M\u00e3 ATC: N04 BA<\/p>\n
Madopar l\u00e0 d\u1ea1ng ph\u1ed1i h\u1ee3p c\u1ee7a Ievodopa v\u00e0 benseraside \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh Parkinson.<\/p>\n
D\u1ea1ng th\u00f4ng th\u01b0\u1eddng:<\/em><\/p>\n Madopar vi\u00ean nang c\u00f3 c\u00e1c d\u1ea1ng Madopar \u201862.5\u2019, \u2018125\u2019, \u2018250\u2019<\/p>\n Madopar vi\u00ean n\u00e9n c\u00f3 kh\u00eda c\u00f3 c\u00e1c d\u1ea1ng Madopar \u2018125\u2019, \u2018250\u2019<\/p>\n D\u1ea1ng vi\u00ean tan nhanh:<\/em><\/p>\n Madopar vi\u00ean n\u00e9n tan c\u00f3 kh\u00eda l\u00e0 Madopar \u201862,5\u2019, \u2018125\u2019<\/p>\n D\u1ea1ng ph\u00f3ng th\u00edch c\u00f3 ki\u1ec3m so\u00e1t:<\/em><\/p>\n Madopar HBS (h\u1ec7 th\u1ed1ng c\u00e2n b\u1eb1ng th\u1ee7y l\u1ef1c) vi\u00ean nang l\u00e0 Madopar \u2018125\u2019<\/p>\n \u0110\u01b0\u1eddng u\u1ed1ng.<\/p>\n M\u1ea1dopar l\u00e0 d\u1ea1ng ph\u1ed1i h\u1ee3p c\u1ee7a levodopa v\u00e0 ch\u1ea5t \u1ee9c ch\u1ebf men decarboxylase benscraside (d\u01b0\u1edbi d\u1ea1ng hydrochloride) v\u1edbi t\u1ec9 l\u1ec7 4:1. C\u00f3 c\u00e1c d\u1ea1ng sau \u0111\u00e2y:<\/p>\n Madopar \u201962,5\u2019 levodopa 50 mg + benserazide 12.5 mg<\/p>\n Madopar \u2018125\u2019 lcvodopa 100 mg \u2022 benscrazidc 25 mg<\/p>\n Madopar \u2018250\u2019 levodopa 200 mg + bensera\/idc 50 ing<\/p>\n T\u00e1 d\u01b0\u1ee3c:<\/p>\n Thu\u1ed1c Madopar<\/strong> b\u00e1n t\u1ea1i nh\u00e0 thu\u1ed1c L\u01b0u V\u0103n Ho\u00e0ng gi\u00e1 255.000 \u0111\u1ed3ng 1 h\u1ed9p, ch\u00fang t\u00f4i giao h\u00e0ng to\u00e0n qu\u1ed1c.<\/p>\n Xem th\u00eam s\u1ea3n ph\u1ea9m kh\u00e1c t\u1ea1i nh\u00e0 thu\u1ed1c c\u1ee7a ch\u00fang t\u00f4i:<\/p>\n Madopar \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh Parkinson. Madopar d\u1ea1ng tan l\u00e0 ch\u1ebf ph\u1ea9m th\u00edch h\u1ee3p cho b\u1ec7nh nh\u1eadn b\u1ecb ch\u1ee9ng kh\u00f3 nu\u1ed1t ho\u1eb7c b\u1ec7nh nh\u00e2n c\u1ea7n d\u1ea1ng ch\u1ebf ph\u1ea9m c\u00f3 t\u00e1c d\u1ee5ng kh\u1edfi ph\u00e1t nhanh h\u01a1n. V\u00ed d\u1ee5 b\u00eanh nh\u00e2n b\u1ecb ch\u1ee9ng m\u1ea5t v\u1eadn \u0111\u1ed9ng v\u00e0o s\u00e1ng s\u1edbm ho\u1eb7c bu\u1ed5i chi\u1ec1u, ho\u1eb7c b\u1ec7nh nh\u00e2n b\u1ecb hi\u1ec7n t\u01b0\u1ee3ng tr\u00ec ho\u00e3n th\u1eddi gian \u2018b\u1eadt\u2019 ho\u1eb7c k\u00e9o d\u00e0i th\u1eddi gian \u2018t\u1eaft”. Madopar DBS \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh d\u00f9ng cho c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 m\u1ecdi d\u1ea1ng \u0111\u00e1p \u1ee9ng dao \u0111\u1ed9ng (v\u00ed d\u1ee5 b\u1ecb r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng \u1edf li\u1ec1u \u0111\u1ec9nh ho\u1eb7c x\u1ea5u \u0111i \u1edf cu\u1ed1i li\u1ec1u- v\u00ed d\u1ee5 nh\u01b0 b\u1ea5t \u0111\u1ed9ng v\u00e0o ban \u0111\u00eam).<\/p>\n Ph\u01b0\u01a1ng ph\u00e1p d\u00f9ng thu\u1ed1c<\/em><\/p>\n Khi d\u00f9ng Madopar th\u00f4ng th\u01b0\u1eddng d\u1ea1ng vi\u00ean nang ho\u1eb7c Madopar HBS, b\u1ec7nh nh\u00e2n ph\u1ea3i lu\u00f4n \u0111\u1ea3m b\u1ea3o l\u00e0 nu\u1ed1t tr\u1ecdn vi\u00ean nang m\u00e0 kh\u00f4ng c\u00e2n v\u1ed7 thu\u1ed1c. Madopar d\u1ea1ng vi\u00ean n\u00e9n th\u00f4ng th\u01b0\u1eddng c\u00f3 th\u1ec3 b\u1ebb \u0111\u01b0\u1ee3c \u0111\u1ec3 d\u1ec5 nu\u1ed1t.<\/p>\n Madopar vi\u00ean n\u00e9n tan c\u00f3 th\u1ec3 pha trong m\u1ed9t ph\u1ea7n t\u01b0 ly n\u01b0\u1edbc (kho\u1ea3ng 25-50ml). Vi\u00ean n\u00e9n r\u00e3 ra ho\u00e0n to\u00e0n trong n\u01b0\u1edbc, t\u1ea1o th\u00e0nh dung d\u1ecbch khu\u1ebfch t\u00e1n d\u1ea1ng s\u1eefa tr\u1eafng trong v\u00e0i ph\u00fat. V\u00ec dung d\u1ecbch l\u1eafng c\u1eb7n nhanh, n\u00ean khu\u1ea5y \u0111\u1ec1u tr\u1ef1\u1edbc khi u\u1ed1ng Madopar vi\u00ean n\u00e9n d\u1ea1ng tan n\u00ean u\u1ed1ng trong v\u00f2ng n\u1eeda gi\u1edd sau khi chu\u1ea9n b\u1ecb d\u1ee5ng d\u1ecbch.<\/p>\n Madopar n\u00ean u\u1ed1ng \u00edt nh\u1ea5t 30 ph\u00fat tr\u01b0\u1edbc ho\u1eb7c 1 gi\u1edd sau khi \u0103n n\u1ebfu c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c. C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 d\u1ea1 d\u00e0y ru\u1ed9t, th\u01b0\u1eddng x\u1ea3y ra ch\u1ee7 y\u1ebfu trong gi\u1ea1i \u0111o\u1ea1n s\u1edbm c\u1ee7a qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tri, c\u00f3 th\u1ec3 ki\u1ec3m so\u00e1t b\u1eb1ng c\u00e1ch u\u1ed1ng Madopar k\u00e8m v\u1edbi th\u1ee9c \u0103n nh\u1eb9 (v\u00ed d\u1ee5:b\u00e1nh quy) ho\u1eb7c d\u1ecbch l\u1ecfng ho\u1eb7c b\u1eb1ng c\u00e1ch t\u0103ng li\u1ec1u t\u1eeb t\u1eeb.<\/p>\n Li\u1ec1u d\u00f9ng<\/em><\/p>\n \u0110i\u1ec1u tr\u1ecb b\u1eb1ng Madopar n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng t\u0103ng d\u1ea7n t\u1eeb t\u1eeb. H\u01a1n n\u1eefa, li\u1ec1u d\u00f9ng n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 x\u00e1c \u0111\u1ecbnh cho t\u1eebng ng\u01b0\u1eddn b\u1ec7nh v\u00e0 \u0111i\u1ec1u ch\u1ec9nh \u0111\u1ec3 \u0111at \u0111\u01b0\u1ee3c li\u1ec1u cho hi\u1ec7u qu\u1ea3 t\u1ed1i \u01b0u. Nh\u1eefng h\u01b0\u1edbng d\u1eabn li\u1ec1u d\u00f9ng sau \u0111\u00e2y do v\u1eady ch\u1ec9 n\u00ean coi l\u00e0 nh\u1eefng ch\u1ec9 d\u1eabn chung trong c\u00e1c giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a b\u1ec7nh\u00a0Parkinson n\u00ean b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi m\u1ed9t vi\u00ean nang Madopar \u201862.5′ ho\u1eb7c 1\/2 vi\u00ean n\u00e9n Madopar \u2018125\u2019, ba ho\u1eb7c b\u1ed1n l\u1ea7n m\u1ed7i ng\u00e0\u1ef5. Ngay sau khi th\u1ea5y c\u00f3 s\u1ef1 dung n\u1ea1p t\u1ed1t v\u1edbi ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb kh\u1edfi \u0111\u1ea7u, li\u1ec1u d\u00f9ng n\u00ean \u0111\u01b0\u1ee3c t\u0103ng d\u1ea7n t\u1eeb t\u1eeb theo \u0111\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n t\u00e1c d\u1ee5ng t\u1ed1i \u01b0u th\u01b0\u1eddng \u0111\u1ea1t \u0111\u01b0\u1ee3c khi li\u1ec1u h\u1eb1ng ng\u00e0y c\u1ee7a Madopar t\u01b0\u01a1ng \u1ee9ng v\u1edbi 300 – 800mg levodopa + 75 – 200mg benseraside, \u0111\u01b0\u1ee3c chia l\u00e0m 3 l\u1ea7n ho\u1eb7c h\u01a1n. C\u1ea7n kho\u1ea3ng th\u1eddi gian t\u1eeb 4 \u0111\u1ebfn 6 tu\u1ea7n \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 t\u1ed1i \u01b0u. N\u1ebfu th\u1ea5y c\u1ea7n ph\u1ea3i t\u0103ng li\u1ec1u d\u00f9ng h\u00e0ng ng\u00e0y th\u00eam n\u1eefa, n\u00ean t\u0103ng theo t\u1eebng th\u00e1ng.<\/p>\n \u0110i\u00eau tr\u1ecb duy tr\u00ec<\/em><\/p>\n Li\u1ec1u duy tr\u00ec trung b\u00ecnh l\u00e0 m\u1ed9t vi\u00ean nang ho\u1eb7c vi\u00ean n\u00e9n Madopar ‘125’ d\u00f9ng 3 \u0111\u1ebfn 6 l\u1ea7n m\u1ed7i ng\u00e0y. Li\u00eau d\u00f9ng ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh c\u1ea9n th\u1eadn \u1edf t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n (xem m\u1ee5c 2.1 Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tri). B\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c \u0111i\u1ec1u tr\u1ecb Parkinson kh\u00e1c v\u1eabn c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng Madopar. Tuy nhi\u00ean, trong khi vi\u1ec7c \u0111i\u1ec1u tr\u1ecb Madopar ti\u1ebfn h\u00e0nh v\u00e0 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb tr\u1edf n\u00ean r\u00f5 r\u00e0ng, li\u1ec1u d\u00f9ng c\u1ee7a c\u00e1c thu\u1ed1c \u0111\u00f3 c\u00f3 th\u1ec3 gi\u1ea3m d\u1ea7n ho\u1eb7c t\u1eeb t\u1eeb ng\u1eebng h\u1eb3n. Madopar vi\u00ean n\u00e9n dang tan \u0111\u1eb7c bi\u1ec7t th\u00edch h\u1ee3p cho b\u1ec7nh nh\u00e2n b\u1ecb ch\u1ee9ng nu\u1ed1t kh\u00f3 ho\u1eb7c trong t\u00ecnh hu\u1ed1ng c\u1ea7n t\u00e1c d\u1ee5ng kh\u1edfi ph\u00e1t c\u1ee7a thu\u1ed1c nhanh. V\u00ed d\u1ee5: b\u1ec7nh nh\u00e2n b\u1ecb m\u1ea5t v\u1eadn \u0111\u1ed9ng v\u00e0o s\u00e1ng s\u1edbm ho\u1eb7c bu\u1ed5i chi\u1ec1u, ho\u1eb7c b\u1ec7nh nh\u00e2n b\u1ecb hi\u00ean t\u01b0\u1ee3ng tr\u00ec ho\u00e3n th\u1eddi gian \u2018b\u1eadt\u2019 ho\u1eb7c k\u00e9o d\u00e0i th\u1eddi gian \u2018t\u1eaft\u2019.<\/p>\n V\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e3 bi\u1ebft c\u00f3 s\u1ef1 dao \u0111\u1ed9ng l\u1edbn v\u1ec1 t\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb c\u1ee7a thu\u1ed1c trong ng\u00e0y \u0111i\u1ec1u tr\u1ecb (hi\u1ec7n t\u01b0\u1ee3ng b\u1eadt – t\u1eaft), th\u00ec n\u00ean d\u00f9ng thu\u1ed1c l\u00e0m nhi\u1ec1u l\u1ea7n v\u1edbi c\u00e1c li\u1ec1u nh\u1ecf h\u01a1n, ho\u1eb7c n\u00ean d\u00f9ng d\u1ea1ng Madopar HBS. Khi chuy\u1ec3n t\u1eeb Madopar th\u00f4ng th\u01b0\u1eddng sang d\u00f9ng d\u1ea1ng Madopar HBS n\u1ec7n th\u1ef1c hi\u1ec7n t\u1eeb ng\u00e0y n\u00e0y sang ng\u00e0y k\u1ebf b\u1eaft \u0111\u1ea7u v\u1edbi li\u1ec1u d\u00f9ng v\u00e0o bu\u1ed5i s\u00e1ng. Li\u1ec1u d\u00f9ng v\u00e0 s\u1ed1 l\u1ea7n d\u00f9ng trong ng\u00e0y n\u00ean b\u1eaft \u0111\u1ea7u gi\u1ed1ng nh\u01b0 li\u1ec1u c\u1ee7a Madopar th\u00f4ng th\u01b0\u1eddng.<\/p>\n Sau hai \u0111\u1ebfn ba ng\u00e0y, li\u1ec1u d\u00f9ng ph\u1ea3i \u0111\u01b0\u1ee3c t\u0103ng d\u1ea7n th\u00eam kho\u1ea3ng 50%. C\u00e1c b\u1ec7nh nh\u00e2n ph\u1ea3i \u0111\u01b0\u1ee3c th\u00f4ng b\u00e1o r\u1eb1ng t\u00ecnh tr\u1ea1ng b\u1ec7nh c\u1ee7a h\u1ecd c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng trong m\u1ed9t th\u1eddi gian.<\/p>\n Do \u0111\u1eb7c t\u00ednh d\u01b0\u1ee3c h\u1ecdc c\u1ee7a Madopar HBS, th\u1eddi gian thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng b\u1ecb tr\u00ec ho\u00e3n. Hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c nhanh h\u01a1n b\u1eb1ng c\u00e1ch d\u00f9ng Madopar HBS chung v\u1edbi Madopar th\u00f4ng th\u01b0\u1eddng ho\u1eb7c Madopar d\u1ea1ng tan. \u0110i\u1ec1u n\u00e0y th\u1ef1c s\u1ef1 c\u00f3 \u00edch \u0111\u1ed1i v\u1edbi li\u1ec1u \u0111\u1ea7u ti\u00ean v\u00e0o bu\u1ed5i s\u00e1ng, n\u00ean d\u00f9ng li\u1ec1u cao h\u01a1n m\u1ed9t ch\u00fat so v\u1edbi c\u00e1c li\u1ec1u ti\u1ebfp theo trong ng\u00e0y. Vi\u1ec7c \u0111\u1ecbnh li\u1ec1u cho t\u1eebng c\u00e1 nh\u00e2n d\u00f9ng Madop\u1ea1r HBS ph\u1ea3i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n t\u1eeb t\u1eeb v\u00e0 c\u1ea9n th\u1eadn, v\u1edbi c\u00e1c qu\u00e3ng c\u00e1ch \u00edt nh\u1ea5t l\u00e0 hai \u0111\u1ebfn ba ng\u00e0y gi\u1eefa m\u1ed7i l\u1ea7n thay \u0111\u1ed5i li\u1ec1u.<\/p>\n \u1ede c\u00e1c b\u1ec7nh nh\u00e2n b\u1ecb b\u1ea5t \u0111\u1ed9ng v\u00e0o b\u1ea1n \u0111\u00eam t\u00e1c d\u1ee5ng t\u00edch c\u1ef1c \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o khi t\u0103ng d\u1ea7n li\u1ec1u cu\u1ed1i c\u00f9ng c\u1ee7a bu\u1ed5i t\u1ed1i t\u1edbi 250 mg Madopar HBS tr\u01b0\u1edbc l\u00fac \u0111i ng\u1ee7.<\/p>\n Hi\u00ean t\u01b0\u1ee3ng \u0111\u00e1p \u1ee9ng qu\u00e1 m\u1ee9c v\u1edbi Mad\u1ecdpar HBS (r\u1ed1i loan v\u1eadn \u0111\u1ed9ng) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1eb1ng c\u00e1ch t\u0103ng kho\u1ea3ng th\u1eddi gian qu\u00e3ng c\u00e1ch gi\u1eefa c\u00e1c l\u1ea7n d\u00f9ng h\u01a1n l\u00e0 b\u1eb1ng c\u00e1ch gi\u1ea3m li\u1ec1u d\u00f9ng \u0111\u01a1n \u0111\u1ed9c. Trong tr\u01b0\u1eddng h\u1ee3p \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi Madopar HBS, n\u00ean quay tr\u1edf l\u1ea1i v\u1edbi \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3 b\u1eb1ng c\u00e1c lo\u1ea1i Madopar chu\u1ea9n ho\u1eb7c Madopai d\u1ea1ng ph\u00e2n t\u00e1n.<\/p>\n C\u00e1c b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i c\u1ea9n th\u1eadn v\u1ec1 c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 v\u1ec1 t\u00e2m th\u1ea7n kh\u00f4ng mong mu\u1ed1n c\u00f3 th\u1ec3 x\u1ea3y ra.<\/p>\n Madopar kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng cho nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 r\u00f5 b\u1ecb qu\u00e1 m\u1eabn v\u1edbi levodopa ho\u1eb7c benseraside. Madopar kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng cho nh\u1eefng b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 25 tu\u1ed5i ( v\u00ec s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a h\u1ec7 x\u01b0\u01a1ng ph\u1ea3i Madopar kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng cho ph\u1ee5 n\u1eef c\u00f3 thai ho\u1eb7c nh\u1eefng ph\u1ee5 n\u1eef c\u00f3 kh\u1ea3 n\u0103ng mang thai nh\u01b0ng kh\u00f4ng \u00e1p d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p tr\u00e1nh thai \u0111\u1ea7y \u0111\u1ee7 (xem m\u1ee5c 2.5.1 Ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 2.5.2 Ph\u1ee5 n\u1eef cho con b\u00fa) Ph\u1ea3i ng\u1eebng thu\u1ed1c ngay n\u1ebfu mang thai trong th\u1eddi gian d\u00f9ng Madopar (theo h\u01b0\u1edbng d\u1eabn c\u1ee7a b\u00e1c s\u0129 cho toa)<\/p>\n C\u00f3 th\u1ec3 x\u1ea3y ra ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eabn c\u1ea3m.<\/p>\n C\u1ea7n ph\u1ea3i th\u01b0\u1eddng xuy\u00ean \u0111o nh\u00e3n \u00e1p cho nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb glo com g\u00f3c m\u1edf, v\u00ec theo l\u00fd thuy\u1ebft, levodopa c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nh\u00e3n \u00e1p.<\/p>\n Tr\u1ea7m c\u1ea3m c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Madopar, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a b\u1ec7nh \u0111ang c\u00f3.<\/p>\n N\u1ebfu b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng levodopa c\u1ea7n ph\u1ea3i g\u00e2y m\u00ea to\u00e0n th\u00e2n, li\u1ec1u l\u01b0\u1ee3ng s\u1eed d\u1ee5ng n\u00ean ti\u1ebfp t\u1ee5c cho \u0111\u1ebfn c\u00e0ng g\u1ea7n ng\u00e0y ph\u1eabu thu\u1eadt c\u00e0ng t\u1ed1t, tr\u1eeb tr\u01b0\u1eddng h\u1ee3p ph\u1ea3i g\u00e2y m\u00ea b\u1eb1ng halothane.<\/p>\n Khi g\u00e2y m\u00ea to\u00e0n th\u00e2n v\u1edbi halothane. Madopar n\u00ean ng\u1eebng tr\u1ef1\u1edbc khi can thi\u1ec7p ph\u1eabu thu\u1eadt 12 – 48 gi\u1edd v\u00ec c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n s\u1ef1 dao \u0111\u1ed9ng v\u1ec1 huy\u1ebft \u00e1p v\u00e0\/ho\u1eb7c lo\u1ea1n nh\u1ecbp tim tr\u00ean nh\u1eefng b\u00eanh nh\u00e2n s\u1eed d\u1ee5ng Madopar. M\u1ea1dopar c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ti\u1ebfp sau khi ph\u1eabu thu\u1eadt; c\u1ea7n t\u0103ng li\u1ec1u d\u1ea7n cho t\u1edbi li\u1ec1u \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt.<\/p>\n Kh\u00f4ng \u0111\u01b0\u1ee3c ng\u1eebng Madopar \u0111\u1ed9t ng\u1ed9t v\u00ec c\u00f3 th\u1ec3 g\u00e2y ra h\u1ed9i ch\u1ee9ng an th\u1ea7n gi\u1ed1ng \u00e1c t\u00ednh (s\u1ed1t cao v\u00e0 co c\u1ee9ng c\u01a1, nh\u1eefng thay \u0111\u1ecfi v\u1ec1 t\u00e2m th\u1ea7n v\u00e0 t\u0103ng creatinine phosphokinase trong huy\u1ebft thanh), h\u1ed9i ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 \u0111e d\u1ecda t\u00ednh m\u1ea1ng. N\u1ebfu th\u1ea5y xu\u1ea5t hi\u1ec7n m\u1ed9t t\u1eadp h\u1ee3p c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 v\u1eady, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i s\u00e1t n\u1ebfu c\u1ea7n ph\u1ea3i cho nh\u1eadp vi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng nhanh v\u00e0 \u0111\u00fang \u0111\u1eafn. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb n\u00e0y bao g\u1ed3m c\u1ea3 t\u00e1i \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Madopar sau khi \u0111\u00e3 \u0111\u00e1nh gi\u00e1 \u0111\u1ea7y \u0111\u1ee7.<\/p>\n Levodopa c\u00f3 li\u00ean quan \u0111\u1ebfn t\u00ecnh tr\u1ea1ng ng\u1ee7 g\u00e0 ho\u1eb7c nh\u1eefng kho\u1ea3ng ng\u1ee7 b\u1ea5t ch\u1ee3t. Ng\u1ee7 b\u1ea5t ch\u1ee3t trong khi \u0111ang ho\u1ea1t \u0111\u1ed9ng h\u00e0ng ng\u00e0y, m\u1ed9t v\u00e0i tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng bi\u1ebft ho\u1eb7c kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u b\u00e1o tr\u01b0\u1edbc \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o d\u00f9 r\u1ea5t hi\u1ebfm. B\u1ec7nh nh\u00e2n ph\u1ea3i \u0111\u01b0\u1ee3c th\u00f4ng b\u00e1o v\u1ec1 \u0111i\u1ec1u n\u00e0y v\u00e0 \u0111\u01b0\u1ee3c khuy\u00ean n\u00ean l\u01b0u \u00fd khi \u0111ang l\u00e1i xe ho\u1eb7c v\u1eadn h\u00e0nh m\u00e1y m\u00f3c khi \u0111ang \u0111i\u1ec1u tr\u1ecb v\u1edbi levodopa. B\u1ec7nh nh\u00e2n \u0111\u00e3 t\u1eebng b\u1ecb ng\u1ee7 g\u00e0 ho\u1eb7c nh\u01b0ng kho\u1ea3ng ng\u1ee7 b\u1ea5t ch\u1ee3t ph\u1ea3i ng\u1eebng l\u00e1i xe ho\u1eb7c v\u1eadn h\u00e0nh m\u00e1y m\u00f3c. H\u01a1n n\u1eefa, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc vi\u1ec7c gi\u1ea3m li\u1ec1u ho\u1eb7c ng\u1eebng \u0111i\u1ec1u tr\u1ecb (xem m\u1ee5c 2.4.3 Kh\u1ea3 n\u0103ng l\u00e1i xe ho\u1eb7c s\u1eed d\u1ee5ng m\u00e1y m\u00f3c).<\/p>\n Thu\u1ed1c nh\u00f3m Dopaminergic<\/p>\n Ch\u01a1i b\u00e0i m\u1ed9t c\u00e1ch b\u1ec7nh l\u00fd, t\u0103ng ham mu\u1ed1n v\u00e0 h\u1ecd\u1ea1t \u0111\u1ed9ng t\u00ecnh d\u1ee5c qu\u00e1 m\u1ee9c \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb v\u1edbi dopamine agonist trong b\u1ec7nh Parkinson. Ch\u01b0a c\u00f3 m\u1ed1i li\u00ean h\u1ec7 \u0111\u1ef1\u1ee3c thi\u1ebft l\u1eadp gi\u1eefa Madopar v\u1edbi c\u00e1c s\u1ef1 ki\u00ean tr\u00ean, thu\u1ed1c c\u0169ng kh\u00f4ng ph\u1ea3i l\u00e0 thu\u1ed1c \u0111\u1ed3ng v\u1eadn dopamine. Tuy nhi\u00ean, c\u0169ng c\u1ea7n l\u01b0u \u00fd v\u00ec Madopar l\u00e0 thu\u1ed1c nh\u00f3m dopaminergic.<\/p>\n M\u1ed9t nh\u00f3m nh\u1ecf b\u1ec7nh nh\u00e2n b\u1ec7nh Parkinson b\u1ecb r\u1ed1i lo\u1ea1n nh\u1eadn th\u1ee9c v\u00e0 h\u00e0nh vi c\u00f3 kh\u1ea3 n\u0103ng d\u00f9ng s\u1ed1 l\u01b0\u1ee3ng thu\u1ed1c t\u0103ng h\u01a1n so v\u1edbi h\u01b0\u1edbng d\u1eabn y t\u1ebf v\u00e0 nhi\u1ec1u h\u01a1n l\u01b0\u1ee3ng thu\u1ed1c c\u1ea7n thi\u1ebft \u0111\u1ec3 tri li\u1ec1u r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng c\u1ee7a h\u1ecd.<\/p>\n B\u1ec7nh nh\u00e2n \u0111i\u1ec1u tri v\u1edbi levodooa v\u00e0 c\u00f3 tri\u1ec7u ch\u1ee9ng ng\u1ee7 g\u00e0 ho\u1eb7c c\u00e1c kho\u1ea3ng ng\u1ee7 b\u1ea5t th\u00ecnh l\u00ecnh ph\u1ea3i \u0111\u01b0\u1ee3c th\u00f4ng b\u00e1o \u0111\u1ec3 kh\u00f4ng l\u00e1i xe ho\u1eb7c tham gia c\u00e1c ho\u1ea1t \u0111\u1ed9ng m\u00e0 kh\u1ea3 n\u0103ng gi\u1ea3m c\u1ea3nh gi\u00e1c c\u00f3 th\u1ec3 l\u00e0m h\u1ecd ho\u1eb7c nh\u1eefng ng\u01b0\u1eddi kh\u00e1c bi nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng nghi\u00eam tr\u1ecdng ho\u1eb7c t\u1eed vong (v\u00ed d\u1ee5 v\u1eadn h\u00e0nh m\u00e1y m\u00f3c) cho \u0111\u1ebfn khi c\u00e1c tri\u1ec7u ch\u1ee9ng ng\u1ee7 g\u00e0 ho\u1eb7c c\u00e1c kho\u1ea3ng ng\u1ee7 b\u1ea5t th\u00ecnh l\u00ecnh \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft (xem M\u1ee5c 2.4.1 T\u1ed5ng qu\u00e1t)<\/p>\n Ki\u1ec3m tra ch\u1ee9c n\u0103ng gan v\u00e0 c\u00f4ng th\u1ee9c m\u00e1u n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong th\u01a1i gian \u0111i\u1ec1u tr\u1ecb. T\u01b0\u1ee3ng t\u00e1c d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/em><\/p>\n S\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi thu\u1ed1c kh\u00e1ng cholinergic trihexyphenidyl v\u1edbi Madopar d\u1ea1ng th\u00f4ng th\u01b0\u1eddng l\u00e0m gi\u1ea3m t\u1ed1c \u0111\u1ed9 h\u1ea5p thu lev\u1ecddopa nh\u01b0ng kh\u00f4ng l\u00e0m gi\u1ea3m m\u1ee9c h\u1ea5p thu. S\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi Trihexyphenidyl v\u1edbi Madopar HBS kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a levodopa.<\/p>\n S\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi c\u00e1c kh\u00e1ng axit v\u00e0 Madopar HBS l\u00e0m gi\u1ea3m m\u1ee9c \u0111\u1ed9 h\u1ea5p thu c\u1ee7a levodopa 32%. Sulphate s\u1eaft l\u00e0m gi\u1ea3m n\u1ed3ng \u0111\u1ed9 t\u1ed1i \u0111a trong huy\u1ebft t\u01b0\u01a1ng v\u00e0 AUC c\u1ee7a levodopa kho\u1ea3ng 30-50%. Ng\u01b0\u1eddi ta quan s\u00e1t th\u1ea5y nh\u1eefng thay \u0111\u1ed5i d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng trong l\u00fac c\u00f9ng \u0111i\u1ec1u tr\u1ecb v\u1edbi sulphate s\u1eaft \u1edf m\u1ed9t s\u1ed1 b\u00eanh nh\u00e2n ch\u1ee9 kh\u00f4ng ph\u1ea3i t\u1ea5t c\u1ea3. Metoclopramide l\u00e0m t\u0103ng t\u1ed1c \u0111\u1ed9 h\u1ea5p thu c\u1ee7a levodopa<\/p>\n Kh\u00f4ng c\u00f3 t\u01b0\u01a1ng t\u00e1c d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc gi\u1eefa levodopa v\u00e0 c\u00e1c ho\u1ea1t ch\u1ea5t sau: bromocriplin, amantadine, selegiline v\u00e0 domperidone.<\/p>\n T\u01b0\u01a1ng t\u00e1c d\u01b0\u1ee3c l\u1ef1c h\u1ecdc<\/em><\/p>\n C\u00e1c thu\u1ed1c an th\u1ea7n, c\u00e1c opioid v\u00e0 c\u00e1c thu\u1ed1c ch\u1eefa t\u0103ng huy\u1ebft \u00e1p c\u00f3 reserpine \u0111\u1ec1u \u1ee9c ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a Madopar.<\/p>\n N\u1ebfu Madopar \u0111\u01b0\u1ee3c d\u00f9ng cho nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf men MAO kh\u00f4ng h\u1ed3i ph\u1ee5c v\u00e0 kh\u00f4ng ch\u1ecdn l\u1ecdc th\u00ec c\u1ea7n ph\u1ea3i ng\u1eebng thu\u1ed1c \u1ee9c ch\u1ebf men MA\u1ecc n\u00e0y trong \u00edt nh\u1ea5t 2 tu\u1ea7n tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Madopar. N\u1ebfu kh\u00f4ng th\u00ec c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 c\u01a1n t\u0103ng huy\u1ebft \u00e1p c\u00f3 th\u1ec3 x\u1ea3y ra (xem m\u1ee5c 2.3 Ch\u1ed1ng ch\u1ec9 \u0111inh). C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc tr\u00ean MAO- B nh\u01b0 selegiline v\u00e0 rasagilinc v\u00e0 c\u00e1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc tr\u00ean MAO-A (nh\u01b0 moclobemide c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh \u0111\u01b0\u1ee3c cho nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Madopar. Theo khuy\u1ebfn c\u00e1o, n\u00ean \u0111i\u1ec1u ch\u1ec9nh l\u1ea1i li\u1ec1u levodopa theo t\u1eebng b\u1ec7nh nh\u00e2n d\u1ef1a tr\u00ean hi\u1ec7u qu\u1ea3 v\u00e0 \u0111\u1ed9 dung n\u1ea1p. S\u1ef1 ph\u1ed1i h\u1ee3p c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf MAO-A v\u00e0 MAO-B cho hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nh\u01b0 \u1ee9c ch\u1ebf MAO kh\u00f4ng ch\u1ecdn l\u1ecdc, v\u00ec v\u1eady kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng d\u1ea1ng ph\u1ed1i h\u1ee3p n\u00e0y v\u1edbi Madopar (xem m\u1ee5c 2.3 Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh).<\/p>\n M\u1ea1dopar kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng c\u00f9ng v\u1edbi c\u00e1c thu\u1ed1c gi\u1ed1ng giao c\u1ea3m (nh\u01b0 epinephrin, norepinephrine, isoproterenol hay amphetamine l\u00e0 nh\u01b0ng ch\u1ea5t k\u00edch th\u00edch h\u1ec7 th\u1ea7n kinh giao c\u1ea3m) v\u00ec levodopa c\u00f3 th\u1ec3 l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c thu\u1ed1c n\u00e0y. N\u1ebfu nh\u1ea5t thi\u1ebft ph\u1ea3i d\u00f9ng c\u00f9ng, c\u1ea7n theo d\u00f5i s\u00e1t h\u1ec7 th\u1ed1ng tim m\u1ea1ch v\u00e0 n\u00ean gi\u1ea3m li\u1ec1u c\u00e1c thu\u1ed1c k\u00edch th\u00edch giao c\u1ea3m.<\/p>\n C\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p \u0111\u01b0\u1ee3c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c nh\u01b0 thu\u1ed1c kh\u00e1ng cholinergic, amantadine, ch\u1ea5t \u0111\u1ed9ng v\u1eadn dopamin, nh\u01b0ng c\u1ea3 t\u00e1c d\u1ee5ng mong mu\u1ed1n v\u00e0 kh\u00f4ng mong mu\u1ed1n \u0111\u1ec1u c\u00f3 th\u1ec3 t\u0103ng l\u00ean. Cho n\u1ec7n c\u1ea7n gi\u1ea3m li\u1ec1u Madopar ho\u1eb7c c\u00e1c thu\u1ed1c kia. Khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf COMT, c\u1ea7n ph\u1ea3i gi\u1ea3m li\u1ec1u Madopar. Kh\u00f4ng n\u00ean d\u1eebng \u0111\u1ed9t ng\u1ed9t thu\u1ed1c kh\u00e1ng cholinergic khi b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng Madopar, v\u00ec levodopa c\u1ea7n c\u00f3 m\u1ed9t th\u1eddi gian \u0111\u1ec3 ph\u00e1t huy t\u00e1c d\u1ee5ng. Levodopa c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng t\u1edbi k\u1ebft qu\u1ea3 c\u1ee7a m\u1ed9t s\u1ed1 x\u00e9t nghi\u00eam v\u1ec1 catecholamine, creatinine, axit u-ric v\u00e0 glucose.<\/p>\n Test Coom c\u00f3 th\u1ec3 cho k\u1ebft qu\u1ea3 d\u01b0\u01a1ng tinh gi\u1ea3 n\u1ebfu th\u1ef1c hi\u1ec7n tr\u00ean b\u1ec7nh nh\u00e2n d\u00f9ng Madopar. Madopar ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1edf ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 ph\u1ee5 n\u1eef c\u00f3 kh\u00e1 n\u0103ng mang thai nh\u01b0ng kh\u00f4ng \u00e1p d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p tr\u00e1nh thai \u0111\u1ea7y \u0111\u1ee7 (xem m\u1ee5c 2.3 Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh. 3.3.4 T\u00ednh g\u00e2y qu\u00e1i thai v\u00e0 m\u1ee5c 3.3.5 \u0110\u1eb7c t\u00ednh kh\u00e1c).<\/p>\n V\u00ec ch\u01b0a bi\u1ebft benserazide c\u00f3 \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft v\u00e0o s\u1eefa hay kh\u00f4ng, c\u00e1c b\u00e0 me c\u1ea7n \u0111i\u1ec1u tri b\u1eb1ng Madopar kh\u00f4ng n\u00ean cho con b\u00fa v\u00ec kh\u00f4ng lo\u1ea1i tr\u1eeb kh\u1ea3 n\u0103ng c\u00f3 bi\u1ebfn d\u1ea1ng x\u01b0\u01a1ng \u1edf tr\u1ebb.<\/p>\n Xem m\u1ee5c 2.3 Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/p>\n C\u1ea3\u00a0Levodopa v\u00e0 benseracide \u0111\u1ec1u chuy\u1ec3n h\u00f3a r\u1ed9ng v\u00e0 d\u01b0\u1edbi 10% levodopa \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft d\u01b0\u1edbi d\u1ea1ng kh\u00f4ng thay \u0111\u1ed5i qua \u0111\u01b0\u1eddng th\u1eadn. Do \u0111\u00f3 kh\u00f4ng c\u1ea7n gi\u1ea3m li\u1ec1u trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p suy ch\u1ee9c n\u0103ng th\u1eadn m\u1ee9c \u0111\u1ed9 nh\u1eb9 ho\u1eb7c trung b\u00ecnh.<\/p>\n Ch\u01b0a c\u00f3 c\u00e1c d\u1eef li\u1ec7u d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a levodopa \u1edf b\u1ec7nh nh\u00e2n suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn. Madopar dung n\u1ea1p t\u1ed1t \u1edf b\u1ec7nh nh\u00e2n t\u0103ng ure m\u00e1u \u0111ang ti\u1ebfn h\u00e0nh l\u1ecdc th\u1eadn.<\/p>\n Levodopa \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a ch\u1ee7 y\u1ebfu b\u1edfi men aromatic amino acid decarboxylase m\u00e0 men n\u00e0y c\u00f2n hi\u1ec7n di\u1ec7n nhi\u1ec1u t\u1ea1i \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, th\u00e2n v\u00e0 tim ngo\u00e0i gan.<\/p>\n Ch\u01b0a c\u00f3 c\u00e1c d\u1eef li\u1ec7u d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a levodopa \u1edf b\u1ec7nh nhan suy gan.<\/p>\n Th\u00f4ng b\u00e1o cho b\u00e1c s\u0129 b\u1ea5t k\u1ef3 t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0o c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c d\u00f9ng thu\u1ed1c.<\/p>\n R\u1ed1i lo\u1ea1n huy\u1ebft h\u1ecdc: thi\u1ebfu m\u00e1u tan huy\u1ebft, gi\u1ea3m b\u1ea1ch c\u1ea7u v\u00e0 ti\u1ec3u c\u1ea7u tho\u00e1ng qua \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong m\u1ed9t v\u00e0i tr\u01b0\u1eddng h\u1ee3p hi\u1ebfm. Do d\u00f3, trong b\u1ea5t k\u1ef3 tr\u01b0\u1eddng h\u1ee3p n\u00e0o \u0111i\u1ec1u tr\u1ecb d\u00e0i h\u1ea1n v\u1edbi c\u00e1c ch\u1ebf ph\u1ea9m c\u00f3 levodopa, n\u00ean theo d\u00f5i c\u00f4ng th\u1ee9c m\u00e1u, ch\u1ee9c n\u0103ng gan, th\u1eadn d\u1ecbnh k\u1ef3.<\/p>\n R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a v\u00e0 dinh d\u01b0\u1ee1ng: \u0111\u00e3 c\u00f3 b\u00e1o c\u00e1o v\u1ec1 t\u00ecnh tr\u1ea1ng ch\u00e1n \u0103n.<\/p>\n R\u1ed1i loan t\u00e2m th\u1ea7n: tr\u1ea7m c\u1ea3m l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng trong b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng chung c\u1ee7a b\u1ec7nh nh\u00e2n Parkinson v\u00e0 c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb v\u1edbi Madopar. H\u1ed3i h\u1ecdp, lo l\u1eafng, m\u1ea5t ng\u1ee7, \u1ea3o gi\u00e1c, hoang t\u01b0\u1edfng v\u00e0 r\u1ed1i loan t\u1ea1m th\u1edfi kh\u1ea3 n\u0103ng \u0111\u1ecbnh h\u01b0\u1edbng c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n gi\u00e0 v\u00e0 b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 ti\u1ec1n s\u1eed b\u1ecb nh\u01b0 v\u1eady.<\/p>\n R\u1ed1i loan h\u1ec7 th\u1ea7n kinh: \u0111\u00e3 c\u00f3 b\u00e1o c\u00e1o c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u01a1n l\u1ebb m\u1ea5t v\u1ecb gi\u00e1c ho\u1eb7c r\u1ed1i lo\u1ea1n v\u1ecb gi\u00e1c. R\u1ed1i loan v\u1ec1 tim m\u1ea1ch: th\u1ec9nh tho\u1ea3ng loan nh\u1ecbp tim c\u00f3 th\u1ec3 x\u1ea3y ra.<\/p>\n R\u1ed1i loan t\u0129nh m\u1ea1ch: th\u1ec9nh tho\u1ea3ng c\u00f3 th\u1ec3 x\u1ea3y ra h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf. Nh\u1eefng r\u1ed1i lo\u1ea1n do t\u01b0 th\u1ebf th\u01b0\u1eddng c\u1ea3i thi\u1ec7n sau khi gi\u1ea3m li\u1ec1u Mad\u1ecdpar.<\/p>\n R\u1ed1i lo\u1ea1n h\u1ec7 ti\u00eau h\u00f3a: bu\u00f4n n\u00f4n, n\u00f4n v\u1ea7 ti\u00eau ch\u1ea3y \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o khi d\u00f9ng Madopar. C\u00e1c hi\u1ec7u qu\u1ea3 kh\u00f4ng mong mu\u1ed1n tr\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, th\u01b0\u1eddng x\u1ea3\u1ef5 ra ch\u1ee7 y\u1ebfu trong giai \u0111o\u1ea1n \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t ch\u1ee7 y\u1ebfu b\u1eb1ng c\u00e1ch u\u1ed1ng Madopar v\u1edbi th\u1ee9c \u0103n ho\u1eb7c ch\u1ea5t l\u1ecfng ho\u1eb7c t\u0103ng li\u1ec1u ch\u1eadm<\/p>\n R\u1ed1i lo\u1ea1n da v\u00e0 m\u00f4 li\u00ean k\u1ebft: ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng tr\u00ean da nh\u01b0 ng\u1ee9a, ph\u00e1t ban x\u1ea3y ra \u1edf m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p hi\u1ebfm.<\/p>\n X\u00e9t nghi\u1ec7m: c\u00f3 th\u1ec3 t\u0103ng tho\u00e1ng qu\u00e1 transaminase v\u00e0 phosphatase ki\u1ec1m c\u1ee7a gan. \u0110\u00e3 c\u00f3 b\u00e1o c\u00e1o v\u1ec1 tr\u01b0\u1eddng h\u1ee3p t\u0103ng gamma – glutamyltransferase. T\u0103ng ure nitrogen trong m\u00e1u c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng madopar.<\/p>\n N\u01b0\u1edbc ti\u1ec3u c\u00f3 th\u1ec3 b\u1ecb thay \u0111\u1ed5i m\u00e0u s\u1eafc, th\u01b0\u1eddng c\u00f3 m\u00e0u \u0111\u1ecf r\u1ed3i chuy\u1ec3n sang m\u00e0u s\u1eabm sau khi \u0111\u1ec3 l\u1eafng.<\/p>\n 2.6.1.1 B\u1ea5t th\u01b0\u1eddng tr\u00ean x\u00e9t nghi\u1ec7m<\/strong><\/p>\n Xem m\u1ee5c 2.6.1 Sau khi \u0111\u01b0a v\u00e0o th\u1ecb tr\u01b0\u1eddng<\/p>\n Tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u<\/em><\/p>\n C\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u Madopar \u1edf li\u1ec1u \u0111i\u1ec1u tr\u1ecb nh\u01b0ng m\u1ee9c \u0111\u1ed9 n\u1eb7ng th\u00ec tr\u1ea7m tr\u1ecdng h\u01a1n.\u00a0Qu\u00e1 li\u1ec1u c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean tim m\u1ea1ch (v\u00ed d\u1ee5 lo\u1ea1n nh\u1ecbp tim), r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n (v\u00ed d\u1ee5 l\u0103n l\u1ed9n, m\u1ea5t ng\u1ee7), t\u00e1c d\u1ee5ng tr\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a (v\u00ed d\u1ee5 bu\u1ed3n n\u00f4n, n\u00f4n) v\u00e0 nh\u1eefng v\u1eadn \u0111\u1ed9ng ngo\u1ea1i \u00fd b\u1ea5t th\u01b0\u1eddng (xem m\u1ee5c 2.6.1 Sau khi \u0111\u01b0a v\u00e0o thi tr\u01b0\u1eddng (T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n)).<\/p>\n N\u1ebfu b\u00eanh nh\u00e2n d\u00f9ng qu\u00e1 li\u1ec1u d\u1ea1ng Madopar ph\u00f3ng th\u00edch ch\u00e2m (v\u00ed d\u1ee5 Madop\u00e1 HBS vi\u00ean nang), s\u1ef1 xu\u1ea5t hi\u00ean c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u c\u00f3 th\u1ec3 b\u1ecb tr\u00ec ho\u00e3n do s\u1ef1 tr\u00ec ho\u00e3n h\u1ea5p thu ho\u1ea1t ch\u1ea5t t\u1eeb da d\u00e0y.<\/p>\n \u0110i\u1ec1u tr\u1ecb<\/em><\/p>\n Th\u1eb9o d\u00f5i c\u00e1c d\u1ea5u hi\u1ec7u sinh t\u1ed3n c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 thi\u1ebft l\u1eadp c\u00e1c bi\u00ean ph\u00e1p h\u1ed7 tr\u1ee3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh theo t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t c\u00f3 th\u1ec3 c\u1ea7n \u0111i\u00eau tr\u1ecb tri\u1ec7u ch\u1ee9ng nh\u01b0 h\u1eadu qu\u1ea3 tr\u00ean h\u1ec7 tim m\u1ea1ch (v\u00ed d\u1ee5 thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp tim) ho\u1eb7c h\u00e2u qu\u1ea3 tr\u00ean h\u1ec7 th\u1ea7n kinh trung \u1ef1\u01a1ng (v\u00ed d\u1ee5 thu\u1ed1c k\u00edch th\u00edch h\u00f4 h\u1ea5p, thu\u1ed1c an th\u1ea7n). Th\u00eam v\u00e0o \u0111\u00f3, \u0111\u1ed1i v\u1edbi d\u1ea1ng ph\u00f3ng th\u00edch ch\u1eadm ph\u1ea3i ng\u0103n ng\u1eeba t\u00ecnh tr\u1ea1ng h\u1ea5p thu th\u00eam sau \u0111\u00f3 d\u00f9ng c\u00e1c bi\u1ec7n ph\u00e1p th\u00edch h\u1ee3p.<\/p>\n Dopamine, ch\u1ea5t \u0111\u00f3ng vai tr\u00f2 l\u00e0 ch\u1ea5t d\u1eabn truy\u1ec1n th\u1ea7n kinh trong n\u00e3o, kh\u00f4ng c\u00f3 \u0111\u1ee7 n\u1ed3ng \u0111\u1ed9 \u1edf v\u1ecb tr\u00ed c\u00e1c nh\u00e2n x\u00e1m trung \u01b0\u01a1ng c\u1ee7a c\u00e1c b\u1ec7nh nh\u00e2n parkinson. Levodopa (INN) ho\u1eb7c L-DOPA (3.4 dihydroxy L-phenylalanin) l\u00e0 ch\u1ea5t trung gian trong qu\u00e1 tr\u00ecnh sinh t\u1ed5ng h\u1ee3p dopamine. Levodopa (ti\u1ec1n ch\u1ea5t c\u1ee7a dopamine) \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 m\u1ed9t ti\u1ec1n ch\u1ea5t \u0111\u1ec3 gia t\u0103ng n\u1ed3ng \u0111\u1ed9 dopamine v\u00ec n\u00f3 c\u00f3 th\u1ec3 xuy\u00ean qua h\u00e0ng r\u00e0o m\u00e1u n\u00e3o trong khi t\u1ef1 dopamine kh\u00f4ng th\u1ec3 qua \u0111\u01b0\u1ee3c. Khi levodopa v\u00e0o h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, n\u00f3 \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a th\u00e0nh dopamine nh\u1edd men L-amino acid decarboxylase th\u01a1m.<\/p>\n Sau khi d\u00f9ng I\u00eavodopa b\u1ecb kh\u1eed nh\u00f3m carboxyl nhanh ch\u00f3ng \u0111\u1ebb tr\u1edf th\u00e0nh dopamine, c\u1ea3 trong n\u00e3o c\u0169ng nh\u01b0 khu v\u1ef1c ngo\u00e0i n\u00e3\u1ecd. K\u1ebft qu\u1ea3 l\u00e0 ph\u1ea7n l\u1edbn levodopa u\u1ed1ng v\u00e0o kh\u00f4ng n\u1eb1m trong c\u00e1c nh\u00e2n x\u00e1m trung \u01b0\u01a1ng, v\u00e0 dopamine \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t ra \u1edf v\u00f9ng ngo\u1ea1i vi th\u01b0\u1eddng g\u00e2y ra nhi\u1ec1u t\u00e1c d\u1ee5ng ph\u1ee5. Do v\u1eady \u0111i\u1ec1u c\u1ea7n \u0111\u1eb7c bi\u1ec7t ch\u00fa \u00fd l\u00e0 ph\u1ea3i ng\u0103n ch\u1eb7n qu\u00e1 tr\u00ecnh kh\u1eed carboxyl c\u1ee7a levodopa \u1edf v\u00f9ng ngo\u00e0i n\u00e3o, \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1ch d\u00f9ng \u0111\u1ed3ng th\u1eddi levodopa v\u1edbi benseraside, ch\u1ea5t \u1ee9c ch\u1ebf men decarboxylase ngo\u1ea1i vi.<\/p>\n Madopar l\u00e0 ph\u1ed1i h\u1ee3p c\u1ee7a 2 ch\u1ea5t n\u00e0y v\u1edbi t\u1ef7 l\u00ea 4 : 1, t\u1ef7 l\u1ec7 n\u00e0y \u0111\u00e3 ch\u1ee9ng minh \u0111\u01b0\u1ee3c t\u00ednh t\u1ed1i \u01b0u trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u00e0 s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 nh\u01b0 khi d\u00f9ng levodopa li\u1ec1u cao m\u1ed9t m\u00ecnh.<\/p>\n D\u1ea1ng th\u00f4ng th\u01b0\u1eddng<\/em><\/p>\n Levodopa \u0111\u01b0\u1ee3c h\u1ea5p thu ch\u1ee7 y\u1ebfu t\u1ea1i \u0111o\u1ea1n tr\u00ean c\u1ee7a ru\u1ed9t non, v\u00e0 s\u1ef1 h\u1ea5p thu kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed. N\u1ed3ng \u0111\u1ed9 t\u1ed1i \u0111a trong huy\u1ebft t\u01b0\u01a1ng c\u1ee7a levodopa \u0111\u1ea1t \u0111\u01b0\u1ee3c kho\u1ea3ng m\u1ed9t gi\u1edd sau khi u\u1ed1ng Madopar chu\u1ea9n. D\u1ea1ng vi\u00ean nh\u1ed9ng v\u00e0 vi\u00ean n\u00e9n c\u1ee7a Madopar th\u00f4ng th\u01b0\u1eddng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1ec1 \u0111\u1ed9 sinh kh\u1ea3 d\u1ee5ng.<\/p>\n N\u1ed3ng \u0111\u1ed9 t\u1ed1i \u0111a trong huy\u1ebft t\u01b0\u01a1ng c\u1ee7a levodopa v\u00e0 m\u1ee9c \u0111\u1ed9 h\u1ea5p thu c\u1ee7a levodopa (AUC) t\u0103ng t\u1ec9 l\u1ec7 v\u1edbi li\u1ec1u d\u00f9ng (50-200mg levodop\u1ea1).<\/p>\n Th\u1ef1c ph\u1ea9m \u0103n v\u00e0o l\u00e0m gi\u1ea3m t\u1ed1c \u0111\u1ed9 v\u00e0 m\u1ee9c \u0111\u1ed9 h\u1ea5p thu c\u1ee7a lexodopa. N\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh c\u1ee7a levodopa trong huy\u1ebft t\u01b0\u01a1ng gi\u1ea3m 30% v\u00e0 xu\u1ea5t hi\u1ec7n tr\u1ec5 h\u01a1n khi Mad\u1ecdpar chu\u1ea9n \u0111\u01b0\u1ee3c d\u00f9ng sau b\u1eefa \u0103n ch\u00ednh. M\u1ee9c \u0111\u1ed9 h\u1ea5p thu c\u1ee7a levodopa gi\u1ea3m 15%.<\/p>\n D\u1ea1ng tan<\/em><\/p>\n Th\u00f4ng s\u1ed1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a levodopa sau khi d\u00f9ng Madopar d\u1ea1ng tan \u1edf ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n kh\u1ecfe m\u1ea1nh v\u00e0 b\u1ec7nh nh\u00e2n b\u1ec7nh Parkinson t\u01b0\u01a1ng t\u01b0 nh\u01b0 \u1edf nh\u00f3m ng\u01b0\u1eddi n\u00e0y d\u00f9ng Madopar chu\u1ea9n, nh\u01b0ng th\u1eddi gian \u0111\u1ea1t \u0111\u01b0\u1ee3c n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh c\u00f3 kh\u1ee5ynh h\u01b0\u1edbng ng\u1eafn h\u01a1n khi d\u00f9ng Madopar d\u1ea1ng tan. \u00cdt c\u00f3 s\u1ef1 bi\u1ebfn thi\u00ean gi\u1eefa c\u00e1c c\u00e1 nh\u00e2n \u0111\u1ed1i v\u1edbi c\u00e1c th\u1ea1m s\u1ed1 h\u1ea5p thu khi Madopar d\u1ea1ng tan \u0111\u01b0\u1ee3c u\u1ed1ng d\u01b0\u1edbi dang h\u1ed7n d\u1ecbch.<\/p>\n D\u1ea1ng ph\u00f3ng th\u00edch c\u00f3 ki\u1ec3m so\u00e1t<\/em><\/p>\n \u0110\u1eb7c t\u00ednh d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a Madophar HBS kh\u00e1c v\u1edbi d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a Madopar d\u1ea1ng th\u00f4ng th\u01b0\u1eddng (vi\u00ean n\u00e9n v\u00e0 vi\u00ean nang) v\u00e0 d\u1ea1ng tan. Ho\u1ea1t ch\u1ea5t \u0111\u01b0\u1ee3c ph\u00f3ng th\u00edch ch\u1eadm trong d\u1ea1 d\u00e0y. N\u1ed3ng \u0111\u1ed9 t\u1ed1i \u0111a trong huy\u1ebft t\u01b0\u01a1ng, t\u1eeb 20 – 30% so v\u1edbi n\u1ed3ng \u0111\u1ed9 t\u1ed1i \u0111a trong huy\u1ebft t\u01b0\u01a1ng c\u1ee7a c\u00e1c d\u1ea1ng thu\u1ed1c th\u00f4ng th\u01b0\u1eddng, \u0111\u1ea1t \u0111\u01b0\u1ee3c 3 gi\u1edd sau khi u\u1ed1ng. \u0110\u01b0\u1eddng cong n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng cho th\u1ea5y c\u00f3 “kho\u1ea3ng th\u1eddi gian m\u1ed9t n\u1eeda gi\u00e1 tr\u1ecb” d\u00e0i h\u01a1n (kho\u1ea3ng th\u1eddi gian m\u00e0 trong \u0111\u00f3 n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong huy\u1ebft t\u01b0\u01a1ng l\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u1eddng ho\u1eb7c cao h\u01a1n m\u1ed9t n\u1eeda c\u1ee7a n\u1ed3ng \u0111\u1ed9 t\u1ed1i \u0111a) c\u00e1c d\u1ea1ng thu\u1ed1c th\u00f4ng th\u01b0\u1eddng, \u0111i\u1ec1u n\u00e0y cho th\u1ea5y thu\u1ed1c c\u00f3 \u0111\u1eb7c t\u00ednh ph\u00f3ng th\u00edch c\u00f3 ki\u1ec3m so\u00e1t nh\u01b0 \u0111\u00e3 c\u1ed1ng b\u1ed1.<\/p>\n \u0110\u1ed9 sinh kh\u1ea3 d\u1ee5ng c\u1ee7a Madopar HBS b\u1eb1ng kho\u1ea3ng 50 – 70% c\u1ee7a d\u1ea1ng vi\u00ean th\u00f4ng th\u01b0\u1eddng v\u00e0 kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng c\u1ee7a th\u1ee9c \u0103n. N\u1ed3ng \u0111\u1ed9 t\u1ed1i da c\u1ee7a levodopa trong huy\u1ebft t\u01b0\u01a1ng kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi th\u1ee9c \u0103n nh\u01b0ng \u0111\u1ea1t \u0111\u01b0\u1ee3c mu\u1ed9n h\u01a1n (5 gi\u1edd) sau khi u\u1ed1ng Madopar HBS sau \u0103n.<\/p>\n Levodopa \u0111i qua h\u00e0ng r\u00e0o m\u00e1u n\u00e3o q\u1ee5a h\u1ec7 th\u1ed1ng v\u1eadn chuy\u1ec3n b\u00e3o h\u00f2a. N\u00f3 kh\u00f4ng g\u1eafn k\u1ebft v\u1edbi protein huy\u1ebft t\u01b0\u01a1ng v\u00e0 th\u1ec3 t\u00edch ph\u00e2n b\u1ed1 l\u00e0 57 lit. AUC c\u1ee7\u1ea1 levodopa trong d\u1ecbch n\u00e3o t\u1ee7y b\u1eb1ng 12% trong huy\u1ebft t\u01b0\u01a1ng.<\/p>\n Ng\u01b0\u1ee3c l\u1ea1i v\u1edbi levodopa, benseraside kh\u00f4ng x\u00e2m nh\u00e2p \u0111\u01b0\u1ee3c q\u1ee5a h\u00e0ng r\u00e0o m\u00e1u n\u00e3o \u1edf li\u1ec1u \u0111i\u1ec1u tr\u1ecb. Thu\u1ed1c ch\u1ee7 y\u1ebfu t\u1eadp trung \u1edf th\u00e2n, ph\u1ed5i, ru\u1ed9t non v\u00e0 gan.<\/p>\n Levodopa \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a qua 2 con \u0111\u01b0\u1eddng ch\u00ednh (kh\u1eed carboxyl v\u00e0 O-methyl h\u00f3a) v\u00e0 2 con \u0111\u01b0\u1eddng nh\u1ecf kh\u00e1c (transamin h\u00f3a v\u00e0 oxy h\u00f3a).<\/p>\n Men axit amin th\u01a1m decarboxylase chuy\u1ec3n levodopa th\u00e0nh dopamine. C\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a ch\u00ednh c\u1ee7a \u0111\u01b0\u1eddng chuy\u1ec3n h\u00f3a n\u00e0y l\u00e0 axid homovanillic v\u00e0 axil dihydroxyphenylacetic. Men Catechol-O- methyltransferase methyl h\u00f3a levodopa th\u00e0nh 3-O-methyldopa. C\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a ch\u00ednh trong huy\u1ebft t\u01b0\u01a1ng c\u00f3 th\u1eddi gian b\u00e1n h\u1ee7y l\u00e0 15 gi\u1edd. V\u00e0 n\u00f3 \u0111\u01b0\u1ee3c t\u00edch l\u0169y \u1edf b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Madopar. Vi\u1ec7c kh\u1eed carboxyl ngo\u1ea1i vi c\u1ee7a levodopa b\u1ecb gi\u1ea3m khi u\u1ed1ng k\u00e8m benserazide \u0111\u01b0\u1ee3c ph\u1ea3n \u00e1nh th\u00f4ng qua n\u1ed3ng \u0111\u1ed9 huy\u1ebft t\u01b0\u01a1ng cao h\u01a1n c\u1ee7a levodopa v\u00e0 3-O-methyldopa v\u00e0 n\u1ed3ng \u0111\u1ed9 huy\u1ebft t\u01b0\u01a1ng th\u1ea5p h\u01a1n c\u1ee7a c\u00e1c cathecholamines (dopamine, noradrenaline) v\u00e0 c\u00e1c axid phenolcarboxylic (axit homovanillic, axit dihydroxyphenylacctic).<\/p>\n Benserazide \u0111\u01b0\u1ee3c hydroxyl h\u00f3a th\u00e0nh trihydroxybenzyIhydrazine trong ni\u00eam m\u1ea1c r\u1ee5\u1ed9t v\u00e0 trong gan. Ch\u1ea5t chuy\u1ec3n h\u00f3a n\u00e0y l\u00e0 ch\u1ea5t \u1ee9c ch\u1ebf ch\u00ednh c\u1ee7a men axit amin th\u01a1m decarboxylase.<\/p>\n Khi c\u00f3 s\u1ef1 \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh kh\u1eed carboxyl c\u1ee7a levodopa \u1edf ngo\u1ea1i vi, th\u1eddi gian b\u00e1n h\u1ee7y c\u1ee7a levodopa v\u00e0o kho\u1ea3ng 1.5 gi\u1edd. Th\u1eddi gian b\u00e1n th\u1ea3i b\u1ecb k\u00e9o d\u00e0i h\u01a1n (25%) \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i (65-78 tu\u1ed5i) m\u1eafc b\u00eanh Parkinson (xem m\u1ee5c 3.2.5 D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u1edf c\u00e1c \u0111\u00f3oi t\u01b0\u1ee3ng \u0111\u1eb7c bi\u1ec7t). \u0110\u1ed9 thanh th\u1ea3i c\u1ee7a levodopa trong huy\u1ebft t\u01b0\u01a1ng kho\u1ea3ng 430 ml ph\u00fat.<\/p>\n Benserazide g\u1ea7n nh\u01b0 \u0111\u01b0\u1ee3c th\u1ea3i tr\u1eeb h\u1ecd\u00e0n to\u00e0n qua qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a. C\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c th\u1ea3i tr\u1eeb qua n\u01b0\u1edbc ti\u1ec3u (64%) v\u00e0 m\u1ed9t ph\u1ea7n nh\u1ecf qua ph\u00e2n (24%).<\/p>\n Kh\u00f4ng c\u00f3 c\u00e1c d\u1ef1 li\u1ec7u v\u1ebd d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u1edf c\u00e1c b\u1ec7nh nh\u00e2n t\u0103ng ur\u00ea m\u00e1u ho\u1eb7c b\u1ec7nh gan<\/p>\n \u1ea2nh h\u01b0\u1edfng c\u1ee7a tu\u1ed5i l\u00ean d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a levodopa \u1edf b\u1ec7nh nh\u00e2n b\u1ec7nh Parkinson l\u1edbn tu\u1ed5i (65-78 tu\u1ed5i) c\u1ea3 th\u1eddi gian b\u00e1n h\u1ee7y v\u00e0 AUC c\u1ee7a levodopa \u0111\u1ec1u cao h\u01a1n \u1edf b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i (34-64 tu\u1ed5i) kho\u1ea3ng 25%. Hi\u1ec7u qu\u1ea3 c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea c\u1ee7a tu\u1ed5i c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng kh\u00f4ng \u0111\u00e1ng k\u1ec3 v\u00e0 \u00edt quan tr\u1ecdng trong ch\u1ebf \u0111\u1ed9 li\u1ec1u d\u00f9ng \u1edf b\u1ea5t c\u1ee9 ch\u1ec9 \u0111\u1ecbnh n\u00e0o.<\/p>\n C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 kh\u1ea3 n\u0103ng sinh ung th\u01b0 ch\u01b0a \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh v\u1edbi Madopar.<\/p>\n Madopar v\u00e0 th\u00e0nh ph\u1ea7n c\u1ee7a thu\u1ed1c (levodopa v\u00e1\u00e0 benseraside) ch\u01b0a quan s\u00e1t th\u1ea5y c\u00f3 kh\u1ea3 n\u0103ng sinh \u0111\u1ed9t bi\u1ebfn trong th\u1eed nghi\u00eam Ames. Ch\u01b0a c\u00f3 c\u00e1c d\u1eef li\u1ec7u nghi\u00ean c\u1ee9u tr\u00ean kh\u1ea3 n\u0103ng sinh s\u1ea3n \u1edf \u0111\u1ed9ng v\u1eadt \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi Madopar.<\/p>\n C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 kh\u1ea3 n\u0103ng g\u00e2y qu\u00e1i thai cho th\u1ea5y kh\u00f4ng c\u00f3 h\u1eadu qu\u1ea3 g\u00e2y qu\u00e1i thai ho\u1eb7c h\u1eadu qu\u1ea3 tr\u00ean s\u1ef1 ph\u00e1t tri\u1ebbn c\u1ee7a x\u01b0\u01a1ng \u1edf chu\u1ed9t (400 mg\/kg, chu\u1ed9t 600mg\/kg) ho\u1eb7c th\u1ecf (120mg\/kg; 150 mg\/kg) li\u1ec1u l\u01b0\u1ee3ng g\u00e2y \u0111\u1ed9c cho b\u00e0o thai, t\u1ec9 l\u1ec7 ch\u1ebft trong t\u1eed cung gia t\u0103ng (th\u1ecf) v\u00e0 \/ho\u1eb7c tr\u1ecdng l\u01b0\u1ee3ng thai gi\u1ea3m (chu\u1ed9t).<\/p>\n C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 \u0111\u1ed9c t\u00ednh chung \u1edf chu\u1ed9t cho th\u1ea5y kh\u1ea3 n\u0103ng g\u00e2y r\u1ed1i lo\u1ea1n s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a x\u01b0\u01a1ng. Nh\u1eefng d\u1eef li\u1ec7u c\u00f3 gi\u00e1 tr\u1ecb tr\u00ean \u0111\u1ed9ng v\u00e2t nhi\u1ec1u h\u01a1n hi\u1ec7n ch\u01b0a c\u00f3.<\/p>\n H\u1ea1n d\u00f9ng: 4 n\u0103m k\u1ec3 t\u1eeb ng\u00e0y s\u1ea3n xu\u1ea5t. H\u1ed9p 1 l\u1ecd ch\u1ee9a 30 (vi\u00ean) Hi\u1ec7n nay, c\u00f4ng ty d\u01b0\u1ee3c ph\u1ea9m \u0111a qu\u1ed1c gia Roche \u0111\u00e3 ng\u1eebng cung c\u1ea5p s\u1ea3n ph\u1ea9m thu\u1ed1c Madopar t\u1ea1i th\u1ecb tr\u01b0\u1eddng Vi\u1ec7t Nam.<\/p>\n1.3. \u0110\u01b0\u1eddng d\u00f9ng<\/h3>\n
1.4. Th\u00e0nh ph\u1ea7n \u0111\u1ecbnh t\u00ednh v\u00e0 \u0111\u1ecbnh l\u01b0\u1ee3ng<\/h3>\n
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1.5. Thu\u1ed1c Madopar b\u00e1n \u1edf \u0111\u00e2u?<\/h3>\n
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2. C\u00e1c \u0111\u1eb7c t\u00ednh l\u00e2m s\u00e0ng<\/h2>\n
2.1. Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb<\/h3>\n
2.2. Li\u1ec1u l\u01b0\u1ee3ng v\u00e0 c\u00e1ch d\u00f9ng thu\u1ed1c<\/h3>\n
\nS\u1ed1 l\u1ea7n d\u00f9ng thu\u1ed1c c\u1ee7a m\u1ed7i c\u00e1 nh\u00e2n (kh\u00f4ng \u00edt h\u01a1n ba) v\u00e0 s\u1ef1 ph\u00e2n chia th\u1eddi gian d\u00f9ng thu\u1ed1c trong ng\u00e0y ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh \u0111\u1ec3 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 t\u1ed1i \u01b0u. Madopar HBS ho\u1eb7c Madopar d\u1ea1ng tan c\u00f3 th\u1ec3 d\u00f9ng \u0111\u1ec3 thay th\u1ebf cho Madopar d\u1ea1ng th\u00f4ng th\u01b0\u1eddng \u0111\u1ec3 d\u1ea1t hi\u1ec7u qu\u1ea3 t\u1ed1i \u01b0u.<\/p>\n2.2.1 C\u00e1c h\u01b0\u1edbng d\u1eabn li\u1ec1u d\u00f9ng \u0111\u1eb7c bi\u1ec7t<\/h4>\n
2.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/h3>\n
\nMadopar kh\u00f4ng \u0111\u01b0\u1ee3c ph\u1ed1i h\u1ee3p v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf kh\u00f4ng ch\u1ecdn l\u1ecdc men monoamine oxid\u1ea1se (MAO) ho\u1eb7c s\u1ef1 ph\u1ed1i h\u1ee3p c\u1ee7a c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc men MAO-A v\u00e0 MAO-B (xem m\u1ee5c 2.4.5 T\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c ho\u1eb7c c\u00e1c d\u1ea1ng t\u01b0\u01a1ng t\u00e1c thu\u1ed1c) Madopar kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng cho nh\u01b0ng b\u1ec7nh nh\u1eadn b\u1ecb b\u1ec7nh n\u1ed9i ti\u1ebft, b\u1ec7nh gan ho\u1eb7c th\u1eadn m\u1ea5t b\u00f9 (tr\u1eeb b\u1ec7nh nh\u00e2n d\u1ea1ng l\u1ecdc th\u1eadn), c\u00e1c r\u1ed1i lo\u1ea1n tim m\u1ea1ch, b\u1ec7nh t\u00e2m th\u1ea7n v\u1edbi bi\u1ec3u hi\u1ec7n lo\u1ea1n th\u1ea7n ho\u1eb7c gl\u00f4-com g\u00f3c \u0111\u00f3ng.<\/p>\n
\n\u0111\u01b0\u1ee3c ho\u00e0n l\u00e2t).<\/p>\n2.4. C\u1ea3nh b\u00e1o v\u00e0 th\u1eadn tr\u1ecdng<\/h3>\n
2.4.1 T\u1ed5ng qu\u00e1t<\/h4>\n
2.4.2 Kh\u1ea3 n\u0103ng l\u1ec7 thu\u1ed9c ho\u1eb7c l\u1ea1m d\u1ee5ng thu\u1ed1c<\/h4>\n
2.4.3 Kh\u1ea3 n\u0103ng l\u00e1i xe v\u00e0 v\u1eadn h\u00e0nh m\u00e1y m\u00f3c<\/h4>\n
2.4.4 X\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng<\/h4>\n
\nB\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng n\u00ean ti\u1ebfn h\u00e0nh ki\u1ec3m tra \u0111\u01b0\u1eddng huy\u1ebft th\u01b0\u1eddng xuy\u00ean, v\u00e0 li\u1ec1u l\u01b0\u1ee3ng c\u1ee7a c\u00e1c loai thu\u1ed1c \u0111i\u1ec1u tri \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh theo h\u00e0m l\u01b0\u1ee3ng \u0111\u01b0\u1eddng trong m\u00e1u.<\/p>\n2.4.5 T\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c v\u00e0 c\u00e1c d\u1ea1ng t trong t\u00e1c<\/h4>\n
\nHi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c b\u1ecb gi\u1ea3m b\u1edfi khi thu\u1ed1c \u0111\u01b0\u1ee3c d\u00f9ng trong b\u1eefa \u0103n gi\u00e0u protein.
\nG\u00e2y m\u00ea to\u00e0n th\u00e2n v\u1edbi halothane; n\u00ean ng\u01b0ng Madopar 12-48 gi\u1edd tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh ph\u1eabu thu\u1eadt c\u1ea7n ph\u1ea3i g\u00e2y m\u00ea to\u00e0n th\u00e2n v\u1edbi halothane v\u00ec t\u00ecnh tr\u1ea1ng huy\u1ebft \u00e1p dao \u0111\u1ed9ng v\u00e0 r\u1ed1i lo\u1ea1n nh\u1ecbp tim c\u00f3 th\u1ec3 x\u1ea3y ra.
\nTrong tr\u01b0\u1eddng h\u1ee3p g\u00e2y m\u00ea to\u00e0n th\u00e2n v\u1edbi c\u00e1c thu\u1ed1c m\u00ea kh\u00e1c xem m\u1ee5c 2.4.1 T\u1ed5ng qu\u00e1t (c\u1ea3nh b\u00e1o v\u00e0 th\u1eadn tr\u1ecdng).<\/p>\n2.5 S\u1eed d\u1ee5ng \u1edf c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u1eb7c bi\u1ec7t<\/h3>\n
2.5.1 Ph\u1ee5 n\u1eef c\u00f3 thai<\/h4>\n
2.5.2 Ph\u1ee5 n\u1eef cho con b\u00fa<\/h4>\n
2.5.3 S\u1eed d\u1ee5ng \u1edf tr\u1ebb em<\/h4>\n
2.5.4 B\u1ec7nh nh\u00e2n suy th\u1eadn<\/h4>\n
2.5.5 B\u1ec7nh nh\u00e2n suy gan<\/h4>\n
2.6 T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/h3>\n
2.6.1 Sau khi d\u01b0a v\u00e0o th\u1ecb tr\u01b0\u1eddng<\/h4>\n
\nV\u00e0o nh\u1eefng giai \u0111oan sau c\u1ee7a \u0111i\u1ec1u tr\u1ecb, c\u00f3 th\u1ebb xu\u1ea5t hi\u1ec7n c\u00e1c \u0111\u1ed9ng t\u00e1c v\u1eadn \u0111\u1ed9ng t\u1ef1 ph\u00e1t (nh\u01b0 \u0111ang m\u00faa gi\u1eadt ho\u1eb7c m\u00faa v\u1edfn). Nh\u1eefng bi\u1ec3u hi\u1ec7n n\u00e0y th\u01b0\u1eddng m\u1ea5t \u0111i ho\u1eb7c dung n\u1ea1p \u0111\u01b0\u1ee3c khi gi\u1ea3m li\u1ec1u. Trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tri d\u00e0i ng\u00e0y, c\u0169ng ph\u1ea3i t\u00ednh t\u1edbi kh\u1ea3 n\u0103ng c\u00f3 s\u1ef1 dao \u0111\u1ed9ng trong \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb. S\u1ef1 da\u1ecd \u0111\u1ed9ng n\u00e0y bao g\u1ed3m giai \u0111o\u1ea1n tr\u01a1, n\u1eb7ng l\u00ean v\u00e0o cu\u1ed1i li\u1ec1u v\u00e0 hi\u1ec7n t\u01b0\u1ee3ng “b\u1eadt – t\u1eaft”. C\u00e1c hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y m\u1ea5t \u0111i ho\u1eb7c c\u00f3 th\u1ec3 dung n\u1ea1p \u0111\u01b0\u1ee3c khi \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u ho\u1eb7c chia nh\u1ecf li\u1ec1u ra d\u00f9ng nhi\u1ec1u l\u1ea7n h\u01a1n. Sau \u0111\u00f3 c\u00f3 th\u1ec3 t\u00ecm c\u00e1ch t\u0103ng li\u1ec1u tr\u1edf lai \u0111\u1ec3 gia t\u0103ng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. Madopar th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn t\u00ecnh trang bu\u1ed3n ng\u1ee7 v\u00e0 r\u1ea5t hi\u1ebfm khi li\u00ean quan \u0111\u1ebfn t\u00ecnh trang bu\u1ed3n ng\u1ee7 qu\u00e1 m\u1ee9c v\u00e0o ban ng\u00e0y ho\u1eb7c c\u00f3 nh\u1eefng giai \u0111o\u1ea1n ng\u1ee7 b\u1ea5t ch\u1ee3t.<\/p>\n2.7 Qu\u00e1 li\u1ec1u<\/h3>\n
3. \u0110\u1eb7c t\u00ednh v\u00e0 hi\u1ec7u qu\u1ea3 d\u01b0\u1ee3c l\u00fd<\/h2>\n
3.1. \u0110\u1eb7c t\u00ednh d\u01b0\u1ee3c l\u1ef1c h\u1ecdc<\/h3>\n
3.1.1 C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/strong><\/h4>\n
3.2 D\u01b0\u1ee3c d\u1ed9ng h\u1ecdc<\/h3>\n
3.2.1 H\u1ea5p thu<\/h4>\n
3.2.2 Ph\u00e2n b\u1ed1<\/h4>\n
3.2.3 Chuy\u1ec3n h\u00f3a<\/h4>\n
3.2.4 Th\u1ea3i tr\u1eeb<\/h4>\n
3.2.5 D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u1edf c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u1eb7c bi\u1ec7t<\/h4>\n
3.3 Tinh an to\u00e0n ti\u1ec1n l\u00e2m s\u00e0ng<\/h3>\n
3.3.1 T\u00ednh sinh ung th\u01b0<\/h4>\n
3.3.2 Tinh g\u00e2y \u0111\u1ed9t bi\u1ebfn<\/h4>\n
\nCh\u01b0a c\u00f3 c\u00e1c d\u1eef li\u1ec7u xa h\u01a1n.<\/p>\n3.3.3 T\u00ednh gi\u1ea3m kh\u1ea3 n\u0103ng sinh s\u1ea3n<\/h4>\n
3.3.4 T\u00ednh g\u00e2y qu\u00e1i thai<\/h4>\n
3.3.5 \u0110\u1eb7c t\u00ednh kh\u00e1c<\/h4>\n
4. C\u00e1c \u0111\u1eb7c t\u00ednh d\u01b0\u1ee3c ph\u1ea9m<\/h2>\n
4.1 B\u1ea3o qu\u1ea3n<\/h3>\n
\nMadopar 250mg: B\u1ea3o qu\u1ea3n thu\u1ed1c kh\u00f4ng qu\u00e1 30\u00b0C. V\u1eb7n ch\u1eb7t n\u1eafp l\u1ecd sau khi m\u1edf. Thu\u1ed1c nh\u1ea1y c\u1ea3m v\u1edbi \u0111\u1ed9 \u1ea9m.
\nThu\u1ed1c kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng sau khi \u0111\u00e3 h\u1ebft h\u1ea1n s\u1eed d\u1ee5ng (EXP) \u0111\u01b0\u1ee3c in tr\u00ean h\u1ed9p thu\u1ed1c.
\nMadopar d\u1ea1ng tan n\u00ean \u0111\u01b0\u1ee3c u\u1ed1ng trong v\u00f2ng n\u1eeda gi\u1edd sau khi h\u00f2a tan vi\u00ean.<\/p>\n5. \u0110\u00f3ng g\u00f3i<\/h2>\n
\nMadopar ‘62.5’, vi\u00ean nang ch\u1ee9a 50mg levodopa + 12.5 mg benseraside 30.100 c\u00f3 30
\nMadopar ‘125’, vi\u00ean nang ch\u1ee9a 100mg levodopa + 25mg benseraside 30.100
\nVi\u00ean n\u00e9n (c\u00f3 kh\u00eda) ch\u1ee9a 100mg levodopa + 25mg benseraside 30.100
\nMadopar \u2018250\u2019 vi\u00ean nang ch\u1ee9a 200mg levodopa + 50mg benseraside 30.100
\nVi\u00ean n\u00e9n (c\u00f3 kh\u00eda) ch\u1ee9a 200mg levodopa + 50mg benseraside 30.100
\nMadopar \u2018vi\u00ean tan 62.5′ vi\u00ean n\u00e9n (c\u00f3 kh\u00eda) ch\u01b0a 50mg levodopa + I2.5mg benseraside 30.100
\nMadopar \u2018vi\u00ean tan 125\u2019 vi\u00ean nen (c\u00f3 kh\u00eda) ch\u1ee9a 100mg levodopa * 25mg benseraside 30.100
\nMadopar HBS, M\u00e8n nang ch\u1ee9a 100mg levodopa + 25mg benseraside 30.100.<\/p>\nThu\u1ed1c thay th\u1ebf thu\u1ed1c Madopar<\/h2>\n