{"id":52159,"date":"2023-09-20T09:29:31","date_gmt":"2023-09-20T09:29:31","guid":{"rendered":"https:\/\/medsname.com\/naltima\/"},"modified":"2026-05-01T10:49:12","modified_gmt":"2026-05-01T10:49:12","slug":"naltima","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/naltima\/","title":{"rendered":"Naltima"},"content":{"rendered":"

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\u26a1 Rychl\u00e1 odpov\u011b\u010f \u2014 Naltima \u2014 naltrexon 50 mg pro poruchy u\u017e\u00edv\u00e1n\u00ed alkoholu nebo opioid\u016f<\/h3>\n

Naltima je naltrexon 50 mg, dlouhodob\u011b p\u016fsob\u00edc\u00ed antagonista \u03bc-opioidn\u00edch receptor\u016f. P\u0159i poru\u0161e u\u017e\u00edv\u00e1n\u00ed alkoholu<\/strong> sni\u017euje p\u0159\u00edjemn\u00fd pocit z pit\u00ed; p\u0159i oporov\u00e1 z\u00e1vislost<\/strong> blokuje \u00fa\u010dinek jak\u00e9hokoli u\u017eit\u00e9ho opi\u00e1tu. Mus\u00edte b\u00fdt bez opi\u00e1t\u016f po dobu 7\u201310 dn\u00ed<\/strong> p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby OUD, jinak vyvol\u00e1 abstinen\u010dn\u00ed p\u0159\u00edznaky. Typick\u00fd je 50 mg jednou denn\u011b pod\u00e1van\u00fd peror\u00e1ln\u00ed re\u017eim, \u010dasto v kombinaci s poradenstv\u00edm a l\u00e9ka\u0159sk\u00fdm dohledem.<\/p>\n<\/div>\n

\nCo 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 recenz\u00ed z\u00e1kazn\u00edk\u016f<\/a>\n<\/div>\n

\ud83d\udce6 Ka\u017ed\u00e1 objedn\u00e1vka je pokryta na\u0161\u00ed 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

Pro\u010d objedn\u00e1vat z MedsBase<\/h3>\n

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

Podm\u00ednka abstinence od opi\u00e1t\u016f.<\/strong> Pokud je naltrexon zah\u00e1jen, zat\u00edmco opi\u00e1ty jsou st\u00e1le v t\u011ble \u2014 v\u010detn\u011b metadonu (del\u0161\u00ed elimina\u010dn\u00ed doba: 14 dn\u00ed), buprenorfinu, kodeinu, tramadolu, oxykodonu, fentanylu, heroinu \u2014 vyvol\u00e1 t\u011b\u017ek\u00fd akutn\u00ed abstinen\u010dn\u00ed syndrom, kter\u00fd m\u016f\u017ee vy\u017eadovat hospitalizaci. Pacient mus\u00ed b\u00fdt minim\u00e1ln\u011b 7\u201310 dn\u00ed bez opi\u00e1t\u016f<\/strong> (del\u0161\u00ed doba u metadonu) a v\u011bt\u0161ina p\u0159edepisuj\u00edc\u00edch l\u00e9ka\u0159\u016f prov\u00e1d\u00ed naloxonov\u00fd provoka\u010dn\u00ed test<\/strong> p\u0159ed pod\u00e1n\u00edm prvn\u00ed d\u00e1vky naltrexonu.<\/div>\n

Co je Naltima?<\/h2>\n

Naltima je l\u00e9\u010div\u00fd p\u0159\u00edpravek obsahuj\u00edc\u00ed naltrexon hydrochlorid 50 mg<\/strong> (tablety), dod\u00e1van\u00fd spole\u010dnost\u00ed Intas Pharmaceuticals. Naltrexon je dlouhodob\u011b p\u016fsob\u00edc\u00ed, peror\u00e1ln\u011b aktivn\u00ed antagonista opioidn\u00edch receptor\u016f s vysokou afinitou k \u03bc-receptor\u016fm (a \u010d\u00e1ste\u010dnou aktivitou u \u03ba- a \u03b4-receptor\u016f). Je jednou ze dvou prvn\u00ed volby peror\u00e1ln\u00edch farmakoterapi\u00ed (spolu s akampros\u00e1tem) pro l\u00e9\u010dbu z\u00e1vislosti na alkoholu podle modern\u00edch doporu\u010den\u00ed a nekontrolovanou alternativou k agonistick\u00e9 l\u00e9\u010db\u011b opioid\u016f pro opiovou z\u00e1vislost.<\/p>\n

Jak naltrexon funguje<\/h2>\n

P\u0159i poru\u0161e u\u017e\u00edv\u00e1n\u00ed alkoholu:<\/strong> uvol\u0148ov\u00e1n\u00ed dopaminu vyvolan\u00e9 alkoholem v nucleus accumbens je \u010d\u00e1ste\u010dn\u011b zprost\u0159edkov\u00e1no opioidn\u00edmi receptory; blokov\u00e1n\u00ed \u03bc-receptor\u016f naltrexonem tento odm\u011b\u0148uj\u00edc\u00ed sign\u00e1l oslabuje. Pacienti popisuj\u00ed pit\u00ed jako \u201cm\u00e9n\u011b uspokojiv\u00e9\u201d sp\u00ed\u0161e ne\u017e averzivn\u00ed \u2013 co\u017e je d\u016fle\u017eit\u00e9, naltrexon nevyvol\u00e1v\u00e1 disulfiramovou reakci, tak\u017ee je bezpe\u010dn\u00fd i p\u0159i ob\u010dasn\u00e9m selh\u00e1n\u00ed pacienta. Studie COMBINE (2006) prok\u00e1zala \u00fa\u010dinnost naltrexonu, zejm\u00e9na v kombinaci s l\u00e9ka\u0159sk\u00fdm dohledem.<\/p>\n

P\u0159i poru\u0161e u\u017e\u00edv\u00e1n\u00ed opioid\u016f:<\/strong> naltrexon se v\u00e1\u017ee na \u03bc-receptory s tak vysokou afinitou, \u017ee n\u00e1sledn\u00e9 u\u017eit\u00ed opioid\u016f nevyvol\u00e1 euforii. Odstra\u0161uj\u00edc\u00ed \u00fa\u010dinek je \u00fapln\u00fd \u2013 injekce heroinu p\u0159i u\u017e\u00edv\u00e1n\u00ed naltrexonu je v podstat\u011b zbyte\u010dn\u00e1 d\u00e1vka. Hlavn\u00edm probl\u00e9mem je adherence: pacient, kter\u00fd vynech\u00e1 dva dny naltrexonu, m\u00e1 jasn\u00e9 okno pro relaps a riziko relapsu po vysazen\u00ed je vysok\u00e9, proto\u017ee neexistuje \u017e\u00e1dn\u00fd agonistick\u00fd \u00fa\u010dinek, na kter\u00fd by se dalo spol\u00e9hat.<\/p>\n

Jak se Naltima pou\u017e\u00edv\u00e1<\/h2>\n

Standardn\u00ed d\u00e1vka pro dosp\u011bl\u00e9 pro ob\u011b indikace je 50 mg jednou denn\u011b<\/strong>:<\/p>\n\n\n\n\n\n\n\n\n
Indikace<\/th>\nStandardn\u00ed re\u017eim<\/th>\nPozn\u00e1mky<\/th>\n<\/tr>\n<\/thead>\n
Porucha u\u017e\u00edv\u00e1n\u00ed alkoholu<\/td>\n50 mg jednou denn\u011b<\/td>\nLze zah\u00e1jit i p\u0159i pokra\u010duj\u00edc\u00edm pit\u00ed; pro prvn\u00ed d\u00e1vku nen\u00ed nutn\u00e1 abstinence<\/td>\n<\/tr>\n
Porucha u\u017e\u00edv\u00e1n\u00ed opioid\u016f<\/td>\n50 mg jednou denn\u011b<\/td>\nMus\u00ed b\u00fdt bez opioid\u016f 7\u201310 dn\u00ed<\/strong> (14 dn\u00ed u metadonu); naloxonov\u00fd test potvrd\u00ed<\/td>\n<\/tr>\n
C\u00edlen\u00e9 pou\u017eit\u00ed (vybran\u00ed pacienti s AUD)<\/td>\n50 mg 1\u20132 hodiny p\u0159ed konzumac\u00ed alkoholu<\/td>\nSinclairova metoda; u\u017eite\u010dn\u00e1 u pacient\u016f usiluj\u00edc\u00edch o kontrolovan\u00e9 pit\u00ed sp\u00ed\u0161e ne\u017e abstinenci<\/td>\n<\/tr>\n
T\u0159ikr\u00e1t t\u00fddn\u011b (vybran\u00ed pacienti)<\/td>\n100 mg v pond\u011bl\u00ed, 100 mg ve st\u0159edu, 150 mg v p\u00e1tek<\/td>\nZlep\u0161uje dodr\u017eov\u00e1n\u00ed l\u00e9\u010dby u OUD<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

U\u017e\u00edvejte s j\u00eddlem nebo bez j\u00eddla. Pokud d\u00e1vku vynech\u00e1te, u\u017eijte ji co nejd\u0159\u00edve, ale vynechejte ji, pokud se bl\u00ed\u017e\u00ed \u010das dal\u0161\u00ed d\u00e1vky \u2013 neduplikujte d\u00e1vky. D\u00e9lka l\u00e9\u010dby je minim\u00e1ln\u011b 3 m\u011bs\u00edce<\/strong>, \u010dasto 6\u201312 m\u011bs\u00edc\u016f<\/strong> u AUD a del\u0161\u00ed u OUD<\/strong>; riziko relapsu je nejvy\u0161\u0161\u00ed b\u011bhem prvn\u00edch 90 dn\u016f po ukon\u010den\u00ed l\u00e9\u010dby.<\/p>\n

Vedlej\u0161\u00ed \u00fa\u010dinky<\/h2>\n
    \n
  • Nevolnost<\/strong> (nej\u010dast\u011bj\u0161\u00ed, ~10\u201315%, ustupuje b\u011bhem 1\u20132 t\u00fddn\u016f; u\u017e\u00edvejte po j\u00eddle)<\/li>\n
  • Bolest hlavy, z\u00e1vrat\u011b<\/strong><\/li>\n
  • Nespavost, \u00fazkost, \u0161patn\u00e1 n\u00e1lada, anhedonie (ob\u010dasn\u00e9 \u2014 n\u011bkte\u0159\u00ed pacienti popisuj\u00ed sn\u00ed\u017een\u00ed schopnosti pro\u017e\u00edvat radost, kter\u00e9 po vysazen\u00ed ustupuje)<\/li>\n
  • \u00danava, ospalost<\/li>\n
  • Bolest b\u0159icha, pr\u016fjem nebo z\u00e1cpa<\/li>\n
  • Hepatotoxicita<\/strong> \u2014 p\u016fvodn\u00ed \u010dern\u00e9 varov\u00e1n\u00ed FDA bylo zalo\u017eeno na po\u0161kozen\u00ed jater u ob\u00e9zn\u00edch pacient\u016f u\u017e\u00edvaj\u00edc\u00edch 300 mg\/den u indikac\u00ed mimo AUD. P\u0159i d\u00e1vce 50 mg\/den je sign\u00e1l mnohem slab\u0161\u00ed. Z\u00e1kladn\u00ed jatern\u00ed testy a jejich kontrola po 6 a 12 t\u00fddnech, pot\u00e9 ka\u017ed\u00e9 3 m\u011bs\u00edce, je rozumn\u00fd postup.<\/li>\n
  • Reakce v m\u00edst\u011b vpichu p\u0159i pou\u017eit\u00ed depotn\u00edch IM formulac\u00ed (neplat\u00ed pro tento peror\u00e1ln\u00ed p\u0159\u00edpravek)<\/li>\n<\/ul>\n

    Kritick\u00e1 bezpe\u010dnost: chirurgick\u00e1 a urgentn\u00ed analgezie<\/h2>\n
    Opioidn\u00ed analgezie je b\u011bhem u\u017e\u00edv\u00e1n\u00ed naltrexonu z velk\u00e9 \u010d\u00e1sti blokov\u00e1na.<\/strong> Pokud pot\u0159ebujete operaci, zubn\u00ed z\u00e1krok nebo byste mohli nav\u0161t\u00edvit pohotovost, informujte ka\u017ed\u00e9ho l\u00e9ka\u0159e, \u017ee u\u017e\u00edv\u00e1te naltrexon, a noste u sebe identifika\u010dn\u00ed kartu<\/strong>. U pl\u00e1novan\u00e9 operace se naltrexon obvykle vysazuje 72 hodin p\u0159edem. Pro urgentn\u00ed analgezii jsou preferov\u00e1ny neopioidn\u00ed mo\u017enosti (paracetamol, NSAID, ketamin, region\u00e1ln\u00ed anestezie); pokud je opioidn\u00ed analgezie nezbytn\u00e1, mohou b\u00fdt pot\u0159eba mnohem vy\u0161\u0161\u00ed ne\u017e obvykl\u00e9 d\u00e1vky kr\u00e1tkodob\u011b p\u016fsob\u00edc\u00edho l\u00e9\u010diva pod dohledem \u2014 toto je rozhodnut\u00ed specialisty-anesteziologa kv\u016fli riziku respira\u010dn\u00ed deprese po odezn\u011bn\u00ed blok\u00e1dy receptor\u016f.<\/div>\n

    Interakce l\u00e9k\u016f<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n
    L\u00e9k\/t\u0159\u00edda<\/th>\n\u00da\u010dinek<\/th>\n\u00da\u010dinek<\/th>\n<\/tr>\n<\/thead>\n
    Opioidn\u00ed analgetika (kodein, tramadol, morfin, oxykodon, fentanyl atd.)<\/td>\nAnalgezie blokov\u00e1na; pokusy o vysok\u00e9 d\u00e1vky riskuj\u00ed respira\u010dn\u00ed depresi po odezn\u011bn\u00ed blok\u00e1dy<\/td>\nPou\u017e\u00edvejte neopioidn\u00ed analgezii tam, kde je to mo\u017en\u00e9; informujte ka\u017ed\u00e9ho p\u0159edepisuj\u00edc\u00edho l\u00e9ka\u0159e<\/td>\n<\/tr>\n
    Opioidn\u00ed agonistick\u00e1 l\u00e9\u010dba OUD (metadon, buprenorfin)<\/td>\nPrecipitovan\u00fd abstinen\u010dn\u00ed syndrom<\/td>\nNelze p\u0159edepisovat sou\u010dasn\u011b; zvolte jednu strategii<\/td>\n<\/tr>\n
    Antidiarrhoika (loperamid, difenoxyl\u00e1t)<\/td>\nSn\u00ed\u017een\u00fd \u00fa\u010dinek<\/td>\nPou\u017eijte bismut nebo neopioidn\u00ed alternativy<\/td>\n<\/tr>\n
    Antitusika (dextromethorfan, kodeinov\u00e9 sirupy proti ka\u0161li)<\/td>\nSn\u00ed\u017een\u00fd \u00fa\u010dinek<\/td>\nAlternativy jako med, jednoduch\u00fd linctus nebo guaifenesin<\/td>\n<\/tr>\n
    Disulfiram<\/td>\nTeoretick\u00e9 riziko hepatotoxicity p\u0159i kombinaci; n\u011bkdy se pou\u017e\u00edv\u00e1 u AUD s dodate\u010dn\u00fdm sledov\u00e1n\u00edm jatern\u00edch test\u016f<\/td>\nRozhodnut\u00ed specialisty<\/td>\n<\/tr>\n
    Thioridazin<\/td>\nLetargie a somnolence<\/td>\nVyvarujte se kombinace<\/td>\n<\/tr>\n
    Yohimbin<\/td>\nM\u016f\u017ee vyvolat paniku u zraniteln\u00fdch pacient\u016f<\/td>\nVyhnout se<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Kontraindikace a speci\u00e1ln\u00ed populace<\/h2>\n
      \n
    • Akutn\u00ed u\u017e\u00edv\u00e1n\u00ed opioid\u016f, z\u00e1vislost na opioidech bez detoxikace (vyvol\u00e1v\u00e1 abstinen\u010dn\u00ed p\u0159\u00edznaky)<\/li>\n
    • Akutn\u00ed hepatitida nebo selh\u00e1n\u00ed jater<\/li>\n
    • P\u0159ecitliv\u011blost na naltrexon<\/li>\n
    • T\u011bhotenstv\u00ed:<\/strong> studie na zv\u00ed\u0159atech prok\u00e1zaly ur\u010ditou teratogenitu; zva\u017ete pokra\u010duj\u00edc\u00ed agonismus opioid\u016f vs. naltrexon individu\u00e1ln\u011b s odborn\u00edkem<\/li>\n
    • Kojen\u00ed:<\/strong> vylu\u010dov\u00e1n\u00ed do mate\u0159sk\u00e9ho ml\u00e9ka je minim\u00e1ln\u00ed; zva\u017ete individu\u00e1ln\u011b pom\u011br p\u0159\u00ednosu a rizika<\/li>\n
    • T\u011b\u017ek\u00e9 ren\u00e1ln\u00ed posti\u017een\u00ed: omezen\u00e9 \u00fadaje; pou\u017e\u00edvejte opatrn\u011b<\/li>\n<\/ul>\n

      Realistick\u00e1 o\u010dek\u00e1v\u00e1n\u00ed<\/h2>\n

      P\u0159i AUD naltrexon sni\u017euje po\u010det dn\u016f s pit\u00edm, dn\u016f s nadm\u011brn\u00fdm pit\u00edm a chu\u0165 na alkohol p\u0159ibli\u017en\u011b o 10\u201325 % oproti placebu po 12 t\u00fddnech \u2014 u\u017eite\u010dn\u00e9, ale samo o sob\u011b ne p\u0159evratn\u00e9. Pacienti se siln\u011bj\u0161\u00ed rodinnou anamn\u00e9zou alkoholismu (polymorfismus OPRM1 A118G) a ti, kte\u0159\u00ed poci\u0165uj\u00ed siln\u00fd \u201crau\u0161\u201d z pit\u00ed, mohou reagovat l\u00e9pe. Kombinace naltrexonu se strukturovanou l\u00e9ka\u0159skou p\u00e9\u010d\u00ed nebo behavior\u00e1ln\u00ed terapi\u00ed p\u0159ibli\u017en\u011b zdvojn\u00e1sobuje p\u0159\u00ednos. P\u0159i OUD je \u00fa\u010dinnost naltrexonu t\u00e9m\u011b\u0159 v\u00fdhradn\u011b z\u00e1visl\u00e1 na adherenci; vynechan\u00e9 d\u00e1vky znamenaj\u00ed vynechanou ochranu. Dlouhodob\u011b p\u016fsob\u00edc\u00ed injek\u010dn\u00ed formy (prodlou\u017een\u00e9 uvol\u0148ov\u00e1n\u00ed IM) existuj\u00ed pr\u00e1v\u011b proto, aby tento probl\u00e9m adherence \u0159e\u0161ily, a mohou b\u00fdt pro n\u011bkter\u00e9 pacienty s OUD vhodn\u011bj\u0161\u00ed ne\u017e peror\u00e1ln\u00ed terapie \u2014 tento produkt je peror\u00e1ln\u00ed forma.<\/p>\n

      Skladov\u00e1n\u00ed<\/h2>\n

      Skladujte p\u0159i pokojov\u00e9 teplot\u011b (15\u201330 \u00b0C \/ 59\u201386 \u00b0F), v p\u016fvodn\u00edm blistru, mimo dosah p\u0159\u00edm\u00e9ho sv\u011btla a vlhkosti. Uchov\u00e1vejte mimo dosah d\u011bt\u00ed \u2014 po\u017eit\u00ed \u010dlenem dom\u00e1cnosti u\u017e\u00edvaj\u00edc\u00edm opioidy by mohlo vyvolat abstinen\u010dn\u00ed p\u0159\u00edznaky.<\/p>\n

      \u010casto kladen\u00e9 dotazy<\/h2>\n

      Pro\u010d mus\u00edm b\u00fdt nejprve 7\u201310 dn\u00ed bez opioid\u016f?<\/h3>\n

      Naltrexon vyt\u011bs\u0148uje opioidy z \u03bc-receptor\u016f s mnohem vy\u0161\u0161\u00ed afinitou, ne\u017e jakou se v\u00e1\u017eou. Pokud opioidy st\u00e1le obsazuj\u00ed receptory, toto vyt\u011bsn\u011bn\u00ed okam\u017eit\u011b spust\u00ed pln\u00fd abstinen\u010dn\u00ed syndrom \u2014 pocen\u00ed, zvracen\u00ed, siln\u00e9 bolesti sval\u016f, neklid \u2014 n\u011bkdy vy\u017eaduj\u00edc\u00ed hospitalizaci. Pravidlo 7\u201310 dn\u016f (14 pro metadon, d\u00e9le pro oxykodon s prodlou\u017een\u00fdm uvol\u0148ov\u00e1n\u00edm) zaji\u0161\u0165uje, \u017ee receptory jsou vy\u010di\u0161t\u011bny.<\/p>\n

      Co je to naloxonov\u00fd test?<\/h3>\n

      P\u0159ed prvn\u00ed d\u00e1vkou naltrexonu m\u016f\u017ee p\u0159edepisuj\u00edc\u00ed l\u00e9ka\u0159 podat malou testovac\u00ed d\u00e1vku naloxonu (intranaz\u00e1ln\u011b nebo subkut\u00e1nn\u011b). Naloxon je kr\u00e1tkodob\u011b p\u016fsob\u00edc\u00ed; pokud je pacient bez opioid\u016f, nic se nestane. Pokud jsou opioidy st\u00e1le p\u0159\u00edtomny, pacient za\u017eije m\u00edrn\u00e9 abstinen\u010dn\u00ed p\u0159\u00edznaky, kter\u00e9 v\u0161ak odezn\u00ed za 30\u201360 minut \u2014 mnohem bezpe\u010dn\u011bj\u0161\u00ed ne\u017e vyvol\u00e1n\u00ed stejn\u00e9 reakce plnou d\u00e1vkou naltrexonu, kter\u00e1 trv\u00e1 24 hodin.<\/p>\n

      Mohu p\u00edt alkohol p\u0159i u\u017e\u00edv\u00e1n\u00ed na AUD?<\/h3>\n

      Ano, technicky vzato \u2014 to je pr\u00e1v\u011b \u00fa\u010del. Naltrexon nevyvol\u00e1v\u00e1 disulfiramovou reakci; sni\u017euje odm\u011bnu spojenou s pit\u00edm. Sinclairova metoda v\u00fdslovn\u011b vyu\u017e\u00edv\u00e1 naltrexon p\u0159ed konzumac\u00ed alkoholu, aby postupn\u011b b\u011bhem t\u00fddn\u016f a\u017e m\u011bs\u00edc\u016f potla\u010dila posiluj\u00edc\u00ed \u00fa\u010dinek alkoholu. P\u0159i tradi\u010dn\u00edm u\u017eit\u00ed zam\u011b\u0159en\u00e9m na abstinenci je c\u00edlem st\u00e1le p\u0159estat p\u00edt; naltrexon sni\u017euje chu\u0165 na alkohol a progresi relapsu, nikoli p\u016fsob\u00ed jako odstra\u0161uj\u00edc\u00ed prost\u0159edek.<\/p>\n

      Zabr\u00e1n\u00ed mi to c\u00edtit pot\u011b\u0161en\u00ed z \u010dehokoli?<\/h3>\n

      N\u011bkte\u0159\u00ed pacienti popisuj\u00ed m\u00edrnou anhedonii (sn\u00ed\u017een\u00e9 pot\u011b\u0161en\u00ed z j\u00eddla, sexu, cvi\u010den\u00ed) p\u0159i u\u017e\u00edv\u00e1n\u00ed naltrexonu, pravd\u011bpodobn\u011b proto, \u017ee endogenn\u00ed opioidn\u00ed syst\u00e9m zprost\u0159edkov\u00e1v\u00e1 malou \u010d\u00e1st norm\u00e1ln\u00ed odm\u011bny. Obvykle je m\u00edrn\u00e1 a po vysazen\u00ed ustupuje. T\u011b\u017ek\u00e1, p\u0159etrv\u00e1vaj\u00edc\u00ed anhedonie je d\u016fvodem k ukon\u010den\u00ed l\u00e9\u010dby.<\/p>\n

      M\u016f\u017eu ho u\u017e\u00edvat s disulfiramem?<\/h3>\n

      Ano, u n\u011bkter\u00fdch pacient\u016f s AUD, kte\u0159\u00ed nereagovali na \u017e\u00e1dn\u00fd z l\u00e9k\u016f samostatn\u011b, se pou\u017e\u00edv\u00e1 kombinace \u2014 naltrexon na chu\u0165 na alkohol, disulfiram jako odstra\u0161uj\u00edc\u00ed prost\u0159edek. Oba maj\u00ed potenci\u00e1l hepatotoxicity, proto by m\u011blo b\u00fdt \u010dast\u011bj\u0161\u00ed sledov\u00e1n\u00ed jatern\u00edch test\u016f. Toto rozhodnut\u00ed pat\u0159\u00ed do rukou specialisty, nen\u00ed rutinn\u00ed.<\/p>\n

      Co kdy\u017e budu pot\u0159ebovat urgentn\u00ed operaci?<\/h3>\n

      Informujte opera\u010dn\u00ed a anesteziologick\u00fd t\u00fdm, \u017ee u\u017e\u00edv\u00e1te naltrexon. Pl\u00e1nuj\u00ed strategii neopioidn\u00ed analgezie, kde je to mo\u017en\u00e9. V p\u0159\u00edpad\u011b skute\u010dn\u00e9 nouze, kdy jsou opioidy nevyhnuteln\u00e9, se n\u011bkdy pou\u017e\u00edvaj\u00ed mnohem vy\u0161\u0161\u00ed ne\u017e obvykl\u00e9 d\u00e1vky pod dohledem, ale poopera\u010dn\u00ed obdob\u00ed vy\u017eaduje pe\u010dliv\u00e9 sledov\u00e1n\u00ed, jak blok\u00e1da receptor\u016f ustupuje. M\u011bjte u sebe l\u00e9ka\u0159sk\u00fd pr\u016fkaz.<\/p>\n

      Za jak dlouho za\u010dne sni\u017eovat chu\u0165 na alkohol?<\/h3>\n

      V\u011bt\u0161ina pacient\u016f s AUD zaznamen\u00e1 sn\u00ed\u017een\u00ed chuti na alkohol a \u201cuspokojen\u00ed z pit\u00ed\u201d b\u011bhem 7\u201314 dn\u016f. \u00dapln\u00fd \u00fa\u010dinek na dny s intenzivn\u00edm pit\u00edm se projev\u00ed b\u011bhem 4\u201312 t\u00fddn\u016f. Pokud po 12 t\u00fddnech nen\u00ed patrn\u00fd \u017e\u00e1dn\u00fd benefit, m\u016f\u017ee l\u00e9ka\u0159 p\u0159ej\u00edt na akampros\u00e1t nebo topiram\u00e1t.<\/p>\n

      Mus\u00edm b\u00fdt v terapii?<\/h3>\n

      Farmakoterapie bez behavior\u00e1ln\u00ed podpory je m\u00e9n\u011b \u00fa\u010dinn\u00e1. Nejsiln\u011bj\u0161\u00ed v\u00fdsledky studie COMBINE poch\u00e1zely z naltrexonu plus<\/em> l\u00e9ka\u0159sk\u00e9ho managementu (strukturovan\u00e9 20minutov\u00e9 n\u00e1v\u0161t\u011bvy u l\u00e9ka\u0159e zam\u011b\u0159en\u00e9 na AUD). Minim\u00e1ln\u011b pravideln\u00e9 kontroly a zapojen\u00ed do peer-support form\u00e1tu (AA, SMART Recovery) v\u00fdrazn\u011b zvy\u0161uj\u00ed \u00fa\u010dinnost.<\/p>\n

      Je depotn\u00ed injekce jin\u00e1?<\/h3>\n

      Ano \u2014 dlouhodob\u011b p\u016fsob\u00edc\u00ed intramuskul\u00e1rn\u00ed injekce (Vivitrol, m\u011bs\u00ed\u010dn\u011b) obch\u00e1z\u00ed probl\u00e9m denn\u00ed adherence a je st\u00e1le v\u00edce preferov\u00e1na pro OUD, kde adherence ur\u010duje v\u00fdsledky. Naltima je peror\u00e1ln\u00ed forma, kter\u00e1 je flexibiln\u011bj\u0161\u00ed a v mnoha p\u0159\u00edpadech l\u00e9pe vyhovuje AUD.<\/p>\n

      Jak dlouho to m\u00e1m u\u017e\u00edvat?<\/h3>\n

      U AUD je typick\u00e9 6\u201312 m\u011bs\u00edc\u016f, n\u011bkdy d\u00e9le u pacient\u016f s v\u00fdraznou anamn\u00e9zou relapsu. U OUD je l\u00e9\u010dba otev\u0159en\u00e1 \u2013 riziko relapsu je nejvy\u0161\u0161\u00ed b\u011bhem 90 dn\u016f po ukon\u010den\u00ed, tak\u017ee v\u011bt\u0161ina pacient\u016f pokra\u010duje alespo\u0148 rok a mnoz\u00ed z\u016fst\u00e1vaj\u00ed d\u00e9le podle doporu\u010den\u00ed p\u0159edepisuj\u00edc\u00edho l\u00e9ka\u0159e.<\/p>\n

      Zdravotn\u00ed upozorn\u011bn\u00ed:<\/strong> Tyto informace jsou ur\u010deny dosp\u011bl\u00fdm pod l\u00e9ka\u0159sk\u00fdm dohledem. Poruchy spojen\u00e9 s u\u017e\u00edv\u00e1n\u00edm n\u00e1vykov\u00fdch l\u00e1tek jsou komplexn\u00ed chronick\u00e1 onemocn\u011bn\u00ed \u2014 farmakoterapie je jednou ze slo\u017eek p\u00e9\u010de a funguje nejl\u00e9pe v kombinaci s poradenstv\u00edm, podporou vrstevn\u00edk\u016f (AA, SMART Recovery, NA, sv\u00e9pomocn\u00e9 skupiny), pravideln\u00fdm hodnocen\u00edm l\u00e9ka\u0159em a l\u00e9\u010dbou soub\u011b\u017en\u00fdch du\u0161evn\u00edch poruch (deprese, \u00fazkost, PTSD, ADHD). Akutn\u00ed abstinen\u010dn\u00ed syndrom p\u0159i alkoholu m\u016f\u017ee zp\u016fsobit z\u00e1chvaty a delirium tremens a p\u0159edstavuje l\u00e9ka\u0159skou pohotovost \u2014 neza\u010d\u00ednejte s udr\u017eovac\u00ed farmakoterapi\u00ed b\u011bhem akutn\u00edho abstinen\u010dn\u00edho syndromu bez odborn\u00e9ho detoxika\u010dn\u00edho programu. Jakoukoli zm\u011bnu medikace, v\u010detn\u011b vysazen\u00ed, konzultujte s kvalifikovan\u00fdm l\u00e9ka\u0159em. Pokud vy nebo n\u011bkdo, koho zn\u00e1te, pro\u017e\u00edv\u00e1 krizi, kontaktujte m\u00edstn\u00ed z\u00e1chrannou slu\u017ebu nebo d\u016fv\u011brnou linku pomoci (nap\u0159. SAMHSA 1-800-662-HELP v USA, Frank 0300 123 6600 ve Velk\u00e9 Brit\u00e1nii).<\/div>\n

      <\/p>\n

      Souvisej\u00edc\u00ed alternativy<\/h3>\n

      Dal\u0161\u00ed produkty v Obecn\u00e9 zdrav\u00ed<\/strong> kter\u00e9 z\u00e1kazn\u00edci tak\u00e9 prohl\u00ed\u017eej\u00ed:<\/p>\n