disulfiram khi u\u1ed1ng chung v\u1edbi r\u01b0\u1ee3u R \u1ed1i lo\u1ea1n gan m\u1eadt:
\nR\u1ea5t hi\u1ec1m: <\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan b\u1ea5t th\u01b0\u1eddng ho\u1eb7c vi\u00eam gan \u0111\u00f2i h\u1ecfi ph\u1ea3i ng\u01b0ng \u0111i\u1ec1u tr\u1ecb Th\u00f4ng b\u00e1o cho b\u1eafc s\u1ef9 nh\u1eefng t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n g\u1eb7p ph\u1ea3i khi s\u1eed d\u1ee5ng thu\u1ed1c. s \u1eed D\u1ee4NG QU\u00c1 LI\u1ec4U V\u00c0 C\u00c1CH X\u1eecTR\u0128:
\n– Qu\u00e1 li\u1ec1u c\u0169ng c\u00f3 th\u1ec3 g\u00e2y h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft c\u1ea5p do s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a sulphonylurea.
\n– S\u1eed d\u1ee5ng qu\u00e1 li\u1ec1u ho\u1eb7c t\u1ed5n t\u1ea1i \u0111\u1ed3ng th\u1eddi c\u00e1c y\u1ebfu t\u1ed5 nguy c\u1ee1 d\u1eabn \u0111\u1ebfn nhi\u1ec5m toan acid lactic do s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a metformin. Nhi\u1ec5m toan acid lactic l\u00e0 tr\u01b0\u1eddng h\u1ee3p c\u1ea5p c\u1ee9u ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ea1i b\u1ec7nh vi\u1ec7n.
\n– \u0110i\u1ec1u tr\u1ecb h\u1eefu hi\u1ec7u nh\u1ea5t l\u00e0 l\u1ea5y \u0111i lactat v\u00e0 metformin b\u1eb1ng th\u1ea9m t\u00e1ch m\u00e1u.
\n– S\u1ef1 thanh th\u1ea3i huy\u1ebft thanh c\u1ee7a glibenclamid c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u00e9o d\u00e0i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh v\u1ec1 gan. Vijglibendamid li\u00ean k\u1ebft m\u1ea1nh v\u1edbi protein, n\u00f3 kh\u00f4ng b\u1ecb lo\u1ea1i tr\u1eeb b\u1eb1ng th\u1ea9m t\u00e1ch.
\nB\u1ea2O QU\u1ea2N: N\u01a1i kh\u00f4 m\u00e1t, nhi\u1ec7t \u0111\u1ed9 d\u01b0\u1edbi 30\u00b0 c, tr\u00e1nh \u00e1nh s\u00e1ng.
\nTI\u00caU CHU\u1ea8N \u00c1P D\u1ee4NG: TCCS.
\nHI\u1ea0N D\u00d9NG: 36 th\u00e1ng k\u1ec3 t\u1eeb ng\u00e0y s\u1ea3n xu\u1ea5t.
\nNh\u00e0 s\u1ea3n xu\u1ea5t: C\u00d4NG TY c\u1ed5 PH\u1ea8N D\u01af\u1ee2C PH\u1ea8M TR\u01af\u1edcNG TH\u1ecc \u0110\u1ecba ch\u1ec9: S\u1ed1 93 Linh Lang – Ba \u0110\u00ecnh – H\u00e0 N\u1ed9i S\u01a1n xu\u1ea5t t\u1ea1i: L\u00f4 MI \u0111\u01b0\u1eddng N3, Khu c\u00f4ng nghi\u1ec7p H\u00f2a X\u00e1, Nam \u0110\u1ecbnh \u0110i\u1ec7n tho\u1ea1i: 024.37666912 – 0228.3670733
\nNG\u00c0Y X\u00c9M X\u00c9T S\u1eecA \u0110\u1ed4I, C\u1eacP NH\u1eacT L\u1ea0I N\u1ed8I DUNG H\u01af\u1edaNG D\u1eaaN s\u1eed D\u1ee4NG THU\u1ed0C.<\/p>\n