{"id":31085,"date":"2021-05-04T18:13:21","date_gmt":"2021-05-04T11:13:21","guid":{"rendered":"https:\/\/pharmog.com\/wp\/?p=31085"},"modified":"2025-01-07T23:13:29","modified_gmt":"2025-01-07T16:13:29","slug":"mycophenolate-mofetil-mycophenolic-acid-baxmune","status":"publish","type":"post","link":"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/","title":{"rendered":"Mycophenolate mofetil (Mycophenolic Acid) &#8211; Baxmune"},"content":{"rendered":"<p><em>Thu\u1ed1c Baxmune 500 l\u00e0 thu\u1ed1c g\u00ec ? D\u01b0\u1edbi \u0111\u00e2y l\u00e0 n\u1ed9i dung t\u1edd h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng g\u1ed1c c\u1ee7a Thu\u1ed1c Baxmune 500 (Th\u00f4ng tin bao g\u1ed3m li\u1ec1u d\u00f9ng, c\u00e1ch d\u00f9ng, ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, th\u1eadn tr\u1ecdng, d\u01b0\u1ee3c l\u00fd&#8230;)<\/em><\/p><div id=\"ez-toc-container\" class=\"ez-toc-v2_0_81 ez-toc-wrap-left counter-hierarchy ez-toc-counter ez-toc-white ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">N\u1ed9i dung ch\u00ednh<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 eztoc-toggle-hide-by-default' ><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#1-ten-hoat-chat-va-biet-duoc\" >1. T\u00ean ho\u1ea1t ch\u1ea5t v\u00e0 bi\u1ec7t d\u01b0\u1ee3c:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#2-dang-bao-che-%e2%80%93-ham-luong\" >2. D\u1ea1ng b\u00e0o ch\u1ebf &#8211; H\u00e0m l\u01b0\u1ee3ng:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#3-video-by-pharmog\" >3. Video by Pharmog:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#4-ung-dung-lam-sang\" >4. \u1ee8ng d\u1ee5ng l\u00e2m s\u00e0ng:<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#41-chi-dinh\" >4.1. Ch\u1ec9 \u0111\u1ecbnh:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#42-lieu-dung-%e2%80%93-cach-dung\" >4.2. Li\u1ec1u d\u00f9ng &#8211; C\u00e1ch d\u00f9ng:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#43-chong-chi-dinh\" >4.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#44-than-trong\" >4.4 Th\u1eadn tr\u1ecdng:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#45-su-dung-cho-phu-nu-co-thai-va-cho-con-bu\" >4.5 S\u1eed d\u1ee5ng cho ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#46-tac-dung-khong-mong-muon-adr\" >4.6 T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n (ADR):<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#47-huong-dan-cach-xu-tri-adr\" >4.7 H\u01b0\u1edbng d\u1eabn c\u00e1ch x\u1eed tr\u00ed ADR:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#48-tuong-tac-voi-cac-thuoc-khac\" >4.8 T\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#49-qua-lieu-va-xu-tri\" >4.9 Qu\u00e1 li\u1ec1u v\u00e0 x\u1eed tr\u00ed:<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#5-co-che-tac-dung-cua-thuoc\" >5. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c :<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#51-duoc-luc-hoc\" >5.1. D\u01b0\u1ee3c l\u1ef1c h\u1ecdc:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-16\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#52-duoc-dong-hoc\" >5.2. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-17\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#53-giai-thich\" >5.3 Gi\u1ea3i th\u00edch:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-18\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#54-thay-the-thuoc\" >5.4 Thay th\u1ebf thu\u1ed1c :<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-19\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#6-phan-thong-tin-kem-theo-cua-thuoc\" >6. Ph\u1ea7n th\u00f4ng tin k\u00e8m theo c\u1ee7a thu\u1ed1c:<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-20\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#61-danh-muc-ta-duoc\" >6.1. Danh m\u1ee5c t\u00e1 d\u01b0\u1ee3c:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-21\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#62-tuong-ky\" >6.2. T\u01b0\u01a1ng k\u1ef5 :<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-22\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#63-bao-quan\" >6.3. B\u1ea3o qu\u1ea3n:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-23\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#64-thong-tin-khac\" >6.4. Th\u00f4ng tin kh\u00e1c :<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-24\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#65-tai-lieu-tham-khao\" >6.5 T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-25\" href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-baxmune\/#7-nguoi-dang-tai-tac-gia\" >7. Ng\u01b0\u1eddi \u0111\u0103ng t\u1ea3i \/T\u00e1c gi\u1ea3:<\/a><\/li><\/ul><\/nav><\/div>\n\n<h1><span class=\"ez-toc-section\" id=\"1-ten-hoat-chat-va-biet-duoc\"><\/span>1. T\u00ean ho\u1ea1t ch\u1ea5t v\u00e0 bi\u1ec7t d\u01b0\u1ee3c:<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p><strong><em>Ho\u1ea1t ch\u1ea5t :<\/em> <\/strong><a href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil\/\"><strong>Mycophenolate mofetil\/ Mycophenolic Acid<\/strong><\/a><\/p>\n<p><strong><em>Ph\u00e2n lo\u1ea1i: <\/em><\/strong><em>Thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch ch\u1ecdn l\u1ecdc.<\/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): L04AA06 &#8211; mycophenolic acid.<\/p>\n<p><strong><em>Bi\u1ec7t d\u01b0\u1ee3c g\u1ed1c:<\/em><\/strong> <a href=\"https:\/\/pharmog.com\/wp\/mycophenolate-mofetil-mycophenolic-acid-cellcept\/\">CellCept<\/a><\/p>\n<p><strong><em>Bi\u1ec7t d\u01b0\u1ee3c:<\/em><\/strong> Baxmune 500<\/p>\n<p><strong><em>H\u00e3ng s\u1ea3n xu\u1ea5t <\/em><\/strong>: Ranbaxy Laboratories Limited<\/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<h1><span class=\"ez-toc-section\" id=\"2-dang-bao-che-%e2%80%93-ham-luong\"><\/span>2. D\u1ea1ng b\u00e0o ch\u1ebf &#8211; H\u00e0m l\u01b0\u1ee3ng:<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p><strong><em>D\u1ea1ng thu\u1ed1c v\u00e0 h\u00e0m l\u01b0\u1ee3ng<\/em><\/strong><\/p>\n<p>Vi\u00ean n\u00e9n 500 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>BAXMUNE 500<\/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>Mycophenolate mofetil<\/td>\n<td>&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<\/td>\n<td>500 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\" width=\"578\" height=\"265\" class=\"wp-image-31086\" src=\"https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2021\/05\/word-image-31.png\" srcset=\"https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2021\/05\/word-image-31.png 578w, https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2021\/05\/word-image-31-300x138.png 300w\" sizes=\"auto, (max-width: 578px) 100vw, 578px\" \/><\/p>\n<h1><span class=\"ez-toc-section\" id=\"3-video-by-pharmog\"><\/span>3. Video by Pharmog:<span class=\"ez-toc-section-end\"><\/span><\/h1>\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<h1><span class=\"ez-toc-section\" id=\"4-ung-dung-lam-sang\"><\/span>4. \u1ee8ng d\u1ee5ng l\u00e2m s\u00e0ng:<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<h2><span class=\"ez-toc-section\" id=\"41-chi-dinh\"><\/span>4.1. Ch\u1ec9 \u0111\u1ecbnh:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Mycophenolat mofetil \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ph\u1ed1i h\u1ee3p v\u1edbi ciclosporin v\u00e0 corticosteroid trong ph\u00f2ng ng\u1eeba th\u1ea3i gh\u00e9p c\u1ea5p t\u00ednh \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c gh\u00e9p th\u1eadn, tim ho\u1eb7c gan d\u1ecb th\u00e2n..<\/p>\n<h2><span class=\"ez-toc-section\" id=\"42-lieu-dung-%e2%80%93-cach-dung\"><\/span>4.2. Li\u1ec1u d\u00f9ng &#8211; C\u00e1ch d\u00f9ng:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><strong><em>C\u00e1ch d\u00f9ng<\/em><\/strong> :<\/p>\n<p>D\u00f9ng u\u1ed1ng.<\/p>\n<p><strong><em>Li\u1ec1u d\u00f9ng:<\/em><\/strong><\/p>\n<p>B\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng v\u00e0 duy tr\u00ec s\u1eed d\u1ee5ng mycophenolate mofetil n\u00ean \u0111\u01b0\u1ee3c quy\u1ebft \u0111\u1ecbnh b\u1edfi c\u00e1c chuy\u1ec3n gia gh\u00e9p t\u1ea1ng \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o ph\u00f9 h\u1ee3p.<\/p>\n<p><em>S\u1eed d\u1ee5ng trong gh\u00e9p th\u1eadn<\/em><\/p>\n<p>Ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh: D\u00f9ng Mycophenolate Mofetil \u0111\u01b0\u1eddng u\u1ed1ng kh\u1edfi \u0111\u1ea7u trong v\u00f2ng 72 gi\u1edd sau khi gh\u00e9p. Li\u1ec1u d\u00f9ng khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn l\u00e0 1g, 2 l\u1ea7n\/ng\u00e0y (li\u1ec1u h\u1eb1ng ng\u00e0y l\u00e0 2g).<\/p>\n<p>Tr\u1ebb em v\u00e0 thanh thi\u1ebfu ni\u00ean (2 \u0111\u1ebfn 18 tu\u1ed5i): Li\u1ec1u d\u00f9ng khuy\u1ebfn c\u00e1o c\u1ee7a Mycophenolate Mofetil l\u00e0 600 mg\/m\u00b2 d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y (t\u1ed1i \u0111a l\u00e0 2 g h\u1eb1ng ng\u00e0y). Vi\u00ean n\u00e9n Mycophenolate Mofetil ch\u1ec9 \u0111\u01b0\u1ee3c k\u00ea toa cho b\u1ec7nh nh\u00e2n c\u00f3 di\u1ec7n t\u00edch b\u1ec1 m\u1eb7t c\u01a1 th\u1ec3 tr\u00ean 1,5 m\u00b2, v\u1edbi li\u1ec1u d\u00f9ng 1 g, 2 l\u1ea7n\/ng\u00e0y (li\u1ec1u d\u00f9ng 2 g h\u1eb1ng ng\u00e0y). V\u00ec m\u1ed9t s\u1ed1 ph\u1ea3n \u1ee9ng ph\u1ee5 x\u1ea3y ra v\u1edbi t\u1ea7n su\u1ea5t cao h\u01a1n trong \u0111\u1ed9 tu\u1ed5i n\u00e0y so v\u1edbi ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh, gi\u1ea3m li\u1ec1u t\u1ea1m th\u1eddi ho\u1eb7c d\u00f9ng thu\u1ed1c gi\u00e1n \u0111o\u1ea1n; \u0111i\u1ec1u n\u00e0y ph\u1ea3i c\u1ea7n l\u01b0u \u00fd \u0111\u1ebfn c\u00e1c y\u1ebfu t\u1ed1 t\u01b0\u01a1ng quan tr\u00ean l\u00e2m s\u00e0ng g\u1ed3m c\u1ea3 m\u1ee9c \u0111\u1ed9 tr\u1ea7m tr\u1ecdng c\u1ee7a ph\u1ea3n \u1ee9ng.<\/p>\n<p>Tr\u1ebb em (&lt; 2 tu\u1ed5i): D\u1eef li\u1ec7u t\u00ednh an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 b\u1ecb gi\u1edbi h\u1ea1n \u1edf tr\u1ebb em d\u01b0\u1edbi 2 tu\u1ed5i. C\u00e1c d\u1eef li\u1ec7u n\u00e0y kh\u00f4ng th\u00edch h\u1ee3p \u0111\u1ec3 khuy\u1ebfn c\u00e1o li\u1ec1u l\u01b0\u1ee3ng thu\u1ed1c v\u00e0 v\u00ec v\u1eady kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng thu\u1ed1c cho \u0111\u1ed9 tu\u1ed5i n\u00e0y.<\/p>\n<p><em>S\u1eed d\u1ee5ng trong gh\u00e9p tim<\/em><\/p>\n<p>Ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh: D\u00f9ng Mycophenolate Mofetil \u0111\u01b0\u1eddng u\u1ed1ng kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb trong v\u00f2ng 5 ng\u00e0y sau khi gh\u00e9p. Li\u1ec1u l\u01b0\u1ee3ng khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n gh\u00e9p tim l\u00e0 1,5 g x 2 l\u1ea7n\/ng\u00e0y (li\u1ec1u 3 g h\u1eb1ng ng\u00e0y).<\/p>\n<p>Tr\u1ebb em: Kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u th\u00edch h\u1ee3p cho b\u1ec7nh nhi \u0111\u01b0\u1ee3c gh\u00e9p tim..<\/p>\n<p><em>S\u1eed d\u1ee5ng trong gh\u00e9p gan<\/em><\/p>\n<p>Ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh: D\u00f9ng Mycophenolate Mofetil \u0111\u01b0\u1eddng ti\u00eam t\u0129nh m\u1ea1ch trong v\u00f2ng 4 ng\u00e0y sau khi gh\u00e9p gan, v\u1edbi Mycophenolate Mofetil d\u00f9ng d\u1ea1ng u\u1ed1ng th\u00ec ph\u1ea3i u\u1ed1ng s\u1edbm ngay sau khi gh\u00e9p v\u00ec n\u00f3 c\u00f3 th\u1ec3 b\u1ecb dung n\u1ea1p thu\u1ed1c. Li\u1ec1u u\u1ed1ng khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n gh\u00e9p gan \u1edf 1,5 g x 2 l\u1ea7n\/ng\u00e0y (li\u1ec1u 3 g h\u1eb1ng ng\u00e0y).<\/p>\n<p>Tr\u1ebb em: Kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u th\u00edch h\u1ee3p cho b\u1ec7nh nhi \u0111\u01b0\u1ee3c gh\u00e9p gan.<\/p>\n<p>S\u1eed d\u1ee5ng \u1edf ng\u01b0\u1eddi cao tu\u1ed5i (t\u1eeb 65 tu\u1ed5i tr\u1edf l\u00ean): Li\u1ec1u khuy\u00ean c\u00e1o l\u00e0 1 g x 2 l\u1ea7n\/ng\u00e0y cho b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn v\u00e0 1,5 g x 2 l\u1ea7n\/ng\u00e0y cho b\u1ec7nh nh\u00e2n gh\u00e9p tim hay b\u1ec7nh nh\u00e2n gh\u00e9p gan..<\/p>\n<p><em>S\u1eed d\u1ee5ng thu\u1ed1c khi suy ch\u1ee9c n\u0103ng th\u1eadn<\/em><\/p>\n<p>\u1ede b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn b\u1ecb suy ch\u1ee9c n\u0103ng th\u1eadn n\u1eb7ng, ngo\u00e0i kho\u1ea3ng th\u1eddi gian ngay sau khi gh\u00e9p, n\u00ean tr\u00e1nh d\u00f9ng li\u1ec1u cao h\u01a1n 1 g x 2 l\u1ea7n\/ng\u00e0y. C\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y n\u00ean \u0111\u01b0\u1ee3c gi\u00e1m s\u00e1t c\u1ea9n th\u1eadn. Kh\u00f4ng c\u1ea7n thi\u1ebft ch\u1ec9nh li\u1ec1u \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 m\u1ea3nh gh\u00e9p th\u1eadn ch\u1eadm ho\u1ea1t \u0111\u1ed9ng sau ph\u1eabu thu\u1eadt. Kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u th\u00edch h\u1ee3p cho c\u00e1c b\u1ec7nh nh\u00e2n gh\u00e9p tim ho\u1eb7c gh\u00e9p gan b\u1ecb suy ch\u1ee9c n\u0103ng th\u1eadn n\u1eb7ng v\u00e0 m\u00e3n t\u00ednh.<\/p>\n<p><em>S\u1eed d\u1ee5ng thu\u1ed1c khi suy ch\u1ee9c n\u0103ng gan n\u1eb7ng<\/em><\/p>\n<p>Kh\u00f4ng c\u1ea7n ch\u1ec9nh li\u1ec1u cho b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn b\u1ecb b\u1ec7nh nhu m\u00f4 gan n\u1eb7ng. Kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u th\u00edch h\u1ee3p cho c\u00e1c b\u1ec7nh nh\u00e2n gh\u00e9p tim c\u00f3 b\u1ec7nh v\u1ec1 nhu m\u00f4 gan n\u1eb7ng.<\/p>\n<p><em>\u0110i\u1ec1u tr\u1ecb gi\u1eefa c\u00e1c kho\u1ea3ng th\u1eddi gian th\u1ea3i gh\u00e9p<\/em><\/p>\n<p>MPA (Acid Mycophenolic) l\u00e0 ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f3 ho\u1ea1t t\u00ednh c\u1ee7a Mycophenolate Mofetil. Th\u1ea3i m\u1ea3nh gh\u00e9p th\u1eadn kh\u00f4ng d\u1eabn \u0111\u1ebfn thay \u0111\u1ed5i d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a MPA; kh\u00f4ng y\u00eau c\u1ea7u gi\u1ea3m li\u1ec1u ho\u1eb7c s\u1eed d\u1ee5ng c\u00e1ch qu\u00e3ng Mycophenolate Mofetil. Kh\u00f4ng c\u00f3 c\u01a1 s\u1edf cho s\u1ef1 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u d\u00f9ng c\u1ee7a Mycophenolate Mofetil sau th\u1ea3i gh\u00e9p tim. Kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc th\u00edch h\u1ee3p trong th\u1eddi gian th\u1ea3i gh\u00e9p gan.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"43-chong-chi-dinh\"><\/span>4.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>C\u00e1c ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn \u0111\u1ed1i v\u1edbi mycophenolate mofetil \u0111\u00e3 \u0111\u01b0\u1ee3c quan s\u00e1t. V\u00ec v\u1eady, mycophenolate mofetil ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n qu\u00e1 m\u1eabn v\u1edbi mycophenolate mofetil ho\u1eb7c v\u1edbi acid mycophenolic.<\/p>\n<p>Mycophenolate mofetil ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng cho ph\u1ee5 n\u1eef nu\u00f4i con b\u1eb1ng s\u1eefa m\u1eb9.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"44-than-trong\"><\/span>4.4 Th\u1eadn tr\u1ecdng:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>B\u1ec7nh nh\u00e2n d\u00f9ng ph\u00e1c \u0111\u1ed3 \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch trong \u0111\u00f3 s\u1eed d\u1ee5ng nhi\u1ec1u thu\u1ed1c, g\u1ed3m c\u00f3 c\u1ea3 mycophenolate mofetil, b\u1ecb t\u0103ng nguy c\u01a1 ti\u1ebfn tri\u1ec3n u b\u1ea1ch huy\u1ebft v\u00e0 c\u00e1c b\u1ec7nh l\u00fd \u00e1c t\u00ednh kh\u00e1c, \u0111\u1eb7c bi\u1ec7t tr\u00ean da. Nguy c\u01a1 d\u01b0\u1eddng nh\u01b0 c\u00f3 li\u00ean quan \u0111\u1ebfn c\u01b0\u1eddng \u0111\u1ed9 v\u00e0 th\u1eddi gian \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch h\u01a1n l\u00e0 s\u1eed d\u1ee5ng b\u1ea5t k\u1ef3 thu\u1ed1c chuy\u1ec3n bi\u1ec7t n\u00e0o. Th\u00f4ng tin chung \u0111\u1ec3 h\u1ea1n ch\u1ebf t\u1ed1i \u0111a nguy c\u01a1 ung th\u01b0 da, \u0111\u00f3 l\u00e0, h\u1ea1n ch\u1ebf ph\u01a1i nhi\u1ec5m v\u1edbi \u00e1nh n\u1eafng v\u00e0 tia UV b\u1eb1ng c\u00e1ch m\u1eb7c \u00e1o qu\u1ea7n b\u1ea3o v\u1ec7 v\u00e0 s\u1eed d\u1ee5ng s\u1ea3n ph\u1ea9m ch\u1ed1ng n\u1eafng v\u1edbi y\u1ebfu t\u1ed1 ch\u1ed1ng n\u1eafng cao.<\/p>\n<p>N\u00ean h\u01b0\u1edbng d\u1eabn b\u1ec7nh nh\u00e2n d\u00f9ng mycophenolate mofetil ph\u1ea3i b\u00e1o c\u00e1o ngay l\u1eadp t\u1ee9c khi c\u00f3 b\u1ea5t c\u1ee9 b\u1eb1ng ch\u1ee9ng nhi\u1ec5m tr\u00f9ng, c\u00f3 v\u1ebft th\u00e2m ho\u1eb7c xu\u1ea5t huy\u1ebft ho\u1eb7c b\u1ea5t c\u1ee9 bi\u1ebfn ch\u1ee9ng c\u1ee7a suy t\u1ee7y x\u01b0\u01a1ng kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n.<\/p>\n<p>B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, g\u1ed3m mycophenolate mofetil, t\u0103ng nguy c\u01a1 nhi\u1ec5m tr\u00f9ng c\u01a1 h\u1ed9i (vi khu\u1ea9n, n\u1ea5m, virus v\u00e0 nguy\u00ean b\u00e0o), nhi\u1ec5m tr\u00f9ng v\u00e0 c\u00e1c nhi\u1ec5m tr\u00f9ng g\u00e2y t\u1eed vong. Trong s\u1ed1 c\u00e1c nhi\u1ec5m tr\u00f9ng c\u01a1 h\u1ed9i l\u00e0 virus BK li\u00ean quan \u0111\u1ebfn b\u1ec7nh th\u1eadn v\u00e0 JC virus li\u00ean quan \u0111\u1ebfn b\u1ec7nh l\u00fd ch\u1ea5t tr\u1eafng \u0111a \u1ed5 ti\u1ebfn tri\u1ec3n &#8211; progressiv\u1ec1 multifocal leukoencephalopathy (PML). C\u00e1c nhi\u1ec5m tr\u00f9ng n\u00e0y th\u01b0\u1eddng c\u00f3 li\u00ean quan \u0111\u1ebfn c\u01b0\u1eddng \u0111\u1ed9 \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u00e1c t\u00ecnh tr\u1ea1ng b\u1ec7nh tr\u1ea7m tr\u1ecdng ho\u1eb7c t\u1eed vong m\u00e0 b\u00e1c s\u0129 n\u00ean c\u00e2n nh\u1eafc trong ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t \u1edf c\u00e1c b\u1ec7nh nh\u00e2n b\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch c\u00f3 ch\u1ee9c n\u0103ng th\u1eadn b\u1ecb suy gi\u1ea3m ho\u1eb7c c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ec1 th\u1ea7n kinh.<\/p>\n<p>Gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh n\u1eb7ng [s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u trung t\u00ednh tuy\u1ec7t \u0111\u1ed1i (ANC) &lt;0,5 x 10^3\/mcL] ti\u1ec5n tri\u1ec3n l\u00ean \u0111\u1ebfn 2,0% b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn, 2,8% b\u1ec7nh nh\u00e2n gh\u00e9p tim, v\u00e0 l\u00ean \u0111\u1ebfn 3,6% b\u1ec7nh nh\u00e2n gh\u00e9p gan s\u1eed d\u1ee5ng mycophenolate 3g, h\u1eb1ng ng\u00e0y. C\u00e1c b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng mycophenolate mofetil n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i v\u1ec1 gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u trung t\u00ednh, c\u00f3 th\u1ec3 c\u00f3 li\u00ean quan do b\u1ea3n th\u00e2n thu\u1ed1c mycophenolate mofetil, c\u00e1c thu\u1ed1c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi, nhi\u1ec5m virus, ho\u1eb7c m\u1ed9t s\u1ed1 do t\u1ea5t c\u1ea3 c\u00e1c nguy\u00ean nh\u00e2n n\u00e0y. B\u1ec7nh nh\u00e2n d\u00f9ng mycophenolate mofetil n\u00ean ki\u1ec3m tra c\u00f4ng th\u1ee9c m\u00e1u to\u00e0n ph\u1ea7n h\u1eb1ng tu\u1ea7n trong th\u00e1ng \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb, 2 l\u1ea7n\/th\u00e1ng cho th\u00e1ng th\u1ee9 hai v\u00e0 th\u1ee9 ba, sau \u0111\u00f3 ki\u1ec3m tra h\u1eb1ng th\u00e1ng trong n\u0103m \u0111\u1ea7u ti\u00ean. N\u1ebfu gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u trung t\u00ednh ti\u1ebfn tri\u1ec3n (s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u trung t\u00ednh tuy\u1ec7t \u0111\u1ed1i (ANC) &lt; 1,3 x 10^3\/mcl), c\u00f3 th\u1ec3 ph\u1ea3i d\u00f9ng thu\u1ed1c ng\u1eaft qu\u00e3ng ho\u1eb7c d\u1eebng s\u1eed d\u1ee5ng mycophenolate mofetil. Gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u trung t\u00ednh \u0111\u00e3 \u0111\u01b0\u1ee3c quan s\u00e1t x\u1ea3y ra th\u01b0\u1eddng xuy\u00ean nh\u1ea5t trong kho\u1ea3ng th\u1eddi gian t\u1eeb 31 \u0111\u1ebfn 180 ng\u00e0y sau khi gh\u00e9p trong \u0111i\u1ec1u tr\u1ecb ph\u00f2ng ng\u1eeba th\u1ea3i gh\u00e9p th\u1eadn, tim v\u00e0 gan.<\/p>\n<p>C\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ea5t s\u1ea3n nguy\u00ean h\u1ed3ng c\u1ea7u \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi mycophenolate mofetil ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch kh\u00e1c. C\u01a1 ch\u1ebf b\u1ea5t s\u1ea3n nguy\u00ean h\u1ed3ng c\u1ea7u do mycophenolate mofetil ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft. B\u1ea5t s\u1ea3n nguy\u00ean h\u1ed3ng c\u1ea7u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft b\u1eb1ng c\u00e1ch gi\u1ea3m li\u1ec1u d\u00f9ng ho\u1eb7c ng\u1eebng \u0111i\u1ec1u tr\u1ecb v\u1edbi mycophenolate mofetil. C\u00e1c thay \u0111\u1ed5i \u0111\u1ed1i v\u1edbi tr\u1ecb li\u1ec7u mycophenolate mofetil ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c b\u1ea3o \u0111\u1ea3m d\u01b0\u1edbi s\u1ef1 gi\u00e1m s\u00e1t th\u00edch h\u1ee3p \u1edf ng\u01b0\u1eddi \u0111\u01b0\u1ee3c gh\u00e9p \u0111\u1ec3 l\u00e0m gi\u1ea3m t\u1ed1i \u0111a nguy c\u01a1 th\u1ea3i m\u1ea3nh gh\u00e9p.<\/p>\n<p>B\u1ec7nh nh\u00e2n trong giai \u0111o\u1ea1n \u0111i\u1ec1u tr\u1ecb v\u1edbi mycophenolate mofetil, vi\u1ec7c ch\u1ee7ng ng\u1eeba vaccin c\u00f3 th\u1ec3 b\u1ecb k\u00e9m hi\u1ec7u qu\u1ea3, v\u00e0 n\u00ean tr\u00e1nh s\u1eed d\u1ee5ng c\u00e1c vaccin s\u1ed1ng \u0111\u00e3 gi\u1ea3m \u0111\u1ed9c l\u1ef1c. Ch\u1ee7ng ng\u1eeba c\u00fam c\u00f3 th\u1ec3 mang l\u1ea1i l\u1ee3i \u00edch. N\u00ean tham kh\u1ea3o h\u01b0\u1edbng d\u1eabn qu\u1ed1c gia v\u1ec1 ch\u1ee7ng ng\u1eeba c\u00fam.<\/p>\n<p>V\u00ec mycophenolate mofetil c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng t\u1ec9 l\u1ec7 t\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean h\u1ec7 ti\u00eau h\u00f3a, g\u1ed3m c\u00e1c tr\u01b0\u1eddng h\u1ee3p lo\u00e9t d\u1ea1 d\u00e0y ru\u1ed9t, xu\u1ea5t huy\u1ebft v\u00e0 th\u1ee7ng d\u1ea1 d\u00e0y ru\u1ed9t, s\u1eed d\u1ee5ng mycophenolate mofetil th\u1eadn tr\u1ecdng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh v\u1ec1 h\u1ec7 ti\u00eau h\u00f3a n\u1eb7ng ti\u1ebfn tri\u1ec3n.<\/p>\n<p>Mycophenolate mofetil l\u00e0 m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf IMPDH (inosine monophosphate dehydrogenase).<\/p>\n<p>V\u00ec v\u1eady, v\u1ec1 l\u00fd thuy\u1ebft, n\u00ean tr\u00e1nh s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n thi\u1ebfu enzyme hypoxanthine-guanine phosphoribosyl-transferase (HGPRT) di truy\u1ec1n nh\u01b0 h\u1ed9i ch\u1ee9ng Lesch-Nyhan v\u00e0 KelleySeegmiller.<\/p>\n<p>Kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng thu\u1ed1c Mycophenolate \u0111\u1ed3ng th\u1eddi v\u1edbi azathioprin v\u00ec vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u.<\/p>\n<p>V\u00ec gi\u1ea3m \u0111\u00e1ng k\u1ec3 AUC c\u1ee7a MPA do cholestyramine, th\u1eadn tr\u1ecdng khi d\u00f9ng mycophenolate mofetil \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c thu\u1ed1c c\u00f3 chu k\u1ef3 gan ru\u1ed9t v\u00ec c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m gi\u1ea3m t\u00e1c \u0111\u1ed9ng c\u1ee7a mycophenolate mofetil.<\/p>\n<p>Nguy c\u01a1: L\u1ee3i \u00edch c\u1ee7a mycophenolate mofetil khi s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi tacrolimus ho\u1eb7c sirolimus ch\u01b0a \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp.<\/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>Kh\u00f4ng c\u00f3 c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 t\u00e1c \u0111\u1ed9ng tr\u00ean kh\u1ea3 n\u0103ng l\u00e1i xe v\u00e0 s\u1eed d\u1ee5ng m\u00e1y m\u00f3c. D\u1eef li\u1ec7u d\u01b0\u1ee3c l\u1ef1c h\u1ecdc v\u00e0 c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o cho th\u1ea5y kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng n\u00e0o tr\u00ean c\u00e1c kh\u1ea3 n\u0103ng n\u00e0y.<\/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<h2><span class=\"ez-toc-section\" id=\"45-su-dung-cho-phu-nu-co-thai-va-cho-con-bu\"><\/span>4.5 S\u1eed d\u1ee5ng cho ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><em>X\u1ebfp h\u1ea1ng c\u1ea3nh b\u00e1o<\/em><\/p>\n<p>AU TGA pregnancy category: D<\/p>\n<p>US FDA pregnancy category: D<\/p>\n<p><em>Th\u1eddi k\u1ef3 mang thai:<\/em><\/p>\n<p>Mycophenolate mofetil (MMF) c\u00f3 th\u1ec3 g\u00e2y h\u1ea1i cho thai nhi khi s\u1eed d\u1ee5ng thu\u1ed1c n\u00e0y cho ph\u1ee5 n\u1eef c\u00f3 thai.<\/p>\n<p>S\u1eed d\u1ee5ng MMF trong thai k\u1ef3 c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng nguy c\u01a1 s\u1ea9y thai trong tam c\u00e1 nguy\u1ec7t th\u1ee9 nh\u1ea5t v\u00e0 t\u0103ng nguy c\u01a1 d\u1ecb t\u1eadt b\u1ea7m sinh, \u0111\u1eb7c bi\u1ec7t d\u1ecb t\u1eadt tai ngo\u00e0i v\u00e0 c\u00e1c b\u1ea5t th\u01b0\u1eddng kh\u00e1c \u1edf m\u1eb7t nh\u01b0 h\u1edf h\u00e0m \u1ebfch v\u00e0 d\u1ecb t\u1eadt c\u00e1c chi, tim, th\u1ef1c qu\u1ea3n v\u00e0 th\u1eadn.<\/p>\n<p>\u1ede c\u00e1c nghi\u00ean c\u1ee9u \u0111\u1ed9c t\u00ednh tr\u00ean sinh s\u1ea3n \u1edf \u0111\u1ed9ng v\u1eadt, cho th\u1ea5y t\u0103ng t\u1ec9 l\u1ec7 h\u01b0 thai v\u00e0 d\u1ecb t\u1eadt khi kh\u00f4ng c\u00f3 ng\u1ed9 \u0111\u1ed9c \u1edf con v\u1eadt m\u1eb9. Chu\u1ed9t c\u1ed1ng v\u00e0 th\u1ecf c\u00e1i \u0111\u01b0\u1ee3c d\u00f9ng mycophenolate mofetil (MME) t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi 0,02 \u0111\u1ebfn 0,9 l\u1ea7n li\u1ec1u khuy\u1ebfn c\u00e1o cho ng\u01b0\u1eddi cho b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn v\u00e0 tim, d\u1ef1a theo s\u1ef1 chuy\u1ec3n \u0111\u1ed5i di\u1ec7n t\u00edch b\u1ec1 m\u1eb7t. \u1ede chu\u1ed9t c\u1ed1ng con, d\u1ecb t\u1eadt g\u1ed3m kh\u00f4ng c\u00f3 nh\u00e3n c\u1ea7u, t\u1eadt kh\u00f4ng c\u00f3 h\u00e0m d\u01b0\u1edbi v\u00e0 tr\u00e0n d\u1ecbch n\u00e3o. \u1ede th\u1ecf con, c\u00e1c d\u1ecb t\u1eadt bao g\u1ed3m l\u1ea1c v\u1ecb tim, l\u1ea1c v\u1ecb th\u1eadn, tho\u00e1t v\u1ecb ho\u00e0nh v\u00e0 tho\u00e1t v\u1ecb r\u1ed1n.<\/p>\n<p>Khuy\u1ebfn c\u00e1o kh\u00f4ng \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng mycophenolate mofetil cho \u0111\u1ebfn khi c\u00f3 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m thai \u00e2m t\u00ednh. Ph\u1ea3i d\u00f9ng bi\u1ec7n ph\u00e1p ng\u1eeba thai hi\u1ec7u qu\u1ea3 tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u tr\u1ecb li\u1ec7u v\u1edbi mycophenolate mofetil, trong khi tr\u1ecb li\u1ec7u v\u00e0 trong su\u1ed1t 6 tu\u1ea7n sau khi d\u1eebng tr\u1ecb li\u1ec7u. B\u1ec7nh nh\u00e2n n\u00ean b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng bi\u1ec7n ph\u00e1p tr\u00e1nh thai 4 tu\u1ea7n tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u tr\u1ecb li\u1ec7u b\u1eb1ng mycophenolate, tr\u1eeb khi d\u00f9ng bi\u1ec7n ph\u00e1p ki\u00eang quan h\u1ec7 t\u00ecnh d\u1ee5c. N\u00ean ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng bi\u1ec7n ph\u00e1p tr\u00e1nh thai trong khi \u0111i\u1ec1u tr\u1ecb v\u00e0 trong su\u1ed1t 6 tu\u1ea7n sau khi d\u1eebng s\u1eed d\u1ee5ng mycophenolate. B\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c th\u00f4ng b\u00e1o r\u1eb1ng mycophenolate l\u00e0m gi\u1ea3m n\u1ed3ng \u0111\u1ed9 hormon trong m\u00e1u c\u1ee7a vi\u00ean thu\u1ed1c ng\u1eeba thai d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng v\u00e0 v\u1ec1 l\u00fd thuy\u1ebft c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c ng\u1eeba thai. B\u1ec7nh nh\u00e2n n\u00ean b\u00e1o cho b\u00e1c s\u0129 ngay l\u1eadp t\u1ee9c khi x\u1ea3y ra c\u00f3 thai.<\/p>\n<p>Kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng mycophenolate mofetil trong thai k\u1ef3 v\u00e0 n\u00ean \u0111\u01b0\u1ee3c \u0111\u1ec3 d\u00e0nh cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p m\u00e0 kh\u00f4ng c\u00f3 \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u00edch h\u1ee3p. Mycophenolate mofetil ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho ph\u1ee5 n\u1eef c\u00f3 thai ch\u1ec9 khi l\u1ee3i \u00edch cao h\u01a1n nguy c\u01a1 x\u1ea3y ra cho thai nhi. D\u1eef li\u1ec7u c\u00f3 h\u1ea1n t\u1eeb vi\u1ec7c s\u1eed d\u1ee5ng mycophenolate mofetil \u1edf ph\u1ee5 n\u1eef c\u00f3 thai. Tuy nhi\u00ean, d\u1ecb t\u1eadt b\u1ea9m sinh g\u1ed3m b\u1ea5t th\u01b0\u1eddng\u1edf tai, nh\u01b0 b\u1ea5t th\u01b0\u1eddng h\u00ecnh d\u1ea1ng ho\u1eb7c thi\u1ebfu tai ngo\u00e0i\/tai gi\u1eefa, \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf tr\u1ebb l\u00e0 con c\u1ee7a c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e3 ph\u01a1i nhi\u1ec5m v\u1edbi Mycophenolate khi ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch kh\u00e1c trong thai k\u1ef3. C\u00e1c tr\u01b0\u1eddng h\u1ee3p x\u1ea3y thai t\u1ef1 ph\u00e1t \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 ph\u01a1i nhi\u1ec5m v\u1edbi mycophenolate mofetil. C\u00e1c nghi\u00ean c\u1ee9u \u1edf \u0111\u1ed9ng v\u1eadt cho th\u1ea5y c\u00f3 x\u1ea3y ra \u0111\u1ed9c t\u00ednh tr\u00ean sinh s\u1ea3n.<\/p>\n<p><em>Th\u1eddi k\u1ef3 cho con b\u00fa:<\/em><\/p>\n<p>Mycophenolate mofetil \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 b\u00e0i ti\u1ebft qua s\u1eefa \u1edf chu\u1ed9t c\u1ed1ng cho con b\u00fa. Kh\u00f4ng bi\u1ebft ch\u1ea5t n\u00e0y c\u00f3 b\u00e0i ti\u1ebft qua s\u1eefa ng\u01b0\u1eddi hay kh\u00f4ng. V\u00ec kh\u1ea3 n\u0103ng x\u1ea3y ra c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 tr\u1ea7m tr\u1ecdng do mycophenolate mofetil \u1edf tr\u1ebb \u0111\u01b0\u1ee3c b\u00fa s\u1eefa m\u1eb9, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng mycophenolate mofetil cho ng\u01b0\u1eddi m\u1eb9 nu\u00f4i con b\u1eb1ng s\u1eefa m\u1eb9.<\/p>\n<p><em>Kh\u1ea3 n\u0103ng g\u00e2y ung th\u01b0, \u0111\u1ed9t bi\u1ebfn gen, suy gi\u1ea3m kh\u1ea3 n\u0103ng th\u1ee5 tinh<\/em><\/p>\n<p>Trong c\u00e1c m\u00f4 h\u00ecnh th\u1eed nghi\u1ec7m, mycophenolate mofetil kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng h\u00ecnh th\u00e0nh kh\u1ed1i u. Li\u1ec1u d\u00f9ng cao nh\u1ea5t \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m trong c\u00e1c nghi\u00ean c\u1ee9u kh\u1ea3 n\u0103ng g\u00e2y ung th\u01b0 \u1edf \u0111\u1ed9ng v\u1eadt cho ph\u01a1i nhi\u1ec5m to\u00e0n th\u00e2n (AUC ho\u1eb7c Cmax) g\u1ea5p kho\u1ea3ng 2 &#8211; 3 l\u1ea7n khi quan s\u00e1t \u1edf b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn khi d\u00f9ng li\u1ec1u khuy\u1ebfn c\u00e1o tr\u00ean l\u00e2m s\u00e0ng l\u00e0 2g\/ng\u00e0y v\u00e0 1,3 &#8211; 2 l\u1ea7n ph\u01a1i nhi\u1ec5m to\u00e0n th\u00e2n (AUC ho\u1eb7c Cmax) khi quan s\u00e1t \u0111\u01b0\u1ee3c \u1edf b\u1ec7nh nh\u00e2n gh\u00e9p tim d\u00f9ng li\u1ec1u khuy\u1ebfn c\u00e1o tr\u00ean l\u00e2m s\u00e0ng l\u00e0 3g\/ng\u00e0y.<\/p>\n<p>Hai th\u1eed nghi\u1ec7m v\u1ec1 kh\u1ea3 n\u0103ng g\u00e2y \u0111\u1ed9c t\u00ednh gen (th\u1eed nghi\u1ec7m t\u1ebf b\u00e0o b\u1ea1ch huy\u1ebft. chu\u1ed9t nh\u1ea5t tr\u00ean in viro v\u00e0 th\u1eed nghi\u1ec7m vi nh\u00e2n t\u1ee7y x\u01b0\u01a1ng chu\u1ed9t nh\u1eaft tr\u00ean in vivo) cho th\u1ea5y mycophenolate mofetil c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y sai c\u1ea5u tr\u00fac nhi\u1ec5m s\u1eafc th\u1ec3. C\u00e1c t\u00e1c \u0111\u1ed9ng n\u00e0y c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u1ef1c h\u1ecdc, v\u00ed d\u1ee5 \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p nucleotide \u1edf c\u00e1c t\u1ebf b\u00e0o c\u1ea3m th\u1ee5. C\u00e1c th\u1eed nghi\u1ec7m tr\u00ean invivo kh\u00e1c \u0111\u1ec3 ph\u00e1t hi\u1ec7n \u0111\u1ed9t bi\u1ebfn gen kh\u00f4ng ch\u1ee9ng minh ho\u1ea1t t\u00ednh g\u00e2y \u0111\u1ed9c gen.<\/p>\n<p>Mycophenolate mofetil kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng tr\u00ean s\u1ef1 th\u1ee5 tinh c\u1ee7a chu\u1ed9t c\u1ed1ng \u0111\u1ef1c \u1edf c\u00e1c li\u1ec1u d\u00f9ng l\u00ean \u0111\u1ebfn 20 mg.kg-1.ng\u00e0y-1. Ph\u01a1i nhi\u1ec5m to\u00e0n th\u00e2n \u1edf li\u1ec1u n\u00e0y th\u1ec3 hi\u1ec7n 2 &#8211; 3 l\u1ea7n ph\u01a1i nhi\u1ec5m tr\u00ean l\u00e2m s\u00e0ng \u1edf li\u1ec1u khuy\u1ebfn c\u00e1o tr\u00ean l\u00e2m s\u00e0ng l\u00e0 2g\/ng\u00e0y \u1edf b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn v\u00e0 1,3-2 l\u1ea7n ph\u01a1i nhi\u1ec5m l\u00e2m s\u00e0ng \u1edf li\u1ec1u khuy\u1ebfn c\u00e1o tr\u00ean l\u00e2m s\u00e0ng l\u00e0 3g\/ng\u00e0y \u1edf b\u1ec7nh nh\u00e2n gh\u00e9p tim. Trong nghi\u00ean c\u1ee9u sinh s\u1ea3n v\u00e0 kh\u1ea3 n\u0103ng th\u1ee5 tinh c\u1ee7a chu\u1ed9t c\u1ed1ng c\u00e1i, c\u00e1c li\u1ec1u u\u1ed1ng 4,5 mg.kg-1 .ng\u00e0y-1 g\u00e2y d\u1ecb t\u1eadt (kh\u00f4ng c\u00f3 nh\u00e3n c\u1ea7u, kh\u00f4ng c\u00f3 h\u00e0m d\u01b0\u1edbi v\u00e0 tr\u00e0n d\u1ecbch n\u00e3o) \u1edf th\u1ebf h\u1ec7 th\u1ee9 nh\u1ea5t khi kh\u00f4ng c\u00f3 ng\u1ed9 \u0111\u1ed9c \u1edf con v\u1eadt m\u1eb9. S\u1ef1 ph\u01a1i nhi\u1ec5m to\u00e0n th\u00e2n \u1edf li\u1ec1u n\u00e0y l\u00e0 kho\u1ea3ng 0,5 l\u1ea7n ph\u01a1i nhi\u1ec5m tr\u00ean l\u00e2m s\u00e0ng \u1edf li\u1ec1u khuy\u1ebfn c\u00e1o l\u00e2m s\u00e0ng l\u00e0 2g\/ng\u00e0y \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn v\u00e0 kho\u1ea3ng 0,3 l\u1ea7n ph\u01a1i nhi\u1ec5m tr\u00ean l\u00e2m s\u00e0ng \u1edf li\u1ec1u khuy\u1ebfn c\u00e1o tr\u00ean l\u00e2m s\u00e0ng l\u00e0 3g\/ng\u00e0y \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n gh\u00e9p tim. Kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng tr\u00ean s\u1ef1 th\u1ee5 tinh ho\u1eb7c c\u00e1c th\u00f4ng s\u1ed1 tr\u00ean sinh s\u1ea3n \u1edf con v\u1eadt m\u1eb9 ho\u1eb7c th\u1ebf h\u1ec7 ti\u1ebfp theo.<\/p>\n<p>Trong c\u00e1c nghi\u00ean c\u1ee9u g\u00e2y qu\u00e1i thai \u1edf chu\u1ed9t c\u1ed1ng v\u00e0 th\u1ecf, s\u1ea9y thai v\u00e0 d\u1ecb t\u1eadt \u0111\u00e3 x\u1ea3y ra \u1edf chu\u1ed9t c\u1ed1ng \u1edf li\u1ec1u 6 mg.kg-1.ng\u00e0y-1 (kh\u00f4ng c\u00f3 nh\u00e3n c\u1ea7u, kh\u00f4ng c\u00f3 h\u00e0m d\u01b0\u1edbi v\u00e0 tr\u00e0n d\u1ecbch n\u00e3o) v\u00e0 \u1edf th\u1ecf v\u1edbi li\u1ec1u 90 mg.kg-1.ng\u00e0y-1 (b\u1ea5t th\u01b0\u1eddng tim m\u1ea1ch v\u00e0 th\u1eadn, nh\u01b0 l\u1ea1c v\u1ecb tim v\u00e0 lac vi th\u1eadn, v\u00e0 tho\u00e1t v\u1ecb ho\u00e0nh v\u00e0 tho\u00e1t v\u1ecb r\u1ed1n) khi kh\u00f4ng c\u00f3 ng\u1ed9 \u0111\u1ed9c \u1edf con v\u1eadt m\u1eb9. Ph\u01a1i nhi\u1ec5m to\u00e0n th\u00e2n \u1edf c\u00e1c li\u1ec1u d\u00f9ng n\u00e0y l\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng ho\u1eb7c th\u1ea5p h\u01a1n 0,5 l\u1ea7n ph\u01a1i nhi\u1ec5m tr\u00ean l\u00e2m s\u00e0ng \u1edf li\u1ec1u d\u00f9ng khuy\u1ebfn c\u00e1o tr\u00ean l\u00e2m s\u00e0ng l\u00e0 2g\/ng\u00e0y \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn v\u00e0 kho\u1ea3ng 0,3 l\u1ea7n ph\u01a1i nhi\u1ec5m tr\u00ean l\u00e2m s\u00e0ng \u1edf li\u1ec1u d\u00f9ng khuy\u1ebfn c\u00e1o tr\u00ean l\u00e2m s\u00e0ng l\u00e0 3g\/ng\u00e0y \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n gh\u00e9p tim<\/p>\n<h2><span class=\"ez-toc-section\" id=\"46-tac-dung-khong-mong-muon-adr\"><\/span>4.6 T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n (ADR):<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n sau \u0111\u00e2y g\u1ed3m c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng: C\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 ch\u00ednh li\u00ean quan \u0111\u1ec1n vi\u1ec7c d\u00f9ng mycophenolate mofetil khi ph\u1ed1i h\u1ee3p v\u1edbi ciclosporin v\u00e0 corticosteroids g\u1ed3m ti\u00eau ch\u1ea3y, gi\u1ea3m b\u1ea1ch c\u1ea7u, nhi\u1ec5m khu\u1ea9n v\u00e0 \u00f3i m\u1eeda, v\u00e0 c\u00f3 ch\u1ee9ng c\u1ee9 t\u1ea7n su\u1ea5t x\u1ea3y ra c\u00e1c lo\u1ea1i nhi\u1ec5m tr\u00f9ng cao h\u01a1n.<\/p>\n<p><em>B\u1ec7nh l\u00fd \u00e1c t\u00ednh<\/em>: B\u1ec7nh nh\u00e2n d\u00f9ng ph\u00e1c \u0111\u1ed3 \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch g\u1ed3m ph\u1ed1i h\u1ee3p nhi\u1ec1u thu\u1ed1c, trong \u0111\u00f3 c\u00f3 mycophenolate mofetil, th\u00ec c\u00f3 nguy c\u01a1 cao h\u01a1n v\u1ec1 ti\u1ebfn tri\u1ec3n c\u00e1c u b\u1ea1ch huy\u1ebft v\u00e0 c\u00e1c b\u1ec7nh l\u00fd \u00e1c t\u00ednh kh\u00e1c, \u0111\u1eb7c bi\u1ec7t tr\u00ean da. T\u0103ng sinh m\u00f4 b\u1ea1ch huy\u1ebft ho\u1eb7c u b\u1ea1ch huy\u1ebft ti\u1ebfn tri\u1ec3n \u1edf 0,6 b\u1ec7nh nh\u00e2n d\u00f9ng mycophenolate mofetil (2g ho\u1eb7c 3g h\u1eb1ng ng\u00e0y) ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch kh\u00e1c trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng c\u00f3 \u0111\u1ed1i ch\u1ee9ng \u1edf c\u00e1c b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn (d\u1eef li\u1ec7u 2 g), b\u1ec7nh nh\u00e2n gh\u00e9p tim v\u00e0 b\u1ec7nh nh\u00e2n gh\u00e9p gan sau \u00edt nh\u1ea5t 1 n\u0103m. C\u00e1c carcinom da kh\u00f4ng ph\u1ea3i u h\u1eafc s\u1eafc t\u1ed1 x\u1ea3y ra \u1edf 3,6% b\u1ec7nh nh\u00e2n; c\u00e1c lo\u1ea1i b\u1ec7nh l\u00fd \u00e1c t\u00ednh kh\u00e1c x\u1ea3y ra \u1edf 1,1% b\u1ec7nh nh\u00e2n. D\u1eef li\u1ec7u t\u00ednh an to\u00e0n th\u1ef1c hi\u1ec7n trong 3 n\u0103m \u1edf b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn v\u00e0 gh\u00e9p tim kh\u00f4ng cho th\u1ea5y b\u1ea5t c\u1ee9 thay \u0111\u1ed5i n\u00e0o v\u1ec1 t\u1ec9 l\u1ec7 m\u1eafc b\u1ec7nh l\u00fd \u00e1c t\u00ednh kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n so v\u1edbi d\u1eef li\u1ec7u trong 1 n\u0103m. B\u1ec7nh nh\u00e2n gh\u00e9p gan \u0111\u01b0\u1ee3c theo d\u00f5i trong \u00edt nh\u1ea5t 1 n\u0103m, nh\u01b0ng d\u01b0\u1edbi 3 n\u0103m.<\/p>\n<p><em>C\u00e1c nhi\u1ec5m tr\u00f9ng c\u01a1 h\u1ed9i:<\/em> C\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c gh\u00e9p t\u1ea1ng t\u0103ng nguy c\u01a1 nhi\u1ec5m tr\u00f9ng c\u01a1 h\u1ed9i; nguy c\u01a1 t\u0103ng khi ch\u1ea5t \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch ho\u00e0n to\u00e0n. C\u00e1c nhi\u1ec5m tr\u00f9ng c\u01a1 h\u1ed9i ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf b\u1ec7nh nh\u00e2n d\u00f9ng mycophenolate mofetil (2g ho\u1eb7c 3g h\u1eb1ng ng\u00e0y) v\u1edbi c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch kh\u00e1c trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng c\u00f3 \u0111\u1ed1i ch\u1ee9ng kh\u00e1c \u1edf b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn (d\u1eef li\u1ec7u 2g), b\u1ec7nh nh\u00e2n gh\u00e9p tim v\u00e0 gh\u00e9p gan \u0111\u01b0\u1ee3c theo d\u00f5i trong \u00edt nh\u1ea5t 1 n\u0103m l\u00e0 nhi\u1ec5m candida ni\u00eam m\u1ea1c da, nhi\u1ec5m virus CMV m\u00e1u\/h\u1ed9i ch\u1ee9ng nhi\u1ec5m CMV v\u00e0 Herpes simplex. T\u1ec9 l\u1ec7 b\u1ec7nh nh\u00e2n nhi\u1ec5m virus CMV m\u00e1u\/h\u1ed9i ch\u1ee9ng nhi\u1ec5m CMV l\u00e0 13,5 %.<\/p>\n<p>Tr\u1ebb em v\u00e0 thanh thi\u1ebfu ni\u00ean (2 \u0111\u1ebfn 18 tu\u1ed5i): Lo\u1ea1i v\u00e0 t\u1ea7n su\u1ea5t ph\u1ea3n \u1ee9ng ph\u1ee5 trong m\u1ed9t nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng, g\u1ed3m 92 b\u1ec7nh nhi t\u1eeb 2 \u0111\u1ebfn 18 tu\u1ed5i d\u00f9ng mycophenolate mofetil d\u1ea1ng u\u1ed1ng v\u1edbi li\u1ec1u 600 mg\/m2, ng\u00e0y 2 l\u1ea7n, th\u00f4ng th\u01b0\u1eddng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 ph\u1ea3n \u1ee9ng ph\u1ee5 quan s\u00e1t \u0111\u01b0\u1ee3c \u1edf b\u1ec7nh nh\u00e2n l\u00e0 ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh d\u00f9ng 1 g mycophenolate mofetil, ng\u00e0y 2 l\u1ea7n. Tuy nhi\u00ean, c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 li\u00ean quan \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb sau \u0111\u00e2y th\u01b0\u1eddng x\u1ea3y ra h\u01a1n \u1edf \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ec7nh nhi, \u0111\u1eb7c bi\u1ec7t l\u00e0 tr\u1ebb em d\u01b0\u1edbi 6 tu\u1ed5i, khi so v\u1edbi ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh: ti\u00eau ch\u1ea3y, nhi\u1ec5m tr\u00f9ng, gi\u1ea3m b\u1ea1ch c\u1ea7u, thi\u1ebfu m\u00e1u v\u00e0 nhi\u1ec5m tr\u00f9ng.<\/p>\n<p>B\u1ec7nh nh\u00e2n cao tu\u1ed5i (&gt; 65 tu\u1ed5i): B\u1ec7nh nh\u00e2n cao tu\u1ed5i (&gt; 65 tu\u1ed5i) c\u00f3 th\u1ec3 th\u01b0\u1eddng t\u0103ng nguy c\u01a1 ph\u1ea3n \u1ee9ng ph\u1ee5 do s\u1ef1 \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch. B\u1ec7nh nh\u00e2n cao tu\u1ed5i d\u00f9ng Mycophenolate mofetil l\u00e0 m\u1ed9t th\u00e0nh ph\u1ea7n trong ph\u00e1c \u0111\u1ed3 \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch ph\u1ed1i h\u1ee3p, c\u00f3 th\u1ec3 t\u0103ng nguy c\u01a1 c\u1ee7a m\u1ed9t s\u1ed1 nhi\u1ec5m tr\u00f9ng (g\u1ed3m b\u1ec7nh x\u00e2m l\u1ea5n m\u00f4 do cytomegalovirus) v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng x\u1ea3y ra xu\u1ea5t huy\u1ebft d\u1ea1 d\u00e0y ru\u1ed9t v\u00e0 ph\u00f9 ph\u1ed5i, so v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n tr\u1ebb h\u01a1n.<\/p>\n<p>C\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 kh\u00e1c: C\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5, c\u00f3 th\u1ec3 ho\u1eb7c c\u00f3 c\u00f3 li\u00ean quan \u0111\u1ebfn mycophenolate mofetil, \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf &gt;1\/10 v\u00e0 \u1edf &gt;1\/100 \u0111\u1ebfn &lt;1\/10 s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi mycophenolate mofetil trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng c\u00f3 \u0111\u1ed1i ch\u1ee9ng \u1edf b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn (d\u1eef li\u1ec7u 2 g), b\u1ec7nh nh\u00e2n gh\u00e9p tim v\u00e0 gan \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea trong b\u1ea3ng sau \u0111\u00e2y.<\/p>\n<p>C\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5, c\u00f3 th\u1ec3 ho\u1eb7c c\u00f3 kh\u1ea3 n\u0103ng li\u00ean quan \u0111\u1ebfn Mycophenolate mofetil, \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi Mycophenolate mofetil trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u00ean th\u1eadn, tim v\u00e0 gan khi s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p v\u1edbi Ciclosporin v\u00e0 Corticosteroids<\/p>\n<p>Trong m\u1ed7i h\u1ec7 c\u01a1 quan, c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea theo c\u00e1c m\u1ee9c t\u1ea7n su\u1ea5t sau \u0111\u00e2y: R\u1ea5t th\u01b0\u1eddng xuy\u00ean (\u2265 1\/10); th\u01b0\u1eddng xuy\u00ean (\u2265 1\/100 \u0111\u1ebfn &lt; 1\/10); kh\u00f4ng th\u01b0\u1eddng xuy\u00ean (\u2265 1\/1.000 \u0111\u1ebfn &lt; 1\/100); hi\u1ebfm (\u2265 1\/10.000 \u0111\u1ebfn &lt; 1\/1.000); r\u1ea5t hi\u1ebfm (&lt; 1\/10.000) v\u00e0 kh\u00f4ng bi\u1ebft (kh\u00f4ng th\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1eeb d\u1eef li\u1ec7u s\u1eb5n c\u00f3). Trong m\u1ed7i nh\u00f3m t\u1ea7n su\u1ea5t, c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n \u0111\u01b0\u1ee3c s\u1eafp x\u1ebfp theo th\u1ee9 t\u1ef1 gi\u1ea3m d\u1ea7n m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng.<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>Nh\u00f3m c\u01a1 quan h\u1ec7 th\u1ed1ng<\/strong><\/td>\n<td><strong>T\u1ea7n su\u1ea5t<\/strong><\/td>\n<td><strong>Ph\u1ea3n \u1ee9ng ph\u1ee5 c\u1ee7a thu\u1ed1c<\/strong><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">Nhi\u1ec5m tr\u00f9ng v\u00e0 nhi\u1ec5m k\u00fd sinh tr\u00f9ng<\/p>\n<p>&nbsp;<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Nhi\u1ec5m khu\u1ea9n, nhi\u1ec5m n\u1ea5m Candida \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u, nhi\u1ec5m herpes simplex, nhi\u1ec5m herpes zoster<\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Vi\u00eam ph\u1ed5i, c\u00fam, nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, b\u1ec7nh do Monilla \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, b\u1ec7nh n\u1ea5m Candida, vi\u00eam d\u1ea1 d\u00e0y-ru\u1ed9t, nhi\u1ec5m tr\u00f9ng, vi\u00eam ph\u1ebf qu\u1ea3n, vi\u00eam h\u1ecdng, vi\u00eam xoang, nhi\u1ec5m n\u1ea5m da, nhi\u1ec5m Candida da, b\u1ec7nh n\u1ea5m Candida \u00e2m \u0111\u1ea1o, vi\u00eam m\u0169i<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">Kh\u1ed1i u t\u00e2n sinh l\u00e0nh t\u00ednh, \u00e1c t\u00ednh v\u00e0 kh\u00f4ng x\u00e1c \u0111\u1ecbnh (bao g\u1ed3m nang v\u00e0 polyp)<\/p>\n<p>&nbsp;<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Ung th\u01b0 da, kh\u1ed1i u t\u00e2n sinh l\u00e0nh t\u00ednh \u1edf da<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">R\u1ed1i lo\u1ea1n m\u00e1u v\u00e0 h\u1ec7 b\u1ea1ch huy\u1ebft<\/p>\n<p>&nbsp;<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Gi\u1ea3m b\u1ea1ch c\u1ea7u, gi\u1ea3m ti\u1ec1u c\u1ea7u, thi\u1ebfu m\u00e1u<\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Gi\u1ea3m to\u00e0n th\u1ec3 huy\u1ebft c\u1ea7u, t\u0103ng b\u1ea1ch c\u1ea7u<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a v\u00e0 dinh d\u01b0\u1ee1ng<\/p>\n<p>&nbsp;<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Nhi\u1ec5m acid, t\u0103ng kali huy\u1ebft, gi\u1ea3m kali huy\u1ebft, t\u0103ng glucose huy\u1ebft, gi\u1ea3m magnesi huy\u1ebft, gi\u1ea3m calc\u1ecb huy\u1ebft, t\u0103ng cholesterol huy\u1ebft, t\u0103ng lipid huy\u1ebft, gi\u1ea3m phosphate huy\u1ebft, t\u0103ng acid uric huy\u1ebft, b\u1ec7nh gout, ch\u00e1n \u0103n<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">R\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1edbng g\u1eb7p<\/td>\n<td>K\u00edch \u0111\u1ed9ng, tr\u1ea1ng th\u00e1i l\u00fa l\u1eabn, tr\u1ea7m c\u1ea3m, lo \u00e2u, suy ngh\u0129 b\u1ea5t th\u01b0\u1eddng, m\u1ea5t ng\u1ee7<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">R\u1ed1i lo\u1ea1n h\u1ec7 th\u1ea7n kinh<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>C\u00f3 gi\u1eadt, t\u0103ng tr\u01b0\u01a1ng l\u1ef1c, run, bu\u1ed3n ng\u1ee7, h\u1ed9i ch\u1ee9ng nh\u01b0\u1ee3c c\u01a1, cho\u00e1ng v\u00e1ng, nh\u1ee9c \u0111\u1ea7u, d\u1ecb c\u1ea3m, r\u1ed1i lo\u1ea1n v\u1ecb gi\u00e1c<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">R\u1ed1i lo\u1ea1n tim<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Nh\u1ecbp tim nhanh<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">R\u1ed1i lo\u1ea1n m\u1ea1ch<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>H\u1ea1 huy\u1ebft \u00e1p, t\u0103ng huy\u1ebft \u00e1p, gi\u00e3n m\u1ea1ch<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">R\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p, ng\u1ef1c v\u00e0 trung th\u1ea5t<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, kh\u00f3 th\u1edf, ho<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>N\u00f4n, \u0111au b\u1ee5ng, ti\u00eau ch\u1ea3y, bu\u1ed3n n\u00f4n<\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a, vi\u00eam m\u00e0ng b\u1ee5ng, t\u1eafc ru\u1ed9t, vi\u00eam \u0111\u1ea1i tr\u00e0ng, lo\u00e9t d\u1ea1 d\u00e0y, lo\u00e9t t\u00e1 tr\u00e0ng, vi\u00eam d\u1ea1 d\u00e0y, vi\u00eam th\u1ef1c qu\u1ea3n, vi\u00eam mi\u1ec7ng, t\u00e1o b\u00f3n, kh\u00f3 ti\u00eau, \u0111\u1ea7y h\u01a1i, \u1ee3 h\u01a1i<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">R\u1ed1i lo\u1ea1n gan m\u1eadt<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Vi\u00eam gan, b\u1ec7nh v\u00e0ng da, t\u0103ng bilirubin huy\u1ebft<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">R\u1ed1i lo\u1ea1n da v\u00e0 m\u00f4 d\u01b0\u1edbi da<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Ch\u1ee9ng t\u0103ng s\u1ea3n c\u1ee7a da, n\u1ed5i ban, m\u1ee5n tr\u1ee9ng c\u00e1, r\u1ee5ng t\u00f3c<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">R\u1ed1i lo\u1ea1n c\u01a1 x\u01b0\u01a1ng kh\u1edbp v\u00e0 m\u00f4 li\u00ean k\u1ebft<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>\u0110au kh\u1edbp<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">R\u1ed1i lo\u1ea1n th\u1eadn v\u00e0 ti\u1ebft ni\u1ec7u<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Suy th\u1eadn<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">R\u1ed1i lo\u1ea1n to\u00e0n th\u00e2n v\u00e0 t\u00ecnh tr\u1ea1ng t\u1ea1i ch\u1ed7 d\u00f9ng thu\u1ed1c<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Ph\u00f9, s\u1ed1t, \u1edbn l\u1ea1nh, \u0111au, kh\u00f3 ch\u1ecbu, suy nh\u01b0\u1ee3c<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\">X\u00e9t nghi\u1ec7m<\/td>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>&#8211;<\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>T\u00e2ng enzyme gan, t\u0103ng creatinine huy\u1ebft, t\u0103ng lactate dehydrogenase huy\u1ebft, t\u0103ng ur\u00ea huy\u1ebft, t\u0103ng phosphatase ki\u1ec1m huy\u1ebft, gi\u1ea3m c\u00e2n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>L\u01b0u \u00fd: 501 (2 g Mycophenolate mofetil h\u00e0ng ng\u00e0y), 289 (3g mycophenolate mofetil h\u00e0ng ng\u00e0y) v\u00e0 277 (h\u00e0ng ng\u00e0y d\u00f9ng 2g ti\u00eam t\u0129nh m\u1ea1ch \/ 3g d\u1ea1ng u\u1ed1ng, Mycophenolate mofetil) b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb trong nghi\u00ean c\u1ee9u pha III \u0111\u1ec3 ph\u00f2ng ng\u1eeba th\u1ea3i gh\u00e9p trong gh\u00e9p th\u1eadn, tim v\u00e0 gan.<\/p>\n<p><em>C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n sau \u0111\u00e2y g\u1ed3m c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 t\u1eeb kinh nghi\u1ec7m sau khi \u0111\u01b0a thu\u1ed1c ra th\u1ecb tr\u01b0\u1eddng:<\/em><\/p>\n<p>C\u00e1c lo\u1ea1i ph\u1ea3n \u1ee9ng ph\u1ee5 trong th\u1eddi gian sau khi \u0111\u01b0a thu\u1ed1c ra th\u1ecb tr\u01b0\u1eddng c\u1ee7a mycophenolate mofetil l\u00e0 t\u01b0\u01a1ng t\u1ef1 v\u1edbi c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 quan s\u00e1t \u0111\u01b0\u1ee3c trong c\u00e1c nghi\u00ean c\u1ee9u gh\u00e9p th\u1eadn, tim v\u00e0 gan c\u00f3 \u0111\u1ed1i ch\u1ee9ng. C\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 b\u1ed5 sung \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong th\u1eddi gian sau khi \u0111\u01b0a thu\u1ed1c ra th\u1ecb tr\u01b0\u1eddng \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 d\u01b0\u1edbi \u0111\u00e2y v\u1edbi t\u1ea7n su\u1ea5t \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u0111\u1eb7t trong d\u1ea5u ngo\u1eb7c \u0111\u01a1n n\u1ebfu \u0111\u01b0\u1ee3c bi\u1ebft.<\/p>\n<p>D\u1ea1 d\u00e0y ru\u1ed9t: t\u0103ng s\u1ea3n l\u1ee3i (&gt;1\/100 \u0111\u1ebfn &lt;1\/10), vi\u00eam ru\u1ed9t k\u1ebft g\u1ed3m vi\u00eam ru\u1ed9t k\u1ebft do cytomegalovirus (&gt;1\/100 \u0111\u1ebfn &lt;1\/10), vi\u00eam t\u1ee5y (&gt;1\/100 \u0111\u1ebfn &lt;1\/10) v\u00e0 teo nhung mao ru\u1ed9t.<\/p>\n<p>C\u00e1c r\u1ed1i lo\u1ea1n li\u00ean quan \u0111\u1ebfn s\u1ef1 \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch: C\u00e1c nhi\u1ec5m tr\u00f9ng n\u1eb7ng \u0111e d\u1ecda t\u00ednh m\u1ea1ng g\u1ed3m vi\u00eam m\u00e0ng n\u00e3o, vi\u00eam m\u00e0ng trong tim, nhi\u1ec5m lao v\u00e0 nhi\u1ec5m mycobacterium kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.<\/p>\n<p>C\u00e1c tr\u01b0\u1eddng h\u1ee3p virus BK li\u00ean quan \u0111\u1ebfn b\u1ec7nh th\u1eadn, c\u0169ng nh\u01b0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p virus JC li\u00ean quan \u0111\u1ebfn b\u1ec7nh l\u00fd ch\u1ea5t tr\u1eafng \u0111a \u1ed5 ti\u1ebfn tri\u1ec3n, \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, g\u1ed3m mycophenolate mofetil.<\/p>\n<p>M\u1ea5t b\u1ea1ch c\u1ea7u h\u1ea1t (&gt;1\/1000 \u0111\u1ebfn &lt;1\/100) v\u00e0 gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o; v\u00ec v\u1eady, th\u01b0\u1eddng xuy\u00ean theo d\u00f5i b\u1ec7nh nh\u00e2n d\u00f9ng mycophenolate mofetil. C\u00f3 c\u00e1c b\u00e1o c\u00e1o v\u1ec1 thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n v\u00e0 suy t\u1ee7y x\u01b0\u01a1ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi mycophenolate mofetil, m\u1ed9t s\u1ed1 trong s\u1ed1 b\u1ec7nh nh\u00e2n n\u00e0y \u0111\u00e3 t\u1eed vong.<\/p>\n<p>R\u1ed1i lo\u1ea1n m\u00e1u v\u00e0 h\u1ec7 b\u1ea1ch huy\u1ebft: C\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ea5t s\u1ea3n nguy\u00ean h\u1ed3ng c\u1ea7u \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi mycophenolate mofetil.<\/p>\n<p>C\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c ph\u00e2n l\u1eadp v\u1ec1 h\u00ecnh th\u00e1i b\u1ea1ch c\u1ea7u trung t\u00ednh b\u1ea5t th\u01b0\u1eddng, g\u1ed3m b\u1ea5t th\u01b0\u1eddng Pelger-Huet m\u1eafc ph\u1ea3i, \u0111\u00e3 \u0111\u01b0\u1ee3c quan s\u00e1t \u1edf c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi mycophenolate mofetil. C\u00e1c thay \u0111\u1ed5i n\u00e0y kh\u00f4ng li\u00ean quan \u0111\u1ebfn gi\u1ea3m ch\u1ee9c n\u0103ng b\u1ea1ch c\u1ea7u. C\u00e1c thay \u0111\u1ed5i n\u00e0y c\u00f3 th\u1ec3 g\u1ee3i \u00fd m\u1ed9t t\u00ecnh tr\u1ea1ng t\u0103ng s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u ch\u01b0a th\u00e0nh th\u1ee5c trong s\u1ef1 th\u00e0nh th\u1ee5c c\u1ee7a b\u1ea1ch c\u1ea7u trong c\u00e1c \u0111i\u1ec1u tra nghi\u00ean c\u1ee9u huy\u1ebft h\u1ecdc, \u0111i\u1ec1u m\u00e0 c\u00f3 th\u1ec3 b\u1ecb di\u1ec5n gi\u1ea3i sai l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a nhi\u1ec5m tr\u00f9ng \u1edf c\u00e1c b\u1ec7nh nh\u00e2n b\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch d\u00f9ng mycophenolate mofetil.<\/p>\n<p>Qu\u00e1 m\u1eabn : C\u00e1c ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn g\u1ed3m ph\u00f9 n\u1ec1 th\u1ea7n kinh m\u1ea1ch v\u00e0 ph\u1ea3n \u1ee9ng ph\u1ea3n v\u1ec7 \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o.<\/p>\n<p>R\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p, tuy\u1ebfn t\u1ee9c v\u00e0 trung th\u1ea5t: C\u00f3 c\u00e1c b\u00e1o c\u00e1o \u0111\u01b0\u1ee3c ph\u00e2n l\u1eadp v\u1ec1 b\u1ec7nh ph\u1ed5i k\u1ebd v\u00e0 x\u01a1 h\u00f3a ph\u1ed5i \u1edf c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi mycophenolate mofetil ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch kh\u00e1c, m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u00e3 t\u1eed vong.<\/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><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<h2><span class=\"ez-toc-section\" id=\"47-huong-dan-cach-xu-tri-adr\"><\/span>4.7 H\u01b0\u1edbng d\u1eabn c\u00e1ch x\u1eed tr\u00ed ADR:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Ng\u1eebng s\u1eed d\u1ee5ng thu\u1ed1c. V\u1edbi c\u00e1c ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i nh\u1eb9, th\u01b0\u1eddng ch\u1ec9 c\u1ea7n ng\u1eebng thu\u1ed1c. Tr\u01b0\u1eddng h\u1ee3p m\u1eabn c\u1ea3m n\u1eb7ng ho\u1eb7c ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng, c\u1ea7n ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 (gi\u1eef tho\u00e1ng kh\u00ed v\u00e0 d\u00f9ng epinephrin, th\u1edf oxygen, d\u00f9ng kh\u00e1ng histamin, corticoid&#8230;).<\/p>\n<h2><span class=\"ez-toc-section\" id=\"48-tuong-tac-voi-cac-thuoc-khac\"><\/span>4.8 T\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>C\u00e1c nghi\u00ean c\u1ee9u t\u01b0\u01a1ng t\u00e1c ch\u1ec9 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh.<\/p>\n<p><em>Aciclovir<\/em>: N\u1ed3ng \u0111\u1ed9 huy\u1ebft t\u01b0\u01a1ng c\u1ee7a aciclovir cao h\u01a1n khi s\u1eed d\u1ee5ng. \u0111\u1ed3ng th\u1eddi v\u1edbi mycophenolate mofetil so v\u1edbi khi s\u1eed d\u1ee5ng aciclovir ri\u00eang l\u1ebb. S\u01b0 thay \u0111\u1ed3i v\u1ec1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a MPAG (d\u1ea1ng li\u00ean h\u1ee3p glucuronid c\u1ee7a MPA) (MPAG t\u0103ng 8%) l\u00e0 t\u1ed1i thi\u1ec3u v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c coi l\u00e0 \u0111\u00e1ng k\u1ec3 tr\u00ean l\u00e2m s\u00e0ng. V\u00ec n\u1ed3ng \u0111\u1ed9 huy\u1ebft t\u01b0\u01a1ng c\u1ee7a MPAG t\u0103ng khi b\u1ecb suy ch\u1ee9c n\u0103ng th\u1eadn, c\u0169ng nh\u01b0 c\u00e1c n\u1ed3ng \u0111\u1ed9 c\u1ee7a acyclovir, kh\u1ea3 n\u0103ng hi\u1ec7n c\u00f3 \u0111\u1ed1i v\u1edbi mycophenolate mofetil v\u00e0 aciclovir, ho\u1eb7c c\u00e1c ti\u1ec1n d\u01b0\u1ee3c c\u1ee7a ch\u00fang, nh\u01b0 valaciclovir, c\u1ea1nh tranh ti\u1ebft qua \u1ed1ng th\u1eadn v\u00e0 t\u0103ng h\u01a1n n\u1eefa n\u1ed3ng \u0111\u1ed9 c\u1ee7a c\u1ea3 hai ch\u1ea5t c\u00f3 th\u1ec3 x\u1ea3y ra.<\/p>\n<p><em>Thu\u1ed1c kh\u00e1ng acid c\u00f3 magnesium v\u00e0 aluminium hydroxides<\/em>: S\u1ef1 h\u1ea5p thu c\u1ee7a mycophenolate mofetil b\u1ecb gi\u1ea3m khi d\u00f9ng chung v\u1edbi thu\u1ed1c kh\u00e1ng acid.<\/p>\n<p><em>Cholestyramine<\/em>: Sau khi d\u00f9ng li\u1ec1u \u0111\u01a1n 1,5g mycophenolate mofetil cho ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng kh\u1ecfe m\u1ea1nh tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec1u 4g cholestyramine, 3 l\u1ea7n\/ng\u00e0y trong 4 ng\u00e0y, gi\u1ea3m 40 % AUC c\u1ee7a MPA. Th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u00ec kh\u1ea3 n\u0103ng gi\u1ea3m hi\u1ec7u qu\u1ea3 c\u1ee7a mycophenolate mofetil.<\/p>\n<p><em>C\u00e1c thu\u1ed1c can thi\u1ec7p v\u00e0o chu k\u1ef3 gan ru\u1ed9t<\/em>: Th\u1eadn tr\u1ecdng v\u1edbi c\u00e1c thu\u1ed1c can thi\u1ec7p v\u00e0o chu k\u1ef3 gan ru\u1ed9t v\u00ec kh\u1ea3 n\u0103ng l\u00e0m gi\u1ea3m hi\u1ec7u qu\u1ea3 c\u1ee7a mycophenolate mofetil.<\/p>\n<p>Ciclosporin A: D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a ciclosporin A (CsA) kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng do mycophenolate mofetil. Ng\u01b0\u1ee3c l\u1ea1i, n\u1ebfu \u0111i\u1ec1u tr\u1ecb \u0111\u1ed3ng th\u1eddi v\u1edbi ciclosporin b\u1ecb d\u1eebng, AUC c\u1ee7a MPA t\u0103ng kho\u1ea3ng 30%.<\/p>\n<p><em>Ganciclovir<\/em>: D\u1ef1a v\u00e0o k\u1ebft qu\u1ea3 c\u1ee7a nghi\u00ean c\u1ee9u d\u00f9ng li\u1ec1u duy nh\u1ea5t c\u1ee7a li\u1ec1u khuy\u1ebfn c\u00e1o c\u1ee7a mycophenolate d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng v\u00e0 ganciclovir d\u00f9ng \u0111\u01b0\u1eddng ti\u00eam t\u0129nh m\u1ea1ch v\u00e0 c\u00e1c t\u00e1c \u0111\u1ed9ng \u0111\u01b0\u1ee3c bi\u1ebft c\u1ee7a suy ch\u1ee9c n\u0103ng th\u1eadn tr\u00ean d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a mycophenolate mofetil v\u00e0 ganciclovir, l\u01b0\u1eddng tr\u01b0\u1edbc \u0111\u01b0\u1ee3c r\u1eb1ng s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi c\u00e1c thu\u1ed1c n\u00e0y (c\u1ea1nh tranh tr\u00ean c\u01a1 ch\u1ebf ti\u1ebft qua \u1ed1ng th\u1eadn) s\u1ebd d\u1eabn \u0111\u1ebfn t\u0103ng n\u1ed3ng \u0111\u1ed9 MPAG v\u00e0 ganciclovir. Kh\u00f4ng c\u00f3 s\u1ef1 thay \u0111\u1ed5i quan tr\u1ecdng n\u00e0o v\u1ec1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a MPA \u0111\u01b0\u1ee3c l\u01b0\u1eddng tr\u01b0\u1edbc v\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft ch\u1ec9nh li\u1ec1u c\u1ee7a mycophenolate mofetil. \u1ede c\u00e1c b\u1ec7nh nh\u00e2n suy ch\u1ee9c n\u0103ng th\u1eadn s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi mycophenolate mofetil v\u00e0 ganciclovir ho\u1eb7c c\u00e1c ti\u1ec1n d\u01b0\u1ee3c nh\u01b0 valganciclovir, n\u00ean tu\u00e2n theo khuy\u1ebfn c\u00e1o li\u1ec1u d\u00f9ng c\u1ee7a ganciclovir v\u00e0 n\u00ean theo d\u00f5i b\u1ec7nh nh\u00e2n c\u1ea9n th\u1eadn. (<\/p>\n<p><em>Thu\u1ed1c ng\u1eeba thai d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng:<\/em> D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc v\u00e0 d\u01b0\u1ee3c l\u1ef1c h\u1ecdc c\u1ee7a th\u00fa\u1ed1c ng\u1eeba thai c\u1ee7a thu\u1ed1c ng\u1eeba thai d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng khi d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi mycophenolate mofetil.<\/p>\n<p><em>Rifampicin<\/em>: \u1ede c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111ang s\u1eed d\u1ee5ng ciclosporin, d\u00f9ng \u0111\u1ed3ng th\u1eddi mycophenolate mofetil v\u00e0 rifampicin l\u00e0m gi\u1ea3m ph\u01a1i nhi\u1ec5m MPA (AUC0-12h) 18% \u0111\u1ebfn 70%. Khuy\u1ebfn c\u00e1o theo d\u00f5i n\u1ed3ng \u0111\u1ed9 ph\u01a1i nhi\u1ec5m MPA v\u00e0 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u d\u00f9ng c\u1ee7a mycophenolate mofetil theo s\u1ef1 duy tr\u00ec t\u00e1c \u0111\u1ed9ng l\u00e2m s\u00e0ng khi d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi rifampicin.<\/p>\n<p><em>Sirolimus<\/em>: \u1ede b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn, s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi mycophenolate mofetil v\u00e0 CsA d\u1eabn \u0111\u1ebfn gi\u1ea3m ph\u01a1i nhi\u1ec5m MPA 30 &#8211; 50% so v\u1edbi b\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c ph\u1ed1i h\u1ee3p g\u1ed3m sirolimus v\u00e0 mycophenolate mofetIl.<\/p>\n<p><em>Sevelamer<\/em>: Gi\u1ea3m Cmax v\u00e0 AUC0-12h c\u1ee7a MPA l\u1ea7n l\u01b0\u1ee3t 30% v\u00e0 25%, \u0111\u01b0\u1ee3c quan s\u00e1t khi d\u00f9ng Mycophenolate mofetil \u0111\u1ed3ng th\u1eddi v\u1edbi sevelamer m\u00e0 kh\u00f4ng c\u00f3 b\u1ea5t k\u1ef3 h\u1eadu qu\u1ea3 n\u00e0o tr\u00ean l\u00e2m s\u00e0ng (nh\u01b0 th\u1ea3i gh\u00e9p). Tuy nhi\u00ean, khuy\u1ebfn c\u00e1o d\u00f9ng Mycophenolate mofetil tr\u01b0\u1edbc \u00edt nh\u1ea5t m\u1ed9t gi\u1edd ho\u1eb7c sau ba gi\u1edd d\u00f9ng sevelamer \u0111\u1ec3 h\u1ea1n ch\u1ebf t\u1ed1i \u0111a t\u00e1c \u0111\u1ed9ng tr\u00ean s\u1ef1 h\u1ea5p th\u1ee5 c\u1ee7a MPA. Kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u v\u1ec1 mycophenolat mofetil v\u1edbi c\u00e1c thu\u1ed1c g\u1eafn k\u1ebft phosphate ngo\u00e0i sevelamer.<\/p>\n<p><em>Trimethoprim\/sulfamethoxazole:<\/em> Kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng tr\u00ean sinh kh\u1ea3 d\u1ee5ng c\u1ee7a MPA.<\/p>\n<p><em>Norfloxacin v\u00e0 metronidazole<\/em>: \u1ede ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n kh\u1ecfe m\u1ea1nh, kh\u00f4ng c\u00f3 t\u01b0\u01a1ng t\u00e1c \u0111\u00e1ng k\u1ec3 khi d\u00f9ng mycophenolate mofetil \u0111\u1ed3ng th\u1eddi v\u1edbi norfloxacin v\u00e0 metronidazole ri\u00eang l\u1ebb. Tuy nhi\u00ean, ph\u1ed1i h\u1ee3p gi\u1eefa norfloxacin v\u00e0 metronidazole l\u00e0m gi\u1ea3m ph\u01a1i nhi\u1ec5m MPA kho\u1ea3ng 30% sau khi d\u00f9ng mycophenolate mofetil li\u1ec1u duy nh\u1ea5t.<\/p>\n<p><em>Ciprofloxacin v\u00e0 amoxicillin + clavulanic acid:<\/em> Gi\u1ea3m n\u1ed3ng \u0111\u1ed9 MPA (v\u00f9ng l\u00f5m) tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c kho\u1ea3ng 50% \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf ng\u01b0\u1eddi \u0111\u01b0\u1ee3c gh\u00e9p th\u1eadn trong nh\u1eefng ng\u00e0y sau khi kh\u1edfi \u0111\u1ea7u ciprofloxacin \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c amoxicillin + clavulanic acid \u0111\u01b0\u1eddng u\u1ed1ng. T\u00e1c \u0111\u1ed9ng n\u00e0y c\u00f3 khuynh h\u01b0\u1edbng gi\u1ea3m khi ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng kh\u00e1ng sinh v\u00e0 t\u00e1c \u0111\u1ed9ng d\u1eebng trong v\u00f2ng v\u00e0i ng\u00e0y d\u1eebng s\u1eed d\u1ee5ng thu\u1ed1c. S\u1ef1 thay \u0111\u1ed5i n\u1ed3ng \u0111\u1ed9 tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c c\u00f3 th\u1ec3 kh\u00f4ng th\u1ec3 hi\u1ec7n ch\u00ednh x\u00e1c s\u1ef1 thay \u0111\u1ed5i s\u1ef1 ph\u01a1i nhi\u1ec5m MPA t\u1ed5ng th\u1ec3. V\u00ec v\u1eady, thay \u0111\u1ed5i li\u1ec1u d\u00f9ng c\u1ee7a mycophenolate mofetil th\u00f4ng th\u01b0\u1eddng kh\u00f4ng c\u1ea7n thi\u1ebft khi thi\u1ebfu ch\u1ee9ng c\u1ee9 c\u1ee7a r\u1ed1i lo\u1ea1n m\u1ea3nh gh\u00e9p. Tuy nhi\u00ean, gi\u00e1m s\u00e1t ch\u1eb7t ch\u1ebd tr\u00ean l\u00e2m s\u00e0ng trong th\u1eddi gian ph\u1ed1i h\u1ee3p thu\u1ed1c v\u00e0 th\u1eddi gian ng\u1eafn sau \u0111i\u1ec1u tr\u1ecb v\u1edbi kh\u00e1ng sinh.<\/p>\n<p><em>Tacrolimus<\/em>: \u1ede b\u1ec7nh nh\u00e2n gh\u00e9p gan kh\u1edfi \u0111\u1ea7u d\u00f9ng mycophenolate mofetil v\u00e0 tacrolimus, AUC v\u00e0 Cmax c\u1ee7a MPA, ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f3 ho\u1ea1t t\u00ednh c\u1ee7a Mycophenolate mofetil, kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 khi d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi tacrolimus. Ng\u01b0\u1ee3c l\u1ea1i, t\u0103ng kho\u1ea3ng 20 % v\u1ec1 AUC c\u1ee7a tacrolimus khi d\u00f9ng \u0111a li\u1ec1u mycophenolate mofetil (1,5g, ng\u00e0y 2 l\u1ea7n) \u0111\u1ed3ng th\u1eddi v\u1edbi tacrolimus. Tuy nhi\u00ean, \u1edf b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn, n\u1ed3ng \u0111\u1ed9 tacrolimus d\u01b0\u1eddng nh\u01b0 kh\u00f4ng b\u1ecb thay \u0111\u1ed5i do mycophenolate mofetil.<\/p>\n<p><em>C\u00e1c t\u01b0\u01a1ng t\u00e1c kh\u00e1c:<\/em> S\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi probenecid v\u1edbi mycophenolate mofetil \u1edf khi l\u00e0m t\u0103ng AUC trong huy\u1ebft t\u01b0\u01a1ng c\u1ee7a MPAG g\u1ea5p 3 l\u1ea7n. V\u00ec v\u1eady, c\u00e1c ch\u1ea5t kh\u00e1c \u0111\u01b0\u1ee3c bi\u1ebft l\u00e0 ti\u1ebft qua \u1ed1ng th\u1eadn c\u00f3 th\u1ec3 c\u1ea1nh tranh v\u1edbi MPAG, v\u00e0 v\u00ec v\u1eady t\u0103ng n\u1ed3ng \u0111\u1ed9 huy\u1ebft t\u01b0\u01a1ng c\u1ee7a MPAG ho\u1eb7c c\u00e1c ch\u1ea5t ti\u1ebft qua \u1ed1ng th\u1eadn.<\/p>\n<p><em>Vaccin s\u1ed1ng<\/em>: C\u00e1c vaccin s\u1ed1ng kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch suy gi\u1ea3m. \u0110\u00e1p \u1ee9ng kh\u00e1ng th\u1ec3 v\u1edbi c\u00e1c vaccin kh\u00e1c c\u00f3 th\u1ec3 b\u1ecb gi\u1ea3m.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"49-qua-lieu-va-xu-tri\"><\/span>4.9 Qu\u00e1 li\u1ec1u v\u00e0 x\u1eed tr\u00ed:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>C\u00e1c b\u00e1o c\u00e1o qu\u00e1 li\u1ec1u x\u1ea3y ra v\u1edbi mycophenolate mofetil t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u00e0 t\u1eeb kinh nghi\u1ec7m sau khi \u0111\u01b0a thu\u1ed1c ra th\u1ecb tr\u01b0\u1eddng. Trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p n\u00e0y, kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0o \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o. Trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p qu\u00e1 li\u1ec1u trong \u0111\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o, c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 n\u1eb1m trong d\u1eef li\u1ec7u t\u00ednh an to\u00e0n \u0111\u00e3 \u0111\u01b0\u1ee3c bi\u1ebft c\u1ee7a thu\u1ed1c.<\/p>\n<p>Ng\u01b0\u1eddi ta cho r\u1eb1ng qu\u00e1 li\u1ec1u mycophenolate mofetil c\u00f3 kh\u1ea3 n\u0103ng \u1ee9c ch\u1ebf qu\u00e1 m\u1ee9c h\u1ec7 mi\u1ec5n d\u1ecbch v\u00e0 l\u00e0m t\u0103ng t\u00ednh nh\u1ea1y c\u1ea3m v\u1edbi nhi\u1ec5m tr\u00f9ng v\u00e0 suy t\u1ee7y x\u01b0\u01a1ng. N\u1ebfu gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh ti\u1ebfn tri\u1ec3n, n\u00ean d\u00f9ng Mycophenolate mofetil ng\u1eaft qu\u00e3ng ho\u1eb7c gi\u1ea3m li\u1ec1u.<\/p>\n<p>Th\u1ea9m ph\u00e2n m\u00e1u kh\u00f4ng lo\u1ea1i b\u1ecf l\u01b0\u1ee3ng thu\u1ed1c \u0111\u00e1ng k\u1ec3 tr\u00ean l\u00e2m s\u00e0ng c\u1ee7a MPA ho\u1eb7c MPAG. T\u00e1c nh\u00e2n gi\u1eef acid m\u1eadt, nh\u01b0 cholestyramine, c\u00f3 th\u1ec3 lo\u1ea1i b\u1ecf MPA b\u1eb1ng c\u00e1ch l\u00e0m gi\u1ea3m chu k\u1ef3 gan ru\u1ed9t c\u1ee7a thu\u1ed1c.<\/p>\n<h1><span class=\"ez-toc-section\" id=\"5-co-che-tac-dung-cua-thuoc\"><\/span>5. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c :<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<h2><span class=\"ez-toc-section\" id=\"51-duoc-luc-hoc\"><\/span>5.1. D\u01b0\u1ee3c l\u1ef1c h\u1ecdc:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><em>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng<\/em><\/p>\n<p>Mycophenolate mofetil l\u00e0 ester 2-morpholinoethyl c\u1ee7a MPA. MPA l\u00e0 m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc, kh\u00f4ng c\u1ea1nh tranh v\u00e0 c\u00f3 h\u1ed3i ph\u1ee5c c\u1ee7a men inosine monophosphate dehydrogenase, v\u00ec v\u1eady, \u1ee9c ch\u1ebf \u0111\u01b0\u1eddng t\u1ed5ng h\u1ee3p nucleotide guanosine tr\u00ean de novo m\u00e0 kh\u00f4ng s\u00e1t nh\u1eadp v\u00e0o DNA. V\u00ec s\u1ef1 t\u0103ng sinh t\u1ebf b\u00e0o lympho T v\u00e0 B ph\u1ee5 thu\u1ed9c ch\u1eb7t ch\u1ebd v\u00e0o s\u1ef1 t\u1ed5ng h\u1ee3p purines tr\u00ean de novo trong khi c\u00e1c lo\u1ea1i t\u1ebf b\u00e0o kh\u00e1c c\u00f3 th\u1ec3 t\u1eadn d\u1ee5ng c\u01a1 ch\u1ebf t\u00e1i s\u1eed d\u1ee5ng nh\u00e2n purine, MPA c\u00f3 kh\u1ea3 n\u0103ng t\u00e1c \u0111\u1ed9ng k\u00ecm t\u1ebf b\u00e0o tr\u00ean c\u00e1c t\u1ebf b\u00e0o lympho \u0111\u00e1ng k\u1ec3 h\u01a1n h\u1eb3n so v\u1edbi c\u00e1c t\u1ebf b\u00e0o kh\u00e1c..<\/p>\n<p><strong><em>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng: <\/em><\/strong><\/p>\n<p>Mycophenolate sodium l\u00e0 mu\u1ed1i Na c\u1ee7a mycophenolic acid (MPA). MPA l\u00e0 ch\u1ea5t \u1ee9c ch\u1ebf men inosine monophosphophate dehydrogenase (IMPDH) c\u00f3 ch\u1ecdn l\u1ecdc, kh\u00f4ng c\u1ea1nh tranh v\u00e0 c\u00f3 th\u1ec3 \u0111\u1ea3o ng\u01b0\u1ee3c \u0111\u01b0\u1ee3c, ch\u1ea5t n\u00e0y \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p nucleotide guanosin theo con \u0111\u01b0\u1eddng m\u1edbi m\u00e0 kh\u00f4ng g\u1eafn v\u00e0o DNA.<\/p>\n<p>MPA c\u00f3 t\u00e1c d\u1ee5ng ki\u1ec1m ch\u1ebf t\u1ebf b\u00e0o tr\u00ean t\u1ebf b\u00e0o lympho m\u1ea1nh h\u01a1n nh\u1eefng t\u1ebf b\u00e0o kh\u00e1c do nh\u00e2n purin c\u1ee7a n\u00f3. Ng\u01b0\u1ee3c v\u1edbi nh\u1eefng lo\u1ea1i t\u1ebf b\u00e0o ch\u00fang s\u1eed d\u1ee5ng c\u00e1c con \u0111\u01b0\u1eddng \u1ee9c ch\u1ebf kh\u00e1c, s\u1ef1 t\u0103ng sinh c\u1ee7a lympho T v\u00e0 B b\u1ecb ph\u1ee5 thu\u1ed9c \u0111\u00e1ng k\u1ec3 v\u00e0o s\u1ef1 t\u1ed5ng h\u1ee3p theo con \u0111\u01b0\u1eddng m\u1edbi. V\u00ec v\u1eady, ki\u1ec3u ho\u1ea1t \u0111\u1ed9ng c\u1ee7a MPA b\u1ed5 sung cho t\u00e1c d\u1ee5ng c\u1ee7a nh\u1eefng ch\u1ea5t \u1ee9c ch\u1ebf calcineurin m\u00e0 nh\u1eefng ch\u1ea5t n\u00e0y can thi\u1ec7p v\u00e0o qu\u00e1 tr\u00ecnh sao ch\u00e9p cytokin v\u00e0 c\u00e1c lympho b\u00e0o T trong pha ngh\u1ec9.<\/p>\n<p><strong>[XEM T\u1ea0I \u0110\u00c2Y]<\/strong><\/p>\n<h2><span class=\"ez-toc-section\" id=\"52-duoc-dong-hoc\"><\/span>5.2. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Sau khi u\u1ed1ng, mycophenolate mofetil \u0111\u01b0\u1ee3c h\u1ea5p thu nhanh ch\u00f3ng v\u00e0 ph\u1ea7n l\u1edbn qua chuy\u1ec3n h\u00f3a l\u1ea7n \u0111\u1ea7u ho\u00e0n to\u00e0n th\u00e0nh ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f3 ho\u1ea1t t\u00ednh, MPA. V\u00ec c\u00f3 ch\u1ee9ng c\u1ee9 c\u1ee7a \u1ee9c ch\u1ebf th\u1ea3i gh\u00e9p c\u00e2p sau khi gh\u00e9p th\u1eadn, ho\u1ea1t t\u00ednh \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch c\u1ee7a Mycophenolate mofetil c\u00f3 li\u00ean quan \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 MPA. Sinh kh\u1ea3 d\u1ee5ng trung b\u00ecnh c\u1ee7a mycophenolate mofetil d\u1ea1ng u\u1ed1ng, d\u1ef1a v\u00e0o di\u1ec7n t\u00edch d\u01b0\u1edbi \u0111\u01b0\u1eddng cong c\u1ee7a MPA, l\u00e0 94 % t\u01b0\u01a1ng \u0111\u1ed1i v\u1edbi mycophenolate mofetil d\u1ea1ng ti\u00eam t\u0129nh m\u1ea1ch. Th\u1ee9c \u0103n kh\u00f4ng \u1ea3nh h\u1eeb\u1edfng \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 h\u1ea5p thu (MPA AUC) c\u1ee7a mycophenolate mofetil khi \u0111\u01b0\u1ee3c d\u00f9ng c\u00e1c li\u1ec1u 1,5g x 2 l\u1ea7n\/ng\u00e0y cho b\u1ec7nh nh\u00e2n gh\u00e9p th\u1eadn. Tuy nhi\u00ean, Cmax c\u1ee7a MPA gi\u1ea3m 40% khi c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a th\u1ee9c \u0103n. Mycophenolate mofetil kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n trong huy\u1ebft t\u01b0\u01a1ng sau khi u\u1ed1ng. MPA \u1edf n\u1ed3ng \u0111\u1ed9 th\u00edch h\u1ee3p tr\u00ean l\u00e2m s\u00e0ng, 97% g\u1eafn k\u1ebft v\u1edbi protein albumin huy\u1ebft t\u01b0\u01a1ng.<\/p>\n<p>V\u00ec c\u00f3 chu k\u1ef3 gan ru\u1ed9t, \u0111\u1ec9nh th\u1ee9 hai c\u1ee7a MPA th\u01b0\u1eddng \u0111\u01b0\u1ee3c quan s\u00e1t sau 6 \u2014 12 gi\u1edd sau khi d\u00f9ng thu\u1ed1c. Gi\u1ea3m AUC c\u1ee7a MPA kho\u1ea3ng 40% c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi cholestyramine (4 g x 3 l\u1ea7n\/ng\u00e0y), cho th\u1ea5y r\u1eb1ng c\u00f3 m\u1ed9t l\u01b0\u1ee3ng \u0111\u00e1ng k\u1ec3 c\u1ee7a chu k\u1ef3 gan ru\u1ed9t.<\/p>\n<p>MPA \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a ch\u1ee7 y\u1ebfu b\u1edfi men glucuronyl transferase th\u00e0nh d\u1ea1ng phenolic glucuronide c\u1ee7a MPA (MPAG), ch\u1ea5t kh\u00f4ng c\u00f3 ho\u1ea1t t\u00ednh d\u01b0\u1ee3c l\u00fd.<\/p>\n<p>M\u1ed9t l\u01b0\u1ee3ng kh\u00f4ng \u0111\u00e1ng k\u1ec3 \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft \u1edf d\u1ea1ng MPA (&lt; 1 % li\u1ec1u d\u00f9ng) trong n\u01b0\u1edbc ti\u1ec3u. D\u00f9ng d\u1ea1ng u\u1ed1ng mycophenolate mofetil \u0111\u00e1nh d\u1ea5u ph\u00f3ng x\u1ea1 d\u1eabn \u0111\u1ebfn h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n li\u1ec1u \u0111\u00e3 d\u00f9ng v\u1edbi 93% li\u1ec1u d\u00f9ng \u0111\u01b0\u1ee3c h\u1ed3i ph\u1ee5c trong n\u01b0\u1edbc ti\u1ec3u v\u00e0 6% li\u1ec1u \u0111\u00e3 d\u00f9ng h\u1ed3i ph\u1ee5c trong ph\u00e2n. H\u1ea7u h\u1ebft (kho\u1ea3ng 87 %) li\u1ec1u \u0111\u00e3 d\u00f9ng \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft trong n\u01b0\u1edbc ti\u1ec3u \u1edf d\u1ea1ng MPAG. C\u00e1c n\u1ed3ng \u0111\u1ed9 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c tr\u00ean l\u00e2m s\u00e0ng, MPA v\u00e0 MPAG kh\u00f4ng \u0111\u01b0\u1ee3c lo\u1ea1i kh\u1ecfi c\u01a1 th\u1ec3 b\u1eb1ng th\u1ea9m ph\u00e2n m\u00e1u. Tuy nhi\u00ean, t\u1ea1i n\u1ed3ng \u0111\u1ed9 huy\u1ebft t\u01b0\u01a1ng cao c\u1ee7a MPAG (&gt; 100mcg\/ml), m\u1ed9t l\u01b0\u1ee3ng nh\u1ecf MPAG \u0111\u01b0\u1ee3c lo\u1ea1i kh\u1ecfi c\u01a1 th\u1ec3.<\/p>\n<p>Trong giai \u0111o\u1ea1n s\u1edbm sau khi gh\u00e9p t\u1ea1ng (&lt; 40 ng\u00e0y sau khi gh\u00e9p), b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c gh\u00e9p th\u1eadn, tim v\u00e0 gan c\u00f3 AUCs trung b\u00ecnh c\u1ee7a MPA l\u00e0 th\u00e2p h\u01a1n kho\u1ea3ng 30% v\u00e0 c\u00f3 Cmax th\u1ea5p kho\u1ea3ng 40 % so v\u1edbi kho\u1ea3ng th\u1eddi gian mu\u1ed9n sau khi gh\u00e9p (3 &#8211; 6 th\u00e1ng sau khi gh\u00e9p).<\/p>\n<p><em>Suy ch\u1ee9c n\u0103ng th\u1eadn <\/em><\/p>\n<p>Trong m\u1ed9t nghi\u00ean c\u1ee9u d\u00f9ng li\u1ec1u duy nh\u1ea5t (6 b\u1ec7nh nh\u00e2n\/nh\u00f3m), AUC c\u1ee7a MPA trung b\u00ecnh trong huy\u1ebft t\u01b0\u01a1ng quan s\u00e1t \u0111\u01b0\u1ee3c \u1edf c\u00e1c b\u1ec7nh nh\u00e2n suy ch\u1ee9c n\u0103ng th\u1eadn n\u1eb7ng m\u00e3n t\u00ednh (t\u1ec9 l\u1ec7 l\u1ecdc c\u1ea7u th\u1eadn &lt; 25 ml.ph\u00fat-1.1,73 m-2) cao h\u01a1n 28 &#8211; 75 % so v\u1edbi AUC trung b\u00ecnh quan s\u00e1t \u0111\u01b0\u1ee3c \u1edf ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng kh\u1ecfe m\u1ea1nh ho\u1eb7c so v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n suy ch\u1ee9c n\u0103ng th\u1eadn \u1edf m\u1ee9c \u0111\u1ed9 nh\u1eb9 h\u01a1n. Tuy nhi\u00ean, AUC c\u1ee7a MPAG trung b\u00ecnh khi d\u00f9ng li\u1ec1u duy nh\u1ea5t cao h\u01a1n 3 &#8211; 6 l\u1ea7n \u1edf b\u1ec7nh nh\u00e2n suy ch\u1ee9c n\u0103ng th\u1eadn n\u1eb7ng so v\u1edbi ng\u01b0\u1eddi suy ch\u1ee9c n\u0103ng th\u1eadn nh\u1eb9 ho\u1eb7c ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng kh\u1ecfe m\u1ea1nh, ph\u00f9 h\u1ee3p v\u1edbi \u0111\u00e0o th\u1ea3i qua th\u1eadn \u0111\u00e3 \u0111\u01b0\u1ee3c bi\u1ebft c\u1ee7a MPAG. Li\u1ec1u \u0111a c\u1ee7a mycophenolate mofetil khi d\u00f9ng cho b\u1ec7nh nh\u00e2n suy ch\u1ee9c n\u0103ng th\u1eadn n\u1eb7ng m\u00e3n t\u00ednh ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u. Kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u th\u00edch h\u1ee3p cho b\u1ec7nh nh\u00e2n gh\u00e9p tim ho\u1eb7c gh\u00e9p gan b\u1ecb suy ch\u1ee9c n\u0103ng th\u1eadn n\u1eb7ng m\u00e3n t\u00ednh ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u. Kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u th\u00edch h\u1ee3p cho b\u1ec7nh nh\u00e2n gh\u00e9p tim ho\u1eb7c gh\u00e9p gan b\u1ecb suy ch\u1ee9c n\u0103ng th\u1eadn n\u1eb7ng m\u00e3n t\u00ednh.<\/p>\n<p><em>M\u1ea3nh gh\u00e9p th\u1eadn ch\u1eadm ho\u1ea1t \u0111\u1ed9ng<\/em><\/p>\n<p>\u1ede b\u1ec7nh nh\u00e2n c\u00f3 m\u1ea3nh gh\u00e9p ch\u1eadm ho\u1ea1t \u0111\u1ed9ng sau khi gh\u00e9p, AUC 0-12h trung b\u00ecnh c\u1ee7a MPA c\u00f3 th\u1ec3 so s\u00e1nh \u0111\u01b0\u1ee3c v\u1edbi AUC quan s\u00e1t \u0111\u01b0\u1ee3c \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c gh\u00e9p c\u01a1 quan c\u00f3 ti\u1ebfn tri\u1ec3n b\u00ecnh th\u01b0\u1eddng AUC0-12h c\u1ee7a MPAG trung b\u00ecnh trong huy\u1ebft t\u01b0\u01a1ng cao g\u1ea5p 2-3 l\u1ea7n so v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n sau gh\u00e9p c\u01a1 quan c\u00f3 ti\u1ebfn tri\u1ec3n b\u00ecnh th\u01b0\u1eddng. T\u0103ng nh\u1eb9 ph\u1ea7n t\u1ef1 do v\u00e0 n\u1ed3ng \u0111\u1ed9 huy\u1ebft t\u01b0\u01a1ng c\u1ee7a MPA \u1edf b\u1ec7nh nh\u00e2n c\u00f3 m\u1ea3nh gh\u00e9p th\u1eadn ch\u1eadm ho\u1ea1t \u0111\u1ed9ng. \u0110i\u1ec1u ch\u1ec9nh li\u1ec1u c\u1ee7a mycophenolate mofetil d\u01b0\u1eddng nh\u01b0 kh\u00f4ng c\u1ea7n thi\u1ebft.<\/p>\n<p><em>Suy ch\u1ee9c n\u0103ng gan<\/em><\/p>\n<p>\u1ede ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n b\u1ecb x\u01a1 gan do r\u01b0\u1ee3u, qu\u00e1 tr\u00ecnh glucuronide h\u00f3a MPA \u1edf gan kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng m\u1ed9t c\u00e1ch t\u01b0\u01a1ng \u0111\u1ed1i do b\u1ec7nh nhu m\u00f4 gan. T\u00e1c \u0111\u1ed9ng c\u1ee7a b\u1ec7nh gan tr\u00ean qu\u00e1 tr\u00ecnh n\u00e0y c\u00f3 kh\u1ea3 n\u0103ng ph\u1ee5 thu\u1ed9c v\u00e0o b\u1ec7nh ri\u00eang bi\u1ec7t. Tuy nhi\u00ean, b\u1ec7nh gan k\u00e8m t\u1ed1n th\u01b0\u01a1ng m\u1eadt, nh\u01b0 x\u01a1 gan m\u1eadt ti\u00ean ph\u00e1t, c\u00f3 th\u1ec3 cho t\u00e1c \u0111\u1ed9ng kh\u00e1c nhau.<\/p>\n<p><em>Tr\u1ebb em v\u00e0 thanh thi\u1ebfu ni\u00ean (tu\u1ed5i t\u1eeb 2 \u0111\u1ebfn 18)<\/em><\/p>\n<p>C\u00e1c th\u00f4ng s\u1ed1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u0111\u01b0\u1ee3c l\u01b0\u1ee3ng gi\u00e1 \u1edf 49 b\u1ec7nh nhi gh\u00e9p th\u1eadn d\u00f9ng 600 mg\/m2 mycophenolate mofetil b\u1eb1ng \u0111\u01b0\u1eddng u\u1ed1ng, ng\u00e0y 2 l\u1ea7n. Li\u1ec1u n\u00e0y cho AUC c\u1ee7a MPA t\u01b0\u01a1ng t\u1ef1 nh\u01b0 AUC quan s\u00e1t \u0111\u01b0\u1ee3c \u1edf b\u1ec7nh nh\u00e2n l\u00e0 ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh \u0111\u01b0\u1ee3c gh\u00e9p th\u1eadn d\u00f9ng Mycophenolate mofetil v\u1edbi li\u1ec1u 1g, 2 l\u1ea7n\/ng\u00e0y trong kho\u1ea3ng th\u1eddi gian s\u1edbm v\u00e0 mu\u1ed9n sau khi gh\u00e9p. Gi\u00e1 tr\u1ecb AUC c\u1ee7a MPA trong c\u00e1c nh\u00f3m theo tu\u1ed5i t\u00e1c l\u00e0 t\u01b0\u01a1ng t\u1ef1 trong kho\u1ea3ng th\u1eddi gian s\u1edbm v\u00e0 mu\u1ed9n sau khi gh\u00e9p.<\/p>\n<p><em>B\u1ec7nh nh\u00e2n cao tu\u1ed5i (&gt;65 tu\u1ed5i)<\/em><\/p>\n<p>T\u00e1c \u0111\u1ed9ng d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a mycophenolate mofetil \u1edf ng\u01b0\u1eddi cao tu\u1ed5i ch\u01b0a \u0111\u01b0\u1ee3c l\u01b0\u1ee3ng gi\u00e1 m\u1ed9t c\u00e1ch ch\u00ednh th\u1ee9c.<\/p>\n<p><em>Thu\u1ed1c ng\u1eeba thai d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng<\/em><\/p>\n<p>D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a thu\u1ed1c ng\u1eeba thai d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng khi d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi mycophenolate mofetil. M\u1ed9t nghi\u00ean c\u1ee9u d\u00f9ng \u0111\u1ed3ng th\u1eddi mycophenolate mofetil (1g, 2 l\u1ea7n\/ng\u00e0y) v\u00e0 thu\u1ed1c ng\u1eeba thai d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng ch\u1ee9a ethinylestradiol (0,02mg \u0111\u1ebfn 0,04mg) v\u00e0 levonorgestrel (0,05mg \u0111\u1ebfn 0,15mg), desogestrel (0,15mg) ho\u1eb7c gestodene (0, 05mg \u0111\u1ebfn 0,10mg) ti\u1ebfn h\u00e0nh \u1edf 18 ph\u1ee5 n\u1eef kh\u00f4ng gh\u00e9p t\u1ea1ng (kh\u00f4ng d\u00f9ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch kh\u00e1c) tr\u00ean 3 chu k\u1ef3 kinh nguy\u1ec7t cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 \u1ea3nh h\u01b0\u1edfng t\u01b0\u01a1ng quan tr\u00ean l\u00e2m s\u00e0ng c\u1ee7a Mycophenolate mofetil tr\u00ean s\u1ef1 \u1ee9c ch\u1ebf r\u1ee5ng tr\u1ee9ng c\u1ee7a thu\u1ed1c ng\u1eeba thai \u0111\u01b0\u1eddng u\u1ed1ng. N\u1ed3ng \u0111\u1ed9 huy\u1ebft thanh c\u1ee7a LH, FSH v\u00e0 progesterone kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3..<\/p>\n<h2><span class=\"ez-toc-section\" id=\"53-giai-thich\"><\/span>5.3 Gi\u1ea3i th\u00edch:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Ch\u01b0a c\u00f3 th\u00f4ng tin. \u0110ang c\u1eadp nh\u1eadt.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"54-thay-the-thuoc\"><\/span>5.4 Thay th\u1ebf thu\u1ed1c :<span class=\"ez-toc-section-end\"><\/span><\/h2>\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<h1><span class=\"ez-toc-section\" id=\"6-phan-thong-tin-kem-theo-cua-thuoc\"><\/span>6. Ph\u1ea7n th\u00f4ng tin k\u00e8m theo c\u1ee7a thu\u1ed1c:<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<h2><span class=\"ez-toc-section\" id=\"61-danh-muc-ta-duoc\"><\/span>6.1. Danh m\u1ee5c t\u00e1 d\u01b0\u1ee3c:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>&nbsp;<\/p>\n<h2><span class=\"ez-toc-section\" id=\"62-tuong-ky\"><\/span>6.2. T\u01b0\u01a1ng k\u1ef5 :<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Kh\u00f4ng \u00e1p d\u1ee5ng.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"63-bao-quan\"><\/span>6.3. B\u1ea3o qu\u1ea3n:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>N\u01a1i kh\u00f4, tr\u00e1nh \u00e1nh s\u00e1ng, nhi\u1ec7t \u0111\u1ed9 d\u01b0\u1edbi 30\u00b0C.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"64-thong-tin-khac\"><\/span>6.4. Th\u00f4ng tin kh\u00e1c :<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Ch\u01b0a c\u00f3 th\u00f4ng tin.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"65-tai-lieu-tham-khao\"><\/span>6.5 T\u00e0i li\u1ec7u tham kh\u1ea3o:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>D\u01b0\u1ee3c Th\u01b0 Qu\u1ed1c Gia Vi\u1ec7t Nam<\/p>\n<p>Ho\u1eb7c HDSD Thu\u1ed1c.<\/p>\n<h1><span class=\"ez-toc-section\" id=\"7-nguoi-dang-tai-tac-gia\"><\/span>7. Ng\u01b0\u1eddi \u0111\u0103ng t\u1ea3i \/T\u00e1c gi\u1ea3:<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>B\u00e0i vi\u1ebft \u0111\u01b0\u1ee3c s\u01b0u t\u1ea7m ho\u1eb7c vi\u1ebft b\u1edfi: <a href=\"https:\/\/pharmog.com\/wp\/thong-tin-tac-gia-bac-sy-do-my-linh\/\">B\u00e1c s\u0129 nhi khoa &#8211; \u0110\u1ed7 M\u1ef9 Linh.<\/a><\/p>\n<p>Ki\u1ec3m duy\u1ec7t , hi\u1ec7u \u0111\u00ednh v\u00e0 \u0111\u0103ng t\u1ea3i: <a href=\"https:\/\/pharmog.com\/wp\/thong-tin-ve-pharmog-team\/\">PHARMOG TEAM<\/a><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thu\u1ed1c Baxmune 500 l\u00e0 thu\u1ed1c g\u00ec ? D\u01b0\u1edbi \u0111\u00e2y l\u00e0 n\u1ed9i dung t\u1edd h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng g\u1ed1c c\u1ee7a Thu\u1ed1c Baxmune 500 (Th\u00f4ng tin bao g\u1ed3m li\u1ec1u d\u00f9ng, c\u00e1ch d\u00f9ng, ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, th\u1eadn tr\u1ecdng, d\u01b0\u1ee3c l\u00fd&#8230;) 1. T\u00ean ho\u1ea1t ch\u1ea5t v\u00e0 bi\u1ec7t d\u01b0\u1ee3c: Ho\u1ea1t ch\u1ea5t : Mycophenolate mofetil\/ Mycophenolic Acid Ph\u00e2n lo\u1ea1i: [&hellip;]<\/p>\n","protected":false},"author":8612,"featured_media":31086,"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":[1227,1228],"class_list":["post-31085","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-biet-duoc","tag-mycophenolate-mofetil","tag-mycophenolic-acid"],"_links":{"self":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/31085","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\/8612"}],"replies":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/comments?post=31085"}],"version-history":[{"count":3,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/31085\/revisions"}],"predecessor-version":[{"id":45769,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/31085\/revisions\/45769"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/media\/31086"}],"wp:attachment":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/media?parent=31085"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/categories?post=31085"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/tags?post=31085"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}