{"id":51450,"date":"2023-09-20T09:21:39","date_gmt":"2023-09-20T09:21:39","guid":{"rendered":"https:\/\/medsname.com\/angizem\/"},"modified":"2026-05-01T10:49:11","modified_gmt":"2026-05-01T10:49:11","slug":"angizem","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/angizem\/","title":{"rendered":"Angizem"},"content":{"rendered":"<p><!-- medsbase-tldr-answer --><\/p>\n<div style=\"background:#fff8e1;border-left:4px solid #f5a623;padding:18px 22px;margin:0 0 24px 0;border-radius:4px;\">\n<h3 class=\"wp-block-heading\" style=\"margin:0 0 8px 0;font-size:16px;font-weight:700;\">\u26a1 Rychl\u00e1 odpov\u011b\u010f \u2014 Co je Angizem?<\/h3>\n<p style=\"margin:0;\"><strong>Angizem<\/strong> je <strong>30 \/ 60 mg tablety diltiazemu s okam\u017eit\u00fdm uvol\u0148ov\u00e1n\u00edm<\/strong> od Sun Pharma \u2014 benzothiazepinov\u00fd nedihydropyridinov\u00fd blok\u00e1tor kalciov\u00fdch kan\u00e1l\u016f. Na rozd\u00edl od dihydropyridin\u016f (amlodipin, nifedipin), kter\u00e9 p\u016fsob\u00ed t\u00e9m\u011b\u0159 v\u00fdhradn\u011b na arteri\u00e1ln\u00ed hladk\u00e9 svalstvo, m\u00e1 diltiazem <strong>St\u0159edn\u00ed srde\u010dn\u00ed \u00fa\u010dinek<\/strong> \u2014 zpomaluje veden\u00ed AV uzlu a sni\u017euje srde\u010dn\u00ed frekvenci (u\u017eite\u010dn\u00e9 pro kontrolu frekvence), ale m\u00e1 men\u0161\u00ed negativn\u00ed inotropii ne\u017e verapamil, proto je l\u00e9pe tolerov\u00e1n u pacient\u016f s hrani\u010dn\u00ed funkc\u00ed lev\u00e9 komory. Tento profil jej \u010din\u00ed u\u017eite\u010dn\u00fdm pro <strong>hypertenzi kombinovanou s kontrolou srde\u010dn\u00ed frekvence<\/strong> (fibrilace s\u00edn\u00ed, chronick\u00e1 angina pectoris, PSVT). Polo\u010das v plazm\u011b u IR formulace 3-5 hodin (TDS\/QDS); CD\/XL formulace \u00fa\u010dinn\u00e9 5-10 hodin (jednou denn\u011b). Typick\u00e1 d\u00e1vka pro hypertenzi: <strong>IR 30-60 mg \u010dty\u0159ikr\u00e1t denn\u011b; CD\/XL 180-240 mg jednou denn\u011b<\/strong>, c\u00edlov\u00e9 d\u00e1vkov\u00e1n\u00ed IR 60-90 mg QDS (240-360 mg\/den); CD\/XL 180-360 mg jednou denn\u011b. <strong>NEKOMBINUJTE diltiazem s betablok\u00e1tory<\/strong> \u2014 riziko aditivn\u00ed bradykardie a srde\u010dn\u00edho bloku. Kontraindikov\u00e1no u srde\u010dn\u00edho selh\u00e1n\u00ed se sn\u00ed\u017eenou ejek\u010dn\u00ed frakc\u00ed (HF-REF), AV bloku druh\u00e9ho\/t\u0159et\u00edho stupn\u011b, t\u011b\u017ek\u00e9 bradykardie, kardiogenn\u00edho \u0161oku a syndromu nemocn\u00e9ho sinu bez kardiostimul\u00e1toru.<\/p>\n<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f4f8fb;border:1px solid #d8e3eb;padding:12px 16px;margin:16px 0;border-radius:4px;font-size:14px;\">\n<strong>Co z\u00edsk\u00e1te s MedsBase:<\/strong> V\u00fdrobce certifikovan\u00fd WHO-GMP \u00b7 Diskr\u00e9tn\u00ed balen\u00ed \u00b7 Celosv\u011btov\u00e1 doprava \u00b7 V\u00edce ne\u017e 1 400 ov\u011b\u0159en\u00fdch <a href=\"https:\/\/medsbase.com\/cs\/reviews\/\">recenz\u00ed z\u00e1kazn\u00edk\u016f<\/a>\n<\/div>\n<p class=\"medsbase-reship-line\" style=\"font-size:14px;color:#444;margin:8px 0 18px;\">\ud83d\udce6 Ka\u017ed\u00e1 objedn\u00e1vka je pokryta na\u0161\u00ed <a href=\"https:\/\/medsbase.com\/cs\/medsbase-re-shipment-assurance-policy\/\"><strong>Z\u00e1rukou op\u011btovn\u00e9ho odesl\u00e1n\u00ed<\/strong><\/a> \u2014 pokud va\u0161e z\u00e1silka nedoraz\u00ed do 20 pracovn\u00edch dn\u016f, p\u0159epos\u00edl\u00e1me ji.<\/p>\n<h3>Pro\u010d objedn\u00e1vat z MedsBase<\/h3>\n<p>Na\u0161e generick\u00e9 l\u00e9ky poch\u00e1zej\u00ed od v\u00fdrobc\u016f certifikovan\u00fdch WHO-GMP a jsou expedov\u00e1ny po cel\u00e9m sv\u011bt\u011b v diskr\u00e9tn\u00edm, nen\u00e1padn\u00e9m balen\u00ed \u2013 na vn\u011bj\u0161\u00ed stran\u011b bal\u00edku nen\u00ed uveden n\u00e1zev l\u00e9ku. Platby kartou jsou sm\u011brov\u00e1ny prost\u0159ednictv\u00edm regulovan\u00e9ho procesoru (popisky na v\u00fdpisu zahrnuj\u00ed regulovan\u00e9ho procesora plateb kartou \u2013 nikdy \u201cMedsBase\u201d nebo n\u00e1zev l\u00e9ku). P\u0159ij\u00edm\u00e1me tak\u00e9 kryptom\u011bny a bankovn\u00ed p\u0159evody SEPA. Ka\u017ed\u00e1 objedn\u00e1vka je zaji\u0161t\u011bna na\u0161\u00ed politikou p\u0159eposl\u00e1n\u00ed.<\/p>\n<h2 class=\"wp-block-heading\">Co je Angizem?<\/h2>\n<p>Angizem jsou peror\u00e1ln\u00ed tablety diltiazemu 30\/60 mg od Sun Pharma, dod\u00e1van\u00e9 v balen\u00ed po 30-90 tablet\u00e1ch. Uveden na trh 1982 (Tanabe jako <strong>Cardizem<\/strong>). Nach\u00e1z\u00ed se mezi DHP (\u010dist\u00e1 vazodilatancia) a verapamilem (siln\u00fd kardiodepresant) \u2014 diltiazem m\u00e1 vyv\u00e1\u017een\u00e9 vaskul\u00e1rn\u00ed + kardi\u00e1ln\u00ed \u00fa\u010dinky.<\/p>\n<p>Diltiazem pat\u0159\u00ed do skupiny <strong>nedihydropyridinov\u00fd blok\u00e1tor kalciov\u00fdch kan\u00e1l\u016f<\/strong> podt\u0159\u00edda, odli\u0161n\u00e1 od dihydropyridin\u016f (amlodipin, nifedipin) sv\u00fdmi <strong>p\u0159\u00edm\u00fdmi srde\u010dn\u00edmi \u00fa\u010dinky<\/strong> \u2014 zpomalen\u00edm AV nod\u00e1ln\u00edho veden\u00ed, sn\u00ed\u017een\u00edm srde\u010dn\u00ed frekvence a (v\u00edce u verapamilu ne\u017e u diltiazemu) sn\u00ed\u017een\u00edm srde\u010dn\u00ed kontraktility. Tento profil \u010din\u00ed ne-DHP u\u017eite\u010dn\u00e9, kdy\u017e hypertenze koexistuje se stavy vy\u017eaduj\u00edc\u00edmi kontrolu frekvence (fibrilace s\u00edn\u00ed, supraventrikul\u00e1rn\u00ed tachykardie, chronick\u00e1 angina pectoris).<\/p>\n<h2 class=\"wp-block-heading\">Jak Diltiazem Funguje<\/h2>\n<p>Diltiazem blokuje L-typ nap\u011b\u0165ov\u011b \u0159\u00edzen\u00fdch kalciov\u00fdch kan\u00e1l\u016f jak v c\u00e9vn\u00ed hladk\u00e9 svalovin\u011b, tak v srde\u010dn\u00edm svalu a p\u0159evodn\u00ed tk\u00e1ni (na rozd\u00edl od DHP, kter\u00e9 jsou vaskul\u00e1rn\u011b selektivn\u00ed). To zp\u016fsobuje:<\/p>\n<ul>\n<li><strong>Arteri\u00e1ln\u00ed vazodilataci<\/strong> \u2014 sn\u00ed\u017een\u00fd syst\u00e9mov\u00fd c\u00e9vn\u00ed odpor, ni\u017e\u0161\u00ed krevn\u00ed tlak<\/li>\n<li><strong>Sn\u00ed\u017eenou rychlost veden\u00ed AV uzlem<\/strong> \u2014 pomalej\u0161\u00ed komorovou frekvenci p\u0159i fibrilaci s\u00edn\u00ed\/flutteru; ukon\u010den\u00ed reentry SVT<\/li>\n<li><strong>Negativn\u00ed chronotropii<\/strong> \u2014 pomalej\u0161\u00ed sinusov\u00fd rytmus<\/li>\n<li><strong>Negativn\u00ed inotropii<\/strong> \u2014 sn\u00ed\u017eenou srde\u010dn\u00ed kontraktilitu (v\u00fdznamnou u verapamilu, m\u00edrnou u diltiazemu)<\/li>\n<li><strong>Sn\u00ed\u017eenou spot\u0159ebu kysl\u00edku myokardem<\/strong> \u2014 antiangin\u00f3zn\u00ed \u00fa\u010dinek<\/li>\n<li><strong>Uvoln\u011bn\u00ed koron\u00e1rn\u00edho vasospasmu<\/strong> \u2014 prvn\u00ed volba u Prinzmetalovy\/variantn\u00ed anginy<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Schv\u00e1len\u00e9 a v\u011bdecky podlo\u017een\u00e9 indikace<\/h2>\n<ul>\n<li><strong>Hypertenze<\/strong> \u2014 zvl\u00e1\u0161t\u011b kdy\u017e je pot\u0159eba kontrola srde\u010dn\u00ed frekvence<\/li>\n<li><strong>Chronick\u00e1 stabiln\u00ed angina<\/strong><\/li>\n<li><strong>Prinzmetalova\/vasospastick\u00e1 angina<\/strong> \u2014 prvn\u00ed volba u koron\u00e1rn\u00edho spasmu<\/li>\n<li><strong>Kontrola frekvence p\u0159i fibrilaci s\u00edn\u00ed\/flutteru<\/strong> \u2014 alternativa k betablok\u00e1tor\u016fm, kdy\u017e je betablok\u00e1da kontraindikov\u00e1na (nap\u0159. u astmatu)<\/li>\n<li><strong>Supraventrikul\u00e1rn\u00ed tachykardie<\/strong> (IV forma pro akutn\u00ed ukon\u010den\u00ed)<\/li>\n<\/ul>\n<p><strong>NEKOMBINUJTE diltiazem s betablok\u00e1torem v b\u011b\u017en\u00e9 praxi \u2014 riziko aditivn\u00ed bradykardie a srde\u010dn\u00edho bloku.<\/strong><\/p>\n<h2 class=\"wp-block-heading\">D\u00e1vkov\u00e1n\u00ed Angizemu<\/h2>\n<p><strong>Hypertenze:<\/strong><\/p>\n<ul>\n<li><strong>Po\u010d\u00e1te\u010dn\u00ed d\u00e1vka:<\/strong> IR 30-60 mg \u010dty\u0159ikr\u00e1t denn\u011b; CD\/XL 180-240 mg jednou denn\u011b<\/li>\n<li><strong>C\u00edlov\u00e1 d\u00e1vka:<\/strong> IR 60-90 mg QDS (240-360 mg\/den); CD\/XL 180-360 mg jednou denn\u011b<\/li>\n<li>Titrujte ka\u017ed\u00fdch 1-2 t\u00fddny<\/li>\n<\/ul>\n<p><strong>Pod\u00e1v\u00e1n\u00ed:<\/strong> s j\u00eddlem nebo bez j\u00eddla. Polykejte cel\u00e9 \u2014 NEROZDRT\u011aTE a nerozd\u011blujte tablety s prodlou\u017een\u00fdm uvol\u0148ov\u00e1n\u00edm (SR\/CD\/XL).<\/p>\n<p><strong>Monitorov\u00e1n\u00ed:<\/strong><\/p>\n<ul>\n<li>M\u011b\u0159it puls a TK na za\u010d\u00e1tku, po 2 t\u00fddnech, 4 t\u00fddnech a n\u00e1sledn\u011b pravideln\u011b<\/li>\n<li>Sledovat bradykardii (&lt;50 tep\u016f\/min = sn\u00ed\u017een\u00ed d\u00e1vky)<\/li>\n<li>EKG na za\u010d\u00e1tku a p\u0159i jak\u00e9koli symptomatick\u00e9 zm\u011bn\u011b (zv\u00e1\u017eit prodlou\u017een\u00ed PR intervalu \/ AV blok)<\/li>\n<li>V\u00fdchoz\u00ed a pravideln\u00e9 jatern\u00ed testy (jatern\u00ed metabolismus)<\/li>\n<li>U pacient\u016f u\u017e\u00edvaj\u00edc\u00edch digoxin: kontrolovat hladinu digoxinu (oba ne-DHP zvy\u0161uj\u00ed hladinu digoxinu ~70%)<\/li>\n<\/ul>\n<p><strong>Ukon\u010den\u00ed l\u00e9\u010dby:<\/strong> Postupn\u00e9 vysazov\u00e1n\u00ed b\u011bhem 1-2 t\u00fddn\u016f u vysok\u00fdch d\u00e1vek chronick\u00e9 terapie \u2014 n\u00e1hl\u00e9 vysazen\u00ed m\u016f\u017ee zp\u016fsobit rebound anginu u pacient\u016f s ICHS.<\/p>\n<h2 class=\"wp-block-heading\">Vedlej\u0161\u00ed \u00fa\u010dinky<\/h2>\n<p><strong>\u010cast\u00e9:<\/strong><\/p>\n<ul>\n<li><strong>Bradykardie<\/strong> (tep &lt;50\/min) \u2014 z\u00e1visl\u00e9 na d\u00e1vce; hlavn\u00ed d\u016fvod pro sn\u00ed\u017een\u00ed d\u00e1vky<\/li>\n<li><strong>Z\u00e1cpa<\/strong> \u2014 zejm\u00e9na verapamil (a\u017e u 40 % u\u017eivatel\u016f); m\u00e9n\u011b \u010dast\u00e9 u diltiazemu<\/li>\n<li>Z\u00e1vrat\u011b, \u00fanava<\/li>\n<li>Bolest hlavy (m\u00e9n\u011b ne\u017e u DHP)<\/li>\n<li>N\u00e1valy horka (m\u00e9n\u011b ne\u017e u DHP)<\/li>\n<li>Perifern\u00ed ed\u00e9m (m\u00e9n\u011b ne\u017e u DHP; st\u00e1le mo\u017en\u00e9)<\/li>\n<li>Nevolnost, b\u0159i\u0161n\u00ed dyskomfort<\/li>\n<\/ul>\n<p><strong>V\u00e1\u017en\u00e9, ale m\u00e9n\u011b \u010dast\u00e9:<\/strong><\/p>\n<ul>\n<li><strong>Srde\u010dn\u00ed blok<\/strong> (prodlou\u017een\u00ed PR intervalu, AV blok 1.\u20133. stupn\u011b) \u2014 zejm\u00e9na v kombinaci s betablok\u00e1tory, digoxinem nebo p\u0159i preexistuj\u00edc\u00edm poruch\u00e1ch veden\u00ed<\/li>\n<li><strong>Zhor\u0161en\u00ed srde\u010dn\u00edho selh\u00e1n\u00ed<\/strong> \u2014 ne-DHP jsou kontraindikov\u00e1ny u HF-REF kv\u016fli negativn\u00edmu inotropn\u00edmu \u00fa\u010dinku<\/li>\n<li>Hyperplazie d\u00e1sn\u00ed (dlouhodob\u00e9 u\u017e\u00edv\u00e1n\u00ed; m\u00e9n\u011b \u010dast\u00e9 ne\u017e u nifedipinu)<\/li>\n<li>Zv\u00fd\u0161en\u00ed jatern\u00edch enzym\u016f (obvykle m\u00edrn\u00e9, reverzibiln\u00ed)<\/li>\n<li>Erektiln\u00ed dysfunkce (\u010dast\u011bj\u0161\u00ed s verapamilem)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Kontraindikace<\/h2>\n<ul>\n<li><strong>Srde\u010dn\u00ed selh\u00e1n\u00ed se sn\u00ed\u017eenou ejek\u010dn\u00ed frakc\u00ed (HF-REF)<\/strong> \u2014 ne-DHP jsou kontraindikov\u00e1ny; mohou vyvolat akutn\u00ed dekompenzaci<\/li>\n<li><strong>AV blok druh\u00e9ho nebo t\u0159et\u00edho stupn\u011b<\/strong> bez funk\u010dn\u00edho kardiostimul\u00e1toru<\/li>\n<li><strong>Sinusov\u00e1 bradykardie &lt;50 tep\u016f\/min<\/strong><\/li>\n<li><strong>Syndrom nemocn\u00e9ho sinu<\/strong> bez kardiostimul\u00e1toru<\/li>\n<li><strong>Kardiogenn\u00ed \u0161ok<\/strong><\/li>\n<li><strong>T\u011b\u017ek\u00e1 aort\u00e1ln\u00ed sten\u00f3za<\/strong><\/li>\n<li><strong>Wolff\u016fv-Parkinson\u016fv-White\u016fv syndrom s fibrilac\u00ed s\u00edn\u00ed<\/strong> \u2014 m\u016f\u017ee vyvolat rychl\u00fd p\u0159evod p\u0159es p\u0159\u00eddatnou dr\u00e1hu a fibrilaci komor<\/li>\n<li><strong>Sou\u010dasn\u00e9 u\u017e\u00edv\u00e1n\u00ed beta-blok\u00e1tor\u016f<\/strong> (b\u011b\u017en\u00e1 praxe) \u2014 aditivn\u00ed bradykardie\/blok srdce<\/li>\n<li>Zn\u00e1m\u00e1 p\u0159ecitliv\u011blost na diltiazem<\/li>\n<\/ul>\n<p><strong>T\u011bhotenstv\u00ed:<\/strong> nen\u00ed rutinn\u00ed l\u00e9\u010dbou prvn\u00ed volby. Verapamil se pou\u017e\u00edv\u00e1 u mate\u0159sk\u00e9 a fet\u00e1ln\u00ed SVT (proch\u00e1z\u00ed placentou). Diltiazem se v t\u011bhotenstv\u00ed obecn\u011b vyh\u00fdb\u00e1. Pro antihypertenzn\u00ed l\u00e9\u010dbu v t\u011bhotenstv\u00ed jsou, <a href=\"https:\/\/medsbase.com\/cs\/labebet\/\">labetalol<\/a>, methyldopa a nifedipin MR bezpe\u010dn\u011bj\u0161\u00edmi mo\u017enostmi.<\/p>\n<p><strong>Kojen\u00ed:<\/strong> mal\u00e9 mno\u017estv\u00ed se vylu\u010duje do ml\u00e9ka; obecn\u011b pova\u017eov\u00e1no za p\u0159ijateln\u00e9 s monitorov\u00e1n\u00edm kojence.<\/p>\n<h2 class=\"wp-block-heading\">Interakce s l\u00e9\u010divy<\/h2>\n<ul>\n<li><strong>Beta-blok\u00e1tory<\/strong> \u2014 <strong>kontraindikov\u00e1no v rutinn\u00ed praxi.<\/strong> Aditivn\u00ed bradykardie, srde\u010dn\u00ed blok, riziko akutn\u00edho srde\u010dn\u00edho selh\u00e1n\u00ed. Pokud jsou oba l\u00e9ky nezbytn\u00e9, vy\u017eaduje kardiologick\u00fd dohled, monitorov\u00e1n\u00ed EKG a n\u011bkdy i z\u00e1lohu kardiostimul\u00e1torem.<\/li>\n<li><strong>Digoxin<\/strong> \u2014 ne-DHP zvy\u0161uj\u00ed hladinu digoxinu p\u0159ibli\u017en\u011b o 70 % (jak diltiazem, tak verapamil inhibuj\u00ed P-glykoprotein). Sni\u017ete d\u00e1vku digoxinu o 30-50 % p\u0159i p\u0159id\u00e1n\u00ed ne-DHP; kontrolujte hladiny.<\/li>\n<li><strong>Amiodaron<\/strong> \u2014 aditivn\u00ed riziko AV bloku<\/li>\n<li><strong>Siln\u00e9 inhibitory CYP3A4<\/strong> (ketokonazol, klarithromycin, ritonavir, grapefruitov\u00fd d\u017eus) \u2014 zvy\u0161uj\u00ed hladiny ne-DHP<\/li>\n<li><strong>Siln\u00e9 induktory CYP3A4<\/strong> (rifampicin, fenytoin, karbamazepin) \u2014 sni\u017euj\u00ed hladiny ne-DHP<\/li>\n<li><strong>Simvastatin, lovastatin<\/strong> \u2014 ob\u011b ne-DHP zvy\u0161uj\u00ed hladiny statin\u016f; omezte simvastatin na 20 mg\/den (10 mg\/den s verapamilem)<\/li>\n<li><strong>Cyklosporin, takrolimus<\/strong> \u2014 zv\u00fd\u0161eny ne-DHP (vyu\u017e\u00edv\u00e1no terapeuticky v transplanta\u010dn\u00ed medic\u00edn\u011b ke sn\u00ed\u017een\u00ed d\u00e1vky inhibitor\u016f kalcineurinu)<\/li>\n<li><strong>Dabigatran<\/strong> \u2014 verapamil zvy\u0161uje expozici dabigatranu; vyhn\u011bte se nebo sni\u017ete d\u00e1vku<\/li>\n<li><strong>Lithium<\/strong> \u2014 ne-DHP mohou zp\u016fsobit neurotoxicitu lithia; monitorujte hladiny lithia<\/li>\n<li><strong>Grapefruitov\u00e1 \u0161\u0165\u00e1va<\/strong> \u2014 inhibice CYP3A4 zvy\u0161uje plazmatick\u00e9 hladiny ne-DHP 1,5-2\u00d7<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">DHP vs ne-DHP CCB<\/h2>\n<table style=\"width:100%;border-collapse:collapse;margin:14px 0;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\"><\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">DHP (amlodipin, nifedipin)<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">ne-DHP (diltiazem)<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Prim\u00e1rn\u00ed \u00fa\u010dinek<\/strong><\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Arteri\u00e1ln\u00ed vazodilataci<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Vazodilatace + srde\u010dn\u00ed deprese<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Vliv na srde\u010dn\u00ed frekvenci<\/strong><\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">M\u00edrn\u00e9 reflexn\u00ed \u2191<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">\u2193 (u\u017eite\u010dn\u00e9 pro kontrolu frekvence p\u0159i fibrilaci s\u00edn\u00ed)<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Kombinovat s betablok\u00e1torem?<\/strong><\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Ano (standardn\u011b u anginy pectoris)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>NE<\/strong> (aditivn\u00ed bradykardie, blok)<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Bezpe\u010dn\u00e9 u HF-REF?<\/strong><\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Amlodipin: ano<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>NE<\/strong> (negativn\u00ed inotropie)<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Perifern\u00ed ed\u00e9m<\/strong><\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">\u010cast\u00e9 (10-25 %)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">M\u00e9n\u011b \u010dast\u00e9 (5-10 %)<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\"><strong>Z\u00e1cpa<\/strong><\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">M\u00e9n\u011b \u010dast\u00e9<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">\u010cast\u00e9 (zejm\u00e9na u verapamilu)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 class=\"wp-block-heading\">Skladov\u00e1n\u00ed<\/h2>\n<p>Skladujte p\u0159i teplot\u011b do 25\u00b0C. Uchov\u00e1vejte mimo dosah d\u011bt\u00ed.<\/p>\n<h2 id=\"faqs\">\u010casto kladen\u00e9 dotazy<\/h2>\n<h3 class=\"wp-block-heading\">Pro\u010d nemohu u\u017e\u00edvat Angizem s beta-blok\u00e1torem?<\/h3>\n<p>Nedihydropyridinov\u00e9 blok\u00e1tory kalciov\u00fdch kan\u00e1l\u016f a beta-blok\u00e1tory OBA zpomaluj\u00ed AV nod\u00e1ln\u00ed veden\u00ed a sni\u017euj\u00ed srde\u010dn\u00ed kontraktilitu. Jejich kombinace vede k aditivn\u00edm \u00fa\u010dink\u016fm: bradykardii, prodlou\u017een\u00ed intervalu PR, AV blok\u00e1d\u011b druh\u00e9ho nebo t\u0159et\u00edho stupn\u011b a u vn\u00edmav\u00fdch pacient\u016f m\u016f\u017ee vyvolat srde\u010dn\u00ed selh\u00e1n\u00ed. Byly hl\u00e1\u0161eny i fat\u00e1ln\u00ed p\u0159\u00edpady. Pokud kontrola TK\/tepov\u00e9 frekvence vy\u017eaduje oba mechanismy, p\u0159ejd\u011bte na <strong>dihydropyridinov\u00fd blok\u00e1tor kalciov\u00fdch kan\u00e1l\u016f<\/strong> (<a href=\"https:\/\/medsbase.com\/cs\/amlode\/\">amlodipin<\/a>, <a href=\"https:\/\/medsbase.com\/cs\/nicardia-retard\/\">nifedipin retard<\/a>), kter\u00fd je s beta-blok\u00e1tory bezpe\u010dn\u00fd.<\/p>\n<h3 class=\"wp-block-heading\">Pro\u010d m\u00e1m po u\u017e\u00edv\u00e1n\u00ed Angizemu nov\u011b z\u00e1cpu?<\/h3>\n<p>Nedihydropyridinov\u00e9 blok\u00e1tory kalciov\u00fdch kan\u00e1l\u016f sni\u017euj\u00ed motilitu hladk\u00e9ho svalstva tr\u00e1vic\u00edho traktu (stejn\u00fd mechanismus, kter\u00fd uvol\u0148uje c\u00e9vn\u00ed hladk\u00e9 svalstvo). Z\u00e1cpa postihuje a\u017e 40 % u\u017eivatel\u016f verapamilu a men\u0161\u00ed procento u\u017eivatel\u016f diltiazemu. \u0158e\u0161en\u00ed: zv\u00fd\u0161it p\u0159\u00edjem vl\u00e1kniny, dostatek tekutin, \u0161etrn\u00e9 proj\u00edmadlo (laktul\u00f3za, makrogol). P\u0159i z\u00e1va\u017en\u00fdch pot\u00ed\u017e\u00edch zva\u017ete p\u0159echod na DHP nebo diltiazem (pokud u\u017e\u00edv\u00e1te verapamil).<\/p>\n<h3 class=\"wp-block-heading\">Mohu u\u017e\u00edvat Angizem, pokud m\u00e1m fibrilaci s\u00edn\u00ed?<\/h3>\n<p>Ano \u2013 nedihydropyridinov\u00e9 blok\u00e1tory kalciov\u00fdch kan\u00e1l\u016f jsou jednou ze standardn\u00edch mo\u017enost\u00ed pro <strong>kontrolu frekvence p\u0159i fibrilaci s\u00edn\u00ed<\/strong>, zejm\u00e9na u pacient\u016f, u kter\u00fdch jsou betablok\u00e1tory kontraindikov\u00e1ny (astma, t\u011b\u017ek\u00e9 perifern\u00ed c\u00e9vn\u00ed onemocn\u011bn\u00ed). Diltiazem i verapamil zpomaluj\u00ed veden\u00ed v AV uzlu a sni\u017euj\u00ed komorovou frekvenci. <strong>Kontraindikov\u00e1no u fibrilace s\u00edn\u00ed s Wolff-Parkinson-White syndromem<\/strong> \u2014 m\u016f\u017ee vyvolat fibrilaci komor.<\/p>\n<h3 class=\"wp-block-heading\">M\u016f\u017eu u\u017e\u00edvat Angizem, pokud m\u00e1m srde\u010dn\u00ed selh\u00e1n\u00ed?<\/h3>\n<p>Obecn\u011b ne. Nedihydropyridinov\u00e9 blok\u00e1tory kalciov\u00fdch kan\u00e1l\u016f maj\u00ed negativn\u00ed inotropn\u00ed \u00fa\u010dinky, kter\u00e9 mohou vyvolat dekompenzaci u srde\u010dn\u00edho selh\u00e1n\u00ed se sn\u00ed\u017eenou ejek\u010dn\u00ed frakc\u00ed (HF-REF). Pokud m\u00e1te HF-REF, vyhn\u011bte se nedihydropyridinov\u00fdm blok\u00e1tor\u016fm kalciov\u00fdch kan\u00e1l\u016f. <a href=\"https:\/\/medsbase.com\/cs\/amlode\/\">Amlodipin<\/a> je preferovan\u00fd blok\u00e1tor kalciov\u00fdch kan\u00e1l\u016f, pokud je pot\u0159eba u HF-REF (bezpe\u010dn\u00fd profil podle studi\u00ed PRAISE a V-HeFT-III).<\/p>\n<h3 class=\"wp-block-heading\">M\u016f\u017eu p\u00edt alkohol p\u0159i u\u017e\u00edv\u00e1n\u00ed Angizemu?<\/h3>\n<p>M\u00edrn\u00e1 konzumace alkoholu je obecn\u011b p\u0159ijateln\u00e1, ale alkohol zesiluje hypotenzn\u00ed a bradykardizuj\u00edc\u00ed \u00fa\u010dinky. Nadm\u011brn\u00e9 pit\u00ed samostatn\u011b zvy\u0161uje krevn\u00ed tlak a m\u011blo by se mu vyhnout.<\/p>\n<h3 class=\"wp-block-heading\">A co grapefruitov\u00fd d\u017eus?<\/h3>\n<p>Grapefruit (d\u017eus i \u010derstv\u00e9 ovoce) inhibuje metabolismus CYP3A4 a m\u016f\u017ee zv\u00fd\u0161it plazmatick\u00e9 hladiny diltiazemu 1,5\u20132\u00d7. Vyhn\u011bte se konzumaci v den u\u017e\u00edv\u00e1n\u00ed l\u00e9ku nebo konzumujte konzistentn\u011b \u2014 ob\u010dasn\u00e1 konzumace grapefruitu naru\u0161uje kontrolu TK\/tepov\u00e9 frekvence.<\/p>\n<h3 class=\"wp-block-heading\">Kde m\u016f\u017eu koupit Angizem online?<\/h3>\n<p>Angizem (diltiazem 30\/60 mg, 30\u201390 tablet) m\u016f\u017eete koupit na MedsBase s diskr\u00e9tn\u00edm balen\u00edm a celosv\u011btovou dopravou.<\/p>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h2 class=\"wp-block-heading\">Souvisej\u00edc\u00ed antihypertenziva na MedsBase<\/h2>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/cs\/amlip\/\">Amlip \u2014 Amlodipin 2,5\/5 mg (DHP blok\u00e1tor kalciov\u00fdch kan\u00e1l\u016f)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/amlode\/\">Amlode \u2014 Amlodipin 5\/10 mg (DHP blok\u00e1tor kalciov\u00fdch kan\u00e1l\u016f)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/aquazide\/\">Aquazide \u2014 diuretikum hydrochlorothiazid<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/concor\/\">Concor \u2014 beta-blok\u00e1tor bisoprolol<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/depin\/\">Depin \u2014 nifedipin 5\/10 mg<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/dilzem-cd\/\">Dilzem CD \u2014 diltiazem CD 120\/180 mg<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/high-blood-pressure-medication\/\"><strong>Prohl\u00e9dnout v\u0161echny l\u00e9ky na vysok\u00fd krevn\u00ed tlak<\/strong><\/a><\/li>\n<\/ul>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:16px 20px;margin:24px 0;border-radius:4px;\"><strong>\u2695 L\u00e9ka\u0159sk\u00e9 upozorn\u011bn\u00ed.<\/strong> Tato str\u00e1nka slou\u017e\u00ed pouze pro informa\u010dn\u00ed \u00fa\u010dely a nenahrazuje l\u00e9ka\u0159skou p\u00e9\u010di kvalifikovan\u00e9ho zdravotnick\u00e9ho pracovn\u00edka. Hypertenze, srde\u010dn\u00ed selh\u00e1n\u00ed a arytmie vy\u017eaduj\u00ed diagn\u00f3zu, monitorov\u00e1n\u00ed a individu\u00e1ln\u00ed d\u00e1vkov\u00e1n\u00ed l\u00e9ka\u0159em \u2014 v\u017edy u\u017e\u00edvejte betablok\u00e1tory pod l\u00e9ka\u0159sk\u00fdm dohledem.<\/div>","protected":false},"excerpt":{"rendered":"<p>Angizem jsou tablety diltiazemu 30\/60 mg s okam\u017eit\u00fdm uvol\u0148ov\u00e1n\u00edm od Sun Pharma \u2014 benzothiazepinov\u00fd nedihydropyridinov\u00fd blok\u00e1tor kalciov\u00fdch kan\u00e1l\u016f. Vyva\u017euje vaskul\u00e1rn\u00ed + srde\u010dn\u00ed \u00fa\u010dinky: vazodilatace plus zpomalen\u00ed AV uzlu a m\u00edrn\u00e1 negativn\u00ed inotropie. Hlavn\u00ed pou\u017eit\u00ed: hypertenze s pot\u0159ebou kontroly srde\u010dn\u00ed frekvence, chronick\u00e1 stabiln\u00ed angina, vazospastick\u00e1 (Prinzmetalova) angina, kontrola frekvence p\u0159i fibrilaci s\u00edn\u00ed, kdy\u017e jsou betablok\u00e1tory kontraindikov\u00e1ny. NEkombinujte s betablok\u00e1tory (aditivn\u00ed bradykardie).<\/p>","protected":false},"featured_media":51451,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3141,3223,3260,3356],"product_tag":[3359,3360],"class_list":{"0":"post-51450","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-heart-blood-pressure","9":"product_cat-high-blood-pressure-medication","10":"product_tag-angizem","11":"product_tag-diltiazem","13":"first","14":"outofstock","15":"shipping-taxable","16":"purchasable","17":"product-type-variable","18":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product\/51450","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=51450"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media\/51451"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media?parent=51450"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_brand?post=51450"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat?post=51450"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_tag?post=51450"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}