{"id":51721,"date":"2023-09-20T09:24:32","date_gmt":"2023-09-20T09:24:32","guid":{"rendered":"https:\/\/medsname.com\/irovel\/"},"modified":"2026-05-01T10:49:11","modified_gmt":"2026-05-01T10:49:11","slug":"irovel","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/irovel\/","title":{"rendered":"Irovel"},"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 Irovel?<\/h3>\n<p style=\"margin:0;\"><strong>Irovel<\/strong> je <strong>150 \/ 300 mg tableta irbesartanu<\/strong> od Sun Pharma \u2014 <strong>blok\u00e1tor receptoru pro angiotensin II (ARB)<\/strong>. ARB jsou <strong>l\u00e9\u010dba hypertenze prvn\u00ed volby<\/strong> vedle ACE inhibitor\u016f, CCB a thiazid\u016f dle doporu\u010den\u00ed NICE, AHA\/ACC a ESC\/ESH \u2014 a jsou <strong>preferovanou alternativou, kdy\u017e ACE inhibitor nen\u00ed tolerov\u00e1n<\/strong> (obvykle kv\u016fli such\u00e9mu ka\u0161li, kter\u00fd postihuje a\u017e 20 % u\u017eivatel\u016f ACE inhibitor\u016f). Zaveden 1997 (Sanofi + Bristol-Myers Squibb jako <strong>Avapro \/ Aprovel \/ Karvea<\/strong>). ARB s nejsiln\u011bj\u0161\u00ed d\u016fkazn\u00ed z\u00e1kladnou pro diabetickou nefropatii. Aktivn\u00ed l\u00e1tka (nikoli prol\u00e9\u010divo); \u017e\u00e1dn\u00e1 metabolick\u00e1 aktivace. Polo\u010das 11-15 hodin; jednodenn\u00ed d\u00e1vkov\u00e1n\u00ed. Typick\u00e1 d\u00e1vka pro hypertenzi: <strong>za\u010d\u00edt 150 mg jednou denn\u011b (75 mg p\u0159i hypovolemii nebo u star\u0161\u00edch pacient\u016f), c\u00edlov\u00e9 d\u00e1vkov\u00e1n\u00ed 150-300 mg jednou denn\u011b<\/strong>. Irbesartan m\u00e1 <strong>nejvy\u0161\u0161\u00ed c\u00edlovou d\u00e1vku mezi ARB<\/strong> (300 mg) a <strong>nejsiln\u011bj\u0161\u00ed d\u016fkazy pro renoprotekci u diabetick\u00e9 nefropatie typu 2<\/strong> \u2014 dv\u011b kl\u00ed\u010dov\u00e9 studie (IRMA-2 a IDNT) prok\u00e1zaly, \u017ee irbesartan je preferovan\u00fdm ARB pro zachov\u00e1n\u00ed ren\u00e1ln\u00ed funkce u pacient\u016f s diabetes mellitus 2. typu a manifestn\u00ed nefropati\u00ed. <strong>Absolutn\u011b kontraindikov\u00e1n v t\u011bhotenstv\u00ed<\/strong> (v\u0161echna trimestra \u2014 stejn\u00fd teratogenn\u00ed profil jako ACE inhibitory: ren\u00e1ln\u00ed ageneze plodu, oligohydramnion, plicn\u00ed hypoplazie), <strong>bilater\u00e1ln\u00ed sten\u00f3za ren\u00e1ln\u00ed arterie<\/strong>, a <strong>sou\u010dasn\u00e9 pod\u00e1v\u00e1n\u00ed sacubitrilu\/valsartanu nebo aliskirenu<\/strong>. Monitorujte hladinu drasl\u00edku a kreatininu.<\/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 Irovel?<\/h2>\n<p>Irovel jsou peror\u00e1ln\u00ed tablety irbesartanu v d\u00e1vk\u00e1ch 150\/300 mg od spole\u010dnosti Sun Pharma, dod\u00e1van\u00e9 v balen\u00ed po 30\u2013180 tablet\u00e1ch. Zaveden na trh v roce 1997 (Sanofi + Bristol-Myers Squibb jako <strong>Avapro \/ Aprovel \/ Karvea<\/strong>). ARB s nejsiln\u011bj\u0161\u00ed d\u016fkazn\u00ed z\u00e1kladnou pro diabetickou nefropatii. Aktivn\u00ed l\u00e1tka (nikoli prol\u00e9\u010divo); nevy\u017eaduje metabolickou aktivaci. Polo\u010das 11\u201315 hodin; d\u00e1vkov\u00e1n\u00ed jednou denn\u011b.<\/p>\n<h2 class=\"wp-block-heading\">Jak irbesartan sni\u017euje krevn\u00ed tlak<\/h2>\n<p>ARB blokuj\u00ed <strong>receptor angiotenzinu II typu 1 (AT<sub>1<\/sub>),<\/strong> p\u0159\u00edmo zabra\u0148uj\u00ed vazb\u011b angiotenzinu II a jeho vazokonstrik\u010dn\u00edm a aldosteron-uvol\u0148uj\u00edc\u00edm \u00fa\u010dink\u016fm. Tento receptor se nach\u00e1z\u00ed o jeden krok d\u00e1le v kask\u00e1d\u011b ne\u017e m\u00edsto p\u016fsoben\u00ed ACE inhibitor\u016f (kter\u00e9 blokuj\u00ed tvorbu angiotenzinu II) a vyvol\u00e1v\u00e1 srovnateln\u00e9 klinick\u00e9 \u00fa\u010dinky:<\/p>\n<ul>\n<li><strong>P\u0159\u00edmou vazodilataci tepen<\/strong> \u2014 sn\u00ed\u017een\u00ed syst\u00e9mov\u00e9 vaskul\u00e1rn\u00ed rezistence = sn\u00ed\u017een\u00ed krevn\u00edho tlaku<\/li>\n<li><strong>Sn\u00ed\u017eenou sekreci aldosteronu<\/strong> \u2014 men\u0161\u00ed retence sod\u00edku a vody<\/li>\n<li><strong>Sn\u00ed\u017eenou aktivaci sympatick\u00e9ho nervov\u00e9ho syst\u00e9mu<\/strong><\/li>\n<li><strong>Zlep\u0161en\u00e1 endoteli\u00e1ln\u00ed funkce a sn\u00ed\u017een\u00e9 ventrikul\u00e1rn\u00ed remodelov\u00e1n\u00ed<\/strong> \u2014 vaskul\u00e1rn\u011b-protektivn\u00ed mechanismus p\u0159esahuj\u00edc\u00ed pouh\u00e9 sn\u00ed\u017een\u00ed krevn\u00edho tlaku<\/li>\n<li><strong>\u017d\u00e1dn\u00e1 akumulace bradykininu<\/strong> \u2014 to je kl\u00ed\u010dov\u00fd klinick\u00fd rozd\u00edl oproti ACE inhibitor\u016fm. ARB NEzp\u016fsobuj\u00ed such\u00fd ka\u0161el, kter\u00fd postihuje a\u017e 20 % u\u017eivatel\u016f ACE inhibitor\u016f, proto\u017ee neovliv\u0148uj\u00ed metabolismus bradykininu.<\/li>\n<\/ul>\n<p>Klinick\u00fd d\u016fsledek tohoto mechanismu: ARB dosahuj\u00ed srovnateln\u00e9 kontroly krevn\u00edho tlaku jako ACE inhibitory, ale s ni\u017e\u0161\u00ed incidenc\u00ed ka\u0161le (0\u20133 % vs. 20 % u ACE inhibitor\u016f) a angioed\u00e9mu (p\u0159ibli\u017en\u011b o 30\u201350 % ni\u017e\u0161\u00ed ne\u017e u ACE inhibitor\u016f, i kdy\u017e ne nulov\u00fd).<\/p>\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 prim\u00e1rn\u00ed indikace; prvn\u00ed volba dle mezin\u00e1rodn\u00edch doporu\u010den\u00ed<\/li>\n<li><strong>Diabetick\u00e1 nefropatie 2. typu<\/strong> \u2014 d\u016fkazy z studi\u00ed IRMA-2 a IDNT; preferovan\u00e9 ARB pro renoprotekci<\/li>\n<li><strong>Hypertenze<\/strong> (rozmez\u00ed 150\u2013300 mg)<\/li>\n<li><strong>Proteinurick\u00e1 chronick\u00e1 onemocn\u011bn\u00ed ledvin<\/strong> obecn\u011b<\/li>\n<li><strong>Nesn\u00e1\u0161enlivost ACE inhibitor\u016f<\/strong> (ka\u0161el, m\u00e9n\u011b \u010dasto angioed\u00e9m) \u2014 standardn\u00ed c\u00edl pro zm\u011bnu<\/li>\n<\/ul>\n<p><strong>Kl\u00ed\u010dov\u00e9 d\u016fkazy z klinick\u00fdch studi\u00ed:<\/strong> <strong>IRMA-2 (2001)<\/strong> \u2014 irbesartan zabr\u00e1nil progresi od mikroalbuminurie k manifestn\u00ed nefropatii u diabetu 2. typu. <strong>IDNT (2001)<\/strong> \u2014 irbesartan sn\u00ed\u017eil zdvojn\u00e1soben\u00ed s\u00e9rov\u00e9ho kreatininu, ESRD nebo \u00famrt\u00ed o 20 % u diabetick\u00e9 nefropatie 2. typu ve srovn\u00e1n\u00ed s placebem a o 23 % ve srovn\u00e1n\u00ed s amlodipinem. <strong>I-PRESERVE (2008)<\/strong> \u2014 \u017e\u00e1dn\u00fd benefit u srde\u010dn\u00edho selh\u00e1n\u00ed s zachovanou ejek\u010dn\u00ed frakc\u00ed.<\/p>\n<h2 class=\"wp-block-heading\">D\u00e1vkov\u00e1n\u00ed Irovel<\/h2>\n<p><strong>Hypertenze:<\/strong><\/p>\n<ul>\n<li><strong>Po\u010d\u00e1te\u010dn\u00ed d\u00e1vka:<\/strong> 150 mg jednou denn\u011b (75 mg p\u0159i hypovolemii nebo u star\u0161\u00edch pacient\u016f)<\/li>\n<li><strong>C\u00edlov\u00e1 d\u00e1vka:<\/strong> 150-300 mg jednou denn\u011b<\/li>\n<li><strong>Maxim\u00e1ln\u00ed d\u00e1vka:<\/strong> 300 mg jednou denn\u011b<\/li>\n<li>Titrujte ka\u017ed\u00e9 2-4 t\u00fddny; pln\u00fd antihypertenzn\u00ed \u00fa\u010dinek za 3-6 t\u00fddn\u016f<\/li>\n<\/ul>\n<p><strong>Srde\u010dn\u00ed selh\u00e1n\u00ed:<\/strong> Studie I-PRESERVE (srde\u010dn\u00ed selh\u00e1n\u00ed s zachovanou ejek\u010dn\u00ed frakc\u00ed) neprok\u00e1zala p\u0159\u00ednos pro v\u00fdsledky; nen\u00ed l\u00e9kem prvn\u00ed volby u srde\u010dn\u00edho selh\u00e1n\u00ed.<\/p>\n<p><strong>Pod\u00e1v\u00e1n\u00ed:<\/strong> jednou denn\u011b, s j\u00eddlem nebo bez. U\u017e\u00edvejte ve stejnou dobu ka\u017ed\u00fd den pro stabiln\u00ed kontrolu krevn\u00edho tlaku.<\/p>\n<p><strong>Monitorov\u00e1n\u00ed:<\/strong><\/p>\n<ul>\n<li>V\u00fdchoz\u00ed vy\u0161et\u0159en\u00ed: mo\u010dovina, elektrolyty (zejm\u00e9na drasl\u00edk), kreatinin, eGFR. Dom\u00e1c\u00ed m\u011b\u0159en\u00ed krevn\u00edho tlaku jako v\u00fdchoz\u00ed hodnota.<\/li>\n<li>Po 1-2 t\u00fddnech: opakovat U&amp;E. M\u00edrn\u00fd vzestup kreatininu (a\u017e o 30 %) je o\u010dek\u00e1van\u00fd a p\u0159ijateln\u00fd. M\u00edrn\u00fd vzestup drasl\u00edku je b\u011b\u017en\u00fd.<\/li>\n<li>Po zv\u00fd\u0161en\u00ed d\u00e1vky: opakujte U&amp;E za 1\u20132 t\u00fddny.<\/li>\n<li>Pr\u016fb\u011b\u017en\u011b: ro\u010dn\u00ed kontrola U&amp;E po stabilizaci.<\/li>\n<li><strong>P\u0159eru\u0161te a vy\u0161et\u0159ete:<\/strong> vzestup kreatininu &gt;30 %, pokles eGFR &gt;25 %, drasl\u00edk &gt;5,5, symptomatick\u00e1 hypotenze.<\/li>\n<\/ul>\n<p><strong>Ukon\u010den\u00ed l\u00e9\u010dby:<\/strong> neexistuje abstinen\u010dn\u00ed syndrom; av\u0161ak n\u00e1hl\u00e9 vysazen\u00ed zp\u016fsob\u00ed rebound hypertenzi b\u011bhem n\u011bkolika dn\u00ed. Sni\u017eujte d\u00e1vky postupn\u011b po dobu 1-2 t\u00fddn\u016f p\u0159i vysazov\u00e1n\u00ed.<\/p>\n<h2 class=\"wp-block-heading\">Vedlej\u0161\u00ed \u00fa\u010dinky<\/h2>\n<p><strong>\u010cast\u00e9 (&gt;1 %, obvykle m\u00edrn\u00e9):<\/strong><\/p>\n<ul>\n<li>Z\u00e1vrat\u011b, ortostatick\u00e1 hypotenze (obvykle m\u00edrn\u00e1; \u010dast\u011bj\u0161\u00ed na za\u010d\u00e1tku l\u00e9\u010dby)<\/li>\n<li>M\u00edrn\u00e1 hyperkal\u00e9mie<\/li>\n<li>O\u010dek\u00e1van\u00fd m\u00edrn\u00fd vzestup kreatininu (a\u017e ~30 % je p\u0159ijateln\u00e9; intraren\u00e1ln\u00ed hemodynamick\u00e1 zm\u011bna, nikoli nefrotoxicita)<\/li>\n<li>\u00danava, bolest hlavy<\/li>\n<li>P\u0159\u00edznaky horn\u00edch cest d\u00fdchac\u00edch, nazofaryngitida<\/li>\n<li>Bolest zad, svalov\u00e9 k\u0159e\u010de<\/li>\n<\/ul>\n<p><strong>M\u00e9n\u011b \u010dast\u00e9, ale d\u016fle\u017eit\u00e9:<\/strong><\/p>\n<ul>\n<li><strong>Angioed\u00e9m<\/strong> \u2014 ni\u017e\u0161\u00ed v\u00fdskyt ne\u017e u ACE inhibitor\u016f, ale st\u00e1le mo\u017en\u00fd. Incidence ~0,1 %. NEPOU\u017d\u00cdVEJTE ARB, pokud m\u00e1 pacient v anamn\u00e9ze dokumentovan\u00fd angioed\u00e9m po ACE inhibitoru v prvn\u00edch 4 t\u00fddnech; opatrn\u00e9 dlouhodob\u00e9 u\u017e\u00edv\u00e1n\u00ed je \u010dasto p\u0159ijateln\u00e9.<\/li>\n<li><strong>T\u011b\u017ek\u00e1 hyperkal\u00e9mie<\/strong> \u2014 zejm\u00e9na s kalium \u0161et\u0159\u00edc\u00edmi diuretiky (spironolakton), drasl\u00edkov\u00fdmi dopl\u0148ky, NSAID nebo CKD<\/li>\n<li><strong>Akutn\u00ed po\u0161kozen\u00ed ledvin p\u0159i oboustrann\u00e9 sten\u00f3ze ren\u00e1ln\u00ed arterie<\/strong> \u2014 stejn\u00fd mechanismus jako ACE inhibitory<\/li>\n<li><strong>Hypotenze po prvn\u00ed d\u00e1vce<\/strong> u pacient\u016f s deplec\u00ed objemu (nap\u0159. p\u0159i vysok\u00fdch d\u00e1vk\u00e1ch diuretik, t\u011b\u017ek\u00e9m srde\u010dn\u00edm selh\u00e1n\u00ed)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Kontraindikace<\/h2>\n<ul>\n<li><strong>T\u011bhotenstv\u00ed \u2014 ABSOLUTN\u00cd kontraindikace ve v\u0161ech trimestrech<\/strong>. Stejn\u00fd teratogenn\u00ed profil jako ACE inhibitory. Okam\u017eit\u011b vysadit p\u0159i zji\u0161t\u011bn\u00ed t\u011bhotenstv\u00ed; p\u0159ej\u00edt na <a href=\"https:\/\/medsbase.com\/cs\/labebet\/\">labetalol<\/a>, methyldopu, nifedipin nebo hydralazin.<\/li>\n<li>Anamn\u00e9za angioed\u00e9mu s jak\u00fdmkoli ACE inhibitorem nebo ARB (do 4 t\u00fddn\u016f)<\/li>\n<li>Oboustrann\u00e1 sten\u00f3za ren\u00e1ln\u00ed arterie nebo sten\u00f3za u jedn\u00e9 funk\u010dn\u00ed ledviny<\/li>\n<li>T\u011b\u017ek\u00e9 po\u0161kozen\u00ed jater (Child-Pugh C) \u2014 zejm\u00e9na u prol\u00e9\u010div ARB<\/li>\n<li>Hyperkal\u00e9mie &gt;5,5 mmol\/l v\u00fdchoz\u00ed<\/li>\n<li>Sou\u010dasn\u00e9 u\u017e\u00edv\u00e1n\u00ed sacubitrilu\/valsartanu (Entresto) \u2014 p\u0159i p\u0159echodu je nutn\u00e1 36hodinov\u00e1 p\u0159est\u00e1vka<\/li>\n<li>Sou\u010dasn\u00e9 u\u017e\u00edv\u00e1n\u00ed aliskirenu u diabetu nebo CKD (po\u0161kozen\u00ed dle studie ALTITUDE)<\/li>\n<li>Sou\u010dasn\u00e9 u\u017e\u00edv\u00e1n\u00ed ACE inhibitoru \u2014 po\u0161kozen\u00ed bez benefit\u016f dle studie ONTARGET<\/li>\n<li>P\u0159ecitliv\u011blost na irbesartan<\/li>\n<\/ul>\n<p><strong>Kojen\u00ed:<\/strong> vyhn\u011bte se u\u017e\u00edv\u00e1n\u00ed v prvn\u00edch t\u00fddnech po porodu p\u0159ed\u010dasn\u011b narozen\u00e9ho d\u00edt\u011bte. Dlouhodob\u00e9 u\u017e\u00edv\u00e1n\u00ed p\u0159i zaveden\u00e9m kojen\u00ed je obecn\u011b pova\u017eov\u00e1no za p\u0159ijateln\u00e9 vzhledem k n\u00edzk\u00e9mu p\u0159enosu do ml\u00e9ka, ale pokud mo\u017eno jsou preferov\u00e1ny alternativn\u00ed antihypertenziva (propranolol, nifedipin).<\/p>\n<h2 class=\"wp-block-heading\">Interakce s l\u00e9\u010divy<\/h2>\n<ul>\n<li><strong>\u0160et\u0159\u00edc\u00ed drasl\u00edk diuretika<\/strong> (spironolakton, eplerenon, amilorid, triamteren) \u2014 aditivn\u00ed hyperkalemie; pe\u010dliv\u011b monitorujte<\/li>\n<li><strong>Dopl\u0148ky drasl\u00edku a n\u00e1hrady soli<\/strong> \u2014 riziko hyperkalemie<\/li>\n<li><strong>NSAID<\/strong> \u2014 sni\u017euj\u00ed antihypertenzn\u00ed \u00fa\u010dinek a zvy\u0161uj\u00ed riziko AKI (zejm\u00e9na \u201ctrojit\u00fd \u00fader\u201d: ARB + diuretikum + NSAID)<\/li>\n<li><strong>Lithium<\/strong> \u2014 ARB sni\u017euj\u00ed clearance lithia; monitorujte hladiny<\/li>\n<li><strong>ACE inhibitory<\/strong> \u2014 NEKOMBINOVAT (po\u0161kozen\u00ed dle ONTARGET)<\/li>\n<li><strong>Sacubitril\/valsartan (Entresto)<\/strong> \u2014 nekombinovat; 36hodinov\u00e1 p\u0159est\u00e1vka<\/li>\n<li><strong>Aliskiren<\/strong> \u2014 vyhn\u011bte se u diabetu nebo CKD (po\u0161kozen\u00ed dle ALTITUDE)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">P\u0159ehled t\u0159\u00eddy ARB<\/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;\">ARB<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Polo\u010das<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Specializovan\u00e1 oblast<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\"><a href=\"https:\/\/medsbase.com\/cs\/losar\/\">Losartan (Losar, Cosart)<\/a><\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">2 h \/ 6-9 h (metabolit)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Urikosurikum (u\u017eite\u010dn\u00e9 p\u0159i dn\u011b); sn\u00ed\u017een\u00ed rizika mrtvice ve studii LIFE<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\"><a href=\"https:\/\/medsbase.com\/cs\/olmin\/\">Olmesartan (Olmin, Olmeheal, Olmesar)<\/a><\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">13 h<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Siln\u00fd \u00fa\u010dinek na mg; FDA varov\u00e1n\u00ed p\u0159ed sprue-like enteropati\u00ed<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\"><a href=\"https:\/\/medsbase.com\/cs\/telmaheal\/\">Telmisartan (Telmaheal, Cresar, Targit)<\/a><\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">24 h (nejdel\u0161\u00ed)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Metabolick\u00fd benefit (PPAR-\u03b3); kardiovaskul\u00e1rn\u00ed ochrana v ONTARGET<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\"><a href=\"https:\/\/medsbase.com\/cs\/diovan-160\/\">Valsartan (Diovan 160, Valent)<\/a><\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">6 h (24h \u00fa\u010dinek)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">D\u016fkazy pro srde\u010dn\u00ed selh\u00e1n\u00ed (Val-HeFT, VALIANT); prekurzor ARNI (Entresto)<\/td>\n<\/tr>\n<tr style=\"background:#fff3cd;\">\n<td style=\"padding:10px;border:1px solid #ddd;\"><a href=\"https:\/\/medsbase.com\/cs\/irovel\/\">Irbesartan (Irovel)<\/a><\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">11-15 h<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Diabetick\u00e1 nefropatie (IRMA-2, IDNT)<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\">Kandesartan<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">9 h<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Srde\u010dn\u00ed selh\u00e1n\u00ed (d\u016fkaz CHARM); nedostupn\u00e9 na MedsBase<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 class=\"wp-block-heading\">ARB vs ACE inhibitory \u2014 kdy zvolit ARB<\/h2>\n<p>ACE inhibitory (<a href=\"https:\/\/medsbase.com\/cs\/ramcor\/\">ramipril<\/a>, <a href=\"https:\/\/medsbase.com\/cs\/enapril\/\">enalapril<\/a>, <a href=\"https:\/\/medsbase.com\/cs\/lispro\/\">lisinoprilem<\/a>, <a href=\"https:\/\/medsbase.com\/cs\/coversyl\/\">perindopril<\/a>) a ARB p\u016fsob\u00ed na stejn\u00e9 renin-angiotenzinov\u00e9 dr\u00e1ze a poskytuj\u00ed srovnateln\u00e9 sn\u00ed\u017een\u00ed TK a kardiovaskul\u00e1rn\u00ed ochranu. Zvolte ARB kdy\u017e:<\/p>\n<ul>\n<li><strong>Ka\u0161el p\u0159i u\u017e\u00edv\u00e1n\u00ed ACE inhibitor\u016f<\/strong> se objev\u00ed (a\u017e u 20 % u\u017eivatel\u016f; nej\u010dast\u011bj\u0161\u00ed d\u016fvod pro zm\u011bnu l\u00e9\u010dby)<\/li>\n<li>Angioed\u00e9m po ACE inhibitory (pou\u017e\u00edvejte ARB opatrn\u011b, ne d\u0159\u00edve ne\u017e 4 t\u00fddny po epizod\u011b angioed\u00e9mu)<\/li>\n<li>N\u011bkte\u0159\u00ed pacienti preferuj\u00ed dlouhodob\u011b p\u016fsob\u00edc\u00ed ARB jako je telmisartan pro rovnom\u011brnou 24hodinovou kontrolu krevn\u00edho tlaku<\/li>\n<li>Specifick\u00e9 indikace molekul \u2014 losartan u hypertenze a dny, irbesartan u diabetick\u00e9 nefropatie 2. typu, valsartan jako prekurzor ARNI u srde\u010dn\u00edho selh\u00e1n\u00ed<\/li>\n<\/ul>\n<p><strong>NEKOMBINUJTE ARB + ACE inhibitor.<\/strong> Studie ONTARGET (2008) prok\u00e1zala, \u017ee tato kombinace zvy\u0161uje v\u00fdskyt ne\u017e\u00e1douc\u00edch \u00fa\u010dink\u016f (hyperkal\u00e9mie, AKI, hypotenze) bez dal\u0161\u00edho kardiovaskul\u00e1rn\u00edho benefitu. Pokud pacient u\u017e\u00edv\u00e1 oba, jeden vysa\u010fte.<\/p>\n<h2 class=\"wp-block-heading\">Skladov\u00e1n\u00ed<\/h2>\n<p>Skladujte Irovel p\u0159i teplot\u011b pod 25\u00b0C v p\u016fvodn\u00edm blistru. Uchov\u00e1vejte mimo dosah d\u011bt\u00ed.<\/p>\n<h2 id=\"faqs\">\u010casto kladen\u00e9 dotazy<\/h2>\n<h3 class=\"wp-block-heading\">Za jak dlouho Irovel sn\u00ed\u017e\u00ed krevn\u00ed tlak?<\/h3>\n<p>Po\u010d\u00e1te\u010dn\u00ed pokles TK do 1-2 hodin; pln\u00fd antihypertenzn\u00ed \u00fa\u010dinek nast\u00e1v\u00e1 za <strong>3-6 t\u00fddn\u016f<\/strong>. M\u011b\u0159te dom\u00e1c\u00ed TK ve stejnou denn\u00ed dobu pro sledov\u00e1n\u00ed \u00fa\u010dinku. Pokud TK nedos\u00e1hne c\u00edlov\u00fdch hodnot za 6 t\u00fddn\u016f, zvy\u0161te d\u00e1vku nebo p\u0159idejte l\u00e9k druh\u00e9 volby (CCB nebo thiazid jsou standardn\u00ed kombinac\u00ed s ARB).<\/p>\n<h3 class=\"wp-block-heading\">P\u0159estal\/a jsem u\u017e\u00edvat ACE inhibitor kv\u016fli ka\u0161li \u2014 zmiz\u00ed m\u016fj ka\u0161el?<\/h3>\n<p>Ano. Ka\u0161el po ACE inhibitory je zp\u016fsoben akumulac\u00ed bradykininu; ARB bradykinin nezvy\u0161uj\u00ed. Ka\u0161el obvykle vymiz\u00ed do <strong>1-4 t\u00fddn\u016f<\/strong> po vysazen\u00ed ACE inhibitoru. Pokud ka\u0161el p\u0159etrv\u00e1v\u00e1 d\u00e9le ne\u017e 6 t\u00fddn\u016f po p\u0159echodu na Irovel, hledejte jinou p\u0159\u00ed\u010dinu (reflux, zadn\u00ed r\u00fdma, astma).<\/p>\n<h3 class=\"wp-block-heading\">Mohu u\u017e\u00edvat Irovel v t\u011bhotenstv\u00ed?<\/h3>\n<p><strong>Ne \u2014 blok\u00e1tory receptor\u016f pro angiotensin II (ARB) jsou v t\u011bhotenstv\u00ed absolutn\u011b kontraindikov\u00e1ny<\/strong>, stejn\u011b jako ACE inhibitory. Zp\u016fsobuj\u00ed ren\u00e1ln\u00ed agenezi plodu, oligohydramnion, plicn\u00ed hypopl\u00e1zii a defekty lebky. Okam\u017eit\u011b p\u0159eru\u0161te l\u00e9\u010dbu, pokud dojde k ot\u011bhotn\u011bn\u00ed. \u017deny v reproduk\u010dn\u00edm v\u011bku by m\u011bly pou\u017e\u00edvat spolehlivou antikoncepci; u t\u011bch, kter\u00e9 pl\u00e1nuj\u00ed t\u011bhotenstv\u00ed, p\u0159ejd\u011bte p\u0159ed po\u010det\u00edm na <a href=\"https:\/\/medsbase.com\/cs\/labebet\/\">labetalol<\/a>, methyldopu nebo nifedipin.<\/p>\n<h3 class=\"wp-block-heading\">Moje hladina kreatininu m\u00edrn\u011b stoupla po zah\u00e1jen\u00ed u\u017e\u00edv\u00e1n\u00ed Irovelu \u2014 m\u00e1m p\u0159estat?<\/h3>\n<p>N\u00e1r\u016fst kreatininu a\u017e o <strong>30%<\/strong> b\u011bhem prvn\u00edch 1\u20132 t\u00fddn\u016f je <strong>je o\u010dek\u00e1van\u00fd a p\u0159ijateln\u00fd<\/strong>. Odr\u00e1\u017e\u00ed norm\u00e1ln\u00ed intraren\u00e1ln\u00ed hemodynamickou adaptaci, kdy\u017e je odstran\u011bn tonus eferentn\u00edch arteriol zprost\u0159edkovan\u00fd angiotensinem II. Vzestup &gt;30% nazna\u010duje bilater\u00e1ln\u00ed sten\u00f3zu ren\u00e1ln\u00ed arterie, hypovol\u00e9mii nebo interakci s NSAID a vy\u017eaduje vy\u0161et\u0159en\u00ed (p\u0159eru\u0161te pod\u00e1v\u00e1n\u00ed l\u00e9ku, prove\u010fte zobrazovac\u00ed vy\u0161et\u0159en\u00ed ledvin, zhodno\u0165te sou\u010dasnou medikaci).<\/p>\n<h3 class=\"wp-block-heading\">M\u00e1m se vyh\u00fdbat potravin\u00e1m bohat\u00fdm na drasl\u00edk p\u0159i u\u017e\u00edv\u00e1n\u00ed Irovelu?<\/h3>\n<p>M\u00edrn\u00fd p\u0159\u00edjem potravin bohat\u00fdch na drasl\u00edk (ban\u00e1ny, pomeran\u010de, \u0161pen\u00e1t, avok\u00e1do, brambory) je pro v\u011bt\u0161inu u\u017eivatel\u016f v po\u0159\u00e1dku. Vyhn\u011bte se dopl\u0148k\u016fm drasl\u00edku (slow-K) a n\u00e1hrad\u00e1m soli obsahuj\u00edc\u00edm drasl\u00edk, pokud nejsou v\u00fdslovn\u011b p\u0159edeps\u00e1ny \u2014 tyto v kombinaci s ARB, zejm\u00e9na u chronick\u00e9ho onemocn\u011bn\u00ed ledvin nebo s drasl\u00edk \u0161et\u0159\u00edc\u00edmi diuretiky, mohou zp\u016fsobit nebezpe\u010dnou hyperkal\u00e9mii.<\/p>\n<h3 class=\"wp-block-heading\">Mohu kombinovat Irovel s dal\u0161\u00edmi l\u00e9ky na krevn\u00ed tlak?<\/h3>\n<p>Ano \u2014 ARB se dob\u0159e kombinuj\u00ed s <strong>blok\u00e1tory kalciov\u00fdch kan\u00e1l\u016f<\/strong> (<a href=\"https:\/\/medsbase.com\/cs\/amlode\/\">amlodipin<\/a>), <strong>thiazidov\u00fdmi diuretiky<\/strong> (<a href=\"https:\/\/medsbase.com\/cs\/aquazide\/\">HCTZ<\/a>), a <strong>beta-blok\u00e1tory<\/strong> (<a href=\"https:\/\/medsbase.com\/cs\/concor\/\">bisoprolol<\/a>, <a href=\"https:\/\/medsbase.com\/cs\/betablock-xl\/\">metoprolol sukcin\u00e1t<\/a>). <strong>NEkombinujte ARB s ACE inhibitorem<\/strong> (ramipril, lisinopril atd.) \u2014 studie ONTARGET prok\u00e1zala \u0161kodu bez p\u0159\u00ednosu.<\/p>\n<h3 class=\"wp-block-heading\">Mohu u\u017e\u00edvat ibuprofen s Irovelem?<\/h3>\n<p>Ob\u010dasn\u00e9 kr\u00e1tkodob\u00e9 u\u017e\u00edv\u00e1n\u00ed je obvykle p\u0159ijateln\u00e9; <strong>chronick\u00e9 denn\u00ed u\u017e\u00edv\u00e1n\u00ed NSAID<\/strong> (ibuprofen, diklofenak, naproxen) sni\u017euj\u00ed antihypertenzn\u00ed \u00fa\u010dinek ARB a v\u00fdrazn\u011b zvy\u0161uj\u00ed riziko akutn\u00edho po\u0161kozen\u00ed ledvin (AKI) \u2014 zejm\u00e9na v kombinaci s diuretikem (tzv. \u201ctrojit\u00e1 r\u00e1na\u201d). P\u0159i chronick\u00e9 bolesti je paracetamol bezpe\u010dn\u011bj\u0161\u00ed; u z\u00e1n\u011bt\u016f proberte alternativy.<\/p>\n<h3 class=\"wp-block-heading\">Je Irovel celo\u017eivotn\u00ed l\u00e9\u010dba?<\/h3>\n<p>U v\u011bt\u0161iny pacient\u016f s esenci\u00e1ln\u00ed hypertenz\u00ed ano \u2014 antihypertenzn\u00ed terapie je celo\u017eivotn\u00ed, proto\u017ee vysazen\u00ed vr\u00e1t\u00ed TK na p\u0159edl\u00e9\u010debn\u00e9 hodnoty b\u011bhem dn\u016f a\u017e t\u00fddn\u016f. N\u011bkte\u0159\u00ed pacienti ztrat\u00ed hypertenzi v\u00fdrazn\u00fdm \u00fabytkem hmotnosti, sn\u00ed\u017een\u00edm p\u0159\u00edjmu alkoholu nebo lep\u0161\u00edm sp\u00e1nkem; jejich l\u00e9ka\u0159 pak m\u016f\u017ee pod kontrolou TK vyzkou\u0161et opatrn\u00e9 vysazen\u00ed. Nikdy nevysazujte Irovel bez l\u00e9ka\u0159sk\u00e9ho doporu\u010den\u00ed.<\/p>\n<h3 class=\"wp-block-heading\">Co kdy\u017e vynech\u00e1m d\u00e1vku?<\/h3>\n<p>Vynechanou d\u00e1vku u\u017eijte co nejd\u0159\u00edve, jak si vzpomenete, pokud nen\u00ed t\u00e9m\u011b\u0159 \u010das na dal\u0161\u00ed d\u00e1vku \u2014 v tom p\u0159\u00edpad\u011b vynechanou d\u00e1vku p\u0159esko\u010dte a pokra\u010dujte v obvykl\u00e9m re\u017eimu. Nezdvojujte d\u00e1vky. Jedna vynechan\u00e1 d\u00e1vka v\u00fdznamn\u011b neovlivn\u00ed dlouhodobou kontrolu TK.<\/p>\n<h3 class=\"wp-block-heading\">Kde lze koupit Irovel online?<\/h3>\n<p>Irovel (irbesartan 150\/300 mg, 30\u2013180 tablet) m\u016f\u017eete koupit na MedsBase s diskr\u00e9tn\u00edm balen\u00edm a celosv\u011btovou dopravou.<\/p>\n<h2 class=\"wp-block-heading\">Souvisej\u00edc\u00ed antihypertenziva na MedsBase<\/h2>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/cs\/amlode\/\">Amlode \u2014 Amlodipin CCB<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/cresar\/\">Cresar \u2014 Telmisartan 20 mg<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/diovan-160\/\">Diovan 160 \u2014 Valsartan 160 mg<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/losatec-h\/\">Losatec-H \u2014 Losartan + HCTZ<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/olmesar\/\">Olmesar \u2014 Olmesartan 20\/40 mg<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/valent\/\">Valent \u2014 Valsartan 80\/160 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>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h3 class=\"wp-block-heading\">Souvisej\u00edc\u00ed alternativy<\/h3>\n<p>Dal\u0161\u00ed produkty v <strong>Chronick\u00e1 onemocn\u011bn\u00ed<\/strong> kter\u00e9 z\u00e1kazn\u00edci tak\u00e9 prohl\u00ed\u017eej\u00ed:<\/p>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/cs\/desowen\/\">Desowen<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/calaptin-40\/\">Calaptin 40<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/topicon\/\">Topicon<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/flexabenz-gel\/\">Flexabenz Gel<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/cs\/oxetol\/\">Oxetol<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>Irovel jsou tablety irbesartanu 150\/300 mg od Sun Pharma \u2014 ARB s nejsiln\u011bj\u0161\u00ed v\u011bdeckou z\u00e1kladnou pro renoprotekci u diabetick\u00e9 nefropatie 2. typu (studie IRMA-2 prok\u00e1zala prevenci progrese z mikroalbuminurie; IDNT sn\u00ed\u017eila riziko zdvojn\u00e1soben\u00ed kreatininu nebo ESRD). M\u00e1 nejvy\u0161\u0161\u00ed c\u00edlovou d\u00e1vku mezi ARB (300 mg jednou denn\u011b). Standardn\u00ed po\u010d\u00e1te\u010dn\u00ed d\u00e1vka je 150 mg; titrujte podle odpov\u011bdi na krevn\u00ed tlak a albuminurii.<\/p>","protected":false},"featured_media":51722,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3141,3223,3260,3356],"product_tag":[3399,3400],"class_list":{"0":"post-51721","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-irbesartan","11":"product_tag-irovel","13":"first","14":"instock","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\/51721","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=51721"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media\/51722"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/media?parent=51721"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_brand?post=51721"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat?post=51721"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_tag?post=51721"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}