{"id":1017,"date":"2026-05-19T09:51:55","date_gmt":"2026-05-19T02:51:55","guid":{"rendered":"https:\/\/opv.vn\/?post_type=product&p=1017"},"modified":"2026-05-19T09:51:55","modified_gmt":"2026-05-19T02:51:55","slug":"tydol-codeine","status":"publish","type":"product","link":"https:\/\/opv.vn\/en\/tydol-codeine\/","title":{"rendered":"TYDOL\u00ae CODEINE"},"content":{"rendered":"<p><strong>D\u01af\u1ee2C L\u1ef0C H\u1eccC<\/strong><strong>:<\/strong><\/p>\n<p><em>Nh\u00f3m d\u01b0\u1ee3c l\u00fd<\/em><em>: <\/em>Thu\u1ed1c gi\u1ea3m \u0111au<\/p>\n<p><em>M<\/em><em>\u00e3 ATC<\/em><em>: <\/em>N02B E51<\/p>\n<p>Acetaminophen l\u00e0 thu\u1ed1c gi\u1ea3m \u0111au v\u00e0 h\u1ea1 s\u1ed1t.<\/p>\n<p>Codein phosphat l\u00e0 thu\u1ed1c gi\u1ea3m \u0111au opioid.<\/p>\n<p><em>Acetaminophen (t\u00ean kh\u00e1c: paracetamol)<\/em> l\u00e0 ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f3 ho\u1ea1t t\u00ednh c\u1ee7a phenacetin, c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au b\u1eb1ng c\u00e1ch ng\u0103n ch\u1eb7n s\u1ef1 ph\u00e1t sinh xung \u0111\u1ed9ng g\u00e2y \u0111au \u1edf ngo\u1ea1i vi. Thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng h\u1ea1 s\u1ed1t b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf trung khu \u0111i\u1ec1u nhi\u1ec7t v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i. Acetaminophen l\u00e0 thu\u1ed1c gi\u1ea3m \u0111au \u2013 h\u1ea1 s\u1ed1t c\u00f3 th\u1ec3 thay th\u1ebf aspirin, tuy v\u1eady acetaminophen kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb vi\u00eam. V\u1edbi li\u1ec1u ngang nhau, acetaminophen c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au h\u1ea1 s\u1ed1t t\u01b0\u01a1ng t\u1ef1 nh\u01b0 aspirin. Acetaminophen l\u00e0m gi\u1ea3m th\u00e2n nhi\u1ec7t \u1edf ng\u01b0\u1eddi b\u1ec7nh s\u1ed1t nh\u01b0ng hi\u1ebfm khi l\u00e0m gi\u1ea3m th\u00e2n nhi\u1ec7t \u1edf ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng. Acetaminophen, v\u1edbi li\u1ec1u \u0111i\u1ec1u tr\u1ecb, \u00edt t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn h\u1ec7 tim m\u1ea1ch v\u00e0 h\u00f4 h\u1ea5p, kh\u00f4ng l\u00e0m thay \u0111\u1ed5i c\u00e2n b\u1eb1ng acid \u2013 base, kh\u00f4ng g\u00e2y k\u00edch \u1ee9ng, vi\u00eam tr\u1ee3t ho\u1eb7c ch\u1ea3y m\u00e1u d\u1ea1 d\u00e0y nh\u01b0 khi d\u00f9ng salicylat. Acetaminophen chuy\u1ec3n h\u00f3a ch\u1ee7 y\u1ebfu qua ph\u1ea3n \u1ee9ng li\u00ean h\u1ee3p sulfat v\u00e0 glucuronid. M\u1ed9t l\u01b0\u1ee3ng nh\u1ecf chuy\u1ec3n th\u00e0nh ch\u1ea5t chuy\u1ec3n h\u00f3a \u0111\u1ed9c, <em>N<\/em>-acetyl-<em>p<\/em>-benzoquinonimin (NAPQI). NAPQI \u0111\u01b0\u1ee3c kh\u1eed \u0111\u1ed9c b\u1eb1ng glutathion v\u00e0 \u0111\u00e0o th\u1ea3i v\u00e0o n\u01b0\u1edbc ti\u1ec3u v\u00e0\/ho\u1eb7c m\u1eadt. Khi ch\u1ea5t chuy\u1ec3n h\u00f3a kh\u00f4ng \u0111\u01b0\u1ee3c li\u00ean h\u1ee3p v\u1edbi glutathion s\u1ebd g\u00e2y \u0111\u1ed9c cho c\u00e1c t\u1ebf b\u00e0o gan v\u00e0 g\u00e2y ho\u1ea1i t\u1eed t\u1ebf b\u00e0o. Acetaminophen th\u01b0\u1eddng an to\u00e0n khi d\u00f9ng v\u1edbi li\u1ec1u \u0111i\u1ec1u tr\u1ecb, v\u00ec l\u01b0\u1ee3ng NAPQI \u0111\u01b0\u1ee3c t\u1ea1o th\u00e0nh t\u01b0\u01a1ng \u0111\u1ed1i \u00edt v\u00e0 glutathion t\u1ea1o th\u00e0nh trong t\u1ebf b\u00e0o gan \u0111\u1ee7 li\u00ean h\u1ee3p v\u1edbi NAPQI. Tuy nhi\u00ean, khi d\u00f9ng qu\u00e1 li\u1ec1u ho\u1eb7c \u0111\u00f4i khi v\u1edbi li\u1ec1u th\u01b0\u1eddng d\u00f9ng \u1edf m\u1ed9t s\u1ed1 ng\u01b0\u1eddi nh\u1ea1y c\u1ea3m (nh\u01b0 suy dinh d\u01b0\u1ee1ng, ho\u1eb7c t\u01b0\u01a1ng t\u00e1c thu\u1ed1c, nghi\u1ec7n r\u01b0\u1ee3u, c\u01a1 \u0111\u1ecba di truy\u1ec1n), n\u1ed3ng \u0111\u1ed9 NAPQI c\u00f3 th\u1ec3 t\u00edch l\u0169y g\u00e2y \u0111\u1ed9c cho gan.<\/p>\n<p><em>Codein<\/em> l\u00e0 m\u1ed9t thu\u1ed1c gi\u1ea3m \u0111au trung \u01b0\u01a1ng c\u00f3 t\u00e1c d\u1ee5ng y\u1ebfu. Codein c\u00f3 t\u00e1c d\u1ee5ng th\u00f4ng qua c\u00e1c th\u1ee5 th\u1ec3 \u00b5 opioid, m\u1eb7c d\u00f9 v\u1eady codein c\u00f3 \u00e1i l\u1ef1c th\u1ea5p \u0111\u1ed1i v\u1edbi c\u00e1c th\u1ee5 th\u1ec3 n\u00e0y v\u00e0 t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au c\u1ee7a thu\u1ed1c c\u00f3 \u0111\u01b0\u1ee3c l\u00e0 do codein \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a th\u00e0nh morphin. Codein, \u0111\u1eb7c bi\u1ec7t khi ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au kh\u00e1c nh\u01b0 acetaminophen, \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 trong gi\u1ea3m \u0111au do c\u1ea3m th\u1ee5 th\u1ea7n kinh c\u1ea5p t\u00ednh.<\/p>\n<p><strong> D\u01af\u1ee2C \u0110\u1ed8NG H\u1eccC<\/strong><strong>:<\/strong><\/p>\n<p><em>Acetaminophen<\/em> \u0111\u01b0\u1ee3c h\u1ea5p thu nhanh t\u1eeb \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u1edbi n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh trong huy\u1ebft t\u01b0\u01a1ng \u0111\u1ea1t \u0111\u01b0\u1ee3c kho\u1ea3ng 30-60 ph\u00fat sau khi u\u1ed1ng. Acetaminophen \u0111\u01b0\u1ee3c ph\u00e2n b\u1ed1 trong h\u1ea7u h\u1ebft trong c\u00e1c m\u00f4 c\u1ee7a c\u01a1 th\u1ec3. Acetaminophen qua nhau thai v\u00e0 hi\u1ec7n di\u1ec7n trong s\u1eefa m\u1eb9. G\u1eafn k\u1ebft v\u1edbi protein huy\u1ebft t\u01b0\u01a1ng kh\u00f4ng \u0111\u00e1ng k\u1ec3 v\u1edbi n\u1ed3ng \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng nh\u01b0ng g\u1eafn k\u1ebft s\u1ebd t\u0103ng khi n\u1ed3ng \u0111\u1ed9 t\u0103ng. Th\u1eddi gian b\u00e1n h\u1ee7y c\u1ee7a acetaminophen thay \u0111\u1ed5i t\u1eeb kho\u1ea3ng 1 \u0111\u1ebfn 3 gi\u1edd. Acetaminophen \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a ch\u1ee7 y\u1ebfu \u1edf gan v\u00e0 b\u00e0i ti\u1ebft trong n\u01b0\u1edbc ti\u1ec3u ch\u1ee7 y\u1ebfu d\u01b0\u1edbi d\u1ea1ng li\u00ean h\u1ee3p glucuronid (60-80%) v\u00e0 li\u00ean h\u1ee3p sulphat (20-30%). D\u01b0\u1edbi 5% \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft d\u01b0\u1edbi d\u1ea1ng acetaminophen kh\u00f4ng \u0111\u1ed5i. M\u1ed9t ph\u1ea7n nh\u1ecf (d\u01b0\u1edbi 4%) \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a th\u00f4ng qua h\u1ec7 th\u1ed1ng cytochrom P450.<\/p>\n<p><em>Codein<\/em> v\u00e0 mu\u1ed1i c\u1ee7a n\u00f3 \u0111\u01b0\u1ee3c h\u1ea5p thu t\u1ed1t qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. Sau khi u\u1ed1ng, n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh codein phosphat trong m\u00e1u \u0111\u1ea1t \u0111\u01b0\u1ee3c sau 1 gi\u1edd. Codein b\u1ecb chuy\u1ec3n ho\u00e1 \u1edf gan b\u1edfi kh\u1eed methyl t\u1ea1o th\u00e0nh morphin, norcodein v\u00e0 nh\u1eefng nh\u1eefng ch\u1ea5t chuy\u1ec3n h\u00f3a kh\u00e1c nh\u01b0 normorphin v\u00e0 hydrocodon. S\u1ef1 chuy\u1ec3n h\u00f3a th\u00e0nh morphin gi\u00e1n ti\u1ebfp ch\u1ecbu t\u00e1c d\u1ee5ng c\u1ee7a cytochrom P<sub>450<\/sub> isoenzym CYP2D6 v\u00e0 t\u00e1c d\u1ee5ng n\u00e0y r\u1ea5t kh\u00e1c nhau do \u1ea3nh h\u01b0\u1edfng c\u1ee7a c\u1ea5u tr\u00fac gen.<\/p>\n<p>Codein v\u00e0 s\u1ea3n ph\u1ea9m chuy\u1ec3n h\u00f3a c\u1ee7a n\u00f3 \u0111\u01b0\u1ee3c th\u1ea3i tr\u1eeb ch\u1ee7 y\u1ebfu qua th\u1eadn v\u00e0 n\u01b0\u1edbc ti\u1ec3u d\u01b0\u1edbi d\u1ea1ng li\u00ean h\u1ee3p v\u1edbi acid glucuronic. Th\u1eddi gian b\u00e1n th\u1ea3i l\u00e0 3 \u2013 4 gi\u1edd sau khi u\u1ed1ng ho\u1eb7c ti\u00eam b\u1eafp. Codein qua \u0111\u01b0\u1ee3c nhau thai v\u00e0 ph\u00e2n b\u1ed1 v\u00e0o s\u1eefa m\u1eb9.<\/p>\n<p><strong>CH\u1ec8 \u0110\u1ecaNH<\/strong><strong>:<\/strong><\/p>\n<p>Tydol Codeine \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n tr\u00ean 12 tu\u1ed5i \u0111\u1ec3 gi\u1ea3m \u0111au c\u1ea5p t\u00ednh \u1edf m\u1ee9c \u0111\u1ed9 trung b\u00ecnh khi c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au kh\u00e1c nh\u01b0 acetaminophen hay ibuprofen (\u0111\u01a1n \u0111\u1ed9c) kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng, v\u00ed d\u1ee5: \u0111au \u0111\u1ea7u, \u0111au n\u1eeda \u0111\u1ea7u, \u0111au b\u1ee5ng kinh, \u0111au r\u0103ng, \u0111au sau ph\u1eabu thu\u1eadt, \u0111au do th\u1ea7n kinh, \u0111au do ch\u1ea5n th\u01b0\u01a1ng, \u0111au trong th\u1ea5p kh\u1edbp.<\/p>\n<p><strong> C\u00c1CH D\u00d9NG<\/strong><strong>, <\/strong><strong>LI\u1ec0U D\u00d9NG<\/strong><strong>:<\/strong><\/p>\n<p><em>C\u00e1ch d\u00f9ng: <\/em>D\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng, u\u1ed1ng v\u1edbi n\u01b0\u1edbc.<\/p>\n<p><em>Li\u1ec1u d\u00f9ng:<\/em><\/p>\n<p>Kho\u1ea3ng th\u1eddi gian \u0111i\u1ec1u tr\u1ecb gi\u1ea3m \u0111au n\u00ean gi\u1edbi h\u1ea1n d\u01b0\u1edbi 3 ng\u00e0y v\u00e0 trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111au, b\u1ec7nh nh\u00e2n\/ng\u01b0\u1eddi ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n n\u00ean \u0111\u1ebfn g\u1eb7p b\u00e1c s\u1ef9 \u0111\u1ec3 \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n.<\/p>\n<p><strong>Ng\u01b0\u1eddi l\u1edbn:<\/strong><\/p>\n<p>1 ho\u1eb7c 2 vi\u00ean m\u1ed7i 4-6 gi\u1edd v\u1edbi li\u1ec1u t\u1ed1i \u0111a l\u00e0 8 vi\u00ean trong th\u1eddi gian 24 gi\u1edd.<\/p>\n<p><strong>Tr\u1ebb em t\u1eeb 12-18 tu\u1ed5i:<\/strong><\/p>\n<p>1 ho\u1eb7c 2 vi\u00ean m\u1ed7i 6 gi\u1edd v\u1edbi li\u1ec1u t\u1ed1i \u0111a l\u00e0 8 vi\u00ean trong th\u1eddi gian 24 gi\u1edd.<\/p>\n<p>Li\u1ec1u d\u00f9ng c\u1ee7a codein t\u00f9y thu\u1ed9c v\u00e0o kh\u1ed1i l\u01b0\u1ee3ng c\u01a1 th\u1ec3 (0,5-1 mg\/kg).<\/p>\n<p><strong>Tr\u1ebb em d\u01b0\u1edbi 12 tu\u1ed5i:<\/strong><\/p>\n<p>Tydol Codeine kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb gi\u1ea3m \u0111au do nguy c\u01a1 ng\u1ed9 \u0111\u1ed9c opioid b\u1edfi c\u00e1c thay \u0111\u1ed5i kh\u00f4ng th\u1ec3 d\u1ef1 \u0111o\u00e1n tr\u01b0\u1edbc trong qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a codein th\u00e0nh morphin (xem ph\u1ea7n <em>Th\u1eadn tr\u1ecdng v\u00e0 c\u1ea3nh b\u00e1o \u0111\u1eb7c bi\u1ec7t khi s\u1eed d\u1ee5ng thu\u1ed1c<\/em>).<\/p>\n<p><strong>CH\u1ed0NG CH\u1ec8 \u0110\u1ecaNH<\/strong><strong>: <\/strong><\/p>\n<ul>\n<li>M\u1eabn c\u1ea3m v\u1edbi b\u1ea5t k\u1ef3 th\u00e0nh ph\u1ea7n n\u00e0o c\u1ee7a thu\u1ed1c.<\/li>\n<li>Suy h\u00f4 h\u1ea5p, b\u1ec7nh gan, thi\u1ebfu G6PD.<\/li>\n<li>Ph\u1ee5 n\u1eef c\u00f3 thai, ph\u1ee5 n\u1eef cho con b\u00fa (xem ph\u1ea7n S\u1eed d\u1ee5ng thu\u1ed1c cho ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 ph\u1ee5 n\u1eef cho con b\u00fa).<\/li>\n<li>Nh\u1eefng b\u1ec7nh nh\u00e2n mang gen chuy\u1ec3n h\u00f3a thu\u1ed1c qua CYP2D6 si\u00eau nhanh.<\/li>\n<li>Kh\u00f4ng d\u00f9ng thu\u1ed1c n\u00e0y cho tr\u1ebb em d\u01b0\u1edbi 12 tu\u1ed5i.<\/li>\n<li>Tr\u1ebb em t\u1eeb 0 \u0111\u1ebfn 18 tu\u1ed5i v\u1eeba th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt c\u1eaft ami\u0111an v\u00e0\/ho\u1eb7c n\u1ea1o V.A \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng ng\u01b0ng th\u1edf khi ng\u1ee7 li\u00ean quan \u0111\u1ebfn t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf do c\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 nguy c\u01a1 cao x\u1ea3y ra c\u00e1c ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i nghi\u00eam tr\u1ecdng v\u00e0 \u0111e d\u1ecda t\u00ednh m\u1ea1ng (xem ph\u1ea7n <em>Th\u1eadn tr\u1ecdng v\u00e0 c\u1ea3nh b\u00e1o \u0111\u1eb7c bi\u1ec7t khi s\u1eed d\u1ee5ng thu\u1ed1c<\/em>).<\/li>\n<\/ul>\n<p><strong>L\u01afU \u00dd <\/strong><strong>V\u00c0<\/strong><strong> TH\u1eacN TR\u1eccNG:<\/strong><\/p>\n<ul>\n<li>Kh\u00f4ng n\u00ean d\u00f9ng chung v\u1edbi thu\u1ed1c kh\u00e1c ch\u1ee9a acetaminophen.<\/li>\n<li>S\u1eed d\u1ee5ng k\u00e9o d\u00e0i v\u00e0 li\u1ec1u cao acetaminophen c\u00f3 th\u1ec3 g\u00e2y th\u01b0\u01a1ng t\u1ed5n t\u1ebf b\u00e0o gan.<\/li>\n<li>Th\u1eadn tr\u1ecdng cho ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p nh\u01b0 hen ph\u1ebf qu\u1ea3n, ng\u01b0\u1eddi c\u00f3 ti\u1ec1n s\u1eed nghi\u1ec7n thu\u1ed1c.<\/li>\n<\/ul>\n<p><strong>Th\u1eadn tr\u1ecdng v\u00e0 c\u1ea3nh b\u00e1o \u0111\u1eb7c bi\u1ec7t khi s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ee9a ho\u1ea1t ch\u1ea5t <\/strong><strong>a<\/strong><strong>cetaminophen:<\/strong><\/p>\n<p>B\u00e1c s\u1ef9 c\u1ea7n c\u1ea3nh b\u00e1o b\u1ec7nh nh\u00e2n v\u1ec1 c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a ph\u1ea3n \u1ee9ng tr\u00ean da nghi\u00eam tr\u1ecdng nh\u01b0 h\u1ed9i ch\u1ee9ng Steven-Johnson (SJS), h\u1ed9i ch\u1ee9ng ho\u1ea1i t\u1eed da nhi\u1ec5m \u0111\u1ed9c (TEN), hay h\u1ed9i ch\u1ee9ng Lyell, h\u1ed9i ch\u1ee9ng ngo\u1ea1i ban m\u1ee5n m\u1ee7 to\u00e0n th\u00e2n c\u1ea5p t\u00ednh (AGEP).<\/p>\n<p><strong>Th\u1eadn tr\u1ecdng v\u00e0 c\u1ea3nh b\u00e1o \u0111\u1eb7c bi\u1ec7t khi s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ee9a ho\u1ea1t ch\u1ea5t codein:<\/strong><\/p>\n<p><u>Chuy\u1ec3n h\u00f3a qua CYP2D6:<\/u><\/p>\n<ul>\n<li>Codein \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a th\u00e0nh morphin (ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f3 ho\u1ea1t t\u00ednh) qua enzym gan CYP2D6 t\u1ea1i gan. N\u1ebfu thi\u1ebfu h\u1ee5t m\u1ed9t ph\u1ea7n ho\u1eb7c to\u00e0n b\u1ed9 enzym n\u00e0y, b\u1ec7nh nh\u00e2n s\u1ebd kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p. \u01af\u1edbc t\u00ednh c\u00f3 \u0111\u1ebfn 7% d\u00e2n s\u1ed1 da tr\u1eafng c\u00f3 th\u1ec3 thi\u1ebfu h\u1ee5t enzym n\u00e0y. Tuy nhi\u00ean, n\u1ebfu b\u1ec7nh nh\u00e2n mang gen chuy\u1ec3n h\u00f3a m\u1ea1nh ho\u1eb7c si\u00eau nhanh, s\u1ebd t\u0103ng nguy c\u01a1 x\u1ea3y ra c\u00e1c ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i do ng\u1ed9 \u0111\u1ed9c opioid ngay c\u1ea3 \u1edf li\u1ec1u k\u00ea \u0111\u01a1n th\u01b0\u1eddng d\u00f9ng. Nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 kh\u1ea3 n\u0103ng chuy\u1ec3n h\u00f3a codein th\u00e0nh morphin nhanh h\u01a1n, d\u1eabn \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 morphin trong huy\u1ebft thanh cao h\u01a1n so v\u1edbi d\u1ef1 ki\u1ebfn.<\/li>\n<li>C\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p c\u1ee7a ng\u1ed9 \u0111\u1ed9c opioid bao g\u1ed3m r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c, bu\u1ed3n ng\u1ee7, th\u1edf n\u00f4ng, co \u0111\u1ed3ng t\u1eed, bu\u1ed3n n\u00f4n, n\u00f4n, t\u00e1o b\u00f3n v\u00e0 ch\u00e1n \u0103n. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p nghi\u00eam tr\u1ecdng, c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a suy gi\u1ea3m tu\u1ea7n ho\u00e0n v\u00e0 h\u00f4 h\u1ea5p, c\u00f3 th\u1ec3 \u0111e d\u1ecda t\u00ednh m\u1ea1ng v\u00e0 r\u1ea5t hi\u1ebfm khi g\u00e2y t\u1eed vong.<\/li>\n<li>T\u1ec9 l\u1ec7 \u01b0\u1edbc t\u00ednh ng\u01b0\u1eddi mang gen chuy\u1ec3n h\u00f3a thu\u1ed1c qua CYP2D6 si\u00eau nhanh trong c\u00e1c ch\u1ee7ng t\u1ed9c kh\u00e1c nhau \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong b\u1ea3ng d\u01b0\u1edbi \u0111\u00e2y:<\/li>\n<\/ul>\n<table>\n<tbody>\n<tr>\n<td width=\"308\"><strong>Ch\u1ee7ng t\u1ed9c<\/strong><\/td>\n<td width=\"307\"><strong>T\u1ef7 l\u1ec7 %<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"308\">Ng\u01b0\u1eddi Ch\u00e2u Phi\/Ethiopia<\/td>\n<td width=\"307\">29%<\/td>\n<\/tr>\n<tr>\n<td width=\"308\">Ng\u01b0\u1eddi M\u1ef9 g\u1ed1c Phi<\/td>\n<td width=\"307\">3,4% \u0111\u1ebfn 6,5%<\/td>\n<\/tr>\n<tr>\n<td width=\"308\">Ng\u01b0\u1eddi Ch\u00e2u \u00c1<\/td>\n<td width=\"307\">1,2% \u0111\u1ebfn 2%<\/td>\n<\/tr>\n<tr>\n<td width=\"308\">Ng\u01b0\u1eddi da tr\u1eafng<\/td>\n<td width=\"307\">3,6% \u0111\u1ebfn 6,5%<\/td>\n<\/tr>\n<tr>\n<td width=\"308\">Ng\u01b0\u1eddi Hy L\u1ea1p<\/td>\n<td width=\"307\">6,0%<\/td>\n<\/tr>\n<tr>\n<td width=\"308\">Ng\u01b0\u1eddi Hungary<\/td>\n<td width=\"307\">1,9%<\/td>\n<\/tr>\n<tr>\n<td width=\"308\">Ng\u01b0\u1eddi B\u1eafc \u00c2u<\/td>\n<td width=\"307\">1% \u0111\u1ebfn 2%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><u>\u00a0<\/u><\/p>\n<p><u>B\u1ec7nh nh\u00e2n suy gi\u1ea3m ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p:<\/u><\/p>\n<p>Codein kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng \u1edf nh\u1eefng tr\u1ebb em c\u00f3 suy gi\u1ea3m ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p, bao g\u1ed3m r\u1ed1i lo\u1ea1n th\u1ea7n kinh c\u01a1, b\u1ec7nh l\u00fd n\u1eb7ng v\u1ec1 tim ho\u1eb7c h\u00f4 h\u1ea5p, nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean v\u00e0 ph\u1ed5i, \u0111a ch\u1ea5n th\u01b0\u01a1ng hay v\u1eeba tr\u1ea3i qua ph\u1eabu thu\u1eadt l\u1edbn. C\u00e1c y\u1ebfu t\u1ed1 n\u00e0y c\u00f3 th\u1ec3 l\u00e0m tr\u1ea7m tr\u1ecdng h\u01a1n c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a ng\u1ed9 \u0111\u1ed9c morphin.<\/p>\n<p><u>S\u1eed d\u1ee5ng sau ph\u1eabu thu\u1eadt cho tr\u1ebb em:<\/u><\/p>\n<p>\u0110\u00e3 c\u00f3 b\u00e1o c\u00e1o trong c\u00e1c y v\u0103n \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 r\u1eb1ng vi\u1ec7c s\u1eed d\u1ee5ng codein \u0111\u01b0\u1ee3c d\u00f9ng sau ph\u1eabu thu\u1eadt cho tr\u1ebb em v\u1eeba th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt c\u1eaft ami\u0111an v\u00e0\/ho\u1eb7c n\u1ea1o V.A \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng ng\u01b0ng th\u1edf khi ng\u1ee7 li\u00ean quan \u0111\u1ebfn t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i hi\u1ebfm g\u1eb7p nh\u01b0ng \u0111e d\u1ecda t\u00ednh m\u1ea1ng, th\u1eadm ch\u00ed t\u1eed vong. T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n nhi n\u00e0y \u0111\u1ec1u s\u1eed d\u1ee5ng codein trong m\u1ee9c li\u1ec1u quy \u0111\u1ecbnh, tuy nhi\u00ean, \u0111\u00e3 c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y nh\u1eefng tr\u1ebb n\u00e0y mang gen chuy\u1ec3n h\u00f3a codein sang morphin m\u1ea1nh ho\u1eb7c si\u00eau nhanh.<\/p>\n<ul>\n<li>Do nguy c\u01a1 suy h\u00f4 h\u1ea5p, ch\u1ec9 s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1ee9a codein \u0111\u1ec3 gi\u1ea3m \u0111au c\u1ea5p t\u00ednh \u1edf m\u1ee9c \u0111\u1ed9 trung b\u00ecnh cho tr\u1ebb tr\u00ean 12 tu\u1ed5i khi c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au kh\u00e1c nh\u01b0 acetaminophen v\u00e0 ibuprofen kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3.<\/li>\n<li>Codein ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf li\u1ec1u th\u1ea5p nh\u1ea5t m\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 v\u00e0 trong th\u1eddi gian ng\u1eafn nh\u1ea5t.<\/li>\n<li>Kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng codein cho tr\u1ebb em c\u00f3 c\u00e1c v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn h\u00f4 h\u1ea5p (V\u00ed d\u1ee5: kh\u00f3 th\u1edf ho\u1eb7c th\u1edf kh\u00f2 kh\u00e8 khi ng\u1ee7\u2026).<\/li>\n<\/ul>\n<p><em>Th\u1eddi k\u1ef3 mang thai:<\/em><\/p>\n<p>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh cho ph\u1ee5 n\u1eef c\u00f3 thai.<\/p>\n<p><em>Th\u1eddi k\u1ef3 cho con b\u00fa:<\/em><\/p>\n<p>Tydol Codeine kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng cho ph\u1ee5 n\u1eef \u0111ang cho con b\u00fa (xem ph\u1ea7n <em>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/em>).<\/p>\n<p>\u1ede li\u1ec1u \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng, codein v\u00e0 ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f3 ho\u1ea1t t\u00ednh c\u00f3 th\u1ec3 c\u00f3 m\u1eb7t trong s\u1eefa m\u1eb9 \u1edf li\u1ec1u r\u1ea5t th\u1ea5p v\u00e0 d\u01b0\u1eddng nh\u01b0 kh\u00f4ng g\u00e2y \u1ea3nh h\u01b0\u1edfng b\u1ea5t l\u1ee3i \u0111\u1ebfn tr\u1ebb b\u00fa m\u1eb9. Tuy nhi\u00ean, n\u1ebfu b\u1ec7nh nh\u00e2n l\u00e0 ng\u01b0\u1eddi mang gen chuy\u1ec3n h\u00f3a thu\u1ed1c qua CYP2D6 si\u00eau nhanh, morphin (ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f3 ho\u1ea1t t\u00ednh c\u1ee7a codein) c\u00f3 th\u1ec3 c\u00f3 trong s\u1eefa m\u1eb9 v\u1edbi n\u1ed3ng \u0111\u1ed9 cao h\u01a1n v\u00e0 trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p r\u1ea5t hi\u1ebfm g\u1eb7p, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u00e1c tri\u1ec7u ch\u1ee9ng ng\u1ed9 \u0111\u1ed9c opioid \u1edf tr\u1ebb s\u01a1 sinh, c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong.<\/p>\n<p><em>\u1ea2nh h\u01b0\u1edfng c\u1ee7a thu\u1ed1c \u0111\u1ed1i v\u1edbi c\u00f4ng vi\u1ec7c:<\/em><\/p>\n<p>Th\u1eadn tr\u1ecdng cho ng\u01b0\u1eddi l\u00e1i t\u00e0u xe, v\u1eadn h\u00e0nh m\u00e1y m\u00f3c, ng\u01b0\u1eddi l\u00e0m vi\u1ec7c tr\u00ean cao v\u00e0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00e1c v\u00ec thu\u1ed1c n\u00e0y c\u00f3 th\u1ec3 g\u00e2y bu\u1ed3n ng\u1ee7.<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>T\u01af\u01a0NG T\u00c1C THU\u1ed0C<\/strong><strong>:<\/strong><\/p>\n<p><em>Salicylat v\u00e0 NSAID:<\/em> D\u00f9ng \u0111\u1ed3ng th\u1eddi k\u00e9o d\u00e0i acetaminophen v\u00e0 salicylat hay c\u00e1c thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng steroid (NSAID) c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 t\u00e1c d\u1ee5ng ph\u1ee5 l\u00ean th\u1eadn.<\/p>\n<p><em>Coumarin:<\/em> Li\u1ec1u cao acetaminophen l\u1eb7p \u0111i l\u1eb7p l\u1ea1i l\u00e0m t\u0103ng nguy c\u01a1 ch\u1ea3y m\u00e1u \u1edf b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng warfarin v\u00e0 c\u00e1c d\u1eabn xu\u1ea5t coumarin kh\u00e1c. Theo d\u00f5i s\u1ef1 \u0111\u00f4ng m\u00e1u v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng ch\u1ea3y m\u00e1u l\u00e0 c\u1ea7n thi\u1ebft.<\/p>\n<p><em>Cloramphenicol:<\/em> Acetaminophen c\u00f3 th\u1ec3 l\u00e0m ch\u1eadm s\u1ef1 th\u1ea3i tr\u1eeb cloramphenicol, d\u1eabn \u0111\u1ebfn nguy c\u01a1 t\u0103ng \u0111\u1ed9c t\u00ednh.<\/p>\n<p><em>Diflunisal:<\/em> Diflunisal c\u00f3 th\u1ec3 l\u00e0m t\u0103ng 50% n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng c\u1ee7a acetaminophen.<\/p>\n<p><em>Thu\u1ed1c kh\u00e1ng cholinergic: <\/em>D\u00f9ng \u0111\u1ed3ng th\u1eddi codein v\u00e0 c\u00e1c t\u00e1c nh\u00e2n kh\u00e1ng cholinergic c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 t\u00e1o b\u00f3n n\u1eb7ng v\u00e0\/ho\u1eb7c b\u00ed ti\u1ec3u. C\u00e1c thu\u1ed1c l\u00e0m gi\u1ea3m qu\u00e1 tr\u00ecnh l\u00e0m r\u1ed7ng d\u1ea1 d\u00e0y, c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m s\u1ef1 h\u1ea5p thu c\u1ee7a acetaminophen.<\/p>\n<p><em>Colestyramin:<\/em> Colestyramin l\u00e0m gi\u1ea3m s\u1ef1 h\u1ea5p thu c\u1ee7a acetaminophen n\u1ebfu u\u1ed1ng acetaminophen trong v\u00f2ng m\u1ed9t gi\u1edd.<\/p>\n<p><em>Propanthelin:<\/em> Vi\u1ec7c gi\u1ea3m qu\u00e1 tr\u00ecnh l\u00e0m r\u1ed7ng d\u1ea1 d\u00e0y c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m s\u1ef1 h\u1ea5p thu c\u1ee7a acetaminophen.<\/p>\n<p><em>Rifampicin:<\/em> D\u00f9ng \u0111\u1ed3ng th\u1eddi c\u00f3 th\u1ec3 l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng nhi\u1ec5m \u0111\u1ed9c acetaminophen.<\/p>\n<p><em>R\u01b0\u1ee3u:<\/em> Codein c\u00f3 th\u1ec3 l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng c\u1ee7a r\u01b0\u1ee3u v\u00e0 kh\u1ea3 n\u0103ng g\u00e2y \u0111\u1ed9c c\u1ee7a acetaminophen c\u00f3 th\u1ec3 t\u0103ng l\u00ean do d\u00f9ng \u0111\u1ed3ng th\u1eddi.<\/p>\n<p><em>Metoclopramid:<\/em> Codein c\u00f3 th\u1ec3 \u0111\u1ed1i kh\u00e1ng t\u00e1c d\u1ee5ng c\u1ee7a metoclopramid tr\u00ean nhu \u0111\u1ed9ng ru\u1ed9t. H\u1ea5p thu acetaminophen \u0111\u01b0\u1ee3c t\u0103ng l\u00ean b\u1edfi c\u00e1c lo\u1ea1i thu\u1ed1c l\u00e0m t\u0103ng qu\u00e1 tr\u00ecnh l\u00e0m r\u1ed7ng d\u1ea1 d\u00e0y.<\/p>\n<p><em>Thu\u1ed1c gi\u1ea3m \u0111au opioid:<\/em> D\u00f9ng \u0111\u1ed3ng th\u1eddi codein v\u00e0 ch\u1ea5t ch\u1ee7 v\u1eadn opioid kh\u00e1c th\u01b0\u1eddng kh\u00f4ng th\u00edch h\u1ee3p do hi\u1ec7p l\u1ef1c \u1ee9c ch\u1ebf h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, \u1ee9c ch\u1ebf h\u00f4 h\u1ea5p v\u00e0 h\u1ea1 huy\u1ebft \u00e1p c\u00f3 th\u1ec3 x\u1ea3y ra. Thu\u1ed1c gi\u1ea3m \u0111au g\u00e2y ng\u1ee7 c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m qu\u00e1 tr\u00ecnh l\u00e0m r\u1ed7ng d\u1ea1 d\u00e0y v\u00e0 do \u0111\u00f3 l\u00e0m gi\u1ea3m s\u1ef1 h\u1ea5p thu acetaminophen.<\/p>\n<p><em>Thu\u1ed1c an th\u1ea7n<\/em><em>, thu\u1ed1c <\/em><em>gi\u1ea3m \u0111au<\/em><em>, thu\u1ed1c ng\u1ee7, thu\u1ed1c m\u00ea to\u00e0n th\u00e2n v\u00e0 \u1ee9c ch\u1ebf th\u1ea7n kinh trung \u01b0\u01a1ng:<\/em> Codein c\u00f3 th\u1ec3 l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y. D\u00f9ng \u0111\u1ed3ng th\u1eddi c\u00e1c thu\u1ed1c an th\u1ea7n c\u00f3 th\u1ec3 l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf h\u00f4 h\u1ea5p c\u1ee7a codein.<\/p>\n<p><em>Barbiturat v\u00e0 thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh:<\/em> Kh\u1ea3 n\u0103ng g\u00e2y \u0111\u1ed9c c\u1ee7a acetaminophen c\u00f3 th\u1ec3 t\u0103ng l\u00ean do d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c t\u00e1c nh\u00e2n c\u1ea3m \u1ee9ng enzym nh\u01b0 r\u01b0\u1ee3u, barbiturat hay thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh (nh\u01b0 phenobarbital, phenytoin, carbamazepin, topiramat).<\/p>\n<p><em>Zidovudin:<\/em> Khi d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi zidovudin, t\u0103ng xu h\u01b0\u1edbng gi\u1ea3m b\u1ea1ch c\u1ea7u ho\u1eb7c nhi\u1ec5m \u0111\u1ed9c gan c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n. C\u1ea7n ph\u1ea3i tr\u00e1nh s\u1ef1 k\u1ebft h\u1ee3p acetaminophen\/codein v\u00e0 zidovudin \u0111\u1eb7c bi\u1ec7t th\u01b0\u1eddng xuy\u00ean ho\u1eb7c nhi\u1ec1u li\u1ec1u. N\u1ebfu d\u00f9ng \u0111\u1ed3ng th\u1eddi acetaminophen v\u00e0 zidovudin th\u00ec n\u00ean theo d\u00f5i l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u v\u00e0 ki\u1ec3m tra ch\u1ee9c n\u0103ng gan, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb suy dinh d\u01b0\u1ee1ng.<\/p>\n<p><em>Thu\u1ed1c tr\u1ecb ti\u00eau ch\u1ea3y, \u1ee9c ch\u1ebf nhu \u0111\u1ed9ng ru\u1ed9t<\/em> <em>(bao g\u1ed3m cao lanh, pectin, loperamid):<\/em> D\u00f9ng \u0111\u1ed3ng th\u1eddi c\u00e1c thu\u1ed1c n\u00e0y v\u1edbi codein c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 t\u00e1o b\u00f3n n\u1eb7ng.<\/p>\n<p><em>Thu\u1ed1c \u1ee9c ch\u1ebf monoamin oxidase:<\/em> C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf MAO kh\u00f4ng ch\u1ecdn l\u1ecdc c\u00f3 th\u1ec3 l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c thu\u1ed1c opioid, d\u1eabn \u0111\u1ebfn s\u1ef1 lo l\u1eafng, b\u1ed1i r\u1ed1i v\u00e0 suy h\u00f4 h\u1ea5p \u0111\u00e1ng k\u1ec3. C\u00e1c ph\u1ea3n \u1ee9ng n\u1eb7ng v\u00e0 \u0111\u00f4i khi g\u00e2y t\u1eed vong \u0111\u00e3 x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng \u0111\u1ed3ng th\u1eddi c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf MAO v\u00e0 pethidin.<\/p>\n<p>Kh\u00f4ng n\u00ean d\u00f9ng codein cho b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng \u1ee9c ch\u1ebf MAO kh\u00f4ng ch\u1ecdn l\u1ecdc ho\u1eb7c trong v\u00f2ng 10 ng\u00e0y sau khi ng\u01b0ng \u0111i\u1ec1u tr\u1ecb. Do kh\u00f4ng bi\u1ebft li\u1ec7u c\u00f3 m\u1ed9t s\u1ef1 t\u01b0\u01a1ng t\u00e1c gi\u1eefa thu\u1ed1c \u1ee9c ch\u1ebf MAO ch\u1ecdn l\u1ecdc (c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf thu\u1eadn ngh\u1ecbch monoamin oxidase A) v\u00e0 codein, c\u1ea7n th\u1eadn tr\u1ecdng v\u1edbi s\u1ef1 k\u1ebft h\u1ee3p thu\u1ed1c n\u00e0y.<\/p>\n<p><em>Thu\u1ed1c ch\u1ed1ng t\u0103ng huy\u1ebft \u00e1p:<\/em> T\u00e1c d\u1ee5ng h\u1ea1 huy\u1ebft \u00e1p c\u1ee7a thu\u1ed1c ch\u1ed1ng t\u0103ng huy\u1ebft \u00e1p c\u00f3 th\u1ec3 t\u0103ng khi d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi codein v\u00e0 d\u1eabn \u0111\u1ebfn h\u1ea1 huy\u1ebft \u00e1p th\u1ebf \u0111\u1ee9ng.<\/p>\n<p><em>Thu\u1ed1c ch\u1eb9n th\u1ea7n kinh c\u01a1:<\/em> Codein c\u00f3 th\u1ec3 l\u00e0m t\u0103ng t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c thu\u1ed1c ch\u1eb9n th\u1ea7n kinh c\u01a1 d\u1eabn \u0111\u1ebfn t\u0103ng \u1ee9c ch\u1ebf h\u00f4 h\u1ea5p.<\/p>\n<p><em>Flucloxacilin:<\/em> D\u00f9ng \u0111\u1ed3ng th\u1eddi flucloxacilin v\u1edbi acetaminophen c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nhi\u1ec5m toan chuy\u1ec3n h\u00f3a, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 suy gi\u1ea3m glutathion, ch\u1eb3ng h\u1ea1n nh\u01b0 nhi\u1ec5m khu\u1ea9n huy\u1ebft, suy dinh d\u01b0\u1ee1ng ho\u1eb7c nghi\u1ec7n r\u01b0\u1ee3u m\u1ea1n t\u00ednh.<\/p>\n<p><strong>T\u00c1C D\u1ee4NG KH\u00d4NG MONG MU\u1ed0N<\/strong><strong>:<\/strong><\/p>\n<p><em>\u1ede li\u1ec1u khuy\u1ebfn c\u00e1o, acetaminophen c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n sau:<\/em><\/p>\n<p>Ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng: Hi\u1ebfm g\u1eb7p nh\u01b0ng c\u00f3 th\u1ec3 bao g\u1ed3m ph\u00e1t ban da, s\u1ed1t do thu\u1ed1c, t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c.<\/p>\n<p>H\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng: Bu\u1ed3n ng\u1ee7, ch\u1ee9c n\u0103ng th\u1ea7n kinh b\u1ecb suy gi\u1ea3m.<\/p>\n<p>H\u1ec7 ti\u00eau h\u00f3a: Ho\u1ea1i t\u1eed gan m\u1ea1n t\u00ednh \u1edf b\u1ec7nh nh\u00e2n d\u00f9ng acetaminophen \u1edf li\u1ec1u \u0111i\u1ec1u tr\u1ecb h\u00e0ng ng\u00e0y trong kho\u1ea3ng m\u1ed9t n\u0103m, v\u00e0 t\u1ed5n th\u01b0\u01a1ng gan sau khi u\u1ed1ng h\u00e0ng ng\u00e0y l\u01b0\u1ee3ng qu\u00e1 l\u1edbn trong th\u1eddi gian ng\u1eafn h\u01a1n. Vi\u00eam t\u1ee5y c\u1ea5p.<\/p>\n<p>H\u1ec7 tim m\u1ea1ch: Vi\u00eam c\u01a1 tim nhi\u1ec5m \u0111\u1ed9c.<\/p>\n<p>M\u00e1u: Lo\u1ea1n t\u1ea1o m\u00e1u bao g\u1ed3m h\u1ed9i ch\u1ee9ng methaemoglobin huy\u1ebft, gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh, gi\u1ea3m to\u00e0n th\u1ec3 huy\u1ebft c\u1ea7u, gi\u1ea3m b\u1ea1ch c\u1ea7u, ban xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u, thi\u1ebfu m\u00e1u t\u00e1n huy\u1ebft v\u00e0 m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t, nh\u01b0ng nh\u1eefng t\u00e1c d\u1ee5ng n\u00e0y kh\u00f4ng nh\u1ea5t thi\u1ebft c\u00f3 li\u00ean quan \u0111\u1ebfn acetaminophen.<\/p>\n<p>H\u1ec7 ti\u1ebft ni\u1ec7u: \u0110\u1ed9c t\u00ednh tr\u00ean th\u1eadn sau li\u1ec1u \u0111i\u1ec1u tr\u1ecb c\u1ee7a acetaminophen l\u00e0 \u00edt g\u1eb7p, nh\u01b0ng ho\u1ea1i t\u1eed nh\u00fa \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o sau khi d\u00f9ng k\u00e9o d\u00e0i.<\/p>\n<p>Kh\u00e1c: H\u1ea7u h\u1ebft c\u00e1c b\u00e1o c\u00e1o v\u1ec1 ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i li\u00ean quan \u0111\u1ebfn qu\u00e1 li\u1ec1u thu\u1ed1c. Tr\u01b0\u1eddng h\u1ee3p r\u1ea5t hi\u1ebfm g\u1eb7p ph\u1ea3n \u1ee9ng da \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o.<\/p>\n<p><em>C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb opioid \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o bao g\u1ed3m:<\/em><\/p>\n<p>Ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng (c\u00f3 th\u1ec3 do gi\u1ea3i ph\u00f3ng histamin): Ph\u00e1t ban, n\u1ed5i m\u1ec1 \u0111ay, kh\u00f3 th\u1edf, t\u0103ng ti\u1ebft m\u1ed3 h\u00f4i, m\u1eb7t \u0111\u1ecf ho\u1eb7c \u0111\u1ecf b\u1eebng.<\/p>\n<p>H\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng: L\u00fa l\u1eabn, bu\u1ed3n ng\u1ee7, ch\u00f3ng m\u1eb7t, hoa m\u1eaft, thay \u0111\u1ed5i t\u00e2m tr\u1ea1ng, \u1ea3o gi\u00e1c, k\u00edch th\u00edch th\u1ea7n kinh trung \u01b0\u01a1ng (b\u1ed3n ch\u1ed3n\/ph\u1ea5n kh\u00edch), co gi\u1eadt, tr\u1ea7m c\u1ea3m, nh\u1ee9c \u0111\u1ea7u, kh\u00f3 ng\u1ee7, hay g\u1eb7p \u00e1c m\u1ed9ng, t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd, dung n\u1ea1p ho\u1eb7c ph\u1ee5 thu\u1ed9c thu\u1ed1c.<\/p>\n<p>H\u1ec7 ti\u00eau h\u00f3a: T\u00e1o b\u00f3n, k\u00edch \u1ee9ng ti\u00eau h\u00f3a, co th\u1eaft \u0111\u01b0\u1eddng m\u1eadt, bu\u1ed3n n\u00f4n, n\u00f4n, ch\u00e1n \u0103n, kh\u00f4 mi\u1ec7ng, li\u1ec7t ru\u1ed9t ho\u1eb7c ph\u00ecnh \u0111\u1ea1i tr\u00e0ng nhi\u1ec5m \u0111\u1ed9c.<\/p>\n<p>H\u1ec7 tim m\u1ea1ch: Nh\u1ecbp tim ch\u1eadm, \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, h\u1ea1 huy\u1ebft \u00e1p.<\/p>\n<p>Th\u1ecb gi\u00e1c: Nh\u00ecn m\u1edd ho\u1eb7c song th\u1ecb<\/p>\n<p>H\u1ec7 ti\u1ebft ni\u1ec7u: Co th\u1eaft ni\u1ec7u qu\u1ea3n, c\u00f3 t\u00e1c d\u1ee5ng ch\u1ed1ng b\u00e0i ni\u1ec7u.<\/p>\n<p>Kh\u00e1c: Run r\u1ea9y, m\u1ec7t m\u1ecfi b\u1ea5t th\u01b0\u1eddng ho\u1eb7c suy nh\u01b0\u1ee3c, kh\u00f3 ch\u1ecbu, co \u0111\u1ed3ng t\u1eed, h\u1ea1 th\u00e2n nhi\u1ec7t.<\/p>\n<p>Ng\u1eebng thu\u1ed1c: Ng\u1eebng thu\u1ed1c \u0111\u1ed9t ng\u1ed9t g\u00e2y ra h\u1ed9i ch\u1ee9ng cai thu\u1ed1c. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 bao g\u1ed3m run, m\u1ea5t ng\u1ee7, bu\u1ed3n n\u00f4n, n\u00f4n, ra m\u1ed3 h\u00f4i v\u00e0 nh\u1ecbp tim t\u0103ng, nh\u1ecbp th\u1edf t\u0103ng v\u00e0 huy\u1ebft \u00e1p t\u0103ng. S\u1ef1 dung n\u1ea1p thu\u1ed1c gi\u1ea3m \u0111i nhanh ch\u00f3ng sau khi ng\u1eebng do \u0111\u00f3, m\u1ed9t li\u1ec1u dung n\u1ea1p tr\u01b0\u1edbc \u0111\u00f3 c\u00f3 th\u1ec3 ch\u1ee9ng minh g\u00e2y t\u1eed vong.<\/p>\n<p>S\u1eed d\u1ee5ng k\u00e9o d\u00e0i th\u01b0\u1eddng xuy\u00ean codein g\u00e2y nghi\u1ec7n, v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng b\u1ed3n ch\u1ed3n v\u00e0 b\u1ecb k\u00edch th\u00edch c\u00f3 th\u1ec3 x\u1ea3y ra khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb sau \u0111\u00f3.<\/p>\n<p>S\u1eed d\u1ee5ng k\u00e9o d\u00e0i c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au \u0111\u1ea7u c\u00f3 th\u1ec3 l\u00e0m cho ch\u1ee9ng \u0111au \u0111\u1ea7u n\u1eb7ng h\u01a1n.<\/p>\n<p><strong>QU\u00c1 LI\u1ec0U V\u00c0 X\u1eec TR\u00cd<\/strong><strong>:<\/strong><\/p>\n<p><em>Tri\u1ec7u ch\u1ee9ng<\/em><em> qu\u00e1 li\u1ec1u acetaminophen<\/em><em>: <\/em>Bu\u1ed3n n\u00f4n, \u00f3i m\u1eeda, ch\u00e1n \u0103n, xanh xao, \u0111au b\u1ee5ng.<\/p>\n<p>D\u00f9ng qu\u00e1 li\u1ec1u acetaminophen c\u00f3 th\u1ec3 g\u00e2y suy gan. D\u00f9ng li\u1ec1u qu\u00e1 cao, tr\u00ean 10 g \u1edf ng\u01b0\u1eddi l\u1edbn (li\u1ec1u th\u1ea5p h\u01a1n \u1edf ng\u01b0\u1eddi nghi\u1ec7n r\u01b0\u1ee3u) v\u00e0 tr\u00ean 150 mg\/kg th\u1ec3 tr\u1ecdng \u1edf tr\u1ebb em, d\u00f9ng li\u1ec1u \u0111\u01a1n c\u00f3 th\u1ec3 g\u00e2y ph\u00e2n h\u1ee7y t\u1ebf b\u00e0o gan \u0111\u01b0a \u0111\u1ebfn ho\u1ea1i t\u1eed ho\u00e0n to\u00e0n v\u00e0 kh\u00f4ng h\u1ed3i ph\u1ee5c, nhi\u1ec5m toan chuy\u1ec3n h\u00f3a, b\u1ec7nh l\u00fd n\u00e3o d\u1eabn \u0111\u1ebfn h\u00f4n m\u00ea ho\u1eb7c t\u1eed vong.<\/p>\n<p><em>\u00a0<\/em><\/p>\n<p><em>X\u1eed tr\u00ed <\/em><em>qu\u00e1 li\u1ec1u acetaminophen<\/em><em>: <\/em><\/p>\n<p>Ch\u1ea9n \u0111o\u00e1n s\u1edbm r\u1ea5t quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb qu\u00e1 li\u1ec1u acetaminophen. Khi nhi\u1ec5m \u0111\u1ed9c n\u1eb7ng, \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 t\u00edch c\u1ef1c.<\/p>\n<p>C\u1ea7n r\u1eeda d\u1ea1 d\u00e0y trong m\u1ecdi tr\u01b0\u1eddng h\u1ee3p, t\u1ed1t nh\u1ea5t trong v\u00f2ng 4 gi\u1edd sau khi u\u1ed1ng.<\/p>\n<h5>D\u00f9ng thu\u1ed1c gi\u1ea3i \u0111\u1ed9c N-acetylcystein d\u1ea1ng u\u1ed1ng ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch<\/h5>\n<p><em>t<\/em><em>ri\u1ec7u ch\u1ee9ng qu\u00e1 li\u1ec1u c\u1ee7a codein phosphat<\/em>: Suy h\u00f4 h\u1ea5p, l\u01a1 m\u01a1 d\u1eabn \u0111\u1ebfn tr\u1ea1ng th\u00e1i \u0111\u1edd \u0111\u1eabn ho\u1eb7c h\u00f4n m\u00ea. M\u1ec1m c\u01a1, da l\u1ea1nh v\u00e0 \u1ea9m, \u0111\u00f4i khi m\u1ea1ch ch\u1eadm v\u00e0 h\u1ea1 huy\u1ebft \u00e1p. Trong tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng: ng\u1eebng th\u1edf, tru\u1ef5 m\u1ea1ch, ng\u1eebng tim v\u00e0 c\u00f3 th\u1ec3 t\u1eed vong.<\/p>\n<p><em>X\u1eed tr\u00ed qu\u00e1 li\u1ec1u codein phosphat<\/em>: ph\u1ea3i ph\u1ee5c h\u1ed3i h\u00f4 h\u1ea5p b\u1eb1ng c\u00e1ch cung c\u1ea5p d\u01b0\u1ee1ng kh\u00ed v\u00e0 h\u00f4 h\u1ea5p h\u1ed7 tr\u1ee3 ki\u1ec3m so\u00e1t. Ch\u1ec9 \u0111\u1ecbnh naloxon ngay b\u1eb1ng \u0111\u01b0\u1eddng ti\u00eam t\u0129nh m\u1ea1ch trong tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng.<\/p>\n<p><strong>C\u00c1C D\u1ea4U <\/strong><strong>HI\u1ec6U C\u1ea6N L\u01afU \u00dd V\u00c0 KHUY\u1ebeN C\u00c1O<\/strong><strong>:<\/strong><\/p>\n<p><strong>Kh\u00f4ng d\u00f9ng qu\u00e1 li\u1ec1u ch\u1ec9 \u0111\u1ecbnh<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>D\u01af\u1ee2C L\u1ef0C H\u1eccC: Nh\u00f3m d\u01b0\u1ee3c l\u00fd: Thu\u1ed1c gi\u1ea3m \u0111au M\u00e3 ATC: N02B E51 Acetaminophen l\u00e0 thu\u1ed1c gi\u1ea3m \u0111au v\u00e0 h\u1ea1 s\u1ed1t. Codein phosphat l\u00e0 thu\u1ed1c gi\u1ea3m \u0111au opioid. Acetaminophen (t\u00ean kh\u00e1c: paracetamol) l\u00e0 ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f3 ho\u1ea1t t\u00ednh c\u1ee7a phenacetin, c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au b\u1eb1ng c\u00e1ch ng\u0103n ch\u1eb7n s\u1ef1 ph\u00e1t sinh xung \u0111\u1ed9ng&#8230;<\/p>\n","protected":false},"featured_media":811,"comment_status":"closed","ping_status":"open","template":"","meta":[],"product_cat":[39],"product_tag":[],"class_list":["post-1017","product","type-product","status-publish","has-post-thumbnail","hentry","product_cat-tydol-analgesics"],"_links":{"self":[{"href":"https:\/\/opv.vn\/en\/wp-json\/wp\/v2\/product\/1017","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opv.vn\/en\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/opv.vn\/en\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/opv.vn\/en\/wp-json\/wp\/v2\/comments?post=1017"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/opv.vn\/en\/wp-json\/wp\/v2\/media\/811"}],"wp:attachment":[{"href":"https:\/\/opv.vn\/en\/wp-json\/wp\/v2\/media?parent=1017"}],"wp:term":[{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/opv.vn\/en\/wp-json\/wp\/v2\/product_cat?post=1017"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/opv.vn\/en\/wp-json\/wp\/v2\/product_tag?post=1017"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}