{"id":9210,"date":"2019-05-06T23:56:14","date_gmt":"2019-05-06T16:56:14","guid":{"rendered":"https:\/\/www.hmm88i.com\/drug\/?p=9210"},"modified":"2024-07-30T10:57:56","modified_gmt":"2024-07-30T03:57:56","slug":"disulfiram","status":"publish","type":"post","link":"https:\/\/hmm88i.com\/drug\/disulfiram\/","title":{"rendered":"Disulfiram l\u00e0 g\u00ec? C\u01a1 ch\u1ebf, t\u00e1c d\u1ee5ng, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c"},"content":{"rendered":"<h2>Disulfiram l\u00e0 g\u00ec?<\/h2>\n<p><a href=\"https:\/\/hmm88i.com\/drug\/disulfiram\/\">Disulfiram<\/a> l\u00e0 lo\u1ea1i thu\u1ed1c \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c C\u01a1 quan Qu\u1ea3n l\u00fd Th\u1ef1c ph\u1ea9m v\u00e0 D\u01b0\u1ee3c ph\u1ea9m Hoa K\u1ef3 (FDA) ph\u00ea duy\u1ec7t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nghi\u1ec7n r\u01b0\u1ee3u m\u00e3n t\u00ednh. \u1ede tr\u1ea1ng th\u00e1i tinh khi\u1ebft, disulfiram l\u00e0 m\u1ed9t lo\u1ea1i b\u1ed9t tr\u1eafng kh\u00f4ng m\u00f9i, g\u1ea7n nh\u01b0 kh\u00f4ng v\u1ecb, h\u00f2a tan \u0111\u01b0\u1ee3c trong n\u01b0\u1edbc v\u00e0 r\u01b0\u1ee3u. Disulfiram g\u00e2y ra ph\u1ea3n \u1ee9ng v\u1eadt l\u00fd \u0111\u1ed9c h\u1ea1i c\u1ea5p t\u00ednh khi t\u00e1c d\u1ee5ng v\u1edbi r\u01b0\u1ee3u. C\u00e1c nghi\u00ean c\u1ee9u v\u00e0 ph\u00e1t hi\u1ec7n l\u00e2m s\u00e0ng \u0111\u1ebfn nay \u0111\u00e3 l\u00e0m r\u00f5 ph\u01b0\u01a1ng th\u1ee9c ho\u1ea1t \u0111\u1ed9ng c\u1ee7a disulfiram v\u00e0 thi\u1ebft l\u1eadp vi\u1ec7c s\u1eed d\u1ee5ng n\u00f3 m\u1ed9t c\u00e1ch an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n s\u1eed d\u1ee5ng r\u01b0\u1ee3u (AUD) \u1edf m\u1ed9t s\u1ed1 nh\u00f3m b\u1ec7nh nh\u00e2n.<\/p>\n<h2>S\u01a1 l\u01b0\u1ee3c v\u1ec1 thu\u1ed1c Disulfiram<\/h2>\n<ul>\n<li>T\u00ean h\u00f3a h\u1ecdc: Bis(diethylthiocarbamoyl) disulfide.<\/li>\n<li>T\u00ean th\u01b0\u01a1ng m\u1ea1i: Antabuse<sup>\u00ae, <\/sup><a href=\"https:\/\/www.hmm88i.com\/drug\/esperal\">Esperal<\/a>, <a href=\"https:\/\/www.hmm88i.com\/drug\/chronol\">CHRONOL<\/a><\/li>\n<li>Nh\u00e0 ph\u00e2n ph\u1ed1i \u1edf Hoa K\u1ef3: Odyssey Enterprises, Inc., East Hanover, NJ, Sanofi Ph\u00e1p.<\/li>\n<li>C\u1ee5c qu\u1ea3n l\u00fd Th\u1ef1c ph\u1ea9m v\u00e0 D\u01b0\u1ee3c ph\u1ea9m Hoa K\u1ef3 ph\u00ea duy\u1ec7t \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nghi\u1ec7n r\u01b0\u1ee3u: n\u0103m 1951.<\/li>\n<li>Li\u1ec1u d\u00f9ng \/ C\u00e1ch d\u00f9ng: U\u1ed1ng m\u1ed7i ng\u00e0y m\u1ed9t l\u1ea7n (thu\u1ed1c c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c nghi\u1ec1n n\u00e1t v\u00e0 tr\u1ed9n v\u1edbi n\u01b0\u1edbc, c\u00e0 ph\u00ea, tr\u00e0, s\u1eefa, n\u01b0\u1edbc ng\u1ecdt, ho\u1eb7c n\u01b0\u1edbc \u00e9p tr\u00e1i c\u00e2y).<\/li>\n<li>Bao b\u00ec: Chai 100 ho\u1eb7c 1.000 vi\u00ean 250 mg ho\u1eb7c chai 50, 100 ho\u1eb7c 500 vi\u00ean 500mg.<\/li>\n<li>B\u1ea3o qu\u1ea3n: \u0110\u1ec3 xa t\u1ea7m tay tr\u1ebb em; \u0111\u00f3ng ch\u1eb7t trong th\u00f9ng ch\u1ee9a ban \u0111\u1ea7u; l\u01b0u tr\u1eef \u1edf nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng, tr\u00e1nh xa nhi\u1ec7t \u0111\u1ed9 v\u00e0 \u0111\u1ed9 \u1ea9m (kh\u00f4ng \u0111\u1ec3 trong ph\u00f2ng t\u1eafm ho\u1eb7c g\u1ea7n b\u1ed3n r\u1eeda); lo\u1ea1i b\u1ecf khi h\u1ebft h\u1ea1n ho\u1eb7c kh\u00f4ng c\u00f2n s\u1eed d\u1ee5ng.<\/li>\n<\/ul>\n<figure id=\"attachment_95492\" aria-describedby=\"caption-attachment-95492\" style=\"width: 1200px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/hmm88i.com\/drug\/disulfiram\/disulfiram-1\/#main\" rel=\"attachment wp-att-95492\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-95492\" src=\"https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2019\/05\/Disulfiram-1-1.jpg\" alt=\"Thu\u1ed1c cai r\u01b0\u1ee3u Esperal 500mg v\u00e0 Chronol\" width=\"1200\" height=\"800\" title=\"\" srcset=\"https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2019\/05\/Disulfiram-1-1.jpg 1200w, https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2019\/05\/Disulfiram-1-1-600x400.jpg 600w, https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2019\/05\/Disulfiram-1-1-768x512.jpg 768w, https:\/\/hmm88i.com\/drug\/wp-content\/uploads\/2019\/05\/Disulfiram-1-1-350x233.jpg 350w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><\/a><figcaption id=\"caption-attachment-95492\" class=\"wp-caption-text\">Thu\u1ed1c cai r\u01b0\u1ee3u Esperal 500mg v\u00e0 Chronol<\/figcaption><\/figure>\n<h2>T\u00f3m t\u1eaft l\u1ecbch s\u1eed ph\u00e1t tri\u1ec3n c\u1ee7a Disulfiram<\/h2>\n<table>\n<tbody>\n<tr>\n<td>Ng\u00e0y<\/td>\n<td>S\u1ef1 ki\u1ec7n<\/td>\n<\/tr>\n<tr>\n<td>Th\u1eadp ni\u00ean 1930<\/td>\n<td>T\u00e1c d\u1ee5ng ch\u1ed1ng l\u1ea1i r\u01b0\u1ee3u c\u1ee7a disulfiram \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n l\u1ea7n \u0111\u1ea7u ti\u00ean khi c\u00e1c c\u00f4ng nh\u00e2n trong ng\u00e0nh cao su l\u01b0u h\u00f3a, ti\u1ebfp x\u00fac v\u1edbi tetraethylthiuram disulfide, sau \u0111\u00f3 b\u1ecb b\u1ec7nh sau khi u\u1ed1ng r\u01b0\u1ee3u.<\/td>\n<\/tr>\n<tr>\n<td>1947<\/td>\n<td>T\u1ea1i Copenhagen, c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u trong qu\u00e1 tr\u00ecnh nghi\u00ean c\u1ee9u c\u00e1c h\u1ee3p ch\u1ea5t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam d\u1ea1 d\u00e0y do k\u00fd sinh tr\u00f9ng d\u00f9ng m\u1ed9t li\u1ec1u nh\u1ecf disulfiram \u0111\u1ec3 ki\u1ec3m tra t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a n\u00f3. Sau \u0111\u00f3 h\u1ecd b\u1ecb \u1ed1m sau khi u\u1ed1ng r\u01b0\u1ee3u. H\u1ecd k\u1ebft lu\u1eadn r\u1eb1ng s\u1ef1 t\u01b0\u01a1ng t\u00e1c gi\u1eefa disulfiram v\u00e0 r\u01b0\u1ee3u l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh khi\u1ebfn h\u1ecd b\u1ecb \u1ed1m v\u00e0 ti\u1ebfn h\u00e0nh m\u1ed9t nghi\u00ean c\u1ee9u \u0111\u1ec3 x\u00e1c nh\u1eadn ph\u00e1t hi\u1ec7n c\u1ee7a m\u00ecnh (Hald &amp; Jacobsen, 1948).<\/td>\n<\/tr>\n<tr>\n<td>Cu\u1ed1i th\u1eadp ni\u00ean 40 \u0111\u1ea7u th\u1eadp ni\u00ean 50<\/td>\n<td>M\u1ed9t nh\u00f3m ng\u01b0\u1eddi \u0110an M\u1ea1ch th\u1ef1c hi\u1ec7n c\u00e1c nghi\u00ean c\u1ee9u b\u1ed5 sung v\u1ec1 \u0111i\u1ec1u tr\u1ecb disulfiram cho b\u1ec7nh nghi\u1ec7n r\u01b0\u1ee3u. D\u1ef1a tr\u00ean m\u00f4 h\u00ecnh ban \u0111\u1ea7u v\u1ec1 \u0111i\u1ec1u ki\u1ec7n kh\u00f4ng mong mu\u1ed1n, nghi\u00ean c\u1ee9u s\u1eed d\u1ee5ng li\u1ec1u disulfiram cao (v\u00ed d\u1ee5: 1.000 \u0111\u1ebfn 3.000 mg m\u1ed7i ng\u00e0y) \u0111\u1ec3 t\u1ed1i \u0111a h\u00f3a ph\u1ea3n \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n<p>&nbsp;<\/p>\n<p>FDA ch\u1ea5p thu\u1eadn disulfiram trong \u0111i\u1ec1u tr\u1ecb nghi\u1ec7n r\u01b0\u1ee3u \u1edf Hoa K\u1ef3.<\/p>\n<p>&nbsp;<\/p>\n<p>Ph\u00f2ng th\u00ed nghi\u1ec7m Wyeth-Ayerst b\u1eaft \u0111\u1ea7u s\u1ea3n xu\u1ea5t c\u00e1c vi\u00ean thu\u1ed1c Antabuse (hi\u1ec7n \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t b\u1edfi PLIVA v\u00e0 \u0111\u01b0\u1ee3c ph\u00e2n ph\u1ed1i t\u1ea1i Hoa K\u1ef3 b\u1edfi c\u00f4ng ty d\u01b0\u1ee3c ph\u1ea9m Odyssey).<\/p>\n<p>&nbsp;<\/p>\n<p>Ruth Fox, MD, ch\u1ee7 t\u1ecbch s\u00e1ng l\u1eadp Hi\u1ec7p h\u1ed9i Thu\u1ed1c g\u00e2y nghi\u1ec7n Hoa K\u1ef3, l\u00e0 ng\u01b0\u1eddi M\u1ef9 \u0111\u1ea7u ti\u00ean s\u1eed d\u1ee5ng disulfiram \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nghi\u1ec7n r\u01b0\u1ee3u, b\u1eaft \u0111\u1ea7u t\u1eeb n\u0103m 1949. Khi b\u1ec7nh nh\u00e2n c\u1ee7a b\u00e0 b\u00e1o c\u00e1o c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nghi\u00eam tr\u1ecdng, Fox \u0111\u00e3 gi\u1ea3m li\u1ec1u v\u00e0 b\u00e0n b\u1ea1c v\u1edbi b\u1ec7nh nh\u00e2n v\u1ec1 c\u00e1c ph\u1ea3n \u1ee9ng nghi\u00eam tr\u1ecdng c\u00f3 th\u1ec3 x\u1ea3y ra do u\u1ed1ng r\u01b0\u1ee3u. B\u00e0 k\u1ebft lu\u1eadn r\u1eb1ng disulfiram c\u00f3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c ng\u0103n ch\u1eb7n vi\u1ec7c u\u1ed1ng r\u01b0\u1ee3u \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nghi\u1ec7n r\u01b0\u1ee3u v\u00e0 \u0111i\u1ec1u tr\u1ecb cho kho\u1ea3ng 2.500 b\u1ec7nh nh\u00e2n v\u1edbi disulfiram.<\/p>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Cu\u1ed1i th\u1eadp ni\u00ean 1950 \u0111\u1ebfn hi\u1ec7n nay<\/td>\n<td>Sau khi b\u00e1o c\u00e1o v\u1ec1 c\u00e1c ph\u1ea3n \u1ee9ng nghi\u00eam tr\u1ecdng, bao g\u1ed3m m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p t\u1eed vong, m\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb chuy\u1ec3n t\u1eeb s\u1eed d\u1ee5ng disulfiram cho \u0111i\u1ec1u ki\u1ec7n kh\u00f4ng mong mu\u1ed1n sang s\u1eed d\u1ee5ng n\u00f3 \u0111\u1ec3 h\u1ed7 tr\u1ee3 cai nghi\u1ec7n. \u0110i\u1ec1u n\u00e0y \u0111\u00f2i h\u1ecfi ph\u1ea3i s\u1eed d\u1ee5ng li\u1ec1u l\u01b0\u1ee3ng th\u1ea5p h\u01a1n \u0111\u1ec3 ki\u1ec3m so\u00e1t \u0111\u1ed9c t\u00ednh c\u1ee7a disulfiram, ngo\u1ea1i tr\u1eeb b\u1ec7nh nh\u00e2n b\u1ecb nh\u1ed3i m\u00e1u c\u01a1 tim ho\u1eb7c x\u01a1 gan v\u00e0 k\u1ebft h\u1ee3p thu\u1ed1c v\u1edbi c\u00e1c lo\u1ea1i h\u1ed7 tr\u1ee3 kh\u00e1c.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>D\u01b0\u1ee3c l\u00fd c\u1ee7a Disulfiram<\/h2>\n<h3>\u0110i\u1ec1u tr\u1ecb g\u00e2y kh\u00f3 ch\u1ecbu<\/h3>\n<p>Kh\u00f4ng gi\u1ed1ng nh\u01b0 c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nghi\u1ec7n r\u01b0\u1ee3u, disulfiram kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn opiate, axit \u03b3-aminobutyric ho\u1eb7c th\u1ee5 th\u1ec3 glutamate \u1edf n\u00e3o tr\u1ef1c ti\u1ebfp. Tuy nhi\u00ean, n\u00f3 c\u00f3 m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng l\u00ean h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, \u1ee9c ch\u1ebf enzyme dopamine-hydroxylase v\u00e0 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng serotonergic. Vi\u1ec7c disulfiram c\u00f3 tr\u1ef1c ti\u1ebfp l\u00e0m gi\u1ea3m ham mu\u1ed1n u\u1ed1ng r\u01b0\u1ee3u hay kh\u00f4ng v\u1eabn ch\u01b0a ch\u1eafc ch\u1eafn. Tuy nhi\u00ean, disulfiram ch\u1eafc ch\u1eafn ph\u00e1 v\u1ee1 s\u1ef1 trao \u0111\u1ed5i ch\u1ea5t c\u1ee7a r\u01b0\u1ee3u, g\u00e2y ra ph\u1ea3n \u1ee9ng nghi\u00eam tr\u1ecdng khi b\u1ec7nh nh\u00e2n u\u1ed1ng disulfiram v\u00e0 r\u01b0\u1ee3u. Nh\u1eadn th\u1ee9c c\u1ee7a b\u1ec7nh nh\u00e2n v\u1ec1 m\u1ed9t ph\u1ea3n \u1ee9ng nghi\u00eam tr\u1ecdng c\u00f3 th\u1ec3 x\u1ea3y ra \u0111\u1ed1i v\u1edbi vi\u1ec7c u\u1ed1ng r\u01b0\u01a1u l\u00e0m t\u0103ng \u0111\u1ed9ng l\u1ef1c c\u1ee7a b\u1ec7nh nh\u00e2n trong vi\u1ec7c ki\u00eang khem. M\u1ed9t s\u1ed1 chuy\u00ean gia (v\u00ed d\u1ee5, Schuckit, 2006) \u0111\u1eb7t c\u00e2u h\u1ecfi v\u1ec1 hi\u1ec7u qu\u1ea3 c\u1ee7a disulfiram v\u00ec th\u1eddi gian gi\u1eefa u\u1ed1ng r\u01b0\u1ee3u v\u00e0 l\u00fac x\u1ea3y ra ph\u1ea3n \u1ee9ng c\u00f3 th\u1ec3 k\u00e9o d\u00e0i \u0111\u1ebfn 30 ph\u00fat v\u00e0 c\u01b0\u1eddng \u0111\u1ed9 c\u1ee7a ph\u1ea3n \u1ee9ng l\u00e0 kh\u00f4ng th\u1ec3 \u0111o\u00e1n tr\u01b0\u1edbc.<\/p>\n<h3>T\u00e1c d\u1ee5ng v\u1edbi qu\u00e1 tr\u00ecnh oxy h\u00f3a r\u01b0\u1ee3u<\/h3>\n<p>Th\u00f4ng th\u01b0\u1eddng, enzyme alcohol dehydrogenase trong gan v\u00e0 n\u00e3o bi\u1ebfn \u0111\u1ed5i r\u01b0\u1ee3u th\u00e0nh acetaldehyd. Enzym aldehyd dehydrogenase (ALDH), c\u0169ng c\u00f3 trong gan v\u00e0 n\u00e3o, oxy h\u00f3a s\u1ea3n ph\u1ea9m ph\u1ee5 acetaldehyd th\u00e0nh axit axetic. Disulfiram ng\u0103n ch\u1eb7n qu\u00e1 tr\u00ecnh oxy h\u00f3a n\u00e0y b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf ALDH, g\u00e2y ra s\u1ef1 gia t\u0103ng nhanh ch\u00f3ng acetaldehyd trong m\u00e1u khi u\u1ed1ng r\u01b0\u1ee3u. K\u1ebft qu\u1ea3 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ph\u1ea3n \u1ee9ng disulfiram-alcohol v\u00e0 n\u00f3 c\u00f3 th\u1ec3 l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 acetaldehyd trong m\u00e1u l\u00ean g\u1ea5p 5 \u0111\u1ebfn 10 l\u1ea7n x\u1ea3y ra m\u00e0 kh\u00f4ng c\u1ea7n c\u00f3 disulfiram. Disulfiram g\u1ea7n nh\u01b0 kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u1ed1c \u0111\u1ed9 \u0111\u00e0o th\u1ea3i r\u01b0\u1ee3u kh\u1ecfi c\u01a1 th\u1ec3.<\/p>\n<h3>Ph\u1ea3n \u1ee9ng disulfiram &#8211; alcohol<\/h3>\n<p>Ph\u1ea3n \u1ee9ng disulfiram &#8211; alcohol th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u kho\u1ea3ng 10 \u0111\u1ebfn 30 ph\u00fat sau khi u\u1ed1ng r\u01b0\u1ee3u. T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a n\u00f3 n\u1eb1m trong kho\u1ea3ng t\u1eeb trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng . C\u01b0\u1eddng \u0111\u1ed9 thay \u0111\u1ed5i theo \u0111\u1eb7c \u0111i\u1ec3m b\u1ec7nh nh\u00e2n. Ph\u1ea3n \u1ee9ng n\u00f3i chung t\u1ef7 l\u1ec7 thu\u1eadn v\u1edbi l\u01b0\u1ee3ng disulfiram v\u00e0 r\u01b0\u1ee3u \u0111\u01b0\u1ee3c u\u1ed1ng. T\u00e1c d\u1ee5ng nh\u1eb9 c\u00f3 th\u1ec3 x\u1ea3y ra khi n\u1ed3ng \u0111\u1ed9 c\u1ed3n trong m\u00e1u t\u1eeb 5 \u0111\u1ebfn 10 mg \/ 100 mL. \u1ede m\u1ee9c 50 mg \/ 100 mL, t\u00e1c d\u1ee5ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n \u0111\u00e0y \u0111\u1ee7. Khi n\u1ed3ng \u0111\u1ed9 \u0111\u1ea1t 125 \u0111\u1ebfn 150 mg \/ 100 mL, c\u00f3 th\u1ec3 x\u1ea3y ra b\u1ea5t t\u1ec9nh . M\u1eb7c d\u00f9 c\u00e1c ph\u1ea3n \u1ee9ng disulfiram-alcohol c\u00f3 th\u1ec3 \u0111e d\u1ecda \u0111\u1ebfn t\u00ednh m\u1ea1ng, nh\u01b0 \u0111\u00e3 n\u00eau trong B\u1ea3ng 2, vi\u1ec7c gi\u1ea3m li\u1ec1u v\u00e0 s\u00e0ng l\u1ecdc y t\u1ebf c\u1ea9n th\u1eadn cho b\u1ec7nh nh\u00e2n hi\u1ec7n nay \u0111\u00e3 khi\u1ebfn t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0y tr\u1edf n\u00ean c\u1ef1c k\u1ef3 hi\u1ebfm.<\/p>\n<p>B\u1ea3ng 2: \u1ea2nh h\u01b0\u1edfng c\u1ee7a ph\u1ea3n \u1ee9ng Disulfiram \u2013 Alcohol<\/p>\n<table>\n<tbody>\n<tr>\n<td>B\u1ed9 ph\u1eadn b\u1ecb \u1ea3nh h\u01b0\u1edfng<\/td>\n<td>V\u1eeba ph\u1ea3i<\/td>\n<td>Nghi\u00eam tr\u1ecdng<\/td>\n<\/tr>\n<tr>\n<td>Da c\u01a1 th\u1ec3<\/td>\n<td>\u0110\u1ed5 m\u1ed3 h\u00f4i<\/p>\n<p>\u1ea4m v\u00e0 \u0111\u1ecf b\u1eebng, \u0111\u1eb7c bi\u1ec7t l\u00e0 tr\u00ean ng\u1ef1c v\u00e0 m\u1eb7t<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>H\u1ec7 h\u00f4 h\u1ea5p<\/td>\n<td>T\u0103ng th\u00f4ng kh\u00ed<\/p>\n<p>Kh\u00f3 th\u1edf<\/td>\n<td>Suy h\u00f4 h\u1ea5p<\/td>\n<\/tr>\n<tr>\n<td>\u0110\u1ea7u, c\u1ed5, c\u1ed5 h\u1ecdng<\/td>\n<td>H\u01a1i th\u1edf c\u00f3 m\u00f9i Acetaldehyd<\/p>\n<p>Nh\u00ecn m\u1edd<\/p>\n<p>\u0110\u1ea7u v\u00e0 c\u1ed5 \u0111au nh\u00f3i<\/p>\n<p>Kh\u00e1t n\u01b0\u1edbc<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>D\u1ea1 d\u00e0y, h\u1ec7 ti\u00eau h\u00f3a<\/td>\n<td>Bu\u1ed3n n\u00f4n, \u00f3i m\u1eeda<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>Ng\u1ef1c, tim, h\u1ec7 tu\u1ea7n ho\u00e0n<\/td>\n<td>\u0110au ng\u1ef1c \/ \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c<\/p>\n<p>Huy\u1ebft \u00e1p th\u1ea5p<\/p>\n<p>Nh\u1ecbp tim nhanh<\/td>\n<td>Suy tim<\/p>\n<p>Ch\u1ee9ng lo\u1ea1n nh\u1ecbp tim<\/p>\n<p>Nh\u1ed3i m\u00e1u c\u01a1 tim (\u1edf nh\u1eefng ng\u01b0\u1eddi m\u1eafc b\u1ec7nh m\u1ea1ch v\u00e0nh t\u1eeb tr\u01b0\u1edbc)<\/p>\n<p>Suy tim sung huy\u1ebft c\u1ea5p t\u00ednh (\u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ecb r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 tim t\u1eeb tr\u01b0\u1edbc)<\/td>\n<\/tr>\n<tr>\n<td>H\u1ec7 th\u1ea7n kinh ho\u1eb7c n\u00e3o b\u1ed9<\/td>\n<td>Ch\u00f3ng m\u1eb7t<\/p>\n<p>B\u1ea5t t\u1ec9nh<\/p>\n<p>Kh\u00f3 ch\u1ecbu<\/p>\n<p>S\u1ef1 nh\u1ea7m l\u1eabn<\/td>\n<td>\u0110\u1ed9ng kinh<\/p>\n<p>V\u00f4 th\u1ee9c<\/td>\n<\/tr>\n<tr>\n<td>Kh\u00e1c<\/td>\n<td>Suy nh\u01b0\u1ee3c<\/td>\n<td>Ch\u1ebft<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>C\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u ban \u0111\u1ea7u tin r\u1eb1ng b\u1ec7nh nh\u00e2n c\u1ea7n tr\u1ea3i qua \u00edt nh\u1ea5t m\u1ed9t ph\u1ea3n \u1ee9ng disulfiram-alcohol c\u00f3 gi\u00e1m s\u00e1t \u0111\u1ec3 hi\u1ec3u t\u00e1c d\u1ee5ng c\u1ee7a n\u00f3. Vi\u1ec7c c\u1ed1 t\u00ecnh g\u00e2y ra ph\u1ea3n \u1ee9ng b\u1eb1ng c\u00e1ch cho m\u1ed9t l\u01b0\u1ee3ng l\u1edbn disulfiram k\u1ebft h\u1ee3p v\u1edbi \u201cth\u1eed th\u00e1ch r\u01b0\u1ee3u c\u1ed3n\u201d \u0111\u00e3 b\u1ecb c\u1ea5m. M\u1ed9t m\u00f4 t\u1ea3 r\u00f5 r\u00e0ng, thuy\u1ebft ph\u1ee5c v\u1ec1 ph\u1ea3n \u1ee9ng \u0111\u01b0\u1ee3c coi l\u00e0 \u0111\u1ee7 cho h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n.<\/p>\n<h3>H\u1ea5p th\u1ee5 v\u00e0 \u0111\u00e0o th\u1ea3i disulfiram<\/h3>\n<p>Kho\u1ea3ng 80 \u0111\u1ebfn 95 % disulfiram \u0111\u01b0\u1ee3c h\u1ea5p thu t\u1eeb \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u00e0 di chuy\u1ec3n nhanh ch\u00f3ng \u0111\u1ebfn c\u00e1c m\u00f4 v\u00e0 c\u01a1 quan. Sau \u0111\u00f3 n\u00f3 \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a th\u00e0nh c\u00e1c disulfide h\u1ed7n h\u1ee3p kh\u00e1c nhau. Ph\u1ea7n kh\u00f4ng h\u1ea5p thu \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft. Disulfiram c\u00f3 li\u00ean k\u1ebft ch\u1eb7t ch\u1ebd v\u1edbi ALDH, kh\u00f4ng th\u1ec3 t\u00e1ch ra \u0111\u01b0\u1ee3c. C\u00f3 th\u1ec3 m\u1ea5t \u0111\u1ebfn 2 tu\u1ea7n \u0111\u1ec3 c\u01a1 th\u1ec3 t\u1ed5ng h\u1ee3p \u0111\u1ee7 enzyme ch\u01b0a b\u1ecb li\u00ean k\u1ebft \u0111\u1ec3 chuy\u1ec3n h\u00f3a r\u01b0\u1ee3u \u0111\u1ea7y \u0111\u1ee7. \u0110\u00e2y l\u00e0 l\u00fd do t\u1ea1i sao u\u1ed1ng r\u01b0\u1ee3u c\u00f3 th\u1ec3 t\u1ea1o ra c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f3 ch\u1ecbu trong t\u1ed1i \u0111a 2 tu\u1ea7n sau khi b\u1ec7nh nh\u00e2n d\u00f9ng li\u1ec1u disulfiram cu\u1ed1i c\u00f9ng.<\/p>\n<h2>T\u1ea1i sao n\u00ean s\u1eed d\u1ee5ng Disulfiram?<\/h2>\n<p>Disulfiram t\u00e1c \u0111\u1ed9ng nh\u01b0 m\u1ed9t bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 \u0111\u1ec3 cai r\u01b0\u1ee3u cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 nh\u1ecbn r\u01b0\u1ee3u trong \u00edt nh\u1ea5t 12 gi\u1edd, cam k\u1ebft duy tr\u00ec ki\u00eang khem, \u0111\u1ed3ng \u00fd d\u00f9ng thu\u1ed1c v\u00e0 kh\u00f4ng c\u00f3 b\u1ea5t k\u1ef3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi disulfiram.<\/p>\n<h3>Hi\u1ec7u qu\u1ea3<\/h3>\n<p>C\u00e1c k\u1ebft qu\u1ea3 v\u1ec1 hi\u1ec7u qu\u1ea3 c\u1ee7a \u0111i\u1ec1u tr\u1ecb disulfiram b\u1ecb x\u00e1o tr\u1ed9n. ( C\u00f3 th\u1ec3 xem m\u1ed9t s\u1ed1 b\u00e1o c\u00e1o t\u1ea1i http:\/\/www.kap.samhsa.gov.)<\/p>\n<h3>K\u1ebft qu\u1ea3 kh\u1ea3 quan<\/h3>\n<p>C\u00e1c nghi\u00ean c\u1ee9u k\u1ebft lu\u1eadn r\u1eb1ng disulfiram c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb AUD th\u01b0\u1eddng xuy\u00ean nh\u1ea5n m\u1ea1nh \u0111\u1ebfn c\u00e1c tr\u01b0\u1eddng h\u1ee3p s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n. C\u1ee5 th\u1ec3, m\u1ee9c \u0111\u1ed9 v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng gi\u00e1m s\u00e1t m\u00e0 b\u1ec7nh nh\u00e2n nh\u1eadn \u0111\u01b0\u1ee3c khi d\u00f9ng disulfiram \u0111\u01b0\u1ee3c cho l\u00e0 y\u1ebfu t\u1ed1 quan tr\u1ecdng trong th\u00e0nh c\u00f4ng c\u1ee7a n\u00f3<\/p>\n<p>M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 ph\u00e1t hi\u1ec7n ra r\u1eb1ng li\u1ec7u ph\u00e1p disulfiram \u0111i\u1ec1u tr\u1ecb theo y\u00eau c\u1ea7u c\u1ee7a t\u00f2a \u00e1n th\u00fac \u0111\u1ea9y hi\u1ec7u qu\u1ea3 b\u1eb1ng c\u00e1ch t\u0103ng vi\u1ec7c tu\u00e2n th\u1ee7 ph\u00e1c \u0111\u1ed3 disulfiram . Th\u1ef1c hi\u1ec7n c\u00e1c khuy\u1ebfn kh\u00edch v\u00e0 giao k\u00e8o v\u1edbi b\u1ec7nh nh\u00e2n v\u00e0 m\u1ed9t ng\u01b0\u1eddi c\u00f3 vai tr\u00f2 kh\u00e1c \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb, nh\u1eafc nh\u1edf th\u01b0\u1eddng xuy\u00ean cho b\u1ec7nh nh\u00e2n, th\u00e1i \u0111\u1ed9 r\u00e8n luy\u1ec7n v\u00e0 h\u1ed7 tr\u1ee3 x\u00e3 h\u1ed9i c\u1ee7a b\u1ec7nh nh\u00e2n c\u0169ng c\u00f3 th\u1ec3 t\u0103ng c\u01b0\u1eddng hi\u1ec7u qu\u1ea3 c\u1ee7a disulfiram b\u1eb1ng vi\u1ec7c gi\u00fap t\u0103ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>H\u1ea7u h\u1ebft c\u00e1c chuy\u00ean gia (v\u00ed d\u1ee5, Schuckit, 2006) \u0111\u1ed3ng \u00fd r\u1eb1ng \u0111\u00e1p \u1ee9ng disulfiram t\u1ed1i \u01b0u \u0111\u00f2i h\u1ecfi ph\u1ea3i s\u1eed d\u1ee5ng n\u00f3 trong m\u1ed9t ch\u01b0\u01a1ng tr\u00ecnh \u0111i\u1ec1u tr\u1ecb l\u1ea1m d\u1ee5ng ch\u1ea5t \u0111\u1eb7c bi\u1ec7t. M\u1ed9t nghi\u00ean c\u1ee9u cho th\u1ea5y r\u1eb1ng disulfiram c\u00f3 th\u1ec3 c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n trong vi\u1ec7c th\u00fac \u0111\u1ea9y cai nghi\u1ec7n ng\u1eafn h\u1ea1n v\u00e0 \u0111i\u1ec1u tr\u1ecb duy tr\u00ec sau cai nghi\u1ec7n h\u01a1n l\u00e0 ng\u0103n ng\u1eeba t\u00e1i ph\u00e1t l\u00e2u d\u00e0i (v\u00ed d\u1ee5, Chandrasekaran, Sivaprakash, &amp; Chitraleka, 2001). Tuy nhi\u00ean, nghi\u00ean c\u1ee9u nghi\u00eam ng\u1eb7t nh\u1ea5t v\u1ec1 li\u1ec7u ph\u00e1p disulfiram (Fuller et al., 1986) cho th\u1ea5y r\u00f5 r\u00e0ng r\u1eb1ng disulfiram (250 mg \/ ng\u00e0y), so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c (1 mg \/ ng\u00e0y) ho\u1eb7c vitamin, l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 s\u1ed1 ng\u00e0y u\u1ed1ng r\u01b0\u1ee3u trong th\u1eddi gian nghi\u00ean c\u1ee9u (1 n\u0103m) \u1edf c\u00e1c c\u1ef1u chi\u1ebfn binh nam c\u00f3 u\u1ed1ng r\u01b0\u1ee3u. Tuy nhi\u00ean, kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa c\u00e1c nh\u00f3m \u0111i\u1ec1u tr\u1ecb v\u1ec1 t\u1ef7 l\u1ec7 c\u1ef1u chi\u1ebfn binh duy tr\u00ec ki\u00eang khem trong su\u1ed1t th\u1eddi gian nghi\u00ean c\u1ee9u.<\/p>\n<h3>Nh\u1eefng ph\u00e1t hi\u1ec7n tr\u00e1i ng\u01b0\u1ee3c<\/h3>\n<p>M\u1ed9t s\u1ed1 chuy\u00ean gia b\u00e1c b\u1ecf disulfiram nh\u01b0 m\u1ed9t l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb kh\u1ea3 thi, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong c\u00e1c c\u01a1 s\u1edf ch\u0103m s\u00f3c ban \u0111\u1ea7u. K\u1ebft lu\u1eadn n\u00e0y d\u1ef1a tr\u00ean k\u1ebft qu\u1ea3 h\u1ed7n h\u1ee3p v\u1edbi disulfiram trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u00e0 c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nghi\u00eam tr\u1ecdng c\u00f3 th\u1ec3 x\u1ea3y ra do ph\u1ea3n \u1ee9ng disulfiram-alcohol, c\u0169ng nh\u01b0 lo ng\u1ea1i v\u1ec1 c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nghi\u00eam tr\u1ecdng ti\u1ec1m t\u00e0ng kh\u00e1c v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb. Kh\u1ea3 n\u0103ng s\u1eafp x\u1ebfp gi\u00e1m s\u00e1t li\u00ean t\u1ee5c vi\u1ec7c u\u1ed1ng disulfiram c\u00f3 th\u1ec3 b\u1ecb h\u1ea1n ch\u1ebf trong c\u00e1c c\u01a1 s\u1edf ch\u0103m s\u00f3c ban \u0111\u1ea7u.<\/p>\n<h3>B\u1ec7nh nh\u00e2n n\u00e0o ph\u00f9 h\u1ee3p v\u1edbi Disulfiram?<\/h3>\n<p>H\u1ed9i \u0111\u1ed3ng \u0111\u1ed3ng thu\u1eadn k\u1ebft lu\u1eadn r\u1eb1ng disulfiram c\u00f3 hi\u1ec7u qu\u1ea3 nh\u1ea5t \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 tr\u1ea3i qua cai nghi\u1ec7n ho\u1eb7c \u0111ang trong giai \u0111o\u1ea1n b\u1eaft \u0111\u1ea7u cai nghi\u1ec7n, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi h\u1ecd cam k\u1ebft ki\u00eang khem v\u00e0 nh\u1eadn \u0111\u01b0\u1ee3c s\u1ef1 gi\u00e1m s\u00e1t li\u00ean t\u1ee5c. Disulfiram c\u00f3 th\u1ec3 kh\u00f4ng l\u00e0m gi\u1ea3m ham mu\u1ed1n u\u1ed1ng r\u01b0\u1ee3u. Tuy nhi\u00ean, n\u00f3 c\u00f3 th\u1ec3 gi\u00fap th\u00fac \u0111\u1ea9y b\u1ec7nh nh\u00e2n kh\u00f4ng u\u1ed1ng. C\u0169ng nh\u01b0 c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c, hi\u1ec7u qu\u1ea3 chung c\u0169ng t\u0103ng l\u00ean khi d\u00f9ng disulfiram k\u1ebft h\u1ee3p v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p can thi\u1ec7p h\u00e0nh vi chuy\u00ean s\u00e2u.<\/p>\n<p>B\u1ec7nh nh\u00e2n b\u1ecb suy gi\u1ea3m nghi\u00eam tr\u1ecdng ho\u1eb7c b\u1ecb \u1ea3nh l\u1edbn t\u1eeb b\u1ec7nh t\u00e2m th\u1ea7n n\u1eb7ng ho\u1eb7c suy gi\u1ea3m nh\u1eadn th\u1ee9c c\u00f3 th\u1ec3 l\u00e0 \u0111\u1ed1i t\u01b0\u1ee3ng kh\u00f4ng ph\u00f9 h\u1ee3p \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng disulfiram.<\/p>\n<h3>T\u00ednh an to\u00e0n c\u1ee7a Disulfiram<\/h3>\n<p>Disulfiram \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb AUD trong g\u1ea7n 60 n\u0103m. T\u1eed vong do ph\u1ea3n \u1ee9ng disulfiram tr\u1edf n\u00ean hi\u1ebfm g\u1eb7p v\u00ec vi\u1ec7c s\u1eed d\u1ee5ng li\u1ec1u th\u1ea5p h\u01a1n v\u00e0 b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh tim n\u1eb7ng \u0111\u01b0\u1ee3c kh\u00f4ng s\u1eed d\u1ee5ng li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng disulfiram. Nhi\u1ec5m \u0111\u1ed9c gan \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n v\u1eabn c\u00f2n l\u00e0 m\u1ed9t m\u1ed1i quan t\u00e2m.<\/p>\n<p>T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a disulfiram th\u01b0\u1eddng kh\u00f4ng \u0111\u00e1ng k\u1ec3. Ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i nghi\u00eam tr\u1ecdng l\u00e0 kh\u00f4ng ph\u1ed5 bi\u1ebfn. Tuy nhi\u00ean, b\u1ec7nh nh\u00e2n d\u00f9ng disulfiram n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i nhi\u1ec5m \u0111\u1ed9c gan. Disulfiram c\u00f3 th\u1ec3 g\u00e2y vi\u00eam gan, nh\u01b0ng nguy c\u01a1 th\u1ea5p. \u01af\u1edbc t\u00ednh vi\u00eam gan do disulfiram g\u00e2y ra l\u00e0 t\u1eeb 1 \/25.000 \u0111\u1ebfn 1 \/30.000 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb m\u1ed7i n\u0103m. S\u1ed1 li\u1ec7u kh\u00f4ng c\u00e2n x\u1ee9ng trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng disulfiram \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb d\u1ecb \u1ee9ng niken (m\u1ed9t ch\u1ec9 \u0111\u1ecbnh kh\u00f4ng th\u01b0\u1eddng xuy\u00ean nh\u01b0ng \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn khi s\u1eed d\u1ee5ng disulfiram).<\/p>\n<p>M\u1ed9t c\u1ea3nh b\u00e1o h\u1ed9p \u0111en v\u1ec1 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng disulfiram \u0111\u01b0\u1ee3c bao g\u1ed3m trong bao b\u00ec \u0111\u00f3ng g\u00f3i Antabuse. Tr\u01b0\u1edbc khi d\u00f9ng disulfiram, b\u00e1c s\u0129 l\u00e2m s\u00e0ng n\u00ean th\u00f4ng b\u00e1o cho b\u1ec7nh nh\u00e2n v\u00e0 gia \u0111\u00ecnh h\u1ecd v\u1ec1 ph\u1ea3n \u1ee9ng disulfiram-alcohol, bao g\u1ed3m c\u1ea3 vi\u1ec7c ph\u1ea3n \u1ee9ng n\u00e0y c\u00f3 th\u1ec3 x\u1ea3y ra trong t\u1edbi 14 ng\u00e0y gi\u1eefa li\u1ec1u disulfiram cu\u1ed1i c\u00f9ng v\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng r\u01b0\u1ee3u.<\/p>\n<h3>C\u1ea3nh b\u00e1o khi s\u1eed d\u1ee5ng Disulfiram<\/h3>\n<p>Kh\u00f4ng bao gi\u1edd n\u00ean d\u00f9ng disulfiram cho b\u1ec7nh nh\u00e2n \u0111ang trong t\u00ecnh tr\u1ea1ng nhi\u1ec5m \u0111\u1ed9c r\u01b0\u1ee3u ho\u1eb7c kh\u00f4ng bi\u1ebft th\u00f4ng tin \u0111\u1ea7y \u0111\u1ee7 v\u1ec1 ti\u1ec3u s\u1eed b\u1ec7nh t\u1eadt c\u1ee7a b\u1ec7nh nh\u00e2n. C\u00e1c b\u00e1c s\u0129 n\u00ean h\u01b0\u1edbng d\u1eabn ng\u01b0\u1eddi th\u00e2n cho ph\u00f9 h\u1ee3p.<\/p>\n<h2>Disulfiram \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 th\u1ebf n\u00e0o?<\/h2>\n<h3>Tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Disulfiram<\/h3>\n<p>C\u00e1c b\u00e1c s\u0129 kh\u00f4ng n\u00ean d\u00f9ng disulfiram cho \u0111\u1ebfn khi th\u1ef1c hi\u1ec7n xong c\u00e1c b\u01b0\u1edbc sau:<\/p>\n<ul>\n<li>Cung c\u1ea5p th\u00f4ng tin cho b\u1ec7nh nh\u00e2n v\u1ec1 disulfiram v\u00e0 c\u00f3 \u0111\u01b0\u1ee3c s\u1ef1 \u0111\u1ed3ng \u00fd.<\/li>\n<li>\u0110\u1ee3i cho \u0111\u1ebfn khi b\u1ec7nh nh\u00e2n ki\u00eang r\u01b0\u1ee3u \u00edt nh\u1ea5t 12 gi\u1edd v\u00e0 ho\u1eb7c n\u1ed3ng \u0111\u1ed9 c\u1ed3n trong h\u01a1i th\u1edf v\u00e0 m\u00e1u b\u1eb1ng kh\u00f4ng.<\/li>\n<li>Th\u1ef1c hi\u1ec7n ki\u1ec3m tra th\u1ec3 ch\u1ea5t, x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan v\u00e0 th\u1eadn c\u01a1 b\u1ea3n v\u00e0 th\u1eed thai cho ph\u1ee5 n\u1eef. Th\u1ef1c hi\u1ec7n \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng (v\u00ed d\u1ee5: ti\u1ec1n s\u1eed b\u1ec7nh tim).<\/li>\n<li>Ho\u00e0n th\u00e0nh th\u00f4ng tin li\u00ean quan \u0111\u1ebfn ti\u1ec1n s\u1eed b\u1ec7nh t\u1eadt v\u00e0 t\u00e2m th\u1ea7n. X\u00e1c \u0111\u1ecbnh li\u1ec7u b\u1ec7nh nh\u00e2n c\u00f3 d\u1ecb \u1ee9ng v\u1edbi disulfiram ho\u1eb7c c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c kh\u00f4ng; thu\u1ed1c theo \u0111\u01a1n v\u00e0 kh\u00f4ng k\u00ea \u0111\u01a1n \u0111ang s\u1eed d\u1ee5ng, bao g\u1ed3m vitamin; ti\u1ec1n s\u1eed b\u1ec7nh tim m\u1ea1ch, ti\u1ec3u \u0111\u01b0\u1eddng, b\u1ec7nh tuy\u1ebfn gi\u00e1p, r\u1ed1i lo\u1ea1n co gi\u1eadt, suy y\u1ebfu h\u1ec7 th\u1ed1ng th\u1ea7n kinh trung \u01b0\u01a1ng, ho\u1eb7c b\u1ec7nh th\u1eadn ho\u1eb7c gan; v\u00e0 \u0111\u1ed1i v\u1edbi ph\u1ee5 n\u1eef, t\u00ecnh tr\u1ea1ng sinh s\u1ea3n, bao g\u1ed3m c\u1ea3 thai k\u1ef3 hi\u1ec7n t\u1ea1i ho\u1eb7c d\u1ef1 \u0111\u1ecbnh c\u00f3 thai ho\u1eb7c cho con b\u00fa.<\/li>\n<\/ul>\n<h3>Gi\u00e1m s\u00e1t vi\u1ec7c \u0103n u\u1ed1ng<\/h3>\n<p>C\u00f3 b\u1eb1ng ch\u1ee9ng m\u1ea1nh m\u1ebd cho th\u1ea5y vi\u1ec7c \u0103n u\u1ed1ng c\u00f3 gi\u00e1m s\u00e1t l\u00e0 c\u1ea7n thi\u1ebft cho vi\u1ec7c tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng disulfiram. M\u1eb7c d\u00f9 kh\u00f4ng th\u1ef1c s\u1ef1 c\u1ea7n thi\u1ebft, qu\u1ea3n l\u00fd \u0111\u01b0\u1ee3c gi\u00e1m s\u00e1t b\u1edfi d\u01b0\u1ee3c s\u0129, nh\u00e0 cung c\u1ea5p d\u1ecbch v\u1ee5 ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe ho\u1eb7c th\u00e0nh vi\u00ean gia \u0111\u00ecnh \u0111\u01b0\u1ee3c \u0111\u01b0a ra nh\u01b0 m\u1ed9t th\u00e0nh ph\u1ea7n ch\u00ednh c\u1ee7a k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb.<\/p>\n<h3>Li\u1ec1u d\u00f9ng Disulfiram<\/h3>\n<p>B\u1ea3ng 3 :<\/p>\n<table>\n<tbody>\n<tr>\n<td>Li\u1ec1u d\u00f9ng ban \u0111\u1ea7u<\/td>\n<td>250 mg \/ ng\u00e0y v\u00e0o bu\u1ed5i s\u00e1ng ho\u1eb7c bu\u1ed5i t\u1ed1i trong 1 -2 tu\u1ea7n<\/td>\n<\/tr>\n<tr>\n<td>Li\u1ec1u duy tr\u00ec trung b\u00ecnh<\/td>\n<td>250mg\/ng\u00e0y<\/td>\n<\/tr>\n<tr>\n<td>Ph\u1ea1m vi li\u1ec1u d\u00f9ng<\/td>\n<td>125-500 mg\/ ng\u00e0y<\/td>\n<\/tr>\n<tr>\n<td>Li\u1ec1u t\u1ed1i \u0111a<\/td>\n<td>500mg\/ng\u00e0y<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Th\u00f4ng tin b\u1ed5 sung v\u1ec1 li\u1ec1u l\u01b0\u1ee3ng bao g\u1ed3m:<\/p>\n<ul>\n<li>H\u01b0\u1edbng d\u1eabn b\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c an th\u1ea7n v\u1edbi disulfiram khi \u0111i ng\u1ee7. N\u1ebfu l\u01b0\u1ee3ng thu\u1ed1c an th\u1ea7n ban ng\u00e0y v\u1eabn c\u00f2n, \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u l\u01b0\u1ee3ng xu\u1ed1ng.<\/li>\n<li>N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 u\u1ed1ng r\u01b0\u1ee3u m\u00e0 kh\u00f4ng g\u1eb7p v\u1ea5n \u0111\u1ec1 g\u00ec khi tu\u00e2n th\u1ee7 li\u1ec1u kh\u1edfi \u0111\u1ea7u th\u01b0\u1eddng quy (r\u1ea5t hi\u1ebfm), h\u00e3y t\u0103ng li\u1ec1u (c\u00f3 th\u1ec3 t\u0103ng li\u1ec1u t\u1edbi 500 mg \/ ng\u00e0y n\u1ebfu theo d\u00f5i c\u1ea9n th\u1eadn). Kh\u00f4ng bao gi\u1edd v\u01b0\u1ee3t qu\u00e1 500 mg \/ ng\u00e0y.<\/li>\n<li>H\u01b0\u1edbng d\u1eabn b\u1ec7nh nh\u00e2n khi b\u1ecf l\u1ee1 m\u1ed9t li\u1ec1u thu\u1ed1c h\u00e3y u\u1ed1ng b\u00f9 ngay khi h\u1ecd nh\u1edb. Tuy nhi\u00ean, n\u1ebfu g\u1ea7n \u0111\u1ebfn gi\u1edd cho li\u1ec1u ti\u1ebfp theo, h\u1ecd n\u00ean b\u1ecf qua li\u1ec1u \u0111\u00e3 qu\u00ean.<\/li>\n<li>N\u00f3i v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng bao gi\u1edd d\u00f9ng \u0111\u1ebfn g\u1ea5p \u0111\u00f4i s\u1ed1 li\u1ec1u \u0111\u01b0\u1ee3c ph\u00e9p.<\/li>\n<\/ul>\n<h3>T\u00e1c d\u1ee5ng ph\u1ee5, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 th\u1eadn tr\u1ecdng khi d\u00f9ng thu\u1ed1c Disulfiram<\/h3>\n<p>Disulfiram c\u00f3 th\u1ec3 g\u00e2y ra t\u00e1c d\u1ee5ng ph\u1ee5 nh\u1eb9. C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 ph\u1ed5 bi\u1ebfn th\u01b0\u1eddng x\u1ea3y ra trong 2 tu\u1ea7n \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u1ea3m d\u1ea7n ho\u1eb7c sau khi gi\u1ea3m li\u1ec1u disulfiram.<\/p>\n<p>B\u1ea3ng :4 T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a Disulfiram<\/p>\n<table>\n<tbody>\n<tr>\n<td>M\u1ee5n tr\u1ee9ng c\u00e1 *<\/p>\n<p>Vi\u00eam da d\u1ecb \u1ee9ng<\/p>\n<p>Bu\u1ed3n ng\u1ee7 nh\u1eb9<\/p>\n<p>M\u1ec7t m\u1ecfi<\/td>\n<td>\u0110au \u0111\u1ea7u<\/p>\n<p>Kh\u00f4ng c\u00f3 s\u1ee9c l\u1ef1c<\/p>\n<p>C\u1ea3m gi\u00e1c c\u00f3 m\u00f9i kim lo\u1ea1i ho\u1eb7c t\u1ecfi<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>* T\u00e1c d\u1ee5ng ph\u1ee5 da li\u1ec5u th\u01b0\u1eddng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u1eed l\u00fd b\u1eb1ng thu\u1ed1c kh\u00e1ng histamine \u0111\u1ed3ng th\u1eddi.<\/p>\n<p>\u0110\u1ed9c t\u00ednh gan bao g\u1ed3m suy gan d\u1eabn \u0111\u1ebfn ph\u1ea3i gh\u00e9p gan ho\u1eb7c c\u00f3 th\u1ec3 t\u1eed vong. Vi\u00eam gan n\u1eb7ng v\u00e0 \u0111\u00f4i khi g\u00e2y t\u1eed vong li\u00ean quan \u0111\u1ebfn vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng disulfiram c\u00f3 th\u1ec3 x\u1ea3y ra ngay c\u1ea3 sau nhi\u1ec1u th\u00e1ng \u0111i\u1ec1u tr\u1ecb. Nhi\u1ec5m \u0111\u1ed9c gan \u0111\u00e3 x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed ch\u1ee9c n\u0103ng gan b\u1ea5t th\u01b0\u1eddng.<\/p>\n<p>B\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn g\u1ecdi b\u00e1c s\u0129 ngay l\u1eadp t\u1ee9c n\u1ebfu h\u1ecd xu\u1ea5t hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng suy gan c\u00f3 th\u1ec3 x\u1ea3y ra (B\u1ea3ng 5)<\/p>\n<p>B\u1ea3ng 5: Tri\u1ec7u ch\u1ee9ng suy gan do Disulfiram<\/p>\n<table>\n<tbody>\n<tr>\n<td>M\u1ec7t m\u1ecfi qu\u00e1 m\u1ee9c<\/p>\n<p>Y\u1ebfu \u0111u\u1ed1i<\/p>\n<p>Thi\u1ebfu n\u0103ng l\u01b0\u1ee3ng<\/p>\n<p>\u0102n kh\u00f4ng th\u1ea5y ngon<\/p>\n<p>\u0110au th\u1eaft d\u1ea1 d\u00e0y<\/td>\n<td>N\u00f4n<\/p>\n<p>V\u00e0ng da \/ m\u1eaft<\/p>\n<p>N\u01b0\u1edbc ti\u1ec3u \u0111\u1eadm<\/p>\n<p>S\u1ed1t<\/p>\n<p>Ph\u00e2n m\u00e0u s\u00e1ng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>B\u1ea3ng 6: T\u00f3m t\u1eaft c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u0111\u1ed1i v\u1edbi li\u1ec7u ph\u00e1p disulfiram v\u00e0 B\u1ea3ng 7 t\u00f3m t\u1eaft c\u00e1c c\u1ea3nh b\u00e1o.<\/p>\n<table>\n<tbody>\n<tr>\n<td>T\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n ho\u1eb7c ho\u00e0n c\u1ea3nh<\/td>\n<td>Khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb<\/td>\n<\/tr>\n<tr>\n<td>Qu\u00e1 m\u1eabn c\u1ea3m v\u1edbi disulfiram ho\u1eb7c c\u00e1c d\u1eabn xu\u1ea5t thiuram kh\u00e1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong thu\u1ed1c tr\u1eeb s\u00e2u v\u00e0 l\u01b0u h\u00f3a cao su; d\u1ecb \u1ee9ng l\u01b0u hu\u1ef3nh ho\u1eb7c niken<\/td>\n<td>Kh\u00f4ng n\u00ean d\u00f9ng disulfiram<\/td>\n<\/tr>\n<tr>\n<td>T\u00e2m th\u1ea7n<\/td>\n<td>Disulfiram ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n b\u1ecb t\u00e2m th\u1ea7n ph\u00e2n li\u1ec7t ho\u1eb7c c\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n kh\u00e1c ph\u1ea3i th\u1eadn tr\u1ecdng<\/td>\n<\/tr>\n<tr>\n<td>B\u1ec7nh c\u01a1 tim n\u1eb7ng ho\u1eb7c t\u1eafc \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/td>\n<td>Disulfiram ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh c\u01a1 tim n\u1eb7ng ho\u1eb7c t\u1eafc m\u1ea1ch v\u00e0nh, v\u1edbi nguy c\u01a1 l\u00e2m s\u00e0ng c\u1ee7a li\u1ec7u ph\u00e1p disulfiram c\u00e2n b\u1eb1ng v\u1edbi nguy c\u01a1 l\u00e2m s\u00e0ng c\u1ee7a l\u1ea1m d\u1ee5ng r\u01b0\u1ee3u li\u00ean t\u1ee5c. Th\u1ef1c hi\u1ec7n \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 tr\u01b0\u1edbc v\u00e0 trong khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng disulfiram v\u00e0 ph\u1ea3i theo d\u00f5i ch\u1eb7t ch\u1ebd.<\/td>\n<\/tr>\n<tr>\n<td>Ph\u1ee5 n\u1eef c\u00f3 thai ho\u1eb7c cho con b\u00fa<\/td>\n<td>M\u1eb7c d\u00f9 disulfiram kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tuy\u1ec7t \u0111\u1ed1i, nh\u01b0ng n\u00ean tr\u00e1nh v\u00ec nguy c\u01a1 cho thai l\u00e0 kh\u00f4ng r\u00f5. Kh\u00f4ng d\u00f9ng disulfiram cho c\u00e1c b\u00e0 m\u1eb9 cho con b\u00fa. B\u1ec7nh nh\u00e2n n\u00ean ng\u1eebng cho con b\u00fa tr\u01b0\u1edbc khi d\u00f9ng disulfiram.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>B\u1ea3ng 7: C\u1ea3nh b\u00e1o v\u1ec1 Disulfiram<\/p>\n<table>\n<tbody>\n<tr>\n<td>T\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n ho\u1eb7c ho\u00e0n c\u1ea3nh<\/td>\n<td>Khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb<\/td>\n<\/tr>\n<tr>\n<td>Ti\u1ec1n s\u1eed b\u1ec7nh tim, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, suy gi\u00e1p, \u0111\u1ed9ng kinh, t\u1ed5n th\u01b0\u01a1ng n\u00e3o, vi\u00eam th\u1eadn m\u00e3n t\u00ednh ho\u1eb7c c\u1ea5p t\u00ednh, x\u01a1 gan, ho\u1eb7c suy gan<\/td>\n<td>S\u1eed d\u1ee5ng c\u1ea9n th\u1eadn. Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh gan t\u1eeb tr\u01b0\u1edbc c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng b\u1ecb nhi\u1ec5m \u0111\u1ed9c gan n\u1eb7ng do \u0111i\u1ec1u tr\u1ecb b\u1eb1ng disulfiram.<\/td>\n<\/tr>\n<tr>\n<td>B\u1ec7nh nh\u00e2n vi\u00eam gan C<\/td>\n<td>Theo c\u00e1c b\u1eb1ng ch\u1ee9ng hi\u1ec7n c\u00f3, n\u1ebfu n\u1ed3ng \u0111\u1ed9 transaminase l\u00e0 b\u00ecnh th\u01b0\u1eddng ho\u1eb7c ch\u1ec9 t\u0103ng \u1edf m\u1ee9c v\u1eeba ph\u1ea3i (th\u1ea5p h\u01a1n n\u0103m l\u1ea7n so v\u1edbi gi\u1edbi h\u1ea1n tr\u00ean m\u1ee9c b\u00ecnh th\u01b0\u1eddng), h\u00e3y s\u1eed d\u1ee5ng v\u1edbi vi\u1ec7c theo d\u00f5i c\u1ea9n th\u1eadn ch\u1ee9c n\u0103ng gan.<\/td>\n<\/tr>\n<tr>\n<td>Tr\u1ebb em v\u00e0 thanh thi\u1ebfu ni\u00ean<\/td>\n<td>T\u00ednh an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 cho tr\u1ebb em ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh. M\u1ed9t nghi\u00ean c\u1ee9u ch\u1ec9 ra r\u1eb1ng disulfiram c\u00f3 th\u1ec3 an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 v\u1edbi thanh thi\u1ebfu ni\u00ean (Niederhofer &amp; Staffen, 2003). H\u00e3y qu\u1ea3n l\u00fd m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng.<\/td>\n<\/tr>\n<tr>\n<td>B\u1ec7nh nh\u00e2n g\u1ea7n \u0111\u00e2y \u0111\u00e3 s\u1eed d\u1ee5ng Metrodiazole, Paraldehyde, r\u01b0\u1ee3u ho\u1eb7c c\u00e1c ch\u1ebf ph\u1ea9m c\u00f3 c\u1ed3n (nh\u01b0 siro ho, thu\u1ed1c b\u1ed5); c\u0169ng c\u00f3 b\u1ec7nh nh\u00e2n ti\u1ebfp x\u00fac v\u1edbi h\u00f3a ch\u1ea5t ethylene dibromide ho\u1eb7c h\u01a1i c\u1ee7a n\u00f3 (v\u00ed d\u1ee5 trong s\u01a1n, v\u00e9c ni ho\u1eb7c shellac)<\/td>\n<td>Kh\u00f4ng s\u1eed d\u1ee5ng disulfiram cho \u0111\u1ebfn khi c\u00e1c ch\u1ea5t n\u00e0y ra h\u1ebft kh\u1ecfi h\u1ec7 th\u1ed1ng tu\u1ea7n ho\u00e0n c\u1ee7a b\u1ec7nh nh\u00e2n.<\/td>\n<\/tr>\n<tr>\n<td>B\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng c\u00e1c s\u1ea3n ph\u1ea9m c\u00f3 ch\u1ee9a c\u1ed3n \u1edf d\u1ea1ng kh\u00e1c(v\u00ed d\u1ee5: gi\u1ea5m, n\u01b0\u1edbc s\u1ed1t, n\u01b0\u1edbc th\u01a1m sau c\u1ea1o r\u00e2u, d\u1ea7u xoa b\u00f3p)<\/td>\n<td>H\u01b0\u1edbng d\u1eabn b\u1ec7nh nh\u00e2n ki\u1ec3m tra b\u1ea5t k\u1ef3 s\u1ea3n ph\u1ea9m c\u00f3 ch\u1ee9a c\u1ed3n n\u00e0o tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng b\u1eb1ng c\u00e1ch b\u00f4i m\u1ed9t \u00edt l\u00ean m\u1ed9t v\u00f9ng da nh\u1ecf trong 1 \u0111\u1ebfn 2 gi\u1edd. N\u1ebfu kh\u00f4ng c\u00f3 v\u1ebft \u0111\u1ecf, ng\u1ee9a ho\u1eb7c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n, s\u1ea3n ph\u1ea9m c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng m\u1ed9t c\u00e1ch an to\u00e0n.<\/td>\n<\/tr>\n<tr>\n<td>T\u1eeb 61 tu\u1ed5i tr\u1edf l\u00ean<\/td>\n<td>N\u00ean gi\u1ea3m li\u1ec1u d\u00f9ng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3>Qu\u1ea3n l\u00ed b\u1ec7nh nh\u00e2n<\/h3>\n<p>B\u1ea3ng 8: li\u1ec7t k\u00ea c\u00e1c ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i nghi\u00eam tr\u1ecdng c\u00f3 th\u1ec3 x\u1ea3y ra v\u1edbi disulfiram v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111\u1ec3 x\u1eed l\u00fd ch\u00fang. Nh\u1eefng ph\u1ea3n \u1ee9ng n\u00e0y l\u00e0 kh\u00f4ng ph\u1ed5 bi\u1ebfn.<\/p>\n<table>\n<tbody>\n<tr>\n<td>Ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i<\/td>\n<td>C\u00e1ch x\u1eed l\u00fd<\/td>\n<\/tr>\n<tr>\n<td>Vi\u00eam d\u00e2y th\u1ea7n kinh th\u1ecb gi\u00e1c<\/td>\n<td>Th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n sau khi b\u1ec7nh nh\u00e2n ph\u00e0n n\u00e0n v\u1ec1 r\u1ed1i lo\u1ea1n th\u1ecb gi\u00e1c. Ng\u1eebng disulfiram v\u00e0 ti\u1ebfn h\u00e0nh ki\u1ec3m tra nh\u00e3n khoa.<\/td>\n<\/tr>\n<tr>\n<td>Vi\u00eam d\u00e2y th\u1ea7n kinh ngo\u1ea1i bi\u00ean, vi\u00eam \u0111a d\u00e2y th\u1ea7n kinh, b\u1ec7nh th\u1ea7n kinh ngo\u1ea1i bi\u00ean<\/td>\n<td>Th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n sau khi b\u1ec7nh nh\u00e2n than phi\u1ec1n v\u1ec1 d\u1ecb c\u1ea3m (t\u00ea ho\u1eb7c ng\u1ee9a ran). Ng\u1eebng disulfiram v\u00e0 quan s\u00e1t b\u1ec7nh nh\u00e2n ho\u1eb7c s\u1eafp x\u1ebfp \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 th\u1ea7n kinh.<\/td>\n<\/tr>\n<tr>\n<td>Vi\u00eam gan, bao g\u1ed3m vi\u00eam gan \u1ee9 m\u1eadt c\u0169ng nh\u01b0 suy gan*<\/td>\n<td>Khi c\u00e1c tri\u1ec7u ch\u1ee9ng r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o ho\u1eb7c nh\u1eadn th\u1ea5y (xem B\u1ea3ng 5), th\u1ef1c hi\u1ec7n xem x\u00e9t v\u1ec1 l\u1ecbch s\u1eed b\u1ec7nh, ki\u1ec3m tra th\u1ec3 ch\u1ea5t v\u00e0 th\u1ef1c hi\u1ec7n c\u00e1c x\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan . Khi t\u00ecm th\u1ea5y b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng ho\u1eb7c x\u00e9t nghi\u1ec7m v\u1ec1 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan, h\u00e3y ng\u1eebng s\u1eed d\u1ee5ng disulfiram ngay l\u1eadp t\u1ee9c. Duy tr\u00ec theo d\u00f5i l\u00e2m s\u00e0ng c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u1ee9c n\u0103ng gan. Xem x\u00e9t c\u00e1c ph\u00e1t hi\u1ec7n \u0111\u1ec3 t\u00ecm c\u00e1ch gi\u1ea3i quy\u1ebft.<\/td>\n<\/tr>\n<tr>\n<td>T\u00e2m th\u1ea7n<\/td>\n<td>Ph\u1ea3n \u1ee9ng t\u00e2m th\u1ea7n v\u1edbi disulfiram \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn, th\u01b0\u1eddng l\u00e0 do li\u1ec1u disulfiram cao v\u00e0 \u0111\u1ed9c t\u00ednh do c\u00e1c thu\u1ed1c kh\u00e1c (v\u00ed d\u1ee5, metronidazole, isoniazid) ho\u1eb7c gi\u1ea3i ph\u00f3ng c\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n ti\u1ec1m \u1ea9n \u1edf b\u1ec7nh nh\u00e2n b\u1ecb c\u0103ng th\u1eb3ng do cai r\u01b0\u1ee3u. Khi r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 c\u00e1c lo\u1ea1i thu\u1ed1c t\u01b0\u01a1ng t\u00e1c kh\u00e1c \u0111ang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, gi\u1ea3m ho\u1eb7c ng\u1eebng disulfiram v\u00e0 \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n ti\u1ec1m \u1ea9n theo ch\u1ec9 \u0111\u1ecbnh.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>*Suy gan nghi\u00eam tr\u1ecdng do disulfiram g\u00e2y ra hi\u1ebfm khi x\u1ea3y ra, v\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh x\u00e1c l\u00e0 kh\u00f4ng r\u00f5.<\/p>\n<h3>Nh\u1eefng t\u01b0\u01a1ng t\u00e1c thu\u1ed1c v\u1edbi Disulfiram v\u00e0 c\u00e1ch x\u1eed l\u00fd<\/h3>\n<p>B\u1ea3ng 9: m\u00f4 t\u1ea3 c\u00e1c t\u01b0\u01a1ng t\u00e1c thu\u1ed1c ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u1edbi disulfiram v\u00e0 x\u1eed l\u00fd l\u00e2m s\u00e0ng.<\/p>\n<table>\n<tbody>\n<tr>\n<td>Thu\u1ed1c<\/td>\n<td>\u1ea2nh h\u01b0\u1edfng v\u1edbi Disulfiram<\/td>\n<td>Bi\u1ec7n ph\u00e1p<\/td>\n<\/tr>\n<tr>\n<td>C\u00e1c thu\u1ed1c gi\u1ea3m \u0111au<\/p>\n<p>Chlordiazepoxide (Librium)<\/p>\n<p>Diazepam (Valium)<\/td>\n<td>Gi\u1ea3m \u0111\u1ed9 \u0111\u00e0o th\u1ea3i kh\u1ecfi huy\u1ebft t\u01b0\u01a1ng c\u1ee7a chlordiazepoxide ho\u1eb7c diazepam<\/td>\n<td>Thay th\u1ebf oxazepam (Serax) ho\u1eb7c lorazepam (Ativan)<\/td>\n<\/tr>\n<tr>\n<td>Isoniazid<\/td>\n<td>C\u00f3 th\u1ec3 g\u00e2y ra d\u00e1ng \u0111i kh\u00f4ng \u1ed5n \u0111\u1ecbnh, thay \u0111\u1ed5i tr\u1ea1ng th\u00e1i tinh th\u1ea7n<\/td>\n<td>Ng\u1eebng disulfiram n\u1ebfu nh\u1eadn th\u1ea5y m\u1ed9t trong hai t\u00e1c d\u1ee5ng \u0111\u01b0\u1ee3c ghi nh\u1eadn<\/td>\n<\/tr>\n<tr>\n<td>Rifampin(Rifadin, Rimactane)<\/td>\n<td>N\u1ebfu \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u1edbi isoniazid \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh lao, h\u00e3y xem t\u00e1c d\u1ee5ng c\u1ee7a isoniazid \u1edf tr\u00ean<\/td>\n<td>\u0110i\u1ec1u ch\u1ec9nh li\u1ec1u l\u01b0\u1ee3ng n\u1ebfu c\u1ea7n thi\u1ebft<\/td>\n<\/tr>\n<tr>\n<td>Metronidazole (Flagyl<sup>\u00ae<\/sup>)<\/td>\n<td>D\u1eabn \u0111\u1ebfn kh\u1ea3 n\u0103ng nh\u1ea7m l\u1eabn ho\u1eb7c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n cao h\u01a1n<\/td>\n<td>Kh\u00f4ng k\u00ea \u0111\u1ed3ng th\u1eddi thu\u1ed1c disulfiram v\u00e0 thu\u1ed1c metronidazole<\/td>\n<\/tr>\n<tr>\n<td>Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u (nh\u01b0 warfarin)<\/td>\n<td>\u1ee8c ch\u1ebf chuy\u1ec3n h\u00f3a thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u warfarin<\/td>\n<td>\u0110i\u1ec1u ch\u1ec9nh li\u1ec1u l\u01b0\u1ee3ng n\u1ebfu th\u1ea5y c\u1ea7n<\/td>\n<\/tr>\n<tr>\n<td>Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0110T\u0110 \u0111\u01b0\u1eddng u\u1ed1ng<\/td>\n<td>G\u00e2y ph\u1ea3n \u1ee9ng gi\u1ed1ng disulfiram v\u1edbi r\u01b0\u1ee3u<\/td>\n<td>Qu\u1ea3n l\u00fd c\u1ea9n th\u1eadn n\u1ebfu \u0111\u01b0\u1ee3c k\u00ea thu\u1ed1c \u0110T\u0110 \u0111\u01b0\u1eddng u\u1ed1ng k\u00e8m theo disulfiram<\/td>\n<\/tr>\n<tr>\n<td>Phenytoin (Dilantin\u00ae)<\/td>\n<td>T\u0103ng n\u1ed3ng \u0111\u1ed9 huy\u1ebft thanh th\u00f4ng qua vi\u1ec7c l\u00e0m \u1ee9c ch\u1ebf CYP450 2C9<\/td>\n<td>\u0110o n\u1ed3ng \u0111\u1ed9 phenytoin huy\u1ebft thanh tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng disulfiram; \u0111\u00e1nh gi\u00e1 l\u1ea1i m\u1ee9c \u0111\u1ed9 trong qu\u00e1 tr\u00ecnh tr\u1ecb li\u1ec7u; \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u n\u1ebfu t\u0103ng n\u1ed3ng \u0111\u1ed9 phenytoin<\/td>\n<\/tr>\n<tr>\n<td>Theophylline<\/td>\n<td>T\u0103ng n\u1ed3ng \u0111\u1ed9 huy\u1ebft thanh th\u00f4ng qua \u1ee9c ch\u1ebf CYP 450 1A2<\/td>\n<td>\u0110o n\u1ed3ng \u0111\u1ed9 theophyllin huy\u1ebft thanh tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng disulfiram; \u0111\u00e1nh gi\u00e1 l\u1ea1i m\u1ee9c \u0111\u1ed9 trong qu\u00e1 tr\u00ecnh tr\u1ecb li\u1ec7u; \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u n\u1ebfu t\u0103ng n\u1ed3ng \u0111\u1ed9 theophyllin<\/td>\n<\/tr>\n<tr>\n<td>Thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m ba v\u00f2ng, amitriptyline (Elavil\u00ae)<\/td>\n<td>C\u00f3 th\u1ec3 g\u00e2y m\u00ea s\u1ea3ng<\/p>\n<p>&nbsp;<\/td>\n<td>\u0110i\u1ec1u ch\u1ec9nh li\u1ec1u l\u01b0\u1ee3ng, ng\u1eebng disulfiram ho\u1eb7c chuy\u1ec3n sang m\u1ed9t lo\u1ea1i thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m kh\u00e1c<\/td>\n<\/tr>\n<tr>\n<td>Desipramine (Norpramin\u00ae), imipramine (Tofranil\u00ae)<\/td>\n<td>Gi\u1ea3m \u0111\u1ed9 thanh th\u1ea3i to\u00e0n b\u1ed9 c\u01a1 th\u1ec3 v\u00e0 t\u0103ng th\u1eddi gian b\u00e1n th\u1ea3i v\u00e0 n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh c\u1ee7a desipramine so v\u1edbi imipramine trong huy\u1ebft t\u01b0\u01a1ng<\/td>\n<td>Gi\u00e1m s\u00e1t ch\u1eb7t ch\u1ebd; \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u l\u01b0\u1ee3ng n\u1ebfu c\u1ea7n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3>Th\u1eddi gian th\u1ef1c hi\u1ec7n c\u00e1c x\u00e9t nghi\u1ec7m<\/h3>\n<p>B\u1ea3ng 10 t\u00f3m t\u1eaft ch\u1ebf \u0111\u1ed9 x\u00e9t nghi\u1ec7m c\u1ea7n th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb cho li\u1ec7u ph\u00e1p disulfiram. Nh\u00ecn chung, ch\u1ee9c n\u0103ng gan \u0111\u00f2i h\u1ecfi ph\u1ea3i \u0111\u01b0\u1ee3c theo d\u00f5i li\u00ean t\u1ee5c v\u00ec s\u1ef1 \u1ea3nh h\u01b0\u1edfng qua l\u1ea1i gi\u1eefa disulfiram v\u1edbi t\u1ed5n th\u01b0\u01a1ng gan. Tr\u00e1i ng\u01b0\u1ee3c v\u1edbi t\u1ed5n th\u01b0\u01a1ng gan do r\u01b0\u1ee3u, th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n t\u1ef7 l\u1ec7 aspartate aminotransferase\/alanine aminotransferase cao, t\u1ed5n th\u01b0\u01a1ng gan do disulfiram th\u01b0\u1eddng cho th\u1ea5y m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u00e0 r\u1ea5t cao c\u1ee7a c\u1ea3 hai lo\u1ea1i enzyme (Bjornsson, Nordlinder, &amp; Olsson, 2006). Ph\u1ee5 n\u1eef c\u00f3 thai n\u00ean ng\u1eebng d\u00f9ng disulfiram ngay l\u1eadp t\u1ee9c. X\u00e9t nghi\u1ec7m n\u01b0\u1edbc ti\u1ec3u kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p hay \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1eed d\u1ee5ng r\u01b0\u1ee3u, m\u1eb7c d\u00f9 \u0111\u00f4i khi n\u00f3 c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n ra vi\u1ec7c s\u1eed d\u1ee5ng x\u1ea3y ra trong v\u00f2ng v\u00e0i gi\u1edd khi th\u1eed nghi\u1ec7m.<\/p>\n<p>B\u1ea3ng 10 C\u00e1c x\u00e9t nghi\u1ec7m trong Li\u1ec7u ph\u00e1p Disulfiram<\/p>\n<table>\n<tbody>\n<tr>\n<td>Kho\u1ea3ng th\u1eddi gian\/ Giai \u0111o\u1ea1n<\/td>\n<td>Lo\u1ea1i ki\u1ec3m tra<\/td>\n<\/tr>\n<tr>\n<td>Tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng disulfiram \u0111\u1ec3 x\u00e1c nh\u1eadn vi\u1ec7c ki\u00eang r\u01b0\u1ee3u v\u00e0 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1eddng c\u01a1 s\u1edf sau khi \u1ed5n \u0111\u1ecbnh<\/td>\n<td>X\u00e9t nghi\u1ec7m h\u01a1i th\u1edf ho\u1eb7c r\u01b0\u1ee3u trong m\u00e1u (n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng \u0111\u1ec3 x\u00e1c nh\u1eadn ki\u00eang)<\/p>\n<p>X\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan: Alanine aminotransferase, aspartate aminotransferase, gamma glutamyltransferase, alkaline phosphatase, lactate dehydrogenase, bilirubin, total protein, albumin, prothrombin time<\/p>\n<p>T\u00ednh l\u01b0\u1ee3ng m\u00e1u to\u00e0n b\u1ed9, h\u00f3a ch\u1ea5t th\u00f4ng th\u01b0\u1eddng (n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng)<\/p>\n<p>X\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng th\u1eadn: BUN, Creatinin<\/p>\n<p>Th\u1eed thai (ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i sinh \u0111\u1ebb)<\/td>\n<\/tr>\n<tr>\n<td>10 \u0111\u1ebfn 14 ng\u00e0y t\u1eeb khi b\u1eaft \u0111\u1ea7u tr\u1ecb li\u1ec7u v\u00e0 sau \u0111\u00f3 h\u00e0ng th\u00e1ng (ho\u1eb7c th\u01b0\u1eddng xuy\u00ean h\u01a1n) trong 6 th\u00e1ng \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb; m\u1ed7i 3 th\u00e1ng sau \u0111\u00f3<\/td>\n<td>X\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan: Alanine aminotransferase, aspartate aminotransferase, gamma glutamyltransferase, bilirubin<\/td>\n<\/tr>\n<tr>\n<td>H\u00e0ng th\u00e1ng trong su\u1ed1t li\u1ec7u tr\u00ecnh<\/td>\n<td>Th\u1eed thai (ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i sinh \u0111\u1ebb)<\/td>\n<\/tr>\n<tr>\n<td>Theo ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng trong qu\u00e1 tr\u00ecnh tr\u1ecb li\u1ec7u<\/td>\n<td>X\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng th\u1eadn: BUN, creatinine<\/p>\n<p>S\u00e0ng l\u1ecdc \u0111\u1ed9c t\u00ednh n\u01b0\u1edbc ti\u1ec3u: Ch\u1ec9 th\u1ef1c hi\u1ec7n khi c\u00f3 lo ng\u1ea1i v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng r\u01b0\u1ee3u ho\u1eb7c ma t\u00fay kh\u00f4ng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3>Qu\u00e1 li\u1ec1u disulfiram v\u00e0 c\u00e1ch x\u1eed l\u00fd<\/h3>\n<p>C\u00e1c tr\u01b0\u1eddng h\u1ee3p ng\u1ed9 \u0111\u1ed9c disulfiram nghi\u00eam tr\u1ecdng \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o, ch\u1ee7 y\u1ebfu \u1edf tr\u1ebb em \u0103n ph\u1ea3i m\u1ed9t l\u01b0\u1ee3ng l\u1edbn do b\u1ec7nh nh\u00e2n s\u01a1 su\u1ea5t trong vi\u1ec7c x\u1eed l\u00fd ho\u1eb7c c\u1ea5n gi\u1eef thu\u1ed1c. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a qu\u00e1 li\u1ec1u bao g\u1ed3m bu\u1ed3n ng\u1ee7 sau \u0111\u00f3 l\u00e0 h\u00f4n m\u00ea ho\u1eb7c bu\u1ed3n n\u00f4n k\u00e9o d\u00e0i, n\u00f4n m\u1eeda, h\u00e0nh vi hung h\u0103ng ho\u1eb7c t\u00e2m th\u1ea7n v\u00e0 t\u00ea li\u1ec7t t\u0103ng d\u1ea7n c\u00f3 th\u1ec3 \u0111\u1ebfn c\u00e1c d\u00e2y th\u1ea7n kinh h\u1ed9p s\u1ecd. \u0110i\u1ec1u tr\u1ecb bao g\u1ed3m s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p oxy, glucose (5% ti\u00eam t\u0129nh m\u1ea1ch) v\u00e0 natri ascorbate (ti\u00eam t\u0129nh m\u1ea1ch 1 gram). B\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c n\u1eb1m tr\u00ean gi\u01b0\u1eddng c\u00e0ng y\u00ean t\u0129nh c\u00e0ng t\u1ed1t v\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng ph\u00f9 h\u1ee3p.<\/p>\n<h3>Nh\u1eefng b\u00e1o c\u00e1o v\u1ec1 t\u00ecnh h\u00ecnh \u0103n u\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n<\/h3>\n<p>C\u00e1c b\u1ec7nh nh\u00e2n cho r\u1eb1ng \u0111\u00e3 s\u1eed d\u1ee5ng li\u1ec1u disulfiram \u0111\u1ea7y \u0111\u1ee7, b\u00e1o c\u00e1o r\u1eb1ng h\u1ecd c\u00f3 th\u1ec3 u\u1ed1ng tho\u1ea3i m\u00e1i v\u00e0 c\u00f3 th\u1ec3 v\u1ee9t b\u1ecf nh\u1eefng vi\u00ean thu\u1ed1c m\u00e0 kh\u00f4ng c\u1ea7n u\u1ed1ng. C\u00e1c b\u00e1c s\u0129 kh\u00f4ng n\u00ean k\u1ebft lu\u1eadn r\u1eb1ng disulfiram l\u00e0 kh\u00f4ng hi\u1ec7u qu\u1ea3 cho \u0111\u1ebfn khi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ee9ng minh r\u1eb1ng \u0111\u00e3 th\u1ef1c s\u1ef1 s\u1eed d\u1ee5ng thu\u1ed1c h\u00e0ng ng\u00e0y. Sau khi x\u00e1c nh\u1eadn tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nh\u00e2n, b\u00e1c s\u0129 n\u00ean c\u00e2n nh\u1eafc t\u0103ng li\u1ec1u disulfiram (xem b\u1ea3ng 3) ho\u1eb7c thay \u0111\u1ed5i b\u1ec7nh nh\u00e2n sang m\u1ed9t lo\u1ea1i thu\u1ed1c kh\u00e1c.<\/p>\n<p>Y\u1ebfu t\u1ed1 di truy\u1ec1n c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn \u0111\u1ed9 nh\u1ea1y c\u1ea3m v\u1edbi disulfiram \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n (\u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 b\u1edfi Kenna, McGeary, &amp; Swift, 2004a, 2004b). S\u1ef1 kh\u00e1c bi\u1ec7t l\u1edbn t\u1ed3n t\u1ea1i trong ho\u1ea1t \u0111\u1ed9ng c\u1ee7a enzyme \u0111\u00edch ALDH. Nh\u1eefng ng\u01b0\u1eddi c\u00f3 ho\u1ea1t \u0111\u1ed9ng ALDH b\u00ean trong th\u1ea5p c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng bi\u1ec3u hi\u1ec7n \u0111\u1ed9 nh\u1ea1y cao v\u1edbi disulfiram v\u00e0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 ALDH b\u00ean trong cao c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng bi\u1ec3u hi\u1ec7n \u00edt ho\u1eb7c kh\u00f4ng nh\u1ea1y c\u1ea3m v\u1edbi disulfiram.<\/p>\n<h3>X\u1eed l\u00fd ph\u1ea3n \u1ee9ng disulfiram v\u00e0 r\u01b0\u1ee3u<\/h3>\n<p>Th\u1eddi gian c\u1ee7a ph\u1ea3n \u1ee9ng disulfiram &#8211; alcohol thay \u0111\u1ed5i t\u1eeb 30 \u0111\u1ebfn 60 ph\u00fat trong tr\u01b0\u1eddng h\u1ee3p nh\u1eb9 \u0111\u1ebfn v\u00e0i gi\u1edd ho\u1eb7c cho \u0111\u1ebfn khi r\u01b0\u1ee3u \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a trong tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng h\u01a1n. Khi \u1ea3nh h\u01b0\u1edfng nghi\u00eam tr\u1ecdng, c\u00e1c bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 c\u00f3 th\u1ec3 c\u1ea7n thi\u1ebft \u0111\u1ec3 kh\u00f4i ph\u1ee5c huy\u1ebft \u00e1p v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1ed1c. C\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng oxy ho\u1eb7c carbogen (95% oxy, 5% carbon dioxide), li\u1ec1u l\u1edbn vitamin C (1 g), ephedrine sulfate ho\u1eb7c thu\u1ed1c kh\u00e1ng histamine ti\u00eam t\u0129nh m\u1ea1ch. N\u1ed3ng \u0111\u1ed9 kali n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i \u0111\u1eb7c bi\u1ec7t tr\u00ean b\u1ec7nh nh\u00e2n v\u00ec h\u1ea1 kali m\u00e1u \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o.<\/p>\n<h3>Cung c\u1ea5p th\u00f4ng tin cho b\u1ec7nh nh\u00e2n<\/h3>\n<p>B\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c gi\u00e1o d\u1ee5c k\u1ef9 l\u01b0\u1ee1ng v\u1ec1 disulfiram. Vi\u1ec7c s\u1eed d\u1ee5ng disulfiram n\u00ean bao g\u1ed3m theo d\u00f5i li\u00ean t\u1ee5c, qu\u1ea3n l\u00fd y t\u1ebf v\u00e0 t\u01b0 v\u1ea5n. \u0110\u01b0\u1ee3c s\u1eed d\u1ee5ng m\u00e0 kh\u00f4ng c\u00f3 hi\u1ec3u bi\u1ebft, \u0111\u1ed9ng l\u1ef1c v\u00e0 s\u1ef1 can thi\u1ec7p h\u1ed7 tr\u1ee3 th\u00edch h\u1ee3p, disulfiram d\u01b0\u1eddng nh\u01b0 kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n tu\u00e2n th\u1ee7 thu\u1ed1c k\u00e9m, c\u00e1c d\u1ea1ng nghi\u1ec7n r\u01b0\u1ee3u n\u1eb7ng h\u01a1n ho\u1eb7c c\u1ea3 hai.<\/p>\n<p>Ngo\u00e0i vi\u1ec7c cung c\u1ea5p th\u00f4ng tin cho b\u1ec7nh nh\u00e2n n\u00f3i chung, c\u00e1c nh\u00e0 cung c\u1ea5p d\u1ecbch v\u1ee5 ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe n\u00ean gi\u00e1o d\u1ee5c b\u1ec7nh nh\u00e2n v\u1ec1 nh\u1eefng \u0111i\u1ec3m ch\u00ednh sau \u0111\u00e2y li\u00ean quan \u0111\u1ebfn li\u1ec7u ph\u00e1p disulfiram:<\/p>\n<ul>\n<li>L\u1ee3i \u00edch v\u00e0 h\u1ea1n ch\u1ebf c\u1ee7a disulfiram<\/li>\n<li>Nh\u1eefng g\u00ec mong ch\u1edd t\u1eeb disulfiram v\u00e0 th\u1eddi gian b\u00ecnh th\u01b0\u1eddng \u0111\u1ec3 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 \u0111\u1ea7y \u0111\u1ee7<\/li>\n<li>Th\u00f4ng tin \u0111\u1ea7y \u0111\u1ee7 v\u1ec1 ph\u1ea3n \u1ee9ng disulfiram-alcohol<\/li>\n<li>C\u1ea3nh b\u00e1o m\u1ea1nh m\u1ebd v\u1ec1 vi\u1ec7c u\u1ed1ng r\u01b0\u1ee3u l\u00e9n l\u00fat khi \u0111ang d\u00f9ng disulfiram<\/li>\n<li>C\u1ea3nh b\u00e1o v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng r\u01b0\u1ee3u \u1edf d\u1ea1ng kh\u00e1c, ch\u1eb3ng h\u1ea1n nh\u01b0 trong n\u01b0\u1edbc s\u1ed1t, gi\u1ea5m, h\u1ed7n h\u1ee3p ho, n\u01b0\u1edbc th\u01a1m sau c\u1ea1o r\u00e2u ho\u1eb7c d\u1ea7u xoa b\u00f3p<\/li>\n<li>T\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c t\u01b0 v\u1ea5n li\u00ean t\u1ee5c v\u00e0 tham gia nh\u00f3m 12-Step ho\u1eb7c gi\u00fap \u0111\u1ee1 l\u1eabn nhau trong khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng disulfiram<\/li>\n<li>T\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c th\u00f4ng b\u00e1o cho nh\u00e2n vi\u00ean t\u01b0 v\u1ea5n v\u00e0 b\u00e1c s\u0129 n\u1ebfu b\u1ec7nh nh\u00e2n chuy\u1ec3n \u0111i ho\u1eb7c b\u1ec7nh t\u00e1i ph\u00e1t<\/li>\n<li>T\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c n\u00f3i v\u1edbi b\u00e1c s\u0129 ho\u1eb7c nha s\u0129 r\u1eb1ng b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng disulfiram khi \u0111\u01b0\u1ee3c l\u00ean l\u1ecbch ph\u1eabu thu\u1eadt, bao g\u1ed3m c\u1ea3 ph\u1eabu thu\u1eadt nha khoa<\/li>\n<li>T\u1ea7m quan tr\u1ecdng c\u1ee7a vi\u1ec7c mang theo th\u1ebb nh\u1eadn d\u1ea1ng an to\u00e0n cho th\u1ea5y b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng disulfiram, c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a ph\u1ea3n \u1ee9ng disulfiram v\u00e0 c\u1ed3n c\u00f3 th\u1ec3 x\u1ea3y ra v\u00e0 b\u00e1c s\u0129 ho\u1eb7c t\u1ed5 ch\u1ee9c ph\u1ea3i li\u00ean l\u1ea1c trong tr\u01b0\u1eddng h\u1ee3p kh\u1ea9n c\u1ea5p<\/li>\n<li>C\u00e1c tri\u1ec7u ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh ti\u1ec1m \u1ea9n ph\u1ea3i b\u00e1o c\u00e1o ngay cho b\u00e1c s\u0129<\/li>\n<li>C\u00e1c tri\u1ec7u ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng gan ti\u1ec1m \u1ea9n ph\u1ea3i b\u00e1o c\u00e1o ngay cho b\u00e1c s\u0129.<\/li>\n<\/ul>\n<p>C\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng n\u00ean ghi nh\u1eadn r\u1eb1ng m\u1ed9t b\u1ec7nh nh\u00e2n \u0111\u00e3 nh\u1eadn v\u00e0 hi\u1ec3u c\u00e1c th\u00f4ng tin \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u1edf tr\u00ean v\u00e0 ph\u1ea3i c\u00f3 \u0111\u01b0\u1ee3c s\u1ef1 \u0111\u1ed3ng \u00fd b\u1eb1ng v\u0103n b\u1ea3n c\u1ee7a b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc khi k\u00ea \u0111\u01a1n thu\u1ed1c disulfiram.<\/p>\n<h2>Ai th\u00edch h\u1ee3p \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Disulfiram?<\/h2>\n<ul>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ed9ng l\u1ef1c \u0111i\u1ec1u tr\u1ecb v\u00e0 cam k\u1ebft ki\u00eang ho\u00e0n to\u00e0n<\/li>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 kh\u1ea3 n\u0103ng hi\u1ec3u \u0111\u01b0\u1ee3c h\u1eadu qu\u1ea3 c\u1ee7a vi\u1ec7c u\u1ed1ng r\u01b0\u1ee3u khi s\u1eed d\u1ee5ng disulfiram<\/li>\n<li>B\u1ec7nh nh\u00e2n th\u00edch h\u1ee3p v\u1ec1 m\u1eb7t y t\u1ebf<\/li>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 nh\u1eadn \u0111\u01b0\u1ee3c vi\u1ec7c theo d\u00f5i s\u1eed d\u1ee5ng thu\u1ed1c<\/li>\n<li>B\u1ec7nh nh\u00e2n ki\u00eang r\u01b0\u1ee3u<\/li>\n<li>B\u1ec7nh nh\u00e2n duy tr\u00ec ki\u00eang khem trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb<\/li>\n<li>B\u1ec7nh nh\u00e2n b\u1ecb ph\u1ee5 thu\u1ed9c ho\u1eb7c l\u1ea1m d\u1ee5ng cocaine<\/li>\n<\/ul>\n<h2>Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb v\u00e0 ng\u1eebng \u0111i\u1ec1u tr\u1ecb Disulfiram<\/h2>\n<p>Qu\u1ea3n l\u00fd disulfiram k\u00e9o d\u00e0i kh\u00f4ng t\u1ea1o ra s\u1ef1 tho\u1ea3i m\u00e1i. H\u00e0ng ng\u00e0y, vi\u1ec7c d\u00f9ng thu\u1ed1c \u0111\u00fang ch\u1ec9 \u0111\u1ecbnh li\u00ean t\u1ee5c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c cho \u0111\u1ebfn khi b\u1ec7nh nh\u00e2n cai nghi\u1ec7n r\u01b0\u1ee3u l\u00e2u d\u00e0i, \u1ed5n \u0111\u1ecbnh. T\u00f9y thu\u1ed9c v\u00e0o b\u1ec7nh nh\u00e2n, li\u1ec7u ph\u00e1p disulfiram c\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong nhi\u1ec1u th\u00e1ng ho\u1eb7c nhi\u1ec1u n\u0103m. M\u1ed9t nghi\u00ean c\u1ee9u k\u00e9o d\u00e0i 9 n\u0103m tr\u00ean 180 b\u1ec7nh nh\u00e2n nghi\u1ec7n r\u01b0\u1ee3u m\u00e3n t\u00ednh (Krampe v\u00e0 c\u1ed9ng s\u1ef1, 2006) \u0111\u00e3 k\u1ebft lu\u1eadn r\u1eb1ng c\u00e1c t\u00e1c \u0111\u1ed9ng c\u00f3 l\u1ee3i c\u1ee7a li\u1ec7u ph\u00e1p disulfiram \u0111\u01b0\u1ee3c gi\u00e1m s\u00e1t l\u00e2u d\u00e0i (12 \u0111\u1ebfn 20 th\u00e1ng) l\u00e0 do t\u00e2m l\u00fd, kh\u00f4ng ph\u1ea3i d\u01b0\u1ee3c l\u00fd, v\u00ec gi\u1ea3 d\u01b0\u1ee3c c\u00f3 t\u00e1c d\u1ee5ng c\u0169ng nh\u01b0 disulfiram. Tuy nhi\u00ean, nghi\u00ean c\u1ee9u cho th\u1ea5y r\u1eb1ng kh\u1ea3 n\u0103ng b\u1ec7nh nh\u00e2n s\u1ebd ti\u1ebfp t\u1ee5c ki\u00eang khem nhi\u1ec1u n\u0103m sau khi ch\u1ea5m d\u1ee9t \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c c\u00f3 li\u00ean quan tr\u1ef1c ti\u1ebfp \u0111\u1ebfn th\u1eddi gian b\u1ec7nh nh\u00e2n ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb theo d\u00f5i b\u1eb1ng disulfiram ho\u1eb7c gi\u1ea3 d\u01b0\u1ee3c.<\/p>\n<p>\u0110\u1ed1i v\u1edbi m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng b\u1eb1ng disulfiram v\u00e0 \u0111ang ph\u1ea3i \u0111\u1ed1i m\u1eb7t v\u1edbi c\u00e1c t\u00ecnh hu\u1ed1ng c\u00f3 nguy c\u01a1 t\u00e1i ph\u00e1t cao nh\u01b0 c\u00e1c s\u1ef1 ki\u1ec7n x\u00e3 h\u1ed9i ho\u1eb7c du l\u1ecbch, c\u00f3 th\u1ec3 n\u00ean kh\u1edfi \u0111\u1ed9ng l\u1ea1i vi\u1ec7c s\u1eed d\u1ee5ng disulfiram c\u00f9ng v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p can thi\u1ec7p h\u00e0nh vi \u0111\u1ec3 gi\u00fap h\u1ecd \u0111\u1ed1i ph\u00f3 v\u1edbi t\u00ecnh hu\u1ed1ng nguy c\u01a1 cao v\u00e0 tr\u00e1nh t\u00e1i ph\u00e1t.<\/p>\n<p>Kh\u00f4ng c\u00f3 h\u1ed9i ch\u1ee9ng cai thu\u1ed1c c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c ng\u1eebng s\u1eed d\u1ee5ng disulfiram, nh\u01b0ng b\u1ec7nh nh\u00e2n ph\u1ea3i \u0111\u01b0\u1ee3c c\u1ea3nh b\u00e1o r\u1eb1ng ph\u1ea3n \u1ee9ng disulfiram-alcohol c\u00f3 th\u1ec3 x\u1ea3y ra trong v\u00f2ng 2 tu\u1ea7n sau khi ng\u1eebng thu\u1ed1c.<\/p>\n<h2>B\u00e0n lu\u1eadn l\u00e2m s\u00e0ng cu\u1ed1i c\u00f9ng<\/h2>\n<p>Disulfiram d\u01b0\u1eddng nh\u01b0 c\u00f3 hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng kh\u00e1 khi\u00eam t\u1ed1n trong vi\u1ec7c duy tr\u00ec ki\u00eang r\u01b0\u1ee3u \u1edf b\u1ec7nh nh\u00e2n AUD, \u0111\u1eb7c bi\u1ec7t khi \u0111\u01b0\u1ee3c gi\u00e1m s\u00e1t. Nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u00fac \u0111\u1ea9y \u0111i\u1ec1u tr\u1ecb, cam k\u1ebft ki\u00eang khem, \u0111\u00e3 gi\u00e1m s\u00e1t vi\u1ec7c s\u1eed d\u1ee5ng li\u1ec1u v\u00e0 hi\u1ec3u v\u00e0 tham gia v\u00e0o \u0111i\u1ec1u tr\u1ecb c\u1ee7a h\u1ecd d\u01b0\u1eddng nh\u01b0 thu \u0111\u01b0\u1ee3c nh\u1eefng l\u1ee3i \u00edch l\u1edbn nh\u1ea5t t\u1eeb \u200b\u200bli\u1ec7u ph\u00e1p disulfiram. Tuy nhi\u00ean, disulfiram d\u01b0\u1eddng nh\u01b0 kh\u00f4ng t\u1ea1o ra t\u1ef7 l\u1ec7 ki\u00eang khem cao h\u01a1n so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. \u0110i\u1ec1u tr\u1ecb b\u1eb1ng disulfiram c\u0169ng c\u00f3 nh\u1eefng r\u1ee7i ro hi\u1ebfm g\u1eb7p nh\u01b0ng nguy c\u01a1 nghi\u00eam tr\u1ecdng v\u1ec1 \u0111\u1ed9c t\u00ednh v\u1edbi th\u1ea7n kinh v\u00e0 gan. B\u1ec7nh nh\u00e2n c\u1ea7n theo d\u00f5i l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m c\u1ea9n th\u1eadn trong khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng disulfiram. Disulfiram c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t cho b\u1ea5t k\u1ef3 b\u1ec7nh nh\u00e2n n\u00e0o nghi\u1ec7n r\u01b0\u1ee3u, kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, c\u00f3 m\u1ee5c ti\u00eau cai nghi\u1ec7n ho\u00e0n to\u00e0n v\u00e0 c\u00f3 th\u1ec3 tu\u00e2n th\u1ee7 theo d\u00f5i th\u00edch h\u1ee3p.<\/p>\n<p>C\u00e1c cu\u1ed9c th\u0103m kh\u00e1m l\u00e2m s\u00e0ng trong \u0111\u00f3 b\u00e1c s\u0129 v\u00e0 b\u1ec7nh nh\u00e2n th\u1ea3o lu\u1eadn v\u1ec1 nh\u1eefng r\u1ee7i ro v\u00e0 l\u1ee3i \u00edch c\u1ee7a li\u1ec7u ph\u00e1p disulfiram c\u00f3 th\u1ec3 th\u00fac \u0111\u1ea9y b\u1ec7nh nh\u00e2n cam k\u1ebft cai nghi\u1ec7n r\u01b0\u1ee3u. Ngo\u00e0i c\u00e1c t\u00e1c \u0111\u1ed9ng d\u01b0\u1ee3c l\u00fd c\u1ee7a thu\u1ed1c, b\u1ec7nh nh\u00e2n ch\u1ec9 c\u1ea7n quy\u1ebft \u0111\u1ecbnh d\u00f9ng thu\u1ed1c c\u00f3 th\u1ec3 t\u0103ng c\u01b0\u1eddng \u0111\u1ed9ng l\u1ef1c cai nghi\u1ec7n. Nh\u1eefng r\u1ee7i ro li\u00ean quan \u0111\u1ebfn disulfiram r\u1ea5t n\u1ed5i ti\u1ebfng v\u00e0 nghi\u00eam tr\u1ecdng. Tuy nhi\u00ean, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c h\u01b0\u1edfng l\u1ee3i t\u1eeb disulfiram mi\u1ec5n l\u00e0 h\u1ecd \u0111\u01b0\u1ee3c theo d\u00f5i l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m c\u1ea9n th\u1eadn \u0111\u1ec3 x\u1eed l\u00fd c\u00e1c r\u1ee7i ro li\u00ean quan \u0111\u1ebfn li\u1ec7u ph\u00e1p n\u00e0y.<\/p>\n<h2>Ngu\u1ed3n<\/h2>\n<p>Chapter 3\u2014Disulfiram &#8211; Incorporating Alcohol Pharmacotherapies Into Medical Practice(<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK64036\/?fbclid=IwAR18NF2T1x5ZjOofyjRVYC4PU9ej_bhH5m89TX6V3tQMNibv7-vnD5pC-8A\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK64036\/<\/a>).<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Disulfiram l\u00e0 g\u00ec? Disulfiram l\u00e0 lo\u1ea1i thu\u1ed1c \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c C\u01a1 quan Qu\u1ea3n l\u00fd Th\u1ef1c ph\u1ea9m v\u00e0 D\u01b0\u1ee3c ph\u1ea9m Hoa K\u1ef3 (FDA) ph\u00ea duy\u1ec7t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nghi\u1ec7n r\u01b0\u1ee3u m\u00e3n t\u00ednh. \u1ede tr\u1ea1ng th\u00e1i tinh khi\u1ebft, disulfiram l\u00e0 m\u1ed9t lo\u1ea1i b\u1ed9t tr\u1eafng kh\u00f4ng m\u00f9i, g\u1ea7n nh\u01b0 kh\u00f4ng v\u1ecb, h\u00f2a tan \u0111\u01b0\u1ee3c trong n\u01b0\u1edbc v\u00e0 [&#8230;]\n","protected":false},"author":1,"featured_media":95490,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9210","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/9210","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/comments?post=9210"}],"version-history":[{"count":3,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/9210\/revisions"}],"predecessor-version":[{"id":95507,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/9210\/revisions\/95507"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/media\/95490"}],"wp:attachment":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/media?parent=9210"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/categories?post=9210"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/tags?post=9210"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}