{"id":18479,"date":"2020-05-15T10:17:56","date_gmt":"2020-05-15T03:17:56","guid":{"rendered":"https:\/\/pharmog.com\/wp\/?p=18479"},"modified":"2025-01-08T20:59:09","modified_gmt":"2025-01-08T13:59:09","slug":"clozapine-dafidi","status":"publish","type":"post","link":"https:\/\/pharmog.com\/wp\/clozapine-dafidi\/","title":{"rendered":"Clozapine &#8211; Dafidi"},"content":{"rendered":"<p><strong>1. T\u00ean ho\u1ea1t ch\u1ea5t v\u00e0 bi\u1ec7t d\u01b0\u1ee3c: <\/strong><\/p>\n<p><strong><em>Ho\u1ea1t ch\u1ea5t :<\/em> <a href=\"https:\/\/pharmog.com\/wp\/clozapine\/\">Clozapine<\/a><\/strong><\/p>\n<p><strong><em>Ph\u00e2n lo\u1ea1i: <\/em><\/strong><em>Thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n<\/em><\/p>\n<p><strong><em>Nh\u00f3m<\/em><\/strong> <strong><em>ph\u00e1p l\u00fd: <\/em><\/strong><em>Thu\u1ed1c k\u00ea \u0111\u01a1n ETC \u2013 (Ethical drugs, prescription drugs, Prescription only medicine)<\/em><\/p>\n<p><strong><em>M\u00e3 ATC<\/em><\/strong> (Anatomical Therapeutic Chemical): N05AH02<\/p>\n<p><strong><em>Bi\u1ec7t d\u01b0\u1ee3c g\u1ed1c:<\/em><\/strong><\/p>\n<p><strong><em>Bi\u1ec7t d\u01b0\u1ee3c:<\/em><\/strong> Dafidi<\/p>\n<p><strong><em>H\u00e3ng s\u1ea3n xu\u1ea5t <\/em><\/strong>: CT CP SX th\u01b0\u01a1ng m\u1ea1i D\u01b0\u1ee3c ph\u1ea9m \u0110\u00f4ng nam.<\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>2. D\u1ea1ng b\u00e0o ch\u1ebf &#8211; H\u00e0m l\u01b0\u1ee3ng: <\/strong><\/p>\n<p><strong><em>D\u1ea1ng thu\u1ed1c v\u00e0 h\u00e0m l\u01b0\u1ee3ng<\/em><\/strong><\/p>\n<p>Vi\u00ean n\u00e9n: 25 mg, 100 mg.<\/p>\n<p><strong><em>Thu\u1ed1c tham kh\u1ea3o:<\/em><\/strong><\/p>\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\"><strong><em>DAFIDI 25<\/em><\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><em>M\u1ed7i vi\u00ean n\u00e9n c\u00f3 ch\u1ee9a:<\/em><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>Clozapine<\/td>\n<td>&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<\/td>\n<td>25 mg<\/td>\n<\/tr>\n<tr>\n<td>T\u00e1 d\u01b0\u1ee3c<\/td>\n<td>&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<\/td>\n<td>v\u1eeba \u0111\u1ee7 (Xem m\u1ee5c 6.1)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-37206\" src=\"https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2020\/05\/DAdifi-25.png\" alt=\"\" width=\"590\" height=\"302\" srcset=\"https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2020\/05\/DAdifi-25.png 590w, https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2020\/05\/DAdifi-25-300x154.png 300w\" sizes=\"auto, (max-width: 590px) 100vw, 590px\" \/><\/p>\n<p><strong>3. Video by Pharmog:<\/strong><\/p>\n<p><strong>[VIDEO D\u01af\u1ee2C L\u00dd]<\/strong><\/p>\n<p>&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<\/p>\n<p>\u25ba K\u1ecbch B\u1ea3n: PharmogTeam<\/p>\n<p>\u25ba Youtube: https:\/\/www.youtube.com\/c\/pharmog<\/p>\n<p>\u25ba Facebook: https:\/\/www.facebook.com\/pharmog\/<\/p>\n<p>\u25ba Group : H\u1ed9i nh\u1eefng ng\u01b0\u1eddi m\u00ea d\u01b0\u1ee3c l\u00fd<\/p>\n<p>\u25ba Instagram : https:\/\/www.instagram.com\/pharmogvn\/<\/p>\n<p>\u25ba Website: pharmog.com<\/p>\n<p><strong>4. \u1ee8ng d\u1ee5ng l\u00e2m s\u00e0ng: <\/strong><\/p>\n<p><strong>4.1. Ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n<p><em>T\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t kh\u00e1ng tr\u1ecb:<\/em><\/p>\n<p>\u0110\u01b0\u1ee3c ch\u1ec9 \u0111inh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n t\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t kh\u00e1ng tr\u1ecb v\u00e0 b\u1ec7nh nh\u00e2n t\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t c\u00f3 nghi\u00eam tr\u1ecdng, ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i v\u1ec1 th\u1ea7n kinh kh\u00f4ng ch\u1eefa cho c\u00e1c \u0111\u1ea1i l\u00fd t\u00e0m th\u1ea7n kh\u00e1c, bao g\u1ed3m c\u00e0 thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.<\/p>\n<p>Kh\u00e1ng \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a nh\u01b0 l\u00e0 m\u1ed9t thi\u1ebfu c\u00e0i thi\u1ec7n l\u00e2m s\u00e0ng th\u1ecfa \u0111\u00e1ng d\u00f9 \u0111\u00e3 s\u1eed d\u1ee5ng \u0111\u1ee7 li\u1ec1u \u00edt nh\u00e2t hai thu\u00f4c ch\u00f4ng lo\u1ea1n th\u00e2n kh\u00e1c nhau, k\u1ec3 c\u1ea3 ch\u1ea5t ch\u1ed1ng lo\u1ea1n th\u1ea7n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, quy \u0111\u1ecbnh \u0111\u1ed1i v\u1edbi kho\u1ea3ng th\u1eddi gian th\u00edch h\u1ee3p.<\/p>\n<p><em>R\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n trong su\u1ed1t qu\u00e1 tr\u00ecnh c\u1ee7a b\u1ec7nh Parkinson<\/em><\/p>\n<p>Clozapin c\u0169ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong c\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n x\u1ea3y ra trong qu\u00e1 tr\u00ecnh c\u1ee7a b\u1ec7nh Parkinson, trong tr\u01b0\u1eddng h\u1ecdp \u0111i\u00eau tr\u1ecb chu\u00e2n \u0111\u00e3 th\u00e1t b\u1ea1i.<\/p>\n<p><strong>4.2. Li\u1ec1u d\u00f9ng &#8211; C\u00e1ch d\u00f9ng:<\/strong><\/p>\n<p><strong><em>C\u00e1ch d\u00f9ng<\/em><\/strong> :<\/p>\n<p>Clozapin \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng, c\u00f3 th\u1ec3 u\u1ed1ng trong b\u1eefa \u0103n ho\u1eb7c c\u00e1ch xa b\u1eefa \u0103n.<\/p>\n<p><strong><em>Li\u1ec1u d\u00f9ng:<\/em><\/strong><\/p>\n<p>Li\u1ec1u d\u00f9ng c\u1ee7a clozapin ph\u1ea3i \u0111\u01b0\u1ee3c hi\u1ec7u ch\u1ec9nh th\u1eadn tr\u1ecdng tr\u00ean t\u1eebng b\u1ec7nh nh\u00e2n v\u00e0 s\u1eed d\u1ee5ng li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3. Li\u1ec1u d\u00f9ng n\u00ean \u0111\u01b0\u1ee3c t\u0103ng d\u1ea7n v\u00e0 chia th\u00e0nh nhi\u1ec1u li\u1ec1u trong ng\u00e0y khi kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 gi\u1ea3m thi\u1ec3u ADR.<\/p>\n<p>Li\u1ec1u l\u01b0\u1ee3ng ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh ri\u00eang. \u0110\u1ed1i v\u1edbi m\u1ed7i b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng li\u1ec1u th\u1ea5p nh\u00e2t c\u00f3 hi\u1ec7u. \u0110\u00f4i v\u1edbi li\u00eau kh\u00f4ng th\u00ea th\u1ef1c hi\u1ec7n \/ th\u1ef1c hi\u1ec7n th\u1eadn tr\u1ecdng v\u00e0 m\u1ed9t l\u1ecbch tr\u00ecnh li\u1ec1u chia \u0111\u1ec1u l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nh\u1eefng r\u1ee7i ro c\u1ee7a h\u1ea1 huy\u1ebft \u00e1p, co gi\u1eadt v\u00e0 an th\u1ea7n.<\/p>\n<p>B\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb Clozapin ph\u1ea3i \u0111\u01b0\u1ee3c gi\u1edbi h\u1ea1n cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ea1ch c\u1ea7u \u0111\u1ebfm &gt; 3500 \/ mm3 (3.5xl09 \/1) v\u00e0 m\u1ed9t ANC &gt; 2000 \/ mm3 (2.0xl09 \/1) trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng trong ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb. \u0110i\u1ec1u chinh li\u1ec1u l\u01b0\u1ee3ng \u0111\u01b0\u1ee3c chi \u0111\u1ecbnh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u0169ng nh\u1eadn \u0111\u01b0\u1ee3c c\u00e1c thu\u00f4c c\u00f3 t\u01b0\u01a1ng t\u00e1c d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc v\u00e0 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc v\u1edbi Clozapin, ch\u1eb3ng h\u1ea1n nh\u01b0 c\u00e1c benzodiazepin ho\u1eb7c thu\u1ed1c \u1ee9c ch\u1ebf serotonin c\u00f3 ch\u1ecdn l\u1ecdc t\u00e1i h\u1ea5p thu<\/p>\n<p><em>Chuy\u1ec3n t\u1eeb m\u1ed9t li\u1ec7u ph\u00e1p ch\u1ed1ng lo\u1ea1n th\u00e2n tr\u01b0\u1edbc \u0111\u1ec1 \u0111i\u00eau tr\u1ecb v\u1edbi Clozapin<\/em><\/p>\n<p>Clozapin kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n kh\u00e1c. Khi \u0111i\u1ec1u tr\u1ecb Clozapin l\u00e0 \u0111\u1ec3 \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n tr\u1ea3i qua li\u1ec7u ph\u00e1p ch\u1ed1ng lo\u1ea1n th\u1ea7n, n\u00f3 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o r\u1eb1ng c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n kh\u00e1c l\u1ea7n \u0111\u1ea7u ti\u00ean n\u00ean ng\u01b0ng b\u1edfi khi gi\u1ea3m li\u1ec1u l\u01b0\u1ee3ng xu\u1ed1ng d\u01b0\u1edbi.<\/p>\n<p>C\u00e1c li\u1ec1u l\u01b0\u1ee3ng sau \u0111\u00e2y \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb:<\/p>\n<p><em>Li\u1ec1u d\u00f9ng cho ng\u01b0\u1eddi l\u1edbn tr\u00ean 16 tu\u1ed5i:<\/em><\/p>\n<p><em>\u0110i\u1ec1u tr\u1ecb t\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t kh\u00e1ng tr\u1ecb:<\/em> Ng\u00e0y \u0111\u1ea7u ti\u00ean: 12,5 mg, 1 ho\u1eb7c 2 l\u1ea7n\/ ng\u00e0y (ng\u01b0\u1eddi cao tu\u1ed5i 12,5 mg, 1 l\u1ea7n\/ng\u00e0y), ng\u00e0y th\u1ee9 hai: 25 &#8211; 50 mg, 1 ho\u1eb7c 2 l\u1ea7n\/ng\u00e0y (ng\u01b0\u1eddi cao tu\u1ed5i 25 &#8211; 37,5 mg, 1 l\u1ea7n\/ng\u00e0y) sau \u0111\u00f3 t\u0103ng d\u1ea7n li\u1ec1u (th\u00eam 25 &#8211; 50 mg\/ng\u00e0y cho m\u1ed7i l\u1ea7n t\u0103ng; ng\u01b0\u1eddi cao tu\u1ed5i th\u00eam t\u1ed1i \u0111a 25 mg\/ng\u00e0y) t\u00f9y thu\u1ed9c v\u00e0o dung n\u1ea1p c\u1ee7a b\u1ec7nh nh\u00e2n trong v\u00f2ng 14 &#8211; 21 ng\u00e0y cho \u0111\u1ebfn khi \u0111\u1ea1t m\u1ee9c li\u1ec1u 300 mg\/ng\u00e0y, chia l\u00e0m nhi\u1ec1u l\u1ea7n (s\u1eed d\u1ee5ng li\u1ec1u l\u1edbn h\u01a1n tr\u01b0\u1edbc khi \u0111i ng\u1ee7, t\u1ed1i \u0111a 200 mg). Trong tr\u01b0\u1eddng h\u1ee3p c\u1ea7n thi\u1ebft, c\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c t\u0103ng li\u1ec1u th\u00eam (th\u00eam 50 &#8211; 100 mg sau m\u1ed7i tu\u1ea7n) \u0111\u1ec3 \u0111\u1ea1t li\u1ec1u \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng d\u00f9ng trong kho\u1ea3ng 250 &#8211; 400 mg\/ng\u00e0y (t\u1ed1i \u0111a 900 mg\/ng\u00e0y). Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u01b0u ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft r\u00f5 nh\u01b0ng th\u01b0\u1eddng k\u00e9o d\u00e0i \u00edt nh\u1ea5t 12 tu\u1ea7n, c\u00f3 th\u1ec3 l\u00ean t\u1edbi 5 &#8211; 9 th\u00e1ng n\u1ebfu b\u1ec7nh kh\u00f4ng ti\u1ebfn tri\u1ec3n x\u1ea5u \u0111i ho\u1eb7c xu\u1ea5t hi\u1ec7n \u0111\u1ed9c t\u00ednh nghi\u00eam tr\u1ecdng c\u1ee7a thu\u1ed1c. L\u01b0u \u00fd khi \u0111\u00e3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, c\u1ea7n ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3. Sau khi \u0111\u00e3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c c\u00e1c tri\u1ec7u ch\u1ee9ng, c\u1ea7n th\u1eadn tr\u1ecdng gi\u1ea3m li\u1ec1u t\u1edbi li\u1ec1u duy tr\u00ec t\u1ed1i thi\u1ec3u c\u00f3 hi\u1ec7u qu\u1ea3.<\/p>\n<p>Li\u1ec1u t\u1ed1i \u0111a : \u0110\u1ebf c\u00f3 \u0111\u01b0\u1ee3c l\u1ee3i \u00edch \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7y \u0111\u00f9, m\u1ed9t v\u00e0i b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u1ea7n li\u1ec1u l\u1edbn h\u01a1n, trong m\u1ed9t v\u00e0i tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 l\u00ean \u0111\u1ebfn 900 mg\/ng\u00e0y. Kh\u1ea3 n\u0103ng t\u0103ng ph\u1ea3n \u1ee9ng ph\u1ee5 (trong c\u01a1n \u0111\u1ed9ng kinh) x\u1ea3y ra \u1edf li\u1ec1u tr\u00ean 450 mg\/ng\u00e0y ph\u1ea3i \u0111\u01b0\u1ee3c l\u01b0u \u00fd.<\/p>\n<p>Li\u1ec1u duy tr\u00ec : Khi \u0111\u00e3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, c\u1ea7n ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3 \u0110i\u1ec1u tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c duy tr\u00ec trong \u00edt nh\u1ea5t 6 th\u00e1ng. N\u1ebfu li\u1ec1u h\u00e0ng ng\u00e0y kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 200 mg n\u00ean d\u00f9ng thu\u1ed1c m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y v\u00e0o bu\u1ed5i t\u1ed1i.<\/p>\n<p>K\u1ebft th\u00fac \u0111i\u1ec1u tr\u1ecb: Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 k\u1ebf ho\u1ea1ch ch\u1ea5m d\u1ee9t \u0111i\u1ec1u tr\u1ecb b\u00e0ng clozapin, n\u00ean gi\u1ea3m d\u1ea7n li\u1ec1u trong th\u1eddi gian 1 \u0111\u1ebfn 2 tu\u1ea7n tr\u01b0\u1edbc khi ng\u01b0ng. N\u1ebfu ng\u01b0ng thu\u1ed1c \u0111\u1ed9t ng\u1ed9t l\u00e0 c\u1ea7n thi\u1ebft (v\u00ed d\u1ee5 v\u00ec leucopoenia), b\u1ec7nh nh\u00e0n ph\u1ea3i \u0111\u01b0\u1ee3c theo d\u00f5i c\u1ea9n th\u1eadn \u0111\u1ec1 ph\u00f2ng s\u1ef1 t\u00e1i ph\u00e1t c\u1ee7a c\u00e1c tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn ph\u1ee5c h\u1ed3i cholinergic, nh\u01b0 ra m\u1ed3 h\u00f4i, nh\u1ee9c \u0111\u1ea7u, bu\u1ed3n n\u00f4n, n\u00f4n m\u1eeda v\u00e0 ti\u00eau ch\u1ea3y<\/p>\n<p><em>Ch\u00fa \u00fd:<\/em> Trong tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb l\u1ea1i sau khi ng\u1eebng clozapin tr\u01b0\u1edbc \u0111\u00f3, c\u1ea7n t\u00f4n tr\u1ecdng kho\u1ea3ng c\u00e1ch \u00edt nh\u1ea5t 2 ng\u00e0y gi\u1eefa 2 \u0111\u1ee3t \u0111i\u1ec1u tr\u1ecb, b\u1eaft \u0111\u1ea7u b\u1eb1ng li\u1ec1u 12,5 mg, 1 ho\u1eb7c 2 l\u1ea7n\/ng\u00e0y trong ng\u00e0y \u0111\u1ea7u ti\u00ean, giai \u0111o\u1ea1n t\u0103ng li\u1ec1u nhanh c\u00f3 th\u1ec3 nhanh h\u01a1n so v\u1edbi giai \u0111o\u1ea1n \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3. Tuy nhi\u00ean c\u1ea7n h\u1ebft s\u1ee9c th\u1eadn tr\u1ecdng n\u1ebfu c\u00f3 xu\u1ea5t hi\u1ec7n ng\u1eebng tim ho\u1eb7c h\u00f4 h\u1ea5p tr\u01b0\u1edbc \u0111\u00f3 khi s\u1eed d\u1ee5ng li\u1ec1u kh\u1edfi \u0111\u1ea7u.<\/p>\n<p><em>Gi\u1ea3m nguy c\u01a1 t\u00e1i ph\u00e1t c\u00e1c h\u00e0nh vi t\u1ef1 t\u1eed \u1edf b\u1ec7nh nh\u00e2n t\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t ho\u1eb7c m\u1eafc c\u00e1c lo\u1ea1n th\u1ea7n kh\u00e1c:<\/em> B\u1eaft \u0111\u1ea7u: 12,5 mg, 1 ho\u1eb7c 2 l\u1ea7n\/ng\u00e0y, sau \u0111\u00f3 t\u0103ng d\u1ea7n li\u1ec1u t\u00f9y theo \u0111\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n (t\u0103ng 25 &#8211; 50 mg\/ng\u00e0y cho m\u1ed7i l\u1ea7n t\u0103ng) \u0111\u1ebfn m\u1ee9c li\u1ec1u 300 &#8211; 450 mg\/ng\u00e0y sau 2 tu\u1ea7n. Li\u1ec1u trung b\u00ecnh th\u01b0\u1eddng d\u00f9ng kho\u1ea3ng 300 mg\/ng\u00e0y (dao \u0111\u1ed9ng t\u1eeb 12,5 mg \u0111\u1ebfn 900 mg\/ng\u00e0y). Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c k\u00e9o d\u00e0i \u00edt nh\u1ea5t 2 n\u0103m n\u1ebfu nh\u01b0 b\u1ec7nh kh\u00f4ng ti\u1ebfn tri\u1ec3n x\u1ea5u \u0111i ho\u1eb7c xu\u1ea5t hi\u1ec7n \u0111\u1ed9c t\u00ednh nghi\u00eam tr\u1ecdng c\u1ee7a thu\u1ed1c.<\/p>\n<p><em>\u0110i\u1ec1u tr\u1ecb c\u00e1c tri\u1ec7u ch\u1ee9ng lo\u1ea1n th\u1ea7n, k\u00edch \u0111\u1ed9ng xu\u1ea5t hi\u1ec7n trong b\u1ec7nh Parkinson<\/em>: B\u1eaft \u0111\u1ea7u 12,5 mg\/ng\u00e0y tr\u01b0\u1edbc khi \u0111i ng\u1ee7, sau \u0111\u00f3 t\u0103ng d\u1ea7n t\u00f9y theo \u0111\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u1edbi m\u1ee9c li\u1ec1u t\u0103ng 12,5 mg, t\u0103ng 2 l\u1ea7n\/tu\u1ea7n. Li\u1ec1u th\u01b0\u1eddng d\u00f9ng dao \u0111\u1ed9ng t\u1eeb 25 mg \u0111\u1ebfn 37,5 mg\/ng\u00e0y, d\u00f9ng tr\u01b0\u1edbc khi \u0111i ng\u1ee7 (t\u1ed1i \u0111a 50 mg\/ng\u00e0y). Trong tr\u01b0\u1eddng h\u1ee3p ngo\u1ea1i l\u1ec7, c\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c t\u0103ng li\u1ec1u th\u00eam (th\u00eam 12,5 mg m\u1ed7i tu\u1ea7n) \u0111\u1ebfn m\u1ee9c li\u1ec1u t\u1ed1i \u0111a 100 mg\/ng\u00e0y, chia 1 &#8211; 2 l\u1ea7n.<\/p>\n<p><em>D\u00f9ng cho ng\u01b0\u1eddi thu\u1ed9c nh\u00f3m \u0111\u1eb7c bi\u1ec7t sau :<\/em><\/p>\n<p>Ng\u01b0\u1eddi suy gan:<\/p>\n<p>B\u1ec7nh nh\u00e2n suy gan n\u00ean th\u1eadn tr\u1ecdng u\u1ed1ng clozapin \u0111\u01b0\u1ee3c gi\u00e1m s\u00e1t th\u01b0\u1eddng xuy\u00ean c\u1ee7a c\u00e1c x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan.<\/p>\n<p>Tr\u1ebb em:<\/p>\n<p>Nghi\u00ean c\u1ee9u tr\u00ean tr\u1ebb em ch\u01b0a \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n. S\u1ef1 an to\u00e0n v\u00e0 hi\u1ec7u qu\u00e0 c\u1ee7a clozapin \u1edf tr\u1ebb em v\u00e0 thanh thi\u1ebfu ni\u00ean d\u01b0\u1edbi 16 tu\u1ed5i ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh. Tr\u1ebb em kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng thu\u1ed1c n\u00e0y.<\/p>\n<p>B\u1ec7nh nh\u00e2n 60 tu\u1ed5i tr\u1edf l\u00ean:<\/p>\n<p>B\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf m\u1ed9t li\u1ec1u \u0111\u1eb7c bi\u1ec7t th\u1ea5p (12,5 mg cho m\u1ed9t l\u1ea7n v\u00e0o ng\u00e0y \u0111\u1ea7u ti\u00ean), li\u1ec1u ti\u1ebfp theo b\u1ecb h\u1ea1n ch\u1ebf \u0111\u1ebfn 25 mg\/ng\u00e0y<strong> .<\/strong><\/p>\n<p><strong>4.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n<p>\u0110\u1ed9ng kinh kh\u00f3 ch\u1eefa tr\u1ecb.<\/p>\n<p>Suy t\u1ee7y ho\u1eb7c \u0111ang d\u00f9ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a t\u1ee7y x\u01b0\u01a1ng. Ti\u1ec1n s\u1eed m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t ho\u1eb7c \u0111ang m\u1eafc h\u1ed9i ch\u1ee9ng m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t n\u1eb7ng.<\/p>\n<p>C\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng theo d\u00f5i ch\u1eb7t ch\u1ebd trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb ch\u1ee9c n\u0103ng t\u1ea1o m\u00e1u li\u00ean quan \u0111\u1ebfn t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a thu\u1ed1c.<\/p>\n<p>M\u1eafc b\u1ec7nh tim n\u1eb7ng (nh\u01b0 vi\u00eam c\u01a1 tim).<\/p>\n<p>Ti\u1ec1n s\u1eed suy tu\u1ea7n ho\u00e0n.<\/p>\n<p>Li\u1ec7t ru\u1ed9t.<\/p>\n<p>C\u00e1c tr\u01b0\u1eddng h\u1ee3p ng\u1ed9 \u0111\u1ed9c thu\u1ed1c, h\u00f4n m\u00ea ho\u1eb7c \u1ee9c ch\u1ebf m\u1ea1nh h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng.<\/p>\n<p>C\u00e1c h\u1ed9i ch\u1ee9ng t\u00e2m th\u1ea7n li\u00ean quan \u0111\u1ebfn r\u01b0\u1ee3u.<\/p>\n<p>Qu\u00e1 m\u1eabn v\u1edbi clozapin.<\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>4.4 Th\u1eadn tr\u1ecdng:<\/strong><\/p>\n<p><em>M\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t:<\/em><\/p>\n<p>Nguy c\u01a1 m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t (s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u &lt; 2 000 t\u1ebf b\u00e0o\/mm<sup>3<\/sup>; s\u1ed1 l\u01b0\u1ee3ng tuy\u1ec7t \u0111\u1ed1i b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh &lt; 500 t\u1ebf b\u00e0o\/mm<sup>3<\/sup>) cao h\u01a1n khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng clozapin so v\u1edbi c\u00e1c thu\u1ed1c an th\u1ea7n kinh kinh \u0111i\u1ec3n kh\u00e1c. Ti\u00eau b\u1ea1ch c\u1ea7u h\u1ea1t \u0111\u00f4i khi c\u00f3 th\u1ec3 \u0111e d\u1ecda t\u00ednh m\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 kh\u00f4ng ng\u1eebng clozapin k\u1ecbp th\u1eddi. V\u00ec v\u1eady, ch\u1ec9 k\u00ea \u0111\u01a1n clozapin cho c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m m\u00e1u tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb (bao g\u1ed3m c\u00f4ng th\u1ee9c b\u1ea1ch c\u1ea7u v\u00e0 s\u1ed1 l\u01b0\u1ee3ng tuy\u1ec7t \u0111\u1ed1i b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh) v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng theo d\u00f5i \u0111\u1ecbnh k\u1ef3 x\u00e9t nghi\u1ec7m n\u00e0y trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>H\u1ea1n ch\u1ebf s\u1eeb d\u1ee5ng Clozapin \u1edf b\u1ec7nh nh\u00e2n c\u00f3 WBC &gt; 3500\/mm2: (3.5 X 10^9\/1) v\u00e0 b\u1ea1ch c\u1ea7\u1ee5 trung t\u00ednh &gt; 2000\/mm2 (2.0 X 10^9\/1) v\u00e0 theo d\u00f5i s\u1ed1 l\u01b0\u1ee3ng WBC v\u00e0 b\u1ea1ch c\u00e2u trung t\u00ednh h\u00e0ng tu\u1ea7n trong 18 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u ti\u00ean v\u00e0 sau \u0111\u00f3 t\u1ed1i thi\u1ec3u 4 tu\u1ea7n.<\/p>\n<p>Tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi Clozapin b\u1ec7nh nh\u00e2n c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m m\u00e1u (xem &#8220;b\u1ea1ch c\u1ea7u trung t\u00ednh&#8221;) v\u00e0 ki\u1ec3m tra s\u1ee9c kho\u00e9. B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh tim ho\u1eb7c c\u00e1c tri\u1ec7u ch\u1ee9ng b\u1ea5t th\u01b0\u1eddng v\u1ec1 tim c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c th\u0103m kh\u00e1m b\u1edfi c\u00e1c b\u00e1c s\u0129 chuy\u00ean khoa.<\/p>\n<p>Nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 ng\u01b0ng s\u1ee9 d\u1ee5ng Clozapin do thi\u1ebfu m\u00e1u WBC ho\u1eb7c b\u1ea1ch c\u1ea7u trung t\u00ednh, kh\u00f4ng \u0111\u01b0\u1ee3c ti\u1ebfp x\u00fac l\u1ea1i v\u1edbi Clozapin.<\/p>\n<p>Eosinophilia : Trong tr\u01b0\u1eddng h\u1ee3p b\u1ea1ch c\u1ea7u \u01b0a eosin, n\u00ean ng\u01b0ng Clozapin n\u1ebfu s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u \u00e1i toan &gt; 3.000\/mm3 (3.0x 10^9\/l); ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb khi b\u1ea1ch c\u1ea7u \u00e1i toan gi\u1ea3m xu\u1ed1ng d\u01b0\u1edbi 1000\/mm3 (l.0x 10^9\/l);<\/p>\n<p>Gi\u00e1m ti\u1ebfu c\u1ea7u : Trong tr\u01b0\u1eddng h\u1ecdp b\u1ec7nh nh\u00e2n b\u1ecb gi\u1ea3m ti\u1ec3u c\u1ea7u, ng\u01b0ng d\u00f9ng Dafidi 25 n\u1ebfu s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u gi\u1ea3m xu\u1ed1ng d\u01b0\u1edbi 50000\/mm3 (50x 10^9\/l);).<\/p>\n<p><em>R\u1ed1i lo\u1ea1n tim mach :<\/em><\/p>\n<p>H\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong giai \u0111o\u1ea1n \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng clozapin. V\u00ec v\u1eady, c\u00f3 th\u1ec3 c\u1ea7n hi\u1ec7u ch\u1ec9nh li\u1ec1u v\u00e0 theo d\u00f5i ch\u1eb7t b\u1ec7nh nh\u00e2n trong giai \u0111o\u1ea1n n\u00e0y.<\/p>\n<p>Nguy c\u01a1 g\u00e2y vi\u00eam c\u01a1 tim v\u00e0 b\u1ec7nh c\u01a1 tim c\u00f3 th\u1ec3 g\u00e2y nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o khi s\u1eed d\u1ee5ng clozapin. Nguy c\u01a1 vi\u00eam c\u01a1 tim th\u01b0\u1eddng x\u1ea3y ra trong v\u00f2ng 2 th\u00e1ng \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb. V\u00ec v\u1eady, c\u1ea7n th\u0103m kh\u00e1m k\u1ef9, l\u00e0m \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 tim m\u1ea1ch tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng clozapin. V\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ea5t th\u01b0\u1eddng v\u1ec1 tim m\u1ea1ch ho\u1eb7c c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh tim m\u1ea1ch, ch\u1ec9 s\u1eed d\u1ee5ng clozapin sau khi \u0111\u00e3 th\u1eadn tr\u1ecdng c\u00e2n nh\u1eafc nguy c\u01a1 &#8211; l\u1ee3i \u00edch. C\u1ea7n nghi ng\u1edd vi\u00eam c\u01a1 tim ho\u1eb7c b\u1ec7nh c\u01a1 tim khi th\u1ea5y xu\u1ea5t hi\u1ec7n tim nhanh k\u00e9o d\u00e0i l\u00fac ngh\u1ec9, \u0111\u1eb7c bi\u1ec7t trong v\u00f2ng 2 th\u00e1ng \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb, c\u00f3 k\u00e8m theo ho\u1eb7c kh\u00f4ng k\u00e8m theo \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, lo\u1ea1n nh\u1ecbp, \u0111au ng\u1ef1c v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u kh\u00e1c c\u1ee7a suy tim (m\u1ec7t m\u1ecfi v\u00f4 c\u0103n, kh\u00f3 th\u1edf, th\u1edf nhanh). D\u1eebng ngay clozapin n\u1ebfu nghi ng\u1edd xu\u1ea5t hi\u1ec7n vi\u00eam c\u01a1 tim ho\u1eb7c b\u1ec7nh c\u01a1 tim v\u00e0 chuy\u1ec3n b\u1ec7nh nh\u00e2n \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb t\u1ea1i chuy\u00ean khoa tim m\u1ea1ch.<\/p>\n<p><em>K\u00e9o d\u00e0i kho\u1ea3ng QT : ,<\/em><\/p>\n<p>C\u0169ng nh\u01b0 c\u00e1c thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n kh\u00e1c, c\u1ea7n th\u1eadn tr\u1ecdng khi d\u00f9ng thu\u1ed1c \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh tim m\u1ea1ch ho\u1eb7c gia \u0111\u00ecnh c\u00f3 ti\u00ean s\u1eed k\u00e9o d\u00e0i kho\u1ea3ng QT. Th\u1eadn tr\u1ecdng khi d\u00f9ng c\u00f9ng l\u00fac v\u1edbi thu\u1ed1c k\u00e9o d\u00e0i kho\u1ea3ng QT<\/p>\n<p><em>Nh\u1ed3i m\u00e1u c\u01a1 tim<\/em> : C\u00f3 th\u1ebf x\u1ea3y ra khi d\u00f9ng Clozapin<\/p>\n<p><em>T\u00e1c d\u1ee5ng tr\u00ean m\u1ea1ch m\u00e1u n\u00e3o<\/em> : Clozapin n\u00ean \u0111\u01b0\u1ee3c s\u1ee9 d\u1ee5ng th\u1eadn tr\u1ecdng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 \u0111\u1ed9t qu\u1ef5 .<\/p>\n<p><em>T\u00e1c d\u1ee5ng kh\u00e1ng cholinergic :<\/em><\/p>\n<p>Th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng clozapin cho b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 t\u00e1o b\u00f3n, t\u1eafc ru\u1ed9t (ti\u1ec1n s\u1eed b\u1ec7nh \u0111\u1ea1i tr\u00e0ng ho\u1eb7c ph\u1eabu thu\u1eadt \u0111\u1ea1i tr\u00e0ng, b\u1ec7nh nh\u00e2n \u0111ang \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c kh\u00e1ng cholinergic kh\u00e1c), b\u1ec7nh nh\u00e2n ph\u00ec \u0111\u1ea1i l\u00e0nh t\u00ednh tuy\u1ebfn ti\u1ec1n li\u1ec7t, b\u1ec7nh nh\u00e2n gl\u00f4c\u00f4m g\u00f3c h\u1eb9p do t\u00e1c d\u1ee5ng kh\u00e1ng cholinergic c\u1ee7a clozapin c\u00f3 th\u1ec3 l\u00e0m n\u1eb7ng th\u00eam c\u00e1c b\u1ec7nh l\u00fd n\u00e0y.<\/p>\n<p><em>\u0110\u1ed9ng kinh:<\/em><\/p>\n<p>Th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng clozapin cho b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed \u0111\u1ed9ng kinh, ch\u1ea5n th\u01b0\u01a1ng v\u00f9ng \u0111\u1ea7u ho\u1eb7c \u0111ang \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m gi\u1ea3m ng\u01b0\u1ee1ng \u0111\u1ed9ng kinh do t\u00e1c d\u1ee5ng co gi\u1eadt ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng clozapin.<\/p>\n<p><em>Ch\u1ee9ng r\u1ed1i loan lipid m\u00e1u :<\/em><\/p>\n<p>Nh\u1eefng thay \u0111\u1ed5i lipid kh\u00f4ng mong mu\u00f4n \u0111\u00e3 \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, bao g\u1ed3m Clozapin.<\/p>\n<p><em>T\u0103ng c\u00e2n<\/em> : T\u0103ng c\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn khi s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, bao g\u1ed3m Clozapin. Theo d\u00f5i l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o<\/p>\n<p>Th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng clozapin cho b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c c\u00f3 r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a glucose, c\u1ea7n theo d\u00f5i ch\u1eb7t n\u1ed3ng \u0111\u1ed9 glucose trong m\u00e1u do kh\u1ea3 n\u0103ng l\u00e0m t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft c\u1ee7a clozapin, \u0111\u00f4i khi \u0111i k\u00e8m v\u1edbi nhi\u1ec5m toan ceton, h\u00f4n m\u00ea t\u0103ng \u00e1p l\u1ef1c th\u1ea5m th\u1ea5u \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o, Kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c thu\u1ed1c an th\u1ea7n kinh kh\u00e1c.<\/p>\n<p><em>Nguy c\u01a1 thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i<\/em>: C\u00e1c tr\u01b0\u1eddng h\u1ee3p thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch (VTE) \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u1edbi c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n. C\u00e1c y\u1ebfu t\u1ed1 g\u00e2y VTE c\u1ea7n \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh tr\u01b0\u1edbc v\u00e0 trong khi \u0111i\u1ec1u tr\u1ecb v\u1edbi Clozapin v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n.<\/p>\n<p>Trong th\u1eddi gian \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Dafidi 25, nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec1 t\u0103ng tho\u00e1ng qua tr\u00ean 38\u00b0C. T\u1ef7 l\u1ec7 m\u1ee9c cao nh\u1ea5t trong v\u00f2ng 3 tu\u1ea7n \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb. S\u1ed1t n\u00e0y n\u00f3i chung l\u00e0 l\u00e0nh t\u00ednh. Th\u1ec9nh tho\u1ea3ng, n\u00f3 c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn s\u1ef1 t\u0103ng ho\u1eb7c gi\u1ea3m s\u1ed1 l\u01b0\u1ecdng b\u1ea1ch c\u1ea7u. B\u1ec7nh nh\u00e2n b\u1ecb s\u1ed1t n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i c\u1ea9n th\u1eadn \u0111\u1ec3 lo\u1ea1i tr\u1eeb kh\u00e1 n\u0103ng nhi\u1ec5m khu\u1ea9n ho\u1eb7c s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t. N\u1ebfu c\u00f3 s\u1ed1t cao, h\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh (NMS) ph\u00e1i \u0111\u01b0\u1ee3c xem x\u00e9t. N\u1ebfu ch\u1ea9n \u0111o\u00e1n c\u00f3 NMS, Dafidi 25 n\u00ean ng\u01b0ng ngay l\u1eadp t\u1ee9c v\u00e0 c\u00f3 c\u00e1c bi\u1ec7n ph\u00e1p y t\u1ebf th\u00edch h\u1ee3p.<\/p>\n<p>Thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, bao g\u1ed3m Dafidi 25, k\u1ebft h\u1ecdp v\u1edbi nh\u1eefng thay \u0111\u1ed1i trao \u0111\u1ed3i ch\u1ea5t c\u00f3 th\u1ec1 l\u00e0m t\u0103ng nguy c\u01a1 tim m\u1ea1ch\/m\u1ea1ch m\u00e1u n\u00e3o. Nh\u1eefng thay \u0111\u1ed5i chuy\u1ec3n h\u00f3a bao g\u1ed3m t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft, r\u1ed1i lo\u1ea1n lipid m\u00e1u v\u00e0 t\u0103ng c\u00e2n.<\/p>\n<p>Ph\u1ea3n \u1ee9ng ng\u1eebng thu\u1ed1c \u0111\u1ed9t ng\u1ed9t \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o sau khi ng\u1eebng \u0111\u1ed9t ng\u1ed9t Clozapin, do \u0111\u00f3 c\u1ea7n ph\u1ea3i gi\u1ea3m li\u1ec1u t\u1eeb t\u1eeb. N\u00eau ng\u01b0ng thu\u1ed1c \u0111\u1ed9t ng\u1ed9t l\u00e0 c\u1ea7n thi\u1ebft (v\u00ed d\u1ee5 do gi\u1ea3m b\u1ea1ch c\u1ea7u), b\u1ec7nh nh\u00e2n ph\u00e1i \u0111\u01b0\u1ee3c theo d\u00f5i c\u1ea7n th\u1eadn \u0111\u1ec3 tr\u00e1nh t\u00e1i ph\u00e1t c\u00e1c tri\u1ec7u ch\u1ee9ng lo\u1ea1n th\u1ea7n kinh v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn ph\u1ee5c h\u1ed3i cholinergic, nh\u01b0 ra m\u1ed3 h\u00f4i, nh\u1ee9c \u0111\u1ea7u, bu\u1ed3n n\u00f4n, n\u00f4n m\u1ee9a v\u00e0 ti\u00eau ch\u1ea3y.<\/p>\n<p>Kh\u00f4ng dung n\u1ea1p lactose: Vi\u00ean n\u00e9n Dafidi 25 c\u00f3 ch\u1ee9a lactose, do \u0111\u00f3 kh\u00f4ng n\u00ean d\u00f9ng cho b\u1ec7nh nh\u00e2n c\u00f3 v\u1ea5n \u0111\u1ec1 v\u1ec1 di truy\u1ec1n kh\u00f4ng dung n\u1ea1p galactose, s\u1ef1 thi\u1ebfu h\u1ee5t lactase ho\u1eb7c k\u00e9m h\u1ea5p thu glucose &#8211; galactose.<\/p>\n<p><em>C\u00e1c \u0111\u1ed1i t\u01b0\u01a1ng \u0111\u1eb7c bi\u1ec7t:<\/em><\/p>\n<p>Th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng clozapin cho b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh gan, tr\u00e1nh s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh gan ti\u1ebfn tri\u1ec3n ho\u1eb7c suy gan do suy gi\u1ea3m ch\u1ee9c n\u0103ng gan bao g\u1ed3m vi\u00eam gan \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o li\u00ean quan \u0111\u1ebfn s\u1eed d\u1ee5ng clozapin. C\u1ea7n l\u00e0m x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng gan khi xu\u1ea5t hi\u1ec7n bu\u1ed3n n\u00f4n, n\u00f4n, m\u1ec7t m\u1ecfi \u1edf b\u1ec7nh nh\u00e2n \u0111ang \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng clozapin.<\/p>\n<p>Th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng clozapin cho tr\u1ebb em. \u0110\u1ed9 an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a clozapin ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c l\u1eadp \u1edf tr\u1ebb em &lt; 16 tu\u1ed5i. Tuy v\u1eady, thu\u1ed1c \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c. C\u1ea7n th\u1eadn tr\u1ecdng do nguy c\u01a1 cao t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean huy\u1ebft h\u1ecdc v\u00e0 nguy c\u01a1 xu\u1ea5t hi\u1ec7n co gi\u1eadt tr\u00ean tr\u1ebb kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed \u0111\u1ed9ng kinh. Nguy c\u01a1 xu\u1ea5t hi\u1ec7n gi\u1ea3m b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh, \u0111\u1ed9ng kinh li\u00ean quan \u0111\u1ebfn clozapin cao h\u01a1n \u1edf l\u1ee9a tu\u1ed5i n\u00e0y.<\/p>\n<p>Th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng clozapin cho ng\u01b0\u1eddi cao tu\u1ed5i. Kh\u1ea3 n\u0103ng nh\u1ea1y c\u1ea3m h\u01a1n v\u1edbi c\u00e1c thu\u1ed1c \u0111i\u1ec1u ch\u1ec9nh r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n (t\u0103ng t\u1ea7n su\u1ea5t xu\u1ea5t hi\u1ec7n r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng ch\u1eadm) c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i. Li\u1ec1u d\u00f9ng c\u1ea7n \u0111\u01b0\u1ee3c hi\u1ec7u ch\u1ec9nh ch\u1eb7t ch\u1ebd v\u1edbi li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 th\u1ec3 khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p><strong>T\u00e1c \u0111\u1ed9ng c\u1ee7a thu\u1ed1c tr\u00ean ng\u01b0\u1eddi l\u00e1i xe v\u00e0 v\u1eadn h\u00e0nh m\u00e1y m\u00f3c.<\/strong><\/p>\n<p>Clozapin c\u00f3 th\u1ec3 g\u00e2y hoa m\u1eaft, ch\u00f3ng m\u1eadt, nh\u1ee9c \u0111\u1ea7u. V\u00ec v\u1eady, kh\u00f4ng n\u00ean d\u00f9ng thu\u00f4c khi \u0111ang l\u00e1i xe v\u00e0 v\u1eadn h\u00e0nh m\u00e1y m\u00f3c.<\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>4.5 S\u1eed d\u1ee5ng cho ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa:<\/strong><\/p>\n<p><em>X\u1ebfp h\u1ea1ng c\u1ea3nh b\u00e1o<\/em><\/p>\n<p>AU TGA pregnancy category: C<\/p>\n<p>US FDA pregnancy category: B<\/p>\n<p><em>Th\u1eddi k\u1ef3 mang thai:<\/em><\/p>\n<p>Chi n\u00ean d\u00f9ng Clozapin khi th\u1eadt s\u1ef1 c\u1ea7n thi\u1ebft v\u00e0 l\u1ee3i \u00edch ti\u1ec1m t\u00e0ng l\u1edbn h\u01a1n nguy c\u01a1 r\u1ee7i ro.<\/p>\n<p><em>Th\u1eddi k\u1ef3 cho con b\u00fa:<\/em><\/p>\n<p>Ph\u1ee5 n\u1eef d\u00f9ng Clozapin n\u00ean ng\u1eebng cho con b\u00fa<\/p>\n<p><strong>4.6 T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n (ADR):<\/strong><\/p>\n<p><em>Th\u01b0\u1eddng g\u1eb7p, ADR &gt;1\/100<\/em><\/p>\n<p>Tim m\u1ea1ch: Nh\u1ecbp tim nhanh, \u0111au ng\u1ef1c, thay \u0111\u1ed5i tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, t\u0103ng huy\u1ebft \u00e1p, h\u1ea1 huy\u1ebft \u00e1p, b\u1ea5t t\u1ec9nh.<\/p>\n<p>Th\u1ea7n kinh trung \u01b0\u01a1ng: Hoa m\u1eaft, ch\u00f3ng m\u1eb7t, m\u1ea5t ng\u1ee7, b\u1ed3n ch\u1ed3n, \u0111\u1ed9ng kinh, \u0111au \u0111\u1ea7u, \u00e1c m\u1ed9ng, c\u1eed \u0111\u1ed9ng ngh\u1ecbch th\u01b0\u1eddng, l\u1eabn l\u1ed9n, co c\u1ee9ng c\u01a1, t\u0103ng \u0111\u1ed9ng, r\u1ed1i lo\u1ea1n \u0111i\u1ec1u ph\u1ed1i, n\u00f3i l\u1eafp, tr\u1ea7m c\u1ea3m, lo \u00e2u. Th\u1ea7n kinh c\u01a1 v\u00e0 c\u01a1 x\u01b0\u01a1ng: Run, y\u1ebfu c\u01a1, c\u1ee9ng c\u01a1, \u0111au c\u01a1, co r\u00fat c\u01a1.<\/p>\n<p>Ti\u00eau h\u00f3a: T\u00e1o b\u00f3n, t\u0103ng c\u00e2n, bu\u1ed3n n\u00f4n, n\u00f4n, t\u0103ng ti\u1ebft n\u01b0\u1edbc b\u1ecdt, kh\u00f3 ch\u1ecbu\/c\u1ea3m gi\u00e1c b\u1ecfng r\u00e1t v\u00f9ng th\u01b0\u1ee3ng v\u1ecb, ch\u00e1n \u0103n, ti\u00eau ch\u1ea3y. H\u00f4 h\u1ea5p: Kh\u00f3 th\u1edf, xung huy\u1ebft m\u0169i.<\/p>\n<p>Sinh d\u1ee5c &#8211; ti\u1ebft ni\u1ec7u: Xu\u1ea5t tinh b\u1ea5t th\u01b0\u1eddng (xu\u1ea5t tinh s\u1edbm, xu\u1ea5t tinh ch\u1eadm, b\u1ea5t l\u1ef1c), b\u00ed ti\u1ec3u ti\u1ec7n<\/p>\n<p>Huy\u1ebft h\u1ecdc: T\u0103ng b\u1ea1ch c\u1ea7u \u01b0a eosin, gi\u1ea3m b\u1ea1ch c\u1ea7u, ti\u00eau b\u1ea1ch c\u1ea7u h\u1ea1t<\/p>\n<p>Gan: X\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan b\u1ea5t th\u01b0\u1eddng.<\/p>\n<p>Da: Ban da.<\/p>\n<p>M\u1eaft: B\u1ea5t th\u01b0\u1eddng v\u1ec1 th\u1ecb l\u1ef1c.<\/p>\n<p><em>\u00cdt g\u1eb7p, 1\/1 000 &lt; ADR &lt; 1\/100<\/em><\/p>\n<p>Lo\u1ea1n nh\u1ecbp (th\u1ea5t v\u00e0 nh\u0129), nh\u1ecbp ch\u1eadm, vi\u00eam gan, v\u00e0ng da, vi\u00eam th\u1eadn k\u1ebd, h\u1ed9i ch\u1ee9ng y\u1ebfu c\u01a1, gl\u00f4c\u00f4m g\u00f3c h\u1eb9p, h\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh, h\u1ea1 th\u00e2n nhi\u1ec7t, tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh.<\/p>\n<p><em>Hi\u1ebfm g\u1eb7p,10 000 &lt;ADR &lt; 1\/1 000 <\/em><\/p>\n<p>Thi\u1ebfu m\u00e1u, t\u0103ng glucose m\u00e1u.<\/p>\n<p><em>R\u1ea5t hi\u1ebfm g\u1eb7p: ADR &lt; 1\/10 000<\/em><\/p>\n<p>H\u00f4n m\u00ea toan ceton, h\u00f4n m\u00ea t\u0103ng \u00e1p l\u1ef1c th\u1ea5m th\u1ea5u, t\u0103ng triglycerid, t\u0103ng cholesterol, lo\u1ea1n v\u1eadn \u0111\u1ed9ng mu\u1ed9n, vi\u00eam c\u01a1 tim, b\u1ec7nh c\u01a1 tim, gi\u1ea3m ti\u1ec3u c\u1ea7u, huy\u1ebft kh\u1ed1i t\u1eafc m\u1ea1ch, t\u1eafc ru\u1ed9t, h\u1ed9i ch\u1ee9ng StevensJohnson, h\u1ed3ng ban \u0111a d\u1ea1ng tr\u00ean da.<\/p>\n<p><em>Th\u00f4ng b\u00e1o cho B\u00e1c s\u0129 nh\u1eefng t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n g\u1eb7p ph\u1ea3i khi s\u1eed d\u1ee5ng thu\u1ed1c.<\/em><\/p>\n<p><strong>4.7 H\u01b0\u1edbng d\u1eabn c\u00e1ch x\u1eed tr\u00ed ADR:<\/strong><\/p>\n<p>C\u00e1c ADR ph\u1ea7n l\u1edbn l\u00e0 do t\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u00fd c\u1ee7a clozapin, tr\u1eeb m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t. Do nguy c\u01a1 n\u00e0y, clozapin ch\u1ec9 d\u00e0nh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c v\u00e0 c\u00e1c lo\u1ea1n th\u1ea7n xu\u1ea5t hi\u1ec7n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1ec7nh Parkinson.<\/p>\n<p>Tuy m\u1ed9t s\u1ed1 ADR th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n khi gi\u1ea3m li\u1ec1u ho\u1eb7c ng\u1eebng thu\u1ed1c, m\u1ed9t s\u1ed1 ADR kh\u00e1c c\u00f3 th\u1ec3 kh\u00f4ng h\u1ed3i ph\u1ee5c v\u00e0 c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong tuy hi\u1ebfm g\u1eb7p. Do m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t l\u00e0 nguy c\u01a1 th\u1ef1c s\u1ef1 do clozapin, c\u00f3 th\u1ec3 k\u00e9o d\u00e0i su\u1ed1t th\u1eddi gian \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u1ea3 khi ng\u1eebng thu\u1ed1c, \u0111\u1ed3ng th\u1eddi c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 d\u1eebng thu\u1ed1c k\u1ecbp th\u1eddi, n\u00ean tr\u01b0\u1edbc, trong v\u00e0 sau khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng clozapin, b\u1eaft bu\u1ed9c ph\u1ea3i c\u00f3 \u0111i\u1ec1u ki\u1ec7n x\u00e9t nghi\u1ec7m s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u v\u00e0 s\u1ed1 l\u01b0\u1ee3ng tuy\u1ec7t \u0111\u1ed1i b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh. N\u1ebfu th\u1ea5y s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u &lt; 2 000 t\u1ebf b\u00e0o\/mm<sup>3<\/sup> v\u00e0\/ho\u1eb7c s\u1ed1 l\u01b0\u1ee3ng tuy\u1ec7t \u0111\u1ed1i b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh &lt; 1 000 t\u1ebf b\u00e0o\/mm<sup>3<\/sup> ph\u1ea3i ng\u1eebng \u0111i\u1ec1u tr\u1ecb v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng l\u1ea1i thu\u1ed1c, \u0111\u1ed3ng th\u1eddi ph\u1ea3i theo d\u00f5i c\u00e1c bi\u1ec3u hi\u1ec7n nhi\u1ec5m khu\u1ea9n v\u00e0 c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 b\u1eb1ng c\u00e1c thu\u1ed1c k\u00edch th\u00edch t\u1ea1o m\u00e1u (filgrastim). Khi gi\u1ea3m b\u1ea1ch c\u1ea7u h\u1ea1t \u0111\u01b0\u1ee3c ch\u1ea5n \u0111o\u00e1n v\u00e0 ng\u1eebng k\u1ecbp th\u1eddi clozapin, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng h\u1ed3i ph\u1ee5c trong v\u00f2ng 7 &#8211; 28 ng\u00e0y sau \u0111\u00f3.<\/p>\n<p>N\u1ebfu s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u \u00e1i toan t\u0103ng &gt; 4 000 t\u1ebf b\u00e0o\/mm<sup>3<\/sup>, ph\u1ea3i ng\u1eebng t\u1ea1m th\u1eddi clozapin cho \u0111\u1ebfn khi s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u \u00e1i toan gi\u1ea3m xu\u1ed1ng &lt; 3 000 t\u1ebf b\u00e0o\/mm<sup>3<\/sup>.<\/p>\n<p>Co gi\u1eadt do clozapin c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c t\u0103ng li\u1ec1u thu\u1ed1c qu\u00e1 nhanh, \u0111\u1eb7c bi\u1ec7t \u1edf ng\u01b0\u1eddi c\u00f3 ti\u1ec1n s\u1eed \u0111\u1ed9ng kinh ho\u1eb7c c\u00f3 s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi c\u00e1c thu\u1ed1c l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 clozapin trong huy\u1ebft t\u01b0\u01a1ng. N\u1ebfu xu\u1ea5t hi\u1ec7n co gi\u1eadt ho\u1eb7c co gi\u1eadt to\u00e0n th\u1ec3 ph\u1ea3i gi\u1ea3m li\u1ec1u clozapin v\u00e0 s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng co gi\u1eadt n\u1ebfu c\u1ea7n thi\u1ebft.<\/p>\n<p>Bu\u1ed3n ng\u1ee7 th\u01b0\u1eddng x\u1ea3y ra trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng clozapin nh\u01b0ng th\u01b0\u1eddng gi\u1ea3m d\u1ea7n sau 1 &#8211; 4 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb v\u00e0 th\u01b0\u1eddng h\u1ebft n\u1ebfu \u0111i\u1ec1u tr\u1ecb k\u00e9o d\u00e0i. \u0110\u1ec3 kh\u1eafc ph\u1ee5c, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng thu\u1ed1c tr\u01b0\u1edbc khi \u0111i ng\u1ee7.<\/p>\n<p>Ng\u1eebng thu\u1ed1c \u0111\u1ed9t ng\u1ed9t (nh\u01b0 trong tr\u01b0\u1eddng h\u1ee3p do gi\u1ea3m b\u1ea1ch c\u1ea7u ho\u1eb7c m\u1ea5t b\u1ea1ch c\u1ea7u) c\u00f3 th\u1ec3 l\u00e0m c\u00e1c tri\u1ec7u ch\u1ee9ng lo\u1ea1n th\u1ea7n tr\u1edf l\u1ea1i. C\u00f3 th\u1ec3 kh\u1eafc ph\u1ee5c b\u1eb1ng c\u00e1ch d\u00f9ng m\u1ed9t thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n kh\u00e1c. S\u1ed1t &gt; 38 <sup>o<\/sup>C trong 3 tu\u1ea7n \u0111\u1ea7u, th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n v\u00e0o gi\u1eefa ng\u00e0y 5 &#8211; 20 \u0111i\u1ec1u tr\u1ecb. S\u1ed1t th\u01b0\u1eddng l\u00e0nh t\u00ednh v\u00e0 t\u1ef1 h\u1ebft. Tuy v\u1eady, c\u1ea7n th\u1eadn tr\u1ecdng ph\u00e2n bi\u1ec7t v\u1edbi s\u1ed1t do nhi\u1ec5m khu\u1ea5n v\u00e0 ki\u1ec3m tra ch\u1eb7t c\u00f4ng th\u1ee9c m\u00e1u. Nh\u1ecbp tim nhanh, h\u1ea1 huy\u1ebft \u00e1p th\u1ebf \u0111\u1ee9ng c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m theo ng\u1ea5t, \u0111\u1eb7c bi\u1ec7t c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong nh\u1eefng tu\u1ea7n \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb, th\u01b0\u1eddng do t\u0103ng nhanh v\u00e0 m\u1ea1nh li\u1ec1u clozapin. Nguy c\u01a1 h\u1ea1 huy\u1ebft \u00e1p th\u1ebf \u0111\u1ee9ng c\u00f3 th\u1ec3 gi\u1ea3m b\u1eb1ng d\u00f9ng li\u1ec1u th\u1ea5p r\u1ed3i t\u0103ng d\u1ea7n li\u1ec1u v\u1edbi m\u1ee9c \u0111\u1ed9 v\u1eeba ph\u1ea3i. Nh\u1ecbp nhanh c\u00f3 th\u1ec3 k\u00e9o d\u00e0i su\u1ed1t th\u1eddi gian \u0111i\u1ec1u tr\u1ecb nh\u01b0ng n\u1ebfu nh\u1ecbp tim nhanh k\u00e9o d\u00e0i li\u00ean t\u1ee5c l\u00fac ngh\u1ec9, k\u00e8m theo \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, lo\u1ea1n nh\u1ecbp tim, \u0111au ng\u1ef1c, m\u1ec7t m\u1ecfi v\u00f4 c\u0103n, kh\u00f3 th\u1edf, th\u1edf nhanh, s\u1ed1t th\u00ec c\u1ea7n ngh\u0129 \u0111\u1ebfn vi\u00eam c\u01a1 tim do clozapin v\u00e0 ph\u1ea3i ng\u1eebng thu\u1ed1c ngay.<\/p>\n<p>T\u0103ng c\u00e2n c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. C\u1ea7n h\u01b0\u1edbng d\u1eabn ch\u1ebf \u0111\u1ed9 \u0103n v\u00e0 ch\u1ebf \u0111\u1ed9 t\u1eadp luy\u1ec7n cho b\u1ec7nh nh\u00e2n trong th\u1eddi gian d\u00f9ng thu\u1ed1c.<\/p>\n<p>T\u0103ng ti\u1ebft n\u01b0\u1edbc b\u1ecdt, m\u1ed9t ph\u1ea3n \u1ee9ng ngh\u1ecbch th\u01b0\u1eddng c\u1ee7a thu\u1ed1c, th\u01b0\u1eddng gi\u1ea3m trong v\u00e0i tu\u1ea7n. T\u00e1o b\u00f3n n\u1ebfu xu\u1ea5t hi\u1ec7n th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng.<\/p>\n<p>Kh\u00f4ng n\u00ean d\u00f9ng meclopramid \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb n\u00f4n n\u1ebfu xu\u1ea5t hi\u1ec7n trong th\u1eddi gian \u0111i\u1ec1u tr\u1ecb do nguy c\u01a1 g\u00e2y h\u1ed9i ch\u1ee9ng Parkinson v\u00e0 lo\u1ea1n \u0111\u1ed9ng mu\u1ed9n.<\/p>\n<p>Do nguy c\u01a1 g\u00e2y t\u0103ng glucose huy\u1ebft n\u1eb7ng, \u0111\u00f4i khi k\u1ebft h\u1ee3p v\u1edbi h\u00f4n m\u00ea nhi\u1ec5m toan ceton, t\u0103ng \u00e1p l\u1ef1c th\u1ea5m th\u1ea5u \u1edf b\u1ec7nh nh\u00e2n d\u00f9ng clozapin, c\u1ea7n khuy\u1ebfn c\u00e1o b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, ho\u1eb7c ng\u01b0\u1eddi c\u00f3 nguy c\u01a1 m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (b\u00e9o ph\u00ec, ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng) ph\u1ea3i ki\u1ec3m tra \u0111\u01b0\u1eddng huy\u1ebft l\u00fac \u0111\u00f3i tr\u01b0\u1edbc v\u00e0 trong khi \u0111i\u1ec1u tr\u1ecb clozapin.<\/p>\n<p><strong>4.8 T\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c:<\/strong><\/p>\n<p><em>Tr\u00e1nh kh\u00f4ng n\u00ean ph\u1ed1i h\u1ee3p:<\/em> Kh\u00f4ng n\u00ean ph\u1ed1i h\u1ee3p clozapin v\u1edbi c\u00e1c thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf t\u1ee7y x\u01b0\u01a1ng (carbamazepin, cotrimoxazol, cloramphenicol, penicilamin, sulfamid kh\u00e1ng khu\u1ea5n, thu\u1ed1c ch\u1ed1ng ung th\u01b0, thu\u1ed1c gi\u1ea3m \u0111au d\u1eabn ch\u1ea5t c\u1ee7a pyrazolon nh\u01b0 azapropazon, phenylbutazon, thu\u1ed1c an th\u1ea7n kinh t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i d\u00f9ng \u0111\u01b0\u1eddng ti\u00eam ho\u1eb7c c\u1ea5y d\u01b0\u1edbi da) do l\u00e0m t\u0103ng nguy c\u01a1 \u1ee9c ch\u1ebf t\u1ee7y x\u01b0\u01a1ng; v\u1edbi droperidol do t\u0103ng nguy c\u01a1 \u0111\u1ed9c t\u00ednh tr\u00ean tim (k\u00e9o d\u00e0i kho\u1ea3ng QT, xo\u1eafn \u0111\u1ec9nh, ng\u1eebng tim); v\u1edbi metoclopramid do t\u0103ng nguy c\u01a1 xu\u1ea5t hi\u1ec7n h\u1ed9i ch\u1ee9ng ngo\u1ea1i th\u00e1p.<\/p>\n<p><em>L\u00e0m t\u0103ng t\u00e1c d\u1ee5ng v\u00e0 \u0111\u1ed9c t\u00ednh c\u1ee7a clozapin:<\/em> D\u00f9ng \u0111\u1ed3ng th\u1eddi clozapin v\u1edbi c\u00e1c thu\u1ed1c benzodiazepin c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 \u1ee9c ch\u1ebf tu\u1ea7n ho\u00e0n d\u1eabn t\u1edbi ng\u1eebng tim v\u00e0 h\u00f4 h\u1ea5p. R\u01b0\u1ee3u, c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf men MAO (IMAO), c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng kh\u00e1c (bao g\u1ed3m c\u1ea3 c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au opioid v\u00e0 c\u00e1c d\u1eabn ch\u1ea5t benzodiazepin) l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf th\u1ea7n kinh trung \u01b0\u01a1ng khi d\u00f9ng c\u00f9ng v\u1edbi clozapin. Lithi c\u00f3 th\u1ec3 l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng xu\u1ea5t hi\u1ec7n h\u1ed9i ch\u1ee9ng an th\u1ea7n kinh \u00e1c t\u00ednh khi d\u00f9ng c\u00f9ng v\u1edbi clozapin. C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf CYP450 (cafein, cimetidin, erythromycin, quinidin, m\u1ed9t s\u1ed1 thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m nh\u01b0 fluvoxamin, paroxetin, fluoxetin, sertralin, c\u00e1c d\u1eabn ch\u1ea5t phenothiazin, c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp nh\u00f3m IC nh\u01b0 propafenon, flecainid, encainid, ciprofloxacin, ritonavir) l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 trong m\u00e1u do \u0111\u00f3 c\u00f3 th\u1ec3 l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng v\u00e0 \u0111\u1ed9c t\u00ednh c\u1ee7a clozapin.<\/p>\n<p><em>L\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a clozapin:<\/em> C\u00e1c thu\u1ed1c g\u00e2y c\u1ea3m \u1ee9ng CYP450 (phenobarbital, carbamazepin, phenytoin, rifampicin, omeprazol, nicotin) l\u00e0m gi\u1ea3m n\u1ed3ng \u0111\u1ed9 trong m\u00e1u do \u0111\u00f3 c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a clozapin<\/p>\n<p><em>L\u00e0m t\u0103ng t\u00e1c d\u1ee5ng v\u00e0 \u0111\u1ed9c t\u00ednh c\u1ee7a m\u1ed9t s\u1ed1 thu\u1ed1c kh\u00e1c:<\/em> Clozapin l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng (t\u00e1o b\u00f3n, kh\u00f4 mi\u1ec7ng, b\u00ed ti\u1ec3u, an th\u1ea7n, r\u1ed1i lo\u1ea1n th\u1ecb gi\u00e1c) c\u1ee7a c\u00e1c thu\u1ed1c kh\u00e1ng cholinergic, l\u00e0m t\u0103ng t\u00e1c d\u1ee5ng h\u1ea1 \u00e1p c\u1ee7a c\u00e1c thu\u1ed1c ch\u1ed1ng t\u0103ng huy\u1ebft \u00e1p.<\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>4.9 Qu\u00e1 li\u1ec1u v\u00e0 x\u1eed tr\u00ed:<\/strong><\/p>\n<p><em>Qu\u00e1 li\u1ec1u c\u1ea5p:<\/em><\/p>\n<p>Qu\u00e1 li\u1ec1u g\u00e2y t\u1eed vong \u1edf ng\u01b0\u1eddi l\u1edbn th\u01b0\u1eddng \u1edf m\u1ee9c li\u1ec1u tr\u00ean 2,5 g. \u1eda tr\u1ebb em, qu\u00e1 li\u1ec1u khi d\u00f9ng 50 &#8211; 200 mg c\u0169ng \u0111\u00e3 g\u00e2y ra c\u00e1c nhi\u1ec5m \u0111\u1ed9c \u1edf m\u1ee9c \u0111\u1ed9 v\u1eeba \u0111\u1ebfn n\u1eb7ng (thay \u0111\u1ed5i t\u00e2m tr\u00ed, t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1, tri\u1ec7u ch\u1ee9ng ngo\u1ea1i th\u00e1p). C\u00e1c tri\u1ec7u ch\u1ee9ng: B\u1ea5t t\u1ec9nh, \u1ee9c ch\u1ebf th\u1ea7n kinh trung \u01b0\u01a1ng, nh\u1ecbp tim nhanh, h\u1ea1 huy\u1ebft \u00e1p, suy h\u00f4 h\u1ea5p, vi\u00eam ph\u1ed5i, t\u0103ng ti\u1ebft n\u01b0\u1edbc b\u1ecdt, \u0111\u00f4i khi xu\u1ea5t hi\u1ec7n c\u01a1n \u0111\u1ed9ng kinh \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn.<\/p>\n<p><em>X\u1eed tr\u00ed:<\/em><\/p>\n<p>Ch\u1ee7 y\u1ebfu l\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u0103m s\u00f3c h\u1ed7 tr\u1ee3 k\u00e8m theo d\u00f5i ch\u1eb7t ch\u1ee9c n\u0103ng tim m\u1ea1ch v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u sinh t\u1ed3n. Cho u\u1ed1ng than ho\u1ea1t t\u00ednh k\u00e8m theo sorbitol \u0111\u1ec3 lo\u1ea1i b\u1ecf v\u00e0 ng\u0103n c\u1ea3n h\u1ea5p thu ph\u1ea7n thu\u1ed1c c\u00f2n l\u01b0u l\u1ea1i trong \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. Theo d\u00f5i c\u00e2n b\u1eb1ng \u0111i\u1ec7n gi\u1ea3i v\u00e0 c\u00e2n b\u1eb1ng acid-base. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng physostigmin n\u1ebfu c\u00f3 bi\u1ec3u hi\u1ec7n ng\u1ed9 \u0111\u1ed9c kh\u00e1ng cholinergic n\u1eb7ng. Ch\u01b0a c\u00f3 thu\u1ed1c gi\u1ea3i \u0111\u1ed9c \u0111\u1eb7c hi\u1ec7u. L\u1ecdc m\u00e1u v\u00e0 th\u1ea5m ph\u00e2n ph\u00fac m\u1ea1c c\u00f3 vai tr\u00f2 r\u1ea5t h\u1ea1n ch\u1ebf trong \u0111i\u1ec1u tr\u1ecb ng\u1ed9 \u0111\u1ed9c c\u1ea5p clozapin.<\/p>\n<p><strong>5. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c :<\/strong><\/p>\n<p><strong>5.1. D\u01b0\u1ee3c l\u1ef1c h\u1ecdc:<\/strong><\/p>\n<p>Clozapin l\u00e0 thu\u1ed1c an th\u1ea7n kinh\/thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh \u0111\u1ea7u ti\u00ean c\u1ee7a th\u1ebf h\u1ec7 th\u1ee9 hai v\u00e0 l\u00e0 d\u1eabn ch\u1ea5t c\u1ee7a dibenzodiazepin. Thu\u1ed1c c\u00f3 nhi\u1ec1u \u0111\u1eb7c t\u00ednh d\u01b0\u1ee3c l\u00fd kh\u00e1c v\u1edbi c\u00e1c thu\u1ed1c an th\u1ea7n kinh kinh \u0111i\u1ec3n d\u1eabn ch\u1ea5t c\u1ee7a phenothiazin hay butyrophenon nh\u01b0 \u00edt g\u00e2y h\u1ed9i ch\u1ee9ng ngo\u1ea1i th\u00e1p, \u00edt l\u00e0m t\u0103ng ti\u1ebft prolactin h\u01a1n.<\/p>\n<p>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng ch\u1ed1ng lo\u1ea1n th\u1ea7n c\u1ee7a clozapin c\u00f2n ch\u01b0a \u0111\u01b0\u1ee3c l\u00e0m s\u00e1ng t\u1ecf ho\u00e0n to\u00e0n. C\u01a1 ch\u1ebf n\u00e0y bao g\u1ed3m s\u1ef1 tham gia c\u1ee7a c\u00e1c h\u1ec7 d\u1eabn truy\u1ec1n th\u1ea7n kinh serotoninergic, adrenergic v\u00e0 cholinergic \u1edf th\u1ea7n kinh trung \u01b0\u01a1ng \u0111\u1ed3ng th\u1eddi c\u00f3 li\u00ean quan \u0111\u1ebfn t\u00e1c d\u1ee5ng ch\u1ecdn l\u1ecdc v\u00f9ng tr\u00ean h\u1ec7 dopaminergic \u1edf v\u00f9ng vi\u1ec1n. Clozapin c\u00f3 \u00e1i l\u1ef1c g\u1eafn y\u1ebfu v\u1edbi th\u1ee5 th\u1ec3 c\u1ee7a dopamin (D1, D2, D3, D5) \u1edf v\u00f9ng th\u1ec3 v\u00e2n v\u00e0 v\u00f9ng h\u1eadu y\u00ean, nh\u01b0ng c\u00f3 \u00e1i l\u1ef1c g\u1eafn v\u1eeba ho\u1eb7c m\u1ea1nh v\u1edbi th\u1ee5 th\u1ec3 D4. \u0110i\u1ec1u n\u00e0y t\u1ea1o s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa clozapin v\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n kinh \u0111i\u1ec3n kh\u00e1c (\u00edt g\u00e2y t\u00e1c d\u1ee5ng ngo\u1ea1i th\u00e1p, \u00edt l\u00e0m t\u0103ng ti\u1ebft prolactin).<\/p>\n<p>T\u00e1c d\u1ee5ng \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 alpha-adrenergic gi\u1ea3i th\u00edch m\u1ed9t ph\u1ea7n t\u00e1c d\u1ee5ng an th\u1ea7n, gi\u00e3n c\u01a1 v\u00e0 c\u00e1c t\u00e1c d\u1ee5ng kh\u00e1c tr\u00ean tim m\u1ea1ch c\u1ee7a clozapin. Clozapin c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng cholinergic n\u00ean c\u00f3 th\u1ec3 g\u00e2y kh\u00f4 mi\u1ec7ng, m\u00ea s\u1ea3ng \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n. T\u00e1c d\u1ee5ng \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 5HT-2 \u1edf th\u1ea7n kinh trung \u01b0\u01a1ng, th\u1ee5 th\u1ec3 5HT-3 \u1edf th\u1ea7n kinh trung \u01b0\u01a1ng v\u00e0 ngo\u1ea1i vi li\u00ean quan m\u1ed9t ph\u1ea7n \u0111\u1ebfn t\u00e1c d\u1ee5ng an th\u1ea7n s\u00e2u, \u0111\u1ebfn hi\u1ec7u qu\u1ea3 tr\u00ean c\u00e1c tri\u1ec7u ch\u1ee9ng \u00e2m t\u00ednh c\u1ee7a t\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t v\u00e0 l\u00e0m t\u0103ng c\u00e2n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng clozapin. Clozapin c\u00f3 ho\u1ea1t t\u00ednh r\u00f5 r\u1ec7t tr\u00ean acid y-aminobutyric (GABA) l\u00e0 ch\u1ea5t c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf c\u00e1c n\u01a1 ron dopaminergic. Tr\u00e1i v\u1edbi t\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n kinh \u0111i\u1ec3n, clozapin l\u00e0m t\u0103ng quay v\u00f2ng GABA \u1edf th\u1ec3 v\u00e2n v\u00e0 nh\u00e2n accubens. Vi\u1ec7c t\u0103ng quay v\u00f2ng v\u00e0 gi\u1ea3i ph\u00f3ng GABA \u1edf th\u1ec3 v\u00e2n c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m ph\u1ea3n \u1ee9ng ngo\u1ea1i th\u00e1p, c\u00f2n \u1edf nh\u00e2n accubens c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn t\u00e1c d\u1ee5ng ch\u1ed1ng lo\u1ea1n th\u1ea7n.<\/p>\n<p>Thu\u1ed1c c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng \u0111\u1ed1i kh\u00e1ng v\u1edbi th\u1ee5 th\u1ec3 c\u1ee7a histamin \u1edf th\u1ea7n kinh trung \u01b0\u01a1ng, g\u00e2y ra t\u00e1c d\u1ee5ng an th\u1ea7n, h\u1ea1 huy\u1ebft \u00e1p v\u00e0 t\u0103ng c\u00e2n. Tr\u00ean \u0111i\u1ec7n n\u00e3o \u0111\u1ed3, clozapin l\u00e0m t\u0103ng ho\u1ea1t t\u00ednh s\u00f3ng delta v\u00e0 theta, l\u00e0m ch\u1eadm t\u1ea7n su\u1ea5t s\u00f3ng alpha tr\u1ed9i. \u1eda m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, clozapin l\u00e0m gi\u1ea3m nhi\u1ec1u th\u1eddi gian ti\u1ec1m t\u00e0ng v\u00e0 t\u0103ng nhi\u1ec1u th\u1eddi gian gi\u1ea5c ng\u1ee7 giai \u0111o\u1ea1n \u0111\u1ed9ng m\u1eaft nhanh (REM).<\/p>\n<p>\u0110\u1ed9ng kinh do clozapin ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u, th\u01b0\u1eddng t\u00edch l\u0169y sau m\u1ed9t n\u0103m s\u1eed d\u1ee5ng thu\u1ed1c v\u1edbi li\u1ec1u 600 &#8211; 900 mg\/ng\u00e0y \u1edf kho\u1ea3ng 5% s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb. N\u1ebfu d\u00f9ng clozapin d\u01b0\u1edbi 300 mg\/ng\u00e0y, t\u1ef7 l\u1ec7 co gi\u1eadt kho\u1ea3ng 1 &#8211; 2%. Clozapin c\u00f3 th\u1ec3 \u1ee9c ch\u1ebf t\u1ee7y x\u01b0\u01a1ng m\u1ea1nh d\u1eabn \u0111\u1ebfn m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t, th\u1eadm ch\u00ed c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong. M\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t kh\u00f4ng li\u00ean quan r\u00f5 r\u00e0ng \u0111\u1ebfn b\u1ea5t c\u1ee9 \u0111\u1eb7c \u0111i\u1ec3m n\u00e0o c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 kh\u00f4ng th\u1ec3 d\u1ef1 \u0111o\u00e1n th\u00f4ng qua li\u1ec1u l\u01b0\u1ee3ng ho\u1eb7c th\u1eddi gian \u0111i\u1ec1u tr\u1ecb. Tuy v\u1eady, t\u1ef7 l\u1ec7 cao nh\u1ea5t th\u01b0\u1eddng g\u1eb7p trong 6 th\u00e1ng \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb clozapin cho b\u1ec7nh nh\u00e2n tr\u00ean 50 tu\u1ed5i.<\/p>\n<p><strong><em>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng: <\/em><\/strong><\/p>\n<p>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng ch\u1ed1ng lo\u1ea1n th\u1ea7n c\u1ee7a clozapin c\u00f2n ch\u01b0a \u0111\u01b0\u1ee3c l\u00e0m s\u00e1ng t\u1ecf ho\u00e0n to\u00e0n. C\u01a1 ch\u1ebf n\u00e0y bao g\u1ed3m s\u1ef1 tham gia c\u1ee7a c\u00e1c h\u1ec7 d\u1eabn truy\u1ec1n th\u1ea7n kinh serotoninergic, adrenergic v\u00e0 cholinergic \u1edf th\u1ea7n kinh trung \u01b0\u01a1ng \u0111\u1ed3ng th\u1eddi c\u00f3 li\u00ean quan \u0111\u1ebfn t\u00e1c d\u1ee5ng ch\u1ecdn l\u1ecdc v\u00f9ng tr\u00ean h\u1ec7 dopaminergic \u1edf v\u00f9ng vi\u1ec1n. Clozapin c\u00f3 \u00e1i l\u1ef1c g\u1eafn y\u1ebfu v\u1edbi th\u1ee5 th\u1ec3 c\u1ee7a dopamin (D1, D2, D3, D5) \u1edf v\u00f9ng th\u1ec3 v\u00e2n v\u00e0 v\u00f9ng h\u1eadu y\u00ean, nh\u01b0ng c\u00f3 \u00e1i l\u1ef1c g\u1eafn v\u1eeba ho\u1eb7c m\u1ea1nh v\u1edbi th\u1ee5 th\u1ec3 D4. \u0110i\u1ec1u n\u00e0y t\u1ea1o s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa clozapin v\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n kinh \u0111i\u1ec3n kh\u00e1c (\u00edt g\u00e2y t\u00e1c d\u1ee5ng ngo\u1ea1i th\u00e1p, \u00edt l\u00e0m t\u0103ng ti\u1ebft prolactin, \u00edt g\u00e2y lo\u1ea1n \u0111\u1ed9ng mu\u1ed9n).<\/p>\n<p>T\u00e1c d\u1ee5ng \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 alpha-adrenergic gi\u1ea3i th\u00edch m\u1ed9t ph\u1ea7n t\u00e1c d\u1ee5ng an th\u1ea7n, gi\u00e3n c\u01a1 v\u00e0 c\u00e1c t\u00e1c d\u1ee5ng kh\u00e1c tr\u00ean tim m\u1ea1ch c\u1ee7a clozapin. Clozapin c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng cholinergic n\u00ean c\u00f3 th\u1ec3 g\u00e2y kh\u00f4 mi\u1ec7ng, m\u00ea s\u1ea3ng \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n. T\u00e1c d\u1ee5ng \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 5HT-2 \u1edf th\u1ea7n kinh trung \u01b0\u01a1ng, th\u1ee5 th\u1ec3 5HT-3 \u1edf th\u1ea7n kinh trung \u01b0\u01a1ng v\u00e0 ngo\u1ea1i vi li\u00ean quan m\u1ed9t ph\u1ea7n \u0111\u1ebfn t\u00e1c d\u1ee5ng an th\u1ea7n s\u00e2u, \u0111\u1ebfn hi\u1ec7u qu\u1ea3 tr\u00ean c\u00e1c tri\u1ec7u ch\u1ee9ng \u00e2m t\u00ednh c\u1ee7a t\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t v\u00e0 l\u00e0m t\u0103ng c\u00e2n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng clozapin. Clozapin c\u00f3 ho\u1ea1t t\u00ednh r\u00f5 r\u1ec7t tr\u00ean acid y-aminobutyric (GABA) l\u00e0 ch\u1ea5t c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf c\u00e1c n\u01a1 ron dopaminergic. Tr\u00e1i v\u1edbi t\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n kinh \u0111i\u1ec3n, clozapin l\u00e0m t\u0103ng quay v\u00f2ng GABA \u1edf th\u1ec3 v\u00e2n v\u00e0 nh\u00e2n accubens. Vi\u1ec7c t\u0103ng quay v\u00f2ng v\u00e0 gi\u1ea3i ph\u00f3ng GABA \u1edf th\u1ec3 v\u00e2n c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m ph\u1ea3n \u1ee9ng ngo\u1ea1i th\u00e1p, c\u00f2n \u1edf nh\u00e2n accubens c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn t\u00e1c d\u1ee5ng ch\u1ed1ng lo\u1ea1n th\u1ea7n. Thu\u1ed1c c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng \u0111\u1ed1i kh\u00e1ng v\u1edbi th\u1ee5 th\u1ec3 c\u1ee7a histamin \u1edf th\u1ea7n kinh trung \u01b0\u01a1ng, g\u00e2y ra t\u00e1c d\u1ee5ng an th\u1ea7n, h\u1ea1 huy\u1ebft \u00e1p v\u00e0 t\u0103ng c\u00e2n. Tr\u00ean \u0111i\u1ec7n n\u00e3o \u0111\u1ed3, clozapin l\u00e0m t\u0103ng ho\u1ea1t t\u00ednh s\u00f3ng delta v\u00e0 theta, l\u00e0m ch\u1eadm t\u1ea7n su\u1ea5t s\u00f3ng alpha tr\u1ed9i. \u1eda m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, clozapin l\u00e0m gi\u1ea3m nhi\u1ec1u th\u1eddi gian ti\u1ec1m t\u00e0ng v\u00e0 t\u0103ng nhi\u1ec1u th\u1eddi gian gi\u1ea5c ng\u1ee7 giai \u0111o\u1ea1n \u0111\u1ed9ng m\u1eaft nhanh (REM). \u0110\u1ed9ng kinh do clozapin ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u, th\u01b0\u1eddng t\u00edch l\u0169y sau m\u1ed9t n\u0103m s\u1eed d\u1ee5ng thu\u1ed1c v\u1edbi li\u1ec1u 600 &#8211; 900 mg\/ng\u00e0y \u1edf kho\u1ea3ng 5% s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb. N\u1ebfu d\u00f9ng clozapin d\u01b0\u1edbi 300 mg\/ng\u00e0y, t\u1ef7 l\u1ec7 co gi\u1eadt kho\u1ea3ng 1 &#8211; 2%. Clozapin c\u00f3 th\u1ec3 \u1ee9c ch\u1ebf t\u1ee7y x\u01b0\u01a1ng m\u1ea1nh d\u1eabn \u0111\u1ebfn m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t, th\u1eadm ch\u00ed c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong. M\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t kh\u00f4ng li\u00ean quan r\u00f5 r\u00e0ng \u0111\u1ebfn b\u1ea5t c\u1ee9 \u0111\u1eb7c \u0111i\u1ec3m n\u00e0o c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 kh\u00f4ng th\u1ec3 d\u1ef1 \u0111o\u00e1n th\u00f4ng qua li\u1ec1u l\u01b0\u1ee3ng ho\u1eb7c th\u1eddi gian \u0111i\u1ec1u tr\u1ecb. Tuy v\u1eady, t\u1ef7 l\u1ec7 cao nh\u1ea5t th\u01b0\u1eddng g\u1eb7p trong 6 th\u00e1ng \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb clozapin cho b\u1ec7nh nh\u00e2n tr\u00ean 50 tu\u1ed5i.<\/p>\n<p>C\u01a1 ch\u1ebf ch\u00ednh x\u00e1c g\u00e2y m\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t do clozapin c\u00f2n ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5, nh\u01b0ng c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn c\u01a1 ch\u1ebf mi\u1ec5n d\u1ecbch v\u00e0 c\u01a1 ch\u1ebf g\u00e2y \u0111\u1ed9c c\u1ee7a thu\u1ed1c ho\u1eb7c d\u1eabn ch\u1ea5t chuy\u1ec3n h\u00f3a c\u1ee7a thu\u1ed1c.<\/p>\n<p><strong>[XEM T\u1ea0I \u0110\u00c2Y]<\/strong><\/p>\n<p><strong>5.2. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc:<\/strong><\/p>\n<p>H\u1ea5p thu: Sau khi u\u1ed1ng, clozapin h\u1ea5p thu nhanh v\u00e0 g\u1ea7n nh\u01b0 ho\u00e0n to\u00e0n qua \u1ed1ng ti\u00eau h\u00f3a (ch\u1ee7 y\u1ebfu \u1edf ti\u1ec3u tr\u00e0ng), tuy nhi\u00ean do b\u1ecb chuy\u1ec3n h\u00f3a b\u01b0\u1edbc 1 \u1edf gan n\u00ean sinh kh\u1ea3 d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng ch\u1ec9 \u0111\u1ea1t 50 &#8211; 60%. Th\u1ee9c \u0103n kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u1ea5p thu thu\u1ed1c. N\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong m\u00e1u \u0111\u1ea1t c\u1ef1c \u0111\u1ea1i kho\u1ea3ng 2,5 gi\u1edd sau khi d\u00f9ng thu\u1ed1c. N\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong huy\u1ebft t\u01b0\u01a1ng \u0111\u1ea1t tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh sau 7 &#8211; 10 ng\u00e0y v\u1edbi li\u1ec1u nh\u1eafc l\u1ea1i, v\u1edbi n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh trung b\u00ecnh 319 nanogam\/ml \u0111\u1ea1t \u0111\u01b0\u1ee3c sau khi d\u00f9ng li\u1ec1u 100 mg, 2 l\u1ea7n\/ng\u00e0y. C\u00f3 s\u1ef1 bi\u1ebfn thi\u00ean l\u1edbn gi\u1eefa c\u00e1c c\u00e1 th\u1ec3 v\u1ec1 n\u1ed3ng \u0111\u1ed9 thu\u1ed1c \u0111\u1ea1t \u0111\u01b0\u1ee3c trong huy\u1ebft t\u01b0\u01a1ng sau khi d\u00f9ng c\u00f9ng 1 li\u1ec1u. T\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u00fd xu\u1ea5t hi\u1ec7n kho\u1ea3ng 15 ph\u00fat sau khi d\u00f9ng thu\u1ed1c v\u00e0 duy tr\u00ec trong 4 &#8211; 12 gi\u1edd sau \u0111\u00f3. \u1eda b\u1ec7nh nh\u00e2n t\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t, t\u00e1c d\u1ee5ng an th\u1ea7n th\u1ec3 hi\u1ec7n r\u00f5 trong v\u00f2ng m\u1ed9t v\u00e0i gi\u1edd sau khi u\u1ed1ng li\u1ec1u \u0111\u1ea7u ti\u00ean, t\u00e1c d\u1ee5ng t\u1ed1i \u0111a \u0111\u1ea1t \u0111\u01b0\u1ee3c trong v\u00f2ng 7 ng\u00e0y. Tuy nhi\u00ean, sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi clozapin, t\u00e1c d\u1ee5ng ch\u1ed1ng lo\u1ea1n th\u1ea7n th\u01b0\u1eddng ch\u1eadm h\u01a1n, xu\u1ea5t hi\u1ec7n trong v\u00f2ng m\u1ed9t \u0111\u1ebfn v\u00e0i tu\u1ea7n, t\u00e1c d\u1ee5ng t\u1ed1i \u0111a c\u00f3 th\u1ec3 c\u1ea7n v\u00e0i th\u00e1ng \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>Ph\u00e2n b\u1ed1: Clozapin v\u00e0 c\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a ph\u00e2n b\u1ed1 nhanh v\u00e0 nhi\u1ec1u v\u00e0o c\u00e1c m\u00f4 trong \u0111\u00f3 c\u00f3 th\u1ea7n kinh trung \u01b0\u01a1ng. Th\u1ec3 t\u00edch ph\u00e2n b\u1ed1 c\u1ee7a thu\u1ed1c kho\u1ea3ng 4,65 l\u00edt\/kg. \u1eda b\u1ec7nh nh\u00e2n t\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t, th\u1ec3 t\u00edch ph\u00e2n b\u1ed1 \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh trung b\u00ecnh 1,6 l\u00edt\/kg. Do th\u1ec3 t\u00edch ph\u00e2n b\u1ed1 nh\u1ecf h\u01a1n so v\u1edbi c\u00e1c thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n kh\u00e1c n\u00ean clozapin \u00edt b\u1ecb l\u01b0u gi\u1eef l\u1ea1i \u1edf c\u00e1c m\u00f4 h\u01a1n. T\u1ef7 l\u1ec7 li\u00ean k\u1ebft v\u1edbi protein huy\u1ebft t\u01b0\u01a1ng kho\u1ea3ng 97%.<\/p>\n<p>Chuy\u1ec3n h\u00f3a: Clozapin \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a \u1edf gan tr\u01b0\u1edbc khi th\u1ea3i tr\u1eeb b\u1eb1ng c\u00e1c ph\u1ea3n \u1ee9ng N-demethyl h\u00f3a, N-oxy h\u00f3a, hydroxyl h\u00f3a, 3\u2019-carbon-oxy h\u00f3a, epoxyl h\u00f3a ch\u1ee7 y\u1ebfu th\u00f4ng qua CYP1A2 sau \u0111\u00f3 \u0111\u01b0\u1ee3c li\u00ean h\u1ee3p v\u1edbi acid glucuronic. D\u1eabn ch\u1ea5t chuy\u1ec3n h\u00f3a demethyl (norclozapin) c\u00f2n gi\u1eef \u0111\u01b0\u1ee3c m\u1ed9t ph\u1ea7n ho\u1ea1t t\u00ednh c\u1ee7a clozapin.<\/p>\n<p>Th\u1ea3i tr\u1eeb: Sau khi u\u1ed1ng li\u1ec1u \u0111\u01a1n 75 mg, n\u1eeda \u0111\u1eddi th\u1ea3i tr\u1eeb trong huy\u1ebft t\u01b0\u01a1ng c\u1ee7a clozapin kho\u1ea3ng 8 gi\u1edd (dao \u0111\u1ed9ng t\u1eeb 4 gi\u1edd \u0111\u1ebfn 12 gi\u1edd). N\u1eeda \u0111\u1eddi th\u1ea3i tr\u1eeb sau khi d\u00f9ng li\u1ec1u nh\u1eafc l\u1ea1i 100 mg, 2 l\u1ea7n\/ng\u00e0y \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh v\u00e0o kho\u1ea3ng 12 gi\u1edd (dao \u0111\u1ed9ng t\u1eeb 4 \u0111\u1ebfn 66 gi\u1edd). Clozapin \u0111\u01b0\u1ee3c \u0111\u00e0o th\u1ea3i ch\u1ee7 y\u1ebfu d\u01b0\u1edbi d\u1ea1ng c\u00e1c d\u1eabn ch\u1ea5t chuy\u1ec3n h\u00f3a, m\u1ed9t ph\u1ea7n nh\u1ecf (2 &#8211; 5%) d\u01b0\u1edbi d\u1ea1ng nguy\u00ean v\u1eb9n qua n\u01b0\u1edbc ti\u1ec3u v\u00e0 ph\u00e2n.<\/p>\n<p><strong>5.3 Gi\u1ea3i th\u00edch: <\/strong><\/p>\n<p>Ch\u01b0a c\u00f3 th\u00f4ng tin. \u0110ang c\u1eadp nh\u1eadt.<\/p>\n<p><strong>5.4 Thay th\u1ebf thu\u1ed1c : <\/strong><\/p>\n<p>Ch\u01b0a c\u00f3 th\u00f4ng tin. \u0110ang c\u1eadp nh\u1eadt.<\/p>\n<p><strong><em>*L\u01b0u \u00fd:<\/em><\/strong><\/p>\n<p><strong><em>C\u00e1c th\u00f4ng tin v\u1ec1 thu\u1ed1c tr\u00ean Pharmog.com ch\u1ec9 mang t\u00ednh ch\u1ea5t tham kh\u1ea3o &#8211; Khi d\u00f9ng thu\u1ed1c c\u1ea7n tuy\u1ec7t \u0111\u1ed1i tu\u00e2n theo theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u00e1c s\u0129 <\/em><\/strong><\/p>\n<p><strong><em>Ch\u00fang t\u00f4i kh\u00f4ng ch\u1ecbu tr\u00e1ch nhi\u1ec7m v\u1ec1 b\u1ea5t c\u1ee9 h\u1eadu qu\u1ea3 n\u00e0o x\u1ea3y ra do t\u1ef1 \u00fd d\u00f9ng thu\u1ed1c d\u1ef1a theo c\u00e1c th\u00f4ng tin tr\u00ean Pharmog.com<\/em><\/strong><\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>6. Ph\u1ea7n th\u00f4ng tin k\u00e8m theo c\u1ee7a thu\u1ed1c:<\/strong><\/p>\n<p><strong>6.1. Danh m\u1ee5c t\u00e1 d\u01b0\u1ee3c:<\/strong><\/p>\n<p>Colloidal silicon dioxide, lactose, magnesium stearate, povidone, starch (corn), talc.<\/p>\n<p><strong>6.2. T\u01b0\u01a1ng k\u1ef5 :<\/strong><\/p>\n<p>Kh\u00f4ng \u00e1p d\u1ee5ng.<\/p>\n<p><strong>6.3. B\u1ea3o qu\u1ea3n: <\/strong><\/p>\n<p>Vi\u00ean n\u00e9n c\u00f3 ch\u1ee9a clozapin c\u1ea7n \u0111\u01b0\u1ee3c b\u1ea3o qu\u1ea3n trong bao b\u00ec k\u00edn, \u1edf nhi\u1ec7t \u0111\u1ed9 kh\u00f4ng qu\u00e1 30 <sup>o<\/sup>C. Vi\u00ean n\u00e9n ph\u00e2n t\u00e1n ch\u1ee9a clozapin c\u1ea7n \u0111\u01b0\u1ee3c b\u1ea3o qu\u1ea3n trong v\u1ec9 thi\u1ebfc k\u00edn, \u1edf nhi\u1ec7t \u0111\u1ed9 kh\u00f4ng qu\u00e1 25 <sup>o<\/sup>C.<\/p>\n<p><strong>6.4. Th\u00f4ng tin kh\u00e1c :<\/strong><\/p>\n<p>Kh\u00f4ng c\u00f3.<\/p>\n<p><strong>6.5 T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong><\/p>\n<p>D\u01b0\u1ee3c Th\u01b0 Qu\u1ed1c Gia Vi\u1ec7t Nam<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>1. T\u00ean ho\u1ea1t ch\u1ea5t v\u00e0 bi\u1ec7t d\u01b0\u1ee3c: Ho\u1ea1t ch\u1ea5t : Clozapine Ph\u00e2n lo\u1ea1i: Thu\u1ed1c ch\u1ed1ng lo\u1ea1n th\u1ea7n Nh\u00f3m ph\u00e1p l\u00fd: Thu\u1ed1c k\u00ea \u0111\u01a1n ETC \u2013 (Ethical drugs, prescription drugs, Prescription only medicine) M\u00e3 ATC (Anatomical Therapeutic Chemical): N05AH02 Bi\u1ec7t d\u01b0\u1ee3c g\u1ed1c: Bi\u1ec7t d\u01b0\u1ee3c: Dafidi H\u00e3ng s\u1ea3n xu\u1ea5t : CT CP SX th\u01b0\u01a1ng m\u1ea1i D\u01b0\u1ee3c ph\u1ea9m [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":37206,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"default","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[419],"tags":[623],"class_list":["post-18479","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-biet-duoc","tag-clozapine"],"_links":{"self":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/18479","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/comments?post=18479"}],"version-history":[{"count":4,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/18479\/revisions"}],"predecessor-version":[{"id":50243,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/18479\/revisions\/50243"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/media\/37206"}],"wp:attachment":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/media?parent=18479"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/categories?post=18479"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/tags?post=18479"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}