{"id":51011,"date":"2023-09-20T09:16:16","date_gmt":"2023-09-20T09:16:16","guid":{"rendered":"https:\/\/medsname.com\/daruvir\/"},"modified":"2026-04-30T16:19:00","modified_gmt":"2026-04-30T16:19:00","slug":"daruvir","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/daruvir\/","title":{"rendered":"Daruvir"},"content":{"rendered":"<div class=\"medsbase-tldr-answer\" style=\"background:#fff8e1;border-left:4px solid #f5a623;padding:14px 18px;margin:18px 0;border-radius:4px;\">\n<h3 style=\"margin-top:0;\">Rychl\u00e1 odpov\u011b\u010f<\/h3>\n<p style=\"margin-bottom:0;\"><strong>Daruvir<\/strong> \u2014 Darunavir 600 mg (Cipla Inc). Inhibitor prote\u00e1zy druh\u00e9 generace. Pod\u00e1van\u00fd s ritonavirem 100 mg dvakr\u00e1t denn\u011b nebo 800 mg + ritonavir 100 mg jednou denn\u011b. Vysok\u00e1 genetick\u00e1 bari\u00e9ra \u2014 preferovan\u00fd inhibitor prote\u00e1zy u rezistentn\u00edho onemocn\u011bn\u00ed.<\/p>\n<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f7f7f7;border-left:4px solid #2c7cb0;padding:14px 18px;margin:18px 0;border-radius:4px;\">\n<p style=\"margin:0 0 6px 0;\"><strong>Co z\u00edsk\u00e1te s MedsBase:<\/strong><\/p>\n<ul style=\"margin:6px 0 0 22px;padding:0;list-style:disc;\">\n<li>v\u00fdrobce certifikovan\u00e9ho WHO-GMP<\/li>\n<li>Diskr\u00e9tn\u00ed balen\u00ed v oby\u010dejn\u00e9 ob\u00e1lce<\/li>\n<li>Dod\u00e1n\u00ed po cel\u00e9m sv\u011bt\u011b<\/li>\n<li>Hodnoceno v\u00edce ne\u017e 1 400 z\u00e1kazn\u00edky (<a href=\"https:\/\/medsbase.com\/cs\/reviews\/\">\u010d\u00edst recenze<\/a>)<\/li>\n<\/ul>\n<\/div>\n<p class=\"medsbase-reship-line\" style=\"background:#eef7ee;border-left:4px solid #4caf50;padding:10px 14px;margin:14px 0;border-radius:3px;\">\ud83d\udce6 <strong>Z\u00e1ruka op\u011btovn\u00e9ho zasl\u00e1n\u00ed:<\/strong> pokud va\u0161e objedn\u00e1vka nedoraz\u00ed do 20 pracovn\u00edch dn\u016f od odesl\u00e1n\u00ed, za\u0161leme ji znovu bez dal\u0161\u00edch n\u00e1klad\u016f. <a href=\"https:\/\/medsbase.com\/cs\/medsbase-re-shipment-assurance-policy\/\">P\u0159e\u010d\u00edst podm\u00ednky<\/a>.<\/p>\n<h3>Pro\u010d objedn\u00e1vat z MedsBase<\/h3>\n<p>Daruvir je expedov\u00e1n od v\u00fdrobce certifikovan\u00e9ho WHO-GMP v neutr\u00e1ln\u00edm balen\u00ed, fakturace prob\u00edh\u00e1 prost\u0159ednictv\u00edm regulovan\u00e9 platebn\u00ed br\u00e1ny (na v\u00fdpisu z karty se objev\u00ed popis regulovan\u00e9 platebn\u00ed br\u00e1ny \u2014 nikdy MedsBase nebo n\u00e1zev l\u00e9ku). Ka\u017ed\u00e1 objedn\u00e1vka je kryta na\u0161\u00ed 20denn\u00ed z\u00e1rukou p\u0159eposl\u00e1n\u00ed.<\/p>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:12px 16px;margin:14px 0;border-radius:3px;\"><strong>Dodr\u017eov\u00e1n\u00ed l\u00e9\u010dby a rezistence<\/strong><br \/>Inhibitory prote\u00e1zy maj\u00ed relativn\u011b vy\u0161\u0161\u00ed genetickou bari\u00e9ru v\u016f\u010di rezistenci ne\u017e NNRTI, ale st\u00e1le vy\u017eaduj\u00ed dodr\u017eov\u00e1n\u00ed l\u00e9\u010dby &gt;95%. V\u017edy kombinov\u00e1ny se dv\u011bma NRTI (obvykle TDF\/FTC nebo ABC\/3TC) pro kompletn\u00ed re\u017eim. PI\/r ozna\u010duje inhibitor prote\u00e1zy pod\u00e1van\u00fd s ritonavirem \u2014 ritonavir se pod\u00e1v\u00e1 v n\u00edzk\u00e9 d\u00e1vce (100 mg) jako inhibitor CYP3A4 ke zv\u00fd\u0161en\u00ed hladiny partnera PI.<\/div>\n<h2>Jak funguj\u00ed inhibitory prote\u00e1zy<\/h2>\n<p>HIV prote\u00e1za \u0161t\u011bp\u00ed gag-pol polyprotein na zral\u00e9, funk\u010dn\u00ed virov\u00e9 proteiny. Bez prote\u00e1zy produkuje HIV nezral\u00e9, neinfek\u010dn\u00ed viriony. Inhibitory prote\u00e1zy se v\u00e1\u017eou na aktivn\u00ed m\u00edsto prote\u00e1zy a blokuj\u00ed \u0161t\u011bpen\u00ed.<\/p>\n<p>Modern\u00ed terapie inhibitory prote\u00e1zy t\u00e9m\u011b\u0159 v\u017edy vyu\u017e\u00edv\u00e1 ritonavir nebo kobicistat jako farmakokinetick\u00fd booster \u2014 tyto inhibitory CYP3A4 zvy\u0161uj\u00ed hladiny partnera (atazanavir, darunavir, lopinavir) a umo\u017e\u0148uj\u00ed jednodenn\u00ed d\u00e1vkov\u00e1n\u00ed.<\/p>\n<h2>Vedlej\u0161\u00ed \u00fa\u010dinky specifick\u00e9 pro t\u0159\u00eddu<\/h2>\n<ul>\n<li><strong>Gastrointestin\u00e1ln\u00ed:<\/strong> pr\u016fjem, nevolnost, bolesti b\u0159icha (zejm\u00e9na lopinavir\/r \u2014 nej\u010dast\u011bji zp\u016fsobuje pr\u016fjem)<\/li>\n<li><strong>Metabolick\u00e9:<\/strong> dyslipid\u00e9mie, inzulinov\u00e1 rezistence, lipodystrofie (m\u00e9n\u011b v\u00fdrazn\u00e9 u nov\u011bj\u0161\u00edch inhibitor\u016f prote\u00e1zy darunaviru, atazanaviru ne\u017e u star\u0161\u00edho lopinaviru)<\/li>\n<li><strong>Jatern\u00ed:<\/strong> zv\u00fd\u0161en\u00ed jatern\u00edch enzym\u016f; opatrnost u HBV\/HCV koinfekce<\/li>\n<li><strong>Kardiovaskul\u00e1rn\u00ed:<\/strong> mal\u00e1 asociace s rizikem infarktu myokardu (star\u0161\u00ed inhibitory prote\u00e1zy); nov\u011bj\u0161\u00ed inhibitory jsou m\u00e9n\u011b posti\u017eeny<\/li>\n<li><strong>Specifick\u00e9 pro atazanavir:<\/strong> reverzibiln\u00ed nep\u0159\u00edm\u00e1 hyperbilirubin\u00e9mie (Gilbert\u016fv syndrom \u2014 kosmetick\u00fd, ne hepatotoxick\u00fd), nefroliti\u00e1za, choleliti\u00e1za<\/li>\n<li><strong>Specifick\u00e9 pro darunavir:<\/strong> vyr\u00e1\u017eka (souvis\u00ed se sulfonamidy), hepatitida<\/li>\n<\/ul>\n<h2>V\u00fdznamn\u00e9 l\u00e9kov\u00e9 interakce<\/h2>\n<ul>\n<li><strong>Siln\u00e9 substr\u00e1ty CYP3A4 s \u00fazk\u00fdm terapeutick\u00fdm indexem \u2014 absolutn\u00ed kontraindikace:<\/strong> simvastatin, lovastatin (pou\u017eijte rad\u011bji pravastatin\/fluvastatin\/pitavastatin); alkaloidy ergotu; pimozid; midazolam\/triazolam (peror\u00e1ln\u00ed); rifampicin; t\u0159ezalka te\u010dkovan\u00e1; cisaprid.<\/li>\n<li><strong>PPI:<\/strong> sni\u017euj\u00ed absorpci atazanaviru \u2014 pod\u00e1vejte s odstupem \u226512 hodin NEBO se vyhn\u011bte kombinaci. M\u00e9n\u011b probl\u00e9m\u016f s darunavirem, lopinavirem.<\/li>\n<li><strong>Rifampicin:<\/strong> sni\u017euje hladiny PI &gt;75 % \u2014 pou\u017eijte rad\u011bji rifabutin s \u00fapravou d\u00e1vkov\u00e1n\u00ed PI.<\/li>\n<li><strong>Hormon\u00e1ln\u00ed antikoncepce:<\/strong> n\u011bkter\u00e1 PI sni\u017euj\u00ed hladiny ethinylestradiolu \u2014 pou\u017eijte bari\u00e9rovou antikoncepci nebo alternativu.<\/li>\n<li><strong>Anti-HCV DAA:<\/strong> v\u017edy zkontrolujte aktu\u00e1ln\u00ed Liverpoolskou HIV-DDI datab\u00e1zi p\u0159ed kombinac\u00ed terapie HIV + HCV.<\/li>\n<\/ul>\n<h2 id=\"faqs\">\u010casto kladen\u00e9 dotazy<\/h2>\n<h3>Pro\u010d se ritonavir pou\u017e\u00edv\u00e1 jako booster?<\/h3>\n<p>Ritonavir v n\u00edzk\u00e9 d\u00e1vce (100 mg) inhibuje CYP3A4, \u010d\u00edm\u017e zvy\u0161uje hladiny spolupod\u00e1van\u00e9ho PI (atazanavir, darunavir, lopinavir). To umo\u017e\u0148uje jednodenn\u00ed d\u00e1vkov\u00e1n\u00ed a ni\u017e\u0161\u00ed po\u010det tablet. Alternativn\u00edm boosterem je kobicistat (nem\u00e1 antivirovou aktivitu, pouze inhibuje CYP).<\/p>\n<h3>Vyl\u00e9\u010d\u00ed tento re\u017eim HIV?<\/h3>\n<p>Ne \u2014 ART potla\u010duje virovou replikaci do\u017eivotn\u011b. P\u0159eru\u0161en\u00ed terapie vede k virov\u00e9mu reboundu b\u011bhem t\u00fddn\u016f. P\u0159i d\u016fsledn\u00e9 terapii a nedetekovateln\u00e9 virov\u00e9 n\u00e1lo\u017ei se d\u00e9lka \u017eivota bl\u00ed\u017e\u00ed HIV-negativn\u00ed populaci (U=U).<\/p>\n<h3>Co kdy\u017e vynech\u00e1m d\u00e1vku?<\/h3>\n<p>Vezm\u011bte si d\u00e1vku, pokud si vzpomenete do 6 hodin po obvykl\u00e9m \u010dase. Pokud je to v\u00edce ne\u017e 6 hodin, vynechejte a pokra\u010dujte v obvykl\u00e9m sch\u00e9matu \u2014 neduplikujte d\u00e1vku. Opakovan\u00e9 vynech\u00e1n\u00ed zvy\u0161uje riziko vzniku rezistence.<\/p>\n<h3>Zvl\u00e1d\u00e1n\u00ed ne\u017e\u00e1douc\u00edch \u00fa\u010dink\u016f?<\/h3>\n<p>Pr\u016fjem je nej\u010dast\u011bj\u0161\u00ed \u2014 obvykle ustoup\u00ed do 4-6 t\u00fddn\u016f; lze pou\u017e\u00edt loperamid. Zm\u011bny lipid\u016f mohou vy\u017eadovat statin (vyhn\u011bte se simvastatinu\/lovastatinu \u2014 pou\u017eijte n\u00edzkou d\u00e1vku atorvastatinu, rosuvastatin nebo pitavastatin). \u017dloutenka u atazanaviru je kosmetick\u00e1 a ne hepatotoxick\u00e1 \u2014 nen\u00ed nutn\u00e9 m\u011bnit l\u00e9\u010dbu.<\/p>\n<h3>Kdy to m\u00e1m u\u017e\u00edvat?<\/h3>\n<p>V\u011bt\u0161ina PI s boostrem se u\u017e\u00edv\u00e1 s j\u00eddlem (zlep\u0161uje vst\u0159eb\u00e1v\u00e1n\u00ed a sn\u00e1\u0161enlivost). Atazanavir\/r vy\u017eaduje kysel\u00e9 prost\u0159ed\u00ed \u017ealudku \u2014 vyhn\u011bte se PPI; H2 blok\u00e1tory jsou vhodn\u00e9 s \u010dasov\u00fdm odstupem. Darunavir\/r a lopinavir\/r jsou m\u00e9n\u011b citliv\u00e9 na pH.<\/p>\n<h3>Interakce l\u00e9k\u016f?<\/h3>\n<p>Hlavn\u00ed t\u0159\u00edda \u2014 v\u017edy sd\u011blte v\u0161echny l\u00e9ky. PI jsou siln\u00e9 inhibitory CYP3A4. Statiny, rifampicin, ergotaminy, or\u00e1ln\u00ed antikoncepce, antikonvulziva, antimykotika a mnoho psychiatrick\u00fdch l\u00e9k\u016f vy\u017eaduje \u00fapravu nebo n\u00e1hradu. Pou\u017eijte Liverpool HIV-DDI datab\u00e1zi (hiv-druginteractions.org).<\/p>\n<h3>HBV koinfekce?<\/h3>\n<p>Re\u017eimy zalo\u017een\u00e9 na PI nel\u00e9\u010d\u00ed HBV. NRTI kost (TDF + FTC nebo 3TC) l\u00e9\u010d\u00ed jak HIV, tak HBV \u2014 tuto kombinaci zachovejte p\u0159i koinfekci HBV. N\u00e1hl\u00e9 vysazen\u00ed m\u016f\u017ee vyvolat vzplanut\u00ed HBV.<\/p>\n<h3>T\u011bhotenstv\u00ed?<\/h3>\n<p>Atazanavir\/r a darunavir\/r maj\u00ed nejv\u00edce \u00fadaj\u016f o pou\u017eit\u00ed v t\u011bhotenstv\u00ed a jsou b\u011b\u017en\u011b u\u017e\u00edv\u00e1ny. Lopinavir\/r je tak\u00e9 p\u0159ijateln\u00fd. PI s boostrem kobicistatem se v t\u011bhotenstv\u00ed obecn\u011b nedoporu\u010duj\u00ed kv\u016fli sn\u00ed\u017een\u00fdm hladin\u00e1m ve 2.\/3. trimestru.<\/p>\n<h3>Kdy jsou PI preferov\u00e1ny?<\/h3>\n<p>PI jsou druhou volbou podle modern\u00edch doporu\u010den\u00ed (inhibitory integr\u00e1zy jsou prvn\u00ed volbou). PI z\u016fst\u00e1vaj\u00ed u\u017eite\u010dn\u00e9 pro: p\u0159edl\u00e9\u010den\u00e9 pacienty s rezistenc\u00ed na INSTI, pacienty s CNS onemocn\u011bn\u00edm (pr\u016fnik do CSF je variabiln\u00ed, ale u\u017eite\u010dn\u00fd), HIV-2 (kde INSTI funguj\u00ed, ale rezisten\u010dn\u00ed cesty se li\u0161\u00ed) a v n\u011bkter\u00fdch situac\u00edch v t\u011bhotenstv\u00ed.<\/p>\n<h3>A co kardiovaskul\u00e1rn\u00ed riziko?<\/h3>\n<p>Star\u0161\u00ed PI (lopinavir, indinavir) nesou mal\u00e9 absolutn\u00ed zv\u00fd\u0161en\u00ed rizika infarktu. Nov\u011bj\u0161\u00ed PI (atazanavir, darunavir) m\u00e9n\u011b. \u0158i\u010fte tradi\u010dn\u00ed rizikov\u00e9 faktory CV (kou\u0159en\u00ed, TK, lipidy, hmotnost, pohyb) \u2014 ty dominuj\u00ed nad m\u00edrn\u00fdm \u00fa\u010dinkem PI.<\/p>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h2>Dal\u0161\u00ed l\u00e9ky na HIV a antivirotika<\/h2>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/cs\/trioday\/\">Trioday<\/a> \u2014 TDF + 3TC + EFV \u2014 jednoduch\u00fd re\u017eim v jedn\u00e9 tablet\u011b od Cipla<\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/triomune\/\">Triomune<\/a> \u2014 d4T + 3TC + NVP \u2014 star\u0161\u00ed 3v1 kombinace (na b\u00e1zi stavudinu)<\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/zepdon\/\">Zepdon<\/a> \u2014 raltegravir 400 mg \u2014 inhibitor integr\u00e1zy<\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/abamune-l\/\">Abamune L<\/a> \u2014 abakavir + lamivudin \u2014 alternativn\u00ed z\u00e1klad NRTI<\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/tenvir-l\/\">Tenvir L<\/a> \u2014 tenofovir + lamivudin \u2014 alternativn\u00ed z\u00e1klad NRTI<\/li>\n<\/ul>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:12px 16px;margin:18px 0;border-radius:3px;font-size:.95em;\"><strong>Zdravotn\u00ed upozorn\u011bn\u00ed:<\/strong> L\u00e9\u010dba HIV je komplexn\u00ed, celo\u017eivotn\u00ed terapie. V\u00fdb\u011br l\u00e9k\u016f z\u00e1vis\u00ed na genotypu, testech rezistence, p\u0159idru\u017een\u00fdch onemocn\u011bn\u00edch a p\u0159edchoz\u00ed l\u00e9\u010db\u011b. Jakoukoli zm\u011bnu re\u017eimu konzultujte s odborn\u00edkem na HIV. Pro prevenci rezistence je nutn\u00e1 adherence &gt;95%. P\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby obsahuj\u00edc\u00ed tenofovir, lamivudin nebo emtricitabin testujte HBV \u2014 vysazen\u00ed m\u016f\u017ee u pacient\u016f s koinfekc\u00ed zp\u016fsobit z\u00e1va\u017en\u00e9 vzplanut\u00ed HBV.<\/div>","protected":false},"excerpt":{"rendered":"<p>Daruvir (Darunavir 600 mg) \u2014 inhibitor prote\u00e1zy druh\u00e9 generace od spole\u010dnosti Cipla s vysokou genetickou bari\u00e9rou v\u016f\u010di rezistenci. V\u017edy pod\u00e1van\u00fd s ritonavirem. Preferovan\u00fd inhibitor prote\u00e1zy pro l\u00e9\u010dbu HIV u pacient\u016f s p\u0159edchoz\u00ed terapi\u00ed.<\/p>","protected":false},"featured_media":51012,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3141,3223,3304],"product_tag":[3315,3316],"class_list":{"0":"post-51011","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-category-overview","7":"product_cat-chronic-conditions","8":"product_cat-hiv-medication","9":"product_tag-darunavir","10":"product_tag-daruvir","12":"first","13":"outofstock","14":"shipping-taxable","15":"purchasable","16":"product-type-variable","17":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product\/51011","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/comments?post=51011"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media\/51012"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media?parent=51011"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_brand?post=51011"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat?post=51011"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_tag?post=51011"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}