{"id":6688,"date":"2019-04-02T12:36:52","date_gmt":"2019-04-02T05:36:52","guid":{"rendered":"https:\/\/pharmog.com\/wp\/?p=6688"},"modified":"2025-01-08T23:02:39","modified_gmt":"2025-01-08T16:02:39","slug":"celecoxib-celebrex","status":"publish","type":"post","link":"https:\/\/pharmog.com\/wp\/celecoxib-celebrex\/","title":{"rendered":"Celecoxib &#8211; Celebrex"},"content":{"rendered":"<p><strong>1. T\u00ean ho\u1ea1t ch\u1ea5t v\u00e0 bi\u1ec7t d\u01b0\u1ee3c: <\/strong><\/p>\n<p><strong><em>Ho\u1ea1t ch\u1ea5t :<\/em> <a href=\"https:\/\/pharmog.com\/wp\/celecoxib\/\">Celecoxib<\/a><\/strong><\/p>\n<p><strong><em>Ph\u00e2n lo\u1ea1i: <\/em><\/strong><em>Thu\u00f4\u0301c kha\u0301ng vi\u00eam Non-steroid (NSAIDS) \u01af\u0301c ch\u00ea\u0301 cho\u0323n lo\u0323c COX-2 (Coxibs).<\/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): M01AH01, L01XX33.<\/p>\n<p><strong><em>Brand name:<\/em><\/strong> CELEBREX.<\/p>\n<p><strong><em>H\u00e3ng s\u1ea3n xu\u1ea5t <\/em><\/strong>: Pfizer<\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>2. D\u1ea1ng b\u00e0o ch\u1ebf &#8211; H\u00e0m l\u01b0\u1ee3ng: <\/strong><\/p>\n<p><strong><em>D\u1ea1ng thu\u1ed1c v\u00e0 h\u00e0m l\u01b0\u1ee3ng<\/em><\/strong><\/p>\n<p>Vi\u00ean nang 100 mg : v\u1ec9 10 vi\u00ean, h\u1ed9p 3 v\u1ec9, 6 v\u1ec9 hay 10 v\u1ec9,<\/p>\n<p>Vi\u00ean nang 200 mg : v\u1ec9 10 vi\u00ean, h\u1ed9p 3 v\u1ec9, 6 v\u1ec9 hay 10 v\u1ec9<\/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>CELEBREX 200mg<\/em><\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><em>M\u1ed7i vi\u00ean nang c\u00f3 ch\u1ee9a:<\/em><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>Celecoxib<\/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=\"934\" height=\"415\" class=\"wp-image-6689\" src=\"https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2019\/04\/word-image-99.png\" srcset=\"https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2019\/04\/word-image-99.png 934w, https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2019\/04\/word-image-99-300x133.png 300w, https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2019\/04\/word-image-99-768x341.png 768w\" sizes=\"auto, (max-width: 934px) 100vw, 934px\" \/><\/p>\n<p><strong>3. Video by Pharmog:<\/strong><\/p>\n<div class=\"ast-oembed-container \" style=\"height: 100%;\"><iframe loading=\"lazy\" title=\"[Pharmog SS1 - T\u1eadp 10] - D\u01b0\u1ee3c l\u00fd v\u1ec1 Thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid - NSAIDs\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/uIvbbYNDCZ8?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/div>\n<p><a href=\"https:\/\/www.youtube.com\/watch?v=uIvbbYNDCZ8&amp;feature=youtu.be\"><strong>[VIDEO D\u01af\u1ee2C L\u00dd]<\/strong><\/a><\/p>\n<p>&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<\/p>\n<p>\u25ba K\u1ecbch B\u1ea3n: PharmogTeam<\/p>\n<p>\u25ba Youtube: https:\/\/www.youtube.com\/c\/pharmog<\/p>\n<p>\u25ba Facebook: https:\/\/www.facebook.com\/pharmog\/<\/p>\n<p>\u25ba Group : H\u1ed9i nh\u1eefng ng\u01b0\u1eddi m\u00ea d\u01b0\u1ee3c l\u00fd<\/p>\n<p>\u25ba Instagram : https:\/\/www.instagram.com\/pharmogvn\/<\/p>\n<p>\u25ba Website: pharmog.com<\/p>\n<p><strong>4. \u1ee8ng d\u1ee5ng l\u00e2m s\u00e0ng: <\/strong><\/p>\n<p><strong>4.1. Ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n<p>\u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng c\u1ee7a tho\u00e1i h\u00f3a kh\u1edbp (Osteoarthritis, OA) v\u00e0 vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p (Rheumatois arthritis, RA).<\/p>\n<p>Gi\u1ea3m nh\u1eb9 c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp (Ankylosing spondylitis, AS)<\/p>\n<p>Ki\u1ec3m so\u00e1t \u0111au c\u1ea5p t\u00ednh<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb th\u1ed1ng kinh nguy\u00ean ph\u00e1t.<\/p>\n<p><strong>4.2. Li\u1ec1u d\u00f9ng &#8211; C\u00e1ch d\u00f9ng:<\/strong><\/p>\n<p><strong><em>C\u00e1ch d\u00f9ng<\/em><\/strong> :<\/p>\n<p>Vi\u00ean nang Celecoxib, v\u1edbi li\u1ec1u d\u00f9ng \u0111\u1ebfn 200mg, 2 l\u1ea7n\/ng\u00e0y c\u00f3 th\u1ec3 d\u00f9ng c\u00f9ng th\u1ee9c \u0103n ho\u1eb7c kh\u00f4ng.<\/p>\n<p>C\u00e1c nguy c\u01a1 tr\u00ean tim m\u1ea1ch c\u1ee7a celecoxib c\u00f3 th\u1ec3 t\u0103ng theo li\u1ec1u v\u00e0 th\u1eddi gian d\u00f9ng thu\u1ed1c, n\u00ean d\u00f9ng li\u1ec1u th\u1ea5p nh\u1ea5t trong th\u1eddi gian ng\u1eafn nh\u1ea5t c\u00f3 th\u1ec3.<\/p>\n<p>V\u1edbi b\u1ec7nh nh\u00e2n kh\u00f3 nu\u1ed1t vi\u00ean nang, c\u00f3 th\u1ec3 cho l\u01b0\u1ee3ng thu\u1ed1c trong vi\u00ean v\u00e0o sinh t\u1ed1 t\u00e1o, ch\u00e1o, s\u1eefa chua ho\u1eb7c chu\u1ed1i nghi\u1ec1n n\u00e1t \u0111\u1ec3 u\u1ed1ng c\u00f9ng. Khi \u0111\u00f3, ph\u1ea3i cho to\u00e0n b\u1ed9 l\u01b0\u1ee3ng thu\u1ed1c v\u00e0o kho\u1ea3ng m\u1ed9t th\u00eca nh\u1ecf n\u01b0\u1edbc sinh t\u1ed1 t\u00e1o, ch\u00e1o, s\u1eefa chua ho\u1eb7c chu\u1ed1i nghi\u1ec1n n\u00e1t \u1edf nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng v\u00e0 ph\u1ea3i u\u1ed1ng ngay v\u1edbi n\u01b0\u1edbc. L\u01b0\u1ee3ng thu\u1ed1c \u0111\u00e3 tr\u1ed9n v\u1edbi n\u01b0\u1edbc sinh t\u1ed1 t\u00e1o, ch\u00e1o ho\u1eb7c s\u1eefa chua \u1ed5n \u0111\u1ecbnh trong kho\u1ea3ng 6 gi\u1edd khi b\u1ea3o qu\u1ea3n trong t\u1ee7 l\u1ea1nh (2\u00b0C &#8211; 8\u00b0C\/35\u00b0F &#8211; 45\u00b0F). Kh\u00f4ng \u0111\u01b0\u1ee3c b\u1ea3o qu\u1ea3n trong t\u1ee7 l\u1ea1nh l\u01b0\u1ee3ng thu\u1ed1c \u0111\u00e3 tr\u1ed9n v\u1edbi chu\u1ed1i nghi\u1ec1n n\u00e1t m\u00e0 ph\u1ea3i u\u1ed1ng ngay.<\/p>\n<p><em>Suy gan:\u00a0<\/em>Kh\u00f4ng c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u tr\u00ean b\u1ec7nh nh\u00e2n suy gan nh\u1eb9 (Child-Pugh nh\u00f3m A). D\u00f9ng celecoxib theo li\u1ec1u b\u1eb1ng m\u1ed9t n\u1eeda li\u1ec1u khuy\u1ebfn c\u00e1o cho c\u00e1c b\u1ec7nh nh\u00e2n vi\u00eam kh\u1edbp ho\u1eb7c b\u1ecb \u0111au trong suy gan v\u1eeba (Child-Pugh nh\u00f3m B).<\/p>\n<p>Ch\u01b0a c\u00f3 c\u00e1c nghi\u00ean c\u1ee9u tr\u00ean b\u1ec7nh nh\u00e2n suy gan n\u1eb7ng (Child-Pugh nh\u00f3m C) (xem ph\u1ea7n T\u00e1c \u0111\u1ed9ng tr\u00ean gan).<\/p>\n<p><em>Suy th\u1eadn:<\/em>\u00a0Kh\u00f4ng c\u1ea7n ch\u1ec9nh li\u1ec1u v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n suy th\u1eadn v\u1eeba v\u00e0 nh\u1eb9. Ch\u01b0a c\u00f3 c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n suy th\u1eadn n\u1eb7ng (xem ph\u1ea7n T\u00e1c \u0111\u1ed9ng tr\u00ean th\u1eadn).<\/p>\n<p><em>D\u00f9ng k\u1ebft h\u1ee3p v\u1edbi fluconazol:\u00a0<\/em>N\u00ean d\u00f9ng celecoxib v\u1edbi li\u1ec1u b\u1eb1ng m\u1ed9t n\u1eeda li\u1ec1u khuy\u1ebfn c\u00e1o tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb v\u1edbi fluconazol, m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf CYP2C9. C\u1ea7n th\u1eadn tr\u1ecdng khi d\u00f9ng k\u1ebft h\u1ee3p celecoxib v\u1edbi c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf CYP2C9 (xem T\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c v\u00e0 c\u00e1c d\u1ea1ng t\u01b0\u01a1ng t\u00e1c kh\u00e1c).<\/p>\n<p><strong><em>Li\u1ec1u d\u00f9ng:<\/em><\/strong><\/p>\n<p><em>Ng\u01b0\u1eddi l\u1edbn<\/em><\/p>\n<p><em>\u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng trong tho\u00e1i h\u00f3a kh\u1edbp (OA):<\/em>\u00a0li\u1ec1u khuy\u1ebfn ngh\u1ecb c\u1ee7a celecoxib l\u00e0 200mg d\u00f9ng li\u1ec1u \u0111\u01a1n ho\u1eb7c 100mg, 2 l\u1ea7n m\u1ed7i ng\u00e0y.<\/p>\n<p><em>\u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng trong vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p (RA):<\/em>\u00a0li\u1ec1u khuy\u1ebfn ngh\u1ecb c\u1ee7a celecoxib l\u00e0 100mg ho\u1eb7c 200mg 2 l\u1ea7n m\u1ed7i ng\u00e0y.<\/p>\n<p><em>Vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp (AS):<\/em>\u00a0li\u1ec1u khuy\u1ebfn ngh\u1ecb c\u1ee7a celecoxib l\u00e0 200mg d\u00f9ng li\u1ec1u \u0111\u01a1n ho\u1eb7c 100mg d\u00f9ng 2 l\u1ea7n m\u1ed7i ng\u00e0y. M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u1ed1t h\u01a1n n\u1ebfu d\u00f9ng t\u1ed5ng li\u1ec1u m\u1ed7i ng\u00e0y 400mg.<\/p>\n<p><em>Ki\u1ec3m so\u00e1t \u0111au c\u1ea5p t\u00ednh:\u00a0<\/em>li\u1ec1u khuy\u1ebfn ngh\u1ecb kh\u1edfi \u0111\u1ea7u c\u1ee7a celecoxib l\u00e0 400mg, d\u00f9ng ti\u1ebfp theo li\u1ec1u 200mg n\u1ebfu c\u1ea7n trong ng\u00e0y \u0111\u1ea7u ti\u00ean. Trong c\u00e1c ng\u00e0y ti\u1ebfp theo, li\u1ec1u khuy\u1ebfn ngh\u1ecb l\u00e0 200mg 2 l\u1ea7n m\u1ed7i ng\u00e0y khi c\u1ea7n.<\/p>\n<p><em>\u0110i\u1ec1u tr\u1ecb \u0111au b\u1ee5ng kinh nguy\u00ean ph\u00e1t:<\/em>\u00a0li\u1ec1u khuy\u1ebfn ngh\u1ecb kh\u1edfi \u0111\u1ea7u c\u1ee7a celecoxib l\u00e0 400mg, ti\u1ebfp theo v\u1edbi li\u1ec1u b\u1ed5 sung 200mg trong ng\u00e0y \u0111\u1ea7u ti\u00ean n\u1ebfu c\u1ea7n. Trong c\u00e1c ng\u00e0y ti\u1ebfp theo, li\u1ec1u khuy\u1ebfn ngh\u1ecb l\u00e0 200mg 2 l\u1ea7n m\u1ed7i ng\u00e0y khi c\u1ea7n.<\/p>\n<p><em>Nh\u1eefng ng\u01b0\u1eddi chuy\u1ec3n h\u00f3a k\u00e9m qua CYP2C9:\u00a0<\/em>Nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 bi\u1ebft ho\u1eb7c nghi ng\u1edd chuy\u1ec3n h\u00f3a k\u00e9m qua CYP2C9 d\u1ef1a tr\u00ean ti\u1ec1n s\u1eed\/kinh nghi\u1ec7m v\u1edbi c\u00e1c c\u01a1 ch\u1ea5t c\u1ee7a CYP2C9 kh\u00e1c c\u1ea7n th\u1eadn tr\u1ecdng khi d\u00f9ng celecoxib. B\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec1u b\u1eb1ng \u00bd li\u1ec1u khuy\u1ebfn ngh\u1ecb th\u1ea5p nh\u1ea5t (xem ph\u1ea7n T\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c v\u00e0 c\u00e1c d\u1ea1ng t\u01b0\u01a1ng t\u00e1c kh\u00e1c v\u00e0 Chuy\u1ec3n h\u00f3a).<\/p>\n<p><em>Ng\u01b0\u1eddi cao tu\u1ed5i<\/em><\/p>\n<p>Nh\u00ecn chung kh\u00f4ng ph\u1ea3i \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u. Tuy nhi\u00ean, v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n cao tu\u1ed5i c\u00f3 c\u00e2n n\u1eb7ng du\u1edbi 50kg, n\u00ean b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec1u khuy\u1ebfn ngh\u1ecb th\u1ea5p nh\u1ea5t.<\/p>\n<p><strong>4.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n<p>Celecoxib ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u0111\u1ed1i v\u1edbi:<\/p>\n<p>B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed qu\u00e1 m\u1eabn v\u1edbi celecoxib ho\u1eb7c b\u1ea5t k\u1ef3 th\u00e0nh ph\u1ea7n n\u00e0o c\u1ee7a thu\u1ed1c.<\/p>\n<p>B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed qu\u00e1 m\u1eabn v\u1edbi sulfonamid<\/p>\n<p>C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed hen, m\u1ec1 \u0111ay ho\u1eb7c c\u00f3 c\u00e1c ph\u1ea3n \u1ee9ng ki\u1ec3u d\u1ecb \u1ee9ng sau khi d\u00f9ng acid acetylsalicylic (ASA [aspirin]) ho\u1eb7c c\u00e1c thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid kh\u00e1c (c\u00e1c NSAID), bao g\u1ed3m c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf \u0111\u1eb7c hi\u1ec7u cyclooxygenase &#8211; 2 (COX-2) kh\u00e1c.<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb \u0111au trong ph\u1eabu thu\u1eadt gh\u00e9p m\u1ea1ch \u0111\u1ed9ng m\u1ea1ch v\u00e0nh nh\u00e2n t\u1ea1o (CABG) (xem ph\u1ea7n C\u1ea3nh b\u00e1o v\u00e0 th\u1eadn tr\u1ecdng \u0111\u1eb7c bi\u1ec7t khi s\u1eed d\u1ee5ng).<\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>4.4 Th\u1eadn tr\u1ecdng:<\/strong><\/p>\n<p><em>C\u00e1c t\u00e1c \u0111\u1ed9ng tr\u00ean tim m\u1ea1ch<\/em><\/p>\n<p><em>Huy\u1ebft kh\u1ed1i tim m\u1ea1ch:\u00a0<\/em>Celecoxib c\u00f3 th\u1ec3 g\u00e2y t\u0103ng nguy c\u01a1 huy\u1ebft kh\u1ed1i tim m\u1ea1ch nghi\u00eam tr\u1ecdng, nh\u1ed3i m\u00e1u c\u01a1 tim, v\u00e0 \u0111\u1ed9t qu\u1ef5, nh\u1eefng bi\u1ebfn c\u1ed1 n\u00e0y c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong. T\u1ea5t c\u1ea3 c\u00e1c NSAID \u0111\u1ec1u c\u00f3 th\u1ec3 c\u00f3 chung nguy c\u01a1 n\u00e0y. Nguy c\u01a1 n\u00e0y c\u00f3 th\u1ec3 t\u0103ng theo li\u1ec1u d\u00f9ng, th\u1eddi gian d\u00f9ng v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch c\u1ee7a b\u1ea3n th\u00e2n. B\u1ec7nh nh\u00e2n v\u1edbi ti\u1ec1n s\u1eed b\u1ec7nh tim m\u1ea1ch c\u00f3 th\u1ec3 c\u00f3 nguy c\u01a1 cao h\u01a1n. \u0110\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 x\u1ea3y ra t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean tim m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb v\u1edbi celecoxib, n\u00ean d\u00f9ng li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3 trong th\u1eddi gian ng\u1eafn nh\u1ea5t c\u00f3 th\u1ec3. Th\u1ea7y thu\u1ed1c v\u00e0 b\u1ec7nh nh\u00e2n c\u1ea7n c\u1ea3nh gi\u00e1c v\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y, ngay c\u1ea3 khi kh\u00f4ng c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ec1 tim m\u1ea1ch tr\u01b0\u1edbc \u0111\u00f3. B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c th\u00f4ng b\u00e1o v\u1ec1 c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a c\u00e1c \u0111\u1ed9c t\u00ednh nghi\u00eam tr\u1ecdng tr\u00ean tim m\u1ea1ch v\u00e0 c\u00e1c b\u01b0\u1edbc ph\u1ea3i l\u00e0m khi ch\u00fang x\u1ea3y ra (xem ph\u1ea7n C\u00e1c \u0111\u1eb7c t\u00ednh d\u01b0\u1ee3c l\u1ef1c h\u1ecdc).<\/p>\n<p>2 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng l\u1edbn, c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1ec1 m\u1ed9t NSAID t\u00e1c \u0111\u1ed9ng ch\u1ecdn l\u1ecdc tr\u00ean COX-2 kh\u00e1c trong \u0111i\u1ec1u tr\u1ecb \u0111au 10 &#8211; 14 ng\u00e0y \u0111\u1ea7u sau khi ph\u1eabu thu\u1eadt gh\u00e9p m\u1ea1ch \u0111\u1ed9ng m\u1ea1ch v\u00e0nh nh\u00e2n t\u1ea1o (CABG) cho th\u1ea5y c\u00f3 s\u1ef1 t\u0103ng t\u1ef7 l\u1ec7 nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 \u0111\u1ed9t qu\u1ef5 (xem ph\u1ea7n Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh).<\/p>\n<p>Celecoxib kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t ch\u1ea5t thay th\u1ebf cho acid acetylsalicylic trong d\u1ef1 ph\u00f2ng c\u00e1c b\u1ec7nh t\u1eafc ngh\u1ebdn huy\u1ebft kh\u1ed1i tim m\u1ea1ch do thi\u1ebfu t\u00e1c \u0111\u1ed9ng tr\u00ean ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u. B\u1edfi v\u00ec celecoxib kh\u00f4ng \u1ee9c ch\u1ebf s\u1ef1 k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u, kh\u00f4ng n\u00ean ng\u1eebng c\u00e1c tr\u1ecb li\u1ec7u kh\u00e1ng ti\u1ec3u c\u1ea7u (v\u00ed d\u1ee5 acid acetylsalicylic).<\/p>\n<p><em>T\u0103ng huy\u1ebft \u00e1p:\u00a0<\/em>C\u0169ng nh\u01b0 t\u1ea5t c\u1ea3 c\u00e1c NSAID, celecoxib c\u00f3 th\u1ec3 l\u00e0m kh\u1edfi ph\u00e1t c\u01a1n t\u0103ng huy\u1ebft \u00e1p ho\u1eb7c l\u00e0m t\u00ecnh tr\u1ea1ng t\u0103ng huy\u1ebft \u00e1p v\u1ed1n c\u00f3 n\u1eb7ng th\u00eam, c\u1ea3 hai y\u1ebfu t\u1ed1 n\u00e0y \u0111\u1ec1u c\u00f3 th\u1ec3 l\u00e0m t\u0103ng bi\u1ebfn c\u1ed1 tim m\u1ea1ch. N\u00ean th\u1eadn tr\u1ecdng khi d\u00f9ng c\u00e1c NSAID, k\u1ec3 c\u1ea3 celecoxib tr\u00ean b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p. C\u1ea7n theo d\u00f5i huy\u1ebft \u00e1p ch\u1eb7t ch\u1ebd khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi celecoxib c\u0169ng nh\u01b0 trong su\u1ed1t th\u1eddi gian \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p><em>\u1ee8 d\u1ecbch v\u00e0 ph\u00f9:\u00a0<\/em>C\u0169ng gi\u1ed1ng nh\u01b0 c\u00e1c thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p prostaglandin, ph\u00f9 n\u1ec1 v\u00e0 \u1ee9 d\u1ecbch \u0111\u00e3 g\u1eb7p tr\u00ean m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n d\u00f9ng celecoxib. Do \u0111\u00f3, c\u1ea7n theo d\u00f5i ch\u1eb7t ch\u1ebd b\u1ec7nh nh\u00e2n b\u1ecb suy tim sung huy\u1ebft ho\u1eb7c t\u0103ng huy\u1ebft \u00e1p t\u1eeb tr\u01b0\u1edbc. N\u00ean d\u00f9ng celecoxib th\u1eadn tr\u1ecdng cho c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng ch\u1ee9c n\u0103ng tim, ph\u00f9 ho\u1eb7c c\u00e1c t\u00ecnh tr\u1ea1ng c\u00f3 kh\u1ea3 n\u0103ng tr\u1edf n\u00ean tr\u1ea7m tr\u1ecdng h\u01a1n do \u1ee9 d\u1ecbch v\u00e0 ph\u00f9 bao g\u1ed3m nh\u1eefng ng\u01b0\u1eddi d\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u, ho\u1eb7c c\u00f3 nguy c\u01a1 gi\u1ea3m th\u1ec3 t\u00edch m\u00e1u.<\/p>\n<p><em>C\u00e1c t\u00e1c \u0111\u1ed9ng tr\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a<\/em><\/p>\n<p>Th\u1ee7ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a tr\u00ean v\u00e0 d\u01b0\u1edbi, lo\u00e9t ho\u1eb7c ch\u1ea3y m\u00e1u \u0111\u00e3 x\u1ea3y ra v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n d\u00f9ng celecoxib. Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao nh\u1ea5t b\u1ecb nh\u1eefng bi\u1ebfn ch\u1ee9ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a lo\u1ea1i n\u00e0y khi d\u00f9ng c\u00e1c thu\u1ed1c NSAID bao g\u1ed3m: ng\u01b0\u1eddi cao tu\u1ed5i, b\u1ec7nh nh\u00e2n b\u1ecb c\u00e1c b\u1ec7nh tim m\u1ea1ch, b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng aspirin, c\u00e1c glucocorticoid ho\u1eb7c c\u00e1c NSAID kh\u00e1c, b\u1ec7nh nh\u00e2n d\u00f9ng th\u1ee9c u\u1ed1ng c\u00f3 c\u1ed3n ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed ho\u1eb7c \u0111ang b\u1ecb c\u00e1c b\u1ec7nh \u0111\u01b0\u1eddng ti\u00eau h\u00f3a ti\u1ebfn tri\u1ec3n nh\u01b0 lo\u00e9t, c\u00e1c t\u00ecnh tr\u1ea1ng ch\u1ea3y m\u00e1u ho\u1eb7c vi\u00eam \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. H\u1ea7u h\u1ebft c\u00e1c b\u00e1o c\u00e1o ng\u1eabu nhi\u00ean v\u1ec1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1eed vong do bi\u1ebfn c\u1ed1 tr\u00ean \u0111\u01b0\u1eddng ti\u00eau ho\u00e1 c\u00f3 li\u00ean quan \u0111\u1ebfn celecoxib l\u00e0 tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n th\u1ec3 ch\u1ea5t y\u1ebfu ho\u1eb7c ng\u01b0\u1eddi cao tu\u1ed5i.<\/p>\n<p><em>C\u00e1c t\u00e1c \u0111\u1ed9ng tr\u00ean th\u1eadn<\/em><\/p>\n<p>C\u00e1c NSAID bao g\u1ed3m celecoxib c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ed9c cho th\u1eadn. C\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u1edbi celecoxib \u0111\u00e3 ch\u1ec9 ra c\u00e1c t\u00e1c \u0111\u1ed9ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 v\u1edbi c\u00e1c NSAID kh\u00e1c \u0111\u01b0\u1ee3c so s\u00e1nh. B\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 nhi\u1ec5m \u0111\u1ed9c th\u1eadn cao nh\u1ea5t l\u00e0 ng\u01b0\u1eddi suy ch\u1ee9c n\u0103ng th\u1eadn, suy tim, suy ch\u1ee9c n\u0103ng gan v\u00e0 ng\u01b0\u1eddi cao tu\u1ed5i. C\u1ea7n theo d\u00f5i c\u1ea9n th\u1eadn nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib.<\/p>\n<p>C\u1ea7n th\u1eadn tr\u1ecdng khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n b\u1ecb m\u1ea5t n\u01b0\u1edbc. Tr\u01b0\u1edbc ti\u00ean n\u00ean b\u00f9 n\u01b0\u1edbc cho b\u1ec7nh nh\u00e2n r\u1ed3i m\u1edbi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib.<\/p>\n<p>B\u1ec7nh th\u1eadn ti\u1ebfn tri\u1ec3n<\/p>\n<p>C\u1ea7n theo d\u00f5i ch\u1eb7t ch\u1ebd ch\u1ee9c n\u0103ng th\u1eadn \u1edf b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh th\u1eadn ti\u1ebfn tri\u1ec3n d\u00f9ng celecoxib (xem ph\u1ea7n Li\u1ec1u d\u00f9ng v\u00e0 c\u00e1ch d\u00f9ng).<\/p>\n<p><em>Ph\u1ea3n \u1ee9ng ph\u1ea3n v\u1ec7<\/em><\/p>\n<p>C\u0169ng nh\u01b0 c\u00e1c thu\u1ed1c NSAID n\u00f3i chung, c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ea3n v\u1ec7 \u0111\u00e3 x\u1ea3y ra tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n d\u00f9ng celecoxib (xem ph\u1ea7n Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh).<\/p>\n<p><em>C\u00e1c ph\u1ea3n \u1ee9ng nghi\u00eam tr\u1ecdng tr\u00ean da<\/em><\/p>\n<p>C\u00e1c ph\u1ea3n \u1ee9ng nghi\u00eam tr\u1ecdng tr\u00ean da, m\u1ed9t s\u1ed1 d\u1eabn \u0111\u1ebfn t\u1eed vong, bao g\u1ed3m vi\u00eam da tr\u00f3c v\u1ea9y, h\u1ed9i ch\u1ee9ng Steven-Johnson, v\u00e0 ho\u1ea1i t\u1eed bi\u1ec3u b\u00ec nhi\u1ec5m \u0111\u1ed9c, \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o nh\u01b0ng r\u1ea5t hi\u1ebfm g\u1eb7p trong s\u1eed d\u1ee5ng celecoxib. B\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 nguy c\u01a1 cao v\u1edbi c\u00e1c bi\u1ebfn c\u1ed1 n\u00e0y trong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb, c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y x\u1ea3y ra ch\u1ee7 y\u1ebfu trong th\u00e1ng \u0111\u1ea7u ti\u00ean d\u00f9ng thu\u1ed1c, c\u1ea7n ng\u01b0ng d\u00f9ng celecoxib ngay khi xu\u1ea5t hi\u1ec7n m\u1ea9n \u0111\u1ecf da, t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c, ho\u1eb7c b\u1ea5t k\u1ef3 d\u1ea5u hi\u1ec7u qu\u00e1 m\u1eabn n\u00e0o.<\/p>\n<p><em>C\u00e1c t\u00e1c \u0111\u1ed9ng tr\u00ean gan<\/em><\/p>\n<p>Ch\u01b0a c\u00f3 nghi\u00ean c\u1ee9u tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n suy gan n\u1eb7ng (Child-Pugh nh\u00f3m C). Kh\u00f4ng s\u1eed d\u1ee5ng celecoxib tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n suy gan n\u1eb7ng. Celecoxib c\u1ea7n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u1eadn tr\u1ecdng tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n suy gan v\u1eeba (Child &#8211; Pugh nh\u00f3m B), v\u00e0 n\u00ean b\u1eaft \u0111\u1ea7u v\u1edbi li\u1ec1u b\u1eb1ng m\u1ed9t n\u1eeda li\u1ec1u khuy\u1ebfn c\u00e1o (xem ph\u1ea7n Li\u1ec1u d\u00f9ng v\u00e0 c\u00e1ch d\u00f9ng).<\/p>\n<p>C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n nghi\u00eam tr\u1ecdng hi\u1ebfm g\u1eb7p tr\u00ean gan, bao g\u1ed3m vi\u00eam gan k\u1ecbch ph\u00e1t (m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p g\u00e2y t\u1eed vong), ho\u1ea1i t\u1eed gan v\u00e0 suy gan (m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p g\u00e2y t\u1eed vong ho\u1eb7c c\u1ea7n ph\u1ea3i gh\u00e9p gan) \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u1edbi celecoxib.<\/p>\n<p>B\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0\/ho\u1eb7c d\u1ea5u hi\u1ec7u c\u1ee7a suy gan ho\u1eb7c ng\u01b0\u1eddi c\u00f3 x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan b\u1ea5t th\u01b0\u1eddng c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd v\u1ec1 c\u00e1c d\u1ea5u hi\u1ec7u ph\u00e1t tri\u1ec3n ph\u1ea3n \u1ee9ng tr\u00ean gan tr\u1ea7m tr\u1ecdng h\u01a1n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u1edbi celecoxib.<\/p>\n<p><em>S\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u0111\u01b0\u1eddng u\u1ed1ng<\/em><\/p>\n<p>Vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi c\u00e1c NSAID v\u1edbi thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u0111\u01b0\u1eddng u\u1ed1ng l\u00e0m t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u1eadn tr\u1ecdng. C\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u0111\u01b0\u1eddng u\u1ed1ng bao g\u1ed3m c\u00e1c thu\u1ed1c d\u1ea1ng warfarin\/coumarin v\u00e0 c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u0111\u01b0\u1eddng u\u1ed1ng th\u1ebf h\u1ec7 m\u1edbi (v\u00ed d\u1ee5: apixaban, dabigatran v\u00e0 rivaroxaban). \u0110\u00e3 c\u00f3 b\u00e1o c\u00e1o v\u1ec1 tr\u01b0\u1eddng h\u1ee3p ch\u1ea3y m\u00e1u nghi\u00eam tr\u1ecdng tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi warfarin ho\u1eb7c c\u00e1c ch\u1ea5t t\u01b0\u01a1ng t\u1ef1, trong \u0111\u00f3 c\u00f3 m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p g\u00e2y t\u1eed vong. Do \u0111\u00e3 c\u00f3 b\u00e1o c\u00e1o v\u1ec1 t\u0103ng th\u1eddi gian prothrombin (INR), t\u00e1c d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng\/INR c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng d\u1ea1ng warfarin\/coumarin ho\u1eb7c ch\u1ec9nh li\u1ec1u sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib (xem ph\u1ea7n T\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c v\u00e0 c\u00e1c d\u1ea1ng t\u01b0\u01a1ng t\u00e1c kh\u00e1c).<\/p>\n<p><em>T\u1ed5ng quan<\/em><\/p>\n<p>V\u1edbi t\u00e1c d\u1ee5ng gi\u1ea3m vi\u00eam, celecoxib c\u00f3 th\u1ec3 l\u00e0m m\u1edd c\u00e1c d\u1ea5u hi\u1ec7u ch\u1ea9n \u0111o\u00e1n, v\u00ed d\u1ee5 nh\u01b0 tri\u1ec7u ch\u1ee9ng s\u1ed1t trong ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m tr\u00f9ng.<\/p>\n<p>C\u1ea7n tr\u00e1nh d\u00f9ng \u0111\u1ed3ng th\u1eddi celecoxib v\u1edbi m\u1ed9t thu\u1ed1c NSAID kh\u00f4ng ph\u1ea3i aspirin.<\/p>\n<p><em>\u1ee8c ch\u1ebf CYP 2D6<\/em><\/p>\n<p>Celecoxib cho th\u1ea5y c\u00f3 kh\u1ea3 n\u0103ng \u1ee9c ch\u1ebf CYP2D6 \u1edf m\u1ee9c trung b\u00ecnh. \u0110\u1ed1i v\u1edbi nh\u1eefng thu\u1ed1c \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a b\u1edfi CYP2D6, c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i gi\u1ea3m li\u1ec1u trong th\u1eddi gian b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib ho\u1eb7c t\u0103ng li\u1ec1u khi ng\u01b0ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib (xem ph\u1ea7n T\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c v\u00e0 c\u00e1c d\u1ea1ng t\u01b0\u01a1ng t\u00e1c kh\u00e1c).<\/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>Ch\u01b0a c\u00f3 nghi\u00ean c\u1ee9u v\u1ec1 t\u00e1c \u0111\u1ed9ng c\u1ee7a celecoxib tr\u00ean kh\u1ea3 n\u0103ng l\u00e1i xe v\u00e0 v\u1eadn h\u00e0nh m\u00e1y m\u00f3c nh\u01b0ng d\u1ef1a tr\u00ean c\u00e1c \u0111\u1eb7c t\u00ednh d\u01b0\u1ee3c l\u1ef1c h\u1ecdc v\u00e0 m\u00f4 t\u1ea3 t\u1ed5ng qu\u00e1t v\u1ec1 an to\u00e0n, c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 \u1ea3nh h\u01b0\u1edfng.<\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>4.5 S\u1eed d\u1ee5ng cho ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa:<\/strong><\/p>\n<p><em>X\u1ebfp h\u1ea1ng c\u1ea3nh b\u00e1o<\/em><\/p>\n<p>AU TGA pregnancy category: B3<\/p>\n<p>US FDA pregnancy category: C (30 tu\u00e2\u0300n \u0111\u00e2\u0300u) &#8211; D (tr\u00ean 30 tu\u00e2\u0300n)<\/p>\n<p><em>\u1ea2nh h\u01b0\u1edfng tr\u00ean kh\u1ea3 n\u0103ng sinh s\u1ea3n<\/em><\/p>\n<p>D\u1ef1a tr\u00ean c\u01a1 ch\u1ebf ho\u1ea1t \u0111\u1ed9ng, vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c NSAID, k\u1ec3 c\u1ea3 celecoxib c\u00f3 th\u1ec3 g\u00e2y tr\u00ec ho\u00e3n ho\u1eb7c ng\u0103n c\u1ea3n s\u1ef1 r\u1ee5ng tr\u1ee9ng, li\u00ean quan \u0111\u1ebfn hi\u1ec7n t\u01b0\u1ee3ng v\u00f4 sinh c\u00f3 th\u1ec3 ph\u1ee5c h\u1ed3i \u1edf m\u1ed9t s\u1ed1 ph\u1ee5 n\u1eef. Nh\u1eefng ph\u1ee5 n\u1eef kh\u00f3 th\u1ee5 thai hay \u0111ang ch\u1eefa v\u00f4 sinh, c\u1ea7n c\u00e2n nh\u1eafc vi\u1ec7c ng\u1eebng d\u00f9ng c\u00e1c NSAID, bao g\u1ed3m c\u1ea3 celecoxib.<\/p>\n<p><em>Th\u1eddi k\u1ef3 mang thai:<\/em><\/p>\n<p>Ch\u01b0a c\u00f3 nghi\u00ean c\u1ee9u tr\u00ean ph\u1ee5 n\u1eef c\u00f3 thai. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed9ng v\u1eadt cho th\u1ea5y c\u00f3 \u0111\u1ed9c t\u00ednh tr\u00ean sinh s\u1ea3n (xem ph\u1ea7n C\u00e1c d\u1eef li\u1ec7u an to\u00e0n ti\u1ec1n l\u00e2m s\u00e0ng). Ch\u01b0a c\u00f3 c\u00e1c d\u1eef li\u1ec7u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng tr\u00ean ng\u01b0\u1eddi.<\/p>\n<p>Celecoxib, c\u0169ng nh\u01b0 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p prostaglandin kh\u00e1c, c\u00f3 th\u1ec3 g\u00e2y v\u00f4 l\u1ef1c c\u01a1 t\u1eed cung v\u00e0 \u0111\u00f3ng s\u1edbm \u1ed1ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, kh\u00f4ng n\u00ean d\u00f9ng celecoxib v\u00e0o 3 th\u00e1ng cu\u1ed1i c\u1ee7a thai k\u1ef3.<\/p>\n<p>Ch\u1ec9 n\u00ean d\u00f9ng celecoxib khi mang thai n\u1ebfu l\u1ee3i \u00edch c\u00f3 th\u1ec3 c\u00f3 \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi m\u1eb9 v\u01b0\u1ee3t tr\u1ed9i nguy c\u01a1 ti\u1ec1m t\u00e0ng \u0111\u1ed1i v\u1edbi thai nhi.<\/p>\n<p>\u1ee8c ch\u1ebf t\u1ed5ng h\u1ee3p prostaglandin c\u00f3 th\u1ec3 g\u00e2y \u1ea3nh h\u01b0\u1edfng b\u1ea5t l\u1ee3i cho ph\u1ee5 n\u1eef mang thai. D\u1eef li\u1ec7u t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u d\u1ecbch t\u1ec5 cho th\u1ea5y nguy c\u01a1 s\u1ea3y thai t\u1ef1 ph\u00e1t t\u0103ng l\u00ean sau khi d\u00f9ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p prostaglandin trong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a thai k\u1ef3. D\u00f9ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p prostaglandin tr\u00ean \u0111\u1ed9ng v\u1eadt cho th\u1ea5y nguy c\u01a1 s\u1ea3y thai t\u0103ng l\u00ean \u1edf giai \u0111o\u1ea1n tr\u01b0\u1edbc v\u00e0 sau khi ph\u00f4i l\u00e0m t\u1ed5.<\/p>\n<p><em>Th\u1eddi k\u1ef3 cho con b\u00fa:<\/em><\/p>\n<p>Nghi\u00ean c\u1ee9u tr\u00ean chu\u1ed9t cho th\u1ea5y celecoxib \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft qua s\u1eefa v\u1edbi n\u1ed3ng \u0111\u1ed9 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng. Tr\u00ean ph\u1ee5 n\u1eef cho con b\u00fa d\u00f9ng celecoxib, r\u1ea5t \u00edt celecoxib xu\u1ea5t hi\u1ec7n trong s\u1eefa. V\u00ec c\u00f3 th\u1ec3 c\u00f3 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a celecoxib tr\u00ean tr\u1ebb \u0111ang b\u00fa m\u1eb9, t\u00f9y theo l\u1ee3i \u00edch c\u1ee7a thu\u1ed1c v\u1edbi ng\u01b0\u1eddi m\u1eb9, n\u00ean c\u00e2n nh\u1eafc ng\u1eebng thu\u1ed1c hay ng\u1eebng cho con b\u00fa.<\/p>\n<p><strong>4.6 T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n (ADR):<\/strong><\/p>\n<p><strong><em>D\u1eef li\u1ec7u trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng<\/em><\/strong><\/p>\n<p>C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n (ADR) trong B\u1ea3ng 1 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u1edbi t\u1ec9 l\u1ec7 l\u1edbn h\u01a1n 0,01% \u1edf nh\u00f3m d\u00f9ng celecoxib v\u00e0 cao h\u01a1n so v\u1edbi b\u00e1o c\u00e1o \u1edf nh\u00f3m d\u00f9ng gi\u1ea3 d\u01b0\u1ee3c, trong 12 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1edbi gi\u1ea3 d\u01b0\u1ee3c v\u00e0\/ho\u1eb7c v\u1edbi ho\u1ea1t ch\u1ea5t kh\u00e1c, k\u00e9o d\u00e0i t\u1edbi 12 tu\u1ea7n, d\u00f9ng li\u1ec1u h\u00e0ng ng\u00e0y t\u1eeb 100mg \u0111\u1ebfn 800mg \u1edf ng\u01b0\u1eddi l\u1edbn. T\u1ea7n su\u1ea5t c\u1ee7a c\u00e1c ADR trong B\u1ea3ng 1 \u0111\u01b0\u1ee3c c\u1eadp nh\u1eadt d\u1ef1a tr\u00ean d\u1eef li\u1ec7u t\u1ed5ng h\u1ee3p t\u1eeb 89 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng m\u00f4 t\u1ea3 vi\u1ec7c s\u1eed d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng \u1edf 38.102 b\u1ec7nh nh\u00e2n d\u00f9ng celecoxib. T\u1ea7n su\u1ea5t ADR \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a nh\u01b0 sau: r\u1ea5t th\u01b0\u1eddng g\u1eb7p (&gt; 10%), th\u01b0\u1eddng g\u1eb7p (&gt; 1% v\u00e0 &lt; 10%), \u00edt g\u1eb7p (&gt; 0,1% v\u00e0 &lt; 1%), hi\u1ebfm g\u1eb7p (&gt; 0,01% v\u00e0 &lt; 0,1%), r\u1ea5t hi\u1ebfm g\u1eb7p (&lt; 0,01%). C\u00e1c ADR trong B\u1ea3ng 1 \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea theo h\u1ec7 c\u01a1 quan v\u00e0 x\u1ebfp th\u1ee9 t\u1ef1 theo t\u1ea7n su\u1ea5t gi\u1ea3m d\u1ea7n.<\/p>\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\"><strong>B\u1ea3ng 1. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a thu\u1ed1c (ADR) trong 12 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1edbi gi\u1ea3 d\u01b0\u1ee3c v\u00e0\/ho\u1eb7c v\u1edbi ho\u1ea1t ch\u1ea5t kh\u00e1c, v\u00e0 t\u1ea7n su\u1ea5t ADR t\u1eeb 89 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean, c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1ec1 \u0111au v\u00e0 vi\u00eam v\u1edbi li\u1ec1u h\u00e0ng ng\u00e0y t\u1eeb 25mg &#8211; 800mg \u1edf nh\u00f3m \u0111\u1ed1i t\u01b0\u1ee3ng ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>H\u1ec7 c\u01a1 quan<\/strong><\/td>\n<td><strong>T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/strong><\/td>\n<\/tr>\n<tr>\n<td>T\u1ea7n su\u1ea5t<\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>Nhi\u1ec5m tr\u00f9ng<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Vi\u00eam ph\u1ebf qu\u1ea3n, vi\u00eam xoang, nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean, nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u<\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td>Vi\u00eam h\u1ecdng, vi\u00eam m\u0169i<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>R\u1ed1i lo\u1ea1n m\u00e1u v\u00e0 h\u1ec7 b\u1ea1ch huy\u1ebft<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td>Thi\u1ebfu m\u00e1u<\/td>\n<\/tr>\n<tr>\n<td>Hi\u1ebfm g\u1eb7p<\/td>\n<td>Gi\u1ea3m ti\u1ec3u c\u1ea7u<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>R\u1ed1i lo\u1ea1n h\u1ec7 mi\u1ec5n d\u1ecbch<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td>Qu\u00e1 m\u1eabn<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>R\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>M\u1ea5t ng\u1ee7<\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td>Lo l\u1eafng<\/td>\n<\/tr>\n<tr>\n<td>Hi\u1ebfm g\u1eb7p<\/td>\n<td>Tr\u1ea1ng th\u00e1i l\u00fa l\u1eabn<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>R\u1ed1i lo\u1ea1n th\u1ea7n kinh<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Ch\u00f3ng m\u1eb7t<\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td>T\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1, bu\u1ed3n ng\u1ee7<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>R\u1ed1i lo\u1ea1n m\u1eaft<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td>Nh\u00ecn m\u1edd<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>R\u1ed1i lo\u1ea1n tai v\u00e0 tai trong<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Kh\u00f4ng th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>\u00d9 tai<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>R\u1ed1i lo\u1ea1n tim<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td>Tim \u0111\u1eadp nhanh<\/td>\n<\/tr>\n<tr>\n<td>Hi\u1ebfm g\u1eb7p<\/td>\n<td>Suy tim sung huy\u1ebft, lo\u1ea1n nh\u1ecbp, tim \u0111\u1eadp nhanh<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>R\u1ed1i lo\u1ea1n m\u1ea1ch m\u00e1u<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>T\u0103ng huy\u1ebft \u00e1p (bao g\u1ed3m c\u1ea3 t\u0103ng huy\u1ebft \u00e1p n\u1eb7ng h\u01a1n)<\/td>\n<\/tr>\n<tr>\n<td>Hi\u1ebfm g\u1eb7p<\/td>\n<td>\u0110\u1ecf m\u1eb7t<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>R\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p, v\u00f9ng ng\u1ef1c v\u00e0 trung th\u1ea5t<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Ho<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>N\u00f4n m\u1eeda, \u0111au b\u1ee5ng, ti\u00eau ch\u1ea3y, kh\u00f3 ti\u00eau, \u0111\u1ea7y b\u1ee5ng<\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td>Lo\u00e9t d\u1ea1 d\u00e0y, r\u1ed1i lo\u1ea1n v\u1ec1 r\u0103ng<\/td>\n<\/tr>\n<tr>\n<td>Hi\u1ebfm g\u1eb7p<\/td>\n<td>Lo\u00e9t t\u00e1 tr\u00e0ng, lo\u00e9t th\u1ef1c qu\u1ea3n<\/td>\n<\/tr>\n<tr>\n<td>R\u1ea5t hi\u1ebfm g\u1eb7p<\/td>\n<td>Th\u1ee7ng ru\u1ed9t, vi\u00eam t\u1ee5y<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>R\u1ed1i lo\u1ea1n gan m\u1eadt<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td>Men gan t\u0103ng (bao g\u1ed3m c\u1ea3 t\u0103ng alanin aminotransferase v\u00e0 t\u0103ng aspartat aminotransferase)<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>R\u1ed1i lo\u1ea1n da v\u00e0 m\u00f4 d\u01b0\u1edbi da<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Ng\u1ee9a (bao g\u1ed3m c\u1ea3 ng\u1ee9a to\u00e0n th\u00e2n), ph\u00e1t ban<\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td>M\u00e0y \u0111ay, b\u1ea7m m\u00e1u<\/td>\n<\/tr>\n<tr>\n<td>Hi\u1ebfm g\u1eb7p<\/td>\n<td>Ph\u00f9 m\u1ea1ch, r\u1ee5ng t\u00f3c<\/td>\n<\/tr>\n<tr>\n<td>R\u1ea5t hi\u1ebfm g\u1eb7p<\/td>\n<td>Vi\u00eam da b\u1ecdng n\u01b0\u1edbc<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>R\u1ed1i lo\u1ea1n to\u00e0n th\u00e2n v\u00e0 t\u1ea1i ch\u1ed7<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Ph\u00f9 ngo\u1ea1i bi\u00ean<\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td>Ph\u00f9 m\u1eb7t, b\u1ec7nh gi\u1ed1ng c\u00fam<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>T\u1ed5n th\u01b0\u01a1ng, nhi\u1ec5m \u0111\u1ed9c v\u00e0 t\u00ecnh tr\u1ea1ng do th\u1ee7 thu\u1eadt<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td>T\u1ed5n th\u01b0\u01a1ng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a thu\u1ed1c* th\u00eam v\u00e0o trong B\u1ea3ng 2 d\u01b0\u1edbi \u0111\u00e2y \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u1edbi t\u1ec9 l\u1ec7 x\u1ea3y ra l\u1edbn h\u01a1n so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c trong nghi\u00ean c\u1ee9u ph\u00f2ng ng\u1eeba polyp k\u00e9o d\u00e0i t\u1edbi 3 n\u0103m v\u1edbi li\u1ec1u h\u00e0ng ng\u00e0y t\u1eeb 400mg \u0111\u1ebfn 800mg (xem ph\u1ea7n An to\u00e0n tr\u00ean tim m\u1ea1ch \u2013 Th\u1eed nghi\u1ec7m d\u00e0i ng\u00e0y tr\u00ean b\u1ec7nh nh\u00e2n b\u1ecb polyp u tuy\u1ebfn r\u1ea3i r\u00e1c). T\u1ea7n su\u1ea5t c\u1ee7a ADR trong B\u1ea3ng 2 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh d\u1ef1a tr\u00ean c\u00e1c nghi\u00ean c\u1ee9u ph\u00f2ng ng\u1eeba polyp l\u00e2u d\u00e0i n\u00e0y v\u00e0 \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a: r\u1ea5t th\u01b0\u1eddng g\u1eb7p (&gt; 10%), th\u01b0\u1eddng g\u1eb7p (&gt; 1% v\u00e0 &lt; 10%), \u00edt g\u1eb7p (&gt; 0,1% v\u00e0 &lt; 1%). C\u00e1c ADR trong B\u1ea3ng 2 \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea theo h\u1ec7 c\u01a1 quan v\u00e0 x\u1ebfp th\u1ee9 t\u1ef1 theo t\u1ea7n su\u1ea5t gi\u1ea3m d\u1ea7n.<\/p>\n<table>\n<tbody>\n<tr>\n<td colspan=\"3\"><strong>B\u1ea3ng 2. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a thu\u1ed1c trong nghi\u00ean c\u1ee9u ph\u00f2ng ng\u1eeba polyp k\u00e9o d\u00e0i t\u1edbi 3 n\u0103m v\u1edbi li\u1ec1u h\u00e0ng ng\u00e0y t\u1eeb 400mg &#8211; 800mg<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><strong>H\u1ec7 c\u01a1 quan<\/strong><\/td>\n<td><strong>T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\">T\u1ea7n su\u1ea5t<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>Nhi\u1ec5m tr\u00f9ng<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td colspan=\"2\">Nhi\u1ec5m khu\u1ea9n tai, nhi\u1ec5m n\u1ea5m**<\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td colspan=\"2\">Nhi\u1ec5m Helicobacter, Herpes zoster, vi\u00eam qu\u1ea7ng, nhi\u1ec5m khu\u1ea9n v\u1ebft th\u01b0\u01a1ng, vi\u00eam l\u1ee3i, vi\u00eam tai trong, nhi\u1ec5m khu\u1ea9n<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>U t\u00e2n sinh l\u00e0nh t\u00ednh, \u00e1c t\u00ednh, v\u00e0 ch\u01b0a ph\u00e2n lo\u1ea1i<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td colspan=\"2\">u m\u1ee1<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>R\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td colspan=\"2\">R\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>R\u1ed1i lo\u1ea1n th\u1ea7n kinh<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td colspan=\"2\">Nh\u1ed3i m\u00e1u n\u00e3o<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>R\u1ed1i lo\u1ea1n m\u1eaft<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td colspan=\"2\">Xu\u1ea5t huy\u1ebft k\u1ebft m\u1ea1c, th\u1ea5y \u0111\u1ed1m \u0111en bay tr\u01b0\u1edbc m\u1eaft (vitreous floaters)<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>R\u1ed1i lo\u1ea1n tai v\u00e0 tai trong<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td colspan=\"2\">Gi\u1ea3m th\u00ednh l\u1ef1c<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>R\u1ed1i lo\u1ea1n tim<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td colspan=\"2\">Nh\u1ed3i m\u00e1u c\u01a1 tim, \u0111au th\u1eaft ng\u1ef1c<\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td colspan=\"2\">\u0110au th\u1eaft ng\u1ef1c th\u1ec3 kh\u00f4ng \u1ed5n \u0111\u1ecbnh, thi\u1ec3u n\u0103ng van \u0111\u1ed9ng m\u1ea1ch, x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, nh\u1ecbp tim ch\u1eadm xoang, ph\u00ec \u0111\u1ea1i t\u00e2m th\u1ea5t<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>R\u1ed1i lo\u1ea1n m\u1ea1ch m\u00e1u<\/strong><\/td>\n<\/tr>\n<tr>\n<td>R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td colspan=\"2\">T\u0103ng huy\u1ebft \u00e1p*<\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td colspan=\"2\">Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u, t\u1ee5 m\u00e1u<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>R\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p, v\u00f9ng ng\u1ef1c v\u00e0 trung th\u1ea5t<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\">Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Kh\u00f3 th\u1edf<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\">\u00cdt g\u1eb7p<\/td>\n<td>Kh\u00f3 ph\u00e1t \u00e2m<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\">R\u1ea5t th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Ti\u00eau ch\u1ea3y*<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\">Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>N\u00f4n m\u1eeda*, kh\u00f3 nu\u1ed1t, h\u1ed9i ch\u1ee9ng ru\u1ed9t k\u00edch th\u00edch, b\u1ec7nh tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y th\u1ef1c qu\u1ea3n, bu\u1ed3n n\u00f4n, chi nang<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\">\u00cdt g\u1eb7p<\/td>\n<td>Tr\u0129 xu\u1ea5t huy\u1ebft, ru\u1ed9t co b\u00f3p th\u01b0\u1eddng xuy\u00ean, lo\u00e9t mi\u1ec7ng, vi\u00eam d\u1ea1 d\u00e0y<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>R\u1ed1i lo\u1ea1n gan m\u1eadt<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\">Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td>Men gan t\u0103ng (bao g\u1ed3m c\u1ea3 t\u0103ng alanin aminotransferase v\u00e0 t\u0103ng aspartat aminotransferase)*<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>R\u1ed1i lo\u1ea1n da v\u00e0 m\u00f4 d\u01b0\u1edbi da<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td colspan=\"2\">Vi\u00eam da d\u1ecb \u1ee9ng<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>R\u1ed1i lo\u1ea1n c\u01a1 x\u01b0\u01a1ng v\u00e0 m\u00f4 li\u00ean k\u1ebft<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td colspan=\"2\">Co th\u1ea5t c\u01a1<\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td colspan=\"2\">U nang bao ho\u1ea1t d\u1ecbch<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>R\u1ed1i lo\u1ea1n th\u1eadn v\u00e0 ti\u1ebft ni\u1ec7u<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td colspan=\"2\">S\u1ecfi th\u1eadn<\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td colspan=\"2\">\u0110i ti\u1ec3u \u0111\u00eam<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>R\u1ed1i lo\u1ea1n tuy\u1ebfn v\u00fa v\u00e0 h\u1ec7 sinh s\u1ea3n<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td colspan=\"2\">Xu\u1ea5t huy\u1ebft \u00e2m \u0111\u1ea1o, vi\u00eam ti\u1ec1n li\u1ec7t tuy\u1ebfn, t\u0103ng s\u1ea3n ti\u1ec1n li\u1ec7t tuy\u1ebfn l\u00e0nh t\u00ednh<\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td colspan=\"2\">Nang bu\u1ed3ng tr\u1ee9ng, c\u00e1c tri\u1ec7u ch\u1ee9ng t\u1eaft kinh, c\u0103ng ng\u1ef1c, th\u1ed1ng kinh<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>R\u1ed1i lo\u1ea1n to\u00e0n th\u00e2n v\u00e0 t\u1ea1i ch\u1ed7<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td colspan=\"2\">Ph\u00f9<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>Th\u0103m kh\u00e1m<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Th\u01b0\u1eddng g\u1eb7p<\/td>\n<td colspan=\"2\">T\u0103ng creatinin m\u00e1u, t\u0103ng kh\u00e1ng nguy\u00ean \u0111\u1eb7c hi\u1ec7u ti\u1ec1n li\u1ec7t, t\u0103ng c\u00e2n<\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td colspan=\"2\">T\u0103ng kali m\u00e1u, t\u0103ng natri m\u00e1u, gi\u1ea3m testosteron m\u00e1u, gi\u1ea3m t\u1ef7 l\u1ec7 h\u1ed3ng c\u1ea7u, t\u0103ng hemoglobin<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><strong>T\u1ed5n th\u01b0\u01a1ng, nhi\u1ec5m \u0111\u1ed9c v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng do th\u1ee7 thu\u1eadt<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\u00cdt g\u1eb7p<\/td>\n<td colspan=\"2\">G\u1eaby b\u00e0n ch\u00e2n, g\u1eaby chi d\u01b0\u1edbi, g\u1eaby x\u01b0\u01a1ng, vi\u00eam m\u1ecfm g\u00f2 x\u01b0\u01a1ng, \u0111\u1ee9t g\u00e2n<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\">* T\u0103ng huy\u1ebft \u00e1p, n\u00f4n m\u1eeda, ti\u00eau ch\u1ea3y v\u00e0 t\u0103ng men gan \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea trong B\u1ea3ng 2 v\u00ec nh\u1eefng bi\u1ebfn c\u1ed1 n\u00e0y c\u00f3 t\u1ea7n su\u1ea5t cao h\u01a1n trong c\u00e1c nghi\u00ean c\u1ee9u k\u00e9o d\u00e0i t\u1edbi 3 n\u0103m, so v\u1edbi B\u1ea3ng 1 bao g\u1ed3m nh\u1eefng t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n trong c\u00e1c nghi\u00ean c\u1ee9u ch\u1ec9 k\u00e9o d\u00e0i 12 tu\u1ea7n.<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\">** Ch\u1ee7 y\u1ebfu l\u00e0 nhi\u1ec5m n\u1ea5m t\u1ea1i ch\u1ed7.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong><em>C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o sau khi \u0111\u01b0a thu\u1ed1c ra th\u1ecb tr\u01b0\u1eddng<\/em><\/strong><\/p>\n<p>C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c sau khi \u0111\u01b0a thu\u1ed1c ra th\u1ecb tr\u01b0\u1eddng \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y d\u01b0\u1edbi \u0111\u00e2y. M\u1eb7c d\u00f9 c\u00e1c ph\u1ea3n \u1ee9ng n\u00e0y \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh t\u1eeb c\u00e1c b\u00e1o c\u00e1o sau l\u01b0u h\u00e0nh, d\u1eef li\u1ec7u th\u1eed nghi\u1ec7m \u0111\u00e3 \u0111\u01b0\u1ee3c tham kh\u1ea3o \u0111\u1ec3 \u01b0\u1edbc t\u00ednh t\u1ea7n su\u1ea5t. Nh\u01b0 \u0111\u00e3 n\u00eau tr\u00ean, t\u1ea7n su\u1ea5t \u0111\u01b0\u1ee3c d\u1ef1a tr\u00ean t\u1eadp h\u1ee3p c\u00e1c th\u1eed nghi\u1ec7m m\u00f4 t\u1ea3 vi\u1ec7c d\u00f9ng thu\u1ed1c tr\u00ean 38.102 b\u1ec7nh nh\u00e2n. T\u1ea7n su\u1ea5t \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a nh\u01b0 sau: r\u1ea5t th\u01b0\u1eddng g\u1eb7p (&gt; 10%)<sub>;<\/sub>\u00a0th\u01b0\u1eddng g\u1eb7p (&gt; 1% v\u00e0 &lt; 10%), \u00edt g\u1eb7p (&gt; 0,1% v\u00e0 &lt; 1%), hi\u1ebfm g\u1eb7p (&gt; 0,01% va &lt; 0,1%), r\u1ea5t hi\u1ebfm g\u1eb7p (&lt; 0,01%), kh\u00f4ng r\u00f5 (kh\u00f4ng th\u1ec3 \u01b0\u1edbc l\u01b0\u1ee3ng t\u1eeb d\u1eef li\u1ec7u c\u00f3 s\u1eb5n).<\/p>\n<p><em>R\u1ed1i lo\u1ea1n h\u1ec7 mi\u1ec5n d\u1ecbch:\u00a0<\/em>R\u1ea5t hi\u1ebfm g\u1eb7p: ph\u1ea3n \u1ee9ng ph\u1ea3n v\u1ec7.<\/p>\n<p><em>R\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n:<\/em>\u00a0Hi\u1ebfm g\u1eb7p: \u1ea3o gi\u00e1c<\/p>\n<p><em>R\u1ed1i lo\u1ea1n th\u1ea7n kinh:\u00a0<\/em>R\u1ea5t hi\u1ebfm g\u1eb7p: xu\u1ea5t huy\u1ebft n\u00e3o, vi\u00eam m\u00e0ng n\u00e3o v\u00f4 khu\u1ea9n, m\u1ea5t v\u1ecb gi\u00e1c, m\u1ea5t kh\u1ee9u gi\u00e1c.<\/p>\n<p><em>R\u1ed1i lo\u1ea1n m\u1eaft:<\/em>\u00a0\u00cdt g\u1eb7p: vi\u00eam k\u1ebft m\u1ea1c<\/p>\n<p><em>R\u1ed1i lo\u1ea1n m\u1ea1ch m\u00e1u:\u00a0<\/em>R\u1ea5t hi\u1ebfm g\u1eb7p: vi\u00eam m\u1ea1ch.<\/p>\n<p><em>R\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p, v\u00f9ng ng\u1ef1c v\u00e0 trung th\u1ea5t:\u00a0<\/em>Hi\u1ebfm g\u1eb7p: ngh\u1ebdn m\u1ea1ch ph\u1ed5i, vi\u00eam ph\u1ed5i.<\/p>\n<p><em>R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a:\u00a0<\/em>Hi\u1ebfm g\u1eb7p: xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a<\/p>\n<p><em>R\u1ed1i lo\u1ea1n gan m\u1eadt:<\/em>\u00a0Hi\u1ebfm g\u1eb7p: vi\u00eam gan; R\u1ea5t hi\u1ebfm g\u1eb7p: suy gan, vi\u00eam gan k\u1ecbch ph\u00e1t, ho\u1ea1i t\u1eed gan (xem ph\u1ea7n c\u00e1c t\u00e1c \u0111\u1ed9ng tr\u00ean gan) \u1ee9 m\u1eadt, vi\u00eam gan t\u1eafc m\u1eadt, b\u1ec7nh v\u00e0ng da<\/p>\n<p><em>R\u1ed1i lo\u1ea1n da v\u00e0 m\u00f4 d\u01b0\u1edbi da:\u00a0<\/em>Hi\u1ebfm g\u1eb7p: ph\u1ea3n \u1ee9ng nh\u1ea1y c\u1ea3m v\u1edbi \u00e1nh s\u00e1ng; R\u1ea5t hi\u1ebfm g\u1eb7p: h\u1ed9i ch\u1ee9ng Stevens-Johnson, h\u1ed3ng ban \u0111a d\u1ea1ng, ho\u1ea1i t\u1eed bi\u1ec3u b\u00ec nhi\u1ec5m \u0111\u1ed9c, ph\u1ea3n \u1ee9ng do thu\u1ed1c k\u00e8m theo t\u0103ng b\u1ea1ch c\u1ea7u \u01b0a eosin v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n (DRESS ho\u1eb7c h\u1ed9i ch\u1ee9ng qu\u00e1 m\u1eabn), ngo\u1ea1i ban m\u1ee5n m\u1ee7 to\u00e0n th\u00e2n c\u1ea5p t\u00ednh (AGEP), vi\u00eam da tr\u00f3c v\u1ea3y.<\/p>\n<p><em>R\u1ed1i lo\u1ea1n th\u1eadn v\u00e0 ti\u1ebft ni\u1ec7u:\u00a0<\/em>Hi\u1ebfm g\u1eb7p: suy th\u1eadn c\u1ea5p (xem ph\u1ea7n C\u00e1c t\u00e1c \u0111\u1ed9ng tr\u00ean th\u1eadn), gi\u1ea3m natri m\u00e1u; R\u1ea5t hi\u1ebfm g\u1eb7p: vi\u00eam th\u1eadn k\u1ebd, h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0, vi\u00eam c\u1ea7u th\u1eadn sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u.<\/p>\n<p><em>R\u1ed1i lo\u1ea1n tuy\u1ebfn v\u00fa v\u00e0 h\u1ec7 sinh s\u1ea3n:\u00a0<\/em>Hi\u1ebfm g\u1eb7p: r\u1ed1i lo\u1ea1n kinh nguy\u1ec7t; Ch\u01b0a x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c: r\u1ed1i lo\u1ea1n kh\u1ea3 n\u0103ng sinh s\u1ea3n \u1edf n\u1eef gi\u1edbi (b\u1ec7nh suy gi\u1ea3m kh\u1ea3 n\u0103ng sinh s\u1ea3n \u1edf n\u1eef gi\u1edbi) (xem ph\u1ea7n \u1ea2nh h\u01b0\u1edfng tr\u00ean kh\u1ea3 n\u0103ng sinh s\u1ea3n, ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa).<\/p>\n<p><em>R\u1ed1i lo\u1ea1n to\u00e0n th\u00e2n v\u00e0 t\u1ea1i ch\u1ed7:<\/em>\u00a0\u00cdt g\u1eb7p: \u0111au ng\u1ef1c<\/p>\n<p>Ph\u1ee5 n\u1eef c\u00f3 \u00fd \u0111\u1ecbnh mang thai \u0111\u01b0\u1ee3c lo\u1ea1i kh\u1ecfi t\u1ea5t c\u1ea3 c\u00e1c th\u1eed nghi\u1ec7m, do \u0111\u00f3 tham kh\u1ea3o c\u01a1 s\u1edf d\u1eef li\u1ec7u th\u1eed nghi\u1ec7m v\u1ec1 t\u1ea7n su\u1ea5t c\u1ee7a tr\u01b0\u1eddng h\u1ee3p n\u00e0y l\u00e0 kh\u00f4ng h\u1ee3p l\u00fd.<\/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<p><strong>4.7 H\u01b0\u1edbng d\u1eabn c\u00e1ch x\u1eed tr\u00ed ADR:<\/strong><\/p>\n<p>N\u1ebfu c\u00f3 bi\u1ec3u hi\u1ec7n \u0111\u1ed9c h\u1ea1i th\u1eadn trong khi \u0111i\u1ec1u tr\u1ecb celecoxib, c\u1ea7n ph\u1ea3i ng\u1eebng thu\u1ed1c, th\u01b0\u1eddng ch\u1ee9c n\u0103ng th\u1eadn s\u1ebd tr\u1edf v\u1ec1 m\u1ee9c tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb thu\u1ed1c.<\/p>\n<p>Test gan c\u00f3 th\u1ec3 t\u0103ng (g\u1ea5p 3 l\u1ea7n m\u1ee9c b\u00ecnh th\u01b0\u1eddng \u1edf gi\u1edbi h\u1ea1n cao). S\u1ef1 t\u0103ng n\u00e0y c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n, ho\u1eb7c kh\u00f4ng thay \u0111\u1ed5i ho\u1eb7c ch\u1ec9 t\u1ea1m th\u1eddi trong m\u1ed9t th\u1eddi gian khi ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb. Nh\u01b0ng n\u1ebfu c\u00f3 bi\u1ec3u hi\u1ec7n n\u1eb7ng c\u1ee7a vi\u00eam gan (v\u00e0ng da, bi\u1ec3u hi\u1ec7n suy gan&#8230;) ph\u1ea3i ng\u1eebng ngay thu\u1ed1c.<\/p>\n<p>N\u00f3i chung, khi d\u00f9ng v\u1edbi li\u1ec1u th\u00f4ng th\u01b0\u1eddng v\u00e0 ng\u1eafn ng\u00e0y, celecoxib dung n\u1ea1p t\u1ed1t.<\/p>\n<p><strong>4.8 T\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c:<\/strong><\/p>\n<p><strong><em>T\u1ed5ng quan<\/em><\/strong><\/p>\n<p>Celecoxib ch\u1ee7 y\u1ebfu chuy\u1ec3n h\u00f3a qua cytocrom P450 (CYP) 2C9 t\u1ea1i gan. C\u1ea7n th\u1eadn tr\u1ecdng khi d\u00f9ng celecoxib tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u00e3 bi\u1ebft ho\u1eb7c nghi ng\u1edd chuy\u1ec3n h\u00f3a qua CYP2C9 k\u00e9m d\u1ef1a tr\u00ean ti\u1ec1n s\u1eed v\u1edbi c\u00e1c c\u01a1 ch\u1ea5t kh\u00e1c c\u1ee7a CYP2C9 v\u00ec n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong huy\u1ebft t\u01b0\u01a1ng c\u00f3 th\u1ec3 cao b\u1ea5t th\u01b0\u1eddng do gi\u1ea3m \u0111\u1ed9 thanh th\u1ea3i chuy\u1ec3n h\u00f3a. N\u00ean b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec1u b\u1eb1ng m\u1ed9t n\u1eeda li\u1ec1u khuy\u1ebfn ngh\u1ecb (xem ph\u1ea7n Li\u1ec1u l\u01b0\u1ee3ng v\u00e0 c\u00e1ch d\u00f9ng v\u00e0 Chuy\u1ec3n h\u00f3a).<\/p>\n<p>Vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi celecoxib v\u1edbi c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf CYP2C9 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn vi\u1ec7c t\u0103ng n\u1ed3ng \u0111\u1ed9 celecoxib trong huy\u1ebft t\u01b0\u01a1ng. V\u00ec v\u1eady, c\u00f3 th\u1ec3 c\u1ea7n gi\u1ea3m li\u1ec1u celecoxib khi celecoxib \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf CYP2C9.<\/p>\n<p>Vi\u1ec7c s\u1eed d\u1ee5ng celecoxib \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c ch\u1ea5t c\u1ea3m \u1ee9ng CYP2C9 nh\u01b0 rifampicin, carbamazepin v\u00e0 barbiturat c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn vi\u1ec7c gi\u1ea3m n\u1ed3ng \u0111\u1ed9 celecoxib trong huy\u1ebft t\u01b0\u01a1ng. V\u00ec v\u1eady, c\u00f3 th\u1ec3 c\u1ea7n t\u0103ng li\u1ec1u celecoxib khi celecoxib \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c ch\u1ea5t c\u1ea3m \u1ee9ng CYP2C9.<\/p>\n<p>Nghi\u00ean c\u1ee9u d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc v\u00e0 nghi\u00ean c\u1ee9u in vitro cho th\u1ea5y m\u1eb7c d\u00f9 celecoxib kh\u00f4ng ph\u1ea3i l\u00e0 c\u01a1 ch\u1ea5t nh\u01b0ng n\u00f3 c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf CYP2D6. Do \u0111\u00f3 c\u00f3 th\u1ec3 c\u00f3 t\u01b0\u01a1ng t\u00e1c in vivo gi\u1eefa celecoxib v\u1edbi c\u00e1c thu\u1ed1c chuy\u1ec3n h\u00f3a b\u1edfi CYP2D6.<\/p>\n<p><strong><em>V\u1edbi c\u00e1c thu\u1ed1c c\u1ee5 th\u1ec3<\/em><\/strong><\/p>\n<p><em>T\u01b0\u01a1ng t\u00e1c gi\u1eefa celecoxib v\u00e0 warfarin ho\u1eb7c c\u00e1c thu\u1ed1c t\u01b0\u01a1ng t\u1ef1:\u00a0<\/em>(xem ph\u1ea7n S\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u0111\u01b0\u1eddng u\u1ed1ng).<\/p>\n<p><em>Lithium:<\/em>\u00a0\u1ede \u0111\u1ed1i t\u01b0\u1ee3ng kh\u1ecfe m\u1ea1nh, n\u1ed3ng \u0111\u1ed9 lithium trong huy\u1ebft t\u01b0\u01a1ng t\u0103ng kho\u1ea3ng 17% khi d\u00f9ng \u0111\u1ed3ng th\u1eddi lithium v\u00e0 celecoxib. C\u1ea7n theo d\u00f5i ch\u1eb7t ch\u1ebd b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng lithium khi d\u00f9ng celecoxib ho\u1eb7c ng\u1eebng d\u00f9ng celecoxib.<\/p>\n<p><em>Aspirin:\u00a0<\/em>Celecoxib kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u00e1c \u0111\u1ed9ng kh\u00e1ng ti\u1ec3u c\u1ea7u c\u1ee7a aspirin li\u1ec1u th\u1ea5p (xem ph\u1ea7n C\u00e1c t\u00e1c \u0111\u1ed9ng tr\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a). V\u00ec kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng tr\u00ean ti\u1ec3u c\u1ea7u, celecoxib kh\u00f4ng ph\u1ea3i l\u00e0 ch\u1ea5t thay th\u1ebf cho aspirin trong \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng b\u1ec7nh tim m\u1ea1ch.<\/p>\n<p><em>C\u00e1c thu\u1ed1c ch\u1ed1ng t\u0103ng huy\u1ebft \u00e1p bao g\u1ed3m c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf men chuy\u1ec3n angiotensin (ACEI), ch\u1ea5t \u0111\u1ed1i kh\u00e1ng angiotensin II (c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin, ARB), c\u00e1c thu\u1ed1c l\u1ee3i ti\u1ec3u v\u00e0 c\u00e1c thu\u1ed1c ch\u1eb9n beta:\u00a0<\/em>Vi\u1ec7c \u1ee9c ch\u1ebf prostaglandin c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c thu\u1ed1c ch\u1ed1ng t\u0103ng huy\u1ebft \u00e1p bao g\u1ed3m ACEI v\u00e0\/ho\u1eb7c ARB, thu\u1ed1c l\u1ee3i ti\u1ec3u v\u00e0 thu\u1ed1c ch\u1eb9n beta, c\u1ea7n l\u01b0u \u00fd t\u01b0\u01a1ng t\u00e1c n\u00e0y khi d\u00f9ng \u0111\u1ed3ng th\u1eddi celecoxib v\u1edbi ACEI v\u00e0\/ho\u1eb7c ARB, thu\u1ed1c l\u1ee3i ti\u1ec3u v\u00e0 thu\u1ed1c ch\u1eb9n beta.<\/p>\n<p>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n cao tu\u1ed5i, b\u1ecb gi\u1ea3m th\u1ec3 d\u1ecbch (bao g\u1ed3m c\u1ea3 nh\u1eefng ng\u01b0\u1eddi \u0111ang d\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u) ho\u1eb7c b\u1ecb t\u1ed5n th\u01b0\u01a1ng ch\u1ee9c n\u0103ng th\u1eadn, vi\u1ec7c d\u00f9ng \u0111\u1ed3ng th\u1eddi thu\u1ed1c NSAID, bao g\u1ed3m thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc COX-2, v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n angiotensin, c\u00e1c ch\u1ea5t \u0111\u1ed1i kh\u00e1ng angiotensin II ho\u1eb7c thu\u1ed1c l\u1ee3i ti\u1ec3u c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1ed5n h\u1ea1i ch\u1ee9c n\u0103ng th\u1eadn bao g\u1ed3m suy th\u1eadn c\u1ea5p t\u00ednh. C\u00e1c t\u00e1c d\u1ee5ng n\u00e0y th\u01b0\u1eddng c\u00f3 th\u1ec3 ph\u1ee5c h\u1ed3i. V\u00ec v\u1eady, c\u1ea7n th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi nh\u1eefng thu\u1ed1c n\u00e0y. C\u1ea7n cho b\u1ec7nh nh\u00e2n u\u1ed1ng n\u01b0\u1edbc \u0111\u1ea7y \u0111\u1ee7 v\u00e0 v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng c\u1ea7n theo d\u00f5i, \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p v\u00e0 \u0111\u00e1nh gi\u00e1 theo \u0111\u1ecbnh k\u1ef3 sau \u0111\u00f3.<\/p>\n<p><em>K\u1ebft qu\u1ea3 t\u1eeb nghi\u00ean c\u1ee9u lisinopril:\u00a0<\/em>Trong m\u1ed9t nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng k\u00e9o d\u00e0i 28 ng\u00e0y \u1edf b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p giai \u0111o\u1ea1n I v\u00e0 II \u0111\u1ed1i ch\u1ee9ng b\u1eb1ng lisinopril, k\u1ebft qu\u1ea3 c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng celecoxib 200mg hai l\u1ea7n m\u1ed7i ng\u00e0y cho th\u1ea5y huy\u1ebft \u00e1p t\u00e2m thu ho\u0103c t\u00e2m tr\u01b0\u01a1ng trung b\u00ecnh h\u1eb1ng ng\u00e0y, \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p theo d\u00f5i huy\u1ebft \u00e1p l\u01b0u \u0111\u1ed9ng 24 gi\u1edd, kh\u00f4ng t\u0103ng c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng khi so s\u00e1nh v\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng gi\u1ea3 d\u01b0\u1ee3c. Trong nh\u1eefng b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi celecoxib 200mg hai l\u1ea7n m\u1ed7i ng\u00e0y, 48% \u0111\u01b0\u1ee3c xem l\u00e0 kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi lisinopril v\u00e0o l\u1ea7n th\u0103m kh\u00e1m cu\u1ed1i c\u00f9ng (ngh\u0129a l\u00e0 huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng &gt;90mmHg ho\u1eb7c huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng t\u0103ng &gt;10% so v\u1edbi m\u1ee9c c\u01a1 s\u1edf), so v\u1edbi 27% \u1edf b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi gi\u1ea3 d\u01b0\u1ee3c; s\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0y c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t th\u1ed1ng k\u00ea.<\/p>\n<p><em>Cyclosporin:\u00a0<\/em>Do c\u00f3 t\u00e1c d\u1ee5ng tr\u00ean prostaglandin th\u1eadn, c\u00e1c NSAID c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 nhi\u1ec5m \u0111\u1ed9c th\u1eadn do cyclosporin.<\/p>\n<p><em>Fluconazol v\u00e0 ketoconazol:\u00a0<\/em>D\u00f9ng \u0111\u1ed3ng th\u1eddi fluconazol li\u1ec1u 200mg, 1 l\u1ea7n\/ng\u00e0y l\u00e0m t\u0103ng g\u1ea5p \u0111\u00f4i n\u1ed3ng \u0111\u1ed9 celecoxib trong huy\u1ebft t\u01b0\u01a1ng. Vi\u1ec7c t\u0103ng l\u00ean n\u00e0y l\u00e0 do t\u00e1c \u0111\u1ed9ng \u1ee9c ch\u1ebf s\u1ef1 chuy\u1ec3n h\u00f3a c\u1ee7a celecoxib qua CYP P450 2C9 b\u1edfi fluconazol. Celecoxib n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u1edbi li\u1ec1u b\u1eb1ng m\u1ed9t n\u1eeda li\u1ec1u khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng fluconazol, m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf CYP2C9 (xem ph\u1ea7n Li\u1ec1u d\u00f9ng v\u00e0 c\u00e1ch d\u00f9ng). Ketoconazol, m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf CYP3A4, kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf chuy\u1ec3n h\u00f3a celecoxib \u0111\u00e1ng k\u1ec3 tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n<p><em>Dextromethorphan v\u00e0 metoprolol:\u00a0<\/em>S\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi celecoxib 200mg hai l\u1ea7n m\u1ed7i ng\u00e0y d\u1eabn \u0111\u1ebfn vi\u1ec7c t\u0103ng l\u1ea7n l\u01b0\u1ee3t 2,6 l\u1ea7n v\u00e0 1,5 l\u1ea7n n\u1ed3ng \u0111\u1ed9 dextromethorphan v\u00e0 metoprolol trong huy\u1ebft t\u01b0\u01a1ng (c\u01a1 ch\u1ea5t c\u1ee7a CYP2D6). Vi\u1ec7c t\u0103ng l\u00ean n\u00e0y l\u00e0 do s\u1ef1 \u1ee9c ch\u1ebf c\u1ee7a celecoxib l\u00ean s\u1ef1 chuy\u1ec3n h\u00f3a c\u01a1 ch\u1ea5t c\u1ee7a CYP2D6 qua CYP2D6. V\u00ec v\u1eady, c\u00f3 th\u1ec3 c\u1ea7n gi\u1ea3m li\u1ec1u l\u01b0\u1ee3ng c\u1ee7a c\u00e1c thu\u1ed1c l\u00e0 c\u01a1 ch\u1ea5t c\u1ee7a CYP2D6 khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib ho\u1eb7c t\u0103ng li\u1ec1u khi ng\u01b0ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib (xem ph\u1ea7n S\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u \u0111\u01b0\u1eddng u\u1ed1ng).<\/p>\n<p><em>Thu\u1ed1c l\u1ee3i ti\u1ec3u:<\/em>\u00a0C\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng cho th\u1ea5y tr\u00ean m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, NSAID c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m t\u00e1c d\u1ee5ng t\u0103ng th\u1ea3i natri qua n\u01b0\u1edbc ti\u1ec3u c\u1ee7a furosemid v\u00e0 thiazid b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p prostaglandin.<\/p>\n<p><em>Methotrexat:<\/em>\u00a0Kh\u00f4ng quan s\u00e1t th\u1ea5y t\u01b0\u01a1ng t\u00e1c d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc n\u00e0o trong nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng gi\u1eefa celecoxib v\u00e0 methotrexat.<\/p>\n<p><em>C\u00e1c thu\u1ed1c tr\u00e1nh thai \u0111\u01b0\u1eddng u\u1ed1ng:\u00a0<\/em>Trong m\u1ed9t nghi\u00ean c\u1ee9u t\u01b0\u01a1ng t\u00e1c, celecoxib kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng r\u00f5 r\u00e0ng tr\u00ean l\u00e2m s\u00e0ng v\u1edbi d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a thu\u1ed1c tr\u00e1nh thai \u0111\u01b0\u1eddng u\u1ed1ng lo\u1ea1i k\u1ebft h\u1ee3p (1mg norethindrone\/0,035mg ethinyl estradiol)<\/p>\n<p><em>C\u00e1c thu\u1ed1c kh\u00e1c:\u00a0<\/em>Ch\u01b0a c\u00f3 b\u00e1o c\u00e1o t\u01b0\u01a1ng t\u00e1c quan tr\u1ecdng n\u00e0o v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng gi\u1eefa celecoxib v\u00e0 thu\u1ed1c kh\u00e1ng acid (nh\u00f4m v\u00e0 magnesi), omeprazol, glibenclamid (glyburid), phenytoin ho\u1eb7c tolbutamid.<\/p>\n<p><strong>4.9 Qu\u00e1 li\u1ec1u v\u00e0 x\u1eed tr\u00ed:<\/strong><\/p>\n<p>D\u1eef li\u1ec7u l\u00e2m s\u00e0ng v\u1ec1 t\u00ecnh tr\u1ea1ng qu\u00e1 li\u1ec1u c\u00f2n h\u1ea1n ch\u1ebf. D\u00f9ng li\u1ec1u \u0111\u01a1n 1200mg ho\u1eb7c \u0111a li\u1ec1u v\u1edbi t\u1ed5ng li\u1ec1u l\u00e0 1200mg\/ng\u00e0y tr\u00ean ng\u01b0\u1eddi kh\u1ecfe m\u1ea1nh kh\u00f4ng cho th\u1ea5y t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n n\u00e0o c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng. Trong tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd qu\u00e1 li\u1ec1u, n\u00ean c\u00f3 c\u00e1c bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 v\u1ec1 y t\u1ebf th\u00edch h\u1ee3p. Th\u1ea9m ph\u00e2n m\u00e1u kh\u00f4ng ph\u1ea3i l\u00e0 bi\u1ec7n ph\u00e1p hi\u1ec7u qu\u1ea3 \u0111\u1ec3 lo\u1ea1i b\u1ecf thu\u1ed1c v\u00ec thu\u1ed1c li\u00ean k\u1ebft m\u1ea1nh v\u1edbi protein<\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>5. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c :<\/strong><\/p>\n<p><strong>5.1. D\u01b0\u1ee3c l\u1ef1c h\u1ecdc:<\/strong><\/p>\n<p>C\u00e1c nghi\u00ean c\u1ee9u in vivo v\u00e0 ex vivo cho th\u1ea5y celecoxib c\u00f3 \u00e1i l\u1ef1c r\u1ea5t th\u1ea5p v\u1edbi enzym COX-1. V\u00ec v\u1eady, \u1edf li\u1ec1u \u0111i\u1ec1u tr\u1ecb, celecoxib kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng tr\u00ean c\u00e1c prostanoid \u0111\u01b0\u1ee3c t\u1ed5ng h\u1ee3p do k\u00edch ho\u1ea1t COX-1, do \u0111\u00f3, kh\u00f4ng \u1ea3nh h\u01b0\u1edfng t\u1edbi c\u00e1c qu\u00e1 tr\u00ecnh sinh l\u00fd b\u00ecnh th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn COX-1 \u1edf m\u00f4, \u0111\u1eb7c bi\u1ec7t v\u1edbi d\u1ea1 d\u00e0y, ru\u1ed9t v\u00e0 ti\u1ec3u c\u1ea7u.<\/p>\n<p><em>C\u00c1C D\u1eee LI\u1ec6U V\u1ec0 TH\u1eec NGHI\u1ec6M L\u00c2M S\u00c0NG<\/em><\/p>\n<p><em>Nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng<\/em><\/p>\n<p><em>Tho\u00e1i ho\u00e1 kh\u1edbp (Osteoarthritis &#8211; OA):<\/em>\u00a0Celecoxib \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 kh\u1ea3 n\u0103ng gi\u1ea3m \u0111au kh\u1edbp \u0111\u00e1ng k\u1ec3 so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. Celecoxib \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trong \u0111i\u1ec1u tr\u1ecb c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a tho\u00e1i h\u00f3a kh\u1edbp g\u1ed1i v\u00e0 h\u00f4ng tr\u00ean kho\u1ea3ng 4200 b\u1ec7nh nh\u00e2n trong th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1edbi gi\u1ea3 d\u01b0\u1ee3c v\u00e0 v\u1edbi ho\u1ea1t ch\u1ea5t kh\u00e1c trong th\u1eddi gian t\u1ed1i \u0111a 12 tu\u1ea7n. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n tho\u00e1i h\u00f3a kh\u1edbp, \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib 100mg hai l\u1ea7n m\u1ed7i ng\u00e0y ho\u1eb7c 200mg m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y d\u1eabn \u0111\u1ebfn c\u1ea3i thi\u1ec7n \u0111\u01b0\u1ee3c ch\u1ec9 s\u1ed1 WOMAC (\u0110\u1ea1i h\u1ecdc Western Ontario v\u00e0 McMaster), l\u00e0 ch\u1ec9 s\u1ed1 t\u1ed5ng h\u1ee3p c\u00e1c \u0111\u1ea1i l\u01b0\u1ee3ng \u0111o l\u01b0\u1eddng v\u1ec1 \u0111au, c\u1ee9ng kh\u1edbp v\u00e0 ch\u1ee9c n\u0103ng trong tho\u00e1i h\u00f3a kh\u1edbp. Trong ba nghi\u00ean c\u1ee9u k\u00e9o d\u00e0i 12 tu\u1ea7n v\u1ec1 \u0111au k\u00e8m theo b\u00f9ng ph\u00e1t tho\u00e1i h\u00f3a kh\u1edbp, c\u00e1c li\u1ec1u celecoxib 100mg hai l\u1ea7n m\u1ed7i ng\u00e0y ho\u1eb7c 200mg hai l\u1ea7n m\u1ed7i ng\u00e0y gi\u00fap gi\u1ea3m \u0111au \u0111\u00e1ng k\u1ec3 trong v\u00f2ng 24 &#8211; 48 gi\u1edd k\u1ec3 t\u1eeb khi b\u1eaft \u0111\u1ea7u d\u00f9ng thu\u1ed1c. \u1ede m\u1ee9c li\u1ec1u 100mg hai l\u1ea7n m\u1ed7i ng\u00e0y ho\u1eb7c 200mg hai l\u1ea7n m\u1ed7i ng\u00e0y, celecoxib \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 t\u00ednh hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 nh\u01b0 naproxen 500mg hai l\u1ea7n m\u1ed7i ng\u00e0y. Li\u1ec1u 200mg hai l\u1ea7n m\u1ed7i ng\u00e0y kh\u00f4ng mang l\u1ea1i th\u00eam l\u1ee3i \u00edch n\u00e0o nh\u01b0 \u0111\u00e3 th\u1ea5y v\u1edbi li\u1ec1u 100mg hai l\u1ea7n m\u1ed7i ng\u00e0y. T\u1ed5ng li\u1ec1u l\u01b0\u1ee3ng h\u00e0ng ng\u00e0y l\u00e0 200mg \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 nh\u01b0 nhau cho d\u00f9 d\u00f9ng 100mg hai l\u1ea7n m\u1ed7i ng\u00e0y hay 200mg m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y.<\/p>\n<p><em>Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p (Rheumatois arthritis &#8211; RAJ):\u00a0<\/em>Celecoxib \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m gi\u1ea3m t\u00ecnh tr\u1ea1ng nh\u1ee9c\/\u0111au kh\u1edbp v\u00e0 s\u01b0ng kh\u1edbp \u0111\u00e1ng k\u1ec3 so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. Celecoxib \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trong \u0111i\u1ec1u tr\u1ecb c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p tr\u00ean kho\u1ea3ng 2100 b\u1ec7nh nh\u00e2n trong th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1edbi gi\u1ea3 d\u01b0\u1ee3c v\u00e0 v\u1edbi ho\u1ea1t ch\u1ea5t kh\u00e1c trong th\u1eddi gian t\u1ed1i \u0111a 24 tu\u1ea7n. Celecoxib cho th\u1ea5y hi\u1ec7u qu\u1ea3 v\u01b0\u1ee3t tr\u1ed9i h\u01a1n gi\u1ea3 d\u01b0\u1ee3c trong c\u00e1c nghi\u00ean c\u1ee9u n\u00e0y, b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng Ch\u1ec9 s\u1ed1 \u0111\u00e1p \u1ee9ng 20 theo H\u1ed9i Th\u1ea5p kh\u1edbp h\u1ecdc Hoa K\u1ef3 (American College of Rheumatology 20, ACR20), m\u1ed9t ch\u1ec9 s\u1ed1 t\u1ed5ng h\u1ee3p c\u00e1c \u0111\u1ea1i l\u01b0\u1ee3ng \u0111o l\u01b0\u1eddng v\u1ec1 l\u00e2m s\u00e0ng, x\u00e9t nghi\u1ec7m v\u00e0 ch\u1ee9c n\u0103ng trong vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p. Li\u1ec1u Celecoxib 100mg hai l\u1ea7n m\u1ed7i ng\u00e0y v\u00e0 200mg hai l\u1ea7n m\u1ed7i ng\u00e0y c\u00f3 hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 nhau v\u00e0 c\u1ea3 hai \u0111\u1ec1u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi naproxen 500mg hai l\u1ea7n m\u1ed7i ng\u00e0y.<\/p>\n<p>M\u1eb7c d\u00f9 celecoxib 100mg hai l\u1ea7n m\u1ed7i ng\u00e0y v\u00e0 200mg hai l\u1ea7n m\u1ed7i ng\u00e0y \u0111\u1ec1u mang l\u1ea1i hi\u1ec7u qu\u1ea3 t\u1ed5ng th\u1ec3 t\u01b0\u01a1ng t\u1ef1 nhau, nh\u01b0ng m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n nh\u1eadn \u0111\u01b0\u1ee3c l\u1ee3i \u00edch l\u1edbn h\u01a1n t\u1eeb li\u1ec1u 200mg hai l\u1ea7n m\u1ed7i ng\u00e0y. Li\u1ec1u 400mg hai l\u1ea7n m\u1ed7i ng\u00e0y kh\u00f4ng mang l\u1ea1i th\u00eam l\u1ee3i \u00edch n\u00e0o nh\u01b0 \u0111\u00e3 th\u1ea5y \u1edf li\u1ec1u 100mg hay 200mg hai l\u1ea7n m\u1ed7i ng\u00e0y.<\/p>\n<p><em>Gi\u1ea3m \u0111au, k\u1ec3 c\u1ea3 \u0111au b\u1ee5ng kinh nguy\u00ean ph\u00e1t:<\/em>\u00a0Trong c\u00e1c m\u00f4 h\u00ecnh gi\u1ea3m \u0111au c\u1ea5p t\u00ednh \u0111\u1ed1ii v\u1edbi \u0111au sau ph\u1eabu thu\u1eadt r\u0103ng mi\u1ec7ng, \u0111au sau ph\u1eabu thu\u1eadt ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh v\u00e0 \u0111au b\u1ee5ng kinh nguy\u00ean ph\u00e1t, celecoxib l\u00e0m gi\u1ea3m c\u01a1n \u0111au t\u1eeb v\u1eeba t\u1edbi n\u1eb7ng theo \u0111\u00e1nh gi\u00e1 c\u1ee7a b\u1ec7nh nh\u00e2n. Li\u1ec1u \u0111\u01a1n tr\u1ecb celecoxib gi\u00fap gi\u1ea3m \u0111au trong v\u00f2ng 60 ph\u00fat (xem ph\u1ea7n Li\u1ec1u d\u00f9ng v\u00e0 c\u00e1ch d\u00f9ng).<\/p>\n<p>Vi<em>\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp (Ankylosing spondylitis &#8211; AS):\u00a0<\/em>Celecoxib \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 \u1edf c\u00e1c b\u1ec7nh nh\u00e2n m\u1eafc vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp trong hai th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1edbi gi\u1ea3 d\u01b0\u1ee3c v\u00e0 v\u1edbi ho\u1ea1t ch\u1ea5t kh\u00e1c (naproxen ho\u1eb7c ketoprofen) trong th\u1eddi gian 6 v\u00e0 12 tu\u1ea7n. Celecoxib \u1edf c\u00e1c li\u1ec1u 100mg hai l\u1ea7n m\u1ed7i ng\u00e0y, 200mg m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y v\u00e0 400mg m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y \u0111\u00e3 cho th\u1ea5y t\u00e1c d\u1ee5ng v\u01b0\u1ee3t tr\u1ed9i v\u1ec1 m\u1eb7t th\u1ed1ng k\u00ea so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c trong c\u00e1c nghi\u00ean c\u1ee9u n\u00e0y, \u0111\u1ed1i v\u1edbi c\u1ea3 ba \u0111\u1ea1i l\u01b0\u1ee3ng ch\u00ednh c\u00f9ng \u0111\u00e1nh gi\u00e1 t\u00ednh hi\u1ec7u qu\u1ea3 bao g\u1ed3m: \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 \u0111au t\u1ed5ng th\u1ec3 (Thang \u0111i\u1ec3m \u01b0\u1edbc l\u01b0\u1ee3ng tr\u1ef1c quan), m\u1ee9c \u0111\u1ed9 ho\u1ea1t \u0111\u1ed9ng t\u1ed5ng th\u1ec3 c\u1ee7a b\u1ec7nh (Thang \u0111i\u1ec3m \u01b0\u1edbc l\u01b0\u1ee3ng tr\u1ef1c quan) v\u00e0 suy gi\u1ea3m ch\u1ee9c n\u0103ng (Ch\u1ec9 s\u1ed1 ch\u1ee9c n\u0103ng vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp Bath). Trong nghi\u00ean c\u1ee9u k\u00e9o d\u00e0i 12 tu\u1ea7n, kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 m\u1ee9c \u0111\u1ed9 c\u1ea3i thi\u1ec7n gi\u1eefa li\u1ec1u 200mg v\u00e0 400mg celecoxib khi so s\u00e1nh m\u1ee9c \u0111\u1ed9 thay \u0111\u1ed5i trung b\u00ecnh so v\u1edbi ban \u0111\u1ea7u, nh\u01b0ng t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng v\u1edbi celecoxib 400mg l\u00e0 53%, l\u1edbn h\u01a1n so v\u1edbi celecoxib 200mg, l\u00e0 44%, b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p \u0110\u00e1nh gi\u00e1 d\u1ef1a tr\u00ean ti\u00eau ch\u00ed \u0111\u00e1p \u1ee9ng trong vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp (ASAS 20). ASAS 20 \u0111\u1ecbnh ngh\u0129a ng\u01b0\u1eddi \u0111\u00e1p \u1ee9ng l\u00e0 ng\u01b0\u1eddi \u0111\u1ea1t m\u1ee9c \u0111\u1ed9 c\u1ea3i thi\u1ec7n so v\u1edbi ban \u0111\u1ea7u \u00edt nh\u1ea5t 20% v\u00e0 m\u1ee9c \u0111\u1ed9 c\u1ea3i thi\u1ec7n tuy\u1ec7t \u0111\u1ed1i \u00edt nh\u1ea5t l\u00e0 10mm, tr\u00ean thang \u0111i\u1ec3m t\u1eeb 0 \u0111\u1ebfn 100mm, \u1edf \u00edt nh\u1ea5t ba trong t\u1ed5ng s\u1ed5 b\u1ed1n y\u1ebfu t\u1ed1 sau: \u0111\u00e1nh gi\u00e1 t\u1ed5ng th\u1ec3 b\u1ec7nh nh\u00e2n, \u0111au, ch\u1ec9 s\u1ed1 ch\u1ee9c n\u0103ng vi\u00eam c\u1ed9t s\u1ed1ng d\u00ednh kh\u1edbp Bath v\u00e0 vi\u00eam. Ph\u00e2n t\u00edch \u0111\u00e1p \u1ee9ng c\u0169ng cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 thay \u0111\u1ed5i n\u00e0o v\u1ec1 t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng khi v\u01b0\u1ee3t qu\u00e1 6 tu\u1ea7n.<\/p>\n<p><em>Th\u00f4ng tin th\u00eam t\u1eeb nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng<\/em><\/p>\n<p><em>Nghi\u00ean c\u1ee9u n\u1ed9i soi<\/em><\/p>\n<p>\u0110\u00e1nh gi\u00e1 n\u1ed9i soi \u0111\u01b0\u1eddng ti\u00eau h\u00f3a tr\u00ean theo \u0111\u1ecbnh k\u1ef3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u00ean h\u01a1n 4.500 b\u1ec7nh nh\u00e2n vi\u00eam kh\u1edbp tham gia trong 5 th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng k\u00e9o d\u00e0i 12 &#8211; 24 tu\u1ea7n \u0111\u1ed1i ch\u1ee9ng v\u1edbi ho\u1ea1t ch\u1ea5t kh\u00e1c, 2 trong s\u1ed1 c\u00e1c nghi\u00ean c\u1ee9u n\u00e0y c\u0169ng c\u00f3 \u0111\u1ed1i ch\u1ee9ng b\u1eb1ng gi\u1ea3 d\u01b0\u1ee3c. Kh\u00f4ng c\u00f3 m\u1ed1i quan h\u1ec7 nh\u1ea5t qu\u00e1n n\u00e0o gi\u1eefa t\u1ef7 l\u1ec7 m\u1eafc vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng v\u1edbi li\u1ec1u celecoxib trong ph\u1ea1m vi nghi\u00ean c\u1ee9u.<\/p>\n<p>B\u1ea3ng 3 t\u00f3m t\u1eaft t\u1ef7 l\u1ec7 lo\u00e9t qua n\u1ed9i soi trong hai nghi\u00ean c\u1ee9u 12 tu\u1ea7n trong \u0111\u00f3 b\u1ec7nh nh\u00e2n tham gia c\u00f3 k\u1ebft qu\u1ea3 n\u1ed9i soi ban \u0111\u1ea7u kh\u00f4ng ph\u00e1t hi\u1ec7n v\u1ebft lo\u00e9t n\u00e0o.<\/p>\n<p>B\u1ea3ng 3. T\u1ec9 l\u1ec7 lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u n\u1ed9i soi \u1edf b\u1ec7nh nh\u00e2n tho\u00e1i h\u00f3a kh\u1edbp v\u00e0 vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>Nghi\u00ean c\u1ee9u 3 th\u00e1ng<\/strong><\/td>\n<td><strong>Nghi\u00ean c\u1ee9u 1\u00a0(N = 1108)<\/strong><\/td>\n<td><strong>Nghi\u00ean c\u1ee9u 2\u00a0(N= 1049)<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Gi\u1ea3 d\u01b0\u1ee3c<\/td>\n<td>2,3% (5\/217)<\/td>\n<td>2,0% (4\/200)<\/td>\n<\/tr>\n<tr>\n<td>Celecoxib 50mg, 2 l\u1ea7n\/ng\u00e0y<\/td>\n<td>3,4% (8\/233)<\/td>\n<td>&#8230;<\/td>\n<\/tr>\n<tr>\n<td>Celecoxib 100mg, 2 l\u1ea7n\/ng\u00e0y<\/td>\n<td>3,1% (7\/227)<\/td>\n<td>4,0% (9\/223)<\/td>\n<\/tr>\n<tr>\n<td>Celecoxib 200mg, 2 l\u1ea7n\/ng\u00e0y<\/td>\n<td>5,9% (13\/221)<\/td>\n<td>2,7% (6\/219)<\/td>\n<\/tr>\n<tr>\n<td>Celecoxib 400mg, 2 l\u1ea7n\/ng\u00e0y<\/td>\n<td>&#8230;<\/td>\n<td>4,1% (8\/197)<\/td>\n<\/tr>\n<tr>\n<td>Naproxen 500mg, 2 l\u1ea7n\/ng\u00e0y<\/td>\n<td>16,2% (34\/210)*<\/td>\n<td>17,6% (37\/210)*<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>* p \u2264 0,05 so v\u1edbi t\u1ea5t c\u1ea3 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c.<\/p>\n<p>B\u1ea3ng 4 t\u00f3m t\u1eaft d\u1eef li\u1ec7u t\u1eeb hai nghi\u00ean c\u1ee9u 12 tu\u1ea7n trong \u0111\u00f3 b\u1ec7nh nh\u00e2n tham gia c\u00f3 k\u1ebft qu\u1ea3 n\u1ed9i soi ban \u0111\u1ea7u kh\u00f4ng ph\u00e1t hi\u1ec7n v\u1ebft lo\u00e9t n\u00e0o. B\u1ec7nh nh\u00e2n \u0111\u00e3 th\u1ef1c hi\u1ec7n n\u1ed9i soi theo \u0111\u1ecbnh k\u1ef3 4 tu\u1ea7n m\u1ed9t l\u1ea7n \u0111\u1ec3 cung c\u1ea5p th\u00f4ng tin v\u1ec1 nguy c\u01a1 lo\u00e9t theo th\u1eddi gian.<\/p>\n<table>\n<tbody>\n<tr>\n<td colspan=\"5\"><strong>B\u1ea3ng 4. T\u1ec9 l\u1ec7 lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u n\u1ed9i soi li\u00ean ti\u1ebfp trong 3 th\u00e1ng \u1edf b\u1ec7nh nh\u00e2n tho\u00e1i h\u00f3a kh\u1edbp v\u00e0 vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p<\/strong><\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td><strong>Tu\u1ea7n 4<\/strong><\/td>\n<td><strong>Tu\u1ea7n 8<\/strong><\/td>\n<td><strong>Tu\u1ea7n 12<\/strong><\/td>\n<td><strong>Tu\u1ea7n cu\u1ed1i c\u00f9ng<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>Nghi\u00ean c\u1ee9u 3 (N=523)<\/strong><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>Celecoxib<\/td>\n<td>4.0%<\/td>\n<td>2.2%<\/td>\n<td>1.5%<\/td>\n<td>7.5%<\/td>\n<\/tr>\n<tr>\n<td><strong>200mg 2 l\u1ea7n\/ng\u00e0y<\/strong><\/td>\n<td>(10\/252)*<\/td>\n<td>(5\/227)*<\/td>\n<td>(3\/196)*<\/td>\n<td>(20\/266)*<\/td>\n<\/tr>\n<tr>\n<td><strong>Naproxen<\/strong><\/td>\n<td>19.0%<\/td>\n<td>14.2%<\/td>\n<td>9.9%<\/td>\n<td>34.6%<\/td>\n<\/tr>\n<tr>\n<td><strong>500mg 2 l\u1ea7n\/ng\u00e0y<\/strong><\/td>\n<td>(47\/247)<\/td>\n<td>(26\/182)<\/td>\n<td>(14\/141)<\/td>\n<td>(89\/257)<\/td>\n<\/tr>\n<tr>\n<td><strong>Nghi\u00ean c\u1ee9u 4 (N = 1062)<\/strong><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td><strong>Celecoxib<\/strong><\/td>\n<td>3.9%<\/td>\n<td>2.4%<\/td>\n<td>1.8%<\/td>\n<td>7.0%<\/td>\n<\/tr>\n<tr>\n<td><strong>200mg 2 l\u1ea7n\/ng\u00e0y<\/strong><\/td>\n<td>(13\/337)+<\/td>\n<td>(7\/296) +<\/td>\n<td>(5\/274)+<\/td>\n<td>(25\/356)+<\/td>\n<\/tr>\n<tr>\n<td><strong>Diclofenac<\/strong><\/td>\n<td>5.1%<\/td>\n<td>3.3%<\/td>\n<td>2.9%<\/td>\n<td>9.7%<\/td>\n<\/tr>\n<tr>\n<td><strong>75mg 2 l\u1ea7n\/ng\u00e0y<\/strong><\/td>\n<td>(18\/350)<\/td>\n<td>(10\/306)<\/td>\n<td>(8\/278)<\/td>\n<td>(36\/372)<\/td>\n<\/tr>\n<tr>\n<td><strong>Ibuprofen<\/strong><\/td>\n<td>13.0%<\/td>\n<td>6.2%<\/td>\n<td>9.6%<\/td>\n<td>23.3%<\/td>\n<\/tr>\n<tr>\n<td><strong>800mg 3 l\u1ea7n\/ng\u00e0y<\/strong><\/td>\n<td>(42\/323)<\/td>\n<td>(15\/241)<\/td>\n<td>(21\/219)<\/td>\n<td>(78\/334)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><sup>*<\/sup>p \u2264 0,05 celecoxib so v\u1edbi naproxen d\u1ef1a tr\u00ean c\u00e1c ph\u00e2n t\u00edch theo \u0111\u1ecbnh k\u00ec v\u00e0 t\u00edch l\u0169y<\/p>\n<p>+p \u2264 0,05 celecoxib so v\u1edbi ibuprofen d\u1ef1a tr\u00ean c\u00e1c ph\u00e2n t\u00edch theo \u0111\u1ecbnh k\u1ef3 v\u00e0 t\u00edch l\u0169y.<\/p>\n<p>M\u1ed9t nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean v\u00e0 m\u00f9 \u0111\u00f4i k\u00e9o d\u00e0i 6 th\u00e1ng tr\u00ean 430 b\u1ec7nh nh\u00e2n vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p \u0111\u00e3 \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh, trong \u0111\u00f3 \u0111\u00e3 th\u1ef1c hi\u1ec7n ki\u1ec3m tra n\u1ed9i soi v\u00e0o th\u1eddi \u0111i\u1ec3m 6 th\u00e1ng.<\/p>\n<p>T\u1ef7 l\u1ec7 lo\u00e9t qua n\u1ed9i soi \u1edf b\u1ec7nh nh\u00e2n d\u00f9ng celecoxib 200mg hai l\u1ea7n m\u1ed7i ng\u00e0y l\u00e0 4%, so v\u1edbi 15% \u1edf b\u1ec7nh nh\u00e2n d\u00f9ng diclofenac SR 75mg hai l\u1ea7n m\u1ed7i ng\u00e0y (p &lt; 0,001).<\/p>\n<p>Trong s\u1ed1 4 tr\u00ean 5 nghi\u00ean c\u1ee9u n\u1ed9i soi, kho\u1ea3ng 11% b\u1ec7nh nh\u00e2n (440\/4000) c\u00f3 d\u00f9ng aspirin (\u2264 325mg\/ng\u00e0y). \u1ede nh\u00f3m d\u00f9ng celecoxib, t\u1ef7 l\u1ec7 lo\u00e9t qua n\u1ed9i soi \u1edf nh\u1eefng ng\u01b0\u1eddi s\u1eed d\u1ee5ng aspirin cao h\u01a1n so v\u1edbi ng\u01b0\u1eddi kh\u00f4ng s\u1eed d\u1ee5ng. Tuy nhi\u00ean, t\u1ef7 l\u1ec7 gia t\u0103ng lo\u00e9t \u1edf nh\u1eefng ng\u01b0\u1eddi s\u1eed d\u1ee5ng aspirin th\u1ea5p h\u01a1n so v\u1edbi t\u1ef7 l\u1ec7 lo\u00e9t qua n\u1ed9i soi quan s\u00e1t th\u1ea5y \u1edf c\u00e1c nh\u00f3m d\u00f9ng ho\u1ea1t ch\u1ea5t so s\u00e1nh, c\u00f3 d\u00f9ng ho\u1eb7c kh\u00f4ng d\u00f9ng aspirin.<\/p>\n<p>Ch\u01b0a x\u00e1c l\u1eadp \u0111\u01b0\u1ee3c m\u1ed1i t\u01b0\u01a1ng quan n\u00e0o gi\u1eefa k\u1ebft qu\u1ea3 c\u1ee7a nghi\u00ean c\u1ee9u n\u1ed9i soi v\u00e0 t\u1ef7 l\u1ec7 t\u01b0\u01a1ng \u0111\u1ed1i c\u1ee7a c\u00e1c bi\u1ebfn c\u1ed1 nghi\u00eam tr\u1ecdng c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng \u1edf \u0111\u01b0\u1eddng ti\u00eau ho\u00e1 tr\u00ean. Xu\u1ea5t huy\u1ebft \u0111\u01b0\u1eddng ti\u00eau h\u00f3a tr\u00ean nghi\u00eam tr\u1ecdng c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng \u0111\u00e3 \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng celecoxib trong c\u00e1c th\u1eed nghi\u1ec7m c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u00e0 nh\u00e3n m\u1edf, m\u1eb7c d\u00f9 kh\u00f4ng th\u01b0\u1eddng xuy\u00ean (xem ph\u1ea7n C\u00e1c t\u00e1c \u0111\u1ed9ng tr\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a)<\/p>\n<p><em>Ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p v\u1ec1 t\u00ednh an to\u00e0n tr\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u tho\u00e1i ho\u00e1 kh\u1edbp v\u00e0 vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p<\/em><\/p>\n<p>M\u1ed9t ph\u00e2n t\u00edch d\u1ef1a tr\u00ean 31 nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1ec1 tho\u00e1i ho\u00e1 kh\u1edbp v\u00e0 vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, bao g\u1ed3m 39.605 b\u1ec7nh nh\u00e2n tho\u00e1i ho\u00e1 kh\u1edbp (N = 25.903), vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p (N = 3.232) ho\u1eb7c nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc m\u1ed9t trong hai t\u00ecnh tr\u1ea1ng n\u00e0y (N = 10.470), v\u00e0 so s\u00e1nh t\u1ef7 l\u1ec7 m\u1eafc c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean \u0111\u01b0\u1eddng ti\u00eau ho\u00e1 \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib v\u1edbi b\u1ec7nh nh\u00e2n d\u00f9ng gi\u1ea3 d\u01b0\u1ee3c ho\u1eb7c c\u00e1c NSAID kh\u00e1c (bao g\u1ed3m c\u1ea3 naproxen, diclofenac v\u00e0 ibuprofen). T\u1ef7 l\u1ec7 lo\u00e9t tr\u00ean l\u00e2m s\u00e0ng v\u00e0 xu\u1ea5t huy\u1ebft do lo\u00e9t khi d\u00f9ng t\u1ed5ng li\u1ec1u h\u00e0ng ng\u00e0y celecoxib 200mg &#8211; 400mg l\u00e0 0,2%, so v\u1edbi t\u1ec9 l\u1ec7 0,6% khi d\u00f9ng c\u00e1c NSAID kh\u00e1c (RR = 0,35; CI 95% 0,22 &#8211; 0,56).<\/p>\n<p><em>Nghi\u00ean c\u1ee9u t\u00ednh an to\u00e0n l\u00e2u d\u00e0i c\u1ee7a celecoxib trong \u0111i\u1ec1u tr\u1ecb Vi\u00eam x\u01b0\u01a1ng kh\u1edbp (nghi\u00ean c\u1ee9u CLASS) bao g\u1ed3m c\u1ea3 vi\u1ec7c s\u1eed d\u1ee5ng c\u00f9ng v\u1edbi aspirin<\/em><\/p>\n<p>Trong m\u1ed9t nghi\u00ean c\u1ee9u ti\u00ean c\u1ee9u v\u1ec1 k\u1ebft qu\u1ea3 an to\u00e0n d\u00e0i h\u1ea1n \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh sau khi \u0111\u01b0a thu\u1ed1c ra th\u1ecb tr\u01b0\u1eddng \u1edf kho\u1ea3ng 5.800 b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh tho\u00e1i h\u00f3a kh\u1edbp v\u00e0 2.200 b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, b\u1ec7nh nh\u00e2n \u0111\u00e3 d\u00f9ng celecoxib 400mg hai l\u1ea7n m\u1ed7i ng\u00e0y (l\u1ea7n l\u01b0\u1ee3t g\u1ea5p 4 l\u1ea7n v\u00e0 g\u1ea5p 2 l\u1ea7n li\u1ec1u khuy\u1ebfn c\u00e1o d\u00f9ng cho tho\u00e1i h\u00f3a kh\u1edbp v\u00e0 vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p), ibuprofen 800mg ba l\u1ea7n m\u1ed7i ng\u00e0y ho\u1eb7c diclofenac 75mg hai l\u1ea7n m\u1ed7i ng\u00e0y (li\u1ec1u \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng). Th\u1eddi gian s\u1eed d\u1ee5ng trung b\u00ecnh v\u1edbi celecoxib (N = 3.987) v\u00e0 diclofenac (N = 1.996) l\u00e0 9 th\u00e1ng trong khi ibuprofen (N = 1.985) l\u00e0 6 th\u00e1ng. T\u1ef7 l\u1ec7 Kaplan-Meier t\u00edch l\u0169y v\u00e0o th\u1eddi \u0111i\u1ec3m 9 th\u00e1ng \u0111\u01b0\u1ee3c cung c\u1ea5p cho t\u1ea5t c\u1ea3 c\u00e1c ph\u00e2n t\u00edch. Ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 ch\u00ednh c\u1ee7a k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u n\u00e0y l\u00e0 t\u1ef7 l\u1ec7 vi\u00eam lo\u00e9t c\u00f3 bi\u1ebfn ch\u1ee9ng (xu\u1ea5t huy\u1ebft, th\u1ee7ng ho\u1eb7c t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ti\u00eau h\u00f3a). B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u00e9p d\u00f9ng \u0111\u1ed3ng th\u1eddi aspirin (ASA) li\u1ec1u th\u1ea5p (&lt; 325mg\/ng\u00e0y) \u0111\u1ec3 ph\u00f2ng b\u1ec7nh tim m\u1ea1ch (ph\u00e2n nh\u00f3m ASA: celecoxib, N = 882; diclofenac, N = 445; ibuprofen, N = 412). S\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 t\u1ef7 l\u1ec7 vi\u00eam lo\u00e9t c\u00f3 bi\u1ebfn ch\u1ee9ng gi\u1eefa celecoxib v\u00e0 nh\u00f3m d\u00f9ng k\u1ebft h\u1ee3p ibuprofen v\u00e0 diclofenac kh\u00f4ng c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t th\u1ed1ng k\u00ea. Nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng \u0111\u1ed3ng th\u1eddi celecoxib v\u00e0 ASA li\u1ec1u th\u1ea5p c\u00f3 t\u1ec9 l\u1ec7 vi\u00eam lo\u00e9t c\u00f3 bi\u1ebfn ch\u1ee9ng cao g\u1ea5p 4 l\u1ea7n so v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng d\u00f9ng ASA (xem ph\u1ea7n C\u00e1c t\u00e1c \u0111\u1ed9ng tr\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a).<\/p>\n<p>C\u00e1c k\u1ebft qu\u1ea3 v\u1ec1 celecoxib \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong B\u1ea3ng 5.<\/p>\n<p>B\u1ea3ng 5. \u1ea2nh h\u01b0\u1edfng c\u1ee7a vi\u1ec7c d\u00f9ng \u0111\u1ed3ng th\u1eddi Aspirin li\u1ec1u th\u1ea5p l\u00ean t\u1ef7 l\u1ec7 lo\u00e9t c\u00f3 bi\u1ebfn ch\u1ee9ng v\u1edbi Celecoxib 400mg 2 l\u1ea7n\/ng\u00e0y (t\u1ef7 l\u1ec7 Kaplan-Meier \u1edf 9 th\u00e1ng [%])<\/p>\n<table>\n<tbody>\n<tr>\n<td><\/td>\n<td>Ng\u01b0\u1eddi kh\u00f4ng d\u00f9ng aspirin N = 3105<\/td>\n<td>Ng\u01b0\u1eddi d\u00f9ng aspirin N = 882<\/td>\n<\/tr>\n<tr>\n<td>Lo\u00e9t c\u00f3 bi\u1ebfn ch\u1ee9ng<\/td>\n<td>0,32<\/td>\n<td>1,12<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><em>Ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7u<\/em><\/p>\n<p>Tr\u00ean ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n kh\u1ecfe m\u1ea1nh, celecoxib \u1edf c\u00e1c m\u1ee9c li\u1ec1u \u0111i\u1ec1u tr\u1ecb v\u00e0 \u1edf c\u00e1c m\u1ee9c \u0111a li\u1ec1u 600mg hai l\u1ea7n m\u1ed7i ng\u00e0y (g\u1ea5p ba l\u1ea7n so v\u1edbi li\u1ec1u khuy\u1ebfn c\u00e1o cao nh\u1ea5t) kh\u00f4ng g\u00e2y \u1ea3nh h\u01b0\u1edfng tr\u00ean qu\u00e1 tr\u00ecnh k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u v\u00e0 th\u1eddi gian xu\u1ea5t huy\u1ebft khi so s\u00e1nh v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. T\u1ea5t c\u1ea3 c\u00e1c nh\u00f3m \u0111\u1ed1i ch\u1ee9ng v\u1edbi ho\u1ea1t ch\u1ea5t kh\u00e1c (ch\u1ea5t \u1ee9c ch\u1ebf COX kh\u00f4ng \u0111\u1eb7c hi\u1ec7u) \u0111\u1ec1u th\u1ea5y gi\u1ea3m \u0111\u00e1ng k\u1ec3 kh\u1ea3 n\u0103ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian xu\u1ea5t huy\u1ebft.<\/p>\n<p><em>Nghi\u00ean c\u1ee9u so s\u00e1nh celecoxib v\u1edbi omeprazol v\u00e0 diclofenac tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 m\u1eafc tho\u00e1i ho\u00e1 kh\u1edbp v\u00e0 vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p (Nghi\u00ean c\u1ee9u CONDOR)<\/em><\/p>\n<p>Trong nghi\u00ean c\u1ee9u ti\u1ebfn c\u1ee9u k\u00e9o d\u00e0i 24 tu\u1ea7n \u1edf b\u1ec7nh nh\u00e2n &gt; 60 tu\u1ed5i ho\u1eb7c c\u00f3 ti\u1ec1n s\u1eed lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng (tr\u1eeb ng\u01b0\u1eddi s\u1eed d\u1ee5ng aspirin li\u1ec1u th\u1ea5p), t\u1ef7 l\u1ec7 ph\u1ea7n tr\u0103m b\u1ec7nh nh\u00e2n g\u1eb7p c\u00e1c bi\u1ebfn c\u1ed1 v\u1ec1 ti\u00eau h\u00f3a (GI) c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng (ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 t\u1ed5ng h\u1ee3p ch\u00ednh) th\u1ea5p h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib 200mg hai l\u1ea7n\/ng\u00e0y so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng diclofenac SR 75mg hai l\u1ea7n\/ng\u00e0y c\u00f9ng v\u1edbi omeprazol 20mg m\u1ed9t l\u1ea7n\/ng\u00e0y. S\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng n\u00e0y l\u00e0 do s\u1ef1 gi\u1ea3m hemoglobin (&gt;2g\/dL) v\u00e0\/ho\u1eb7c th\u1ec3 t\u00edch h\u1ed3ng c\u1ea7u (&gt;10%) \u0111\u00e3 bi\u1ebft ho\u1eb7c \u0111\u01b0\u1ee3c xem l\u00e0 c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. K\u1ebft qu\u1ea3 cho t\u1eebng th\u00e0nh ph\u1ea7n c\u1ee7a ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 t\u1ed5ng h\u1ee3p n\u00e0y nh\u01b0 sau:<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>Th\u00e0nh ph\u1ea7n c\u1ee7a ti\u00eau ch\u00ed \u0111\u00e1nh\u00a0gi\u00e1 GI t\u1ed5ng h\u1ee3p \u0111\u00e3 bi\u1ebft<\/strong><\/td>\n<td><strong>Celecoxib 200mg\u00a02 l\u1ea7n\/ng\u00e0y\u00a0(N = 2238)<\/strong><\/td>\n<td><strong>Diclofenac SR 75mg\u00a02 l\u1ea7n\/ng\u00e0y\u00a0+ Omeprazol 20mg\u00a01 l\u1ea7n\/ng\u00e0y (N = 2246)<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>Th\u00e0nh ph\u1ea7n<\/strong><\/td>\n<td><strong>N (%) b\u1ec7nh nh\u00e2n<\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>Xu\u1ea5t huy\u1ebft d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng<\/td>\n<td>3(0,1)<\/td>\n<td>3(0,1)<\/td>\n<\/tr>\n<tr>\n<td>Xu\u1ea5t huy\u1ebft ru\u1ed9t gi\u00e0<\/td>\n<td>1 ( &lt; 0,1)<\/td>\n<td>1 ( &lt; 0,1)<\/td>\n<\/tr>\n<tr>\n<td>Xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a c\u1ea5p t\u00ednh kh\u00f4ng r\u00f5<strong>\u00a0ngu\u1ed3n g\u1ed1c<\/strong><\/td>\n<td>1 ( &lt; 0,1)<\/td>\n<td>0 (0,0)<\/td>\n<\/tr>\n<tr>\n<td>Gi\u1ea3m hemoglobin (&gt;2g\/dL) v\u00e0\/ho\u1eb7c<strong>\u00a0th\u1ec3 t\u00edch h\u1ed3ng c\u1ea7u (&gt;10%) c\u00f3 \u00fd ngh\u0129a\u00a0v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng \u0111\u00e3 bi\u1ebft l\u00e0 c\u00f3 ngu\u1ed3n\u00a0g\u1ed1c GI<\/strong><\/td>\n<td>5(0,2)<\/td>\n<td>24(1,1)<\/td>\n<\/tr>\n<tr>\n<td>Gi\u1ea3m hemoglobin (&gt;2g\/dL) v\u00e0\/ho\u1eb7c<strong>\u00a0th\u1ec3 t\u00edch h\u1ed3ng c\u1ea7u (&gt;10%) c\u00f3 \u00fd ngh\u0129a\u00a0v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c xem l\u00e0 c\u00f3 ngu\u1ed3n\u00a0g\u1ed1c GI<\/strong><\/td>\n<td>10 (0,4)<\/td>\n<td>53(2,3)<\/td>\n<\/tr>\n<tr>\n<td><strong>T\u1ed5ng*<\/strong><\/td>\n<td><strong>20(0,9)<\/strong><\/td>\n<td><strong>81 (3,6)<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>\u0110\u1ed1i v\u1edbi c\u00e1c th\u00e0nh ph\u1ea7n sau \u0111\u00e2y c\u1ee7a ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 GI t\u1ed5ng h\u1ee3p \u0111\u00e3 bi\u1ebft, kh\u00f4ng c\u00f3 bi\u1ebfn c\u1ed1 n\u00e0o trong c\u1ea3 hai nh\u00f3m \u0111i\u1ec1u tr\u1ecb: t\u1eafc ngh\u1ebdn l\u1ed1i ra c\u1ee7a d\u1ea1 d\u00e0y; th\u1ee7ng d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng, ru\u1ed9t non ho\u1eb7c ru\u1ed9t gi\u00e0; xu\u1ea5t huy\u1ebft ru\u1ed9t non. T\u1ea5t c\u1ea3 c\u00e1c bi\u1ebfn c\u1ed1 c\u1ea5u th\u00e0nh ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 GI t\u1ed5ng h\u1ee3p \u0111\u00e3 \u0111\u01b0\u1ee3c ban gi\u00e1m \u0111\u1ecbnh chuy\u00ean m\u00f4n \u0111\u1ed9c l\u1eadp ph\u00e1n x\u00e9t v\u00e0 ban gi\u00e1m \u0111\u1ecbnh n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn c\u00e1c lo\u1ea1i thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u00e3 \u0111\u01b0\u1ee3c cho d\u00f9ng theo ph\u01b0\u01a1ng ph\u00e1p ng\u1eabu nhi\u00ean.<\/p>\n<p>* Trong m\u1ed9t ph\u00e2n t\u00edch t\u1ef7 l\u1ec7 s\u1ed1ng c\u00f2n (time-to-event anslysis) b\u1eb1ng k\u1ef9 thu\u1eadt b\u1ea3ng th\u1ed1ng k\u00ea tu\u1ed5i th\u1ecd trung b\u00ecnh, p &lt; 0,0001 l\u00e0 x\u00e1c su\u1ea5t d\u00f9ng \u0111\u1ec3 so s\u00e1nh gi\u1eefa nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib v\u00e0 nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng diclofenac k\u1ebft h\u1ee3p v\u1edbi omeprazol cho ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 n\u00e0y.<\/p>\n<p><em>An to\u00e0n tr\u00ean tim m\u1ea1ch &#8211; Nghi\u00ean c\u1ee9u d\u00e0i h\u1ea1n tr\u00ean b\u1ec7nh nh\u00e2n b\u1ecb polyp u tuy\u1ebfn r\u1ea3i r\u00e1c:<\/em><\/p>\n<p>Hai nghi\u00ean c\u1ee9u tr\u00ean b\u1ec7nh nh\u00e2n b\u1ecb polyp u tuy\u1ebfn r\u1ea3i r\u00e1c \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh v\u1edbi celecoxib, t\u1ee9c l\u00e0 th\u1eed nghi\u1ec7m APC (Ph\u00f2ng ng\u1eeba u tuy\u1ebfn b\u1eb1ng Celecoxib) v\u00e0 th\u1eed nghi\u1ec7m PreSAP (Ph\u00f2ng ng\u1eeba polyp u tuy\u1ebfn t\u1ef1 ph\u00e1t). Trong th\u1eed nghi\u1ec7m APC, c\u00f3 s\u1ef1 gia t\u0103ng li\u00ean quan \u0111\u1ebfn li\u1ec1u \u1edf ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 t\u1ed5ng h\u1ee3p v\u1ec1 t\u1eed vong do tim m\u1ea1ch, nh\u1ed3i m\u00e1u c\u01a1 tim hay \u0111\u1ed9t qu\u1ef5 (\u0111\u01b0\u1ee3c gi\u00e1m \u0111\u1ecbnh) khi d\u00f9ng celecoxib so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c trong 3 n\u0103m \u0111i\u1ec1u tr\u1ecb. Th\u1eed nghi\u1ec7m PreSAP kh\u00f4ng cho th\u1ea5y nguy c\u01a1 gia t\u0103ng c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t th\u1ed1ng k\u00ea \u0111\u1ed1i v\u1edbi ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 t\u1ed5ng h\u1ee3p n\u00e0y.<\/p>\n<p>Trong th\u1eed nghi\u1ec7m APC, t\u1ef7 l\u1ec7 nguy c\u01a1 so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c \u1edf ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 t\u1ed5ng h\u1ee3p v\u1ec1 t\u1eed vong do tim m\u1ea1ch, nh\u1ed3i m\u00e1u c\u01a1 tim hay \u0111\u1ed9t qu\u1ef5 (\u0111\u01b0\u1ee3c gi\u00e1m \u0111\u1ecbnh) l\u00e0 3,4 (CI 95% 1,4 &#8211; 8,5) khi d\u00f9ng celecoxib 400mg hai l\u1ea7n m\u1ed7i ng\u00e0y v\u00e0 2,8 (CI 95% 1,1 &#8211; 7,2) khi d\u00f9ng celecoxib 200mg hai l\u1ea7n m\u1ed7i ng\u00e0y. T\u1ec9 l\u1ec7 t\u00edch l\u0169y \u0111\u1ed1i v\u1edbi ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 t\u1ed5ng h\u1ee3p n\u00e0y trong v\u00f2ng 3 n\u0103m l\u1ea7n l\u01b0\u1ee3t l\u00e0 3,0% (20\/671) v\u00e0 2,5% (17\/685) \u0111\u1ed1i v\u1edbi nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib 200mg hai l\u1ea7n m\u1ed7i ng\u00e0y v\u00e0 400mg hai l\u1ea7n m\u1ed7i ng\u00e0y, so v\u1edbi 0,9% (6\/679) \u1edf nh\u00f3m d\u00f9ng gi\u1ea3 d\u01b0\u1ee3c. S\u1ef1 gia t\u0103ng \u1edf c\u1ea3 hai nh\u00f3m s\u1eed d\u1ee5ng celecoxib so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c ch\u1ee7 y\u1ebfu l\u00e0 do nh\u1ed3i m\u00e1u c\u01a1 tim.<\/p>\n<p>Trong th\u1eed nghi\u1ec7m PreSAP, t\u1ef7 l\u1ec7 nguy c\u01a1 so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c \u1edf c\u00f9ng ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 t\u1ed5ng h\u1ee3p n\u00e0y l\u00e0 1,2 (CI 95% 0,6 &#8211; 2,4) khi d\u00f9ng celecoxib 400mg m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y. T\u1ec9 l\u1ec7 t\u00edch l\u0169y \u0111\u1ed1i v\u1edbi ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 t\u1ed5ng h\u1ee3p n\u00e0y qua 3 n\u0103m l\u00e0 2,3% (21\/933), so v\u1edbi 1,9% (12\/628) \u1edf nh\u00f3m d\u00f9ng gi\u1ea3 d\u01b0\u1ee3c.<\/p>\n<p><em>An to\u00e0n tr\u00ean tim m\u1ea1ch &#8211; Nghi\u00ean c\u1ee9u d\u00e0i h\u1ea1n c\u1ee7a th\u1eed nghi\u1ec7m ph\u00f2ng ng\u1eeba b\u1eb1ng thu\u1ed1c kh\u00e1ng vi\u00eam trong b\u1ec7nh Alzheimer (Nghi\u00ean c\u1ee9u ADAPT)<\/em><\/p>\n<p>D\u1eef li\u1ec7u t\u1eeb nghi\u00ean c\u1ee9u ADAPT kh\u00f4ng cho th\u1ea5y nguy c\u01a1 m\u1eafc b\u1ec7nh tim m\u1ea1ch t\u0103ng l\u00ean \u0111\u00e1ng k\u1ec3 khi d\u00f9ng celecoxib 200mg hai l\u1ea7n m\u1ed7i ng\u00e0y so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. Nguy c\u01a1 t\u01b0\u01a1ng \u0111\u1ed1i so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c \u1edf m\u1ed9t ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 t\u1ed5ng h\u1ee3p t\u01b0\u01a1ng t\u1ef1 (t\u1eed vong do tim m\u1ea1ch, nh\u1ed3i m\u00e1u c\u01a1 tim, \u0111\u1ed9t qu\u1ef5) l\u00e0 1,14 (CI 95% 0,61 &#8211; 2,12) khi d\u00f9ng celecoxib 200mg hai l\u1ea7n m\u1ed7i ng\u00e0y.<\/p>\n<p><em>An to\u00e0n tr\u00ean tim m\u1ea1ch &#8211; Ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c l\u00e2u d\u00e0i<\/em><\/p>\n<p>Ch\u01b0a c\u00f3 nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng c\u00f3 \u0111\u1ed1i ch\u1ee9ng d\u00e0i h\u1ea1n n\u00e0o \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf ri\u00eang \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 an to\u00e0n tr\u00ean tim m\u1ea1ch c\u1ee7a vi\u1ec7c d\u00f9ng celecoxib l\u00e2u d\u00e0i trong b\u1ea5t k\u1ef3 kho\u1ea3ng th\u1eddi gian n\u00e0o \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh. Tuy nhi\u00ean, m\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p v\u1ec1 d\u1eef li\u1ec7u an to\u00e0n (c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i nghi\u00eam tr\u1ecdng do nghi\u00ean c\u1ee9u vi\u00ean b\u00e1o c\u00e1o, \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u00e1m \u0111\u1ecbnh) t\u1eeb 39 nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng v\u1ec1 celecoxib ho\u00e0n th\u00e0nh trong th\u1eddi gian t\u1ed1i \u0111a 65 tu\u1ea7n \u0111\u00e3 \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh, t\u01b0\u01a1ng \u1ee9ng v\u1edbi 41.077 b\u1ec7nh nh\u00e2n [23.030 (56,1%) b\u1ec7nh nh\u00e2n d\u00f9ng t\u1ed5ng li\u1ec1u h\u00e0ng ng\u00e0y (TDD) celecoxib 200mg &#8211; 800mg, 13.990 (34,1%) b\u1ec7nh nh\u00e2n d\u00f9ng c\u00e1c thu\u1ed1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc v\u00e0 4.057 (9,9%) b\u1ec7nh nh\u00e2n d\u00f9ng gi\u1ea3 d\u01b0\u1ee3c].<\/p>\n<p>Trong ph\u00e2n t\u00edch n\u00e0y, t\u1ef7 l\u1ec7 bi\u1ebfn c\u1ed1 \u0111\u01b0\u1ee3c gi\u00e1m \u0111\u1ecbnh \u1edf ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 t\u1ed5ng h\u1ee3p (bao g\u1ed3m t\u1eed vong do tim m\u1ea1ch, nh\u1ed3i m\u00e1u c\u01a1 tim kh\u00f4ng g\u00e2y t\u1eed vong v\u00e0 \u0111\u1ed9t qu\u1ef5 kh\u00f4ng g\u00e2y t\u1eed vong) l\u00e0 t\u01b0\u01a1ng t\u1ef1 nhau gi\u1eefa bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib (N = 19.773; 0,96 bi\u1ebfn c\u1ed1\/100 b\u1ec7nh nh\u00e2n\/n\u0103m) v\u00e0 NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc (N = 13.990; 1,12 bi\u1ebfn c\u1ed1\/100 b\u1ec7nh nh\u00e2n\/n\u0103m) (RR = 0,90, 95% CI 0,60 &#8211; 1,33). M\u00f4 h\u00ecnh t\u00e1c d\u1ee5ng n\u00e0y \u0111\u01b0\u1ee3c duy tr\u00ec d\u00f9 c\u00f3 d\u00f9ng hay kh\u00f4ng d\u00f9ng ASA ( &lt; 325mg). T\u1ef7 l\u1ec7 bi\u1ebfn c\u1ed1 \u0111\u01b0\u1ee3c gi\u00e1m \u0111\u1ecbnh l\u00e0 nh\u1ed3i m\u00e1u c\u01a1 tim kh\u00f4ng g\u00e2y t\u1eed vong c\u00f3 xu h\u01b0\u1edbng cao h\u01a1n (RR = 1,76, CI 95% 0,93 &#8211; 3,35); tuy nhi\u00ean t\u1ef7 l\u1ec7 \u0111\u1ed9t qu\u1ef5 kh\u00f4ng g\u00e2y t\u1eed vong c\u00f3 xu h\u01b0\u1edbng th\u1ea5p h\u01a1n (RR = 0,51, CI 95% 0,23 &#8211; 1,10) v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong do tim m\u1ea1ch l\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng (RR = 0,57, CI 95 % 0,28 &#8211; 1,14) khi d\u00f9ng celecoxib so v\u1edbi d\u00f9ng k\u1ebft h\u1ee3p c\u00e1c NSAID kh\u00f4ng ch\u1ecdn l\u1ecdc.<\/p>\n<p>Trong ph\u00e2n t\u00edch n\u00e0y, t\u1ef7 l\u1ec7 bi\u1ebfn c\u1ed1 \u0111\u01b0\u1ee3c gi\u00e1m \u0111\u1ecbnh \u0111\u1ed1i v\u1edbi ti\u00eau ch\u00ed t\u1ed5ng h\u1ee3p bao g\u1ed3m t\u1eed vong do tim m\u1ea1ch, nh\u1ed3i m\u00e1u c\u01a1 tim kh\u00f4ng g\u00e2y t\u1eed vong v\u00e0 \u0111\u1ed9t qu\u1ef5 kh\u00f4ng g\u00e2y t\u1eed vong l\u00e0 1,42\/100 b\u1ec7nh nh\u00e2n\/n\u0103m khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib (N = 7.462) v\u00e0 1,20\/100 b\u1ec7nh nh\u00e2n\/n\u0103m khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng gi\u1ea3 d\u01b0\u1ee3c (N = 4.057) (RR =1,11; CI 95% 0,47 &#8211; 2,67). M\u00f4 h\u00ecnh t\u00e1c d\u1ee5ng n\u00e0y \u0111\u01b0\u1ee3c duy tr\u00ec d\u00f9 c\u00f3 d\u00f9ng hay kh\u00f4ng d\u00f9ng ASA (&lt; 325mg). T\u1ef7 l\u1ec7 nh\u1ed3i m\u00e1u c\u01a1 tim kh\u00f4ng g\u00e2y t\u1eed vong c\u00f3 xu h\u01b0\u1edbng cao h\u01a1n (RR = 1,56; CI 95% 0,21 &#8211; 11,90); t\u1ef7 l\u1ec7 t\u1eed vong do b\u1ec7nh tim m\u1ea1ch c\u0169ng cao h\u01a1n (RR = 1,26; CI 95% 0,33 &#8211; 4,77) v\u00e0 t\u1ef7 l\u1ec7 b\u1ecb \u0111\u1ed9t qu\u1ef5 kh\u00f4ng g\u00e2y t\u1eed vong l\u00e0 t\u01b0\u01a1ng t\u1ef1 nhau (RR = 0,80; CI 95 % 0,19 &#8211; 3,31) khi d\u00f9ng celecoxib so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c.<\/p>\n<p><em>An to\u00e0n tr\u00ean tim m\u1ea1ch<\/em><\/p>\n<p>K\u1ebft qu\u1ea3 an to\u00e0n tr\u00ean tim m\u1ea1ch \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trong nghi\u00ean c\u1ee9u CLASS (xem \u1edf tr\u00ean \u0111\u1ec3 bi\u1ebft m\u00f4 t\u1ea3 c\u1ee7a nghi\u00ean c\u1ee9u). T\u1ef7 l\u1ec7 Kaplan &#8211; Meier t\u00edch l\u0169y cho c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i nghi\u00eam tr\u1ecdng v\u1ec1 huy\u1ebft kh\u1ed1i t\u1eafc ngh\u1ebdn tim m\u1ea1ch do nghi\u00ean c\u1ee9u vi\u00ean b\u00e1o c\u00e1o (bao g\u1ed3m nh\u1ed3i m\u00e1u c\u01a1 tim, ngh\u1ebdn m\u1ea1ch ph\u1ed5i, huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u, \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh, c\u01a1n thi\u1ebfu m\u00e1u n\u00e3o tho\u00e1ng qua v\u00e0 tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9) cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa c\u00e1c nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib, diclofenac ho\u1eb7c ibuprofen. T\u1ef7 l\u1ec7 t\u00edch l\u0169y v\u00e0o th\u1eddi \u0111i\u1ec3m 9 th\u00e1ng \u1edf t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n d\u00f9ng celecoxib, diclofenac v\u00e0 ibuprofen l\u1ea7n l\u01b0\u1ee3t l\u00e0 1,2%, 1,4% v\u00e0 1,1%. T\u1ef7 l\u1ec7 t\u00edch l\u0169y \u1edf nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng s\u1eed d\u1ee5ng aspirin (ASA) v\u00e0o th\u1eddi \u0111i\u1ec3m 9 th\u00e1ng \u1edf t\u1eebng nh\u00f3m trong s\u1ed1 ba nh\u00f3m \u0111i\u1ec1u tr\u1ecb \u0111\u1ec1u th\u1ea5p h\u01a1n 1%. T\u1ef7 l\u1ec7 t\u00edch l\u0169y \u0111\u1ed1i v\u1edbi nh\u1ed3i m\u00e1u c\u01a1 tim \u1edf nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng d\u00f9ng ASA v\u00e0o th\u1eddi \u0111i\u1ec3m 9 th\u00e1ng \u1edf t\u1eebng nh\u00f3m trong s\u1ed1 ba nh\u00f3m \u0111i\u1ec1u tr\u1ecb \u0111\u1ec1u th\u1ea5p h\u01a1n 0,2%. Kh\u00f4ng c\u00f3 nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c n\u00e0o trong th\u1eed nghi\u1ec7m CLASS, \u0111i\u1ec1u n\u00e0y gi\u1edbi h\u1ea1n kh\u1ea3 n\u0103ng x\u00e1c \u0111\u1ecbnh xem li\u1ec7u ba lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m \u0111\u1ec1u kh\u00f4ng c\u00f3 nguy c\u01a1 gia t\u0103ng bi\u1ebfn c\u1ed1 tim m\u1ea1ch hay t\u1ea5t c\u1ea3 ch\u00fang \u0111\u1ec1u l\u00e0m t\u0103ng nguy c\u01a1 \u0111\u1ebfn m\u1ed9t m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng t\u1ef1 nhau.<\/p>\n<p><strong><em>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng: <\/em><\/strong><\/p>\n<p>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a celecoxib l\u00e0 \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p prostaglandin ch\u1ee7 y\u1ebfu b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf cyclooxygenase-2 (COX-2). \u1ede n\u1ed3ng \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb tr\u00ean ng\u01b0\u1eddi, celecoxib kh\u00f4ng \u1ee9c ch\u1ebf enzym cyclooxygenase-1 (COX-1). COX-2 \u0111\u01b0\u1ee3c t\u1ea1o ra nh\u1eb1m \u0111\u00e1p \u1ee9ng v\u1edbi t\u00e1c nh\u00e2n g\u00e2y vi\u00eam. \u0110i\u1ec1u n\u00e0y d\u1eabn \u0111\u1ebfn vi\u1ec7c t\u1ed5ng h\u1ee3p v\u00e0 t\u00edch l\u0169y c\u00e1c prostanoid g\u00e2y vi\u00eam, \u0111\u1eb7c bi\u1ec7t l\u00e0 prostaglandin E2, g\u00e2y vi\u00eam, ph\u00f9 n\u1ec1 v\u00e0 \u0111au. Celecoxib t\u00e1c d\u1ee5ng nh\u01b0 m\u1ed9t ch\u1ea5t kh\u00e1ng vi\u00eam, gi\u1ea3m \u0111au, v\u00e0 h\u1ea1 nhi\u1ec7t tr\u00ean c\u00e1c m\u00f4 h\u00ecnh \u0111\u1ed9ng v\u1eadt do ng\u0103n c\u1ea3n qu\u00e1 tr\u00ecnh s\u1ea3n xu\u1ea5t c\u00e1c prostanoid g\u00e2y vi\u00eam th\u00f4ng qua \u1ee9c ch\u1ebf COX-2. Trong c\u00e1c m\u00f4 h\u00ecnh u ru\u1ed9t k\u1ebft \u1edf \u0111\u1ed9ng v\u1eadt, celecoxib gi\u1ea3m t\u1ef7 l\u1ec7 v\u00e0 s\u1ef1 nh\u00e2n l\u00ean c\u1ee7a c\u00e1c kh\u1ed1i u.<\/p>\n<div class=\"ast-oembed-container \" style=\"height: 100%;\"><iframe loading=\"lazy\" title=\"[Pharmog SS1 - T\u1eadp 10] - D\u01b0\u1ee3c l\u00fd v\u1ec1 Thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid - NSAIDs\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/uIvbbYNDCZ8?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/div>\n<p><a href=\"https:\/\/www.youtube.com\/watch?v=uIvbbYNDCZ8&amp;feature=youtu.be\"><strong>[XEM T\u1ea0I \u0110\u00c2Y]<\/strong><\/a><\/p>\n<p><strong>5.2. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc:<\/strong><\/p>\n<p><em>H\u1ea5p thu<\/em><\/p>\n<p>D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a celecoxib \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u00ean kho\u1ea3ng 1500 ng\u01b0\u1eddi. Khi d\u00f9ng l\u00fac \u0111\u00f3i celecoxib d\u1ec5 d\u00e0ng \u0111\u01b0\u1ee3c h\u1ea5p thu v\u00e0 \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh trong huy\u1ebft t\u01b0\u01a1ng sau kho\u1ea3ng 2 &#8211; 3 gi\u1edd. Sinh kh\u1ea3 d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng d\u1ea1ng vi\u00ean nang l\u00e0 99% so v\u1edbi d\u1ea1ng h\u1ed7n d\u1ecbch (d\u1ea1ng u\u1ed1ng t\u1ed1i \u01b0u hi\u1ec7n c\u00f3). Khi \u0111\u01b0\u1ee3c d\u00f9ng l\u00fac \u0111\u00f3i, c\u1ea3 n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh trong huy\u1ebft t\u01b0\u01a1ng (C<sub>max<\/sub>) v\u00e0 di\u1ec7n t\u00edch d\u01b0\u1edbi \u0111\u01b0\u1eddng cong (AUC) \u0111\u1ec1u t\u1ef7 l\u1ec7 v\u1edbi li\u1ec1u cho \u0111\u1ebfn 200mg, 2 l\u1ea7n\/ng\u00e0y; \u1edf li\u1ec1u cao h\u01a1n, t\u1ef7 l\u1ec7 t\u0103ng t\u01b0\u01a1ng \u1ee9ng c\u1ee7a C<sub>max<\/sub>\u00a0v\u00e0 AUC th\u1ea5p h\u01a1n.<\/p>\n<p><em>Ph\u00e2n b\u1ed1<\/em><\/p>\n<p>T\u1ef7 l\u1ec7 g\u1eafn k\u1ebft v\u1edbi protein huy\u1ebft t\u01b0\u1ee3ng (t\u1ef7 l\u1ec7 n\u00e0y kh\u00f4ng ph\u1ee5 thu\u1ed9c n\u1ed3ng \u0111\u1ed9) l\u00e0 kho\u1ea3ng 97% \u1edf n\u1ed3ng \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb trong huy\u1ebft t\u01b0\u01a1ng v\u00e0 celecoxib kh\u00f4ng \u01b0u ti\u00ean g\u1eafn v\u1edbi h\u1ed3ng c\u1ea7u.<\/p>\n<p><em>Chuy\u1ec3n h\u00f3a<\/em><\/p>\n<p>Celecoxib \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a ch\u1ee7 y\u1ebfu qua cytocrom P450 2C9. Ba s\u1ea3n ph\u1ea9m chuy\u1ec3n h\u00f3a kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf COX-1 ho\u1eb7c COX-2 \u0111\u01b0\u1ee3c nh\u1eadn di\u1ec7n trong huy\u1ebft thanh ng\u01b0\u1eddi l\u00e0 alcol b\u1eadc nh\u1ea5t, acid carboxylic t\u01b0\u01a1ng \u1ee9ng v\u00e0 li\u00ean h\u1ee3p glucuronid c\u1ee7a n\u00f3.<\/p>\n<p>Ho\u1ea1t t\u00ednh c\u1ee7a cytocrom P450 2C9 gi\u1ea3m \u1edf ng\u01b0\u1eddi c\u00f3 \u0111a h\u00ecnh di truy\u1ec1n v\u00e0 \u0111i\u1ec1u n\u00e0y d\u1eabn \u0111\u1ebfn gi\u1ea3m ho\u1ea1t t\u00ednh enzym, v\u00ed d\u1ee5 ng\u01b0\u1eddi \u0111\u1ed3ng h\u1ee3p t\u1eed v\u1edbi \u0111a h\u00ecnh CYP2C9*3.<\/p>\n<p>Trong nghi\u00ean c\u1ee9u d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc v\u1edbi celecoxib 200mg d\u00f9ng 1 l\u1ea7n\/ng\u00e0y \u1edf ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n kh\u1ecfe m\u1ea1nh, ki\u1ec3u gen l\u00e0 CYP2C9*1\/*1, CYP2C9*1\/*3,ho\u1eb7c CYP2C9*3\/*3, gi\u00e1 tr\u1ecb trung b\u00ecnh C<sub>max<\/sub>\u00a0v\u00e0 AUC<sub>0-24<\/sub>\u00a0c\u1ee7a celecoxib v\u00e0o ng\u00e0y 7 l\u1ea7n l\u01b0\u1ee3t l\u00e0 x\u1ea5p x\u1ec9 g\u1ea5p 4 l\u1ea7n v\u00e0 7 l\u1ea7n, \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 ki\u1ec3u gen CYP2C9*3\/*3 so v\u1edbi c\u00e1c ki\u1ec3u gen kh\u00e1c. Trong 3 nghi\u00ean c\u1ee9u \u0111\u01a1n li\u1ec1u ri\u00eang r\u1ebd, c\u00f3 t\u1ed5ng c\u1ed9ng 5 \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 ki\u1ec3u gen CYP2C9*3\/*3, gi\u00e1 tr\u1ecb AUC<sub>0-24<\/sub>\u00a0c\u1ee7a li\u1ec1u \u0111\u01a1n t\u1eb7ng kho\u1ea3ng 3 l\u1ea7n so v\u1edbi nh\u1eefng ng\u01b0\u1eddi chuy\u1ec3n h\u00f3a b\u00ecnh th\u01b0\u1eddng. \u01af\u1edbc t\u00ednh t\u1ea7n su\u1ea5t xu\u1ea5t hi\u1ec7n c\u1ee7a ki\u1ec3u gen *3\/*3 l\u00e0 0,3% \u0111\u1ebfn 1,0% \u1edf c\u00e1c nh\u00f3m d\u00e2n t\u1ed9c kh\u00e1c nhau.<\/p>\n<p>B\u1ec7nh nh\u00e2n \u0111\u00e3 bi\u1ebft ho\u1eb7c nghi ng\u1edd c\u00f3 chuy\u1ec3n h\u00f3a CYP2C9 k\u00e9m d\u1ef1a tr\u00ean ti\u1ec1n s\u1eed\/kinh nghi\u1ec7m v\u1edbi c\u00e1c c\u01a1 ch\u1ea5t kh\u00e1c c\u1ee7a CYP2C9 n\u00ean th\u1eadn tr\u1ecdng khi d\u00f9ng celecoxib. N\u00ean xem x\u00e9t vi\u1ec7c b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec1u b\u1eb1ng m\u1ed9t n\u1eeda li\u1ec1u khuy\u1ebfn ngh\u1ecb th\u1ea5p nh\u1ea5t (Xem ph\u1ea7n Li\u1ec1u d\u00f9ng v\u00e0 c\u00e1ch d\u00f9ng v\u00e0 T\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c v\u00e0 c\u00e1c d\u1ea1ng t\u01b0\u01a1ng t\u00e1c kh\u00e1c).<\/p>\n<p><em>Th\u1ea3i tr\u1eeb<\/em><\/p>\n<p>Celecoxib th\u1ea3i tr\u1eeb ch\u1ee7 y\u1ebfu do chuy\u1ec3n h\u00f3a qua gan v\u1edbi d\u01b0\u1edbi 1% li\u1ec1u d\u00f9ng \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft nguy\u00ean d\u1ea1ng qua n\u01b0\u1edbc ti\u1ec3u. Sau khi d\u00f9ng \u0111a li\u1ec1u, th\u1eddi gian b\u00e1n th\u1ea3i l\u00e0 8 &#8211; 12 gi\u1edd v\u00e0 t\u1ed1c \u0111\u1ed9 thanh th\u1ea3i kho\u1ea3ng 500mL\/ph\u00fat. V\u1edbi \u0111a li\u1ec1u, n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong huy\u1ebft t\u01b0\u01a1ng \u0111\u1ea1t m\u1ee9c \u1ed5n \u0111\u1ecbnh tr\u01b0\u1edbc ng\u00e0y th\u1ee9 5. Bi\u1ebfn thi\u00ean gi\u1eefa c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng \u1edf c\u00e1c th\u00f4ng s\u1ed1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc (AUC, C<sub>max<\/sub>, th\u1eddi gian b\u00e1n th\u1ea3i) l\u00e0 kho\u1ea3ng 30%. Th\u1ec3 t\u00edch ph\u00e2n b\u1ed1 \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh trung b\u00ecnh kho\u1ea3ng 500L\/70kg \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh kh\u1ecfe m\u1ea1nh cho th\u1ea5y s\u1ef1 ph\u00e2n b\u1ed1 r\u1ed9ng kh\u1eafp c\u1ee7a celecoxib v\u00e0o c\u00e1c m\u00f4. C\u00e1c nghi\u00ean c\u1ee9u ti\u1ec1n l\u00e2m s\u00e0ng \u0111\u00e3 x\u00e1c \u0111\u1ecbnh thu\u1ed1c qua \u0111\u01b0\u1ee3c h\u00e0ng r\u00e0o m\u00e1u n\u00e3o.<\/p>\n<p><em>\u1ea2nh h\u01b0\u1edfng c\u1ee7a th\u1ee9c \u0103n<\/em><\/p>\n<p>D\u00f9ng thu\u1ed1c c\u00f9ng th\u1ee9c \u0103n (gi\u00e0u ch\u1ea5t b\u00e9o) l\u00e0m ch\u1eadm s\u1ef1 h\u1ea5p thu c\u1ee7a celecoxib th\u1ec3 hi\u1ec7n qua T<sub>max<\/sub>\u00a0\u0111\u1ea1t \u0111\u01b0\u1ee3c sau kho\u1ea3ng 4 gi\u1edd v\u00e0 l\u00e0m sinh kh\u1ea3 d\u1ee5ng t\u0103ng kho\u1ea3ng 20% (xem ph\u1ea7n Li\u1ec1u d\u00f9ng v\u00e0 c\u00e1ch d\u00f9ng).<\/p>\n<p>\u1ede ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n kh\u1ecfe m\u1ea1nh, l\u01b0\u1ee3ng h\u1ea5p thu to\u00e0n th\u00e2n (AUC) c\u1ee7a celecoxib t\u01b0\u01a1ng \u0111\u01b0\u01a1ng gi\u1eefa d\u1ea1ng u\u1ed1ng nguy\u00ean vi\u00ean nang ho\u1eb7c d\u1ea1ng h\u00f2a tan trong n\u01b0\u1edbc s\u1ed1t t\u00e1o. Kh\u00f4ng c\u00f3 s\u1ef1 thay \u0111\u1ed5i c\u00f3 \u00fd ngh\u0129a v\u1ec1 C<sub>max<\/sub>, T<sub>max<\/sub>\u00a0ho\u1eb7c T<sub>1\/2<\/sub>\u00a0sau khi u\u1ed1ng thu\u1ed1c nguy\u00ean vi\u00ean ho\u1eb7c h\u00f2a tan v\u00e0o n\u01b0\u1edbc s\u1ed1t t\u00e1o.<\/p>\n<p><strong><em>C\u00e1c nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u1eb7c bi\u1ec7t<\/em><\/strong><\/p>\n<p><em>Ng\u01b0\u1eddi cao tu\u1ed5i<\/em><\/p>\n<p>\u1ede ng\u01b0\u1eddi tr\u00ean 65 tu\u1ed5i, gi\u00e1 tr\u1ecb trung b\u00ecnh C<sub>max\u00a0<\/sub>v\u00e0 AUC c\u1ee7a celecoxib t\u0103ng l\u00ean 1,5 &#8211; 2 l\u1ea7n. \u0110i\u1ec1u n\u00e0y ch\u1ee7 y\u1ebfu li\u00ean quan \u0111\u1ebfn c\u00e2n n\u1eb7ng ch\u1ee9 kh\u00f4ng do thay \u0111\u1ed5i v\u1ec1 tu\u1ed5i t\u00e1c, celecoxib c\u00f3 n\u1ed3ng \u0111\u1ed9 cao h\u01a1n tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 c\u00e2n n\u1eb7ng \u00edt h\u01a1n v\u00e0 do \u0111\u00f3 cao h\u01a1n \u1edf nh\u1eefng ng\u01b0\u1eddi l\u1edbn tu\u1ed5i c\u00f3 c\u00e2n n\u1eb7ng trung b\u00ecnh th\u1ea5p h\u01a1n nh\u1eefng ng\u01b0\u1eddi tr\u1ebb. Do v\u1eady, ph\u1ee5 n\u1eef l\u1edbn tu\u1ed5i c\u00f3 xu h\u01b0\u1edbng c\u00f3 n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong huy\u00eat t\u01b0\u01a1ng cao h\u01a1n \u0111\u00e0n \u00f4ng l\u1edbn tu\u1ed5i. N\u00f3i chung kh\u00f4ng c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u. Tuy nhi\u00ean, v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i c\u00f3 c\u00e2n n\u1eb7ng d\u01b0\u1edbi trung b\u00ecnh ( &lt; 50kg), n\u00ean b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec1u khuy\u1ebfn ngh\u1ecb th\u1ea5p nh\u1ea5t.<\/p>\n<p><em>Ch\u1ee7ng t\u1ed9c<\/em><\/p>\n<p>M\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p c\u00e1c nghi\u00ean c\u1ee9u d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u0111\u00e3 d\u1ef1 \u0111o\u00e1n AUC c\u1ee7a celecoxib \u1edf ng\u01b0\u1eddi da den cao h\u01a1n kho\u1ea3ng 40% so v\u1edbi ng\u01b0\u1eddi da tr\u1eafng. Nguy\u00ean nh\u00e2n v\u00e0 \u00fd ngh\u0129a l\u00e2m s\u00e0ng c\u1ee7a v\u1ea5n \u0111\u1ec1 n\u00e0y v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft.<\/p>\n<p><em>Suy gan<\/em><\/p>\n<p>N\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng c\u1ee7a celecoxib \u1edf b\u1ec7nh nh\u00e2n suy gan nh\u1eb9 (Child-Pugh Lo\u1ea1i A) kh\u00f4ng c\u00f3 kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 so v\u1edbi n\u1ed3ng \u0111\u1ed9 \u1edf nh\u00f3m \u0111\u1ed1i ch\u1ee9ng c\u00f3 tu\u1ed5i v\u00e0 gi\u1edbi t\u00ednh t\u01b0\u01a1ng \u1ee9ng. Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n suy gan v\u1eeba (Child-Pugh Lo\u1ea1i B) n\u1ed3ng \u0111\u1ed9 celecoxib trong huy\u1ebft t\u01b0\u01a1ng cao h\u01a1n kho\u1ea3ng 2 l\u1ea7n so v\u1edbi nh\u00f3m \u0111\u1ed1i ch\u1ee9ng t\u01b0\u01a1ng \u1ee9ng (xem ph\u1ea7n Li\u1ec1u d\u00f9ng v\u00e0 c\u00e1ch d\u00f9ng).<\/p>\n<p><em>Suy th\u1eadn<\/em><\/p>\n<p>Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n t\u00ecnh nguy\u1ec7n cao tu\u1ed5i b\u1ecb gi\u1ea3m t\u1ed1c \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn (GFR) do tu\u1ed5i (GFR trung b\u00ecnh &gt;65ml\/ph\u00fat\/1,73m<sup>2<\/sup>) v\u00e0 c\u00e1c b\u1ec7nh nh\u00e2n b\u1ecb suy th\u1eadn m\u1ea1n \u1ed5n \u0111\u1ecbnh (GFR 35 &#8211; 60ml\/ph\u00fat\/1,73m<sup>2<\/sup>), d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a celecoxib t\u01b0\u01a1ng t\u1ef1 v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ee9c n\u0103ng th\u1eadn b\u00ecnh th\u01b0\u1eddng. Kh\u00f4ng c\u00f3 m\u1ed1i li\u00ean h\u1ec7 \u0111\u00e1ng k\u1ec3 n\u00e0o \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y gi\u1eefa creatinin huy\u1ebft thanh (ho\u1eb7c h\u1ec7 s\u1ed1 thanh th\u1ea3i creatinin) v\u00e0 \u0111\u1ed9 thanh th\u1ea3i celecoxib. Suy th\u1eadn n\u1eb7ng kh\u00f4ng l\u00e0m thay \u0111\u1ed5i \u0111\u1ed9 thanh th\u1ea3i celecoxib do \u0111\u01b0\u1eddng th\u1ea3i tr\u1eeb ch\u00ednh c\u1ee7a thu\u1ed1c l\u00e0 qua chuy\u1ec3n h\u00f3a t\u1ea1i gan th\u00e0nh d\u1ea1ng kh\u00f4ng ho\u1ea1t t\u00ednh.<\/p>\n<p><em>\u1ea2nh h\u01b0\u1edfng tr\u00ean th\u1eadn<\/em><\/p>\n<p>C\u00e1c vai tr\u00f2 li\u00ean quan c\u1ee7a COX-1 v\u00e0 COX-2 trong sinh l\u00fd th\u1eadn ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ea7y \u0111\u1ee7. Celecoxib l\u00e0m gi\u1ea3m s\u1ef1 th\u1ea3i tr\u1eeb qua th\u1eadn c\u1ee7a PGE<sub>2<\/sub>\u00a0v\u00e0 6-keto PGF<sub>1<\/sub>\u00a0\u03b1 (m\u1ed9t ch\u1ea5t chuy\u1ec3n h\u00f3a c\u1ee7a prostacyclin) nh\u01b0ng kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn th\u1ea3i tr\u1eeb thromboxan B<sub>2<\/sub>\u00a0huy\u1ebft thanh v\u00e0 11-dehydro-TXB<sub>2<\/sub>, m\u1ed9t ch\u1ea5t chuy\u1ec3n h\u00f3a c\u1ee7a thromboxan (c\u1ea3 hai \u0111\u1ec1u l\u00e0 s\u1ea3n ph\u1ea9m c\u1ee7a COX-1) C\u00e1c nghi\u00ean c\u1ee9u \u0111\u1eb7c th\u00f9 \u0111\u00e3 cho th\u1ea5y celecoxib kh\u00f4ng l\u00e0m gi\u1ea3m GFR \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i ho\u1eb7c b\u1ec7nh nh\u00e2n suy th\u1eadn m\u1ea1n. C\u00e1c nghi\u00ean c\u1ee9u n\u00e0y c\u0169ng cho th\u1ea5y c\u00f3 s\u1ef1 gi\u1ea3m b\u00e0i ti\u1ebft natri t\u1ea1m th\u1eddi. Trong c\u00e1c nghi\u00ean c\u1ee9u tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n vi\u00eam kh\u1edbp, \u0111\u00e3 quan s\u00e1t th\u1ea5y t\u1ef7 l\u1ec7 ph\u00f9 m\u1ea1ch ngo\u1ea1i vi t\u01b0\u01a1ng \u0111\u01b0\u01a1ng so v\u1edbi b\u1ec7nh nh\u00e2n d\u00f9ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf COX kh\u00f4ng \u0111\u1eb7c hi\u1ec7u (c\u0169ng c\u00f3 t\u00e1c \u0111\u1ed9ng \u1ee9c ch\u1ebf COX-2). \u0110i\u1ec1u n\u00e0y th\u1ea5y r\u00f5 nh\u1ea5t tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u. Tuy nhi\u00ean kh\u00f4ng ghi nh\u1eadn t\u0103ng t\u1ef7 l\u1ec7 c\u1ee7a t\u0103ng huy\u1ebft \u00e1p v\u00e0 suy tim; ph\u00f9 m\u1ea1ch ngo\u1ea1i vi th\u01b0\u1eddng nh\u1eb9 v\u00e0 t\u1ef1 h\u1ebft.<\/p>\n<p><strong>5.3 Gi\u1ea3i th\u00edch: <\/strong><\/p>\n<p>Ch\u01b0a c\u00f3 th\u00f4ng tin. \u0110ang c\u1eadp nh\u1eadt.<\/p>\n<p><strong>5.4 Thay th\u1ebf thu\u1ed1c : <\/strong><\/p>\n<p>Ch\u01b0a c\u00f3 th\u00f4ng tin. \u0110ang c\u1eadp nh\u1eadt.<\/p>\n<p><strong><em>*L\u01b0u \u00fd:<\/em><\/strong><\/p>\n<p><strong><em>C\u00e1c th\u00f4ng tin v\u1ec1 thu\u1ed1c tr\u00ean Pharmog.com ch\u1ec9 mang t\u00ednh ch\u1ea5t tham kh\u1ea3o &#8211; Khi d\u00f9ng thu\u1ed1c c\u1ea7n tuy\u1ec7t \u0111\u1ed1i tu\u00e2n theo theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u00e1c s\u0129 <\/em><\/strong><\/p>\n<p><strong><em>Ch\u00fang t\u00f4i kh\u00f4ng ch\u1ecbu tr\u00e1ch nhi\u1ec7m v\u1ec1 b\u1ea5t c\u1ee9 h\u1eadu qu\u1ea3 n\u00e0o x\u1ea3y ra do t\u1ef1 \u00fd d\u00f9ng thu\u1ed1c d\u1ef1a theo c\u00e1c th\u00f4ng tin tr\u00ean Pharmog.com<\/em><\/strong><\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<p><strong>6. Ph\u1ea7n th\u00f4ng tin k\u00e8m theo c\u1ee7a thu\u1ed1c:<\/strong><\/p>\n<p><strong>6.1. Danh m\u1ee5c t\u00e1 d\u01b0\u1ee3c:<\/strong><\/p>\n<p>T\u00e1 d\u01b0\u1ee3c: Vi\u00ean nang ch\u1ee9a lactose monohy\u0111rat, natri lauryl sulfat, povidon K30, natri croscarmellose, magnesi stearat. V\u1ecf nang ch\u1ee9a gelatin, n\u01b0\u1edbc tinh khi\u1ebft, natri lauryl sulfat, silic dioxid keo, titan dioxid; m\u1ef1c in ch\u1ee9a s\u1eaft oxid E172, shellac.<\/p>\n<p><strong>6.2. T\u01b0\u01a1ng k\u1ef5 :<\/strong><\/p>\n<p>Kh\u00f4ng \u00e1p d\u1ee5ng.<\/p>\n<p><strong>6.3. B\u1ea3o qu\u1ea3n: <\/strong><\/p>\n<p>B\u1ea3o qu\u1ea3n d\u01b0\u1edbi 30\u00b0C. L\u01b0\u1ee3ng thu\u1ed1c h\u00f2a tan trong n\u01b0\u1edbc sinh t\u1ed1 t\u00e1o, ch\u00e1o, s\u1eefa chua \u1ed5n \u0111\u1ecbnh trong t\u1ed1i \u0111a 6 gi\u1edd khi b\u1ea3o qu\u1ea3n trong t\u1ee7 l\u1ea1nh (2 &#8211; 8\u00b0C). Kh\u00f4ng \u0111\u01b0\u1ee3c b\u1ea3o qu\u1ea3n l\u01b0\u1ee3ng thu\u1ed1c tr\u1ed9n l\u1eabn trong chu\u1ed1i nghi\u1ec1n n\u00e1t trong t\u1ee7 l\u1ea1nh m\u00e0 ph\u1ea3i u\u1ed1ng lu\u00f4n.<\/p>\n<p><strong>6.4. Th\u00f4ng tin kh\u00e1c :<\/strong><\/p>\n<p><em>C\u00e1c d\u1eef li\u1ec7u an to\u00e0n ti\u1ec1n l\u00e2m s\u00e0ng<\/em><\/p>\n<p>C\u00e1c d\u1eef li\u1ec7u an to\u00e0n ti\u1ec1n l\u00e2m s\u00e0ng cho th\u1ea5y kh\u00f4ng c\u00f3 r\u1ee7i ro \u0111\u1eb7c bi\u1ec7t n\u00e0o cho con ng\u01b0\u1eddi d\u1ef1a tr\u00ean c\u00e1c nghi\u00ean c\u1ee9u c\u01a1 b\u1ea3n v\u1ec1 \u0111\u1ed9c t\u00ednh v\u1edbi li\u1ec1u nh\u1eafc l\u1ea1i, t\u00e1c d\u1ee5ng g\u00e2y \u0111\u1ed9t bi\u1ebfn ho\u1eb7c ung th\u01b0.<\/p>\n<p>Vi\u1ec7c d\u00f9ng celecoxib \u0111\u01b0\u1eddng u\u1ed1ng &gt;150mg\/kg\/ng\u00e0y tr\u00ean th\u1ecf \u0111ang trong qu\u00e1 tr\u00ecnh t\u1ea1o c\u01a1 quan (g\u1ea5p x\u1ea5p x\u1ec9 2 l\u1ea7n so v\u1edbi li\u1ec1u s\u1eed d\u1ee5ng tr\u00ean ng\u01b0\u1eddi 200mg hai l\u1ea7n\/ng\u00e0y t\u00ednh theo AUC<sub>0-24<\/sub>) l\u00e0m t\u0103ng t\u1ec9 l\u1ec7 m\u1eafc th\u00f4ng li\u00ean th\u1ea5t, m\u1ed9t bi\u1ebfn c\u1ed1 hi\u1ebfm g\u1eb7p, v\u00e0 d\u1ecb t\u1eadt \u1edf thai nhi, nh\u01b0 l\u00e0 d\u00ednh x\u01b0\u01a1ng s\u01b0\u1eddn, d\u00ednh c\u00e1c \u0111\u1ed1t \u1ee9c v\u00e0 bi\u1ebfn d\u1ea1ng \u0111\u1ed1t \u1ee9c. Quan s\u00e1t th\u1ea5y c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng tho\u00e1t v\u1ecb c\u01a1 ho\u00e0nh ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u khi cho chu\u1ed9t c\u1ed1ng \u0111ang trong qu\u00e1 tr\u00ecnh t\u1ea1o c\u01a1 quan d\u00f9ng celecoxib \u0111\u01b0\u1eddng u\u1ed1ng v\u1edbi li\u1ec1u &gt; 30mg\/kg\/ng\u00e0y (g\u1ea5p x\u1ea5p x\u1ec9 6 l\u1ea7n so v\u1edbi li\u1ec1u s\u1eed d\u1ee5ng tr\u00ean ng\u01b0\u1eddi 200mg hai l\u1ea7n\/ng\u00e0y t\u00ednh theo AUC<sub>0-24<\/sub>). Nh\u1eefng t\u00e1c \u0111\u1ed9ng n\u00e0y \u0111\u01b0\u1ee3c d\u1ef1 \u0111o\u00e1n x\u1ea3y ra l\u00e0 do \u1ee9c ch\u1ebf s\u1ef1 t\u1ed5ng h\u1ee3p prostaglandin. Tr\u00ean chu\u1ed9t c\u1ed1ng, d\u00f9ng celecoxib trong th\u1eddi k\u1ef3 ph\u00e1t tri\u1ec3n \u0111\u1ea7u c\u1ee7a b\u00e0o thai g\u00e2y s\u1ea3y thai tr\u01b0\u1edbc v\u00e0 sau khi tr\u1ee9ng l\u00e0m t\u1ed5 v\u00e0 l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng s\u1ed1ng s\u00f3t c\u1ee7a ph\u00f4i thai\/thai nhi.<\/p>\n<p><em>\u0110\u1ed9c t\u00ednh tr\u00ean \u0111\u1ed9ng v\u1eadt<\/em><\/p>\n<p>\u0110\u00e3 ghi nh\u1eadn tr\u01b0\u1eddng h\u1ee3p t\u0103ng t\u1ec9 l\u1ec7 b\u1ecb nang tinh d\u1ecbch (spermatocele) c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m theo nh\u1eefng thay \u0111\u1ed5i th\u1ee9 ph\u00e1t nh\u01b0 gi\u1ea3m tinh d\u1ecbch do m\u00e0o tinh c\u0169ng nh\u01b0 gi\u00e3n \u1ed1ng d\u1eabn tinh t\u1eeb r\u1ea5t nh\u1eb9 \u0111\u1ebfn gi\u00e3n nh\u1eb9 tr\u00ean chu\u1ed9t ch\u01b0a tr\u01b0\u1edfng th\u00e0nh. C\u00e1c ph\u00e1t hi\u1ec7n tr\u00ean h\u1ec7 sinh s\u1ea3n n\u00e0y m\u1eb7c d\u00f9 c\u00f3 li\u00ean quan \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb nh\u01b0ng kh\u00f4ng l\u00e0m t\u0103ng t\u1ec9 l\u1ec7 ho\u1eb7c m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng theo li\u1ec1u d\u00f9ng v\u00e0 c\u00f3 th\u1ec3 l\u00e0 t\u00ecnh tr\u1ea1ng t\u1ef1 ph\u00e1t. Kh\u00f4ng ghi nh\u1eadn c\u00e1c ph\u00e1t hi\u1ec7n t\u01b0\u01a1ng t\u1ef1 tr\u00ean h\u1ec7 sinh s\u1ea3n trong nghi\u00ean c\u1ee9u tr\u00ean ch\u1ecf ch\u01b0a tr\u01b0\u1edfng th\u00e0nh, ch\u00f3 tr\u01b0\u1edfng th\u00e0nh ho\u1eb7c chu\u1ed9t tr\u01b0\u1edfng th\u00e0nh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng celecoxib. Ch\u01b0a bi\u1ebft \u00fd ngh\u0129a l\u00e2m s\u00e0ng c\u1ee7a nh\u1eefng quan s\u00e1t n\u00e0y.<\/p>\n<p><strong>6.5 T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong><\/p>\n<p>D\u01b0\u1ee3c Th\u01b0 Qu\u1ed1c Gia Vi\u1ec7t Nam<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>1. T\u00ean ho\u1ea1t ch\u1ea5t v\u00e0 bi\u1ec7t d\u01b0\u1ee3c: Ho\u1ea1t ch\u1ea5t : Celecoxib Ph\u00e2n lo\u1ea1i: Thu\u00f4\u0301c kha\u0301ng vi\u00eam Non-steroid (NSAIDS) \u01af\u0301c ch\u00ea\u0301 cho\u0323n lo\u0323c COX-2 (Coxibs). Nh\u00f3m ph\u00e1p l\u00fd: Thu\u1ed1c k\u00ea \u0111\u01a1n ETC \u2013 (Ethical drugs, prescription drugs, Prescription only medicine) M\u00e3 ATC (Anatomical Therapeutic Chemical): M01AH01, L01XX33. Brand name: CELEBREX. H\u00e3ng s\u1ea3n xu\u1ea5t : Pfizer 2. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":6689,"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":[370],"tags":[420],"class_list":["post-6688","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-biet-duoc-goc","tag-celecoxib"],"_links":{"self":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/6688","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/comments?post=6688"}],"version-history":[{"count":5,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/6688\/revisions"}],"predecessor-version":[{"id":52267,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/6688\/revisions\/52267"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/media\/6689"}],"wp:attachment":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/media?parent=6688"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/categories?post=6688"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/tags?post=6688"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}