{"id":4081,"date":"2019-02-12T16:18:13","date_gmt":"2019-02-12T09:18:13","guid":{"rendered":"https:\/\/pharmog.com\/wp\/?p=4081"},"modified":"2025-01-08T22:27:39","modified_gmt":"2025-01-08T15:27:39","slug":"topiramate","status":"publish","type":"post","link":"https:\/\/pharmog.com\/wp\/topiramate\/","title":{"rendered":"Topiramate"},"content":{"rendered":"<p><em>Thu\u1ed1c Topiramate 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 Topiramate (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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/#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\/topiramate\/\"><strong>Topiramate<\/strong><\/a><\/p>\n<p><strong><em>Ph\u00e2n lo\u1ea1i: <\/em><\/strong><em>Thu\u1ed1c ch\u1ed1ng co gi\u1eadt \/ thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh<\/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): N03AX11.<\/p>\n<p><strong><em>Bi\u1ec7t d\u01b0\u1ee3c g\u1ed1c:<\/em><\/strong> <a href=\"https:\/\/pharmog.com\/wp\/topiramate-topamax\/\">Topamax<\/a><\/p>\n<p><strong><em>Thu\u1ed1c Generic:<\/em><\/strong> <a href=\"https:\/\/pharmog.com\/wp\/topiramate-huether\/\">Huether<\/a> , Tizadyn , Pharmapir , pms-Topiramate , <a href=\"https:\/\/pharmog.com\/wp\/topiramate-suntopirol\/\">Suntopirol<\/a> , Tormita , <a href=\"https:\/\/pharmog.com\/wp\/topiramate-prosgesy\/\">Prosgesy<\/a> , <a href=\"https:\/\/pharmog.com\/wp\/topiramate-hitop-tablets\/\">Hitop Tablets<\/a>, Inta-TO .<\/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\/nang : 15mg, 25 mg, 50 mg, 100 mg, 200 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>TOPIRAMATE 200MG USP<\/em><\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><em>M\u1ed7i vi\u00ean n\u00e9n bao phim c\u00f3 ch\u1ee9a:<\/em><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>Topiramate<\/td>\n<td>&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<\/td>\n<td>200 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=\"335\" height=\"392\" class=\"wp-image-39566\" src=\"https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2019\/02\/word-image-84.png\" srcset=\"https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2019\/02\/word-image-84.png 335w, https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2019\/02\/word-image-84-256x300.png 256w\" sizes=\"auto, (max-width: 335px) 100vw, 335px\" \/><\/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>\u0110\u01a1n tr\u1ecb li\u1ec7u cho ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em tr\u00ean 6 tu\u1ed5i trong \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh c\u1ee5c b\u1ed9 c\u00f3 k\u00e8m ho\u1eb7c kh\u00f4ng k\u00e8m \u0111\u1ed9ng kinh to\u00e0n th\u1ec3 th\u1ee9 ph\u00e1t, v\u00e0 c\u01a1n \u0111\u1ed9ng kinh co c\u1ee9ng &#8211; co gi\u1eadt to\u00e0n th\u1ec3 nguy\u00ean ph\u00e1t.<\/p>\n<p>Ph\u1ed1i h\u1ee3p trong \u0111i\u1ec1u tr\u1ecb cho ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em t\u1eeb 2 tu\u1ed5i tr\u1edf l\u00ean b\u1ecb c\u01a1n \u0111\u1ed9ng kinh kh\u1edfi ph\u00e1t c\u1ee5c b\u1ed9, c\u00f3 k\u00e8m ho\u1eb7c kh\u00f4ng k\u00e8m \u0111\u1ed9ng kinh to\u00e0n th\u1ec3 th\u1ee9 ph\u00e1t ho\u1eb7c c\u01a1n \u0111\u1ed9ng kinh co c\u1ee9ng &#8211; co gi\u1eadt to\u00e0n th\u1ec3 nguy\u00ean ph\u00e1t v\u00e0 trong \u0111i\u1ec1u tr\u1ecb c\u01a1n \u0111\u1ed9ng kinh li\u00ean quan \u0111\u1ebfn h\u1ed9i ch\u1ee9ng Lennox-Gastaut.<\/p>\n<p>Topiramate \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng \u0111au n\u1eeda \u0111\u1ea7u \u1edf ng\u01b0\u1eddi l\u1edbn sau khi \u0111\u00e1nh gi\u00e1 k\u1ef9 l\u01b0\u1ee1ng c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c. Topiramat kh\u00f4ng d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u01a1n \u0111au n\u1eeda \u0111\u1ea7u c\u1ea5p.<\/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>Topiramate \u1edf d\u1ea1ng vi\u00ean n\u00e9n d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng. Khuy\u1ebfn c\u00e1o khi d\u00f9ng kh\u00f4ng \u0111\u01b0\u1ee3c b\u1ebb vi\u00ean Topiramate.<\/p>\n<p>C\u00f3 th\u1ec3 u\u1ed1ng Topiramate m\u00e0 kh\u00f4ng c\u1ea7n quan t\u00e2m \u0111\u1ebfn b\u1eefa \u0103n..<\/p>\n<p>Kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i ki\u1ec3m so\u00e1t n\u1ed3ng \u0111\u1ed9 topiramat trong huy\u1ebft t\u01b0\u01a1ng \u0111\u1ec3 t\u1ed1i \u01b0u h\u00f3a \u0111i\u1ec1u tr\u1ecb v\u1edbi Topiramate. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p hi\u1ebfm, s\u1eed d\u1ee5ng th\u00eam Topiramate v\u1edbi phenytoin c\u00f3 th\u1ec3 c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u phenytoin \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng t\u1ed1i \u01b0u. C\u00f3 th\u1ec3 c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u Topiramate n\u1ebfu th\u00eam v\u00e0o ho\u1eb7c ng\u1eebng phenytoin v\u00e0 carbamazepin trong \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p v\u1edbi Topiramate.<\/p>\n<p>N\u00ean kh\u1edfi \u0111\u1ea7u li\u1ec1u th\u1ea5p v\u00e0 ch\u1ec9nh li\u1ec1u sau \u0111\u00f3 \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee9c li\u1ec1u c\u00f3 hi\u1ec7u qu\u1ea3.<\/p>\n<p><strong><em>Li\u1ec1u d\u00f9ng:<\/em><\/strong><\/p>\n<p><em>\u0110\u1ed9ng kinh &#8211; \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p<\/em><\/p>\n<p><em>Ng\u01b0\u1eddi l\u1edbn<\/em><\/p>\n<p>N\u00ean kh\u1edfi \u0111\u1ea7u v\u1edbi li\u1ec1u 25 t\u1edbi 50mg v\u00e0o m\u1ed7i bu\u1ed5i t\u1ed1i trong m\u1ed9t tu\u1ea7n. \u0110\u00e3 c\u00f3 b\u00e1o vi\u1ec7c s\u1eed d\u1ee5ng li\u1ec1u kh\u1edfi \u0111\u1ea7u th\u1ea5p h\u01a1n nh\u01b0ng ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u m\u1ed9t c\u00e1ch h\u1ec7 th\u1ed1ng. Sau \u0111\u00f3 c\u00e1ch m\u1ed7i m\u1ed9t tu\u1ea7n ho\u1eb7c m\u1ed7i hai tu\u1ea7n, n\u00ean t\u0103ng li\u1ec1u th\u00eam 25 t\u1edbi 50mg\/ng\u00e0y v\u00e0 chia l\u00e0m 2 l\u1ea7n u\u1ed1ng m\u1ed7i ng\u00e0y. Vi\u1ec7c ch\u1ec9nh li\u1ec1u ph\u1ea3i d\u1ef1a v\u00e0o \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb khi d\u00f9ng li\u1ec1u 1 l\u1ea7n\/ng\u00e0y.<\/p>\n<p>Trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng khi \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p, m\u1ee9c li\u1ec1u 200mg l\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 v\u00e0 l\u00e0 li\u1ec1u th\u1ea5p nh\u1ea5t \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u. V\u00ec v\u1eady, li\u1ec1u n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem nh\u01b0 l\u00e0 li\u1ec1u t\u1ed1i thi\u1ec3u \u0111\u1ea1t hi\u1ec7u qu\u1ea3. Li\u1ec1u d\u00f9ng th\u00f4ng th\u01b0\u1eddng h\u00e0ng ng\u00e0y l\u00e0 200 \u0111\u1ebfn 400mg, chia l\u00e0m hai l\u1ea7n. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c d\u00f9ng \u1edf li\u1ec1u cao 1600mg\/ng\u00e0y.<\/p>\n<p>C\u00e1c khuy\u1ebfn c\u00e1o v\u1ec1 li\u1ec1u d\u00f9ng n\u00e0y \u00e1p d\u1ee5ng cho t\u1ea5t c\u1ea3 ng\u01b0\u1eddi l\u1edbn, k\u1ec3 c\u1ea3 ng\u01b0\u1eddi cao tu\u1ed5i hi\u1ec7n kh\u00f4ng c\u00f3 b\u1ec7nh v\u1ec1 th\u1eadn.<\/p>\n<p><em>Tr\u1ebb em t\u1eeb 2 tu\u1ed5i tr\u1edf l\u00ean<\/em><\/p>\n<p>T\u1ed5ng li\u1ec1u d\u00f9ng h\u00e0ng ng\u00e0y c\u1ee7a Topiramate khi \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o kho\u1ea3ng 5 \u0111\u1ebfn 9mg\/kg\/ng\u00e0y, chia l\u00e0m hai l\u1ea7n. Vi\u1ec7c ch\u1ec9nh li\u1ec1u n\u00ean \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ea7u b\u1eb1ng 25mg (ho\u1eb7c th\u1ea5p h\u01a1n, d\u1ef1a tr\u00ean ph\u1ea1m vi li\u1ec1u t\u1eeb 1 \u0111\u1ebfn 3mg\/kg\/ng\u00e0y) v\u00e0o m\u1ed7i t\u1ed1i trong tu\u1ea7n \u0111\u1ea7u ti\u00ean. Sau \u0111\u00f3 \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng t\u1ed1i \u01b0u, sau c\u00e1ch m\u1ed7i 1 ho\u1eb7c 2 tu\u1ea7n n\u00ean t\u0103ng li\u1ec1u trong gi\u1edbi h\u1ea1n kho\u1ea3ng 1 \u0111\u1ebfn 3mg\/kg\/ng\u00e0y (chia l\u00e0m hai l\u1ea7n u\u1ed1ng). Vi\u1ec7c ch\u1ec9nh li\u1ec1u n\u00ean d\u1ef1a tr\u00ean \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n<p>Li\u1ec1u d\u00f9ng h\u00e0ng ng\u00e0y l\u00ean t\u1edbi 30mg\/kg\/ng\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u v\u00e0 n\u00f3i chung \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t.<\/p>\n<p><em>\u0110\u1ed9ng kinh &#8211; \u0110\u01a1n tr\u1ecb li\u1ec7u<\/em><\/p>\n<p>Khi ng\u1eebng c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh ph\u1ed1i h\u1ee3p \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u01a1n tr\u1ecb li\u1ec7u b\u1eb1ng topiramat, n\u00ean xem x\u00e9t \u0111\u1ebfn nh\u1eefng t\u00e1c \u0111\u1ed9ng c\u00f3 th\u1ec3 c\u00f3 c\u1ee7a vi\u1ec7c n\u00e0y tr\u00ean s\u1ef1 ki\u1ec3m so\u00e1t c\u01a1n \u0111\u1ed9ng kinh. Li\u1ec1u c\u1ee7a c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o gi\u1ea3m t\u1eeb t\u1eeb v\u1edbi t\u1ef7 l\u1ec7 kho\u1ea3ng 1\/3 m\u1ed7i hai tu\u1ea7n tr\u1eeb khi c\u1ea7n ph\u1ea3i ng\u1eebng ngay c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh ph\u1ed1i h\u1ee3p v\u00ec li\u00ean quan \u0111\u1ebfn t\u00ednh an to\u00e0n .<\/p>\n<p>Khi ng\u1eebng d\u00f9ng c\u00e1c thu\u1ed1c g\u00e2y c\u1ea3m \u1ee9ng men, n\u1ed3ng \u0111\u1ed9 c\u1ee7a topiramat s\u1ebd t\u0103ng.<\/p>\n<p>C\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i gi\u1ea3m li\u1ec1u Topiramate n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng.<\/p>\n<p><em>Ng\u01b0\u1eddi l\u1edbn<\/em><\/p>\n<p>S\u1ef1 ch\u1ec9nh li\u1ec1u n\u00ean kh\u1edfi \u0111\u1ea7u \u1edf li\u1ec1u 25mg d\u00f9ng m\u1ed7i bu\u1ed5i t\u1ed1i trong m\u1ed9t tu\u1ea7n. Sau \u0111\u00f3, c\u00e1ch m\u1ed7i 1 tu\u1ea7n ho\u1eb7c m\u1ed7i hai tu\u1ea7n, n\u00ean t\u0103ng li\u1ec1u th\u00eam 25 ho\u1eb7c 50mg\/ng\u00e0y v\u00e0 chia l\u00e0m 2 l\u1ea7n u\u1ed1ng m\u1ed9t ng\u00e0y. N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 dung n\u1ea1p v\u1edbi ch\u1ebf \u0111\u1ed9 ch\u1ec9nh li\u1ec1u nh\u01b0 v\u1eady, th\u00ec n\u00ean t\u0103ng li\u1ec1u \u00edt h\u01a1n ho\u1eb7c k\u00e9o d\u00e0i kho\u1ea3ng th\u1eddi gian gi\u1eefa c\u00e1c l\u1ea7n t\u0103ng li\u1ec1u. Li\u1ec1u v\u00e0 t\u1ed1c \u0111\u1ed9 ch\u1ec9nh li\u1ec1u n\u00ean d\u1ef1a tr\u00ean \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n<p>Li\u1ec1u kh\u1edfi \u0111\u1ea7u khuy\u1ebfn c\u00e1o khi \u0111\u01a1n tr\u1ecb li\u1ec7u b\u1eb1ng topiramat \u1edf ng\u01b0\u1eddi l\u1edbn trong kho\u1ea3ng 100 \u0111\u1ebfn 200mg\/ng\u00e0y chia l\u00e0m 2 l\u1ea7n v\u00e0 li\u1ec1u h\u00e0ng ng\u00e0y t\u1ed1i \u0111a \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 500mg\/ng\u00e0y chia l\u00e0m 2 l\u1ea7n. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u1ed9ng kinh th\u1ec3 kh\u00e1ng tr\u1ecb dung n\u1ea1p v\u1edbi topiramat \u1edf li\u1ec1u 1000mg\/ng\u00e0y trong \u0111\u01a1n tr\u1ecb li\u1ec7u. C\u00e1c li\u1ec1u khuy\u1ebfn cao n\u00e0y \u00e1p d\u1ee5ng cho t\u1ea5t c\u1ea3 ng\u01b0\u1eddi l\u1edbn, k\u1ec3 c\u1ea3 ng\u01b0\u1eddi cao tu\u1ed5i kh\u00f4ng c\u00f3 b\u1ec7nh v\u1ec1 th\u1eadn.<\/p>\n<p><em>Tr\u1ebb em t\u1eeb 6 tu\u1ed5i tr\u1edf l\u00ean<\/em><\/p>\n<p>Tr\u1ebb em t\u1eeb 6 tu\u1ed5i tr\u1edf l\u00ean n\u00ean b\u1eaft \u0111\u1ea7u v\u1edbi li\u1ec1u t\u1eeb 0,5mg \u0111\u1ebfn 1mg\/kg v\u00e0o bu\u1ed5i t\u1ed1i, trong tu\u1ea7n \u0111\u1ea7u. Sau \u0111\u00f3 c\u00e1ch m\u1ed7i 1 ho\u1eb7c 2 tu\u1ea7n, t\u0103ng li\u1ec1u kho\u1ea3ng 0,5 \u0111\u1ebfn 1mg\/kg\/ng\u00e0y, chia l\u00e0m hai l\u1ea7n u\u1ed1ng. N\u1ebfu tr\u1ebb kh\u00f4ng th\u1ec3 dung n\u1ea1p v\u1edbi ch\u1ebf \u0111\u1ed9 ch\u1ec9nh li\u1ec1u tr\u00ean, th\u00ec n\u00ean t\u0103ng li\u1ec1u \u00edt h\u01a1n ho\u1eb7c k\u00e9o d\u00e0i th\u1eddi gian gi\u1eefa c\u00e1c l\u1ea7n t\u0103ng li\u1ec1u. Li\u1ec1u v\u00e0 t\u1ed1c \u0111\u1ed9 ch\u1ec9nh li\u1ec1u n\u00ean d\u1ef1a tr\u00ean \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n<p>Li\u1ec1u kh\u1edfi \u0111\u1ea7u khuy\u1ebfn c\u00e1o khi \u0111\u01a1n tr\u1ecb li\u1ec7u b\u1eb1ng topiramat \u1edf tr\u1ebb em t\u1eeb 6 tu\u1ed5i tr\u1edf l\u00ean l\u00e0 t\u1eeb 100 \u0111\u1ebfn 400mg\/ng\u00e0y. Tr\u1ebb em m\u1edbi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n c\u01a1n \u0111\u1ed9ng kinh kh\u1edfi ph\u00e1t c\u1ee5c b\u1ed9 \u0111\u00e3 d\u00f9ng li\u1ec1u l\u00ean \u0111\u1ebfn 500mg\/ng\u00e0y.<\/p>\n<p><em>\u0110au n\u1eeda \u0111\u1ea7u:<\/em><\/p>\n<p><em>Ng\u01b0\u1eddi l\u1edbn<\/em><\/p>\n<p>T\u1ed5ng li\u1ec1u khuy\u00ean d\u00f9ng m\u1ed7i ng\u00e0y c\u1ee7a topiramat trong \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng \u0111au n\u1eeda \u0111\u1ea7u l\u00e0 100mg\/ng\u00e0y, chia l\u00e0m 2 l\u1ea7n. S\u1ef1 ch\u1ec9nh li\u1ec1u n\u00ean kh\u1edfi \u0111\u1ea7u b\u1eb1ng li\u1ec1u 25mg d\u00f9ng m\u1ed7i t\u1ed1i trong m\u1ed9t tu\u1ea7n. Sau \u0111\u00f3 m\u1ed7i tu\u1ea7n n\u00ean t\u0103ng th\u00eam 25mg\/ng\u00e0y. N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 dung n\u1ea1p v\u1edbi ch\u1ebf \u0111\u1ed9 ch\u1ec9nh li\u1ec1u nh\u01b0 v\u1eady th\u00ec n\u00ean k\u00e9o d\u00e0i h\u01a1n kho\u1ea3ng th\u1eddi gian gi\u1eefa c\u00e1c l\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u. \u1ede m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 hi\u1ec7u qu\u1ea3 v\u1edbi t\u1ed5ng li\u1ec1u h\u1eb1ng ng\u00e0y 50mg\/ng\u00e0y. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u00e3 s\u1eed d\u1ee5ng t\u1ed5ng li\u1ec1u h\u1eb1ng ng\u00e0y l\u00ean \u0111\u1ebfn 200mg\/ng\u00e0y. Li\u1ec1u v\u00e0 t\u1ed1c \u0111\u1ed9 ch\u1ec9nh li\u1ec1u n\u00ean d\u1ef1a tr\u00ean \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n<p><em>B\u1ec7nh nh\u00e2n \u0111\u1eb7c bi\u1ec7t<\/em><\/p>\n<p><em>Suy th\u1eadn<\/em><\/p>\n<p>\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n suy th\u1eadn (\u0111\u1ed9 thanh th\u1ea3i creatinin &lt; 70 ml\/ph\u00fat), n\u00ean th\u1eadn tr\u1ecdng khi u\u1ed1ng topiramat b\u1edfi \u0111\u1ed9 thanh th\u1ea3i c\u1ee7a topiramat \u1edf th\u1eadn v\u00e0 huy\u1ebft t\u01b0\u01a1ng gi\u1ea3m. B\u1ec7nh nh\u00e2n suy th\u1eadn c\u1ea7n th\u1eddi gian d\u00e0i h\u01a1n \u0111\u1ec3 \u0111\u1ea1t t\u1edbi tr\u1ea1ng th\u00e1i h\u1eb1ng \u0111\u1ecbnh t\u1ea1i m\u1ed7i m\u1ee9c li\u1ec1u. Khuy\u1ebfn c\u00e1o gi\u1ea3m m\u1ed9t n\u1eeda li\u1ec1u kh\u1edfi \u0111\u1ea7u v\u00e0 li\u1ec1u duy tr\u00ec, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i, v\u00ec Topiramate b\u1ecb lo\u1ea1i kh\u1ecfi h\u1ee5y\u1ebft t\u01b0\u01a1ng khi ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, n\u00ean b\u1ed5 sung th\u00eam n\u1eeda li\u1ec1u Topiramate th\u01b0\u1eddng d\u00f9ng h\u1eb1ng ng\u00e0y trong nh\u1eefng ng\u00e0y ch\u1ea1y th\u1eadn. Li\u1ec1u Topiramate b\u1ed5 sung khi ch\u1ea1y th\u1eadn n\u00ean \u0111\u01b0\u1ee3c chia ra d\u00f9ng v\u00e0o l\u00fac b\u1eaft \u0111\u1ea7u v\u00e0 khi k\u1ebft th\u00fac quy tr\u00ecnh ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o. Li\u1ec1u b\u1ed5 sung c\u00f3 th\u1ec3 kh\u00e1c nhau d\u1ef1a tr\u00ean \u0111\u1eb7c t\u00ednh thi\u1ebft b\u1ecb th\u1ea9m t\u00e1ch m\u00e1u s\u1eed d\u1ee5ng.<\/p>\n<p><em>Suy gan<\/em><\/p>\n<p>Topiramat n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng th\u1eadn tr\u1ecdng \u1edf b\u1ec7nh nh\u00e2n suy 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>Qu\u00e1 m\u1eabn c\u1ea3m v\u1edbi b\u1ea5t c\u1ee9 th\u00e0nh ph\u1ea7n n\u00e0o c\u1ee7a thu\u1ed1c.<\/p>\n<p>D\u1ef1 ph\u00f2ng \u0111au n\u1eeda \u0111\u1ea7u cho ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i sinh s\u1ea3n kh\u00f4ng s\u1eed d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p tr\u00e1nh thai ph\u00f9 h\u1ee3p.<\/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=\"44-than-trong\"><\/span>4.4 Th\u1eadn tr\u1ecdng:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><em>Ng\u1eebng thu\u1ed1c Topiramate<\/em><\/p>\n<p>Tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 hay kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed c\u00f3 c\u01a1n co gi\u1eadt, hay \u0111\u1ed9ng kinh, ph\u1ea3i ng\u1eebng t\u1eeb t\u1eeb c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh, bao g\u1ed3m c\u1ea3 Topiramate, nh\u1eb1m gi\u1ea3m thi\u1ec3u nguy c\u01a1 b\u1ecb c\u01a1n \u0111\u1ed9ng kinh, ho\u1eb7c nguy c\u01a1 t\u0103ng t\u1ea7n s\u1ed1 c\u01a1n \u0111\u1ed9ng kinh. Trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng, c\u1ee9 m\u1ed7i m\u1ed9t tu\u1ea7n l\u1ea1i gi\u1ea3m li\u1ec1u u\u1ed1ng h\u00e0ng ng\u00e0y 50 t\u1edbi 100mg \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi l\u1edbn b\u1ecb \u0111\u1ed9ng kinh, v\u00e0 25 t\u1edbi 50mg \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi l\u1edbn \u0111ang d\u00f9ng Topiramate \u0111\u1ebfn 100mg\/ng\u00e0y cho d\u1ef1 ph\u00f2ng \u0111au n\u1eeda \u0111\u1ea7u. Trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u00ean tr\u1ebb em, Topiramate \u0111\u01b0\u1ee3c gi\u1ea3m li\u1ec1u t\u1eeb t\u1eeb trong kho\u1ea3ng th\u1eddi gian 2 t\u1edbi 8 tu\u1ea7n. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p m\u00e0 v\u00ec l\u00fd do y khoa n\u00ean bu\u1ed9c ph\u1ea3i ng\u1eebng Topiramate nhanh ch\u00f3ng, khuy\u1ebfn c\u00e1o ph\u1ea3i theo d\u00f5i m\u1ed9t c\u00e1ch th\u00edch h\u1ee3p.<\/p>\n<p><em>B\u1ec7nh nh\u00e2n suy th\u1eadn<\/em><\/p>\n<p>\u0110\u01b0\u1eddng th\u1ea3i tr\u1eeb ch\u1ee7 y\u1ebfu c\u1ee7a topiramat d\u1ea1ng kh\u00f4ng \u0111\u1ed5i v\u00e0 c\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a c\u1ee7a n\u00f3 l\u00e0 qua th\u1eadn. S\u1ef1 th\u1ea3i tr\u1eeb qua th\u1eadn ph\u1ee5 thu\u1ed9c ch\u1ee9c n\u0103ng c\u1ee7a th\u1eadn v\u00e0 kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o tu\u1ed5i t\u00e1c. Nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb suy th\u1eadn \u1edf m\u1ee9c \u0111\u1ed9 trung b\u00ecnh ho\u1eb7c n\u1eb7ng c\u00f3 th\u1ec3 c\u1ea7n 10 \u0111\u1ebfn 15 ng\u00e0y \u0111\u1ec3 n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong huy\u1ebft t\u01b0\u01a1ng \u0111\u1ea1t \u0111\u01b0\u1ee3c tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh trong khi \u1edf ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ch\u1ee9c n\u0103ng th\u1eadn b\u00ecnh th\u01b0\u1eddng ch\u1ec9 c\u1ea7n t\u1eeb 4 \u0111\u1ebfn 8 ng\u00e0y.<\/p>\n<p>\u0110\u1ed1i v\u1edbi t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n, ch\u1ebf \u0111\u1ed9 ch\u1ec9nh li\u1ec1u ph\u1ea3i theo s\u1ef1 h\u01b0\u1edbng d\u1eabn b\u1edfi \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng (ch\u1eb3ng h\u1ea1n nh\u01b0 ki\u1ec3m so\u00e1t c\u01a1n \u0111\u1ed9ng kinh, tr\u00e1nh c\u00e1c t\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd) v\u00e0 l\u01b0u \u00fd ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 bi\u1ebft c\u00f3 suy th\u1eadn c\u00f3 th\u1ec3 c\u1ea7n m\u1ed9t th\u1eddi gian d\u00e0i h\u01a1n \u0111\u1ec3 n\u1ed3ng \u0111\u1ed9 thu\u1ed1c \u0111\u1ea1t \u0111\u01b0\u1ee3c tr\u1ea1ng th\u00e1i h\u1eb1ng \u0111\u1ecbnh t\u1ea1i m\u1ed7i li\u1ec1u.<\/p>\n<p><em>S\u1ef1 b\u00f9 n\u01b0\u1edbc:<\/em><\/p>\n<p>Gi\u1ea3m ti\u1ebft m\u1ed3 h\u00f4i v\u00e0 kh\u00f4ng ti\u1ebft m\u1ed3 h\u00f4i \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng topiramat. Gi\u1ea3m ti\u1ebft m\u1ed3 h\u00f4i v\u00e0 t\u0103ng th\u00e2n nhi\u1ec7t c\u00f3 th\u1ec3 x\u1ea3y ra \u0111\u1eb7c bi\u1ec7t \u1edf tr\u1ebb nh\u1ecf trong m\u00f4i tr\u01b0\u1eddng nhi\u1ec7t \u0111\u1ed9 cao.<\/p>\n<p>Vi\u1ec7c d\u00f9ng n\u01b0\u1edbc \u0111\u1ea7y \u0111\u1ee7 trong khi \u0111ang d\u00f9ng topiramat l\u00e0 \u0111i\u1ec1u r\u1ea5t quan tr\u1ecdng. D\u00f9ng n\u01b0\u1edbc c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m nguy c\u01a1 b\u1ecb s\u1ecfi th\u1eadn. D\u00f9ng \u0111\u1ee7 n\u01b0\u1edbc tr\u01b0\u1edbc v\u00e0 trong c\u00e1c ho\u1ea1t \u0111\u1ed9ng, nh\u01b0 t\u1eadp luy\u1ec7n hay \u1edf n\u01a1i c\u00f3 nhi\u1ec7t \u0111\u1ed9 cao, c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m nguy c\u01a1 b\u1ecb c\u00e1c t\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd li\u00ean quan t\u1edbi nhi\u1ec7t.<\/p>\n<p><em>R\u1ed1i lo\u1ea1n kh\u00ed s\u1eafc\/tr\u1ea7m c\u1ea3m<\/em><\/p>\n<p>C\u00f3 s\u1ef1 gia t\u0103ng r\u1ed1i lo\u1ea1n kh\u00ed s\u1eafc v\u00e0 tr\u1ea7m c\u1ea3m \u0111\u01b0\u1ee3c ghi nh\u1eadn trong th\u1eddi gian \u0111i\u1ec1u tr\u1ecb<\/p>\n<p><em>T\u1ef1 t\u1eed\/c\u00f3 \u00fd \u0111\u1ecbnh t\u1ef1 t\u1eed<\/em><\/p>\n<p>T\u0103ng nguy c\u01a1 t\u1ef1 t\u1eed trong \u00fd ngh\u0129 ho\u1eb7c h\u00e0nh vi \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh, bao g\u1ed3m Topiramate, cho b\u1ea5t k\u1ef3 ch\u1ec9 \u0111\u1ecbnh n\u00e0o. M\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean, c\u00f3 \u0111\u1ed1i ch\u1ee9ng gi\u1ea3 d\u01b0\u1ee3c c\u1ee7a c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh cho th\u1ea5y t\u0103ng nguy c\u01a1 c\u00f3 \u00fd \u0111\u1ecbnh t\u1ef1 t\u1eed hay h\u00e0nh vi t\u1ef1 t\u1eed (0,43% \u1edf c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh so v\u1edbi 0,24% gi\u1ea3 d\u01b0\u1ee3c). C\u01a1 ch\u1ebf c\u1ee7a nguy c\u01a1 n\u00e0y kh\u00f4ng bi\u1ebft r\u00f5.<\/p>\n<p>Trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng m\u00f9 \u0111\u00f4i, c\u00e1c bi\u1ebfn c\u1ed1 li\u00ean quan \u0111\u1ebfn t\u1ef1 t\u1eed (\u00fd \u0111\u1ecbnh t\u1ef1 t\u1eed, c\u00f3 c\u1ed1 g\u1eafng t\u1ef1 t\u1eed, v\u00e0 t\u1ef1 t\u1eed) x\u1ea3y ra v\u1edbi t\u1ea7n su\u1ea5t 0,5% b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb v\u1edbi topiramat (46 trong s\u1ed1 8652 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb) so v\u1edbi 0,2% \u0111i\u1ec1u tr\u1ecb v\u1edbi gi\u1ea3 d\u01b0\u1ee3c (8 trong s\u1ed1 4045 b\u1ec7nh nh\u00e2n). M\u1ed9t tr\u01b0\u1eddng h\u1ee3p t\u1ef1 t\u1eed \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong m\u1ed9t th\u1eed nghi\u1ec7m m\u00f9 \u0111\u00f4i \u1edf b\u1ec7nh nh\u00e2n b\u1ecb r\u1ed1i lo\u1ea1n l\u01b0\u1ee1ng c\u1ef1c d\u00f9ng topiramat.<\/p>\n<p>V\u00ec v\u1eady b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a \u00fd \u0111\u1ecbnh v\u00e0 h\u00e0nh vi t\u1ef1 t\u1eed v\u00e0 n\u00ean c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb m\u1ed9t c\u00e1ch th\u00edch h\u1ee3p. N\u00ean khuy\u00ean b\u1ec7nh nh\u00e2n (v\u00e0 ng\u01b0\u1eddi nh\u00e0 b\u1ec7nh nh\u00e2n khi c\u1ea7n thi\u1ebft) c\u1ea7n c\u00f3 t\u01b0 v\u1ea5n y khoa ngay l\u1eadp t\u1ee9c khi c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a \u00fd \u0111\u1ecbnh v\u00e0 h\u00e0nh vi t\u1ef1 t\u1eed.<\/p>\n<p><em>S\u1ecfi th\u1eadn<\/em><\/p>\n<p>M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 kh\u1ea3 n\u0103ng b\u1ecb s\u1ecfi th\u1eadn, c\u00f3 th\u1ec3 t\u0103ng nguy c\u01a1 h\u00ecnh th\u00e0nh s\u1ecfi th\u1eadn v\u00e0 b\u1ecb c\u00e1c tri\u1ec7u ch\u1ee9ng, d\u1ea5u hi\u1ec7u li\u00ean quan, nh\u01b0 l\u00e0 c\u01a1n \u0111au qu\u1eb7n th\u1eadn, \u0111au v\u00f9ng th\u1eadn, ho\u1eb7c \u0111au b\u00ean h\u00f4ng.<\/p>\n<p>C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 cho b\u1ec7nh s\u1ecfi th\u1eadn g\u1ed3m: h\u00ecnh th\u00e0nh s\u1ecfi tr\u01b0\u1edbc \u0111\u00f3, ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 b\u1ec7nh s\u1ecfi th\u1eadn v\u00e0 t\u0103ng calci ni\u1ec7u. C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 n\u00e0y kh\u00f4ng th\u1ec3 d\u1ef1 \u0111o\u00e1n m\u1ed9t c\u00e1ch \u0111\u00e1ng tin c\u1eady vi\u1ec7c h\u00ecnh th\u00e0nh s\u1ecfi trong khi \u0111i\u1ec1u tr\u1ecb topiramat. H\u01a1n n\u1eefa, b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng thu\u1ed1c kh\u00e1c c\u00f3 th\u1ec3 g\u00e2y s\u1ecfi th\u1eadn th\u00ec nguy c\u01a1 c\u00f3 th\u1ec3 t\u0103ng.<\/p>\n<p><em>Suy gan<\/em><\/p>\n<p>\u1ede ng\u01b0\u1eddi suy gan, topiramat n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng th\u1eadn tr\u1ecdng, v\u00ec \u0111\u1ed9 thanh th\u1ea3i c\u1ee7a topiramat c\u00f3 th\u1ec3 b\u1ecb gi\u1ea3m.<\/p>\n<p><em>C\u1eadn th\u1ecb c\u1ea5p v\u00e0 Gl\u00f4c\u00f4m g\u00f3c \u0111\u00f3ng th\u1ee9 ph\u00e1t<\/em><\/p>\n<p>M\u1ed9t h\u1ed9i ch\u1ee9ng bao g\u1ed3m c\u1eadn th\u1ecb c\u1ea5p v\u1edbi Gl\u00f4c\u00f4m g\u00f3c \u0111\u00f3ng th\u1ee9 ph\u00e1t \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf b\u1ec7nh nh\u00e2n u\u1ed1ng Topiramate. C\u00e1c tri\u1ec7u ch\u1ee9ng bao g\u1ed3m c\u01a1n gi\u1ea3m th\u1ecb l\u1ef1c c\u1ea5p k\u1ecbch ph\u00e1t v\u00e0\/ho\u1eb7c \u0111au m\u1eaft. C\u00e1c bi\u1ec3u hi\u1ec7n khi kh\u00e1m m\u1eaft bao g\u1ed3m: c\u1eadn th\u1ecb, ti\u1ec1n ph\u00f2ng n\u00f4ng, xung huy\u1ebft m\u1eaft (\u0111\u1ecf m\u1eaft) v\u00e0 t\u0103ng \u00e1p l\u1ef1c n\u1ed9i nh\u00e3n. C\u00f3 th\u1ec3 c\u00f3 ho\u1eb7c kh\u00f4ng gi\u00e3n \u0111\u1ed3ng t\u1eed. H\u1ed9i ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec1 li\u00ean quan v\u1edbi tr\u00e0n d\u1ecbch tr\u00ean mi d\u1eabn \u0111\u1ebfn chi\u1ebfm ch\u1ed7 ph\u00eda tr\u01b0\u1edbc th\u1ee7y tinh th\u1ec3 v\u00e0 m\u1ed1ng m\u1eaft v\u1edbi Gl\u00f4c\u00f4m g\u00f3c \u0111\u00f3ng th\u1ee9 ph\u00e1t. C\u00e1c tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh th\u01b0\u1eddng x\u1ea3y ra trong v\u00f2ng 1 th\u00e1ng \u0111\u1ea7u d\u00f9ng Topiramate. Tr\u00e1i v\u1edbi Gl\u00f4c\u00f4m g\u00f3c h\u1eb9p nguy\u00ean ph\u00e1t r\u1ea5t hi\u1ebfm g\u1eb7p \u1edf ng\u01b0\u1eddi d\u01b0\u1edbi 40 tu\u1ed5i, Gl\u00f4c\u00f4m g\u00f3c \u0111\u00f3ng th\u1ee9 ph\u00e1t li\u00ean quan t\u1edbi topiramat g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n nhi c\u0169ng nh\u01b0 \u1edf ng\u01b0\u1eddi l\u1edbn. \u0110i\u1ec1u tr\u1ecb bao g\u1ed3m ng\u1eebng Topiramate c\u00e0ng nhanh c\u00e0ng t\u1ed1t theo quy\u1ebft \u0111\u1ecbnh c\u1ee7a b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb v\u00e0 h\u1ea1 nh\u00e3n \u00e1p b\u1eb1ng c\u00e1c bi\u1ec7n ph\u00e1p th\u00edch h\u1ee3p. Nh\u1eefng bi\u1ec7n ph\u00e1p n\u00e0y th\u01b0\u1eddng gi\u00fap h\u1ea1 nh\u00e3n \u00e1p.<\/p>\n<p>T\u0103ng nh\u00e3n \u00e1p do b\u1ea5t k\u1ef3 nguy\u00ean nh\u00e2n n\u00e0o, n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u1ec1u c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn di ch\u1ee9ng nghi\u00eam tr\u1ecdng bao g\u1ed3m m\u1ea5t th\u1ecb l\u1ef1c v\u0129nh vi\u1ec5n.<\/p>\n<p><em>C\u00e1c khi\u1ebfm khuy\u1ebft th\u1ecb gi\u00e1c<\/em><\/p>\n<p>C\u00e1c khi\u1ebfm khuy\u1ebft th\u1ecb gi\u00e1c m\u00e0 kh\u00f4ng li\u00ean quan t\u1edbi t\u0103ng nh\u00e3n \u00e1p \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng topiramat. Trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng, h\u1ea7u h\u1ebft c\u00e1c bi\u1ebfn c\u1ed1 n\u00e0y \u0111\u00e3 c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c sau khi ng\u01b0ng d\u00f9ng topiramat. N\u1ebfu v\u1ea5n \u0111\u1ec1 v\u1ec1 th\u1ecb gi\u00e1c x\u1ea3y ra b\u1ea5t c\u1ee9 th\u1eddi \u0111i\u1ec3m n\u00e0o trong su\u1ed1t qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng topiramat, n\u00ean xem x\u00e9t \u0111\u1ec3 ng\u1eebng d\u00f9ng thu\u1ed1c.<\/p>\n<p><em>Toan chuy\u1ec3n h\u00f3a<\/em><\/p>\n<p>T\u0103ng clo trong m\u00e1u, kh\u00f4ng c\u00f3 kho\u1ea3ng tr\u1ed1ng anion, toan chuy\u1ec3n h\u00f3a (v\u00ed d\u1ee5: gi\u1ea3m bicarbonat huy\u1ebft t\u01b0\u01a1ng d\u01b0\u1edbi m\u1ee9c gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng m\u00e0 kh\u00f4ng c\u00f3 ki\u1ec1m h\u00f4 h\u1ea5p) c\u00f3 li\u00ean quan v\u1edbi vi\u1ec7c \u0111i\u1ec1u tr\u1ecb v\u1edbi topiramat. Gi\u1ea3m bicarbonat huy\u1ebft t\u01b0\u01a1ng l\u00e0 do hi\u1ec7u qu\u1ea3 \u1ee9c ch\u1ebf c\u1ee7a topiramat tr\u00ean men carbonic anhydrase th\u1eadn. Nh\u00ecn chung t\u00ecnh tr\u1ea1ng gi\u1ea3m bicarbonat n\u00e0y x\u1ea3y ra \u1edf giai \u0111o\u1ea1n s\u1edbm c\u1ee7a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb m\u1eb7c d\u00f9 n\u00f3 v\u1eabn c\u00f3 th\u1ec3 x\u1ea3y ra t\u1ea1i b\u1ea5t k\u1ef3 th\u1eddi \u0111i\u1ec3m n\u00e0o trong khi \u0111i\u1ec1u tr\u1ecb. M\u1ee9c \u0111\u1ed9 gi\u1ea3m th\u01b0\u1eddng t\u1eeb nh\u1eb9 t\u1edbi trung b\u00ecnh (gi\u1ea3m trung b\u00ecnh l\u00e0 4mmol\/L \u1edf li\u1ec1u 100mg\/ng\u00e0y hay nhi\u1ec1u h\u01a1n \u1edf ng\u01b0\u1eddi l\u1edbn v\u00e0 kho\u1ea3ng 6mg\/kg\/ng\u00e0y \u1edf b\u1ec7nh nh\u00e2n nhi). Hi\u1ebfm khi m\u1ee9c \u0111\u1ed9 gi\u1ea3m \u0111\u1ebfn tr\u1ecb s\u1ed1 c\u00f2n d\u01b0\u1edbi 10mmol\/L. C\u00e1c t\u00ecnh tr\u1ea1ng hay vi\u1ec7c tr\u1ecb li\u1ec7u c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nhi\u1ec5m toan (nh\u01b0 l\u00e0 b\u1ec7nh th\u1eadn, r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p n\u1eb7ng, tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh, ti\u00eau ch\u1ea3y, ph\u1eabu thu\u1eadt, ch\u1ebf \u0111\u1ed9 \u0103n sinh ketone, ho\u1eb7c s\u1eed d\u1ee5ng m\u1ecdt s\u1ed1 thu\u1ed1c nh\u1ea5t \u0111\u1ecbnh) c\u00f3 th\u1ec3 l\u00e0m t\u0103ng th\u00eam t\u00e1c \u0111\u1ed9ng gi\u1ea3m bicarbonat c\u1ee7a topiramat.<\/p>\n<p>Toan chuy\u1ec3n h\u00f3a m\u1ea1n t\u00ednh \u1edf b\u1ec7nh nh\u00e2n nhi c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u1ed1c \u0111\u1ed9 ph\u00e1t tri\u1ec3n. \u1ea2nh h\u01b0\u1edfng c\u1ee7a topiramat l\u00ean s\u1ef1 t\u0103ng tr\u01b0\u1edfng v\u00e0 nh\u1eefng d\u1ecb t\u1eadt li\u00ean quan \u0111\u1ebfn x\u01b0\u01a1ng ch\u01b0a \u0111\u01b0\u1ee3c ki\u1ec3m tra m\u1ed9t c\u00e1ch h\u1ec7 th\u1ed1ng \u1edf b\u1ec7nh nh\u00e2n nhi ho\u1eb7c ng\u01b0\u1eddi l\u1edbn.<\/p>\n<p>Ph\u1ee5 thu\u1ed9c v\u00e0o t\u1eebng ho\u00e0n c\u1ea3nh m\u00e0 c\u00e1c \u0111\u00e1nh gi\u00e1 th\u00edch h\u1ee3p bao g\u1ed3m c\u1ea3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 bicarbonat huy\u1ebft thanh \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o khi \u0111i\u1ec1u tr\u1ecb v\u1edbi topiramat. N\u1ebfu toan chuy\u1ec3n h\u00f3a xu\u1ea5t hi\u1ec7n v\u00e0 k\u00e9o d\u00e0i, c\u00e2n nh\u1eafc gi\u1ea3m li\u1ec1u ho\u1eb7c c\u00f3 th\u1ec3 ng\u1eebng s\u1eed d\u1ee5ng topiramat (ng\u01b0ng li\u1ec1u gi\u1ea3m d\u1ea7n).<\/p>\n<p><em>B\u1ed5 sung ch\u1ea5t dinh d\u01b0\u1ee1ng<\/em><\/p>\n<p>C\u00f3 th\u1ec3 xem x\u00e9t vi\u1ec7c cung c\u1ea5p th\u1ef1c ph\u1ea9m b\u1ed5 sung ho\u1eb7c t\u0103ng ch\u1ebf \u0111\u1ed9 \u0103n, n\u1ebfu b\u1ec7nh nh\u00e2n gi\u1ea3m c\u00e2n trong khi d\u00f9ng thu\u1ed1c n\u00e0y.<\/p>\n<p><em>Suy gi\u1ea3m nh\u1eadn th\u1ee9c<\/em><\/p>\n<p>Suy gi\u1ea3m nh\u1eadn th\u1ee9c trong b\u1ec7nh \u0111\u1ed9ng kinh l\u00e0 do nhi\u1ec1u y\u1ebfu t\u1ed1, c\u00f3 th\u1ec3 do b\u1ec7nh l\u00fd n\u1ec1n, do b\u1ec7nh \u0111\u1ed9ng kinh ho\u1eb7c do \u0111i\u1ec1u tr\u1ecb \u0111\u1ed9ng kinh. \u0110\u00e3 c\u00f3 nh\u1eefng b\u00e1o c\u00e1o trong y v\u0103n v\u1ec1 suy gi\u1ea3m ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c \u1edf ng\u01b0\u1eddi l\u1edbn khi \u0111i\u1ec1u tr\u1ecb v\u1edbi topiramat m\u00e0 \u0111\u00e3 ph\u1ea3i y\u00eau c\u1ea7u gi\u1ea3m li\u1ec1u ho\u1eb7c ng\u1eebng \u0111i\u1ec1u tr\u1ecb. Tuy nhi\u00ean, nh\u1eefng nghi\u00ean c\u1ee9u v\u1ec1 t\u00e1c \u0111\u1ed9ng l\u00ean nh\u1eadn th\u1ee9c \u1edf tr\u1ebb em \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi topiramat l\u00e0 ch\u01b0a \u0111\u1ea7y \u0111\u1ee7 v\u00e0 \u1ea3nh h\u01b0\u1edfng c\u1ee7a n\u00f3 c\u1ea7n \u0111\u01b0\u1ee3c l\u00e0m s\u00e1ng t\u1ecf.<\/p>\n<p><em>T\u0103ng ammoniac huy\u1ebft v\u00e0 b\u1ec7nh n\u00e3o<\/em><\/p>\n<p>T\u0103ng ammoniac huy\u1ebft c\u00f3 hay kh\u00f4ng c\u00f3 li\u00ean quan \u0111\u1ebfn b\u1ec7nh n\u00e3o \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o khi \u0111i\u1ec1u tr\u1ecb v\u1edbi topiramat. Nguy c\u01a1 t\u0103ng ammoniac huy\u1ebft khi d\u00f9ng topiramat x\u1ea3y ra li\u00ean quan \u0111\u1ebfn li\u1ec1u.<\/p>\n<p>T\u0103ng ammoniac huy\u1ebft \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o th\u01b0\u1eddng xuy\u00ean h\u01a1n khi d\u00f9ng \u0111\u1ed3ng th\u1eddi topiramat v\u1edbi acid valproic.<\/p>\n<p>C\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh n\u00e3o do t\u0103ng ammoniac huy\u1ebft g\u1ed3m c\u00e1c thay \u0111\u1ed5i c\u1ea5p t\u00ednh m\u1ee9c \u0111\u1ed9 t\u1ec9nh t\u00e1o v\u00e0\/ho\u1eb7c ch\u1ee9c n\u0103ng nh\u1ea1n th\u1ee9c v\u1edbi bi\u1ec3u hi\u1ec7n l\u00e0 t\u00ecnh tr\u1ea1ng h\u00f4n m\u00ea. Trong \u0111a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p, b\u1ec7nh n\u00e3o do t\u0103ng ammoniac huy\u1ebft gi\u1ea3m khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb. C\u00e1c b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n tr\u1ea1ng th\u00e1i h\u00f4n m\u00ea kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n, ho\u1eb7c nh\u1eefng thay \u0111\u1ed5i tr\u1ea1ng th\u00e1i t\u00e2m th\u1ea7n do \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p ho\u1eb7c \u0111\u01a1n tr\u1ecb li\u1ec7u v\u1edbi topiramat, n\u00ean ngh\u0129 \u0111\u1ebfn b\u1ec7nh n\u00e3o do t\u0103ng ammoniac huy\u1ebft v\u00e0 \u0111o n\u1ed3ng \u0111\u1ed9 ammoniac.<\/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>Topiramate g\u00e2y \u1ea3nh h\u01b0\u1edfng nh\u1eb9 ho\u1eb7c trung b\u00ecnh l\u00ean kh\u1ea3 n\u0103ng l\u00e1i xe v\u00e0 v\u1eadn h\u00e0nh m\u00e1y m\u00f3c. Topiramate t\u00e1c \u0111\u1ed9ng tr\u00ean h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, c\u00f3 th\u1ec3 g\u00e2y bu\u1ed3n ng\u1ee7, ch\u00f3ng m\u1eb7t ho\u1eb7c c\u00e1c tri\u1ec7u ch\u1ee9ng li\u00ean quan kh\u00e1c. N\u00f3 c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c r\u1ed1i lo\u1ea1n th\u1ecb gi\u00e1c v\u00e0\/ho\u1eb7c nh\u00ecn m\u1edd. Nh\u1eefng t\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i n\u00e0y c\u00f3 th\u1ec3 g\u00e2y nguy hi\u1ec3m cho ng\u01b0\u1eddi b\u1ec7nh khi l\u00e1i xe hay v\u1eadn h\u00e0nh m\u00e1y m\u00f3c, \u0111\u1eb7c bi\u1ec7t cho \u0111\u1ebfn khi kinh nghi\u1ec7m d\u00f9ng thu\u1ed1c tr\u00ean t\u1eebng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp.<\/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>Topiramat g\u00e2y qu\u00e1i thai \u1edf chu\u1ed9t nh\u1eaft, chu\u1ed9t c\u1ed1ng v\u00e0 th\u1ecf. \u1ede chu\u1ed9t c\u1ed1ng, topiramat qua \u0111\u01b0\u1ee3c h\u00e0ng r\u00e0o nhau thai.<\/p>\n<p>Khuy\u1ebfn c\u00e1o ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i sinh s\u1ea3n n\u00ean s\u1eed d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p tr\u00e1nh thai ph\u00f9 h\u1ee3p v\u00e0 l\u1ef1a ch\u1ecdn c\u00e1c li\u1ec7u ph\u00e1p thay th\u1ebf.<\/p>\n<p>Ch\u1ec9 \u0111\u1ecbnh \u0111\u1ed9ng kinh : Trong th\u1eddi k\u1ef3 mang thai, topiramat n\u00ean \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n sau khi th\u00f4ng b\u00e1o \u0111\u1ea7y \u0111\u1ee7 cho ng\u01b0\u1eddi m\u1eb9 v\u1ec1 nguy c\u01a1 c\u1ee7a ch\u1ee9ng \u0111\u1ed9ng kinh kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u1ed1i v\u1edbi ph\u1ee5 n\u1eef mang thai v\u00e0 nguy c\u01a1 ti\u1ec1m t\u00e0ng v\u1edbi b\u00e0o thai do thu\u1ed1c.<\/p>\n<p>Ch\u1ec9 \u0111\u1ecbnh d\u1ef1 ph\u00f2ng \u0111au n\u1eeda \u0111\u1ea7u: Topiramat ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i sinh s\u1ea3n n\u1ebfu kh\u00f4ng s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p tr\u00e1nh thai hi\u1ec7u qu\u1ea3.<\/p>\n<p><em>Th\u1eddi k\u1ef3 cho con b\u00fa:<\/em><\/p>\n<p>Nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed9ng v\u1eadt \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng topiramat \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft trong s\u1eefa. V\u00ec nhi\u1ec1u thu\u1ed1c \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft qua s\u1eefa m\u1eb9, n\u00ean c\u1ea7n quy\u1ebft \u0111\u1ecbnh l\u00e0 ng\u1eebng\/tr\u00e1nh d\u00f9ng topiramat hay ng\u1eebng cho con b\u00fa, tu\u1ef3 theo t\u1ea7m quan tr\u1ecdng c\u1ee7a thu\u1ed1c \u0111\u1ed1i v\u1edbi ng\u01b0\u01a1i m\u1eb9.<\/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 ph\u1ee5 c\u00f3 th\u1ec3 x\u1ea3y ra: t\u00ea, r\u00e1t hay ng\u1ee9a ran \u1edf b\u00e0n tay ho\u1eb7c b\u00e0n ch\u00e2n; ph\u1ea3n \u1ee9ng ch\u1eadm l\u1ea1i; kh\u00f3 t\u1eadp trung; v\u1ea5n \u0111\u1ec1 n\u00f3i n\u0103ng; v\u1ea5n \u0111\u1ec1 b\u1ed9 nh\u1edb; thi\u1ebfu s\u1ef1 ph\u1ed1i h\u1ee3p; nh\u1ea7m l\u1eabn; c\u0103ng th\u1eb3ng; h\u00e0nh vi hung h\u0103ng; c\u00e1u g\u1eaft; t\u00e2m tr\u1ea1ng l\u00e2ng l\u00e2ng; tr\u1ea7m c\u1ea3m; \u0111au \u0111\u1ea7u; bu\u1ed3n ng\u1ee7; y\u1ebfu \u0111u\u1ed1i; l\u1eafc kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c c\u1ee7a m\u1ed9t ph\u1ea7n c\u1ee7a c\u01a1 th\u1ec3; c\u1eed \u0111\u1ed9ng m\u1eaft kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c; kh\u00e1t li\u00ean t\u1ee5c; gi\u1ea3m c\u00e2n; t\u00e1o b\u00f3n; ti\u00eau ch\u1ea3y; \u0111\u1ea7y h\u01a1i; \u1ee3 n\u00f3ng; s\u01b0ng l\u01b0\u1ee1i; ph\u00e1t tri\u1ec3n qu\u00e1 m\u1ee9c c\u1ee7a n\u01b0\u1edbu; kh\u00f4 mi\u1ec7ng; t\u0103ng ti\u1ebft n\u01b0\u1edbc b\u1ecdt; kh\u00f3 nu\u1ed1t; ch\u1ea3y m\u00e1u m\u0169i; \u0111\u00f4i m\u1eaft \u0111\u1ea7y n\u01b0\u1edbc ho\u1eb7c kh\u00f4; \u0111au l\u01b0ng, c\u01a1 b\u1eafp, \u0111au x\u01b0\u01a1ng; m\u1ea5t kinh; ch\u1ea3y m\u00e1u kinh nhi\u1ec1u; v\u1ea5n \u0111\u1ec1 v\u1ec1 da ho\u1eb7c thay \u0111\u1ed5i m\u00e0u s\u1eafc da; g\u00e0u; r\u1ee5ng t\u00f3c; t\u0103ng tr\u01b0\u1edfng c\u1ee7a l\u00f4ng \u1edf nh\u1eefng n\u01a1i kh\u00e1c th\u01b0\u1eddng; \u00f9 tai; kh\u00f3 kh\u0103n \u0111\u1ec3 ng\u1ee7 ho\u1eb7c duy tr\u00ec gi\u1ea5c ng\u1ee7; s\u01b0ng b\u00e0n tay, c\u00e1nh tay, b\u00e0n ch\u00e2n, m\u1eaft c\u00e1 ch\u00e2n, ho\u1eb7c c\u1eb3ng ch\u00e2n; kh\u00f3 \u0111i ti\u1ec3u ho\u1eb7c \u0111au khi \u0111i ti\u1ec3u<\/p>\n<p>M\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng ph\u1ee5 c\u00f3 th\u1ec3 nghi\u00eam tr\u1ecdng. N\u1ebfu b\u1ea1n g\u1eb7p b\u1ea5t k\u1ef3 tri\u1ec7u ch\u1ee9ng n\u00e0o sau \u0111\u00e2y, h\u00e3y t\u00ecm ki\u1ebfm s\u1ef1 h\u1ed7 tr\u1ef1 y t\u1ebf ngay l\u1eadp t\u1ee9c: m\u1edd m\u1eaft; nh\u00ecn \u0111\u00f4i; \u0111au m\u1eaft; c\u00e1c c\u01a1n \u0111\u1ed9ng kinh n\u1eb7ng h\u01a1n; nh\u1ecbp tim ch\u1eadm ho\u1eb7c kh\u00f4ng \u0111\u1ec1u; t\u1ee9c ng\u01b0\u0323c; kh\u00f3 th\u1edf; th\u1edf nhanh, th\u1edf n\u00f4ng; m\u1ec7t m\u1ecfi qu\u00e1 m\u1ee9c; bu\u1ed3n n\u00f4n; n\u00f4n; \u0111au b\u1ee5ng; \u0103n m\u1ea5t ngon; \u0111au l\u01b0ng d\u1eef d\u1ed9i; n\u01b0\u1edbc ti\u1ec3u c\u00f3 m\u00e1u, \u0111\u1ee5c m\u00e0u ho\u1eb7c c\u00f3 m\u00f9i h\u00f4i; \u0111i ti\u1ec3u th\u01b0\u1eddng xuy\u00ean; s\u1ed1t; \u1edbn l\u1ea1nh.<\/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<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<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=\"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><em>T\u00e1c \u0111\u1ed9ng c\u1ee7a Topiramate v\u1edbi c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh kh\u00e1c<\/em><\/p>\n<p>Vi\u1ec7c ph\u1ed1i h\u1ee3p th\u00eam Topiramate khi \u0111ang \u0111i\u1ec1u tr\u1ecb v\u1edbi c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh kh\u00e1c (phentoin, carbamazepin, acid valproic, phenobarbital, primidon) kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 \u0111\u1ea1t tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh trong huy\u1ebft t\u01b0\u01a1ng c\u1ee7a c\u00e1c thu\u1ed1c n\u00e0y, ngo\u1ea1i tr\u1eeb \u1edf v\u00e0i b\u1ec7nh nh\u00e2n, vi\u1ec7c ph\u1ed1i h\u1ee3p th\u00eam Topiramate khi \u0111ang \u0111i\u1ec1u tr\u1ecb v\u1edbi phenytoin c\u00f3 th\u1ec3 l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 c\u1ee7a phenytoin trong huy\u1ebft t\u01b0\u01a1ng. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 l\u00e0 do s\u1ef1 \u1ee9c ch\u1ebf c\u1ee7a m\u1ed9t enzym \u0111\u1eb7c hi\u1ec7u d\u1ea1ng \u0111\u1ed3ng ph\u00e2n \u0111a h\u00ecnh (CYP2C19). V\u00ec v\u1eady, b\u1ea5t c\u1ee9 ng\u01b0\u1eddi b\u1ec7nh n\u00e0o \u0111ang d\u00f9ng phenytoin c\u00f3 nh\u1eefng d\u1ea5u hi\u1ec7u ho\u1eb7c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a \u0111\u1ed9c t\u00ednh thu\u1ed1c, th\u00ec n\u00ean ki\u1ec3m tra n\u1ed3ng \u0111\u1ed9 c\u1ee7a phenytoin.<\/p>\n<p><em>T\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh kh\u00e1c tr\u00ean Topiramate<\/em><\/p>\n<p>Phenytoin v\u00e0 carbamazepin l\u00e0m gi\u1ea3m n\u1ed3ng \u0111\u1ed9 huy\u1ebft t\u01b0\u01a1ng c\u1ee7a Topiramate. Khi ph\u1ed1i h\u1ee3p th\u00eam ho\u1eb7c ng\u1eebng phenytoin hay carbamazepin trong khi \u0111ang \u0111i\u1ec1u tr\u1ecb v\u1edbi Topiramate c\u00f3 th\u1ec3 c\u1ea7n ch\u1ec9nh li\u1ec1u d\u00f9ng c\u1ee7a Topiramate. Vi\u1ec7c ch\u1ec9nh li\u1ec1u n\u00e0y n\u00ean ti\u1ebfn h\u00e0nh d\u1ef1a v\u00e0o hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng. D\u00f9ng th\u00eam ho\u1eb7c ng\u1eebng acid valproic kh\u00f4ng l\u00e0m thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3 v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng c\u1ee7a Topiramate v\u00e0 do d\u00f3, kh\u00f4ng c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u d\u00f9ng c\u1ee7a Topiramate.<\/p>\n<p><em>C\u00e1c t\u01b0\u01a1ng t\u00e1c thu\u1ed1c kh\u00e1c<\/em><\/p>\n<p><em>Digoxin<\/em><\/p>\n<p>Trong nghi\u00ean c\u1ee9u \u0111\u01a1n li\u1ec1u, di\u1ec7n t\u00edch d\u01b0\u1edbi \u0111\u01b0\u1eddng cong (AUC) c\u1ee7a n\u1ed3ng \u0111\u1ed9 digoxin trong huy\u1ebft thanh gi\u1ea3m 12% khi d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi Topiramate. T\u01b0\u01a1ng quan v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng c\u1ee7a quan s\u00e1t n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp. Khi Topiramate \u0111\u01b0\u1ee3c ph\u1ed1i h\u1ee3p th\u00eam v\u00e0o hay ng\u1eebng d\u00f9ng \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh \u0111ang \u0111i\u1ec1u tr\u1ecb v\u1edbi digoxin, c\u1ea7n ch\u00fa \u00fd ki\u1ec3m tra th\u01b0\u1eddng k\u1ef3 digoxin trong huy\u1ebft thanh.<\/p>\n<p><em>C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng<\/em><\/p>\n<p>Vi\u1ec7c d\u00f9ng chung Topiramate v\u1edbi r\u01b0\u1ee3u ho\u1eb7c c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng kh\u00e1c ch\u01b0a \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trong c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng, v\u00ec v\u1eady khuy\u1ebfn c\u00e1o Topiramate kh\u00f4ng d\u00f9ng chung v\u1edbi r\u01b0\u1ee3u ho\u1eb7c c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng kh\u00e1c.<\/p>\n<p><em>C\u00e1c thu\u1ed1c tr\u00e1nh thai \u0111\u01b0\u1eddng u\u1ed1ng<\/em><\/p>\n<p>Trong nghi\u00ean c\u1ee9u t\u01b0\u01a1ng t\u00e1c d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u1edf nh\u1eefng ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n kho\u1ebb m\u1ea1nh \u0111ang s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c thu\u1ed1c tr\u00e1nh thai \u0111\u01b0\u1eddng u\u1ed1ng d\u1ea1ng k\u1ebft h\u1ee3p ch\u1ee9a 1mg norethindron (NET) v\u00e0 35mcg ethinyl estradiol (EE), Topiramate \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u01a1n thu\u1ea7n v\u1edbi li\u1ec1u 50 &#8211; 200mg\/ng\u00e0y kh\u00f4ng l\u00e0m thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3 c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea trong ph\u01a1i nhi\u1ec5m trung b\u00ecnh (AUC) c\u1ee7a c\u00e1c th\u00e0nh ph\u1ea7n c\u00f3 trong thu\u1ed1c ng\u1eeba thai u\u1ed1ng. Trong 1 nghi\u00ean c\u1ee9u kh\u00e1c, ph\u01a1i nhi\u1ec5m v\u1edbi EE gi\u1ea3m c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea \u1edf li\u1ec1u 200, 400 v\u00e0 800mg\/ng\u00e0y (t\u01b0\u01a1ng \u1ee9ng l\u00e0 18%, 21% v\u00e0 30%) khi s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang u\u1ed1ng acid valproic, \u1edf c\u1ea3 2 nghi\u00ean c\u1ee9u, Topiramate (50mg\/ng\u00e0y \u0111\u1ebfn 800mg\/ng\u00e0y) kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 l\u00ean ph\u01a1i nhi\u1ec5m v\u1edbi NET. M\u1eb7c d\u00f9 trong kho\u1ea3ng li\u1ec1u Topiramate t\u1eeb 200 &#8211; 800mg\/ng\u00e0y, ph\u01a1i nhi\u1ec5m EE c\u00f3 s\u1ef1 suy gi\u1ea3m ph\u1ee5 thu\u1ed9c li\u1ec1u, nh\u01b0ng trong kho\u1ea3ng li\u1ec1u Topiramate t\u1eeb 50 &#8211; 200mg\/ng\u00e0y, ph\u01a1i nhi\u1ec5m EE kh\u00f4ng b\u1ecb thay \u0111\u1ed5i ph\u1ee5 thu\u1ed9c li\u1ec1u \u0111\u00e1ng k\u1ec3. Ch\u01b0a quan s\u00e1t th\u1ea5y \u00fd ngh\u0129a l\u00e2m s\u00e0ng c\u1ee7a nh\u1eefng thay \u0111\u1ed5i n\u00e0y. Kh\u1ea3 n\u0103ng l\u00e0m gi\u1ea3m hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c tr\u00e1nh thai \u0111\u01b0\u1eddng u\u1ed1ng v\u00e0 t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft \u0111\u1ed9t xu\u1ea5t n\u00ean \u0111\u01b0\u1ee3c ch\u00fa \u00fd \u1edf b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng thu\u1ed1c tr\u00e1nh thai \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u1ed3ng th\u1eddi v\u1edbi Topiramate. B\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng thu\u1ed1c tr\u00e1nh thai c\u00f3 ch\u1ee9a estrogen n\u00ean \u0111\u01b0\u1ee3c d\u1eb7n d\u00f2 v\u1ec1 vi\u1ec7c b\u00e1o c\u00e1o b\u1ea5t k\u1ef3 s\u1ef1 thay \u0111\u1ed5i n\u00e0o trong v\u1ea5n \u0111\u1ec1 xu\u1ea5t huy\u1ebft c\u1ee7a h\u1ecd. Hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c tr\u00e1nh thai c\u00f3 th\u1ec3 gi\u1ea3m th\u1eadm ch\u00ed khi kh\u00f4ng c\u00f3 xu\u1ea5t huy\u1ebft.<\/p>\n<p><em>Lithium<\/em><\/p>\n<p>Tr\u00ean ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n kh\u1ecfe m\u1ea1nh, quan s\u00e1t th\u1ea5y c\u00f3 s\u1ef1 gi\u1ea3m ph\u01a1i nhi\u1ec5m h\u1ec7 th\u1ed1ng v\u1edbi lithium (18% di\u1ec7n t\u00edch d\u01b0\u1edbi \u0111\u01b0\u1eddng cong n\u1ed3ng \u0111\u1ed9 huy\u1ebft thanh &#8211; AUC), khi d\u00f9ng c\u00f9ng topiramat 200mg\/ng\u00e0y. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb r\u1ed1i lo\u1ea1n l\u01b0\u1ee1ng c\u1ef1c, d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a lithium kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng trong th\u1eddi gian \u0111i\u1ec1u tr\u1ecb v\u1edbi topiramat 200mg\/ng\u00e0y; tuy nhi\u00ean, sau khi d\u00f9ng topiramat t\u1edbi m\u1ee9c 600mg\/ng\u00e0y th\u00ec c\u00f3 t\u0103ng ph\u01a1i nhi\u1ec5m h\u1ec7 th\u1ed1ng (26% AUC). Khi d\u00f9ng chung v\u1edbi topiramat, c\u1ea7n ph\u1ea3i theo d\u00f5i n\u1ed3ng \u0111\u1ed9 lithium.<\/p>\n<p><em>Risperidon<\/em><\/p>\n<p>C\u00e1c nghi\u00ean c\u1ee9u t\u01b0\u01a1ng t\u00e1c gi\u1eefa thu\u1ed1c &#8211; thu\u1ed1c tr\u00ean ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n kh\u1ecfe m\u1ea1nh v\u00e0 ng\u01b0\u1eddi b\u1ec7nh b\u1ecb r\u1ed1i lo\u1ea1n l\u01b0\u1ee1ng c\u1ef1c, trong \u0111i\u1ec1u ki\u1ec7n d\u00f9ng \u0111\u01a1n li\u1ec1u, v\u00e0 \u0111a li\u1ec1u, cho k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 nhau. Khi d\u00f9ng chung v\u1edbi topiramat, \u1edf nh\u1eefng li\u1ec1u topiramat t\u0103ng t\u1eebng n\u1ea5c l\u00e0 100, 250 v\u00e0 400mg\/ng\u00e0y, th\u00ec th\u1ea5y c\u00f3 gi\u1ea3m ph\u01a1i nhi\u1ec5m h\u1ec7 th\u1ed1ng (16% v\u00e0 33% AUC \u1edf tr\u1ea1ng th\u00e1i h\u1eb1ng \u0111\u1ecbnh, v\u1edbi c\u00e1c li\u1ec1u l\u1ea7n l\u01b0\u1ee3t l\u00e0 250 v\u00e0 400mg\/ng\u00e0y) c\u1ee7a risperidon (li\u1ec1u t\u1eeb 1 \u0111\u1ebfn 6mg\/ng\u00e0y). C\u00f3 thay \u0111\u1ed5i r\u1ea5t \u00edt v\u1ec1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a to\u00e0n b\u1ed9 ph\u1ea7n b\u00e1n ho\u1ea1t t\u00ednh (risperidon v\u00e0 9-hydroxyrisperidon), v\u00e0 kh\u00f4ng thay c\u00f3 thay \u0111\u1ed5i v\u1ec1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a 9-hydroxyrisperidon. Kh\u00f4ng c\u00f3 thay \u0111\u1ed5i c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng trong ph\u01a1i nhi\u1ec5m h\u1ec7 th\u1ed1ng c\u1ee7a to\u00e0n b\u1ed9 ph\u1ea7n b\u00e1n ho\u1ea1t t\u00ednh c\u1ee7a risperidon, hay topiramat, do v\u1eady t\u01b0\u01a1ng t\u00e1c thu\u1ed1c gi\u1eefa hai thu\u1ed1c n\u00e0y kh\u00f4ng c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng.<\/p>\n<p><em>Hydrochlorothiazid (HCTZ)<\/em><\/p>\n<p>M\u1ed9t nghi\u00ean c\u1ee9u v\u1ec1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c &#8211; thu\u1ed1c \u1edf tr\u00ean ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n kh\u1ecfe m\u1ea1nh, nh\u1eb1m \u0111\u00e1nh gi\u00e1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc trong tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh c\u1ee7a HCTZ (li\u1ec1u 25mg m\u1ed7i 24 gi\u1edd) v\u00e0 topiramat (96mg m\u1ed7i 12 gi\u1edd), khi d\u00f9ng \u0111\u01a1n \u0111\u1ed9c, hay k\u1ebft h\u1ee3p v\u1edbi nhau. K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u cho th\u1ea5y C<sub>max<\/sub>\u00a0c\u1ee7a topiramat t\u0103ng 27% v\u00e0 AUC t\u0103ng 29% khi ph\u1ed1i h\u1ee3p th\u00eam v\u1edbi HCTZ. \u00dd ngh\u0129a l\u00e2m s\u00e0ng c\u1ee7a nh\u1eefng thay \u0111\u1ed5i n\u00e0y ch\u01b0a r\u00f5. \u0110i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p HCTZ v\u1edbi topiramat c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i ch\u1ec9nh li\u1ec1u topiramat. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh c\u1ee7a HCTZ kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 b\u1edfi d\u00f9ng \u0111\u1ed3ng th\u1eddi topiramat. K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m l\u00e2m s\u00e0ng cho th\u1ea5y c\u00f3 gi\u1ea3m kali huy\u1ebft thanh sau khi d\u00f9ng topiramat hay HCTZ<sub>,\u00a0<\/sub>m\u1ee9c gi\u1ea3m nhi\u1ec1u h\u01a1n khi hai thu\u1ed1c n\u00e0y d\u00f9ng c\u00f9ng l\u00fac v\u1edbi nhau.<\/p>\n<p><em>Metformin<\/em><\/p>\n<p>M\u1ed9t nghi\u00ean c\u1ee9u t\u01b0\u01a1ng t\u00e1c thu\u1ed1c &#8211; thu\u1ed1c \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n kh\u1ecfe m\u1ea1nh \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u1ec1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh c\u1ee7a metformin v\u00e0 topiramat trong huy\u1ebft t\u01b0\u01a1ng khi d\u00f9ng metformin \u0111\u01a1n \u0111\u1ed9c hay d\u00f9ng \u0111\u1ed3ng th\u1eddi metformin v\u00e0 topiramat. K\u1ebft qu\u1ea3 c\u1ee7a nghi\u00ean c\u1ee9u cho th\u1ea5y C<sub>max<\/sub>\u00a0v\u00e0 AUC\u00a0<sub>0-12h\u00a0<\/sub>trung b\u00ecnh c\u1ee7a metformin t\u0103ng l\u1ea7n l\u01b0\u1ee3t l\u00e0 18% v\u00e0 25%, trong khi gi\u00e1 tr\u1ecb CL\/F trung b\u00ecnh gi\u1ea3m 20% khi metformin \u0111\u1ef1\u1ee3c d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi topiramat. Topiramat kh\u00f4ng \u1ea3nh h\u01b0\u1edfng l\u00ean t<sub>max<\/sub>\u00a0c\u1ee7a metformin. \u00dd ngh\u0129a l\u00e2m s\u00e0ng c\u1ee7a t\u00e1c \u0111\u1ed9ng c\u1ee7a topiramat l\u00ean d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a metformin l\u00e0 ch\u01b0a r\u00f5.<\/p>\n<p>S\u1ef1 thanh th\u1ea3i qua huy\u1ebft t\u01b0\u01a1ng khi u\u1ed1ng topiramat gi\u1ea3m khi d\u00f9ng k\u00e8m v\u1edbi metformin. M\u1ee9c \u0111\u1ed9 thay \u0111\u1ed5i c\u1ee7a s\u1ef1 thanh th\u1ea3i th\u00ec kh\u00f4ng \u0111\u01b0\u1ee3c bi\u1ebft r\u00f5. \u00dd ngh\u0129a l\u00e2m s\u00e0ng c\u1ee7a t\u00e1c \u0111\u1ed9ng c\u1ee7a metformin \u0111\u1ed1i v\u1edbi d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a topiramat th\u00ec kh\u00f4ng r\u00f5. Khi Topiramate \u0111\u01b0\u1ee3c d\u00f9ng ph\u1ed1i h\u1ee3p hay ng\u1eebng \u1edf b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb metformin, ph\u1ea3i \u0111\u1eb7c bi\u1ec7t ch\u00fa \u00fd theo d\u00f5i th\u01b0\u1eddng xuy\u00ean \u0111\u1ec3 ki\u1ec3m so\u00e1t th\u00edch h\u1ee3p t\u00ecnh tr\u1ea1ng b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng.<\/p>\n<p><em>Pioglitazon<\/em><\/p>\n<p>Nghi\u00ean c\u1ee9u t\u01b0\u01a1ng t\u00e1c thu\u1ed1c &#8211; thu\u1ed1c \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n kh\u1ecfe m\u1ea1nh \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh c\u1ee7a pioglitazon v\u00e0 topiramat khi d\u00f9ng \u0111\u01a1n \u0111\u1ed9c hay d\u00f9ng \u0111\u1ed3ng th\u1eddi. Quan s\u00e1t th\u1ea5y gi\u1ea3m 15% AUC<sub>\u03c4,ss<\/sub>\u00a0c\u1ee7a pioglitazon m\u00e0 kh\u00f4ng thay \u0111\u1ed5i v\u1ec1 C<sub>max,ss<\/sub>. K\u1ebft qu\u1ea3 n\u00e0y kh\u00f4ng c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea. Th\u00eam v\u00e0o \u0111\u00f3, th\u1ea5y c\u00f3 gi\u1ea3m 13% C<sub>max,ss<\/sub>\u00a0v\u00e0 16% AUC<sub>\u03c4,ss<\/sub>\u00a0c\u1ee7a ch\u1ea5t chuy\u1ec3n h\u00f3a hydroxy c\u00f3 ho\u1ea1t t\u00ednh, v\u00e0 gi\u1ea3m 60% C<sub>max,ss<\/sub>\u00a0v\u00e0 AUC<sub>\u03c4,ss<\/sub>\u00a0c\u1ee7a ch\u1ea5t chuy\u1ec3n h\u00f3a keto c\u00f3 ho\u1ea1t t\u00ednh. \u00dd ngh\u0129a l\u00e2m s\u00e0ng c\u1ee7a nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y kh\u00f4ng bi\u1ebft r\u00f5. Khi \u0111ang \u0111i\u1ec1u tr\u1ecb pioglitazon m\u00e0 th\u00eam Topiramate, hay khi \u0111ang \u0111i\u1ec1u tr\u1ecb Topiramate m\u00e0 th\u00eam pioglitazon, th\u00ec ph\u1ea3i ch\u00fa \u00fd theo d\u00f5i b\u1ec7nh nh\u00e2n th\u01b0\u1eddng xuy\u00ean \u0111\u1ec3 ki\u1ec3m so\u00e1t t\u00ecnh tr\u1ea1ng b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng m\u1ed9t c\u00e1ch th\u00edch h\u1ee3p.<\/p>\n<p><em>Glyburid<\/em><\/p>\n<p>Nghi\u00ean c\u1ee9u t\u01b0\u01a1ng t\u00e1c thu\u1ed1c &#8211; thu\u1ed1c \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf b\u1ec7nh nh\u00e2n ti\u1ec3u \u0111\u01b0\u1eddng tu\u00fdp 2 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u1ec1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh c\u1ee7a glyburid (5mg\/ng\u00e0y) d\u00f9ng \u0111\u01a1n \u0111\u1ed9c hay d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi topiramat (150mg\/ng\u00e0y). Th\u1ea5y c\u00f3 gi\u1ea3m 25% AUC<sub>24<\/sub>\u00a0c\u1ee7a glyburid trong khi d\u00f9ng topiramat. Ph\u01a1i nhi\u1ec5m h\u1ec7 th\u1ed1ng c\u1ee7a c\u00e1c ch\u1ea5t chuy\u1ec3n h\u00f3a c\u00f3 ho\u1ea1t t\u00ednh, 4-trans-hydroxy-glyburid (M1) v\u00e0 3-cis-hydroxyglyburid (M2), c\u0169ng b\u1ecb gi\u1ea3m l\u1ea7n l\u01b0\u1ee3t l\u00e0 13% v\u00e0 15%. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh c\u1ee7a topiramat kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng khi d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi glyburid. Khi \u0111ang \u0111i\u1ec1u tr\u1ecb glyburid m\u00e0 th\u00eam topiramat, hay khi \u0111ang \u0111i\u1ec1u tr\u1ecb topiramat m\u00e0 th\u00eam glyburid, th\u00ec ph\u1ea3i theo d\u00f5i ch\u1eb7t ch\u1ebd b\u1ec7nh nh\u00e2n \u0111\u1ec1u \u0111\u1eb7n, nh\u1eb1m ki\u1ec3m so\u00e1t t\u00ecnh tr\u1ea1ng b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng m\u1ed9t c\u00e1ch th\u00edch h\u1ee3p.<\/p>\n<p><em>C\u00e1c lo\u1ea1i t\u01b0\u01a1ng t\u00e1c kh\u00e1c<\/em><\/p>\n<p><em>C\u00e1c thu\u1ed1c c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y s\u1ecfi th\u1eadn<\/em><\/p>\n<p>Topiramate khi d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c thu\u1ed1c c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y s\u1ecfi th\u1eadn th\u00ec c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 b\u1ecb s\u1ecfi th\u1eadn. Trong khi d\u00f9ng Topiramate, n\u00ean tr\u00e1nh d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c thu\u1ed1c n\u00e0y v\u00ec ch\u00fang c\u00f3 th\u1ec3 t\u1ea1o ra m\u00f4i tr\u01b0\u1eddng sinh l\u00fd, l\u00e0m t\u0103ng nguy c\u01a1 h\u00ecnh th\u00e0nh s\u1ecfi th\u1eadn.<\/p>\n<p><em>Acid Valproic<\/em><\/p>\n<p>Khi d\u00f9ng chung topiramat v\u1edbi acid valproic tr\u00ean b\u1ec7nh nh\u00e2n v\u1ed1n dung n\u1ea1p v\u1edbi t\u1eebng thu\u1ed1c n\u1ebfu d\u00f9ng \u0111\u01a1n \u0111\u1ed9c, ng\u01b0\u1eddi ta th\u1ea5y c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng amoniac m\u00e1u c\u00f3 th\u1ec3 c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m theo b\u1ec7nh n\u00e3o. Trong \u0111a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p, c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u s\u1ebd gi\u1ea3m b\u1edbt \u0111i khi ng\u1eebng m\u1ed9t trong hai thu\u1ed1c (xem C\u1ea3nh b\u00e1o v\u00e0 Th\u1eadn tr\u1ecdng v\u00e0 T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n). Ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i n\u00e0y kh\u00f4ng ph\u1ea3i l\u00e0 do t\u01b0\u01a1ng t\u00e1c d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc.<\/p>\n<p>Gi\u1ea3m th\u00e2n nhi\u1ec7t, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 s\u1ef1 gi\u1ea3m kh\u00f4ng c\u00f3 ch\u1ee7 \u0111\u00edch nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 xu\u1ed1ng d\u01b0\u1edbi 35\u00b0C, \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi topiramat v\u00e0 acid valproic (VPA) c\u00f3 ho\u1eb7c kh\u00f4ng k\u1ebft h\u1ee3p v\u1edbi t\u0103ng ammoniac m\u00e1u. Ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i n\u00e0y \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng \u0111\u1ed3ng th\u1eddi topiramat v\u00e0 valproat c\u00f3 th\u1ec3 x\u1ea3y ra sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi topiramat ho\u1eb7c sau khi t\u0103ng li\u1ec1u h\u00e0ng ng\u00e0y c\u1ee7a topiramat..<\/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><em>Tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u<\/em><\/p>\n<p>Qu\u00e1 li\u1ec1u topiramat \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o. D\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng bao g\u1ed3m: co gi\u1eadt, bu\u1ed3n ng\u1ee7, r\u1ed1i lo\u1ea1n ng\u00f4n ng\u1eef, nh\u00ecn m\u1edd, nh\u00ecn \u0111\u00f4i, sa s\u00fat tinh th\u1ea7n, l\u1edd \u0111\u1edd, b\u1ea5t th\u01b0\u1eddng ph\u1ed1i h\u1ee3p, s\u1eefng s\u1edd, h\u1ea1 huy\u1ebft \u00e1p, \u0111au b\u1ee5ng, k\u00edch \u0111\u1ed9ng, cho\u00e1ng v\u00e1ng v\u00e0 tr\u1ea7m c\u1ea3m. H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p, ti\u1ebfn tri\u1ec3n l\u00e2m s\u00e0ng kh\u00f4ng tr\u1ea7m tr\u1ecdng ngo\u1ea1i tr\u1eeb nh\u1eefng tr\u01b0\u1eddng h\u1ee3p t\u1eed vong \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o sau khi s\u1eed d\u1ee5ng qu\u00e1 li\u1ec1u nhi\u1ec1u thu\u1ed1c c\u00f3 bao g\u1ed3m topiramat. Qu\u00e1 li\u1ec1u topiramat c\u00f3 th\u1ec3 g\u00e2y n\u00ean toan chuy\u1ec3n h\u00f3a n\u1eb7ng.<\/p>\n<p>B\u00e1o c\u00e1o qu\u00e1 li\u1ec1u topiramat cao nh\u1ea5t \u0111\u01b0\u1ee3c t\u00ednh v\u00e0o kho\u1ea3ng 96g v\u00e0 110g topiramat v\u00e0 d\u1eabn \u0111\u1ebfn h\u00f4n m\u00ea k\u00e9o d\u00e0i 20 &#8211; 24 gi\u1edd, sau \u0111\u00f3 ph\u1ee5c h\u1ed3i ho\u00e0n to\u00e0n sau 3 \u0111\u1ec1n 4 ng\u00e0y.<\/p>\n<p><em>\u0110i\u1ec1u tr\u1ecb<\/em><\/p>\n<p>Trong tr\u01b0\u1eddng h\u1ee3p qu\u00e1 li\u1ec1u c\u1ea5p, n\u1ebfu b\u1ec7nh nh\u00e2n v\u1eeba m\u1edbi u\u1ed1ng v\u00e0o, n\u00ean l\u00e0m tr\u1ed1ng d\u1ea1 d\u00e0y ngay b\u1eb1ng c\u00e1ch r\u1eeda d\u1ea1 d\u00e0y ho\u1eb7c g\u00e2y n\u00f4n. Than ho\u1ea1t t\u00ednh c\u00f3 kh\u1ea3 n\u0103ng h\u1ea5p th\u1ee5 topiramat in vitro. N\u00ean d\u00f9ng c\u00e1c bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 th\u00edch h\u1ee3p. L\u1ecdc m\u00e1u l\u00e0 ph\u01b0\u01a1ng c\u00e1ch h\u1eefu hi\u1ec7u \u0111\u1ec3 lo\u1ea1i topiramat ra kh\u1ecfi c\u01a1 th\u1ec3. B\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c b\u00f9 n\u01b0\u1edbc \u0111\u1ea7y \u0111\u1ee7.<\/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=\"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>Topiramat \u0111\u01b0\u1ee3c x\u1ebfp lo\u1ea1i l\u00e0 m\u1ed9t monosaccharid \u0111\u01b0\u1ee3c thay th\u1ebf g\u1ed1c sulfamat.<\/p>\n<p>Nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed9ng v\u1eadt, topiramat c\u00f3 ho\u1ea1t t\u00ednh ch\u1ed1ng co gi\u1eadt \u1edf chu\u1ed9t c\u1ed1ng v\u00e0 chu\u1ed9t nh\u1eaft trong c\u00e1c th\u1eed nghi\u1ec7m l\u00ean c\u01a1n co gi\u1eadt b\u1eb1ng s\u1ed1c \u0111i\u1ec7n t\u1ed1i \u0111a (MES) v\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 trong c\u00e1c lo\u00e0i g\u1eb7m nh\u1ea5m b\u1ecb ch\u1ee9ng \u0111\u1ed9ng kinh, bao g\u1ed3m \u0111\u1ed9ng kinh co c\u1ee9ng v\u00e0 \u0111\u1ed9ng kinh gi\u1ed1ng c\u01a1n v\u1eafng trong chu\u1ed9t c\u1ed1ng b\u1ecb \u0111\u1ed9ng kinh t\u1ef1 ph\u00e1t (SER) v\u00e0 c\u00e1c c\u01a1n \u0111\u1ed9ng kinh co c\u1ee9ng co gi\u1eadt \u1edf chu\u1ed9t c\u1ed1ng b\u1edfi s\u1ef1 k\u00edch th\u00edch v\u00f9ng h\u1ea1nh nh\u00e2n ho\u1eb7c b\u1edfi s\u1ef1 thi\u1ebfu m\u00e1u to\u00e0n th\u1ec3. Topiramat ch\u1ec9 c\u00f3 t\u00e1c d\u1ee5ng y\u1ebfu trong \u1ee9c ch\u1ebf c\u01a1n \u0111\u1ed9ng kinh co gi\u1eadt do t\u00e1c \u0111\u1ed9ng c\u1ee7a ch\u1ea5t \u0111\u1ed1i kh\u00e1ng c\u1ee7a th\u1ee5 th\u1ec3 GABA<sub>A<\/sub>\u00a0l\u00e0 pentylenetetrazol.<\/p>\n<p>Nghi\u00ean c\u1ee9u tr\u00ean chu\u1ed9t nh\u1eaft d\u00f9ng \u0111\u1ed3ng th\u1eddi topiramat v\u00e0 carbamazepin ho\u1eb7c phenobarbital cho th\u1ea5y t\u00e1c d\u1ee5ng ch\u1ed1ng co gi\u1eadt l\u00e0 hi\u1ec7p \u0111\u1ed3ng, trong khi k\u1ebft h\u1ee3p v\u1edbi phenytoin ch\u1ec9 cho th\u1ea5y c\u00f3 ho\u1ea1t t\u00ednh ch\u1ed1ng co gi\u1eadt c\u00f3 t\u00e1c d\u1ee5ng c\u1ed9ng. Trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng c\u00f3 \u0111\u1ed1i ch\u1ee9ng, d\u00f9ng topiramat nh\u01b0 thu\u1ed1c ph\u1ed1i h\u1ee3p, kh\u00f4ng c\u00f3 m\u1ed1i t\u01b0\u01a1ng quan n\u00e0o gi\u1eefa n\u1ed3ng \u0111\u1ed9 \u0111\u00e1y c\u1ee7a topiramat trong huy\u1ebft t\u01b0\u01a1ng v\u1edbi hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng c\u1ee7a thu\u1ed1c n\u00e0y. Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 s\u1ef1 dung n\u1ea1p \u1edf ng\u01b0\u1eddi.<\/p>\n<p><strong><em>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng: <\/em><\/strong><\/p>\n<p>C\u01a1 ch\u1ebf ch\u00ednh x\u00e1c gi\u00fap topiramat c\u00f3 hi\u1ec7u qu\u1ea3 trong ch\u1ed1ng co gi\u1eadt v\u00e0 d\u1ef1 ph\u00f2ng \u0111au n\u1eeda \u0111\u1ea7u ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft r\u00f5. C\u00e1c nghi\u00ean c\u1ee9u sinh ho\u00e1 v\u00e0 \u0111i\u1ec7n sinh l\u00fd tr\u00ean c\u00e1c n\u01a1ron \u0111\u01b0\u1ee3c nu\u00f4i c\u1ea5y \u0111\u00e3 x\u00e1c \u0111\u1ecbnh ba \u0111\u1eb7c t\u00ednh c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n v\u00e0o hi\u1ec7u qu\u1ea3 ch\u1ed1ng \u0111\u1ed9ng kinh c\u1ee7a topiramat. C\u00e1c \u0111i\u1ec7n th\u1ebf ho\u1ea1t \u0111\u1ed9ng \u0111\u01b0\u1ee3c l\u1eb7p \u0111i l\u1eb7p l\u1ea1i b\u1edfi s\u1ef1 kh\u1eed c\u1ef1c k\u00e9o d\u00e0i c\u1ee7a n\u01a1ron b\u1ecb \u1ee9c ch\u1ebf b\u1edfi topiramat theo ki\u1ec3u l\u1ec7 thu\u1ed9c th\u1eddi gian, d\u1eabn \u0111\u1ebfn t\u00e1c \u0111\u1ed9ng ch\u1eb9n k\u00eanh natri t\u00f9y thu\u1ed9c tr\u1ea1ng th\u00e1i. Topiramat l\u00e0m t\u0103ng t\u1ea7n su\u1ea5t m\u00e0 t\u1ea1i \u0111\u00f3 c\u00e1c th\u1ee5 th\u1ec3 GABA<sub>A<\/sub>\u00a0\u0111\u01b0\u1ee3c ho\u1ea1t ho\u00e1 b\u1edfi \u03b3- aminobutyrat (GABA), v\u00e0 l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng c\u1ee7a GABA \u0111\u1ec3 t\u1ea1o ra lu\u1ed3ng ion clorid \u0111i v\u00e0o trong c\u00e1c n\u01a1ron, cho th\u1ea5y r\u1eb1ng topiramat l\u00e0m t\u0103ng ho\u1ea1t t\u00ednh c\u1ee7a c\u00e1c ch\u1ea5t d\u1eabn truy\u1ec1n th\u1ea7n kinh \u1ee9c ch\u1ebf.<\/p>\n<p>T\u00e1c \u0111\u1ed9ng n\u00e0y kh\u00f4ng b\u1ecb \u1ee9c ch\u1ebf b\u1edfi flumazenil, m\u1ed9t ch\u1ea5t \u0111\u1ed1i kh\u00e1ng v\u1edbi benzodiazepin, v\u00e0 topiramat c\u0169ng kh\u00f4ng l\u00e0m t\u0103ng th\u1eddi gian m\u1edf k\u00eanh, kh\u00e1c bi\u1ec7t gi\u1eefa topiramat v\u00e0 c\u00e1c barbiturat l\u00e0 \u0111i\u1ec1u ch\u1ec9nh th\u1ee5 th\u1ec3 GABA<sub>A<\/sub>.<\/p>\n<p>V\u00ec \u0111\u1eb7c t\u00ednh ch\u1ed1ng \u0111\u1ed9ng kinh c\u1ee7a topiramat kh\u00e1c bi\u1ec7t ho\u00e0n to\u00e0n v\u1edbi t\u00ednh ch\u1ea5t c\u1ee7a c\u00e1c benzodiazepin, n\u00ean topiramat c\u00f3 th\u1ec3 \u0111i\u1ec1u ch\u1ec9nh m\u1ed9t d\u01b0\u1edbi nh\u00f3m (subtype) c\u1ee7a th\u1ee5 th\u1ec3 GABA<sub>A<\/sub>\u00a0k\u00e9m nh\u1ea1y c\u1ea3m v\u1edbi benzodiazepin. Topiramat l\u00e0m m\u1ea5t kh\u1ea3 n\u0103ng c\u1ee7a kainat g\u00e2y ho\u1ea1t h\u00f3a kainat\/AMPA (alpha-amino-3-hydroxy-5 methyl-isoxazole-4-propionic acid), l\u00e0 m\u1ed9t d\u01b0\u1edbi nh\u00f3m (subtype) c\u1ee7a th\u1ee5 th\u1ec3 amino acid (glutamat) k\u00edch th\u00edch, nh\u01b0ng l\u1ea1i kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng r\u00f5 r\u00e0ng tr\u00ean ho\u1ea1t t\u00ednh c\u1ee7a N-methyl-D-aspartat (NMDA) t\u1ea1i d\u01b0\u1edbi nh\u00f3m (subtype) c\u1ee7a th\u1ee5 th\u1ec3 NMDA. Nh\u1eefng t\u00e1c d\u1ee5ng n\u00e0y c\u1ee7a topiramat ph\u1ee5 thu\u1ed9c n\u1ed3ng \u0111\u1ed9, trong kho\u1ea3ng n\u1ed3ng \u0111\u1ed9 t\u1eeb 1mcM t\u1edbi 200mcM, v\u1edbi ho\u1ea1t t\u00ednh \u00edt nh\u1ea5t quan s\u00e1t \u0111\u01b0\u1ee3c l\u00e0 \u1edf n\u1ed3ng \u0111\u1ed9 1mcM t\u1edbi 10mcM.<\/p>\n<p>Ngo\u00e0i ra, topiramat \u1ee9c ch\u1ebf m\u1ed9t v\u00e0i isoenzym c\u1ee7a anhydrase carbonic. T\u00e1c d\u1ee5ng d\u01b0\u1ee3c l\u00fd n\u00e0y c\u1ee7a topiramat y\u1ebfu h\u01a1n nhi\u1ec1u so v\u1edbi t\u00e1c d\u1ee5ng cua acetazolamid, l\u00e0 ch\u1ea5t \u1ee9c ch\u1ebf anhydrase carbonic \u0111\u00e3 \u0111\u01b0\u1ee3c bi\u1ebft, v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c cho l\u00e0 m\u1ed9t c\u01a1 ch\u1ebf ch\u00ednh c\u1ee7a ho\u1ea1t t\u00ednh ch\u1ed1ng \u0111\u1ed9ng kinh c\u1ee7a topiramat.<\/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><em>H\u1ea5p thu<\/em><\/p>\n<p>Topiramat h\u1ea5p thu t\u1ed1t v\u00e0 nhanh. Sau khi u\u1ed1ng 100mg topiramat, ng\u01b0\u1eddi kh\u1ecfe m\u1ea1nh c\u00f3 n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh trung b\u00ecnh trong huy\u1ebft t\u01b0\u01a1ng (C<sub>max<\/sub>) l\u00e0 1,5mg\/ml \u0111\u1ea1t \u0111\u01b0\u1ee3c trong v\u00f2ng 2 \u0111\u1ebfn 3 gi\u1edd.<\/p>\n<p>D\u1ef1a tr\u00ean s\u1ef1 thu h\u1ed3i l\u1ea1i ho\u1ea1t t\u00ednh ph\u00f3ng x\u1ea1 t\u1eeb n\u01b0\u1edbc ti\u1ec3u, th\u1ea5y ph\u1ea1m vi h\u1ea5p thu trung b\u00ecnh c\u1ee7a 100mg li\u1ec1u u\u1ed1ng\u00a0<sup>14<\/sup>C-topiramat \u00edt nh\u1ea5t l\u00e0 81%. Th\u1ee9c \u0103n kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng \u0111\u00e1ng k\u1ec3 v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng tr\u00ean sinh kh\u1ea3 d\u1ee5ng c\u1ee7a topiramat.<\/p>\n<p><em>Ph\u00e2n b\u1ed1<\/em><\/p>\n<p>N\u00f3i chung, c\u00f3 kho\u1ea3ng 13 &#8211; 17% topiramat g\u1eafn k\u1ebft v\u1edbi protein huy\u1ebft t\u01b0\u01a1ng. M\u1ed9t v\u1ecb tr\u00ed c\u00f3 kh\u1ea3 n\u0103ng g\u1eafn k\u1ebft th\u1ea5p cho topiramat trong\/tr\u00ean h\u1ed3ng c\u1ea7u v\u00e0 c\u00f3 th\u1ec3 b\u00e3o ho\u00e0 v\u1edbi n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng 4mg\/ml \u0111\u00e3 \u0111\u01b0\u1ee3c bi\u1ebft. Th\u1ec3 t\u00edch ph\u00e2n b\u1ed1 bi\u1ebfn \u0111\u1ed5i t\u1ec9 l\u1ec7 ngh\u1ecbch v\u1edbi li\u1ec1u d\u00f9ng. Th\u1ec3 t\u00edch bi\u1ec3u ki\u1ebfn trung b\u00ecnh c\u1ee7aa s\u1ef1 ph\u00e2n b\u1ed1 thu\u1ed1c l\u00e0 0,08 &#8211; 0,55 L\/kg khi d\u00f9ng li\u1ec1u duy nh\u1ea5t t\u1eeb 100 &#8211; 1200mg. Gi\u1edbi t\u00ednh \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n c\u00f3 t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn th\u1ec3 t\u00edch ph\u00e2n b\u1ed1 c\u1ee7a thu\u1ed1c, gi\u00e1 tr\u1ecb v\u1edbi n\u1eef gi\u1edbi kho\u1ea3ng 50% so v\u1edbi c\u1ee7a nam gi\u1edbi. \u0110i\u1ec1u n\u00e0y \u0111\u01b0\u1ee3c cho l\u00e0 do ph\u1ea7n tr\u0103m ch\u1ea5t b\u00e9o trong c\u01a1 th\u1ec3 c\u1ee7a b\u1ec7nh nh\u00e2n n\u1eef cao h\u01a1n v\u00e0 \u0111i\u1ec1u n\u00e0y kh\u00f4ng c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng.<\/p>\n<p><em>Chuy\u1ec3n h\u00f3a<\/em><\/p>\n<p>Topiramat kh\u00f4ng \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a nhi\u1ec1u (\u2248 20%) \u1edf ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n kh\u1ecfe m\u1ea1nh. Topiramat \u0111\u01b0\u1ee3c chuy\u1ec3n h\u1ecfa \u0111\u1ebfn 50% \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh l\u00e0 nh\u1eefng ch\u1ea5t g\u00e2y c\u1ea3m \u1ee9ng c\u00e1c enzym chuy\u1ec3n h\u00f3a thu\u1ed1c. S\u00e1u ch\u1ea5t chuy\u1ec3n h\u00f3a, h\u00ecnh th\u00e0nh qua s\u1ef1 hydroxyl h\u00f3a, th\u1ee7y ph\u00e2n v\u00e0 glucuro &#8211; li\u00ean h\u1ee3p \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4 l\u1eadp, \u0111\u1ecbnh t\u00ednh t\u1eeb huy\u1ebft t\u01b0\u01a1ng, n\u01b0\u1edbc ti\u1ec3u v\u00e0 ph\u00e2n. M\u1ed7i ch\u1ea5t chuy\u1ec3n ho\u00e1 c\u00f3 m\u1eb7t d\u01b0\u1edbi 3% c\u1ee7a t\u1ed5ng s\u1ed1 ho\u1ea1t t\u00ednh ph\u00f3ng x\u1ea1 b\u00e0i ti\u1ebft sau khi d\u00f9ng\u00a0<sup>14<\/sup>C-topiramat. Hai ch\u1ea5t chuy\u1ec3n ho\u00e1 g\u1ea7n nh\u01b0 v\u1eabn c\u00f2n gi\u1eef c\u1ea5u tr\u00fac c\u1ee7a topiramat \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m v\u00e0 nh\u1eadn th\u1ea5y c\u00f2n m\u1ed9t \u00edt hay kh\u00f4ng c\u00f3 ho\u1ea1t t\u00ednh ch\u1ed1ng co gi\u1eadt.<\/p>\n<p><em>Th\u1ea3i tr\u1eeb<\/em><\/p>\n<p>\u1ede ng\u01b0\u1eddi, con \u0111\u01b0\u1eddng th\u1ea3i tr\u1eeb ch\u00ednh c\u1ee7a topiramat d\u1ea1ng kh\u00f4ng \u0111\u1ed5i v\u00e0 c\u00e1c ch\u1ea5t chuy\u1ec3n ho\u00e1 c\u1ee7a n\u00f3 l\u00e0 qua th\u1eadn (\u00edt nh\u1ea5t l\u00e0 81% c\u1ee7a li\u1ec1u d\u00f9ng). Kho\u1ea3ng 66% c\u1ee7a li\u1ec1u d\u00f9ng\u00a0<sup>14<\/sup>C-topiramat \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft d\u01b0\u1edbi d\u1ea1ng kh\u00f4ng \u0111\u1ed5i trong n\u01b0\u1edbc ti\u1ec3u trong v\u00f2ng 4 ng\u00e0y.<\/p>\n<p>Sau khi d\u00f9ng li\u1ec1u 50mg v\u00e0 100mg topiramat hai l\u1ea7n\/ng\u00e0y, s\u1ef1 thanh th\u1ea3i \u1edf th\u1eadn trung b\u00ecnh t\u01b0\u01a1ng \u1ee9ng kho\u1ea3ng 18ml\/ph\u00fat v\u00e0 17ml\/ph\u00fat. C\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 s\u1ef1 t\u00e1i h\u1ea5p thu qua \u1ed1ng th\u1eadn c\u1ee7a topiramat. B\u1eb1ng ch\u1ee9ng n\u00e0y \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 b\u1edfi nghi\u00ean c\u1ee9u \u1edf chu\u1ed9t c\u1ed1ng d\u00f9ng \u0111\u1ed3ng th\u1eddi topiramat v\u00e0 probenecid, v\u00e0 c\u00f3 s\u1ef1 t\u0103ng \u0111\u00e1ng k\u1ec3 s\u1ef1 thanh th\u1ea3i th\u1eadn c\u1ee7a topiramat. N\u00f3i chung, s\u1ef1 thanh th\u1ea3i huy\u1ebft t\u01b0\u01a1ng kho\u1ea3ng 20 &#8211; 30ml\/ph\u00fat \u1edf ng\u01b0\u1eddi sau khi u\u1ed1ng topiramat.<\/p>\n<p>Topiramat c\u00f3 s\u1ef1 thay \u0111\u1ed5i n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng gi\u1eefa nh\u1eefng c\u00e1 th\u1ec3 kh\u00e1c nhau th\u1ea5p v\u00e0 v\u00ec v\u1eady c\u00f3 th\u1ec3 \u0111o\u00e1n tr\u01b0\u1edbc \u0111\u01b0\u1ee3c d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a topiramat tuy\u1ebfn t\u00ednh v\u1edbi s\u1ef1 thanh th\u1ea3i c\u00f2n \u1ed5n \u0111\u1ecbnh c\u1ee7a huy\u1ebft t\u01b0\u01a1ng v\u00e0 di\u1ec7n t\u00edch d\u01b0\u1edbi \u0111\u01b0\u1eddng cong c\u1ee7a n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng t\u0103ng t\u1ec9 l\u1ec7 v\u1edbi li\u1ec1u duy nh\u1ea5t 100 \u0111\u1ebfn 400mg \u1edf ng\u01b0\u1eddi kh\u1ecfe m\u1ea1nh. Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ch\u1ee9c n\u0103ng th\u1eadn b\u00ecnh th\u01b0\u1eddng c\u00f3 th\u1ec3 m\u1ea5t 4 \u0111\u1ebfn 8 ng\u00e0y \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng \u1edf tr\u1ea1ng th\u00e1i h\u1eb1ng \u0111\u1ecbnh. C<sub>max<\/sub>\u00a0trung b\u00ecnh l\u00e0 6,76mg\/ml sau khi d\u00f9ng \u0111a li\u1ec1u 100mg\/hai l\u1ea7n\/ng\u00e0y \u1edf ng\u01b0\u1eddi kh\u1ecfe m\u1ea1nh. Sau khi d\u00f9ng \u0111a li\u1ec1u 50mg v\u00e0 100mg\/hai l\u1ea7n\/ng\u00e0y, th\u1eddi gian b\u00e1n th\u1ea3i trung b\u00ecnh trong huy\u1ebft t\u01b0\u01a1ng l\u00e0 kho\u1ea3ng 21 gi\u1edd.<\/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>&#8230;..<\/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>Kh\u00f4ng c\u00f3.<\/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","protected":false},"excerpt":{"rendered":"<p>Thu\u1ed1c Topiramate 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 Topiramate (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 : Topiramate Ph\u00e2n lo\u1ea1i: Thu\u1ed1c ch\u1ed1ng co gi\u1eadt \/ [&hellip;]<\/p>\n","protected":false},"author":8612,"featured_media":39567,"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":[2],"tags":[1634],"class_list":["post-4081","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-thuoc-a-z","tag-topiramate"],"_links":{"self":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/4081","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=4081"}],"version-history":[{"count":4,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/4081\/revisions"}],"predecessor-version":[{"id":39568,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/4081\/revisions\/39568"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/media\/39567"}],"wp:attachment":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/media?parent=4081"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/categories?post=4081"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/tags?post=4081"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}