D\u01af\u1ee2C L\u1ef0C H\u1eccC<\/p>\n
Nh\u00f3m d\u01b0\u1ee3c l\u00fd: Thu\u1ed1c gi\u1ea3m \u0111au<\/p>\n
M\u00e3 ATC: N02B E51<\/p>\n
Acetaminophen l\u00e0 thu\u1ed1c gi\u1ea3m \u0111au v\u00e0 h\u1ea1 s\u1ed1t.<\/p>\n
Codein phosphat l\u00e0 thu\u1ed1c gi\u1ea3m \u0111au opioid.<\/p>\n
Acetaminophen 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.<\/p>\n
Codein 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
D\u01af\u1ee2C \u0110\u1ed8NG H\u1eccC:<\/strong><\/p>\n Acetaminophen \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 \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 Codein v\u00e0 mu\u1ed1i c\u1ee7a n\u00f3 \u0111\u01b0\u1ee3c h\u1ea5p thu t\u1ed1t qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. Codein b\u1ecb chuy\u1ec3n ho\u00e1 \u1edf gan v\u00e0 th\u1ea3i tr\u1eeb \u1edf th\u1eadn d\u01b0\u1edbi d\u1ea1ng t\u1ef1 do ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi acid glucoronid. Codein ho\u1eb7c s\u1ea3n ph\u1ea9m chuy\u1ec3n ho\u00e1 b\u00e0i ti\u1ebft qua ph\u00e2n r\u1ea5t \u00edt. Codein qua \u0111\u01b0\u1ee3c nhau thai v\u00e0 ph\u00e2n b\u1ed1 v\u00e0o s\u1eefa m\u1eb9.<\/p>\n CH\u1ec8 \u0110\u1ecaNH:<\/strong><\/p>\n Tydol Codeine Forte \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 hi\u1ec7u qu\u1ea3.<\/p>\n C\u00c1CH D\u00d9NG, LI\u1ec0U D\u00d9NG:<\/strong><\/p>\n C\u00e1ch d\u00f9ng: D\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng.<\/p>\n Li\u1ec1u d\u00f9ng:<\/p>\n Ng\u01b0\u1eddi l\u1edbn:<\/p>\n 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 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 Tr\u1ebb em t\u1eeb 12-18 tu\u1ed5i:<\/p>\n 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 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 Tr\u1ebb em d\u01b0\u1edbi 12 tu\u1ed5i:<\/p>\n Tydol Codeine Forte 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 Th\u1eadn tr\u1ecdng v\u00e0 c\u1ea3nh b\u00e1o \u0111\u1eb7c bi\u1ec7t khi s\u1eed d\u1ee5ng thu\u1ed1c). CH\u1ed0NG CH\u1ec8 \u0110\u1ecaNH:<\/strong><\/p>\n – M\u1eabn c\u1ea3m v\u1edbi b\u1ea5t k\u1ef3 th\u00e0nh ph\u1ea7n n\u00e0o c\u1ee7a thu\u1ed1c.<\/p>\n – Suy h\u00f4 h\u1ea5p c\u1ea5p.<\/p>\n – T\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p.<\/p>\n – Nghi\u1ec7n r\u01b0\u1ee3u c\u1ea5p.<\/p>\n – Suy gan n\u1eb7ng.<\/p>\n – Ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u ho\u1eb7c t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd.<\/p>\n – H\u00f4n m\u00ea.<\/p>\n – Nguy c\u01a1 li\u1ec7t ru\u1ed9t.<\/p>\n – Trong t\u00ecnh tr\u1ea1ng ti\u00eau ch\u1ea3y c\u1ea5p nh\u01b0 vi\u00eam \u0111\u1ea1i tr\u00e0ng lo\u00e9t c\u1ea5p ho\u1eb7c vi\u00eam \u0111\u1ea1i tr\u00e0ng li\u00ean quan kh\u00e1ng sinh (v\u00ed d\u1ee5, vi\u00eam \u0111\u1ea1i tr\u00e0ng gi\u1ea3 m\u1ea1c) ho\u1eb7c ti\u00eau ch\u1ea3y do ng\u1ed9 \u0111\u1ed9c.<\/p>\n – 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).<\/p>\n – Nh\u1eefng b\u1ec7nh nh\u00e2n mang gen chuy\u1ec3n h\u00f3a thu\u1ed1c qua CYP2D6 si\u00eau nhanh.<\/p>\n – Kh\u00f4ng d\u00f9ng thu\u1ed1c n\u00e0y cho tr\u1ebb em d\u01b0\u1edbi 12 tu\u1ed5i.<\/p>\n – 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 Th\u1eadn tr\u1ecdng v\u00e0 c\u1ea3nh b\u00e1o \u0111\u1eb7c bi\u1ec7t khi s\u1eed d\u1ee5ng thu\u1ed1c).<\/p>\n L\u01afU \u00dd V\u00c0 TH\u1eacN TR\u1eccNG:<\/strong><\/p>\n – Kh\u00f4ng n\u00ean d\u00f9ng chung v\u1edbi thu\u1ed1c kh\u00e1c ch\u1ee9a acetaminophen.<\/p>\n – 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.<\/p>\n – 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.<\/p>\n 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 acetaminophen:<\/p>\n B\u00e1c s\u0129 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 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:<\/p>\n Chuy\u1ec3n h\u00f3a qua CYP2D6:<\/p>\n – 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.<\/p>\n – 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.<\/p>\n – 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:<\/p>\n Ch\u1ee7ng t\u1ed9c T\u1ef7 l\u1ec7 %<\/p>\n Ng\u01b0\u1eddi Ch\u00e2u Phi\/Ethiopia 29%<\/p>\n Ng\u01b0\u1eddi M\u1ef9 g\u1ed1c Phi 3,4% \u0111\u1ebfn 6,5%<\/p>\n Ng\u01b0\u1eddi Ch\u00e2u \u00c1 1,2% \u0111\u1ebfn 2%<\/p>\n Ng\u01b0\u1eddi da tr\u1eafng 3,6% \u0111\u1ebfn 6,5%<\/p>\n Ng\u01b0\u1eddi Hy L\u1ea1p 6,0%<\/p>\n Ng\u01b0\u1eddi Hungary 1,9%<\/p>\n Ng\u01b0\u1eddi B\u1eafc \u00c2u 1% \u0111\u1ebfn 2%<\/p>\n B\u1ec7nh nh\u00e2n suy gi\u1ea3m ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p:<\/p>\n 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. \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 – 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.<\/p>\n – 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.<\/p>\n – 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).<\/p>\n Ph\u1ee5 n\u1eef c\u00f3 thai:<\/p>\n – Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh cho ph\u1ee5 n\u1eef c\u00f3 thai.<\/p>\n Ph\u1ee5 n\u1eef cho con b\u00fa:<\/p>\n – Tydol Codeine Forte kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng cho ph\u1ee5 n\u1eef \u0111ang cho con b\u00fa (xem ph\u1ea7n Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh).<\/p>\n – \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 \u1ea2nh h\u01b0\u1edfng c\u1ee7a thu\u1ed1c \u0111\u1ed1i v\u1edbi c\u00f4ng vi\u1ec7c:<\/p>\n – 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 T\u01af\u01a0NG T\u00c1C THU\u1ed0C:<\/strong><\/p>\n \u1ede li\u1ec1u cao ho\u1eb7c v\u1edbi \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng, acetaminophen c\u00f3 th\u1ec3 l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng c\u1ee7a warfarin. S\u1ef1 h\u1ea5p thu c\u1ee7a acetaminophen gi\u1ea3m b\u1edfi cholestyramin v\u00e0 t\u0103ng b\u1edfi domperidon v\u00e0 metoclopramid.<\/p>\n Thu\u1ed1c g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o: Acetaminophen c\u00f3 th\u1ec3 \u1ee9c ch\u1ebf s\u1ef1 chuy\u1ec3n h\u00f3a c\u1ee7a busulfan ti\u00eam t\u0129nh m\u1ea1ch (nh\u00e0 s\u1ea3n xu\u1ea5t c\u1ee7a busulfan ti\u00eam t\u0129nh m\u1ea1ch khuy\u00ean th\u1eadn tr\u1ecdng trong v\u00f2ng 72 gi\u1edd s\u1eed d\u1ee5ng acetaminophen).<\/p>\n Thu\u1ed1c g\u00e2y m\u00ea: D\u00f9ng \u0111\u1ed3ng th\u1eddi codein v\u00e0 c\u00e1c thu\u1ed1c g\u00e2y m\u00ea c\u00f3 th\u1ec3 g\u00e2y t\u0103ng \u1ee9c ch\u1ebf h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng v\u00e0\/ho\u1eb7c suy h\u00f4 h\u1ea5p v\u00e0\/ho\u1eb7c h\u1ea1 huy\u1ebft \u00e1p.<\/p>\n Thu\u1ed1c kh\u00e1ng histamin: D\u00f9ng \u0111\u1ed3ng th\u1eddi codein v\u00e0 thu\u1ed1c kh\u00e1ng histamin c\u00f3 t\u00ednh ch\u1ea5t an th\u1ea7n c\u00f3 th\u1ec3 g\u00e2y t\u0103ng \u1ee9c ch\u1ebf h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng v\u00e0\/ho\u1eb7c suy h\u00f4 h\u1ea5p v\u00e0\/ho\u1eb7c h\u1ea1 huy\u1ebft \u00e1p.<\/p>\n Codein ng\u0103n c\u1ea3n t\u00e1c d\u1ee5ng tr\u00ean nhu \u0111\u1ed9ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a c\u1ee7a metoclopramid v\u00e0 cisaprid. N\u00f3 l\u00e0m ch\u1eadm s\u1ef1 h\u1ea5p thu c\u1ee7a flecainid v\u00e0 mexiletin v\u00e0 t\u0103ng t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c ng\u1ee7 v\u00e0 thu\u1ed1c an th\u1ea7n. T\u00e1c d\u1ee5ng gi\u1ea3m \u0111au c\u1ee7a codein c\u00f3 kh\u1ea3 n\u0103ng b\u1ecb gi\u1ea3m \u0111\u00e1ng k\u1ec3 b\u1edfi quinidin do l\u00e0m gi\u1ea3m qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a codein.<\/p>\n Thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m: C\u00e1c t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf c\u1ee7a thu\u1ed1c gi\u1ea3m \u0111au opioid c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u0103ng c\u01b0\u1eddng b\u1edfi thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m ba v\u00f2ng. Thu\u1ed1c \u1ee9c ch\u1ebf monoamin oxidase (IMAO) d\u00f9ng v\u1edbi pethidin c\u00f3 li\u00ean quan \u0111\u1ebfn k\u00edch th\u00edch ho\u1eb7c \u1ee9c ch\u1ebf th\u1ea7n kinh trung \u01b0\u01a1ng n\u1eb7ng (bao g\u1ed3m t\u0103ng huy\u1ebft \u00e1p ho\u1eb7c h\u1ea1 huy\u1ebft \u00e1p). M\u1eb7c d\u00f9 \u0111i\u1ec1u n\u00e0y \u0111\u00e3 kh\u00f4ng \u0111\u01b0\u1ee3c ghi nh\u1eadn v\u1edbi codein, nh\u01b0ng c\u00f3 th\u1ec3 x\u1ea3y ra t\u01b0\u01a1ng t\u00e1c t\u01b0\u01a1ng t\u1ef1, do \u0111\u00f3 n\u00ean tr\u00e1nh s\u1eed d\u1ee5ng codein trong khi b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng thu\u1ed1c IMAO v\u00e0 2 tu\u1ea7n sau khi ng\u01b0ng thu\u1ed1c IMAO.<\/p>\n Thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n: T\u0103ng t\u00e1c d\u1ee5ng an th\u1ea7n v\u00e0 h\u1ea1 huy\u1ebft \u00e1p.<\/p>\n R\u01b0\u1ee3u: T\u00e1c d\u1ee5ng h\u1ea1 huy\u1ebft \u00e1p, an th\u1ea7n v\u00e0 \u1ee9c ch\u1ebf h\u00f4 h\u1ea5p c\u1ee7a r\u01b0\u1ee3u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c t\u0103ng c\u01b0\u1eddng.<\/p>\n S\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi codein v\u1edbi c\u00e1c thu\u1ed1c ch\u1ed1ng ti\u00eau ch\u1ea3y v\u00e0 thu\u1ed1c ch\u1ed1ng nhu \u0111\u1ed9ng ru\u1ed9t nh\u01b0 loperamid v\u00e0 cao lanh c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 t\u00e1o b\u00f3n n\u1eb7ng.<\/p>\n Natri oxybat: D\u00f9ng \u0111\u1ed3ng th\u1eddi codein v\u00e0 natri oxybat c\u00f3 th\u1ec3 g\u00e2y t\u0103ng \u1ee9c ch\u1ebf h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng v\u00e0\/ho\u1eb7c suy h\u00f4 h\u1ea5p v\u00e0\/ho\u1eb7c h\u1ea1 huy\u1ebft \u00e1p.<\/p>\n S\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi thu\u1ed1c kh\u00e1ng muscarinic c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn li\u1ec7t ru\u1ed9t ho\u1eb7c b\u00ed ti\u1ec3u.<\/p>\n Thu\u1ed1c l\u00e0m l\u00e0nh v\u1ebft lo\u00e9t d\u1ea1 d\u00e0y: Cimetidin c\u00f3 th\u1ec3 \u1ee9c ch\u1ebf s\u1ef1 chuy\u1ec3n h\u00f3a c\u1ee7a dihydrocodein d\u1eabn \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng t\u0103ng l\u00ean.<\/p>\n C\u00e1c x\u00e9t nghi\u1ec7m can thi\u1ec7p trong ph\u00f2ng th\u00ed nghi\u1ec7m: Opioid c\u00f3 th\u1ec3 g\u00e2y tr\u1edf ng\u1ea1i c\u00e1c nghi\u00ean c\u1ee9u l\u00e0m r\u1ed7ng d\u1ea1 d\u00e0y do ch\u00fang l\u00e0m r\u1ed7ng d\u1ea1 d\u00e0y ch\u1eadm v\u00e0 opioid c\u00f3 th\u1ec3 g\u00e2y tr\u1edf ng\u1ea1i ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh gan m\u1eadt, s\u1eed d\u1ee5ng tecneti Tc-99m disofenin do \u0111i\u1ec1u tr\u1ecb opioid c\u00f3 th\u1ec3 g\u00e2y co th\u1eaft c\u01a1 v\u00f2ng Oddi v\u00e0 t\u0103ng \u00e1p l\u1ef1c \u0111\u01b0\u1eddng m\u1eadt.<\/p>\n T\u00c1C D\u1ee4NG KH\u00d4NG MONG MU\u1ed0N:<\/strong><\/p>\n S\u1eed d\u1ee5ng k\u00e9o d\u00e0i th\u01b0\u1eddng xuy\u00ean codein g\u00e2y nghi\u1ec7n v\u00e0 dung n\u1ea1p thu\u1ed1c. C\u00e1c tri\u1ec7u ch\u1ee9ng b\u1ed3n ch\u1ed3n v\u00e0 kh\u00f3 ch\u1ecbu c\u00f3 th\u1ec3 x\u1ea3y ra khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb sau \u0111\u00f3.<\/p>\n 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 Dung n\u1ea1p thu\u1ed1c v\u00e0 m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng ph\u1ee5 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t – bu\u1ed3n ng\u1ee7, bu\u1ed3n n\u00f4n, n\u00f4n, l\u00fa l\u1eabn \u2013 th\u01b0\u1eddng ti\u1ebfn tri\u1ec3n v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng l\u00e2u d\u00e0i.<\/p>\n H\u1ec7 mi\u1ec5n d\u1ecbch: Ph\u00e1t ban d\u00e1t s\u1ea7n \u0111\u00e3 \u0111\u01b0\u1ee3c xem nh\u01b0 l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a h\u1ed9i ch\u1ee9ng qu\u00e1 m\u1eabn c\u1ea3m li\u00ean quan \u0111\u1ebfn codein phosphat d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng; s\u1ed1t, l\u00e1ch to v\u00e0 h\u1ea1ch to c\u0169ng x\u1ea3y ra.<\/p>\n N\u1ed9i ti\u1ebft: T\u0103ng \u0111\u01b0\u1eddng huy\u1ebft.<\/p>\n Chuy\u1ec3n h\u00f3a v\u00e0 dinh d\u01b0\u1ee1ng: Ch\u00e1n \u0103n.<\/p>\n T\u00e2m th\u1ea7n: Tr\u1ea7m c\u1ea3m, \u1ea3o gi\u00e1c v\u00e0 \u00e1c m\u1ed9ng, b\u1ed3n ch\u1ed3n, l\u00fa l\u1eabn, thay \u0111\u1ed5i t\u00e2m tr\u1ea1ng, ph\u1ea5n kh\u00edch, b\u1ea5t an.<\/p>\n H\u1ec7 th\u1ea7n kinh: Co gi\u1eadt (nh\u1ea5t l\u00e0 \u1edf tr\u1ebb s\u01a1 sinh v\u00e0 tr\u1ebb em), ch\u00f3ng m\u1eb7t, bu\u1ed3n ng\u1ee7, nh\u1ee9c \u0111\u1ea7u. T\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n.<\/p>\n Th\u1ecb gi\u00e1c: Co \u0111\u1ed3ng t\u1eed, m\u1edd m\u1eaft ho\u1eb7c nh\u00ecn \u0111\u00f4i, nh\u1eefng r\u1ed1i lo\u1ea1n th\u1ecb gi\u00e1c kh\u00e1c.<\/p>\n Tai v\u00e0 m\u00ea \u0111\u1ea1o: Ch\u00f3ng m\u1eb7t<\/p>\n Tim: H\u1ea1 huy\u1ebft \u00e1p th\u1ebf \u0111\u1ee9ng, \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, nh\u1ecbp tim nhanh v\u00e0 nh\u1ecbp tim ch\u1eadm.<\/p>\n M\u1ea1ch: H\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf, \u0111\u1ecf b\u1eebng m\u1eb7t. Li\u1ec1u l\u1edbn g\u00e2y ra h\u1ea1 huy\u1ebft \u00e1p.<\/p>\n H\u00f4 h\u1ea5p, l\u1ed3ng ng\u1ef1c v\u00e0 trung th\u1ea5t: Kh\u00f3 th\u1edf, li\u1ec1u l\u1edbn g\u00e2y ra suy h\u00f4 h\u1ea5p.<\/p>\n Ti\u00eau h\u00f3a: Bu\u1ed3n n\u00f4n, n\u00f4n, t\u00e1o b\u00f3n, kh\u00f4 mi\u1ec7ng, \u0111au b\u1ee5ng, vi\u00eam tu\u1ef5.<\/p>\n Gan m\u1eadt: Co th\u1eaft \u0111\u01b0\u1eddng m\u1eadt (c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn c\u00e1c ch\u1ec9 s\u1ed1 enzym gan b\u1ecb thay \u0111\u1ed5i).<\/p>\n Da v\u00e0 m\u00f4 d\u01b0\u1edbi da: Ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng nh\u01b0 n\u1ed5i m\u00e0y \u0111ay, ng\u1ee9a, ph\u00e1t ban da, \u0111\u1ed5 m\u1ed3 h\u00f4i v\u00e0 m\u1eb7t ph\u00f9 n\u1ec1.<\/p>\n C\u01a1 x\u01b0\u01a1ng v\u00e0 m\u00f4 li\u00ean k\u1ebft: C\u1eed \u0111\u1ed9ng c\u01a1 kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c. C\u1ee9ng c\u01a1 b\u1eafp c\u00f3 th\u1ec3 x\u1ea3y ra sau khi d\u00f9ng li\u1ec1u cao.<\/p>\n Th\u1eadn v\u00e0 ti\u1ebft ni\u1ec7u: Ti\u1ec3u r\u1eaft, b\u00ed ti\u1ec3u, ni\u1ec7u qu\u1ea3n co th\u1eaft, kh\u00f3 ti\u1ec3u. T\u00e1c d\u1ee5ng ch\u1ed1ng b\u00e0i ni\u1ec7u c\u0169ng c\u00f3 th\u1ec3 x\u1ea3y ra v\u1edbi codein.<\/p>\n H\u1ec7 sinh s\u1ea3n v\u00e0 tuy\u1ebfn v\u00fa: R\u1ed1i lo\u1ea1n sinh l\u00fd, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01b0\u01a1ng d\u01b0\u01a1ng, gi\u1ea3m n\u0103ng l\u1ef1c. Gi\u1ea3m libido.<\/p>\n To\u00e0n th\u00e2n: Kh\u00f3 ch\u1ecbu, m\u1ec7t m\u1ecfi, h\u1ea1 th\u00e2n nhi\u1ec7t.<\/p>\n QU\u00c1 LI\u1ec0U V\u00c0 X\u1eec TR\u00cd<\/strong><\/p>\n Tri\u1ec7u ch\u1ee9ng qu\u00e1 li\u1ec1u acetaminophen: Bu\u1ed3n n\u00f4n, \u00f3i m\u1eeda, ch\u00e1n \u0103n, xanh xao, \u0111au b\u1ee5ng.<\/p>\n 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 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 X\u1eed tr\u00ed qu\u00e1 li\u1ec1u acetaminophen: 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. 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 D\u00f9ng thu\u1ed1c gi\u1ea3i \u0111\u1ed9c N-Acetylcystein d\u1ea1ng u\u1ed1ng ho\u1eb7c ti\u00eam t\u0129nh m\u1ea1ch. X\u1eed tr\u00ed qu\u00e1 li\u1ec1u codein phosphat: N\u00e2ng \u0111\u1ee1 h\u00f4 h\u1ea5p b\u1eb1ng c\u00e1ch cung c\u1ea5p oxy v\u00e0 h\u00f4 h\u1ea5p h\u1ed7 tr\u1ee3 ki\u1ec3m so\u00e1t. Ch\u1ec9 \u0111\u1ecbnh d\u00f9ng naloxon ngay b\u1eb1ng \u0111\u01b0\u1eddng ti\u00eam t\u0129nh m\u1ea1ch.<\/p>\n C\u00c1C D\u1ea4U HI\u1ec6U C\u1ea6N L\u01afU \u00dd V\u00c0 KHUY\u1ebeN C\u00c1O<\/strong><\/p>\n Kh\u00f4ng d\u00f9ng qu\u00e1 li\u1ec1u ch\u1ec9 \u0111\u1ecbnh.<\/p>\n","protected":false},"excerpt":{"rendered":" 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 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…<\/p>\n","protected":false},"featured_media":813,"comment_status":"closed","ping_status":"open","template":"","meta":[],"product_cat":[39],"product_tag":[],"class_list":["post-1018","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\/1018","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=1018"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/opv.vn\/en\/wp-json\/wp\/v2\/media\/813"}],"wp:attachment":[{"href":"https:\/\/opv.vn\/en\/wp-json\/wp\/v2\/media?parent=1018"}],"wp:term":[{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/opv.vn\/en\/wp-json\/wp\/v2\/product_cat?post=1018"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/opv.vn\/en\/wp-json\/wp\/v2\/product_tag?post=1018"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nNg\u01b0\u1eddi cao tu\u1ed5i v\u00e0 ng\u01b0\u1eddi suy gan: N\u00ean gi\u1ea3m li\u1ec1u \u1edf ng\u01b0\u1eddi cao tu\u1ed5i hay ng\u01b0\u1eddi suy gan.<\/p>\n
\nS\u1eed d\u1ee5ng sau ph\u1eabu thu\u1eadt cho tr\u1ebb em:<\/p>\n
\ntri\u1ec7u ch\u1ee9ng qu\u00e1 li\u1ec1u c\u1ee7a codein phosphat: Suy h\u00f4 h\u1ea5p, bu\u1ed3n ng\u1ee7 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