Thông tin sản phẩm
Ho\u1ea1t ch\u1ea5t: Lisinopril dihydrate t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi Lisinopril khan 10mg.
", "index": 1}, {"title": "C\u00f4ng d\u1ee5ng", "content": "", "index": 2}, {"title": "T\u00e1c d\u1ee5ng ph\u1ee5", "content": "Các tác d\u1ee5ng không mong mu\u1ed1n sau \u0111ã \u0111\u01b0\u1ee3c quan sát và ghi nh\u1eadn trong khi dùng Zestril và các thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n khác v\u1edbi t\u1ea7n xu\u1ea5t x\u1ea3y ra nh\u01b0 sau: R\u1ea5t th\u01b0\u1eddng g\u1eb7p (≥ 10%), th\u01b0\u1eddng g\u1eb7p (≥ 1%, < 10%), ít g\u1eb7p (≥ 0,1%, < 1%), hi\u1ebfm g\u1eb7p (≥ 0,01%, < 0,1%), r\u1ea5t hi\u1ebfm g\u1eb7p (< 0,01%) k\u1ec3 c\u1ea3 các tr\u01b0\u1eddng h\u1ee3p riêng l\u1ebb.
\nR\u1ed1i lo\u1ea1n máu và h\u1ec7 b\u1ea1ch huy\u1ebft
\n- Hi\u1ebfm g\u1eb7p: gi\u1ea3m haemoglobin, gi\u1ea3m haematocrit.
\n- R\u1ea5t hi\u1ebfm: suy t\u1ee7y x\u01b0\u01a1ng, thi\u1ebfu máu, gi\u1ea3m ti\u1ec3u c\u1ea7u, gi\u1ea3m b\u1ea1ch c\u1ea7u, gi\u1ea3m b\u1ea1ch c\u1ea7u trung tính, m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t (xem C\u1ea3nh báo), thi\u1ebfu máu tán huy\u1ebft, b\u1ec7nh h\u1ea1ch b\u1ea1ch huy\u1ebft, b\u1ec7nh t\u1ef1 mi\u1ec5n.
\nR\u1ed1i lo\u1ea1n chuy\u1ec3n hóa và dinh d\u01b0\u1ee1ng
\n- R\u1ea5t hi\u1ebfm: t\u1ee5t \u0111\u01b0\u1eddng huy\u1ebft.
\nR\u1ed1i lo\u1ea1n h\u1ec7 th\u1ea7n kinh và tâm th\u1ea7n
\n- Th\u01b0\u1eddng g\u1eb7p: chóng m\u1eb7t, nh\u1ee9c \u0111\u1ea7u.
\n- Ít g\u1eb7p: thay \u0111\u1ed5i khí s\u1eafc, d\u1ecb c\u1ea3m, chóng m\u1eb7t, r\u1ed1i lo\u1ea1n v\u1ecb giác, r\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7, \u1ea3o giác.
\n- Hi\u1ebfm g\u1eb7p: lú l\u1eabn tâm th\u1ea7n, r\u1ed1i lo\u1ea1n kh\u1ee9u giác.
\n- T\u1ea7n su\u1ea5t ch\u01b0a bi\u1ebft: tri\u1ec7u ch\u1ee9ng tr\u1ea7m c\u1ea3m, ng\u1ea5t.
\nR\u1ed1i lo\u1ea1n tim m\u1ea1ch
\n- Th\u01b0\u1eddng g\u1eb7p: tác \u0111\u1ed9ng t\u01b0 th\u1ebf (k\u1ec3 c\u1ea3 t\u1ee5t huy\u1ebft áp).
\n- Ít g\u1eb7p: nh\u1ed3i máu c\u01a1 tim ho\u1eb7c tai bi\u1ebfn m\u1ea1ch máu não, có l\u1ebd là th\u1ee9 phát do h\u1ea1 huy\u1ebft áp quá m\u1ee9c \u1edf b\u1ec7nh nhân có nguy c\u01a1 cao (xem C\u1ea3nh báo), h\u1ed3i h\u1ed9p, nh\u1ecbp tim nhanh. Hi\u1ec7n t\u01b0\u1ee3ng Raynaud.
\nR\u1ed1i lo\u1ea1n hô h\u1ea5p, l\u1ed3ng ng\u1ef1c và trung th\u1ea5t
\n- Th\u01b0\u1eddng g\u1eb7p: ho.
\n- Ít g\u1eb7p: viêm m\u0169i.
\n- R\u1ea5t hi\u1ebfm: co th\u1eaft ph\u1ebf qu\u1ea3n, viêm xoang. Viêm ph\u1ebf nang do d\u1ecb \u1ee9ng/viêm ph\u1ed5i t\u0103ng b\u1ea1ch c\u1ea7u ái toan.
\nR\u1ed1i lo\u1ea1n tiêu hóa
\n- Th\u01b0\u1eddng g\u1eb7p: tiêu ch\u1ea3y, bu\u1ed3n nôn.
\n- Ít g\u1eb7p: nôn, \u0111au b\u1ee5ng, khó tiêu.
\n- Hi\u1ebfm g\u1eb7p: khô mi\u1ec7ng.
\n- R\u1ea5t hi\u1ebfm: viêm t\u1ee5y, phù m\u1ea1ch t\u1ea1i ru\u1ed9t, viêm t\u1ebf bào gan ho\u1eb7c viêm gan \u1ee9 m\u1eadt, vàng da và suy gan (xem C\u1ea3nh báo).
\nR\u1ed1i lo\u1ea1n da và mô d\u01b0\u1edbi da
\n- Ít g\u1eb7p: n\u1ed5i m\u1ea9n, ng\u1ee9a, quá m\u1eabn/phù th\u1ea7n kinh-m\u1ea1ch: phù th\u1ea7n kinh-m\u1ea1ch \u1edf m\u1eb7t, tay chân, môi, l\u01b0\u1ee1i, thanh môn và/ho\u1eb7c thanh qu\u1ea3n (xem C\u1ea3nh báo).
\n- Hi\u1ebfm g\u1eb7p: n\u1ed5i m\u1ec1 \u0111ay, r\u1ee5ng tóc, v\u1ea9y n\u1ebfn.
\n- R\u1ea5t hi\u1ebfm: toát m\u1ed3 hôi, b\u1ec7nh pemphigus, ho\u1ea1i t\u1eed bi\u1ec3u bì gây \u0111\u1ed9c, h\u1ed9i ch\u1ee9ng Stevens-Johnson và h\u1ed3ng ban \u0111a d\u1ea1ng, u lympho gi\u1ea3 trên da.
\nPh\u1ee9c h\u1ee3p tri\u1ec7u ch\u1ee9ng \u0111ã \u0111\u01b0\u1ee3c ghi nh\u1eadn và có th\u1ec3 bao g\u1ed3m m\u1ed9t ho\u1eb7c nhi\u1ec1u tri\u1ec7u ch\u1ee9ng sau \u0111ây:
\nS\u1ed1t, viêm m\u1ea1ch máu, \u0111au c\u01a1, \u0111au kh\u1edbp/viêm kh\u1edbp, kháng th\u1ec3 kháng nhân (ANA) D\u01b0\u01a1ng tính, t\u0103ng v\u1eadn t\u1ed1c l\u1eafng máu (ESR), t\u0103ng b\u1ea1ch c\u1ea7u ái toan, t\u0103ng b\u1ea1ch c\u1ea7u, n\u1ed5i m\u1ea9n, nh\u1ea1y c\u1ea3m ánh sáng ho\u1eb7c các bi\u1ec3u hi\u1ec7n khác \u1edf da có th\u1ec3 x\u1ea3y ra.
\nR\u1ed1i lo\u1ea1n th\u1eadn và ti\u1ebft ni\u1ec7u
\n- Th\u01b0\u1eddng g\u1eb7p: r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn.
\n- Hi\u1ebfm g\u1eb7p: urê huy\u1ebft, suy th\u1eadn c\u1ea5p.
\n- R\u1ea5t hi\u1ebfm: thi\u1ec3u ni\u1ec7u/vô ni\u1ec7u.
\nR\u1ed1i lo\u1ea1n n\u1ed9i ti\u1ebft
\n- T\u1ea7n su\u1ea5t ch\u01b0a bi\u1ebft: bài ti\u1ebft hormone kháng l\u1ee3i ti\u1ec3u không thích h\u1ee3p.
\nR\u1ed1i lo\u1ea1n h\u1ec7 sinh s\u1ea3n và tuy\u1ebfn vú
\n- Ít g\u1eb7p: b\u1ea5t l\u1ef1c.
\n- Hi\u1ebfm g\u1eb7p: n\u1eef hóa tuy\u1ebfn vú.
\nCác r\u1ed1i lo\u1ea1n t\u1ed5ng quát và tình tr\u1ea1ng t\u1ea1i ch\u1ed7
\n- Ít g\u1eb7p: m\u1ec7t m\u1ecfi, suy nh\u01b0\u1ee3c.
\nCác k\u1ebft qu\u1ea3 xét nghi\u1ec7m
\n- Ít g\u1eb7p: t\u0103ng urê máu, t\u0103ng creatinine huy\u1ebft thanh, t\u0103ng men gan, t\u0103ng kali máu.
\n- Hi\u1ebfm g\u1eb7p: t\u0103ng bilirubin huy\u1ebft thanh, gi\u1ea3m natri máu.
\nD\u1eef li\u1ec7u an toàn t\u1eeb các nghiên c\u1ee9u lâm sàng cho th\u1ea5y lisinopril nói chung \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t \u1edf tr\u1ebb em t\u0103ng huy\u1ebft áp, do \u0111ó thông tin an toàn trong nhóm tu\u1ed5i này là t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nh\u01b0 khi quan sát \u1edf ng\u01b0\u1eddi l\u1edbn.
\n- Các thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft áp: Khi ph\u1ed1i h\u1ee3p v\u1edbi các thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft áp khác, tình tr\u1ea1ng huy\u1ebft áp h\u1ea1 nhi\u1ec1u h\u01a1n có th\u1ec3 x\u1ea3y ra.
\nTránh dùng lisinopril k\u1ebft h\u1ee3p v\u1edbi các thu\u1ed1c ch\u1ee9a aliskiren (xem Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh và C\u1ea3nh báo).
\nKhi ph\u1ed1i h\u1ee3p v\u1edbi glyceryl trinitrate và các nitrate khác ho\u1eb7c ch\u1ea5t giãn m\u1ea1ch có th\u1ec3 làm gi\u1ea3m huy\u1ebft áp h\u01a1n n\u1eefa.
\n- Thu\u1ed1c l\u1ee3i ti\u1ec3u: Khi thêm m\u1ed9t thu\u1ed1c l\u1ee3i ti\u1ec3u vào phác \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nhân \u0111ang s\u1eed d\u1ee5ng Zestril, tác d\u1ee5ng \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft áp th\u01b0\u1eddng t\u0103ng thêm.
\nB\u1ec7nh nhân \u0111ang dùng thu\u1ed1c l\u1ee3i ti\u1ec3u và \u0111\u1eb7c bi\u1ec7t là nh\u1eefng b\u1ec7nh nhân m\u1edbi dùng l\u1ee3i ti\u1ec3u, \u0111ôi khi b\u1ecb h\u1ea1 huy\u1ebft áp quá m\u1ee9c khi dùng thêm Zestril. Kh\u1ea3 n\u0103ng b\u1ecb h\u1ea1 huy\u1ebft áp có tri\u1ec7u ch\u1ee9ng v\u1edbi Zestril, có th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3m t\u1ed1i thi\u1ec3u b\u1eb1ng cách ng\u01b0ng thu\u1ed1c l\u1ee3i ti\u1ec3u tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi Zestril (Xem C\u1ea3nh báo và Li\u1ec1u l\u01b0\u1ee3ng & cách dùng).
\n- Ch\u1ea5t b\u1ed5 sung kali, thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali ho\u1eb7c các ch\u1ea5t thay th\u1ebf mu\u1ed1i ch\u1ee9a kali: M\u1eb7c dù trong các th\u1eed nghi\u1ec7m lâm sàng n\u1ed3ng \u0111\u1ed9 kali trong huy\u1ebft thanh th\u01b0\u1eddng \u1edf trong m\u1ee9c gi\u1edbi h\u1ea1n, tình tr\u1ea1ng t\u0103ng kali máu \u0111ã x\u1ea3y ra \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nhân. Các y\u1ebfu t\u1ed1 nguy c\u01a1 gây t\u0103ng kali máu bao g\u1ed3m suy th\u1eadn, \u0111ái tháo \u0111\u01b0\u1eddng, và dùng \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali (nh\u01b0 spironolactone, triamterene ho\u1eb7c amiloride), ch\u1ea5t b\u1ed5 sung kali ho\u1eb7c ch\u1ea5t thay th\u1ebf mu\u1ed1i ch\u1ee9a kali. Vi\u1ec7c dùng các ch\u1ea5t b\u1ed5 sung kali, thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali ho\u1eb7c ch\u1ea5t thay th\u1ebf mu\u1ed1i ch\u1ee9a kali, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nhân suy th\u1eadn, có th\u1ec3 d\u1eabn \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 kali huy\u1ebft thanh t\u0103ng \u0111áng k\u1ec3. N\u1ebfu dùng Zestril chung v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u m\u1ea5t kali, s\u1ef1 gi\u1ea3m kali huy\u1ebft gây ra do thu\u1ed1c l\u1ee3i ti\u1ec3u có th\u1ec3 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n.
\n- Lithium: S\u1ef1 gia t\u0103ng n\u1ed3ng \u0111\u1ed9 và \u0111\u1ed9c tính c\u1ee7a lithium trong huy\u1ebft thanh có h\u1ed3i ph\u1ee5c \u0111ã \u0111\u01b0\u1ee3c ghi nh\u1eadn khi dùng \u0111\u1ed3ng th\u1eddi lithium v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n. Khi dùng chung thu\u1ed1c l\u1ee3i ti\u1ec3u lo\u1ea1i thiazide v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n có th\u1ec3 làm t\u0103ng nguy c\u01a1 \u0111\u1ed9c tính c\u1ee7a lithium. Không khuy\u1ebfn cáo dùng Zestril chung v\u1edbi lithium, nh\u01b0ng n\u1ebfu c\u1ea7n thi\u1ebft ph\u1ea3i k\u1ebft h\u1ee3p thì ph\u1ea3i theo dõi c\u1ea9n th\u1eadn m\u1ee9c lithium trong huy\u1ebft thanh (xem C\u1ea3nh báo).
\n- Thu\u1ed1c kháng viêm không steroid (NSAID) k\u1ec3 c\u1ea3 axít acetylsalicylic >= 3 g/ngày: S\u1eed d\u1ee5ng NSAID kéo dài có th\u1ec3 gi\u1ea3m tác \u0111\u1ed9ng \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft áp c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n. Khi dùng chung NSAID và thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n gây tác \u0111\u1ed9ng c\u1ed9ng h\u1ee3p t\u0103ng kali huy\u1ebft thanh và d\u1eabn \u0111\u1ebfn suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn. Các tác \u0111\u1ed9ng này th\u01b0\u1eddng có th\u1ec3 h\u1ed3i ph\u1ee5c. Trong m\u1ed9t s\u1ed1 hi\u1ebfm tr\u01b0\u1eddng h\u1ee3p, suy th\u1eadn c\u1ea5p có th\u1ec3 x\u1ea3y ra, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nhân có ch\u1ee9c n\u0103ng th\u1eadn b\u1ecb suy gi\u1ea3m tr\u01b0\u1edbc \u0111ó nh\u01b0 ng\u01b0\u1eddi cao tu\u1ed5i, b\u1ec7nh nhân m\u1ea5t n\u01b0\u1edbc.
\n- Vàng: Ph\u1ea3n \u1ee9ng Nitritoid (tri\u1ec7u ch\u1ee9ng c\u1ee7a s\u1ef1 giãn m\u1ea1ch, mà có th\u1ec3 r\u1ea5t tr\u1ea7m tr\u1ecdng, bao g\u1ed3m: \u0111\u1ecf b\u1eebng, bu\u1ed3n nôn, chóng m\u1eb7t và h\u1ea1 huy\u1ebft áp) sau khi s\u1eed d\u1ee5ng Vàng d\u01b0\u1edbi d\u1ea1ng tiêm (ví d\u1ee5: natri aurothiomalate) \u0111ã \u0111\u01b0\u1ee3c ghi nh\u1eadn th\u01b0\u1eddng xuyên x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh nhân \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n.
\n- Thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m 3 vòng/Thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n/Thu\u1ed1c gây mê: Khi dùng chung thu\u1ed1c gây mê, thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m 3 vòng và thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n có th\u1ec3 d\u1eabn \u0111\u1ebfn gi\u1ea3m huy\u1ebft áp h\u01a1n n\u1eefa (xem C\u1ea3nh báo).
\n- Thu\u1ed1c gi\u1ed1ng giao c\u1ea3m: Thu\u1ed1c gi\u1ed1ng giao c\u1ea3m có th\u1ec3 làm gi\u1ea3m tác \u0111\u1ed9ng \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft áp c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n.
\n- Thu\u1ed1c tr\u1ecb b\u1ec7nh \u0111ái tháo \u0111\u01b0\u1eddng: Các nghiên c\u1ee9u d\u1ecbch t\u1ec5 h\u1ecdc \u0111\u1ec1 ngh\u1ecb r\u1eb1ng dùng \u0111\u1ed3ng th\u1eddi thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n và thu\u1ed1c tr\u1ecb \u0111ái tháo \u0111\u01b0\u1eddng (insulin, thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft d\u1ea1ng u\u1ed1ng) có th\u1ec3 làm t\u0103ng tác \u0111\u1ed9ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft v\u1edbi nguy c\u01a1 t\u1ee5t \u0111\u01b0\u1eddng huy\u1ebft. Hi\u1ec7n t\u01b0\u1ee3ng này d\u01b0\u1eddng nh\u01b0 có th\u1ec3 x\u1ea3y ra nhi\u1ec1u h\u01a1n trong nh\u1eefng tu\u1ea7n \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tiên và \u1edf b\u1ec7nh nhân suy th\u1eadn.
\n- Axít acetylsalicylic, thu\u1ed1c tan huy\u1ebft kh\u1ed1i, thu\u1ed1c ch\u1eb9n bêta, thu\u1ed1c nhóm nitrate: Zestril có th\u1ec3 s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi axít acetylsalicylic (\u1edf các li\u1ec1u dùng cho b\u1ec7nh lý tim m\u1ea1ch), thu\u1ed1c tan huy\u1ebft kh\u1ed1i, thu\u1ed1c ch\u1eb9n bêta và/ho\u1eb7c nhóm nitrate.
\nT\u0103ng huy\u1ebft áp:\u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft áp.
\nSuy tim:\u0111i\u1ec1u tr\u1ecb suy tim có tri\u1ec7u ch\u1ee9ng.
\nNh\u1ed3i máu c\u01a1 tim c\u1ea5p:\u0111i\u1ec1u tr\u1ecb ng\u1eafn h\u1ea1n (6 tu\u1ea7n) \u1edf b\u1ec7nh nhân có huy\u1ebft \u0111\u1ed9ng h\u1ecdc \u1ed5n \u0111\u1ecbnh trong vòng 24 gi\u1edd \u0111\u1ea7u \u1edf b\u1ec7nh nh\u1ed3i máu c\u01a1 tim c\u1ea5p.
\nBi\u1ebfn ch\u1ee9ng trên th\u1eadn c\u1ee7a b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng:\u1edf b\u1ec7nh nhân ti\u1ec3u \u0111\u01b0\u1eddng ph\u1ee5 thu\u1ed9c insulin có huy\u1ebft áp bình th\u01b0\u1eddng và b\u1ec7nh nhân ti\u1ec3u \u0111\u01b0\u1eddng không ph\u1ee5 thu\u1ed9c insulin có t\u0103ng huy\u1ebft áp v\u1eeba m\u1edbi ch\u1edbm m\u1eafc b\u1ec7nh lý th\u1eadn \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi vi albumin ni\u1ec7u, Zestril làm gi\u1ea3m t\u1ed1c \u0111\u1ed9 ti\u1ebft albumin ni\u1ec7u (xem ph\u1ea7n D\u01b0\u1ee3c l\u1ef1c h\u1ecdc).
", "index": 4}, {"title": "Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh", "content": "- Quá m\u1eabn v\u1edbi Zestril ho\u1eb7c b\u1ea5t k\u1ef3 tá d\u01b0\u1ee3c nào ho\u1eb7c các thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n angiotensin (ACE) khác.
\n- Ti\u1ec1n s\u1eed phù m\u1ea1ch do dùng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n.
\n- Phù m\u1ea1ch di truy\u1ec1n ho\u1eb7c vô c\u0103n.
\n- Ph\u1ee5 n\u1eef có thai \u1edf 3 tháng gi\u1eefa và cu\u1ed1i c\u1ee7a thai k\u1ef3 (xem S\u1eed d\u1ee5ng \u1edf ph\u1ee5 n\u1eef có thai và cho con bú).
\n- Dùng ph\u1ed1i h\u1ee3p v\u1edbi thu\u1ed1c ch\u1ee9a aliskiren \u1edf b\u1ec7nh nhân \u0111ái tháo \u0111\u01b0\u1eddng (týp I ho\u1eb7c II) ho\u1eb7c b\u1ec7nh nhân suy th\u1eadn trung bình \u0111\u1ebfn n\u1eb7ng (GFR < 60ml/phút/1,73m2).
", "index": 5}, {"title": "Li\u1ec1u d\u00f9ng", "content": "Nên u\u1ed1ng Zestril m\u1ed9t l\u1ea7n duy nh\u1ea5t m\u1ed7i ngày.
\nC\u0169ng nh\u01b0 các thu\u1ed1c khác dùng m\u1ed9t l\u1ea7n duy nh\u1ea5t trong ngày, Zestril nên \u0111\u01b0\u1ee3c u\u1ed1ng \u1edf cùng th\u1eddi \u0111i\u1ec3m trong ngày. Th\u1ee9c \u0103n không \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 h\u1ea5p thu c\u1ee7a viên nén Zestril.
\nLi\u1ec1u l\u01b0\u1ee3ng tùy thu\u1ed9c theo tình tr\u1ea1ng và \u0111áp \u1ee9ng huy\u1ebft áp c\u1ee7a t\u1eebng cá nhân (xem ph\u1ea7n C\u1ea3nh báo).
\nT\u0103ng huy\u1ebft áp
\nZestril có th\u1ec3 dùng riêng l\u1ebb ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi các nhóm thu\u1ed1c tr\u1ecb t\u0103ng huy\u1ebft áp nhóm khác.
\nLi\u1ec1u kh\u1edfi \u0111\u1ea7u
\n\u1ede b\u1ec7nh nhân t\u0103ng huy\u1ebft áp, li\u1ec1u kh\u1edfi \u0111\u1ea7u \u0111\u01b0\u1ee3c khuy\u1ebfn cáo là 10mg. B\u1ec7nh nhân có h\u1ec7 renin-angiotensin-aldosterone ho\u1ea1t hóa m\u1ea1nh (\u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nhân t\u0103ng huy\u1ebft áp do b\u1ec7nh lý m\u1ea1ch máu-th\u1eadn, thi\u1ebfu n\u01b0\u1edbc và/ho\u1eb7c thi\u1ebfu mu\u1ed1i, m\u1ea5t bù tim ho\u1eb7c t\u0103ng huy\u1ebft áp tr\u1ea7m tr\u1ecdng) có th\u1ec3 b\u1ecb h\u1ea1 huy\u1ebft áp quá m\u1ee9c sau khi dùng li\u1ec1u kh\u1edfi \u0111\u1ea7u. Nên dùng li\u1ec1u kh\u1edfi \u0111\u1ea7u 2,5 - 5mg cho các lo\u1ea1i b\u1ec7nh nhân này và vi\u1ec7c kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb c\u1ea7n có s\u1ef1 theo dõi c\u1ee7a bác s\u1ef9. C\u1ea7n ph\u1ea3i dùng li\u1ec1u kh\u1edfi \u0111\u1ea7u th\u1ea5p h\u01a1n khi có t\u1ed5n th\u01b0\u01a1ng th\u1eadn (xem B\u1ea3ng 1 d\u01b0\u1edbi \u0111ây).
\nLi\u1ec1u duy trì
\nLi\u1ec1u duy trì thông th\u01b0\u1eddng có hi\u1ec7u qu\u1ea3 là 20mg, u\u1ed1ng m\u1ed9t l\u1ea7n duy nh\u1ea5t m\u1ed7i ngày. Nói chung, n\u1ebfu không \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb mong mu\u1ed1n sau 2 - 4 tu\u1ea7n v\u1edbi li\u1ec1u \u0111i\u1ec1u tr\u1ecb nào \u0111ó thì có th\u1ec3 t\u0103ng li\u1ec1u. Li\u1ec1u t\u1ed1i \u0111a s\u1eed d\u1ee5ng trong các th\u1eed nghi\u1ec7m lâm sàng dài h\u1ea1n có \u0111\u1ed1i ch\u1ee9ng là 80mg/ngày.
\nB\u1ec7nh nhân \u0111ang dùng thu\u1ed1c l\u1ee3i ti\u1ec3u
\nH\u1ea1 huy\u1ebft áp có tri\u1ec7u ch\u1ee9ng có th\u1ec3 x\u1ea3y ra khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi Zestril. \u0110i\u1ec1u này d\u1ec5 x\u1ea3y ra h\u01a1n \u1edf b\u1ec7nh nhân \u0111ang \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u. Do \u0111ó ph\u1ea3i th\u1eadn tr\u1ecdng vì nh\u1eefng b\u1ec7nh nhân này có th\u1ec3 \u0111ang thi\u1ebfu n\u01b0\u1edbc và/ho\u1eb7c mu\u1ed1i. N\u1ebfu \u0111\u01b0\u1ee3c, nên ng\u01b0ng thu\u1ed1c l\u1ee3i ti\u1ec3u 2 - 3 ngày tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi Zestril. \u1ede b\u1ec7nh nhân t\u0103ng huy\u1ebft áp không th\u1ec3 ng\u01b0ng thu\u1ed1c l\u1ee3i ti\u1ec3u, nên dùng Zestril v\u1edbi li\u1ec1u kh\u1edfi \u0111\u1ea7u 5mg. Nên theo dõi ch\u1ee9c n\u0103ng th\u1eadn và l\u01b0\u1ee3ng kali huy\u1ebft thanh. Li\u1ec1u Zestril ti\u1ebfp theo nên \u0111i\u1ec1u ch\u1ec9nh tùy theo \u0111áp \u1ee9ng c\u1ee7a huy\u1ebft áp. N\u1ebfu c\u1ea7n thi\u1ebft, có th\u1ec3 ti\u1ebfp t\u1ee5c dùng thu\u1ed1c l\u1ee3i ti\u1ec3u (xem C\u1ea3nh báo & T\u01b0\u01a1ng tác).
\n\u0110i\u1ec1u ch\u1ec9nh li\u1ec1u s\u1eed d\u1ee5ng \u1edf b\u1ec7nh nhân suy th\u1eadn
\nLi\u1ec1u s\u1eed d\u1ee5ng \u1edf b\u1ec7nh nhân suy th\u1eadn ph\u1ea3i \u0111\u01b0\u1ee3c d\u1ef1a trên \u0111\u1ed9 thanh th\u1ea3i creatinine nh\u01b0 mô t\u1ea3 \u1edf b\u1ea3ng 1 d\u01b0\u1edbi \u0111ây.
\n| \n B\u1ea3ng 1. Li\u1ec1u \u0111i\u1ec1u ch\u1ec9nh \u1edf b\u1ec7nh nhân suy th\u1eadn \n | \n|
| \n \u0110\u1ed9 thanh th\u1ea3i Creatinine (mL/phút) \n | \n\n Li\u1ec1u kh\u1edfi \u0111\u1ea7u (mg/ngày) \n | \n
| \n Ít h\u01a1n 10mL/phút (k\u1ec3 c\u1ea3 b\u1ec7nh nhân th\u1ea9m phân) \n | \n\n 2.5mg* \n | \n
| \n 10 - 30mL/phút \n | \n\n 2.5 - 5mg \n | \n
| \n 31 - 80mL/phút \n | \n\n 5 - 10mg \n | \n
| \n *Li\u1ec1u s\u1eed d\u1ee5ng và/ho\u1eb7c s\u1ed1 l\u1ea7n dùng thu\u1ed1c c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh theo \u0111áp \u1ee9ng v\u1ec1 huy\u1ebft áp \n | \n
Li\u1ec1u l\u01b0\u1ee3ng có th\u1ec3 \u0111\u01b0\u1ee3c chu\u1ea9n \u0111\u1ed9 t\u0103ng d\u1ea7n cho \u0111\u1ebfn khi ki\u1ec3m soát \u0111\u01b0\u1ee3c huy\u1ebft áp ho\u1eb7c t\u1edbi li\u1ec1u t\u1ed1i \u0111a 40mg/ngày.
\nS\u1eed d\u1ee5ng trên tr\u1ebb em b\u1ecb b\u1ec7nh cao huy\u1ebft áp t\u1eeb 6 - 16 tu\u1ed5i
\nLi\u1ec1u kh\u1edfi \u0111\u1ea7u khuy\u1ebfn cáo là 2,5mg m\u1ed9t l\u1ea7n m\u1ed7i ngày \u1edf b\u1ec7nh nhân có cân n\u1eb7ng t\u1eeb 20kg \u0111\u1ebfn < 50kg, và 5mg m\u1ed9t l\u1ea7n m\u1ed7i ngày \u1edf b\u1ec7nh nhân ≥ 50kg. Li\u1ec1u dùng nên \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh tùy theo cá th\u1ec3 \u0111\u1ebfn t\u1ed1i \u0111a 20mg/ngày \u1edf b\u1ec7nh nhân có cân n\u1eb7ng t\u1eeb 20 \u0111\u1ebfn < 50kg, và không quá 40mg/ngày \u1edf b\u1ec7nh nhân ≥ 50kg. Li\u1ec1u trên 0,61mg/kg (ho\u1eb7c v\u01b0\u1ee3t quá 40mg/ngày) ch\u01b0a \u0111\u01b0\u1ee3c nghiên c\u1ee9u \u1edf tr\u1ebb em (xem ph\u1ea7n D\u01b0\u1ee3c l\u1ef1c h\u1ecdc). \u1ede tr\u1ebb em có ch\u1ee9c n\u0103ng th\u1eadn suy gi\u1ea3m, nên xem xét kh\u1edfi \u0111\u1ea7u v\u1edbi li\u1ec1u th\u1ea5p h\u01a1n ho\u1eb7c xem xét t\u0103ng t\u1eebng m\u1ee9c li\u1ec1u.
\nSuy tim
\n\u1ede b\u1ec7nh nhân suy tim có tri\u1ec7u ch\u1ee9ng, Zestril nên \u0111\u01b0\u1ee3c dùng nh\u01b0 m\u1ed9t tr\u1ecb li\u1ec7u h\u1ed7 tr\u1ee3 cho thu\u1ed1c l\u1ee3i ti\u1ec3u và, khi thích h\u1ee3p, v\u1edbi digitalis ho\u1eb7c thu\u1ed1c ch\u1eb9n bêta. Zestril có th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u1edbi li\u1ec1u kh\u1edfi \u0111\u1ea7u 2.5mg, 1 l\u1ea7n/ngày và nên u\u1ed1ng khi có s\u1ef1 theo dõi c\u1ee7a bác s\u1ef9 \u0111\u1ec3 xác \u0111\u1ecbnh tác \u0111\u1ed9ng l\u1ea7n \u0111\u1ea7u c\u1ee7a thu\u1ed1c lên huy\u1ebft áp. Nên t\u0103ng li\u1ec1u Zestril:
\n- T\u1eebng m\u1ee9c không quá 10mg.
\n- Th\u1eddi gian \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u không ít h\u01a1n 2 tu\u1ea7n.
\n- Li\u1ec1u t\u1ed1i \u0111a b\u1ec7nh nhân có th\u1ec3 dung n\u1ea1p lên \u0111\u1ebfn 35mg, 1 l\u1ea7n/ngày.
\nVi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u l\u01b0\u1ee3ng ph\u1ea3i \u0111\u01b0\u1ee3c d\u1ef1a trên \u0111áp \u1ee9ng lâm sàng c\u1ee7a t\u1eebng b\u1ec7nh nhân. \u1ede b\u1ec7nh nhân có nguy c\u01a1 cao h\u1ea1 huy\u1ebft áp có tri\u1ec7u ch\u1ee9ng, ví d\u1ee5 b\u1ec7nh nhân thi\u1ebfu mu\u1ed1i có hay không có gi\u1ea3m natri máu, b\u1ec7nh nhân gi\u1ea3m th\u1ec3 tích tu\u1ea7n hoàn ho\u1eb7c b\u1ec7nh nhân \u0111ã \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb tích c\u1ef1c b\u1eb1ng thu\u1ed1c l\u1ee3i ti\u1ec3u, các r\u1ed1i lo\u1ea1n này ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh, n\u1ebfu \u0111\u01b0\u1ee3c, tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb v\u1edbi Zestril. Nên theo dõi ch\u1ee9c n\u0103ng th\u1eadn và kali huy\u1ebft thanh (xem C\u1ea3nh báo).
\nNh\u1ed3i máu c\u01a1 tim c\u1ea5p
\nN\u1ebfu c\u1ea7n, b\u1ec7nh nhân nên \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng các thu\u1ed1c \u0111i\u1ec1u tr\u1ecb chu\u1ea9n nh\u01b0 thu\u1ed1c tan huy\u1ebft kh\u1ed1i, aspirin và thu\u1ed1c ch\u1eb9n bêta. Có th\u1ec3 dùng glyceryl trinitrate \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch ho\u1eb7c \u0111\u01b0\u1eddng qua da cùng lúc v\u1edbi Zestril.
\nLi\u1ec1u kh\u1edfi \u0111\u1ea7u (3 ngày \u0111\u1ea7u tiên sau c\u01a1n nh\u1ed3i máu c\u01a1 tim)
\n\u0110i\u1ec1u tr\u1ecb b\u1eb1ng Zestril có th\u1ec3 kh\u1edfi \u0111\u1ea7u trong vòng 24 gi\u1edd t\u1eeb khi kh\u1edfi phát các tri\u1ec7u ch\u1ee9ng. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb không nên b\u1eaft \u0111\u1ea7u n\u1ebfu huy\u1ebft áp tâm thu th\u1ea5p h\u01a1n 100mmHg. Li\u1ec1u kh\u1edfi \u0111\u1ea7u c\u1ee7a Zestril là 5mg qua \u0111\u01b0\u1eddng u\u1ed1ng, ti\u1ebfp theo là 5mg sau 24 gi\u1edd, 10mg sau 48 gi\u1edd và 10mg m\u1ed9t l\u1ea7n/ngày cho các ngày sau \u0111ó. B\u1ec7nh nhân có huy\u1ebft áp tâm thu th\u1ea5p (≤ 120mmHg) khi kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb hay trong vòng 3 ngày \u0111\u1ea7u tiên sau c\u01a1n nh\u1ed3i máu c\u01a1 tim nên dùng li\u1ec1u th\u1ea5p h\u01a1n 2.5mg \u0111\u01b0\u1eddng u\u1ed1ng (xem C\u1ea3nh báo).
\n\u1ede b\u1ec7nh nhân suy th\u1eadn (\u0111\u1ed9 thanh th\u1ea3i creatinine < 80mL/phút), li\u1ec1u kh\u1edfi \u0111\u1ea7u Zestril nên \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh tùy theo \u0111\u1ed9 thanh th\u1ea3i creatinine c\u1ee7a b\u1ec7nh nhân (xem B\u1ea3ng 1).
\nLi\u1ec1u duy trì
\nLi\u1ec1u duy trì là 10mg, 1 l\u1ea7n/ngày. N\u1ebfu h\u1ea1 huy\u1ebft áp x\u1ea3y ra (huy\u1ebft áp tâm thu ≤ 100mmHg), li\u1ec1u duy trì h\u1eb1ng ngày 5mg nên \u0111\u01b0\u1ee3c gi\u1ea3m t\u1ea1m th\u1eddi xu\u1ed1ng còn 2.5mg n\u1ebfu c\u1ea7n thi\u1ebft. N\u1ebfu h\u1ea1 huy\u1ebft áp kéo dài x\u1ea3y ra (huy\u1ebft áp tâm thu th\u1ea5p h\u01a1n 90mmHg kéo dài lâu h\u01a1n m\u1ed9t gi\u1edd), nên ng\u01b0ng dùng thu\u1ed1c Zestril.
\nVi\u1ec7c \u0111i\u1ec1u tr\u1ecb nên \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c trong 6 tu\u1ea7n l\u1ec5 và sau \u0111ó b\u1ec7nh nhân nên \u0111\u01b0\u1ee3c tái \u0111ánh giá. B\u1ec7nh nhân có các tri\u1ec7u ch\u1ee9ng suy tim nên ti\u1ebfp t\u1ee5c dùng Zestril (Xem ph\u1ea7n Li\u1ec1u l\u01b0\u1ee3ng và cách dùng).
\nBi\u1ebfn ch\u1ee9ng trên th\u1eadn c\u1ee7a b\u1ec7nh \u0111ái tháo \u0111\u01b0\u1eddng
\n\u1ede b\u1ec7nh nhân \u0111ái tháo \u0111\u01b0\u1eddng ph\u1ee5 thu\u1ed9c insulin có huy\u1ebft áp bình th\u01b0\u1eddng, li\u1ec1u hàng ngày là 10mg Zestril, 1 l\u1ea7n/ngày, có th\u1ec3 t\u0103ng lên 20mg, 1 l\u1ea7n/ngày, n\u1ebfu c\u1ea7n thi\u1ebft, \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c huy\u1ebft áp tâm tr\u01b0\u01a1ng \u1edf t\u01b0 th\u1ebf ng\u1ed3i d\u01b0\u1edbi 75mmHg. \u1ede b\u1ec7nh nhân \u0111ái tháo \u0111\u01b0\u1eddng không ph\u1ee5 thu\u1ed9c insulin b\u1ecb t\u0103ng huy\u1ebft áp, dùng phác \u0111\u1ed3 li\u1ec1u l\u01b0\u1ee3ng nh\u01b0 trên \u0111\u1ec3 \u0111\u1ea1t \u0111\u1ebfn huy\u1ebft áp tâm tr\u01b0\u01a1ng \u1edf t\u01b0 th\u1ebf ng\u1ed3i d\u01b0\u1edbi 90mmHg.
\n\u1ede b\u1ec7nh nhân suy th\u1eadn (\u0111\u1ed9 thanh th\u1ea3i creatinine < 80mL/phút), li\u1ec1u kh\u1edfi \u0111\u1ea7u Zestril nên \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh theo \u0111\u1ed9 thanh th\u1ea3i creatinine c\u1ee7a b\u1ec7nh nhân (xem B\u1ea3ng 1).
\nS\u1eed d\u1ee5ng thu\u1ed1c \u1edf ng\u01b0\u1eddi cao tu\u1ed5i
\nTrong các nghiên c\u1ee9u lâm sàng, không có thay \u0111\u1ed5i nào liên quan \u0111\u1ebfn tu\u1ed5i tác b\u1ec7nh nhân v\u1ec1 hi\u1ec7u qu\u1ea3 và tính an toàn c\u1ee7a thu\u1ed1c. Tuy nhiên, khi tu\u1ed5i cao kèm theo gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn, nên tuân theo s\u1ef1 h\u01b0\u1edbng d\u1eabn c\u1ee7a b\u1ea3ng 1 \u0111\u1ec3 xác \u0111\u1ecbnh li\u1ec1u kh\u1edfi \u0111\u1ea7u c\u1ee7a Zestril. Sau \u0111ó, li\u1ec1u l\u01b0\u1ee3ng nên \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh tùy theo \u0111áp \u1ee9ng c\u1ee7a huy\u1ebft áp.
\nS\u1eed d\u1ee5ng trên b\u1ec7nh nhân ghép th\u1eadn
\nCh\u01b0a có kinh nghi\u1ec7m v\u1ec1 vi\u1ec7c dùng Zestril trên b\u1ec7nh nhân m\u1edbi ghép th\u1eadn. Do v\u1eady, không khuy\u1ebfn cáo dùng Zestril trên các b\u1ec7nh nhân này.
", "index": 6}, {"title": "\u0110\u00f3ng g\u00f3i", "content": "