Thông tin sản phẩm
Ho\u1ea1t ch\u1ea5t: Enalapril maleate 5 mg
\nTá d\u01b0\u1ee3c: Lactose monohydrat, tinh b\u1ed9t ngô, natri bicarbonat, tinh b\u1ed9t ti\u1ec1n gelatin hóa, magnesi stearat.
", "index": 1}, {"title": "C\u00f4ng d\u1ee5ng", "content": "", "index": 2}, {"title": "T\u00e1c d\u1ee5ng ph\u1ee5", "content": "Tác d\u1ee5ng không mong mu\u1ed1n th\u01b0\u1eddng nh\u1eb9 và thoáng qua, nh\u01b0ng có kho\u1ea3ng 3% \u0111\u1ebfn 6% ng\u01b0\u1eddi dùng thu\u1ed1c ph\u1ea3i ng\u01b0ng \u0111i\u1ec1u tr\u1ecb.
\n\u0110ã có bi\u1ec3u hi\u1ec7n h\u1ea1 huy\u1ebft áp tri\u1ec7u ch\u1ee9ng khá n\u1eb7ng sau khi dùng li\u1ec1u enalapril \u0111\u1ea7u tiên; có \u0111\u1ebfn 2 - 3% s\u1ed1 ng\u01b0\u1eddi trong các th\u1eed nghi\u1ec7m lâm sàng ph\u1ea3i ng\u01b0ng \u0111i\u1ec1u tr\u1ecb, \u0111\u1eb7c bi\u1ec7t v\u1edbi nh\u1eefng ng\u01b0\u1eddi suy tim, h\u1ea1 natri huy\u1ebft, và v\u1edbi ng\u01b0\u1eddi cao tu\u1ed5i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u.
\n\u1ede ng\u01b0\u1eddi suy tim sung huy\u1ebft th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n h\u1ea1 huy\u1ebft áp tri\u1ec7u ch\u1ee9ng, ch\u1ee9c n\u0103ng th\u1eadn x\u1ea5u \u0111i và t\u0103ng n\u1ed3ng \u0111\u1ed9 kali huy\u1ebft thanh, \u0111\u1eb7c bi\u1ec7t trong th\u1eddi gian \u0111\u1ea7u dùng enalapril \u1edf ng\u01b0\u1eddi \u0111i\u1ec1u tr\u1ecb \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u.
\nCh\u1ee9c n\u0103ng th\u1eadn x\u1ea5u \u0111i (t\u0103ng nh\u1ea5t th\u1eddi urê huy\u1ebft và t\u0103ng n\u1ed3ng \u0111\u1ed9 creatinin huy\u1ebft thanh) \u0111ã x\u1ea3y ra \u1edf kho\u1ea3ng 20% ng\u01b0\u1eddi t\u0103ng huy\u1ebft áp do b\u1ec7nh th\u1eadn, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng ng\u01b0\u1eddi h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn hai bên ho\u1eb7c h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn \u1edf ng\u01b0\u1eddi ch\u1ec9 có th\u1eadn \u0111\u01a1n \u0111\u1ed9c (m\u1ed9t th\u1eadn).
\nTh\u01b0\u1eddng g\u1eb7p (1/100 ≤ ADR < 1/10)
\nTh\u1ea7n kinh: \u0110au \u0111\u1ea7u, chóng m\u1eb7t, m\u1ec7t m\u1ecfi, m\u1ea5t ng\u1ee7, d\u1ecb c\u1ea3m, lo\u1ea1n c\u1ea3m.
\nTiêu hóa: R\u1ed1i lo\u1ea1n v\u1ecb giác, tiêu ch\u1ea3y, bu\u1ed3n nôn, nôn và \u0111au b\u1ee5ng.
\nTim m\u1ea1ch: Phù m\u1ea1ch, h\u1ea1 huy\u1ebft áp n\u1eb7ng, h\u1ea1 huy\u1ebft áp th\u1ebf \u0111\u1ee9ng, ng\u1ea5t, \u0111ánh tr\u1ed1ng ng\u1ef1c và \u0111au ng\u1ef1c.
\nDa: Phát ban.
\nHô h\u1ea5p: Ho khan, có th\u1ec3 do t\u0103ng kinin \u1edf mô ho\u1eb7c prostaglandin \u1edf ph\u1ed5i.
\nKhác: Suy th\u1eadn
\nÍt g\u1eb7p (1/1000 ≤ ADR < 1/100)
\nHuy\u1ebft h\u1ecdc: Gi\u1ea3m hemoglobin và hematocrit, gi\u1ea3m b\u1ea1ch c\u1ea7u h\u1ea1t, b\u1ea1ch c\u1ea7u trung tính.
\nTi\u1ebft ni\u1ec7u: Protein ni\u1ec7u.
\nTh\u1ea7n kinh: H\u1ed1t ho\u1ea3ng, kích \u0111\u1ed9ng, tr\u1ea7m c\u1ea3m n\u1eb7ng.
\nHi\u1ebfm g\u1eb7p (1/10.000 < ADR < 1/1000)
\nTiêu hóa: T\u1eafc ru\u1ed9t, viêm t\u1ee5y, viêm gan nhi\u1ec5m \u0111\u1ed9c \u1ee9 m\u1eadt, t\u0103ng c\u1ea3m niêm m\u1ea1c mi\u1ec7ng.
\nKhác: Quá m\u1eabn, tr\u1ea7m c\u1ea3m, nhìn m\u1edd, ng\u1eb7t m\u0169i, \u0111au c\u01a1, co th\u1eaft ph\u1ebf qu\u1ea3n và hen.
\nH\u01b0\u1edbng d\u1eabn cách x\u1eed trí tác d\u1ee5ng không mong mu\u1ed1n
\nKhi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb, nên dùng thu\u1ed1c li\u1ec1u th\u1ea5p và ki\u1ec3m tra n\u1ed3ng \u0111\u1ed9 natri huy\u1ebft thanh. Có th\u1ec3 x\u1ea3y ra phù m\u1ea1ch, \u0111\u1eb7c bi\u1ec7t sau khi dùng li\u1ec1u enalapril \u0111\u1ea7u tiên, và n\u1ebfu có thêm phù thanh qu\u1ea3n có th\u1ec3 gây t\u1eed vong. C\u1ea7n thông báo cho b\u1ec7nh nhân v\u1ec1 nh\u1eefng d\u1ea5u hi\u1ec7u và tri\u1ec7u ch\u1ee9ng c\u1ee7a phù m\u1ea1ch (phù m\u1eb7t, m\u1eaft, môi, l\u01b0\u1ee1i, ho\u1eb7c khó th\u1edf), khi th\u1ea5y có tri\u1ec7u ch\u1ee9ng này ph\u1ea3i ng\u1eebng dùng thu\u1ed1c và thông báo ngay cho bác s\u0129. \u0110i\u1ec1u tr\u1ecb phù m\u1ea1ch \u1edf l\u01b0\u1ee1i, thanh môn ho\u1eb7c thanh qu\u1ea3n, bao.g\u1ed3m các bi\u1ec7n pháp sau:
\nNg\u01b0ng dùng enalapril và cho b\u1ec7nh nhân vào vi\u1ec7n; tiêm adrenalin d\u01b0\u1edbi da; tiêm t\u0129nh m\u1ea1ch diphenhydramin hydroclorid; tiêm t\u0129nh m\u1ea1ch hydrocortison.
\n\u0110\u1ecbnh k\u1ef3 theo dõi s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u \u1edf b\u1ec7nh nhân s\u1eed d\u1ee5ng enalapril, \u0111\u1eb7c bi\u1ec7t \u1edf ng\u01b0\u1eddi suy th\u1eadn.
\nPh\u1ea3i theo dõi huy\u1ebft áp và ch\u1ee9c n\u0103ng th\u1eadn ch\u1eb7t ch\u1ebd tr\u01b0\u1edbc và sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb.
\nN\u1ebfu không \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111áp \u1ee9ng \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7y \u0111\u1ee7 trong vòng 4 tu\u1ea7n, nên t\u0103ng li\u1ec1u dùng ho\u1eb7c \u0111i\u1ec1u tr\u1ecb thêm b\u1eb1ng nh\u1eefng thu\u1ed1c ch\u1ed1ng t\u0103ng huy\u1ebft áp khác.
\nKhi có h\u1ea1 huy\u1ebft áp n\u1eb7ng c\u1ea7n truy\u1ec1n t\u0129nh m\u1ea1ch natri clorid 0,9%. Enalapril th\u01b0\u1eddng không \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 kali huy\u1ebft thanh. N\u1ebfu dùng enalapril cùng v\u1edbi thu\u1ed1c l\u1ee3i ni\u1ec7u có th\u1ec3 gi\u1ea3m nguy c\u01a1 gi\u1ea3i phóng aldosteron th\u1ee9 phát cùng v\u1edbi h\u1ea1 kali huy\u1ebft. \u1ede ng\u01b0\u1eddi suy th\u1eadn, enalapril có th\u1ec3 gây t\u0103ng n\u1ed3ng \u0111\u1ed9 kali huy\u1ebft thanh. B\u1edfi v\u1eady, không khuy\u1ebfn cáo dùng thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali và thu\u1ed1c b\u1ed5 sung kali cho b\u1ec7nh nhân suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn vì có th\u1ec3 làm t\u0103ng kali huy\u1ebft. N\u1ebfu v\u1eabn c\u1ea7n ph\u1ea3i \u0111i\u1ec1u tr\u1ecb \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c l\u1ee3i ni\u1ec7u, ph\u1ea3i h\u1ebft s\u1ee9c th\u1eadn tr\u1ecdng và th\u01b0\u1eddng xuyên \u0111o kali huy\u1ebft. C\u1ea7n ph\u1ea3i \u0111o creatinin huy\u1ebft tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb thu\u1ed1c cho b\u1ec7nh nhân có nghi ng\u1edd b\u1ecb h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn.
\nTrong ph\u1eabu thu\u1eadt l\u1edbn ho\u1eb7c trong khi gây mê b\u1eb1ng thu\u1ed1c có tác d\u1ee5ng h\u1ea1 huy\u1ebft áp, enalapril có th\u1ec3 ng\u0103n c\u1ea3n t\u1ea1o angiotensin II, gây gi\u1ea3i phóng renin bù tr\u1eeb d\u1eabn \u0111\u1ebfn h\u1ea1 huy\u1ebft áp k\u1ecbch phát, c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh b\u1eb1ng t\u0103ng th\u1ec3 tích tu\u1ea7n hoàn (b\u1eb1ng d\u1ecbch truy\u1ec1n)
\nL\u01b0u ý khi s\u1eed d\u1ee5ng:
\n\u1ee8c ch\u1ebf kép h\u1ec7 renin-angiotensin-aldosteron (RAA): Có b\u1eb1ng ch\u1ee9ng cho th\u1ea5y vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi các thu\u1ed1c \u1ee9c ch\u1ebf ACE, thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin II ho\u1eb7c aliskiren làm t\u0103ng nguy c\u01a1 h\u1ea1 huy\u1ebft áp, t\u0103ng kali huy\u1ebft và suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn (bao g\u1ed3m suy th\u1eadn c\u1ea5p). \u1ee8c ch\u1ebf kép h\u1ec7 RAA b\u1eb1ng vi\u1ec7c dùng k\u1ebft h\u1ee3p thu\u1ed1c \u1ee9c ch\u1ebf ACE, thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin II ho\u1eb7c thu\u1ed1c ch\u1ee9a aliskiren không \u0111\u01b0\u1ee3c khuy\u1ebfn cáo. N\u1ebfu vi\u1ec7c \u0111i\u1ec1u tr\u1ecb này c\u1ea7n thi\u1ebft, khi \u0111i\u1ec1u tr\u1ecb ph\u1ea3i th\u01b0\u1eddng xuyên theo dõi ch\u1ee9c n\u0103ng th\u1eadn, ch\u1ea5t \u0111i\u1ec7n gi\u1ea3i và huy\u1ebft áp m\u1ed9t cách ch\u1eb7t ch\u1ebd. Các thu\u1ed1c \u1ee9c ch\u1ebf ACE, thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin II không nên dùng \u0111\u1ed3ng th\u1eddi trên b\u1ec7nh nhân có b\u1ec7nh th\u1eadn do \u0111ái tháo \u0111\u01b0\u1eddng.
\nH\u1ea1 huy\u1ebft áp có tri\u1ec7u chúng: H\u1ea1 huy\u1ebft áp có tri\u1ec7u ch\u1ee9ng r\u1ea9t hi\u1ebfm g\u1eb7p \u1edd b\u1ec7nh nhân t\u0103ng huy\u1ebft áp không bi\u1ebfn ch\u1ee9ng, \u1edf b\u1ec7nh nhân t\u0103ng huy\u1ebft áp dùng enalapril, d\u1ec5 có khuynh h\u01b0\u1edbng x\u1ea3y ra h\u1ea1 huy\u1ebft áp có tri\u1ec7u ch\u1ee9ng n\u1ebfu b\u1ec7nh nhân gi\u1ea3m th\u1ec3 tích tu\u1ea7n hoàn, nh\u01b0 dùng thu\u1ed1c l\u1ee3i ti\u1ec3u, ch\u1ebf \u0111\u1ed9 \u0103n h\u1ea1n ch\u1ebf mu\u1ed1i, th\u1ea9m phân, tiêu ch\u1ea3y ho\u1eb7c nôn. \u0110ã th\u1ea5y h\u1ea1 huy\u1ebft áp có tri\u1ec7u ch\u1ee9ng \u1edf b\u1ec7nh nhân suy tim có ho\u1eb7c không có suy th\u1eadn kèm theo. \u0110i\u1ec1u này có nhi\u1ec1u kh\u1ea3 n\u0103ng x\u1ea3y ra \u1edf b\u1ec7nh nhân suy tim n\u1eb7ng h\u01a1n, do dùng thu\u1ed1c l\u1ee3i ni\u1ec7u quai li\u1ec1u cao, gi\u1ea3m natri huy\u1ebft ho\u1eb7c suy ch\u1ee9c n\u0103ng th\u1eadn, \u1edf các b\u1ec7nh nhân này, nên kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb d\u01b0\u1edbi s\u1ef1 theo dõi y khoa và b\u1ec7nh nhân ph\u1ea3i \u0111\u01b0\u1ee3c theo dõi m\u1ed7i l\u1ea7n ch\u1ec9nh li\u1ec1u enalapril và/ ho\u1eb7c thu\u1ed1c l\u1ee3i ti\u1ec3u. Nh\u1eefng l\u01b0u ý t\u01b0\u01a1ng t\u1ef1 có th\u1ec3 áp d\u1ee5ng cho b\u1ec7nh nhân thi\u1ebfu máu c\u1ee5c b\u1ed9 c\u01a1 tim ho\u1eb7c b\u1ec7nh lý m\u1ea1ch máu não, vì s\u1ef1 gi\u1ea3m huy\u1ebft áp quá m\u1ee9c trên các b\u1ec7nh nhân này có th\u1ec3 d\u1eabn t\u1edbi nh\u1ed3i máu c\u01a1 tim ho\u1eb7c tai bi\u1ebfn m\u1ea1ch máu não.
\nN\u1ebfu h\u1ea1 huy\u1ebft áp x\u1ea3y ra, nên \u0111\u1ec3 b\u1ec7nh nhân n\u1eb1m ng\u1eeda và n\u1ebfu c\u1ea7n, truy\u1ec1n t\u0129nh m\u1ea1ch dung d\u1ecbch mu\u1ed1i \u0111\u1eb3ng tr\u01b0\u01a1ng. H\u1ea1 huy\u1ebft áp thoáng qua không ph\u1ea3i là ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh cho vi\u1ec7c ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb và th\u01b0\u1eddng không có gì tr\u1edf ng\u1ea1i khi dùng li\u1ec1u ti\u1ebfp theo m\u1ed9t khi huy\u1ebft áp \u0111ã t\u0103ng lên sau khi bù \u0111\u1ee7 d\u1ecbch.
\nM\u1ed9t s\u1ed1 b\u1ec7nh nhân suy tim có huy\u1ebft áp bình th\u01b0\u1eddng ho\u1eb7c huy\u1ebft áp th\u1ea5p, khi dùng enalapril có th\u1ec3 làm huy\u1ebft áp h\u1ea1 thêm. Tác d\u1ee5ng này \u0111ã \u0111\u01b0\u1ee3c bi\u1ebft tr\u01b0\u1edbc và th\u01b0\u1eddng không ph\u1ea3i là lý do \u0111\u1ec3 ng\u1eebng \u0111i\u1ec1u tr\u1ecb. N\u1ebfu h\u1ea1 huy\u1ebft áp có tri\u1ec7u ch\u1ee9ng x\u1ea3y ra, có th\u1ec3 gi\u1ea3m li\u1ec1u và/ho\u1eb7c ng\u01b0ng thu\u1ed1c l\u1ee3i ti\u1ec3u và/ ho\u1eb7c enalapril.
\nH\u1eb9p \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ho\u1eb7c van 2 lá/ phì \u0111\u1ea1i c\u01a1 tim: C\u0169ng nh\u01b0 các thu\u1ed1c gây giãn m\u1ea1ch khác, c\u1ea7n dùng th\u1eadn tr\u1ecdng thu\u1ed1c \u1ee9c ch\u1ebf ACE cho b\u1ec7nh nhân t\u1eafc ngh\u1ebdn van và \u0111\u01b0\u1eddng ra c\u1ee7a tâm th\u1ea5t trái và tránh dùng trong tr\u01b0\u1eddng h\u1ee3p s\u1ed1c tim và t\u1eafc ngh\u1ebdn huy\u1ebft \u0111\u1ed9ng \u0111áng k\u1ec3.
\nSuy ch\u1ee9c n\u0103ng th\u1eadn: Tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nhân b\u1ecb suy th\u1eadn (\u0111\u1ed9 thanh th\u1ea3i creatinin < 80 ml/phút), li\u1ec1u ban \u0111\u1ea7u c\u1ee7a enalapril nên \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh theo \u0111\u1ed9 thanh th\u1ea3i c\u1ee7a creatinin c\u1ee7a b\u1ec7nh nhân, sau \u0111ó \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u theo \u0111áp \u1ee9ng c\u1ee7a t\u1eebng b\u1ec7nh nhân. C\u1ea7n ph\u1ea3i theo dõi th\u01b0\u1eddng xuyên n\u1ed3ng \u0111\u1ed9 kali và creatinin trên b\u1ec7nh nhân này.
\n\u0110ã có báo cáo suy th\u1eadn x\u1ea3y ra khi dùng enalapril trên b\u1ec7nh nhân b\u1ecb suy tim n\u1eb7ng ho\u1eb7c b\u1ecb b\u1ec7nh th\u1eadn, g\u1ed3m c\u1ea3 h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn. N\u1ebfu \u0111\u01b0\u1ee3c phát hi\u1ec7n và \u0111i\u1ec1u ch\u1ec9nh k\u1ecbp th\u1eddi, thì tình tr\u1ea1ng suy th\u1eadn do dùng enalapril có th\u1ec3 \u0111\u01b0\u1ee3c ph\u1ee5c h\u1ed3i.
\nM\u1ed9t s\u1ed1 b\u1ec7nh nhân t\u0103ng huy\u1ebft áp không có bi\u1ec3u hi\u1ec7n b\u1ec7nh th\u1eadn t\u1eeb tr\u01b0\u1edbc \u0111ã ti\u1ebfn tri\u1ec3n tình tr\u1ea1ng t\u0103ng urê và creatinin huy\u1ebft khi dùng enalapril v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u. Gi\u1ea3m li\u1ec1u enalapril và/ho\u1eb7c ng\u01b0ng thu\u1ed1c l\u1ee3i ti\u1ec3u. Tình tr\u1ea1ng này có th\u1ec3 n\u1eb7ng h\u01a1n n\u1ebfu b\u1ec7nh nhân b\u1ecb h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn.
\nT\u0103ng huy\u1ebft áp do m\u1ea1ch máu th\u1eadn: \u0110\u1ed1i v\u1edbi b\u1ec7nh nhân b\u1ecb h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn hai bên ho\u1eb7c m\u1ed9t bên \u1edf ng\u01b0\u1eddi ch\u1ec9 có m\u1ed9t th\u1eadn, nguy c\u01a1 h\u1ea1 huy\u1ebft áp và suy th\u1eadn khi \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf ACE cao h\u01a1n. M\u1ea5t ch\u1ee9c n\u0103ng th\u1eadn có th\u1ec3 x\u1ea3y ra ch\u1ec9 v\u1edbi nh\u1eefng thay \u0111\u1ed5i nh\u1ecf v\u1ec1 creatinin huy\u1ebft thanh.
\n\u1ede nh\u1eefng b\u1ec7nh nhân này, nên b\u1eaft \u0111àu \u0111i\u1ec1u tr\u1ecb d\u01b0\u1edbi s\u1ef1 giám sát y khoa ch\u1eb7t ch\u1ebd v\u1edbi li\u1ec1u th\u1ea5p, ch\u1ec9nh liêu th\u1eadn tr\u1ecdng và theo dõi ch\u1ee9c n\u0103ng th\u1eadn.
\nGhép th\u1eadn: Ch\u01b0a có kinh nghi\u1ec7m s\u1eed d\u1ee5ng enalapril cho b\u1ec7nh nhân m\u1edbi ghép th\u1eadn. Do v\u1eady, không khuy\u1ebfn cáo dùng enalapril cho ng\u01b0\u1eddi ghép th\u1eadn.
\nSuy gan: Hi\u1ebfm khi \u0111i\u1ec1u tr\u1ecb v\u1edbi các thu\u1ed1c \u1ee9c ch\u1ebf ACE gây ra h\u1ed9i ch\u1ee9ng vàng da \u1ee9 m\u1eadt ho\u1eb7c viêm gan và ti\u1ebfn tri\u1ec3n \u0111\u1ebfn ho\u1ea1i t\u1eed gan bùng phát, \u0111ôi khi d\u1eabn \u0111\u1ebfn t\u1eed vong. C\u01a1 ch\u1ebf c\u1ee7a h\u1ed9i ch\u1ee9ng trên ch\u01b0a \u0111\u01b0\u1ee3c làm rõ. Trong khi \u0111i\u1ec1u tr\u1ecb v\u1edbi nhóm thu\u1ed1c này, n\u1ebfu có hi\u1ec7n t\u01b0\u1ee3ng vàng da hay enzym gan t\u0103ng cao thì nên ng\u01b0ng thu\u1ed1c và có nh\u1eefng theo dõi y t\u1ebf thích h\u1ee3p.
\nGi\u1ea3m b\u1ea1ch c\u1ea7u trung tính/ m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t: Gi\u1ea3m b\u1ea1ch c\u1ea7u trung tính, m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t, gi\u1ea3m ti\u1ec3u c\u1ea7u, thi\u1ebfu máu \u0111ã \u0111\u01b0\u1ee3c báo cáo \u1edf nh\u1eefng b\u1ec7nh nhân \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf ACE. \u1ede nh\u1eefng b\u1ec7nh nhân có ch\u1ee9c n\u0103ng th\u1eadn bình th\u01b0\u1eddng và không có y\u1ebfu t\u1ed1 ph\u1ee9c t\u1ea1p khác, gi\u1ea3m b\u1ea1ch c\u1ea7u trung tính hi\u1ebfm khi x\u1ea3y ra. Enalapril \u0111\u01b0\u1ee3c dùng th\u1eadn tr\u1ecdng trên nh\u1eefng b\u1ec7nh nhân b\u1ecb b\u1ec7nh collagen m\u1ea1ch máu, \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, \u0111i\u1ec1u tr\u1ecb b\u1eb1ng allopurinol ho\u1eb7c procainamid, ho\u1eb7c k\u1ebft h\u1ee3p nh\u1eefng y\u1ebfu t\u1ed1 này, \u0111\u1eb7c bi\u1ec7t v\u1edbi b\u1ec7nh nhân b\u1ecb suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn tr\u01b0\u1edbc \u0111ó. Trong m\u1ed9t vài tr\u01b0\u1eddng h\u1ee3p không \u0111áp \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb kháng sinh \u0111\u1eb7c tr\u1ecb, m\u1ed9t s\u1ed1 b\u1ec7nh nhân \u0111ã ti\u1ebfn tri\u1ec3n nhi\u1ec5m trùng n\u1eb7ng. Khi dùng enalapril cho nh\u1eefng b\u1ec7nh nhân này nên theo dõi s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u \u0111\u1ecbnh k\u1ef3 và h\u01b0\u1edbng d\u1eabn b\u1ec7nh nhân nh\u1eadn bi\u1ebft s\u1edbm các d\u1ea5u hi\u1ec7u nhi\u1ec5m trùng.
\nQuá m\u1eabn/phù m\u1ea1ch: Phù \u1edf m\u1eb7t, tay chân, môi, l\u01b0\u1ee1i, thanh môn và/ ho\u1eb7c thanh qu\u1ea3n hi\u1ebfm g\u1eb7p \u1edf nh\u1eefng b\u1ec7nh nhân \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf ACE, k\u1ec3 c\u1ea3 enalapril. Quá m\u1eabn có th\u1ec3 x\u1ea3y ra b\u1ea5t c\u1ee9 lúc nào trong th\u1eddi gian \u0111i\u1ec1u tr\u1ecb. Khi x\u1ea3y ra quá m\u1eabn trong quá trình \u0111i\u1ec1u tr\u1ecb, nên ng\u01b0ng dùng enalapril, theo dõi cho \u0111\u1ebfn khi các tri\u1ec7u ch\u1ee9ng bi\u1ebfn m\u1ea5t hoàn toàn. Th\u1eadm chí trong tr\u01b0\u1eddng h\u1ee3p ch\u1ec9 phù l\u01b0\u1ee1i, không có d\u1ea5u hi\u1ec7u khó th\u1edf, v\u1eabn ph\u1ea3i theo dõi k\u1ef9 và lâu dài b\u1ec7nh nhân vì tr\u1ecb li\u1ec7u kháng hist\u1ea1min và corticoid có th\u1ec3 không \u0111\u1ee7 hi\u1ec7u qu\u1ea3. Nh\u1eefng b\u1ec7nh nhân có ti\u1ec1n s\u1eed phù m\u1ea1ch không liên quan \u0111\u1ebfn các thu\u1ed1c \u1ee9c ch\u1ebf ACE có th\u1ec3 có nguy c\u01a1 b\u1ecb phù m\u1ea1ch cao khi dùng m\u1ed9t thu\u1ed1c \u1ee9c ch\u1ebf ACE.
\nPh\u1ea3n \u1ee9ng d\u1ea1ng ph\u1ea3n v\u1ec7 trong quá trình gi\u1ea3i m\u1eabn c\u1ea3m v\u1edbi côn trùng Hymenoptera: Hi\u1ebfm g\u1eb7p b\u1ec7nh nhân dùng thu\u1ed1c \u1ee9c ch\u1ebf ACE b\u1ecb ph\u1ea3n \u1ee9ng d\u1ea1ng ph\u1ea3n v\u1ec7 \u0111e d\u1ecda tính m\u1ea1ng trong khi \u0111ang \u0111i\u1ec1u tr\u1ecb gi\u1ea3i m\u1eabn c\u1ea3m v\u1edbi n\u1ecdc \u0111\u1ed9c Hymenoptera. \u0110ã tránh \u0111\u01b0\u1ee3c các ph\u1ea3n \u1ee9ng này khi t\u1ea1m ng\u1eebng \u0111i\u1ec1u tr\u1ecb thu\u1ed1c \u1ee9c ch\u1ebf ACE tr\u01b0\u1edbc m\u1ed7i làn gi\u1ea3i m\u1eabn c\u1ea3m.
\nPh\u1ea3n \u1ee9ng d\u1ea1ng ph\u1ea3n v\u1ec7 trong quá trình th\u1ea9m ph\u1ea7n lo\u1ea1i LDL: M\u1ed9t s\u1ed1 b\u1ec7nh nhân s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf ACE trong quá trình th\u1ea9m phân lo\u1ea1i LDL b\u1eb1ng dextran sulfat có th\u1ec3 x\u1ea3y ra ph\u1ea3n \u1ee9ng d\u1ea1ng ph\u1ea3n v\u1ec7 nguy hi\u1ec3m \u0111\u1ebfn tính m\u1ea1ng, m\u1eb7c dù các tr\u01b0\u1eddng h\u1ef1p này hi\u1ebfm khi x\u1ea3y ra. Có th\u1ec3 lo\u1ea1i tr\u1eeb các ph\u1ea3n \u1ee9ng này b\u1eb1ng cách t\u1ea1m ng\u1eebng s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf ACE tr\u01b0\u1edbc m\u1ed7i \u0111\u1ee3t th\u1ea9m phân.
\nB\u1ec7nh nhân th\u1ea9m phân máu: Các ph\u1ea3n \u1ee9ng d\u1ea1ng ph\u1ea3n v\u1ec7 \u0111ã \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf b\u1ec7nh nhân \u0111\u01b0\u1ee3c th\u1ea9m phân v\u1edbi màng l\u1ecdc có tính th\u1ea5m cao và \u0111i\u1ec1u tr\u1ecb cùng lúc v\u1edbi m\u1ed9t thu\u1ed1c \u1ee9c ch\u1ebf ACE. \u1ede nh\u1eefng b\u1ec7nh nhân này, nên l\u01b0u ý dùng m\u1ed9t lo\u1ea1i màng th\u1ea9m phân khác ho\u1eb7c m\u1ed9t nhóm thu\u1ed1c h\u1ea1 huy\u1ebft áp khác.
\nGi\u1ea3m glucose máu: Khi b\u1eaft \u0111\u1ea7u dùng thu\u1ed1c \u1ee9c ch\u1ebf ACE cho b\u1ec7nh nhân \u0111ái tháo \u0111\u01b0\u1eddng \u0111ã \u0111i\u1ec1u tr\u1ecb v\u1edbi m\u1ed9t thu\u1ed1c ch\u1ed1ng \u0111ái tháo \u0111\u01b0\u1eddng d\u1ea1ng u\u1ed1ng ho\u1eb7c insulin, ph\u1ea3i cho b\u1ec7nh nhân bi\u1ebft cách theo dõi ch\u1eb7t ch\u1ebd tình tr\u1ea1ng h\u1ea1 glucose máu, \u0111\u1eb7c bi\u1ec7t trong tháng \u0111\u1ea7u tiên khi b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p.
\nHo: Ho \u0111ã \u0111\u01b0\u1ee3c ghi nh\u1eadn khi s\u1eed d\u1ee5ng \u1ee9c ch\u1ebf ACE. \u0110i\u1ec3n hình là ho khan, kéo dài và s\u1ebd h\u1ebft khi ng\u01b0ng thu\u1ed1c. Nên l\u01b0u ý \u0111\u1ebfn ph\u1ea3n \u1ee9ng ho do dùng thu\u1ed1c \u1ee9c ch\u1ebf ACE khi ch\u1ea9n \u0111oán phân bi\u1ec7t v\u1edbi các b\u1ec7nh lý gây ho.
\nPh\u1eabu thu\u1eadt gây mê: \u1ede b\u1ec7nh nhân \u0111ang tr\u1ea3i qua cu\u1ed9c ph\u1eabu thu\u1eadt l\u1edbn ho\u1eb7c trong lúc gây mê v\u1edbi các thu\u1ed1c gây mê có tác d\u1ee5ng h\u1ea1 huy\u1ebft áp, enalapril ng\u0103n ch\u1eb7n s\u1ef1 hình thành angiotensin II, gây gi\u1ea3i phóng renin bù tr\u1eeb. N\u1ebfu h\u1ea1 huy\u1ebft áp x\u1ea3y ra và \u0111\u01b0\u1ee3c cho là do c\u01a1 ch\u1ebf này, có th\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng cách làm t\u0103ng th\u1ec3 tích.
\nT\u0103ng kali huy\u1ebft: T\u0103ng kali huy\u1ebft \u0111\u01b0\u1ee3c th\u1ea5y \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nhân \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf ACE, k\u1ec3 c\u1ea3 enalapril. Các y\u1ebfu t\u1ed1 nguy c\u01a1 gây t\u0103ng kali huy\u1ebft bao g\u1ed3m suy th\u1eadn, suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn, tu\u1ed5i tác (> 70 tu\u1ed5i), \u0111ái tháo \u0111\u01b0\u1eddng, tình tr\u1ea1ng m\u1ea5t n\u01b0\u1edbc, m\u1ea5t bù tim c\u1ea5p tính, nhi\u1ec5m toan chuy\u1ec3n hóa và s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali (nh\u01b0 spironolacton, eplerenon, triamteren, ho\u1eb7c amilorid), thu\u1ed1c b\u1ed5 sung kali ho\u1eb7c các ch\u1ea5t thay th\u1ebf mu\u1ed1i ch\u1ee9a kali hay thu\u1ed1c khác có liên quan \u0111\u1ebfn t\u0103ng kali huy\u1ebft (nh\u01b0 heparin). Vi\u1ec7c s\u1eed d\u1ee5ng các thu\u1ed1c b\u1ed5 sung kali, thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali hay các ch\u1ea5t thay th\u1ebf mu\u1ed1i ch\u1ee9a kali, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nhân suy th\u1eadn có th\u1ec3 gây t\u0103ng n\u1ed3ng \u0111\u1ed9 kali huy\u1ebft \u0111áng k\u1ec3. T\u0103ng kali huy\u1ebft có th\u1ec3 gây lo\u1ea1n nh\u1ecbp nghiêm tr\u1ecdng và \u0111ôi khi có th\u1ec3 gây t\u1eed vong. N\u1ebfu vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi enalapril và b\u1ea5t k\u1ef3 thu\u1ed1c nào k\u1ec3 trên \u0111\u01b0\u1ee3c xem là h\u1ee3p lý thì c\u1ea7n ph\u1ea3i th\u1eadn tr\u1ecdng và th\u01b0\u1eddng xuyên theo dõi n\u1ed3ng \u0111\u1ed9 kali trong huy\u1ebft thanh.
\nLithi: Vi\u1ec7c k\u1ebft h\u1ee3p lithi và enalapril không \u0111\u01b0\u1ee3c khuy\u1ebfn cáo.
\nEnalapril STELLA 5mg có ch\u1ee9a lactose. Không nên dùng thu\u1ed1c này cho b\u1ec7nh nhân có các v\u1ea5n \u0111\u1ec1 v\u1ec1 di truy\u1ec1n hi\u1ebfm g\u1eb7p không dung n\u1ea1p galactose, thi\u1ebfu h\u1ee5t enzym lactase toàn ph\u1ea7n hay kém h\u1ea5p thu glucose-galactose.
\nT\u01b0\u01a1ng tác v\u1edbi các thu\u1ed1c khác
\nT\u01b0\u01a1ng tác c\u1ee7a thu\u1ed1c
\nH\u1ea1 huy\u1ebft áp quá m\u1ee9c có th\u1ec3 x\u1ea3y ra khi s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u, các thu\u1ed1c ch\u1ed1ng t\u0103ng huy\u1ebft áp khác ho\u1eb7c các tác nhân gây h\u1ea1 huy\u1ebft áp khác nh\u01b0 r\u01b0\u1ee3u.
\nHi\u1ec7n t\u01b0\u1ee3ng t\u0103ng kali huy\u1ebft c\u1ed9ng g\u1ed9p có th\u1ec3 x\u1ea3y ra \u1edf b\u1ec7nh nhân \u0111ang dùng thu\u1ed1c \u1ee9c ch\u1ebf ACE v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u gi\u1eef kali, thu\u1ed1c b\u1ed5 sung kali (bao g\u1ed3m ch\u1ea5t thay th\u1ebf mu\u1ed1i ch\u1ee9a kali) ho\u1eb7c các thu\u1ed1c khác gây t\u0103ng kali huy\u1ebft (nh\u01b0 cyclosporin ho\u1eb7c indomethacin), nên theo dõi n\u1ed3ng \u0111\u1ed9 kali huy\u1ebft thanh.
\nTác d\u1ee5ng không mong mu\u1ed1n trên th\u1eadn c\u1ee7a các thu\u1ed1c \u1ee9c ch\u1ebf ACE có th\u1ec3 t\u0103ng lên khi dùng v\u1edbi các thu\u1ed1c khác \u1ea3nh h\u01b0\u1edfng lên ch\u1ee9c n\u0103ng th\u1eadn nh\u01b0 thu\u1ed1c kháng viêm không steroid.
\nLithi: \u0110\u1ed9c tính lithi \u0111ã \u0111\u01b0\u1ee3c báo cáo \u1edf nh\u1eefng b\u1ec7nh nhân dùng lithi \u0111\u1ed3ng th\u1eddi v\u1edbi các thu\u1ed1c gây th\u1ea3i tr\u1eeb natri nh\u01b0 thu\u1ed1c \u1ee9c ch\u1ebf ACE. Nên theo dõi n\u1ed3ng \u0111\u1ed9 lithi huy\u1ebft thanh th\u01b0\u1eddng xuyên n\u1ebfu dùng enalapril v\u1edbi lithi.
\nS\u1eed d\u1ee5ng enalapril \u0111\u1ed3ng th\u1eddi v\u1edbi các thu\u1ed1c giãn ph\u1ebf qu\u1ea3n ki\u1ec3u giao c\u1ea3m, các thu\u1ed1c ch\u1ed1ng viêm không steroid (NSAID) có th\u1ec3 làm gi\u1ea3m tác d\u1ee5ng h\u1ea1 huy\u1ebft áp c\u1ee7a enalapril.
\nS\u1eed d\u1ee5ng enalapril \u0111\u1ed3ng th\u1eddi v\u1edbi các thu\u1ed1c tránh thai \u0111\u01b0\u1eddng u\u1ed1ng gây t\u0103ng nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch và khó ki\u1ec3m soát huy\u1ebft áp.
\nT\u01b0\u01a1ng k\u1ef5 c\u1ee7a thu\u1ed1c
\nDo không có các nghiên c\u1ee9u v\u1ec1 tính t\u01b0\u01a1ng k\u1ef5 c\u1ee7a thu\u1ed1c, không tr\u1ed9n l\u1eabn thu\u1ed1c này v\u1edbi các thu\u1ed1c khác.
", "index": 3}, {"title": "Ch\u1ec9 \u0111\u1ecbnh", "content": "T\u0103ng huy\u1ebft áp: Enalapril \u0111\u01b0\u1ee3c dùng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft áp t\u1eeb nh\u1eb9 \u0111\u1ebfn n\u1eb7ng. Thu\u1ed1c \u0111\u01b0\u1ee3c dùng \u0111\u01a1n tr\u1ecb ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi các thu\u1ed1c ch\u1ed1ng t\u0103ng huy\u1ebft áp khác.
\nSuy tim sung huy\u1ebft: Enalapril th\u01b0\u1eddng \u0111\u01b0\u1ee3c dùng k\u1ebft h\u1ee3p v\u1edbi glycosid tim, thu\u1ed1c l\u1ee3i ti\u1ec3u và thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 beta-adrenergic \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb suy tim sung huy\u1ebft có tri\u1ec7u ch\u1ee9ng.
\n\u0110i\u1ec1u tr\u1ecb d\u1ef1 phòng \u1edf b\u1ec7nh nhân r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t trái không tri\u1ec7u ch\u1ee9ng \u0111\u1ec3 làm ch\u1eadm s\u1ef1 phát tri\u1ec3n tr\u1edf thành suy tim có tri\u1ec7u ch\u1ee9ng và \u1edf b\u1ec7nh nhân r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t trái \u0111\u1ec3 làm gi\u1ea3m t\u1ec9 l\u1ec7 m\u1eafc b\u1ec7nh thi\u1ebfu máu c\u1ee5c b\u1ed9 m\u1ea1ch vành, k\u1ec3 c\u1ea3 nh\u1ed3i máu c\u01a1 tim.
", "index": 4}, {"title": "Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh", "content": "Quá m\u1eabn v\u1edbi thu\u1ed1c hay b\u1ea5t k\u1ef3 thành ph\u1ea7n nào trong công th\u1ee9c.
\nCó ti\u1ec1n s\u1eed phù m\u1ea1ch do \u0111i\u1ec1u tr\u1ecb thu\u1ed1c \u1ee9c ch\u1ebf ACE và b\u1ec7nh nhân b\u1ecb phù m\u1ea1ch di truy\u1ec1n hay t\u1ef1 phát.
\nH\u1eb9p \u0111\u1ed9ng m\u1ea1ch hai bên th\u1eadn ho\u1eb7c h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn \u1edf ng\u01b0\u1eddi ch\u1ec9 có m\u1ed9t th\u1eadn.
\nH\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 và b\u1ec7nh c\u01a1 tim t\u1eafc ngh\u1ebdn n\u1eb7ng.
\nH\u1ea1 huy\u1ebft áp tr\u01b0\u1edbc \u0111ó.
\nPh\u1ee5 n\u1eef có thai 3 tháng gi\u1eefa và 3 tháng cu\u1ed1i thai k\u1ef3.
", "index": 5}, {"title": "Li\u1ec1u d\u00f9ng", "content": "Cách dùng
\nEnalapril STELLA 5 mg \u0111\u01b0\u1ee3c dùng b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng.
\nLi\u1ec1u dùng
\n\u0110i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft áp:
\nLi\u1ec1u kh\u1edfi \u0111\u1ea7u 5 mg enalapril maleate/ngày. Vì có th\u1ec3 x\u1ea3y ra h\u1ea1 huy\u1ebft áp \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nhân khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf ACE, nên dùng li\u1ec1u \u0111\u1ea7u tiên vào lúc \u0111i ng\u1ee7.
\n\u1ede nh\u1eefng b\u1ec7nh nhân b\u1ecb suy th\u1eadn ho\u1eb7c \u0111ang dùng thu\u1ed1c l\u1ee3i ti\u1ec3u: Li\u1ec1u kh\u1edfi \u0111\u1ea7u 2,5 mg/ngày. Nên ng\u01b0ng dùng thu\u1ed1c l\u1ee3i ti\u1ec3u 2 - 3 ngày tr\u01b0\u1edbc khi kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng enalapril và ti\u1ebfp t\u1ee5c s